TY 2017 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) DR SRINIVAS VUPPALA...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 0.0	X		0	0
(2) HEATHER VON HERRMANN...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 1.0	X		0	0
(3) GEORGE MCGRATH...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 0.0	X		0	0
(4) JUSTIN ROOF...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(5) JERRY JENERETTE...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(6) CHRISTY EVERETT...................................................................... DIRECTOR	1.0 ................. 1.0	X		0	0
(7) WILLIAM MARSH...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(8) MARJORIE O'GRADY...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 0.0	X		0	0
(9) WILLIAM HARDEE III...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(10) MICHAEL DUFF...................................................................... DIRECTOR	1.0 ................. 0.0	X		0	0
(11) DR REGINALD DAVES...................................................................... VICE CHAIRMAN	1.0 ................. 1.0	X		0	0
(12) DELAN STEVENS...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 0.0	X		0	0
(13) SUSAN MUNGO...................................................................... DIRECTOR (AS OF 10/17)	1.0 ................. 0.0	X		0	0
(14) BRET BARR...................................................................... PRESIDENT (AS OF 1/2018)	1.0 ................. 40.0	X	X	401,134	109,504
(15) PHILIP A CLAYON...................................................................... PRESIDENT (THRU 12/2017)	1.0 ................. 40.0	X	X	818,481	308,181
(16) M WAYNE STATON...................................................................... CHAIRMAN	1.0 ................. 1.0	X	X	0	0
(17) PETER HEARN...................................................................... VICE CHAIRMAN	1.0 ................. 0.0	X	X	0	0

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow

Attach to Form 990 or Form 990-EZ.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................1

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iii) Type of organization (described on lines 1- 10 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)
(i) Name of supported organization	(ii) EIN		Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(A) CONWAY HOSPITAL INC	570314381	3	Yes		453,904	0

Total 1					453,904

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Yes

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Yes

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

Yes

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Yes

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1	0
2	Recoveries of prior-year distributions	2	0
3	Other gross income (see instructions)	3	191,265	191,554
4	Add lines 1 through 3	4	191,265	191,554
5	Depreciation and depletion	5	0
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	69,731	80,931
7	Other expenses (see instructions)	7	0
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8	121,534	110,623

	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	3,662,443	4,312,303
b	Average monthly cash balances	1b	516,960	151,224
c	Fair market value of other non-exempt-use assets	1c	19,000	19,042
d	Total (add lines 1a, 1b, and 1c)	1d	4,198,403	4,482,569
e	Discount claimed for blockage or other factors (explain in detail in Part VI): 0
2	Acquisition indebtedness applicable to non-exempt use assets	2	0
3	Subtract line 2 from line 1d	3	4,198,403	4,482,569
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4	62,976	67,239
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5	4,135,427	4,415,330
6	Multiply line 5 by .035	6	144,740	154,537
7	Recoveries of prior-year distributions	7	0
8	Minimum Asset Amount (add line 7 to line 6)	8	144,740	154,537

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1	121,534
2	Enter 85% of line 1	2	103,304
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3	144,740
4	Enter greater of line 2 or line 3	4	144,740
5	Income tax imposed in prior year	5	0
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6	144,740

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes		339,993
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity		0
3 Administrative expenses paid to accomplish exempt purposes of supported organizations		0
4 Amounts paid to acquire exempt-use assets		0
5 Qualified set-aside amounts (prior IRS approval required)		0
6 Other distributions (describe in Part VI). See instructions		113,911
7Total annual distributions. Add lines 1 through 6.		453,904
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions		453,904
9 Distributable amount for 2019 from Section C, line 6		144,740
10 Line 8 amount divided by Line 9 amount		31359.96 %

Section E - Distribution Allocations (see instructions)	(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6			144,740
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.		0
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......0
c From 2016.......0
d From 2017.......169,632
e From 2018.......329,096
fTotal of lines 3a through e	498,728
g Applied to underdistributions of prior years		0
h Applied to 2019 distributable amount			144,740
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.	353,988
4Distributions for 2019 from Section D, line 7:
$ 453,904
a Applied to underdistributions of prior years		0
b Applied to 2019 distributable amount			0
c Remainder. Subtract lines 4a and 4b from 4.	453,904
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.		0
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.			0
7 Excess distributions carryover to 2020. Add lines 3j and 4c.	807,892
8 Breakdown of line 7:
a Excess from 2015.....0
b Excess from 2016.....0
c Excess from 2017.....24,892
d Excess from 2018.....329,096
e Excess from 2019.....453,904

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation
SCHEDULE A, PART IV, SECTION D, LINE 3	BRIAN ARGO IS THE TREASURER OF CONWAY HOSPITAL FOUNDATION, INC.(EIN# 57-0870199)(SUPPORTING ORGANIZATION) AND ALSO THE CHIEF FINANCIAL OFFICER OF CONWAY HOSPITAL,INC.(EIN# 57-0314381)(SUPPORTED ORGANIZATION). THE SUPPORTED ORGANIZATION, CONWAY MEDICAL CENTER, HAS A SIGNIFICANT VOICE IN THE INVESTMENT POLICIES THROUGH THE ABOVE MENTIONED BOARD MEMBER, BRIAN ARGO, ACTING AS CHAIRMAN OF THE INVESTMENT COMMITTEE OF CONWAY MEDICAL CENTER FOUNDATION, INC. THE COMMITTEE REVIEWS ALL INVESTMENT POLICIES AND INVESTMENT DECISIONS WITH HELP ON AN OUTSIDE FINANCIAL ADVISOR. THE SUPPORTED ORGANIZATION, CONWAY MEDICAL CENTER, DIRECTS THE USE OF CONWAY MEDICAL CENTER FOUNDATION'S INCOME OR ASSETS DURING THE YEAR BY MAKING HOSPITAL RECOMMENDATIONS AND REQUEST OF WHERE SUPPORT IS REQUIRED. THE FOUNDATION REGULARLY SUPPORTS ALL RECOMMENDATIONS AND REQUESTS SUBJECT TO FUND RESTRICTIONS. SCHEDULE A, PART IV, SECTION D, LINE 3 ATTENTIVENESS, RESPONSIVENESS & INTEGRAL PART TEST (HEALTHREACH/COMBATING DIABETES) THE ABOVE PROGRAMS ARE FUNDED THROUGH DONATIONS OF THE FOUNDATION PAID 100% DIRECTLY TO CMC. DONATIONS PAID TO OTHERS FOR THE YEAR ENDED 9/30/2018 RELATED TO THESE PROGRAMS ARE $155,493. ATTENTIVENESS, RESPONSIVENESS, & INTEGRAL PART TEST (CMC SMART SNACKS PROGRAM) CMC SMART SNACKS IS A COMMUNITY OUTREACH SERVICE OF HEALTHREACH PROGRAM OF CONWAY MEDICAL CENTER. CHILDREN, WHO ARE RECEIPENTS OF SUBSIDIZED MEALS, ARE SELECTED AS RECEIPENTS BY TEACHERS AND COUNSELORS AT THEIR RESPECTIVE SCHOOLS. THE GOAL IS TO PROVIDE THESE UNDERPRIVILEGED CHILDREN WITH HEALTHY WEEKEND SNACKS TO HOPEFULLY IMPROVE HEALTH AND PERFORMANCE IN THE CLASSROOM. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $71,443. ATTENTIVENESS, RESPSONSIVENESS & INTEGRAL PART TEST (CMC MAMMOGRAPHY INITIATIVE) THE MAMMOGRAPHY INITIATIVE FALLS IN THE HEALTHREACH PROGRAM ALSO. PATIENTS ARE REFERRED BY LOCAL PHYSICIANS, FEDERAL HEALTH CLINICS, AND THE FREE MEDICAL CLINIC. ALL TESTS ARE PERFORMED AT CONWAY MEDICAL CENTER AND PAYMENTS FOR SERVICES, AT DISCOUNTED RATES, ARE PROVIDED TO THE HOSPITAL AND ALL PHYSICIANS BY THE FOUNDATION. THE GOAL OF THE MAMMOGRAPHY INITIATIVE IS EARLY DETECTION, A REDUCTION OF THE NEED FOR MORE INTENSE THERAPY LATER AND REDUCED MEDICAL COSTS. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $134,542. ATTENTIVENESS, RESPONSIVENESS & INTEGRAL PART TEST (COLON CANCER SCREENING INITIATIVE) THE COLON CANCER SCREENING INITIATIVE WAS DEVELOPED TO PROVIDE SCREENINGS FOR THE UNINSURED AND UNDERSERVED POPULATION IN HORRY COUNTY. WORKING WITH FRIENDSHIP MEDICAL CLINIC WHO PROVIDES REFERRALS FOR THE PROGRAM, SCREENINGS ARE PROVIDED AND FURTHER TESTS ARE PERFORMED AS NEEDED. ALL TESTS ARE PERFORMED AT CONWAY MEDICAL CENTER WITH DISCOUNTED RATES PROVIDED FOR THE SERVICES. IN ADDITION ALL PHYSICIANS INVOLVED ACCEPT DISCOUNTED PAYMENT. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $3,100. ATTENTIVENESS, RESPONSIVE & INTEGRAL PART TEST (SCHOLARSHIP PROGRAM) THE SCHOLARSHIP PROGRAM DIRECTLY ASSISTS EMPLOYEES OF CMC IN ASSISTING THEM TO FURTHER THEIR EDUCATION IN THE HEALTH CARE INDUSTRY. THE PROGRAM IS SUPPORTED 100% FROM CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $89,326.
SCHEDULE A, PART V, LINE 1 AND 6	DETAIL AND RECONCILIATION BY PROGRAM PAID TO CMC PAID - $339,993 HEALTHREACH $125,000 SCHOLARSHIPS $ 6,000 DIABETES $ 2,218 CARDIAC REHAB $ 967 MAMMOGRAPHY $152,594 SMART SNACKS $ 24,714 COLONOSCOPY $ 3,000 FRIENDSHIP MEDICAL $ 25,000 MISC OUTREACH $ 500 ON BEHALF OF CMC - $113,911 HEALTHREACH $ 441 SCHOLARSHIPS $ 62,326 MAMMOGRAPHY $ 2,949 SMART SNACKS $ 46,729 COLONOSCOPY $ 100 MISC OUTREACH $ 1,366 TOTAL $453,904

Return Reference

Explanation

SCHEDULE A, PART IV, SECTION D, LINE 3

BRIAN ARGO IS THE TREASURER OF CONWAY HOSPITAL FOUNDATION, INC.(EIN# 57-0870199)(SUPPORTING ORGANIZATION) AND ALSO THE CHIEF FINANCIAL OFFICER OF CONWAY HOSPITAL,INC.(EIN# 57-0314381)(SUPPORTED ORGANIZATION). THE SUPPORTED ORGANIZATION, CONWAY MEDICAL CENTER, HAS A SIGNIFICANT VOICE IN THE INVESTMENT POLICIES THROUGH THE ABOVE MENTIONED BOARD MEMBER, BRIAN ARGO, ACTING AS CHAIRMAN OF THE INVESTMENT COMMITTEE OF CONWAY MEDICAL CENTER FOUNDATION, INC. THE COMMITTEE REVIEWS ALL INVESTMENT POLICIES AND INVESTMENT DECISIONS WITH HELP ON AN OUTSIDE FINANCIAL ADVISOR. THE SUPPORTED ORGANIZATION, CONWAY MEDICAL CENTER, DIRECTS THE USE OF CONWAY MEDICAL CENTER FOUNDATION'S INCOME OR ASSETS DURING THE YEAR BY MAKING HOSPITAL RECOMMENDATIONS AND REQUEST OF WHERE SUPPORT IS REQUIRED. THE FOUNDATION REGULARLY SUPPORTS ALL RECOMMENDATIONS AND REQUESTS SUBJECT TO FUND RESTRICTIONS. SCHEDULE A, PART IV, SECTION D, LINE 3 ATTENTIVENESS, RESPONSIVENESS & INTEGRAL PART TEST (HEALTHREACH/COMBATING DIABETES) THE ABOVE PROGRAMS ARE FUNDED THROUGH DONATIONS OF THE FOUNDATION PAID 100% DIRECTLY TO CMC. DONATIONS PAID TO OTHERS FOR THE YEAR ENDED 9/30/2018 RELATED TO THESE PROGRAMS ARE $155,493. ATTENTIVENESS, RESPONSIVENESS, & INTEGRAL PART TEST (CMC SMART SNACKS PROGRAM) CMC SMART SNACKS IS A COMMUNITY OUTREACH SERVICE OF HEALTHREACH PROGRAM OF CONWAY MEDICAL CENTER. CHILDREN, WHO ARE RECEIPENTS OF SUBSIDIZED MEALS, ARE SELECTED AS RECEIPENTS BY TEACHERS AND COUNSELORS AT THEIR RESPECTIVE SCHOOLS. THE GOAL IS TO PROVIDE THESE UNDERPRIVILEGED CHILDREN WITH HEALTHY WEEKEND SNACKS TO HOPEFULLY IMPROVE HEALTH AND PERFORMANCE IN THE CLASSROOM. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $71,443. ATTENTIVENESS, RESPSONSIVENESS & INTEGRAL PART TEST (CMC MAMMOGRAPHY INITIATIVE) THE MAMMOGRAPHY INITIATIVE FALLS IN THE HEALTHREACH PROGRAM ALSO. PATIENTS ARE REFERRED BY LOCAL PHYSICIANS, FEDERAL HEALTH CLINICS, AND THE FREE MEDICAL CLINIC. ALL TESTS ARE PERFORMED AT CONWAY MEDICAL CENTER AND PAYMENTS FOR SERVICES, AT DISCOUNTED RATES, ARE PROVIDED TO THE HOSPITAL AND ALL PHYSICIANS BY THE FOUNDATION. THE GOAL OF THE MAMMOGRAPHY INITIATIVE IS EARLY DETECTION, A REDUCTION OF THE NEED FOR MORE INTENSE THERAPY LATER AND REDUCED MEDICAL COSTS. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $134,542. ATTENTIVENESS, RESPONSIVENESS & INTEGRAL PART TEST (COLON CANCER SCREENING INITIATIVE) THE COLON CANCER SCREENING INITIATIVE WAS DEVELOPED TO PROVIDE SCREENINGS FOR THE UNINSURED AND UNDERSERVED POPULATION IN HORRY COUNTY. WORKING WITH FRIENDSHIP MEDICAL CLINIC WHO PROVIDES REFERRALS FOR THE PROGRAM, SCREENINGS ARE PROVIDED AND FURTHER TESTS ARE PERFORMED AS NEEDED. ALL TESTS ARE PERFORMED AT CONWAY MEDICAL CENTER WITH DISCOUNTED RATES PROVIDED FOR THE SERVICES. IN ADDITION ALL PHYSICIANS INVOLVED ACCEPT DISCOUNTED PAYMENT. THIS PROGRAM IS SUPPORTED 100% FROM THE CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $3,100. ATTENTIVENESS, RESPONSIVE & INTEGRAL PART TEST (SCHOLARSHIP PROGRAM) THE SCHOLARSHIP PROGRAM DIRECTLY ASSISTS EMPLOYEES OF CMC IN ASSISTING THEM TO FURTHER THEIR EDUCATION IN THE HEALTH CARE INDUSTRY. THE PROGRAM IS SUPPORTED 100% FROM CONTRIBUTIONS OF THE FOUNDATION. DONATIONS FOR THE YEAR ENDED 9/30/2018 ARE $89,326.

SCHEDULE A, PART V, LINE 1 AND 6

DETAIL AND RECONCILIATION BY PROGRAM PAID TO CMC PAID - $339,993 HEALTHREACH $125,000 SCHOLARSHIPS $ 6,000 DIABETES $ 2,218 CARDIAC REHAB $ 967 MAMMOGRAPHY $152,594 SMART SNACKS $ 24,714 COLONOSCOPY $ 3,000 FRIENDSHIP MEDICAL $ 25,000 MISC OUTREACH $ 500 ON BEHALF OF CMC - $113,911 HEALTHREACH $ 441 SCHOLARSHIPS $ 62,326 MAMMOGRAPHY $ 2,949 SMART SNACKS $ 46,729 COLONOSCOPY $ 100 MISC OUTREACH $ 1,366 TOTAL $453,904

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Conway Hospital Foundation Inc

Part I Contributors	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Conway Hospital Foundation Inc		Employer identification number 57-0870199

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (See instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Conway Hospital Foundation Inc			Employer identification number 57-0870199
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a)
No. from Part I

(b) Purpose of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....	4,109,460	3,714,106	3,488,917	3,468,693	3,168,544
b	Contributions ...	196,531	321,331	242,943	266,360	280,515
c	Net investment earnings, gains, and losses	363,724	403,119	187,247	-46,641	221,714
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...	398,904	329,096	205,001	199,495	202,080
f	Administrative expenses ....
g	End of year balance ......	4,270,811	4,109,460	3,714,106	3,488,917	3,468,693

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

30.400 %

Permanent endowment SchDMd Bullet

45.640 %

Term endowment SchDMd Bullet

23.960 %

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....
b	Buildings ....
c	Leasehold improvements
d	Equipment ....
e	Other .....
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	0
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	899,596
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	-96,330
b	Donated services and use of facilities .........	2b	315,805
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d .....................			2e	219,475
3	Subtract line 2e from line 1..................			3	680,121
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	680,121

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	917,099
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a	315,805
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d
e	Add lines 2a through 2d....................			2e	315,805
3	Subtract line 2e from line 1...................			3	601,294
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	601,294

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference

Explanation

ENDOWMENT FUND

SCHEDULE D, PART V, LINE 4 THE FOUNDATION HAS ENDOWMENTS DESIGNATED FOR THE BENEFIT OF VARIOUS OPERATIONAL DEPARTMENTS OF THE HOSPITAL.

TAX LIABILITY FOR UNCERTAIN TAX POSITION (ASC740)

SCHEDULE D, PART X, LINE 2 THE FOUNDATION IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND CLASSIFIED BY THE INTERNAL REVENUE SERVICE AS OTHER THAN A PRIVATE FOUNDATION. THEREFORE, NO PROVISION FOR INCOME TAXES HAS BEEN INCLUDED IN THE FINANCIAL STATEMENTS. FOR THE YEARS ENDED SEPTEMBER 30, 2018 AND 2017, MANAGEMENT OF THE FOUNDATION BELIEVES IT HAS ADEQUATE SUPPORT FOR ALL MATERIAL TAX POSITIONS AND THAT IT IS MORE-LIKELY-THAN-NOT, BASED ON THE TECHNICAL MERITS, THAT THE POSITIONS WILL BE SUSTAINED UPON EXAMINATION. ACCORDINGLY, THE FOUNDATION HAS NOT RECORDED ANY RESERVES OR RELATED ACCRUALS FOR INTEREST AND PENALTIES FOR UNCERTAIN INCOME TAX POSITIONS AS OF SEPTEMBER 30, 2018 OR 2017. ALL TAX-EXEMPT ENTITIES ARE SUBJECT TO REVIEW AND AUDIT BY FEDERAL, STATE AND OTHER APPLICABLE AGENCIES. SUCH AGENCIES MAY REVIEW THE TAXABILITY OF UNRELATED BUSINESS INCOME, OR THE QUALIFICATION OF THE TAX-EXEMPT ENTITY UNDER THE INTERNAL REVENUE CODE AND APPLICABLE STATE STATUTES.

Schedule D (Form 990) 2019

Additional Data

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SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 Golf Tournament (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	135,842	135,842
2	Less: Contributions . . . .	40,842	40,842
3	Gross income (line 1 minus line 2) . . . . . .	95,000	95,000

4	Cash prizes . . . . .
5	Noncash prizes . . . .	9,640	9,640
6	Rent/facility costs . . . .	22,498	22,498
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	45,654	45,654
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		77,792
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		17,208

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

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Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Conway Hospital Foundation Inc

Employer identification number
57-0870199

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) CONWAY HOSPITAL INC 300 SINGLETON RIDGE ROAD CONWAY,SC29526	57-0314381	501(C)(3)	429,191	24,714	FMV	DRINKS-SMART SNACKS	FINANCIAL ASSISTANCE FOR HOSPITAL PROJECTS

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
SCHEDULE I, PART I, LINE 2	FOUNDATION BOARD APPROVES BUDGET PRIOR TO BEGINNING THE FISCAL YEAR DETAILING CONWAY HOSPITAL, INC PROJECTS THAT WILL BE FUNDED DURING THE YEAR. BOARD ALSO APPROVES OTHER EXPENDITURES FOR FUNDING AS FUNDS ARE AVAILABLE. FOUNDATION RECEIVES DOCUMENTATION OF ITEMS TO BE FUNDED FOR REVIEW PRIOR TO FUNDING BEING PROVIDED.
SCHEDULE I, PART II, LINE 1, COLUMN (H)	NAME OF ORGANIZATION OR GOVERNMENT: CONWAY HOSPITAL, INC (H) PURPOSE OF GRANT OR ASSISTANCE; TO PROVIDE FINANCIAL ASSISTANCE FOR HOSPITAL PROJECTS FOR THE ADVANCEMENT OF HEALTH CARE OBJECTIVES OF CONWAY HOSPITAL, INC.

Schedule I (Form 990) 2019

Additional Data

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1BRET BARR PRESIDENT (AS OF 1/2018)	(i) (ii)	0 ------------- 306,597	0 ------------- 78,169	0 ------------- 16,368	0 ------------- 78,271	0 ------------- 31,233	0 ------------- 510,638	0 ------------- 10,503
2PHILIP A CLAYON PRESIDENT (THRU 12/2017)	(i) (ii)	0 ------------- 505,887	0 ------------- 251,452	0 ------------- 61,142	0 ------------- 279,737	0 ------------- 28,444	0 ------------- 1,126,662	0 ------------- 61,142
3TERRY EGAN FORMER EXECUTIVE DIRECTOR	(i) (ii)	0 ------------- 154,432	0 ------------- 35,210	0 ------------- 0	0 ------------- 17,652	0 ------------- 26,104	0 ------------- 233,398	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference

Explanation

SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN

SCHEDULE J, PART I, LINE 4B CONWAY HOSPITAL PROVIDES A NON-QUALIFIED SUPPLEMENTAL EMPLOYEE RETIREMENT PLAN, A CAPITAL ACCUMULATION PLAN AND AN ENVISION PLUS PLAN TO SENIOR EXECUTIVES SUBJECT TO CERTAIN VESTING REQUIREMENTS AND/OR SUBSTANTIAL RISKS OF FORFEITURE. THE FOLLOWING EXECUTIVES PARTICIPATED IN ONE OR MORE OF THE PLANS DURING THE YEAR: PHILIP CLAYTON AND BRET BARR DURING THE CALENDAR YEAR REPORTED WITHIN THIS YEAR, THE FOLLOWING INDIVIDUALS RECEIVED PAYOUTS FROM THE PLAN: BRET BARR $10,503 PHILIP CLAYTON $61,142 THESE AMOUNTS ARE INCLUDED IN THE WAGES REPORTED ON THIS FORM 990.

Schedule J (Form 990) 2019

Additional Data

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SCHEDULE M
(Form 990)

Department of the Treasury

Internal Revenue Service

Noncash Contributions

Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image

Attach to Form 990.
Right pointing arrow large image

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Types of Property

	(a) Check if applicable	(b) Number of contributions or items contributed	(c) Noncash contribution amounts reported on Form 990, Part VIII, line 1g	(d) Method of determining noncash contribution amounts
1 Art—Works of art ....
2 Art—Historical treasures .
3 Art—Fractional interests ..
4 Books and publications ..
5 Clothing and household goods .......
6 Cars and other vehicles ..
7 Boats and planes ....
8 Intellectual property ...
9 Securities—Publicly traded .
10 Securities—Closely held stock .
11 Securities—Partnership, LLC, or trust interests ....
12 Securities—Miscellaneous ..
13 Qualified conservation contribution—Historic structures .....
14 Qualified conservation contribution—Other ...
15 Real estate—Residential .
16 Real estate—Commercial ..
17 Real estate—Other ...
18 Collectibles .....
19 Food inventory ...
20 Drugs and medical supplies .
21 Taxidermy ......
22 Historical artifacts ....
23 Scientific specimens ..
24 Archeological artifacts ...
25 Other ( Auction Items )	X	26	14,540	FMV
26 Other ( General & Administrative Expenses )	X	1	66,624	FMV
27 Other ( furniture )	X	1	5,000	FMV
28 Other ( )

Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement

Yes

30a

During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period? ...................

30a

If "Yes," describe the arrangement in Part II.

Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?

32a

Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash

contributions? ..........................

32a

If "Yes," describe in Part II.

If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked,

describe in Part II.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 51227J

Schedule M (Form 990) (2019)

Page 2

Part IISupplemental Information. Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.

Return Reference	Explanation
SCHEDULE M, PART I, COLUMN (B)	LINE 25 REPRESENTS VARIOUS CONTRIBUTIONS OF 28 SEPARATE ITEMS FOR AUCTION DURING THE YEAR THROUGH THE KINGSTON GOLF CLASSIC FUNDRAISER EVENT OR THE EMPLOYEE FUNDRAISER DRIVE.

Schedule M (Form 990) (2019)

Additional Data

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Software Version:

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SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Return Reference	Explanation
DESCRIPTION OF ORGANIZATION MISSION	FORM 990, PART III, LINE 1 THE FOUNDATION IS DEDICATED TO IMPROVING THE QUALITY OF LIFE OF ALL INDIVIDUALS IN THE CONWAY HOSPITAL SERVICE AREA. THE ORGANIZATION DEVELOPS COOPERATION BETWEEN THE HOSPITAL STAFF AND BOARD, MEDICAL STAFF. THE COMMUNITY, AND OTHER SUPPORTING ORGANIZATIONS THROUGH EDUCATIONAL AND PROMOTIONAL ACTIVITIES, RESOURCES FOR THE FOUNDATION DERIVE FROM FUND RAISING, DONATIONS, GRANTS, AND OTHER SOURCES WHERE APPROPRIATE TO ASSURE LONG TERM GROWTH AND DEVELOPMENT. CRITICAL SUCCESS FACTORS: DEVELPOMENT OF FINANCIAL RESOURCES, MANAGEMENT OF FINANCIAL AND OR HUMAN RESOURSES, RESPONSIVENESS TO THE HOSPITAL, COMMITMENT TO PLANNING, LEADERSHIP BY BOARD AND STAFF.
BUSINESS RELATIONSHIPS	FORM 990, PART VI, SECTION A, LINE 2 PHILIP CLAYTON, BRETT BARR, AND BRIAN ARGO HAVE A BUSINESS RELATIONSHIP. ALL THREE ARE SEPARATE BUSINESS RELATIONSHIPS FROM THEIR RESPONSIBILITIES TO THE FOUNDATION.
FORM 990 REVIEW PROCESS	FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION PROVIDED THE 990 TO THE GOVERNING BODY PRIOR TO ITS FILING FOR REVIEW BY THE GOVERNING BODY. THE TREASURER DISCUSSES THE VARIOUS ASPECTS OF FORM 990 FOR THE ORGANIZATION WITH THE GOVERNING BODY AND DISCUSSES THE INFORMATION THAT IS REPORTED IN FORM 990 ABOUT THE ORGANIZATION AND ITS AVAILABILITY FOR PUBLIC INSPECTION.
CONFLICT OF INTEREST POLICY MONITORING & ENFORCEMENT	FORM 990, PART VI, SECTION B, LINE 12C QUESTIONNAIRES ARE PROVIDED TO OFFICERS, DIRECTORS AND KEY EMPLOYEES WHEN THEY BEGIN SERVICE AND ANNUALLY THEREAFTER. MANAGEMENT REVIEWS INFORMATION FROM QUESTIONNAIRES AS PROVIDED. IN THE EVENT OF SUCH NOTIFICATION, THE BOARD CHAIR OR CHIEF EXECUTIVE OFFICER SHALL INVESTIGATE THE POSSIBLE UNDISCLOSED INTEREST.
HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC	FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON WRITTEN REQUEST TO THE MANAGEMENT OF THE ORGANIZATION AT THE CONWAY OFFICES.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

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Software Version:

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SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Conway Hospital Foundation Inc

Employer identification number

57-0870199

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.

(a) Name, address, and EIN (if applicable) of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1)CONWAY HOSPITAL INC 300 SINGLETON RIDGE ROAD CONWAY,SC29526 57-0314381	HOSPITAL	SC	501(c)(3)	3			No

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(i) Section 512(b)(13) controlled entity?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	Yes	No

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.

Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................

b Gift, grant, or capital contribution to related organization(s) ............................

Yes

c Gift, grant, or capital contribution from related organization(s) ............................

Yes

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

Yes

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

r Other transfer of cash or property to related organization(s) ............................

s Other transfer of cash or property from related organization(s) ............................

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CONWAY HOSPITAL INC	B	453,904	FMV
(2) CONWAY HOSPITAL INC	N	261,846	FMV
(3) CONWAY HOSPITAL INC	O	81,164	FMV

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	585,926	252,220
9	Program service revenue (Part VIII, line 2g) .........	0	0
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	204,115	410,693
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	108,083	17,208
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	898,124	680,121
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	329,096	453,904
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 68,307
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	384,331	147,390
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	713,427	601,294
19	Revenue less expenses. Subtract line 18 from line 12.......	184,697	78,827
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	4,415,478	4,576,475
21	Total liabilities (Part X, line 26).............	0	178,500
22	Net assets or fund balances. Subtract line 21 from line 20.....	4,415,478	4,397,975

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 464,147 including grants of $ 453,904 ) (Revenue $ )
	TO PROVIDE FINANCIAL ASSISTANCE FOR HOSPITAL PROJECTS RELATED TO NURSING, SCHOLARSHIPS, COMMUNITY OUTREACH, MATERNAL/CHILD CARE AND HEALTH REACH SERVICES FOR THE UNDERPRIVILEGED THROUGH CONWAY HOSPITAL, INC. AND AFFILIATES.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses464,147

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)			(D) Reportable compensation from the organization (W-2/1099-MISC)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and title
(18) ROBERT HUCKS........................................................................ SECRETARY	1.0 .......................0.0	X	X		0	0	0
(19) SHARRON FLYNN........................................................................ DIRECTOR	1.0 .......................0.0	X			0	0	0
(20) BRIAN ARGO........................................................................ TREASURER (BEG 07/17)	1.0 .......................40.0		X		0	114,264	8,931
(21) TERRY EGAN........................................................................ FORMER EXECUTIVE DIRECTOR	40.0 .......................0.0			X	0	189,642	43,756

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	1,523,521	470,372

1	Briefly describe the organization’s mission or most significant activities: FUND RAISING FOR ADVANCEMENT OF HEALTH CARE OBJECTIVES OF CONWAY HOSPITAL, INC.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	15
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	14
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	43
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	0

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	40,842
d	Related organizations		1d	45,704
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	165,674

g	Noncash contributions included in lines 1a - 1f:$		1g	86,164

h Total. Add lines 1a-1f.......		252,220

		Business Code
2a
b
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		0

3 Investment income (including dividends, interest, and othersimilar amounts) ......			96,554		96,554
4 Income from investment of tax-exempt bond proceeds			0
5 Royalties...........			0
		(ii) Personal	(i) Real
6a	Gross rents			6a
b	Less: rental expenses			6b
c	Rental income or (loss)	0	0	6c
d	Net rental income or (loss).......			0
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory		1,600,998	7a
b	Less: cost or other basis and sales expenses		1,286,859	7b
c	Gain or (loss)		314,139	7c
d	Net gain or (loss).........			314,139		314,139
8a	Gross income from fundraising events (not including $ 40,842of contributions reported on line 1c). See Part IV, line 18 ....
			8a	95,000
b	Less: direct expenses ...		8b	77,792
c	Net income or (loss) from fundraising events..			17,208		17,208
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a	0
b	Less: direct expenses ...		9b	0
c	Net income or (loss) from gaming activities..			0
10a	Gross sales of inventory, less returns and allowances ..
			10a	0
b	Less: cost of goods sold ..		10b	0
c	Net income or (loss) from sales of inventory..			0
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......			0
12	Total revenue. See instructions.....			680,121		427,901

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	453,904	453,904
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........	0
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............	0
4	Benefits paid to or for members .......	0
5	Compensation of current officers, directors, trustees, and key employees ...........	0
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........	0
7	Other salaries and wages........	0
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	0
9	Other employee benefits .......	0
10	Payroll taxes ...........	0
11	Fees for services (non-employees):
a	Management ......	0
b	Legal .........	0
c	Accounting ...........	0
d	Lobbying ...........	0
e	Professional fundraising services. See Part IV, line 17	0
f	Investment management fees ......	0
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	52,066		52,066
12	Advertising and promotion ....	0
13	Office expenses .......	8,666	2,600	2,600	3,466
14	Information technology ......	0
15	Royalties ..	0
16	Occupancy ...........	0
17	Travel ............	2,300		2,300
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .	0
19	Conferences, conventions, and meetings ....	0
20	Interest ...........	0
21	Payments to affiliates .......	0
22	Depreciation, depletion, and amortization ..	0
23	Insurance ...	4,231		4,231
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	FUNDRAISING EXPENSES	54,650			54,650
b	.	0
c	.	0
d	.	0
e	All other expenses	25,477	7,643	7,643	10,191
25	Total functional expenses. Add lines 1 through 24e	601,294	464,147	68,840	68,307
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		131,216	1	47,471
2	Savings and temporary cash investments .........		103,597	2	231,265
3	Pledges and grants receivable, net ......		107,986	3	55,781
4	Accounts receivable, net .............		0	4	0
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
			0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
			0	6	0
7	Notes and loans receivable, net ...........		0	7	0
8	Inventories for sale or use ............		0	8	0
9	Prepaid expenses and deferred charges ......		0	9	0
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b	0	10c	0
11	Investments—publicly traded securities .		4,053,679	11	4,221,958
12	Investments—other securities. See Part IV, line 11 .....		19,000	12	20,000
13	Investments—program-related. See Part IV, line 11 ..		0	13	0
14	Intangible assets ...............		0	14	0
15	Other assets. See Part IV, line 11 ...........		0	15	0
16	Total assets. Add lines 1 through 15 (must equal line 33)...		4,415,478	16	4,576,475

17	Accounts payable and accrued expenses .....	0	17	0
18	Grants payable ...	0	18	178,500
19	Deferred revenue .........	0	19	0
20	Tax-exempt bond liabilities .........	0	20	0
21	Escrow or custodial account liability. Complete Part IV of Schedule D	0	21	0
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	22	0
23	Secured mortgages and notes payable to unrelated third parties ..	0	23	0
24	Unsecured notes and loans payable to unrelated third parties ..	0	24	0
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D	0	25	0
26	Total liabilities. Add lines 17 through 25..	0	26	178,500

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	4,415,478	32	4,397,975
33	Total liabilities and net assets/fund balances ........	4,415,478	33	4,576,475