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 | |||||
| Total | ||||||
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.) .... | 1,342,434 | 1,383,315 | 1,431,794 | 1,479,384 | 1,489,442 | 7,126,369 |
| 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 | 1,342,434 | 1,383,315 | 1,431,794 | 1,479,384 | 1,489,442 | 7,126,369 |
| 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. | 7,126,369 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,342,434 | 1,383,315 | 1,431,794 | 1,479,384 | 1,489,442 | 7,126,369 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 3,458 | 3,590 | 3,915 | 525 | 295 | 11,783 |
| 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. | 7,138,152 | |||||
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 |
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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) |
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| 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 |
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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 VI, Section A, line 4 | SUMMARY OF SIGNIFICANT CHANGES: THE ORGANIZATION ENTERED INTO AN AFFILIATION AGREEMENT WITH ALLIANT HEALTH SOLUTIONS, EFFECTIVE JANUARY 1, 2015 WITH THESE RESULTING ORGANIZATIONAL CHANGES: (A) ARTICLES OF INCORPORATION. EFFECTIVE AS OF THE EFFECTIVE DATE (AS DEFINED BELOW), THE ORGANIZATION SHALL AMEND AND RESTATE ITS ARTICLES OF INCORPORATION TO CREATE A SINGLE CLASS OF MEMBER. B) BYLAWS. EFFECTIVE AS OF THE EFFECTIVE DATE, THE ORGANIZATION SHALL AMEND ITS BYLAWS TO IDENTIFY THE FOLLOWING "MAJOR DECISIONS" THAT CAN ONLY BE MADE IF APPROVED BY THE ORGANIZATION'S SOLE MEMBER: I) ANY DECISION TO DISCONTINUE THE BUSINESS OF THE ORGANIZATION IF SUCH DISCONTINUANCE IS FIRST APPROVED BY THE BOARD OF DIRECTORS OF THE ORGANIZATION (THE ORGANIZATION BOARD"). II) ANY MERGER OR COMBINATION OF ANY SORT BY THE ORGANIZATION WITH ANY OTHER ENTITY OR PERSON; III) ANY AMENDMENT OR REVISION OF THE ORGANIZATION'S ARTICLES OF INCORPORATION OR BYLAWS; IV) THE ESTABLISHMENT OR CREATION OF ANY MEMBERSHIP IN THE ORGANIZATION; V) ANY DECISION THAT COMPROMISES THE RIGHTS OR OBLIGATIONS OF ALLIANT; VI) ANY ACQUISITION OF ANY REAL PROPERTY OR ANY INTEREST IN ANY REAL PROPERTY; VII) ANY DEBT FINANCING OR REFINANCING OF THE ORGANIZATION OR ANY ASSETS OF THE ORGANIZATION; PROVIDED, HOWEVER, THAT THE ORGANIZATION'S BOARD AND THE ORGANIZATION OFFICERS SHALL EACH HAVE THE POWER AND AUTHORITY, WITHOUT OBTAINING THE APPROVAL OF ALLIANT, TO CAUSE THE ORGANIZATION TO INCUR TRADE OBLIGATIONS IN THE ORDINARY COURSE OF BUSINESS AND, TO THE EXTENT APPLICABLE, IN COMPLIANCE WITH THE ORGANIZATION'S BYLAWS; VIII) ANY SALE OR TRANSFER OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; IX) THE INCURRENCE OF ANY VOLUNTARY ENCUMBRANCE UPON ANY OF THE ASSETS OF THE ORGANIZATION, OTHER THAN ANY SUCH ENCUMBRANCE THAT ARISES BY OPERATION OF LAW FOR AMOUNTS NOT YET DUE AND PAYABLE; X) REINVESTING THE PROCEEDS FROM THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; XI) EXCEPT IN THE ORDINARY COURSE OF BUSINESS, DISTRIBUTING ANY ASSETS OF THE ORGANIZATION TO ANYONE OR ANY ENTITY; XII) ANY ACT IN CONTRAVENTION OF THE BYLAWS OR KNOWINGLY REFRAINING FROM TAKING ANY ACT REQUIRED BY THE BYLAWS; XIII) ANY ACT THAT WOULD MAKE IT IMPOSSIBLE TO CARRY ON THE ORDINARY BUSINESS OF THE ORGANIZATION; XIV) ALLOWING ANY THIRD PARTY TO POSSESS THE ORGANIZATION'S PROPERTY OR ASSIGNING TO ANY THIRD PARTY THE RIGHTS OF THE ORGANIZATION IN SPECIFIC ORGANIZATION PROPERTY, IN EITHER CASE, FOR OTHER THAN A CORPORATE PURPOSE; XV) ANY TRANSACTION BETWEEN THE ORGANIZATION AND ANY ORGANIZATION INTEREST HOLDER OR AN AFFILIATE OF AN ORGANIZATION INTEREST HOLDER; XVI) ANY LOAN BY THE ORGANIZATION TO ANY THIRD PARTY; XVII) ANY MATERIAL CHANGE IN THE NATURE OF THE BUSINESS OF THE ORGANIZATION FROM THAT SET FORTH IN ITS ARTICLES OF INCORPORATION OR BYLAWS; XVIII) ANY GUARANTY BY THE ORGANIZATION OF ANY DEBT OR OTHER OBLIGATION OF ANY THIRD PARTY; OR XIX) ANY OTHER DECISION OR ACTION THAT REQUIRES ALLIANT'S APPROVAL UNDER THE ORGANIZATION'S BYLAWS. |
| Form 990, Part VI, Section A, line 6 | Alliant Health Solutions is the sole member of the organization. |
| Form 990, Part VI, Section A, line 7a | The organization has only one member and thus only has one class of members. Each member has one vote. The member does not receive any form of compensation. Upon dissolution, there is no distribution of assets to the member. The member does not pay any membership dues. |
| Form 990, Part VI, Section A, line 7b | The member of the organization has the right to vote on members elected to the governing body and significant decisions regarding changes to organization documents (i.e. articles of incorporation and bylaws). |
| Form 990, Part VI, Section B, line 11 | THE EXECUTIVE DIRECTOR AND TREASURER REVIEW THE 990 PRIOR TO FILING BY DOING THE FOLLOWING: REVIEWING THE YES/NO ANSWERS GIVEN ON THE 990 FORM FOR ACCURACY, CROSS REFERENCING THE FINANCIAL NUMBERS TO THE AUDITED FINANCIAL STATEMENTS, AND CORROBORATING OTHER INFORMATION GIVEN ON THE FORM BASED ON FIRST-HAND KNOWLEDGE OF THE ORGANIZATION |
| Form 990, Part VI, Section B, line 12c | Each board member and key employee is given a copy of the conflict of interest policy as a part of their start up package. On an annual basis, major business relationships are reviewed for any possible conflicts of interest transactions. |
| Form 990, Part VI, Section B, line 15 | THE GOVERNING BODY REVIEWS AND APPROVES THE COMPENSATION PACKAGE FOR THE EXECUTIVE DIRECTOR. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION IN QUESTION IS NOT ALLOWED TO PARTICIPATE IN THE DELIBERATIONS. ALL DOCUMENTS USED TO JUSTIFY THE COMPENSATION PACKAGE GIVEN, NOTES OF DISCUSSIONS CONDUCTED, AND FINAL DECISIONS MADE ARE MAINTAINED WITHIN THE MINUTES OF MEETINGS HELD. |
| Form 990, Part VI, Section C, line 18 | The 990 report is made available to the general public through www.guidestar.org. |
| Form 990, Part VI, Section C, line 19 | Our financial statement information is included in our 990 report, which is available to the general public through www.guidestar.org. Our articles of incorporation and bylaws are made available upon request. Our audited financial statements are made available to the general public upon request. |
| Form 990, Part XII, Line 2c: | THE AUDIT REPORT IS PRESENTED TO THE BOARD OF DIRECTORS AT THE COMPLETION OF THE AUDIT. THE AUDITOR WORKS CLOSELY WITH THE BOARD OF DIRECTORS DURING THE YEAR SHOULD ANY CONCERNS ARISE. |
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