Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for 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)
HILL COUNTRY MEMORIAL HOSPITAL |
746083124 | 3 | Yes | 1,576,985 | 0 | |
| (B)
GREATER HILL COUNTRY HOSPICE |
742912643 | 3 | Yes | 0 | 0 | |
|
Total 2
|
1,576,985 | 0 | ||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 | 0 | |||
| 2 | Recoveries of prior-year distributions | 2 | 0 | |||
| 3 | Other gross income (see instructions) | 3 | 464,706 | 727,405 | ||
| 4 | Add lines 1 through 3 | 4 | 464,706 | 727,405 | ||
| 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 | 76,217 | 106,373 | ||
| 7 | Other expenses (see instructions) | 7 | 0 | |||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | 388,489 | 621,032 | ||
| 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 | 18,065,501 | 19,116,304 | ||
| b | Average monthly cash balances | 1b | 5,418,450 | 5,298,279 | ||
| c | Fair market value of other non-exempt-use assets | 1c | 0 | |||
| d | Total (add lines 1a, 1b, and 1c) | 1d | 23,483,951 | 24,414,583 | ||
| 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 | 23,483,951 | 24,414,583 | ||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | 352,259 | 366,219 | ||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | 23,131,692 | 24,048,364 | ||
| 6 | Multiply line 5 by .035 | 6 | 809,609 | 841,693 | ||
| 7 | Recoveries of prior-year distributions | 7 | 0 | |||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | 809,609 | 841,693 | ||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | 388,489 | |||
| 2 | Enter 85% of line 1 | 2 | 330,216 | |||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | 809,609 | |||
| 4 | Enter greater of line 2 or line 3 | 4 | 809,609 | |||
| 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 | 809,609 | |||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1,576,985 | |
|
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 | 0 | |
| 7Total annual distributions. Add lines 1 through 6. | 1,576,985 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
0 | |
| 9 Distributable amount for 2018 from Section C, line 6 | 809,609 | |
| 10 Line 8 amount divided by Line 9 amount | 0 % | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
809,609 | |||
|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
0 | |||
| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013.......0 | ||||
| b From 2014.......1,868,742 | ||||
| c From 2015.......1,753,332 | ||||
| d From 2016.......1,024,403 | ||||
| e From 2017.......4,486,563 | ||||
| fTotal of lines 3a through e | 9,133,040 | |||
| g Applied to underdistributions of prior years | 0 | |||
| h Applied to 2018 distributable amount | 0 | |||
|
i
Carryover from 2013 not applied (see instructions) |
0 | |||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | 9,133,040 | |||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ 1,576,985 | ||||
| a Applied to underdistributions of prior years | 0 | |||
| b Applied to 2018 distributable amount | 809,609 | |||
| c Remainder. Subtract lines 4a and 4b from 4. | 767,376 | |||
|
5
Remaining underdistributions for years prior to 2018, 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 2018. 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 2019. Add lines 3j and 4c. |
9,900,416 | |||
| 8 Breakdown of line 7: | ||||
| a Excess from 2014......1,868,742 | ||||
| b Excess from 2015.....1,753,332 | ||||
| c Excess from 2016.....1,024,403 | ||||
| d Excess from 2017.....4,486,563 | ||||
| e Excess from 2018.....767,376 | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART IV, SECTION D, LINE 3 | SUPPORTED ORGANIZATION'S VOICE IN POLICIES: THE HCMH FOUNDATION EACH YEAR RECOMMENDS A LIAISON DIRECTOR TO THE HCM HOSPITAL. THIS MUTUALLY AGREED UPON CANDIDATE SERVES AS A FULL VOTING MEMBER OF BOTH BOARDS. ADDITIONALLY, THIS LIAISON DIRECTOR IS INVITED TO ATTEND ALL EXECUTIVE AND INVESTMENT COMMITTEE MEETINGS OF THE HCMH FOUNDATION TO PROVIDE INPUT AND A VOICE IN THE POLICIES AND PROCEEDINGS OF SAID COMMITTEES. THE HCM CFO IS ALSO INVITED TO ATTEND ALL INVESTMENT COMMITTEE MEETINGS FOR INPUT. THE HCMH FOUNDATION EXECUTIVE DIRECTOR SERVES AS A MEMBER OF THE HCM EXECUTIVE TEAM. THE HCMH FOUNDATION BOARD CHAIR AND EXECUTIVE DIRECTOR ATTEND ALL REGULARLY SCHEDULED MEETINGS OF THE HCM BOARD OF TRUSTEES. |
| 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 B, LINE 11B | PROCESS TO REVIEW FORM 990: HILL COUNTRY MEMORIAL HOSPITAL FOUNDATION IS COMMITTED TO APPROPRIATE OVERSIGHT BY THE ORGANIZATION'S BOARD OF DIRECTORS. AS SUCH hcmh FOUNDATION WORKS TO ENSURE THE HIGHEST STANDARD IN REVIEW OF ITS INTERNAL REVENUE SERVICE FORM 990. EACH YEAR, WHEN THE DRAFT OF THE FORM 990 IS FINALIZED, THE AUDIT COMMITTEE REVIEWS IT AND MAKES RECOMMENDATION FOR APPROVAL TO THE EXECUTIVE COMMITTEE. ONCE APPROVED BY BOTH THE AUDIT AND EXECUTIVE COMMITTEES, BUT PRIOR TO THE SUBMISSION OF THE ORGANIZATION'S FORM 990 TO THE INTERNAL REVENUE SERVICE, EACH VOTING MEMBER OF THE BOARD OF DIRECTORS SHALL BE PROVIDED WITH A COPY OF THE FINAL 990 FORM AS COMPLETED BY BKD. BOARD MEMBERS ARE PROVIDED WITH AT LEAST FIVE BUSINESS DAYS TO REVIEW THE FORM, RAISE QUESTIONS, MAKE SUGGESTIONS, AND ADDRESS ANY POTENTIAL PROBLEMS OR CONCERNS WITH THE EXECUTIVE DIRECTOR OR THE AUDIT COMMITTEE OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST: EVERY YEAR AT THE JANUARY BOARD MEETING THE BOARD SECRETARY PROVIDES EACH MEMBER OF THE HCMH FOUNDATION BOARD OF DIRECTORS WITH A COPY OF THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND DISCLOSURE STATEMENT. MEMBERS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY, COMPLETE THE DISCLOSURE STATEMENT AND RETURN THE DISCLOSURE STATEMENT TO THE FOUNDATION OFFICE WITHIN ONE MONTH OF THE JANUARY QUARTERLY BOARD MEETING. THIS PROCESS IS MONITORED BY THE BOARD SECRETARY. THESE FORMS ARE KEPT ON FILE IN THE FOUNDATION OFFICE AND REVIEWED ANNUALLY BY THE FOUNDATION SECRETARY TO IDENTIFY ANY POSSIBLE CONFLICTS OF INTEREST. IN 2018 THERE WAS 100% COMPLIANCE. POTENTIAL CONFLICTS OF INTEREST ARE DISCUSSED AT THE GOVERNANCE COMMITTEE AND RECORDED IN THE MINUTES. IF A CONFLICT IS FOUND TO EXIST THE COMMITTEE SENDS A LETTER TO THE BOARD MEMBER INSTRUCTING THEM TO ABSTAIN FROM VOTING WHEN APPLICABLE. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE PROCESS FOR DETERMINING COMPENSATION: THE PROCESS USED FOR DETERMINING COMPENSATION FOR THE HCMH FOUNDATION EXECUTIVE DIRECTOR OCCURS ANNUALLY. IN CONJUNCTION WITH THE HILL COUNTRY MEMORIAL HUMAN RESOURCES DEPARTMENT, DATA IS GATHERED FROM VARIOUS COMPENSATION STUDIES INCLUDING, BUT NOT LIMITED TO, THE ASSOCIATION FOR HEALTHCARE PHILANTHROPY AND THE ASSOCIATION OF FUNDRAISING PROFESSIONALS. THE RESULTS OF THESE COMPARISONS ARE PRESENTED TO THE FOUNDATION EXECUTIVE COMMITTEE. IF INCONSISTENCIES ARISE FROM THE COMPARISON, THE COMMITTEE EVALUATES A MODIFICATION OF THE EXECUTIVE DIRECTOR'S COMPENSATION TO BRING IT MORE IN LINE WITH THE LABOR MARKET. THE LAST COMPENSATION COMPARISON OCCURRED IN DECEMBER 2018. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: THE HCMH FOUNDATION GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION AT THE FOUNDATION OFFICE DURING REGULAR BUSINESS HOURS. THE ORGANIZATION CHARGES A REASONABLE FEE FOR PREPARING A COPY OF RECORDS OR REPORTS. |
| FORM 990, PART VI, SECTION A, LINE 1A | DELEGATION OF AUTHORITY: The Executive Committee shall be comprised of the Chairman, Vice Chairman, Secretary, Treasurer and four Directors elected at large by the Board. When the Board is not in session, the Executive Committee shall have and exercise all of the authority of the Board in the management of the Corporation. Minutes of the Executive Committee meetings shall be submitted to the Board, and its actions shall be subject to ratification by the Board at the next regular Board meeting. |
| FORM 990, PART V, LINE 2A | NUMBER OF EMPLOYEES ON FORM W-3: THE ORGANIZATION'S FORM W-2S ARE ISSUED BY A RELATED ORGANIZATION, HILL COUNTRY MEMORIAL HOSPITAL, AND COSTS ARE ALLOCATED TO THE FOUNDATION. THE NUMBER OF EMPLOYEES REPORTED ON PART V, LINE 2A IS THE NUMBER OF EMPLOYEES WHO SPENT TIME WORKING FOR THE FILING ORGANIZATION. |
| FORM 990, PART XI, LINE 8 | PRIOR PERIOD ADJUSTMENT: Beginning of year net assets have been revised for an error of $300,000 that $100,000 should have been included in due to affiliated organizations and $200,000 should have been a reduction of contributions receivable rather than in net assets. The reduction of beginning of year net assets did not have a significant impact on the respective line item. |
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| Software Version: |