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 | |||||
| (A)
Hospice of Henderson County Inc dba Four Seasons Compassion for Life |
561252665 | 9 | Yes | 812,816 | 0 | |
|
Total 1
|
812,816 | 0 | ||||
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 |
|---|---|
| Schedule A, Part IV, Section C, Line 1 Majority director detail | The Articles of Incorporation of Four Seasons Compassion for Life Foundation ("the Foundation") identify that the exclusive purpose of the Foundation is to foster, promote, support, develop and encourage the function of the supported organization (Hospice of Henderson County, Inc. D/B/A Four Seasons Compassion for Life). As a supporting organization, Four Seasons Compassion for Life Foundation is supervised in connection with the supported organization, and therefore is designated as a Type II supporting organization. Four Seasons Compassion for Life Foundation meets this classification because the management of the Foundation is vested in the same persons that control and manage the supported organization. The Bylaws of the Foundation require that the Board of Directors of the Foundation include three at large members of the supported organization's Board of Directors. The Bylaws of the Foundation further require that the management team of the Foundation include the supported organization's Chief Executive Officer, who shall be an ex-officio non-voting member of the Foundation Board of Directors and shall be the person primarily responsible for the day to day operation of the Foundation and management of its staff. The fact that the management of the Foundation is vested in the same persons that control and manage the supported organization allows the Foundation and its supported organization to function collectively as a system. The Foundation provides support to the supported organization that furthers the supported organization's tax-exempt purpose of providing hospice and palliative care services to terminally ill individuals and their families. The fact that the Foundation and its supported organization have management and governing body overlap assures that the Foundation is responsive to the needs and demands of the supported organization and that the Foundation constitutes an integral part of and maintains a significant involvement in the operations of the supported organization. |
| Software ID: | 17005876 |
| Software Version: | 2017v2.2 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS COMPENSATED BY Four Seasons Compassion for Life, A RELATED ORGANIZATION. Therefore, this question is answered "no" in accordance with Form 990 instructions. To determine compensation for the organization's CEO, the Executive Committee and Chairman of the Board of Directors of Four Seasons Compassion for Life review and discuss the CEO's performance on an annual basis. Comparability data is also considered when evaluating CEO compensation. These discussions are documented in the minutes of Executive Committee meetings. This process was last undertaken during FYE 9/30/2018. |
| Form 990, Part VI, Line 15b PROCESS TO ESTABLISH COMPENSATION OF OTHER EMPLOYEES | ALL OTHER OFFICERS OF THE ORGANIZATION ARE COMPENSATED BY Four Seasons Compassion for Life, A RELATED ORGANIZATION. Therefore, this question is answered "no" in accordance with Form 990 instructions. Compensation of other officers is determined and documented by the CEO. The CEO considers each employee's annual performance evaluations when determining compensation, as well as comparability information compiled to ensure the reasonableness of compensation. This process is documented in each employee's file and was last undertaken during FYE 9/30/2018. |
| Form 990, Part VI, Line 13 Written whistleblower policy | THE ORGANIZATION HAS DRAFTED A WRITTEN WHISTLEBLOWER POLICY, AND IS IN THE PROCESS OF OBTAINING BOARD APPROVAL OF THIS POLICY. Because this policy has not yet been approved by the Board, this question has been answered "no" in accordance with IRS guidance. |
| Form 990, Part VI, Line 14 Written document retention and destruction policy | THE ORGANIZATION HAS DRAFTED A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY, AND IS IN THE PROCESS OF OBTAINING BOARD APPROVAL OF THIS POLICY. Because this policy has not yet been approved by the Board, this question has been answered "no" in accordance with IRS guidance. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | THE EXECUTIVE COMMITTEE IS COMPOSED OF THE ORGANIZATION'S BOARD CHAIR, VICE-CHAIR, SECRETARY, TREASURER, IMMEDIATE PAST CHAIR, AND TWO AT-LARGE FOUNDATION BOARD MEMBERS TO BE CHOSEN BY THE FOUNDATION CHAIR. The Executive Committee shall have and may exercise all the power of the Board that may be lawfully delegated. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE Form 990 is PREPARED BY AN INDEPENDENT ACCOUNTANT WITH ASSISTANCE AND OVERSIGHT BY MANAGEMENT. A copy of the Form 990 is made available to all members of the Board of Directors subsequent to submission to the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ALL BOARD MEMBERS and officers ARE REQUIRED ANNUALLY TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MAY EXIST BETWEEN THEMSELVES AND THE ORGANIZATION. ANY CONFLICTS NOTED ARE REPORTED AND DISCUSSED, AND ANY ACTION DETERMINED NECESSARY IS TAKEN BY THE EXECUTIVE COMMITTEE OF THE BOARD. Individuals with a conflict on interest are prohibited from voting on any matter where that conflict exists. EACH BOARD MEMBER IS REQUIRED TO SIGN THE "CONFLICT OF INTEREST AGREEMENT." |
| Form 990, Part VI, Line 19 Required documents available to the public | The organization's governing documents, financial statements, and conflict of interest policy ARE AVAILABLE UPON REQUEST TO THE PUBLIC AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. |
| Form 990, Part IX, Line 11g Other Fees | SHARED SERVICES - Total Expense: 538891, Program Service Expense: 538891, Management and General Expenses: 0, Fundraising Expenses: 0; Other professional fees - Total Expense: 26004, Program Service Expense: 0, Management and General Expenses: 26004, Fundraising Expenses: 0; |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | ASSET TRANSFER FROM Four Seasons Compassion for Life - 346367; |
| Software ID: | 17005876 |
| Software Version: | 2017v2.2 |