Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
H L SNYDER MEDICAL FOUNDATION
Employer identification number
48-0622380
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
68,280
57,641
59,531
67,376
58,053
310,881
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
68,280
57,641
59,531
67,376
58,053
310,881
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
148,233
6
Public support. Subtract line 5 from line 4.
162,648
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
68,280
57,641
59,531
67,376
58,053
310,881
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
210,197
191,467
204,569
198,403
222,829
1,027,465
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
1,338,346
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
12.150 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
15.610 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
FACTS AND CIRCUMSTANCE TEST -JUNE 30, 2014 THE H. L. SNYDER MEDICAL FOUNDATION MEETS THE FACTS AND CIRCUMSTANCES TEST. 1. PUBLIC SUPPORT WAS 12.15% IN 2013. ABOVE THE 10% BENCHMARK 2. BOARD MEMBERS RESPRESENT BROAD PUBLIC SUPPORT. THEY HAVE FIFTY-THREE BOARD MEMBERS AS OF JUNE 30, 2014. 3. GRANTS AND FELLOWSHIPS TO MEDICAL RESEARCH PROGRAMS ARE AWARDED. THE RESEARCH PROGRAM OUTCOME, WOULD BENEFIT THE GENERAL PUBLIC. ADDITIONALLY, THE H.L. SNYDER MEDICAL FOUNDATION AWARDS SCHOLARSHIPS TO STUDENTS PURSUING EDUCATION IN THE MEDICAL FIELD. APPLICATIONS FOR SCHOLARSHIPS ARE ACCEPTED FROM THE PUBLIC. THE GENERAL PUBLIC HAS THE OPPORTURNITY FOR SCHOLARSHIPS. 4. THE H.L. SNYDER MEDICAL FOUNDATION GAVE 7,980.00 TO THE LOCAL SCHOOL DISTRICT, 30,000.00 TO THE LOCAL 501(C)3 HOSPITAL, AND 835.78 TO ANOTHER 501(C)3 DURING THE FISCAL YEAR ENDED JUNE 30, 2014.
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
H L SNYDER MEDICAL FOUNDATION
Employer identification number
48-0622380
Return Reference
Explanation
FORM 990, PAGE 6, PART VI, LINE 2
CAROLINE BLAKESLEE LINCOLN SNYDER, M.D. TRUSTEE TRUSTEE FAMILY RELATIONSHIP CAROLINE BLAKESLEE MARJORIE SNYDER TRUSTEE TRUSTEE FAMILY RELATIONSHIP MARJORIE SNYDER LINCOLN SNYDER, M.D. TRUSTEE TRUSTEE FAMILY RELATIONSHIP KATIE EASTMAN TOM HERLOCKER, ATTY. TRUSTEE PRESIDENT FAMILY RELATIONSHIP TOM HERLOCKER, ATTY. DENNIS HERLOCKER, ATTY. PRESIDENT TRUSTEE FAMILY RELATIONSHIP HANNELORE SNYDER BROWN HEIDI SNYDER FLAGG, M.D. SECRETARY TRUSTEE FAMILY RELATIONSHIP HANNELORE SNYDER BROWN C. JOHN SNYDER, M.D. SECRETARY EXEC. DIRECT FAMILY RELATIONSHIP C. JOHN SNYDER, M.D. NANCY SNYDER EXEC. DIRECT TRUSTEE FAMILY RELATOINSHIP JIM SNYDER JOHN W. SNYDER TRUSTEE TRUSTEE FAMILY RELATIONSHIP JOHN W. SNYDER SUSAN FORRESTER TRUSTEE TRUSTEE FAMILY RELATIONSHIP SHARON TAYLOR WILLIAM A. TAYLOR, JR. TRUSTEE TRUSTEE FAMILY RELATIONSHIP C. JOHN SNYDER, M.D. JIM SNYDER EXEC. DIRECT TRUSTEE FAMILY RELATIONSHIP CATHY HOLADAY C. DAVID MCDERMOTT TRUSTEE TRUSTEE FAMILY RELATIONSHIP MARJORIE MCDERMOTT CATHY HOLADAY TRUSTEE TRUSTEE FAMILY RELATIONSHIP MARJORIE MCDERMOTT C. DAVID MCDERMOTT TRUSTEE TRUSTEE FAMILY RELATIONSHIP BRIAN GENTRY TODD GENTRY TRUSTEE TRUSTEE FAMILY RELATIONSHIP HARRY GARSCHAGEN JEAN GARSCAGEN TRUSTEE TRUSTEE FAMILY RELATIONSHIP HARRY GARSCHAGEN ANDREW GARSCHAGEN TRUSTEE TRUSTEE FAMILY RELATIONSHIP JEAN GARSCHAGEN ANDREW GARSCHAGEN TRUSTEE TRUSTEE FAMILY RELATIONSHIP LUCY FREEMAN, ATTY DAN FREEMAN, O.D. ASST SEC. TRUSTEE FAMILY RELATHIONSHIP LUCY FREEMAN, ATTY. TOM HERLOCKER, ATTY. ASST. SEC. PRESIDENT FAMILY RELATHIONSHIP WILLIS BLAKESLEE BROOK BLAKESLEE TRUSTEE TRUSTEE FAMILY RELATIONSHIP WILLIS BLAKESLEE CAROLINE BLAKESLEE TRUSTEE TRUSTEE FAMILY RELATIONSHIP WALKER FORRESTER SUSAN FORRESTER TRUSTEE TRUSTEE FAMILY RELATIONSHIP ALEXANDRA MOORE HARRY GARSCHAGEN TRUSTEE TRUSTEE FAMILY RELATIONSHIP ALEXANDRA MOORE JEAN GARSCHAGEN TRUSTEE TRUSTEE FAMILY RELATIONSHIP WALKER FORRESTER JIM SNYDER TRUSTEE TRUSTEE FAMILY RELATIONSHIP
FORM 990, PAGE 6, PART VI, LINE 11B
PAID PREPARER COMPLETES RETURN. REVIEW OF COMPLETED RETURN MADE WITH MEMBER REPRESENATIVE DESIGNATED BY THE BOARD OF TRUSTEES OF THE H.L. SNYDER MEDICAL FOUNDATION. PRIOR TO FILING THE 06/30/2014 FORM 990 TAX RETURN, THE ADMINISTRATOR FOR THE H.L. SNYDER MEDICAL FOUNDATION WILL SEND AN EMAIL TO BOARD MEMBERS TO DETERMINE IF THEY WISH TO REVIEW THE FORM 990 BY PDF PRIOR TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
EXECUTIVE FINANCE COMMITEE MEETS EVERY THREE MONTHS, ANY ISSUES WOULD BE ADDDRESSED AT THEIR MEETINGS.
FORM 990, PAGE 6, PART VI, LINE 15A
ANY SALARY ADJUSTMENTS FOR ADMINISTRATOR POSITION ARE APPROVED BY A COMMITEE OF BOARD MEMBERS.
FORM 990, PAGE 6, PART VI, LINE 15B
ANY SALARY ADJUSTMENTS FOR THE ADMINISTRATOR ARE REVIEWED BY A COMMITEE OF BOARD MEMBERS. THE ADMINISTRATOR POSITION IS THE ONLY PAID POSITION OF THE H.L. SNYDER MEDICAL FOUNDATION.
FORM 990, PAGE 6, PART VI, LINE 19
BASIC DOCUMENTS ARE ALREADY PUBLIC RECORD - FORM 990 AND ARTICLES OF INCORPORATION.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.