Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (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) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
||||||
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. | ||||||
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 | ||||||
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.) | ||||||
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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
|||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| SCHEDULE E, PART I, LINE 3 | STUDENT AND FACULTY HANDBOOKS, RECRUITING MATERIALS, PUBLIC WEBSITE,INTRANET ELECTRONIC SHARE DRIVE FOR CURRENT FACULTY, STAFF, AND STUDENTS. |
| SCHEDULE E, PART I, LINE 6 | THE SCHOOL RECEIVES VIRGINIA TUITION ASSISTANCE GRANT FUNDS (FINANCIAL AID) FROM THE STATE COUNCIL OF HIGHER EDUCATION (SCHEV) FOR VIRGINIA RESIDENTS. |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | BY A MAJORITY VOTE OF THE DIRECTORS IN OFFICE, THE BOARD OF DIRECTORS MAY DESIGNATE AN EXECUTIVE COMMITTEE CONSISTING OF AT LEAST FIVE DIRECTORS, ONE OF WHOM SHALL BE A CLASS C DIRECTOR. AT ALL TIMES, APART FROM THE CHAIRMAN OF THE EXECUTIVE COMMITTEE, THERE SHALL BE AN EQUAL NUMBER OF CLASS A AND CLASS B DIRECTORS AS THE OTHER MEMBERS OF THE EXECUTIVE COMMITTEE. THE CLASS A AND CLASS B VICE CHAIRMEN OF THE BOARD MAY DESIGNATE ONE OR MORE OF THEIR RESPECTIVE CLASS DIRECTORS AS ALTERNATE CLASS A OR B MEMBERS OF THE EXECUTIVE COMMITTEE, WHO MAY REPLACE ANY ABSENT OR DISQUALIFIED CLASS A OR B MEMBER AT ANY MEETING OF THE COMMITTEE UPON THE REQUEST OF THE RESPECTIVE CLASS A OR CLASS B VICE-CHAIRMAN OF THE BOARD. EXCEPT AS OTHERWISE REQUIRED BY LAW OR THESE BYLAWS, THE EXECUTIVE COMMITTEE SHALL HAVE SUCH AUTHORITY AS THE BOARD OF DIRECTORS SHALL GRANT TO IT FOR THE MANAGEMENT OF THE CORPORATION, INCLUDING THE POWER TO AUTHORIZE THE SEAL OF THE CORPORATION TO BE AFFIXED TO ALL PAPERS THAT MAY REQUIRE IT. THE EXECUTIVE COMMITTEE SHALL KEEP REGULAR MINUTES OF ITS PROCEEDINGS AND SHALL REPORT THE SAME TO THE BOARD OF DIRECTORS WHEN REQUIRED. VACANCIES IN THE EXECUTIVE COMMITTEE SHALL BE FILLED BY THE CLASS A OR CLASS B VICE CHAIRMAN OF THE BOARD (FOR THEIR RESPECTIVE CLASS DIRECTORS). |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BYLAWS STATE THAT TWO ORGANIZATION EACH APPOINT FOUR BOARD MEMBERS. VIRGINIA TECH APPOINTS FOUR MEMBERS OF THE BOARD OF DIRECTORS. CARILION APPOINTS FOUR MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ACCOUNTING DIRECTOR AND THE DEAN AND CFO REVIEW THE RETURN. THE FULL BOARD RECEIVES A COPY OF THE DRAFT AND FINAL RETURNS. BOARD MEMBERS WILL ADVISE MANAGEMENT OF ANY CONCERNS OR CHANGES WHICH NEED TO BE MADE. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANNUALLY BOARD MEMBERS AND KEY EMPLOYEES ARE PROVIDED TRAINING ON THE CONFLICTS OF INTEREST POLICY AND THEY SIGN A DISCLOSURE STATEMENT. THOSE STATEMENTS ARE REVIEWED BY THE FINANCE AND AUDIT COMMITTEE OF THE BOARD OF DIRECTORS TO DETERMINE WHETHER OR NOT AN ACTUAL OR PERCEIVED CONFLICT EXISTS. UPON THEIR DETERMINATION AND RECOMMENDATION, INDIVIDUAL BOARD MEMBERS RECUSE THEMSELVES FROM VOTING ON BUSINESS DECISIONS ON A CASE-BY-CASE BASIS. IF IT IS DETERMINED THAT THE CONFLICT IS SO BROAD IN SCOPE SO AS TO PRECLUDE MEANINGFUL PARTICIPATION IN THE OVERSIGHT AND POLICY DEVELOPMENT OF THE SCHOOL, BOARD MEMBERS ARE ASKED TO RESIGN, OR MAY BE REMOVED FOR CAUSE. THE FOLLOWING PERSONS ARE COVERED UNDER THIS POLICY: BOARD OF DIRECTORS, THE PRESIDENT, THE SECRETARY, THE TREASURER, THE CHIEF FINANCIAL OFFICER, ALL SENIOR/ASSOCIATE/ASSISTANT DEANS, CHAIRS OF DEPARTMENTS, AND ALL PERSONNEL WITH PURCHASING AUTHORITY. WHERE A CONFLICT EXISTS, THE INDIVIDUAL MUST OBTAIN THE SIGNATURE OF A CORPORATE OFFICER TO APPROVE A TRANSACTION. |
| FORM 990, PART VI, SECTION B, LINE 15 | BASE SALARIES ARE SET USING NATIONAL BENCHMARKS FROM THE ASSOCIATION OF ACADEMIC MEDICAL CENTERS (AAMC) AND THE COLLEGE UNIVERSITY PROFESSIONALS (CUPA) DATA. A MARKET REVIEW IS CONDUCTED ON AN ANNUAL BASIS BY CARILION CLINIC'S HUMAN RESOURCES DEPT. DONNA LITTLEPAGE, CFO AND BOARD TREASURER IS NOT COMPENSATED FOR BEING THE CFO OF VIRGINIA TECH CARILION SCHOOL OF MEDICINE. |
| FORM 990, PART VI, SECTION C, LINE 19 | NOT AVAILABLE FOR PUBLIC INSPECTION |
| FORM 990, PART XII, LINE 2C | THE PROCESS OF FINANCIAL STATEMENT REVIEW AND OVERSIGHT HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART V, LINE 1A AND 1B | ALL FORM 1099'S FOR VIRGINIA TECH CARILION SCHOOL OF MEDICINE ARE FILED BY CARILION CLINIC. |
| FORM 990, PART VI, LINE 6 | PER VIRGINIA TECH CARILION SCHOOL OF MEDICINE'S (THE ORGANIZATION) ARTICLES OF INCORPORATION AND BYLAWS THEY DO NOT HAVE MEMBERS. HOWEVER, VIRGINIA TECH AND CARILION CLINIC (CARILION) BOTH HAVE THE POWER TO APPOINT TWO BOARD MEMBERS TO THE ORGANIZATION'S BOARD. CARILION, VIRGINIA POLYTECHNIC INSTITUTE AND STATE UNIVERSITY (VIRGINIA TECH) AND THE VIRGINIA TECH FOUNDATION, INC. (FOUNDATION) ENTERED INTO A MEMORANDUM OF UNDERSTANDING (MOU) WHICH SERVED AS THE GOVERNING DOCUMENT FOR THE ORGANIZATION AND THE VIRGINIA TECH CARILION RESEARCH INSTITUTE (VTCRI). THE MOU INDICATES THE ORGANIZATION'S BOARD IS STRUCTURED SO THAT ITS OPERATIONS WOULD NOT BE CONTROLLED EITHER BY VIRGINIA TECH OR CARILION OR THE TWO JOINTLY. |
| Software ID: | |
| Software Version: |