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)
PALMETTO HEALTH |
582296052 | 3 | Yes | 6,493,119 | 0 | |
| Total 1 | 6,493,119 | 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. |
||||
| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| PART IV, SECTION E, LINE 2A: | THE FOUNDATION EXISTS TO SUPPORT THE MISSION AND PURPOSES OF PALMETTO HEALTH AND ITS RELATED ACTIVITIES. THIS IS ACCOMPLISHED BY BUILDING AWARENESS OF KEY HEALTH ISSUES IN THE COMMUNITY AND DEVELOPING FINANCIAL RESOURCES FOR PALMETTO HEALTH TO USE IN ADDRESSING SUCH ISSUES. THE INITIATIVES OF THE FOUNDATION ARE LINKED TO THE STRATEGIC PLAN OF PALMETTO HEALTH AND MEASURED TO IMPROVE THE PHYSICAL, EMOTIONAL, AND SPIRITUAL HEALTH OF OUR COMMUNITY. WE SHARE THIS FUNDAMENTAL COMMITMENT IN IMPROVING THE HUMAN CONDITION IN OUR COMMUNITY. |
| 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, PART V, LINE 2B: | THE FOUNDATION HAS AN EMPLOYEE LEASING AGREEMENT UNDER WHICH ALL FOUNDATION PERSONNEL ARE LEASED FROM AN OUTSIDE AGENCY. THE AGENCY HANDLES ALL PAYROLL ADMINISTRATION, EMPLOYEE BENEFITS AND RELATED MATTERS IN EXCHANGE FOR A MONTHLY FEE. ALL LEASED EMPLOYEES WHO WORK FULL TIME AND ARE AT LEAST TWENTY-ONE YEARS OF AGE ARE COVERED UNDER A DEFINED CONTRIBUTION 401(K) PLAN MAINTAINED BY THE LEASING AGENCY. ELIGIBLE PARTICIPANTS MAY CONTRIBUTE UP TO FIFTEEN PERCENT OF THEIR ANNUAL COMPENSATION UP TO FEDERALLY MANDATED MAXIMUMS. THE FOUNDATION MAKES MATCHING CONTRIBUTIONS UP TO 6.75% OF THE PARTICIPANTS' ELIGIBLE COMPENSATION. THE PLAN IS SUBJECT TO THE PROVISIONS OF THE EMPLOYEE RETIREMENT INCOME SECURITY ACT OF 1974 (ERISA). THE FOUNDATION'S CONTRIBUTIONS TO THE PLAN TOTALED $59,707 AND $97,812 DURING THE YEARS ENDED SEPTEMBER 30, 2016 AND 2015, RESPECTIVELY. |
| FORM 990, PART VI, SECTION B, LINE 11 | A DRAFT OF THE FORM 990 WAS EMAILED TO THE FINANCE COMMITTEE WITH THE OPPORTUNITY FOR QUESTIONS OR OBJECTIONS. A QUORUM FOR APPROVAL TO RECOMMEND THE FORM 990 TO BOARD FOR REVIEW WAS OBTAINED BY THE GIVEN DEADLINE. A DRAFT OF THE FORM 990 WAS ALSO EMAILED TO THE BOARD MEMBERS TO REVIEW AND SUBMIT ANY QUESTIONS AND CONCERNS. IF THEY DID NOT SUBMIT AN OBJECTION BY THE DEADLINE, IT WAS CONSIDERED APPROVED. THE BOARD MEMBERS WERE GIVEN 5 WORKING DAYS TO RESPOND. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND EMPLOYEES WILL RENEW CONFLICT OF INTEREST AND CONFIDENTIALITY AGREEMENTS ANNUALLY BEGINNING WITH THE FIRST BOARD MEETING OF EACH CALENDAR YEAR. |
| FORM 990, PART VI, SECTION B, LINE 15 | OFFICER'S COMPENSATION IS DETERMINED BASED ON PERFORMANCE AND BOARD REVIEWS. SALARIES ARE DERIVED FROM COMPARABLE INDUSTRY DATA AND ACHIEVEMENT OF PERFORMANCE STANDARDS ESTABLISHIED AT THE BEGINNING OF EACH FISCAL YEAR. |
| FORM 990, PART VI, SECTION C, LINE 19 | FORM 990 IS POSTED ON THE ORGANIZATION'S WEBSITE AS A PDF FILE ONCE THE FORM 990 IS FILED AND ACCEPTED. THE FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | BOARD DEVELOPMENT COSTS: PROGRAM SERVICE EXPENSES 45,277. MANAGEMENT AND GENERAL EXPENSES 11,670. FUNDRAISING EXPENSES 29,583. TOTAL EXPENSES 86,530. PRINTING & PUBLISHING: PROGRAM SERVICE EXPENSES 23,460. MANAGEMENT AND GENERAL EXPENSES 6,047. FUNDRAISING EXPENSES 15,328. TOTAL EXPENSES 44,835. DUES EXPENSE: PROGRAM SERVICE EXPENSES 19,501. MANAGEMENT AND GENERAL EXPENSES 5,026. FUNDRAISING EXPENSES 12,741. TOTAL EXPENSES 37,268. RECOGNITION EXPENSE: PROGRAM SERVICE EXPENSES 14,902. MANAGEMENT AND GENERAL EXPENSES 3,841. FUNDRAISING EXPENSES 9,737. TOTAL EXPENSES 28,480. SUPPLIES: PROGRAM SERVICE EXPENSES 9,004. MANAGEMENT AND GENERAL EXPENSES 2,321. FUNDRAISING EXPENSES 5,883. TOTAL EXPENSES 17,208. POSTAGE AND SHIPPING: PROGRAM SERVICE EXPENSES 4,479. MANAGEMENT AND GENERAL EXPENSES 1,154. FUNDRAISING EXPENSES 2,927. TOTAL EXPENSES 8,560. VEHICLE GAS & MAINTENANCE: PROGRAM SERVICE EXPENSES 3,767. MANAGEMENT AND GENERAL EXPENSES 971. FUNDRAISING EXPENSES 2,462. TOTAL EXPENSES 7,200. PROMOTIONAL EXPENSES - PUBLIC RELATIONS: PROGRAM SERVICE EXPENSES 3,174. MANAGEMENT AND GENERAL EXPENSES 818. FUNDRAISING EXPENSES 2,074. TOTAL EXPENSES 6,066. TELEPHONE: PROGRAM SERVICE EXPENSES 2,422. MANAGEMENT AND GENERAL EXPENSES 624. FUNDRAISING EXPENSES 1,583. TOTAL EXPENSES 4,629. EMPLOYEE RECRUITMENT: PROGRAM SERVICE EXPENSES 1,644. MANAGEMENT AND GENERAL EXPENSES 424. FUNDRAISING EXPENSES 1,074. TOTAL EXPENSES 3,142. CATERING EXPENSE: PROGRAM SERVICE EXPENSES 1,244. MANAGEMENT AND GENERAL EXPENSES 321. FUNDRAISING EXPENSES 813. TOTAL EXPENSES 2,378. LESS AMOUNTS ALLOCABLE TO SPECIAL EVENTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES -141,059. TOTAL EXPENSES -141,059. ELIMINATIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES -330,975. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -330,975. FUNDRAISING EXPENSES REIMBURSED BY PALMETTO HEALTH: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES -31,678. FUNDRAISING EXPENSES -1,518,322. TOTAL EXPENSES -1,550,000. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF SPLIT INTEREST AGREEMENT 21,289. |
| FORM 990, PART XII, LINE 2C, RESPONSIBILITY OF AUDIT OVERSIGHT: | THE ORGANIZATION HAS A SEPARATE AUDIT COMMITTEE THAT OVERSEES THE AUDIT PROCESS. |
| Software ID: | |
| Software Version: |