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 |
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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. |
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|
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. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 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 |
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| Return Reference | Explanation |
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| 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 | PAGE 1, LINE H(B)-AFFLIATED GROUP TANNER MEDICAL CENTER ALABAMA, INC. (FEI 47-5348597) HAS FILED A FORM 1023, APPLICATION FOR RECOGNITION OF EXEMPTION UNDER SECTION 501(C)(3), REQUESTING RETROACTIVE RECOGNITION OF TAX EXEMPT STATUS FROM THE DATE THE ORGANIZATION WAS INCORPORATED. THE ORGANIZATION WAS INCORPORATED ON SEPTEMBER 14, 2015. THE APPLICATION FOR RECOGNITION OF TAX EXEMPT STATUS WAS FILED IN NOVEMBER 2017 WHICH IS THE MONTH THE ORGANIZATION BEGAN OPERATING AND IS WITHIN 27 MONTHS OF THE DATE OF ITS INCORPORATION. THE ORGANIZATION WAS ORIGINALLY AND INADVERTENTLY INCLUDED IN THE GROUP EXEMPTION FOR TANNER MEDICAL CENTER, INC. (FEI 80-0785570). IN ORDER TO OBTAIN ITS STAND-ALONE EXEMPTION STATUS, THE ORGANIZATION HAS REQUESTED THAT IT BE REMOVED FROM THE GROUP RULING FROM THE DATE OF ITS INCLUSION. |
| FORM 990, PAGE 6, PART VI, LINE 3 | CYPRESS HEALTHCARE PARTNERS, LLC, AN UNRELATED ORGANIZATION, IS A CONSULTING FIRM PROVIDING MANAGEMENT SERVICES TO TANNER. CYPRESS HEALTHCARE PARTNERS, LLC ASSIGNED WILLIAM HINES AS CHIEF ADMINISTRATIVE OFFICER. SERVICE PROVIDED BY WILLIAM HINES INCLUDES DIRECTING VARIOUS DEPARTMENTAL OPERATIONS (TMC ENGINEERING, DIETARY, HUMAN RESOURCES ETC.), MANAGING PHYSICIAN PRACTICES, AND HOSPICE AND HOME HEALTH OPERATIONS. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE ORGANIZATION'S DIRECTORS ARE THE DIRECTORS OF TANNER MEDICAL CENTER, INC. (TMC), A 501(C)(3) TAX EXEMPT ENTITY AND RELATED ORGANIZATION. THE DIRECTORS ARE ELECTED AS PROVIDED BY THE BYLAWS OF TMC. A DIRECTOR SERVES ONLY SO LONG AS THEY SERVE AS TMC DIRECTOR. PERSONS REMOVED FROM THE TMC GOVERNING BOARD SHALL AUTOMATICALLY BE REMOVED FROM THE ORGANIZATION'S GOVERNING BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 11B | TMC'S ACCOUNTING DEPARTMENT GATHERS INFORMATION FOR THE PREPARATION OF THE FORM 990 AND CONSULTS WITH THE CFO AND TMC COMPLIANCE OFFICER ON CERTAIN MATTERS. PRIOR TO FILING WITH THE IRS, A DRAFT COPY AS PREPARED BY THE EXTERNAL ACCOUNTING FIRM IS REVIEWED BY THE CFO FOR ACCURACY. ONCE CORRECTIONS ARE MADE, THE FINAL VERSION IS DISTRIBUTED TO ALL VOTING BOARD MEMBERS VIA ELECTRONIC MEANS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE POLICY COVERS ALL EMPLOYEES, SUPPLIERS, MEDICAL STAFF AND VOLUNTEERS. CONFLICTS ARE REVIEWED BY THE TMC COMPLIANCE OFFICER FOR RESOLUTION. THE COMPLIANCE OFFICER THEN CONSULTS WITH THE EXECUTIVE TEAM AND THE CEO FOR FINAL RESOLUTION. PER THE POLICY, ANY PERSON WITH A CONFLICT WILL RECUSE THEMSELVES FROM THE DECISION MAKING PROCESS COMPLETELY. BOARD MEMBERS PHYSICALLY LEAVE THE ROOM WHEN DISCUSSIONS OCCUR THAT ARE POTENTIAL CONFLICTS. TANNER BIDS OUT SERVICES AND IF A COMPANY OWNED BY A BOARD MEMBER CHOOSES TO BID, THERE ARE ADDITIONAL STEPS TAKEN FOR TRANSPARENCY, SUCH AS ADVERTISING THE BIDDING PROCESS IN THE NEWSPAPER. ALL SERVICES ARE COMPARED TO FAIR MARKET VALUE. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION MAKES AVAILABLE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS TO MEMBERS OF THE PUBIC WHO MAKE THEIR REQUEST AT THE ADMINISTRATIVE OFFICE OF THE ORGANIZATION. |
| FORM 990, PART XI, LINE 9 | PERMANENT EQUITY TRANSFERS - CLINICS -27,217,565 EIGHT CLINICS WHICH FILED SEPARATE FORM 990S WERE ADDED TO THE GROUP IN FYE 6/30/18. THE DECREASE REPRESENTS THE NET ASSETS BALANCE AS OF FYE 6/30/17 FOR ALL EIGHT CLINICS NOW CONSOLIDATED IN THE GROUP RETURN. |
| Software ID: | |
| Software Version: |
| Name | Address | EIN | Name control |
|---|---|---|---|
| TMC INTERNAL MEDICINE OF VILLA RICA |
705 DIXIE STREET CARROLLTON, GA 301173818 |
26-2988495 |
TANN |
| TMC CAROUSEL PEDIATRICS INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
26-3590073 |
TANN |
| TMC-TANNER NEUROLOGY ASSOCIATES INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
26-3911032 |
TANN |
| TANNER MEDICAL GROUP INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
26-4045534 |
TANN |
| TANNER PRIMARY CARE OF HEFLIN |
140 B TOMPKINS ST HEFLIN, AL 362640000 |
27-3857816 |
TANN |
| TANNER PRIMARY CARE OF WEDOWEE INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
45-4857914 |
TANN |
| TMC HIGGINS GENERAL HOSPITAL INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2414416 |
TANN |
| TMC VILLA RICA HOSPITAL INC |
705 DIXIE STREET CARROLLTON, GA 301773818 |
58-2453303 |
TANN |
| TMC-HOSPICE CARE INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2453302 |
TANN |
| TMC-HOME HEALTH INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2453296 |
TANN |
| TMC-BEHAVIORAL HEALTH OF WEST GEORGIA |
705 DIXIE STREET CARROLLTON, GA 301173818 |
81-2238385 |
TANN |
| TANNER FAMILY HEALTHCARE OF FRANKLIN INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
26-0585684 |
TANN |
| TANNER INTENSIVE MEDICAL SERVICES |
705 DIXIE STREET CARROLLTON, GA 301173818 |
20-0336940 |
TANN |
| TMC HARALSON FAMILY HEALTH CARE CENTER INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2378722 |
TANN |
| TMC IMMEDIATE CARE INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
20-0379196 |
TANN |
| TMC OCCUPATIONAL HEALTH INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2362404 |
TANN |
| TMC TALLAPOOSA FAMILY HEALTH CARE CENTER INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2378724 |
TANN |
| TMC WEST CARROLL FAMILY HEALTHCARE CENTER INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
58-2504393 |
TANN |
| TMC WEST GEORGIA ANESTHESIA ASSOCIATES INC |
705 DIXIE STREET CARROLLTON, GA 301173818 |
20-3604642 |
TANN |