Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 1,436,553 | 2,225,724 | 1,549,546 | 2,215,153 | 2,853,929 | 10,280,905 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 1,436,553 | 2,225,724 | 1,549,546 | 2,215,153 | 2,853,929 | 10,280,905 |
| 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).. | 458,821 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 9,822,084 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,436,553 | 2,225,724 | 1,549,546 | 2,215,153 | 2,853,929 | 10,280,905 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 113,552 | 195,423 | 548,735 | 308,482 | 565,447 | 1,731,639 |
| 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 VI.).. | 1,955 | 5,300 | 7,255 | |||
| 11 | Total support Add lines 7 through 10. | 12,019,799 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| CORE FORM, PART V, QUESTION 1A & 2A | Employees are paid by Beacon Health System, Inc.(EIN 45-3864076) and expensed to Memorial Health Foundation through contract labor. Beacon Health System, Inc. issues all W-2s and 1099s. |
| CORE FORM, PART VI, SECTION A, QUESTION 6 | BEACON HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF MEMORIAL HEALTH FOUNDATION, INC. |
| CORE FORM, PART VI, SECTION A QUESTION 7A | The Corporate Member shall appoint the Board of Directors of the Corporation and shall have such powers of advance approval regarding Corporate actions as are delineated in the By-laws of the Corporation. |
| CORE FORM, PART VI, SECTION A, QUESTION 7B | Decisions of the Board of Directors must be approved by the Corporate Member. THE FOLLOWING MATTERS ARE SPECIFICALLY RESERVED TO REQUIRE THE APPROVAL OF THE CORPORATE MEMBER: - MAKE AND APPROVE CHANGES TO THE GOVERNING DOCUMENTS OF THE CORPORATION. - APPOINT, UPON THE RECOMMENDATION OF THE NOMINATING AND GOVERNANCE COMMITTEE OF THE CORPORATE MEMBER, OR REMOVE, WITH OR WITHOUT CAUSE, THE MEMBERS OF THE GOVERNING BOARD OF THE CORPORATION. REMOVAL DOES NOT REQUIRE A RECOMMENDATION OF THE CORPORATION ORGANIZATION'S GOVERNING BOARD. THE PROCESS OF APPOINTMENT AND REMOVAL OF THE BOARD OF THE HOSPITALS SHALL BE AS SET FORTH IN THE HOSPITALS' RESPECTIVE BYLAWS. - APPROVE THE INCURRENCE OF DEBT OF THE CORPORATION IN ACCORDANCE WITH SYSTEM POLICIES. - APPROVE THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION AND DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN CORPORATE MEMBERSHIP OR OWNERSHIP, OR CORPORATE REORGANIZATION OF THE CORPORATION, BUT AS TO EITHER HOSPITAL ONLY IF SUCH ACTION HAS BEEN APPROVED BY SUPERMAJORITY VOTE OF THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER. - APPROVE THE FORMATION OF A SUBSIDIARY ORGANIZATION, AND THE SALE, TRANSFER OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF A SUBSIDIARY ORGANIZATION OF THE CORPORATE MEMBER, OR THE DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR CHANGE IN CORPORATE MEMBERSHIP OR OWNERSHIP OF A SUBSIDIARY ORGANIZATION. - APPROVE THE MATERIAL TRANSFER OR ENCUMBRANCE OF THE ASSETS OF THE CORPORATION IN ACCORDANCE WITH SYSTEM POLICIES, PROVIDED THAT THE TRANSFER OF ASSETS EXCEPT IN CONNECTION WITH SYSTEM BORROWING WILL REQUIRE APPROVAL BY SUPERMAJORITY VOTE OF THE BOARD OF DIRECTORS OF THE CORPORATE MEMBER. - APPROVE THE ANNUAL OPERATING BUDGET, CAPITAL PLAN, STRATEGIC PLAN, AND BUSINESS PLAN FOR THE CORPORATION. - APPROVE THE MISSION AND VISION STATEMENTS FOR THE CORPORATION. - WITH INPUT FROM THE CHIEF EXECUTIVE OFFICER OF THE CORPORATE MEMBER, APPROVE ANY MATERIAL TRANSACTIONS OF THE CORPORATION WHICH ARE NOT OTHERWISE INCLUDED IN THE CORPORATE MEMBER APPROVED OPERATING OR CAPITAL BUDGETS OF THE CORPORATION OR AS OTHERWISE AUTHORIZED IN THE BYLAWS OR OPERATING AGREEMENT OF THE CORPORATION. - RESOLVE ANY ISSUES BETWEEN CORPORATION AS TO PARTICIPATION, OR FAILURE TO PARTICIPATE IN, SPECIFIC MANAGED CARE AGREEMENTS AND THE TERMS THEREOF. - APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR ANY SUBSTANTIAL PART OF THE CORPORATION'S OPERATIONS. |
| CORE FORM, PART VI, SECTION B, LINE 11B | THE ORGANIZATION INCORPORATES NUMEROUS PARTIES IN THE PRODUCTION AND REVIEW OF THE FORM 990 AND ASSOCIATED SCHEDULES. SENIOR ACCOUNTING STAFF AND MANAGEMENT COMPLETE THE FORM 990 AND SCHEDULES. SOME FORMS AND SCHEDULES ARE REVIEWED BY THE CONTROLLER. SUBSEQUENT TO THOSE STEPS, THE ORGANIZATION ENGAGED ERNST & YOUNG TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN, THE CFO, THE COMPENSATION COMMITTEE OF THE ORGANIZATION, AND THE CEO CONDUCT A GENERAL OVERVIEW OF THE FORM 990, INCLUDING APPLICABLE COMPENSATION SCHEDULES. IN ADDITION, EACH BOARD MEMBER RECEIVES NOTIFICATION OF THE IRS FORM 990 PLACEMENT ON THE ORGANIZATION'S BOARD PORTALS WHICH ALLOWS FOR BOARD MEMBER REVIEW PRIOR TO FILING THE RETURN. |
| CORE FORM, PART VI, SECTION B, LINE 12C | THERE ARE THREE SEPARATE FORMS THAT ARE SENT OUT THROUGH THE INTERNAL AUDIT DEPARTMENT TO KEY EMPLOYEES OR BOARD MEMBERS REGARDING CONFLICT OF INTEREST. THEY ARE AS FOLLOWS: 1. THE FIRST IS A CONFLICT OF INTEREST STATEMENT THAT IS SENT TO SENIOR LEVEL ADMINISTRATION, MANAGEMENT, AND SELECT STAFF SUCH AS PURCHASING DEPARTMENT EMPLOYEES. THE PURPOSE OF THE STATEMENT IS TO REQUIRE THESE EMPLOYEES TO DISCLOSE ANY POTENTIAL CONFLICT OF INTERESTS THEY MAY HAVE. THE STATEMENTS ARE SENT IN JANUARY OF EACH YEAR for the previous year activities and WE PURSUE THE REPLIES TO GET A 100% RESPONSE RATE. IN THE CURRENT YEAR WE SENT OUT OVER 250 STATEMENTS AND DID ACHIEVE A 100% RESPONSE RATE. EACH RESPONSE IS REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT AND THE RESULTS ARE REPORTED TO THE CEO OF Beacon Health System, the Audit Committee Chairman, AS WELL AS THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 2. THE SECOND STATEMENT IS THE BOARD DUALITY OF INTEREST STATEMENT THAT is SENT TO CURRENT BOARD MEMBERS, FORMER BOARD MEMBERS FROM THE LAST FIVE YEARS, and OTHER KEY EMPLOYEES. THE DUALITY OF INTEREST STATEMENT is sent using a web based survey tool provided by Ernst & Young. THE REPLIES ARE REVIEWED BY THE DIRECTOR OF INTERNAL AUDIT. THE RESULTS of the surveys are summarized using the web based tool, and are reviewed by Ernst & Young in completing the 990. The RESULTS ARE REPORTED TO THE CEO OF Beacon Health System, the Audit Committee Chairman, AND THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS. 3. THE THIRD STATEMENT IS ENTITLED "CODE OF ETHICS FOR SENIOR FINANCIAL OFFICERS". THE STATEMENT REQUIRES AN ACKNOWLEDGEMENT FORM TO BE SIGNED BY Beacon Health System's KEY FINANCIAL EMPLOYEES THAT Beacon's FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN EARLY JANUARY, 2015 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2015, TWENTY-ONE DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND WE HAD A 100% COMPLIANCE RATE. ANY POTENTIAL CONFLICTS OF INTERESTS ARE REVIEWED BY INDEPENDENT PARTIES BOTH INTERNAL AND EXTERNAL TO THE ORGANIZATION, AND IF NECESSARY, CORRECTIVE ACTION WOULD BE TAKEN TO RESOLVE A TRUE CONFLICT. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT OF INTEREST would be EXCLUDED FROM ALL REVIEW PROCEEDINGS. |
| CORE FORM, PART VI, SECTION B, QUESTION 14 | Memorial Health Foundation's board of directors has not specifically adopted a document retention and destruction policy, however in practice it follows the related policy of its sibling, Beacon Medical Group. |
| CORE FORM, PART VI, LINE 15A & 15B | Beacon Health System, Inc. has an extensive examination that is conducted,for Vice President and higher, using comparable market data that is then reviewed by an independant consultant hired by, and reporting to, the Board of Directors. Recommendations are presented to the Board for deliberation and final decision. Deliberation and final decision are performed by the independent members of the Board. |
| CORE FORM, PART VI, SECTION C, LINE 19 | The governing documents and conflict of interest policy are not made available to the public. The financial statements are distributed quarterly to the Electronic Municipal Market Access (EMMA) website as part of the continuing disclosures for the Beacon Health System, Inc. bonds. |
| CORE FORM, PART VIII, QUESTION 1F | MHF BOOKED A PLEDGE OF $500,000 IN 2014 THAT WAS INCLUDED ON ITS AUDITED FINANCIAL STATEMENTS, AND WHICH MHF WILL UNBOOK IN 2015 BASED ON INFORMATION RECEIVED FROM MHF IN 2015. FOR MORE ACCURATE REPORTING, MHF HAS NOT INCLUDED THE PLEDGE ON ITS 2014 FORM 990, WHICH WILL RESULT IN A DIFFERENCE FROM ITS AUDITED FINANCIAL STATEMENTS IN 2014 AND 2015 OF $500,000. |
| CORE FORM, PART XI, LINE 9 | Other changes in fund balance: Writeoff of Intercompany BHS $383,809 Writeoff of Intercompany BMG 14,284 Writeoff of Intercompany MHSB (37,466) Change in Grube Trust 24,248 Piano 20,000 Total $404,875 |
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