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)
Barlow Respiratory Hospital |
951647809 | 3 | Yes | 0 | 0 | |
| (B)
Barlow Foundation |
954560787 | 7 | Yes | 0 | 0 | |
| (C)
Barlow Ventures |
822403049 | 3 | No | 0 | 0 | |
|
Total 3
|
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 |
|---|---|
| Part IV, Section E, Line 3a: Organization Has Power to Appoint Or Elect Governing Persons | All members and officers of the supported organizations, Barlow Respiratory Hospital, Barlow Foundation and Barlow Ventures are appointed by the Barlow Group. |
| Part IV, Section E, Line 3b: Role Played in Management of Policies, Programs, & Activities | All annual budgets and major decisions of the supported organizations are subject to the approval of their corporate member, Barlow Group. |
| Software ID: | 17005038 |
| 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 6: Explanation of Classes of Members or Shareholder | The Barlow Group, a California nonprofit public benefit corporation is the only member. The Barlow Groups also serves as the only member of the Barlow Foundation which is the fund raising arm for Barlow Respiratory Hospital. |
| Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body | There are two categories of directors- Designated directors and Selected directors.Designated Directors of which there shall be no more than five (5), shall be the individuals serving in the positions enumerated below:(a)President of Barlow Group;(b)President of the corporation;(c)Medical Director of the Hospital;(d)Chief of the medical staff of the Hospital (the Medical Staff) (duly elected by the Medical Staff).(e)Chairperson of the Board of Barlow Foundation, or another member of the Board of Barlow Foundation as designated by the Barlow Foundation and approved by the Board of Barlow Group.Each Designated Director shall serve on the Board so long as he or she holds at least one of the positions enumerated above.All directors other than the Designated Directors shall be Selected Directors. Pursuant to Section 5220(d) of the California Nonprofit Public Benefit Corporation Law, all Selected Directors shall be designated by the Member and shall serve at the pleasure of the Member. All directors of the corporation shall be individuals also serving on the Members Board of Directors. Selected Directors shall serve for the same term as the Selected Director serves on the Members Board of Directors.Notwithstanding any other provision of these Bylaws, at no time shall the Board include in the aggregate more than forty-nine percent (49%) interested persons as defined by Section 5227 of the California Nonprofit Public Benefit Corporation Law. |
| Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders | Each of the following powers may be executed only with the prior written approval of the Member:(a)To retain an attorney or firm of attorneys to provide legal services for the corporation and to fix the amount of compensation for such services, except in such a case where the retention of an attorney or firm of attorneys concerns a non-routine situation, such as, by way of example only, the existence of a conflict of interest that requires the use of an attorney or firm of attorneys not previously consented to;(b)To retain an accountant or firm of accountants to provide accounting and auditing services for the corporation and to fix the amount of compensation for such services;(c) To authorize any unbudgeted expenditure in excess of $100,000 for capital improvements to the properties owned or leased by the corporation and not approved by a budget procedure;(d)To establish any programs with respect to marketing and/or public relations, which relate to strategic planning on a system-wide basis for the Barlow Group and its affiliates and to retain any consultants at a cost in excess of $250,000 with respect thereto;(e)To incur or guarantee indebtedness, as so defined in accordance with Generally Accepted Accounting Principles;(f)To mortgage, pledge or otherwise encumber any real property of the corporation, and to mortgage, pledge or otherwise encumber property or assets, other than real property, of the corporation with a value in excess of $50,000;(g)To sell, lease, assign or otherwise transfer any real property of the corporation, and to sell, lease, assign or otherwise transfer property or assets, other than real property, of the corporation with a value in excess of $50,000;(h)To adopt or modify an annual budget and an annual business plan for this corporation;(i)To form a subsidiary or enter into an agreement to act as a general partner;(j)To remove the President, the Chief Financial Officer or the Medical Director from office; and(k)To amend or repeal the Bylaws. |
| Form 990, Part VI, Line 11b: Form 990 Review Process | The Chief Financial Officer and the Finance Department staff will prepare and file the returns. When it is deemed appropriate, consultative support and /or review will be solicited from an external public accounting firm. Prior to filing, the return for each of the Barlow Organizations will be distributed to the Barlow Group Board of Directors for their review. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | A Code of Conduct has been developed and is reviewed and an affirmation statement is signed annually. In addition a "Conflict of interest Board of Directors" Policy is reviewed and a "Conflict of Interest Disclosure Questionnaire" is completed every two years. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | The CEO and CFO are employees of a related organization Barlow Respiratory Hospital and their compensation is determined by that organization. The Personnel/Compensation Committee a subcommittee of the Barlow Respiratory Hospital Board of Directors is charged with the responsibility of establishing and recommending changes to the compensation of the CEO and CFO. The Committee utilizes the Hospital Association of Southern Californias Health Executive Compensation report to benchmark their compensation to the marketplace. Specifically the single Facility Southern California Salary Range amounts for minimum-midpoint-maximum compensation serve as the benchmarks for determining comparative marketplace compensation. The CEO and CFO are eligible to participate in the same paid time off and employee insurance benefits as all Hospital management level employees. The CEO has a written contract which documents her compensation and benefits. The Committee reviews the experience levels of the individuals, their accomplishments and the overall accomplishments of the organization in recommending compensation and/or changes in compensation for these positions. The Committees recommendations are then submitted to the full Board of Directors for discussion and approval. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The CEO and CFO are employees of a related organization Barlow Respiratory Hospital and their compensation is determined by that organization. The Personnel/Compensation Committee a subcommittee of the Barlow Respiratory Hospital Board of Directors is charged with the responsibility of establishing and recommending changes to the compensation of the CEO and CFO. The Committee utilizes the Hospital Association of Southern Californias Health Executive Compensation report to benchmark their compensation to the marketplace. Specifically the single Facility Southern California Salary Range amounts for minimum-midpoint-maximum compensation serve as the benchmarks for determining comparative marketplace compensation. The CEO and CFO are eligible to participate in the same paid time off and employee insurance benefits as all Hospital management level employees. The CEO has a written contract which documents her compensation and benefits. The Committee reviews the experience levels of the individuals, their accomplishments and the overall accomplishments of the organization in recommending compensation and/or changes in compensation for these positions. The Committees recommendations are then submitted to the full Board of Directors for discussion and approval. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | The audited financial statements, governing/organizing documents, and conflict of interest policy are all available upon request. |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Change in value of split-interest agreements = $396770 |
| Other Changes In Net Assets Or Fund Balances - Other Increases | Due to Hospital transferred from Foundation = $83550 |
| Software ID: | 17005038 |
| Software Version: | 2017v2.2 |