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)
HOSPITAL SERVICE DISTRICT 1 PARISH OF OUACHITA STATE OF LOUISIANA |
721194469 | 6 | Yes | 0 | 0 | |
| Total 1 | 0 | |||||
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) |
||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 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) |
||||
|
6
Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
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 |
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| Return Reference | Explanation |
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| Software ID: | |
| 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 - ORGANIZATION'S MISSION | THE FOUNDATION ADMINISTERED ACTIVITIES RELATED TO RENDERING CARE TO THE SICK AND INJURED OR IN THE PROMOTION OF HEALTH, COOPERATED WITH OTHER PUBLIC AND PRIVATE INSTITUTIONS AND AGENCIES ENGAGED IN PROVIDING HOSPITAL AND OTHER HEALTH CARE SERVICES TO RESIDENTS OF THE DISTRICT, AND PARTICIPATED IN ACTIVITIES DESIGNED AND CONDUCTED TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. THE FOUNDATION'S AREA OF SERVICE INCLUDED THE FOLLOWING EIGHT NORTHEASTERN LOUISIANA PARISHES: CALDWELL, FRANKLIN, JACKSON, LINCOLN, MOREHOUSE, OUACHITA, RICHLAND AND UNION. |
| FORM 990, PAGE 2, PART III, LINE 3 | THE FOUNDATION'S UPDATED AGREEMENT DATED AUGUST 1, 2011, WITH OUACHITA PARISH SCHOOL BOARD (OPSB) AS A CO-SPONSOR TO COVER FINANCIAL DEFICIENCIES OF FEDERAL, STATE AND LOCAL FUNDING SOURCES, AS WELL AS INSURANCE REIMBURSEMENTS AND EXPENSES ASSOCIATED WITH SCHOOL BASED HEALTH CENTERS LOCATED AT RISER MIDDLE SCHOOL AND WEST MONROE HIGH SCHOOL, WAS TERMINATED AUGUST 1, 2015, WITH THE TRANSFER OF OWNERSHIP TO MOREHOUSE COMMUNITY MEDICAL CENTERS, INC., A FEDERALLY QUALIFIED HEALTH CENTER. A FINAL INVOICE DATED SEPTEMBER 23, 2015, WAS PRESENTED TO THE LIVING WELL FOUNDATION FROM THE OPSB FOR OPERATIONAL SUPPORT FOR SCHOOL YEAR 2014-2015. UPON THE TRANSFER OF OWNERSHIP OF THE SCHOOL BASED HEALTH CENTERS BY THE CO-SPONSORS OPSB AND THE FOUNDATION TO MOREHOUSE COMMUNITY MEDICAL CENTERS, INC., (MCMC), A MEMORANDUM OF UNDERSTANDING WAS AGREED UPON BY THE LIVING WELL FOUNDATION AND THE MOREHOUSE COMMUNITY MEDICAL CENTERS, INC., TO PROVIDE FINANCIAL SUPPORT BY THE FOUNDATION FOR 1 YEAR OF OPERATIONS BASED ON FINAL RECONCILIATION OF FINANCIAL PERFORMANCE FOR SCHOOL YEAR 2015-2016 AT JUNE 30, 2015, IF NEEDED. IN ORDER TO ALLOW FOR THIRD PARTY REIMBURSEMENT PAYMENTS, THE MOU INCLUDED AN 18-MONTH TIMEFRAME FOR COLLECTIONS AND RECONCILIATIONS OF THE 2015-2016 SCHOOL YEAR BILLINGS. THIS COMMITMENT WITH THE MCMC WAS DESIGNED TO ENSURE THAT STUDENTS WHO ARE LIMITED IN THEIR ABILITY TO ACCESS THE EXISTING HEALTHCARE SYSTEMS IN THE COMMUNITY WOULD CONTINUE TO HAVE ACCESS TO MEDICAL AND MENTAL HEALTHCARE ON CAMPUS. AS OF DECEMBER 31, 2015, NO FINANCIAL SUPPORT WAS REQUIRED FOR THE FIRST 5 MONTHS OF OPERATIONS FROM AUGUST 1, 2015 PER THE MCMC. |
| FORM 990, PAGE 2, PART III, LINE 4A | STUDENTS WHO ARE LIMITED IN THEIR ABILITY TO ACCESS THE EXISTING HEALTHCARE SYSTEMS IN THE COMMUNITY. DURING 2015 THE FOUNDATION PROVIDED FUNDING OF 99,587 TO RISER MIDDLE SCHOOL AND 99,819 TO WEST MONROE HIGH SCHOOL. THE AGREEMENT WITH OUACHITA PARISH SCHOOL BOARD WAS TERMINATED AUGUST 1, 2015 WITH THE TRANFER OF OWNERSHIP OF THE SCHOOL BASED HEALTH CENTERS TO MOREHOUSE COMMUNITY MEDICAL CENTERS, INC., A FEDERALLY QUALIFIED HEALTH CENTER. |
| FORM 990, PAGE 6, PART VI, LINE 4 | AS AMENDED, THE ARTICLES OF INCORPORATION STATE THAT THE FOUNDATION'S DIRECTORS STILL MUST BE A RESIDENT OF THE PORTION OF OUACHITA PARISH WHICH LIES WEST OF THE OUACHITA RIVER WHEN ELECTED, AND, EVEN IF A DIRECTOR CHANGES HIS OR HER RESIDENCY OUTSIDE THIS AREA OF OUACHITA PARISH, HE OR SHE STILL MUST (A) RESIDE WITHIN THE SERVICE AREA OF THE FOUNDATION AND (B) MAINTAIN REGULAR EMPLOYMENT IN THAT PORTION OF OUACHITA PARISH WHICH LIES WEST OF THE OUACHITA RIVER IN ORDER TO CONTINUE TO SERVE AS A DIRECTOR. UNTIL DECEMBER 31, 2016, THE FOUNDATION HAS BEEN GRANTED PERMISSION TO TEMPORARILY RE-ASSIGN THE DUTIES ASSIGNED TO THE PLANNING/OPERATIONS COMMITTEE (INCLUDING THE DUTIES RELEVANT TO FORM 990 PART VI) TO THE FOUNDATION AS THE FOUNDATION TIME-TO-TIME DETERMINES APPROPRIATE TO OTHER COMMITTEES (STANDING OR ADDITIONAL), OR TO THE EXECUTIVE COMMITTEE OR TO THE BOARD OF DIRECTORS. EXCEPT AS THE FOUNDATION MAY DETERMINE APPROPRIATE, THE PLANNING/OPERATIONS COMMITTEE SHALL BE INACTIVE, AND SHALL HAVE NO ASSIGNED DUTIES. IN AN EFFORT TO MAKE THE EXECUTIVE COMMITTEE MORE EFFECTIVE AND MORE VERSATILE, AN ADDITIONAL MEMBER HAS BEEN ADDED TO THE EXECUTIVE COMMITTEE. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE FOUNDATION HAS ONE MEMBER, THE HOSPITAL SERVICE DISTRICT 1 OF THE PARISH OF OUACHITA STATE OF LOUISIANA |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE HOSPITAL SERVICE DISTRICT 1 PARISH OF OUACHITA STATE OF LOUISIANA SHALL BE ENTITLED TO ELECT TWO-THIRDS OF THE DIRECTORS AND THE POLICE JURY OF OUACHITA PARISH STATE OF LOUISIANA SHALL BE ENTITLED TO ELECT ONE-THIRD OF THE DIRECTORS. THE MEMBERS OF THE BOARD OF DIRECTORS MUST MEET THE REQUIREMENTS SET FORTH IN THE ARTICLES OF INCORPORATION OF LIVING WELL FOUNDATION. |
| FORM 990, PAGE 6, PART VI, LINE 7B | CERTAIN MATTERS AS LISTED IN THE BY-LAWS OF LIVING WELL FOUNDATION REQUIRE APPROVAL OF THE BOARD OF COMMISSIONERS OF HOSPITAL DISTRICT 1 PARISH OF OUACHITA STATE OF LOUISIANA. |
| FORM 990, PAGE 6, PART VI, LINE 11B | PRESIDENT/CEO AND BOARD CHAIR REVIEW AND PROVIDE INPUT ON ANY NOTED ITEMS. ATTORNEY, CPA, AND AUDITOR PROVIDE INPUT ON ITEMS AS NEEDED. UPON COMPLETION OF FORM 990, IT IS PUT ON WEBSITE AS PUBLIC INFO AND DISTRIBUTED BY EMAIL TO ALL BOARD MEMBERS. AT BOARD MEETING, IT IS DISCUSSED THAT THE 990 IS IN PROCESS AND WILL BE FILED BY THE FILING DUE DATE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | BEFORE PERSONS BECOME BOARD MEMBERS,THEY ARE PRESENTED WITH THE CONFLICT OF INTEREST POLICY WITH WHICH THEY ARE EXPECTED TO COMPLY. AFTER BECOMING BOARD MEMBERS THEY ARE EXPECTED TO NOTIFY THE BOARD OF ANY CONFLICTS OF INTEREST THAT MAY ARISE. FOR GRANT-MAKING ACTIVITIES, DIRECTORS, ETC. ARE REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICT OF INTEREST OR FINANCIAL INTEREST AS DEFINED WITHIN THE BY-LAWS AND THE BOARD UNDERTAKES DETERMINATION OF THAT CONFLICT OR FINANCIAL INTEREST PRIOR TO ANY DECISIONS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | IN DETERMINING THE COMPENSATION FOR THE CEO, THE PLANNING/OPERATIONS COMMITTEE INCLUDES COMPARABILITY DATA, A REVIEW AND APPROVAL BY INDEPENDENT PERSONS AND SUBSTANTIATION OF THE DELIBERATION AND DECISIONS MADE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | IN DETERMINING THE COMPENSATION FOR THE OTHER OFFICER, THE PLANNING/OPERATIONS COMMITTEE INCLUDES COMPARABILITY DATA, A REVIEW AND APPROVAL BY INDEPENDENT PERSONS AND SUBSTANTIATION OF THE DELIBERATION AND DECISIONS MADE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | LIVING WELL FOUNDATION FURNISHES THE ARTICLES OF INCORPORATION BYLAWS, GRANT MAKING GUIDELINES, MINUTES OF ALL MEETINGS, BUDGETS AND OTHER INFORMATION ON THE ORGANIZATION WEBSITE WWW.LIVINGWELLFOUNDATION.NET. ALL ITEMS ARE ALSO AVAILABLE AT THE OFFICE LOCATION FOR PUBLIC REVIEW UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | RECOVERIES OF PRIOR YEAR GRANTS -11,823 RECOVERIES OF PRIOR YEAR GRANTS 11,823 |
| Software ID: | |
| Software Version: |