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 | |||||
| (A)
1889 FOUNDATION INC |
251719695 | Yes | 500,000 | 0 | ||
Total 1
|
500,000 | |||||
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 | 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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 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) |
||||
| 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) |
||||
|
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 |
|---|---|
| FORM 990, PART III, LINE 3 | THE 1889-CHS FOUNDATION WAS FORMERLY KNOWN AS THE CONEMAUGH HEALTH SYSTEM. THE CONEMAUGH HEALTH SYSTEM INCLUDED THREE HOSPITALS AND THE CONEMAUGH HEALTH FOUNDATION. ON AUGUST 31, 2014, THE THREE HOSPITALS WERE SOLD TO DUKE LIFEPOINT. THE CONEMAUGH HEALTH SYSTEM AND CONEMAUGH FOUNDATION TRANSFORMED FROM ORGANIZATIONS THAT SUPPORTED THE HOSPITALS TO ORGANIZATIONS THAT SUPPORT INNOVATIVE PROGRAMS AND INITIATIVES THAT IMPROVE AND TRANSFORM THE OVERALL HEALTH OF THE REGION. |
| FORM 990, PART VI, SECTION A, LINE 4 | 1889 - CHS FOUNDATION, INC.'S SOLE MEMBER IS NOW 1889 FOUNDATION, INC. THE 1889 FOUNDATION HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 6 | 1889 FOUNDATION, INC. IS THE SOLE MEMBER OF 1889 - CHS FOUNDATION, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER OF 1889 -CHS FOUNDATION, INC., 1889 FOUNDATION, INC., HAS THE POWER TO APPROVE OR DISAPPROVE THE ELECTION OF OR REMOVAL OF MEMBERS OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION A, LINE 7B | ALL DECISIONS OF THE GOVERNING BODY OF 1889 - CHS FOUNDATION, INC. ARE SUBJECT TO APPROVAL BY ITS SOLE MEMBER, 1889 FOUNDATION, INC. THE FOLLOWING POWERS SHALL BE RESERVED EXCLUSIVELY TO THE SOLE MEMBER: (A) TO APPROVE OR DISAPPROVE ANY AMENDMENTS TO THE SUBSIDIARY CORPORATION'S ARTICLES OF INCORPORATION AND BYLAWS BEFORE THEY BECOME EFFECTIVE; (B) THE POWER TO DIRECT THE AMENDMENT OF THE SUBSIDIARY CORPORATION'S BYLAWS AND/OR ARTICLES OF INCORPORATION, PROVIDED SUCH ACTION IS APPROVED BY AT LEAST TWO-THIRDS (2/3) OF THE SITTING DIRECTORS OF THE CORPORATION AFTER AT LEAST FIFTEEN (15) DAYS PRIOR WRITTEN NOTICE TO THE MEMBER, SETTING FORTH THE TIME, DATE AND PLACE OF THE MEETING, THAT SUCH ACTION WILL BE CONSIDERED AT THE NEXT MEETING OF THE CORPORATION'S BOARD. (C) TO APPROVE OR DISAPPROVE THE ELECTION OR REMOVAL OF MEMBERS OF THE BOARD OF DIRECTORS OF THE CORPORATION AND THE BOARD OF DIRECTORS OF ANY SUBSIDIARY; (D) TO APPROVE OR DISAPPROVE ALL OPERATING AND CAPITAL BUDGETS; (E) TO APPROVE OR DISAPPROVE THE ADOPTION OF OR THE AMENDMENT OF ANY SUBSIDIARY CORPORATION'S MISSION STATEMENT; (F) TO APPROVE OR DISAPPROVE DEBT OF THE SUBSIDIARY CORPORATION NOT ALREADY IN AN APPROVED BUDGET; (G) TO APPROVE THE PURCHASE, SALE, LEASE, OR MORTGAGE OF REAL PROPERTY BY THE SUBSIDIARY CORPORATION; (H) TO APPROVE THE DISTRIBUTION, DISBURSEMENT, LOAN, OR DONATION OF FUNDS OR ASSETS OF THE SUBSIDIARY CORPORATION; (I) TO APPROVE OR DISAPPROVE THE SUBSIDIARY CORPORATION'S STRATEGIC PLANNING PROCESS AND PLAN, AS WELL AS AMENDMENTS THERETO, INCLUDING BUT NOT LIMITED TO THE SUBSIDIARY CORPORATION'S PROGRAMMING DECISIONS; (J) TO APPROVE OR DISAPPROVE ANY MERGER, CONSOLIDATION, DIVISION, LIQUIDATION, DISSOLUTION OR WINDING UP, OR SALE OF ALL OR SUBSTANTIALLY ALL THE ASSETS OF THE SUBSIDIARY CORPORATION; AND (K) TO APPROVE GIFTS AND GRANTS OVER $5,000 PER YEAR. |
| FORM 990, PART VI, SECTION B, LINE 11 | 1889 - CHS FOUNDATION, INC. HAS A CPA FIRM PREPARE ITS FORM 990. THE RETURN IS COMPLETED IN DRAFT FORM AND REVIEWED BY MANANGEMENT OF THE ORGANIZATION. THE FORM 990 IS THEN PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | 1889 - CHS FOUNDATION, INC. ANNUALLY REQUIRES ITS BOARD MEMBERS, OFFICERS AND KEY EMPLOYEES TO FILL OUT A CONFLICT OF INTEREST FORM. DURING BOARD MEETINGS, IF AN INTERESTED PARTY HAS A CONFLICT, HE OR SHE RECUSES THEMSELVES FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINE 15 | 1889 - CHS FOUNDATION, INC.'S BOARD OF DIRECTORS ANNUALLY REVIEWS AND APPROVES THE COMPENSATION OF THEIR ORGANIZATION'S TOP MANAGEMENT. |
| FORM 990, PART VI, SECTION C, LINE 18 | 1889 - CHS FOUNDATION, INC. MAKES ITS FORM 990 AND FORM 1023 AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | AT THIS TIME, 1889 - CHS FOUNDATION, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC. |
| PART VII | THE 1889-CHS FOUNDATION WAS FORMERLY KNOWN AS THE CONEMAUGH HEALTH SYSTEM. THE CONEMAUGH HEALTH SYSTEM INCLUDED THREE HOSPITALS AND THE CONEMAUGH HEALTH FOUNDATION. ON AUGUST 31, 2014, THE THREE HOSPITALS WERE SOLD TO DUKE LIFEPOINT. THE CONEMAUGH HEALTH SYSTEM AND CONEMAUGH FOUNDATION TRANSFORMED FROM ORGANIZATIONS THAT SUPPORTED THE HOSPITALS TO ORGANIZATIONS THAT SUPPORT INNOVATIVE PROGRAMS AND INITIATIVES THAT IMPROVE AND TRANSFORM THE OVERALL HEALTH OF THE REGION. A MAJORITY OF THE OFFICERS LISTED ON PART VII ARE NO LONGER OFFICERS OF THE 1889-CHS FOUNDATION AND 1889 FOUNDATION (FORMERLY KNOWN AS CONEMAUGH HEALTH FOUNDATION). |
| FORM 990, PART IX, LINE 11G | MISC FEES: PROGRAM SERVICE EXPENSES 41,681. MANAGEMENT AND GENERAL EXPENSES 7,356. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,037. CONSULTING FEES: PROGRAM SERVICE EXPENSES 4,506,370. MANAGEMENT AND GENERAL EXPENSES 795,242. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,301,612. |
| FORM 990, PART XI, LINE 9: | TRANSFER FROM RELATED PARTY 128,890,232. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION HAS AN FINANCE COMMITTEE THAT IS RESPONSIBLE FOR OVERSEEING THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS HAS NOT CHANGED FROM PRIOR YEAR. |
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