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 (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 | |||||
| (A)
BEACON MEDICAL GROUP INC |
351536132 | 4 | Yes | 15,628,832 | 0 | |
| (B)
ELKHART GENERAL HOSPITAL INC |
350877574 | 3 | Yes | 67,559,399 | 0 | |
| (C)
MEMORIAL HOSPITAL OF SOUTH BEND INC |
350868132 | 3 | Yes | 45,599,896 | 0 | |
| (D)
MEMORIAL HEALTH FOUNDATION |
351536129 | 7 | No | 307,193 | 0 | |
| Total 4 | 129,095,320 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | ||||||
| 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 | ||||||
| 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).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 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.).. | ||||||
| 11 | Total support. Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART I, LINE 11e | BEACON HEALTH SYSTEM, INC. RECEIVED A WRITTEN DETERMINATION LETTER THAT IT IS A TYPE III, FUNCTIONALLY INTEGRATED SUPPORTING ORGANIZATION. HOWEVER, THE CONTROL PROVISIONS IN ITS BYLAWS FIT THE TECHNICAL REQUIREMENTS FOR A TYPE I SUPPORTING ORGANIZATION, AS INDICATED IN PART IV OF THIS SCHEDULE, THUS BEACON HEALTH SYSTEM IS CURRENTLY REPORTING AS A TYPE I SUPPORTING ORGANIZATION. SCHEDULE A, PART IV, SECTION A, LINE 1 BEACON HEALTH SYSTEM'S ARTICLES OF INCORPORATION STATE THAT IT IS ORGANIZED TO CONTROL AS A SOLE MEMEBER AN INTEGRATED REGIONAL HEALTH CARE SYSTEM COMPRISED OF ONE OR MORE SUBSIDIARY ORGANIZATIONS, INCLUDING ELKHART GENERAL HOSPITAL, INC. ("EGH"), MEMORIAL HEALTH SYSTEM, INC. (NOW BEACON MEDICAL GROUP) ("BMG"), AND ALL OTHER RESPECTIVE AFFILIATES, WHICH INCLUDES MEMORIAL HOSPITAL OF SOUTH BEND ("MHSB"). EGH, BMG, AND MHSB ARE SPECIFICALLY DESIGNATED BY NAME, AND MEMORIAL HEALTH FOUNDATION IS DESIGNATED BY CLASS, AS IT IS A RESPECTIVE AFFILIATE WITH BEACON HEALTH SYSTEM AS ITS SOLE MEMBER. SCHEDULE A, PART IV, QUESTION 6 BEACON HEALTH SYSTEM (BHS) PROVIDED A SMALL NUMBER OF GRANTS TO SELECT COMMUNITY ORGANIZATIONS WHICH FURTHER THE CHARITABLE PURPOSES OF ITS SUPPORTED ORGANIZATIONS. AS BHS IS THE PARENT OF AN INTEGRATED HEALTH SYSTEM, ITS SUPPORTED ORGANIZATIONS ARE AWARE AND APPROVE OF THESE GRANTS. THE HEALTH SYSTEM IS RE-ALIGNING ITS GRANTMAKING ACTIVITY IN 2016 TO DIRECT ALL GRANTS THROUGH ITS AFFILIATED FOUNDATION AND HOSPITAL ORGANIZATIONS. SCHEDULE A, PART IV, SECTION B, LINE 2 BEACON HEALTH SYSTEM IS CONTROLLED BY ITS AFFILITATED HOSPITALS, ELKHART GENERAL HOSPITAL AND MEMORIAL HOSPITAL OF SOUTH BEND. SEE THE DISCLOSURE IN SCHEDULE O FOR THE CORE FORM 990, PART VI, SECTION A LINE 7a. CONSISTENT WITH ITS EXEMPT PURPOSES AS STATED IN ITS ARTICLES OF INCORPORATION, BEACON HEALTH SYSTEM ALSO SUPPORTED OTHER AFFILIATES WITHIN THE INTEGRATED REGIONAL HEALTH CARE SYSTEM, INCLUDING BEACON MEDICAL GROUP AND MEMORIAL HEALTH FOUNDATION, WHICH DID NOT SHARE IN THE CONTROL OF BEACON HEALTH SYSTEM. MEMORIAL HEALTH FOUNDATION PROVIDES FUNDRAISING AND ENDOWMENT SUPPORT TO BOTH HOSPITALS. BEACON MEDICAL GROUP PROVIDES SUPPORT THROUGH THE OPERATION OF PHYSICIAN PRACTICES. |
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| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | IN 2015, BEACON HEALTH SYSTEM, INC. ACQUIRED COMMUNITY OCCUPATIONAL MEDICINE, LLC (COM) AND CHA ACO, LLC (CHA ACO). BOTH ENTITIES ARE FOR-PROFIT INDIANA LIMITED LIABILITY COMPANIES. AS A RESULT, THESE ENTITIES ARE NOW WHOLLY OWNED BY BHS AND TREATED AS DISREGARDED ENTITIES FOR TAX PURPOSES. COM PRIMARILY PROVIDES OCCUPATIONAL MEDICINE SERVICES TO LOCAL EMPLOYERS. CHA ACO COORDINATES HIGH-QUALITY CARE FOR MEDICARE BENEFICIARIES PARTICIPATING IN THE MEDICARE SHARED SAVINGS PROGRAMS. THIS PURCHASE HAS RESULTED IN AN OVERALL INCREASE IN PROGRAM SERVICE REVENUE. FORM 990, PART VI, SECTION A, LINE 7A THE 14 MEMBERS OF BOARD OF DIRECTORS OF BEACON HEALTH SYSTEM WERE INITIALLY APPOINTED 50% BY ELKHART GENERAL HOSPITAL, INC. AND 50% BY BEACON MEDICAL GROUP, INC. THE REPRESENTATION WILL CONTINUE FOR A PERIOD OF 7 YEARS FROM THE DATE OF BEACON HEALTH SYSTEM'S FORMATION. SUCCESSOR APPOINTEES TO THE BOARD ARE RECOMMENDED FROM THE RESPECTIVE HOSPITALS, OR A COMMITTEE APPOINTED BY THE RESPECTIVE HOSPITALS TO THE NOMIMATING AND GOVERNANCE COMMITTEE OF THE BOARD, THEN APPOINTED TO THE BOARD. AT THE EXPIRATION OF THIS 7 YEAR TERM, THE BEACON HEALTH SYSTEM BOARD OF DIRECTORS WILL BE APPOINTED BY THE NOMINATING AND GOVERNANCE COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B SEE PART VI, SECTION A, LINE 7A DISCLOSURE FORM 990, 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 US, LLP TO REVIEW THE COMPLETED FORM 990 AND APPROPRIATE SCHEDULES. PRIOR TO FILING THE RETURN THE COMPENSATION COMMITTEE OF THE ORGANIZATION AND 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. FORM 990, 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 425 STATEMENTS AND ACHIEVED 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 THE WEB BASED SURVEY TOOL PROVIDED BY ERNST & YOUNG LLP. 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 FORM 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 ACKNOWLEDGMENT FORM TO BE SIGNED BY BEACON HEALTH SYSTEM, INC'S KEY FINANCIAL EMPLOYEES THAT BEACON HEALTH SYSTEMS, INC'S FINANCIAL INFORMATION IS TO THE BEST OF THEIR KNOWLEDGE TRUE AND ACCURATE. THIS STATEMENT WAS SENT OUT IN JANUARY, 2016 AND THE SIGNED ACKNOWLEDGEMENTS ARE KEPT BY THE DIRECTOR OF INTERNAL AUDIT. IN 2016, 22 DESIGNATED EMPLOYEES WERE REQUESTED TO SIGN THE FORM AND 100% COMPLIED WITH THIS REQUEST. 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. FORM 990, PART VI, SECTION B, LINE 14 BEACON HEALTH SYSTEM'S BOARD OF DIRECTORS HAS NOT SPECIFICALLY ADOPTED A DOCUMENT RETENTION AND DESTRUCTION POLICY, HOWEVER IN PRACTICE IT FOLLOWS THE RELATED POLICY OF MEMORIAL HOSPITAL OF SOUTH BEND, INC. (EIN #:35-0868132) FORM 990, PART VI, SECTION B, LINE 15a & 15b BEACON HEALTH SYSTEM, INC. HAS AN EXTENSIVE EXAMINATION THAT IS CONDUCTED, FOR VICE PRESIDENT AND HIGHER COMPENSATION. VICE PRESIDENT AND HIGHER COMPENSATION IS DETERMINED AFTER AN EXTENSIVE EXAMINATION IS CONDUCTED USING COMPARABLE MARKET DATA AND THEN REVIEWED BY AN INDEPENDENT CONSULTANT HIRED BY, AND REPORTING TO, THE BOARD OF DIRECTORS. HUMAN RESOURCES CONDUCTS THE ANALYSIS AND MAKES RECOMMENDATIONS TO THE CEO WHO THEN MAKES THE RECOMMENDATIONS FOR ALL OTHER EXECUTIVES/OFFICERS TO THE BOARD FOR APPROVAL. THE INDEPENDENT CONSULTING GROUP SEPARATELY MAKES THE RECOMMENDATIONS REGARDING THE CEO'S COMPENSATION TO THE BOARD FOR APPROVAL. RECOMMENDATIONS ARE PRESENTED TO THE COMPENSATION COMMITTEE OF THE BEACON HEALTH SYSTEM, INC. BOARD FOR DELIBERATION AND FINAL DECISION. DELIBERATION AND FINAL DECISION ARE PERFORMED BY THE INDEPENDENT MEMBERS OF THE BOARD. FORM 990, 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. FORM 990, PART XI, LINE 9 WRITE OFF INTER COMPANY MEMORIAL HOSPITAL OF SB $ 10,233,525 WRITE OFF INTER COMPANY MEMORIAL HEALTH FOUNDATION $ -174,283 WRITE OFF INTER COMPANY ELKHART GENERAL HOSPITAL $ -6,165,718 WRITE OFF INTER COMPANY BEACON MEDICAL GROUP $ 588,931 WRITE OFF INTER COMPANY BEACON HEALTH VENTURES $ -9,041,088 CAPITAL CONTRIBUTIONS $ -501,000 TRANSFERS TO/FROM AFFILIATES $ 3,200,869 TOTAL $ -1,858,764 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONSULTING TOTAL FEES:3437461 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EQUIPMENT RENTAL & MAINTENANCE TOTAL FEES:12576228 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RADIOLOGY FEES TOTAL FEES:43549 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB READING FEES TOTAL FEES:283961 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PURCHASED SERVICES TOTAL FEES:6732433 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:TRANSCRIPTION TOTAL FEES:110 |
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