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 | |||||
|
Total |
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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) |
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| 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) |
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| 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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
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. |
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|
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. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| 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, PART VI, SECTION A, LINE 4 | THE BYLAWS OF THE FILING ORGANIZATION WERE AMENDED TO REFLECT THE NEW ORGANIZATIONAL STRUCTURE OF THE GROUP. AS MENTIONED OTHERWISE IN THIS FILING, PARKER HEALTH GROUP, INC. IS NOW THE PARENT AND SOLE MEMBER OF EACH OF ITS AFFILIATES. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS PARKER HEALTH GROUP, INC., A RELATED TAX-EXEMPT ENTITY. |
| FORM 990, PART VI, SECTION A, LINE 7A | AS SOLE MEMBER, PARKER HEALTH GROUP, INC. HAS THE POWER TO ELECT MEMBERS OF THE ORGANIZATION'S BOARD OF TRUSTEES. |
| FORM 990, PART VI, SECTION A, LINE 7B | AS SOLE MEMBER, PARKER HEALTH GROUP, INC. HAS THE POWER TO ALTER, AMEND OR REPEAL THE ORGANIZATION'S BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | MANAGEMENT PERFORMS AN INITIAL REVIEW OF THE FORM 990. ONCE MANAGEMENT IS SATISFIED, THE FINANCE COMMITTEE SUBSEQUENTLY REVIEWS THE RETURN IN DETAIL. BOARD MEMBERS ARE THEN PROVIDED WITH COPIES OF THE RETURN PRIOR TO THE RETURN BEING FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | TRUSTEES, OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST STATEMENT. ANY TRUSTEE, OFFICER, OR KEY EMPLOYEE WHO HAS AN INTEREST IN A CONTRACT OR OTHER TRANSACTION PRESENTED TO THE BOARD OF TRUSTEES OR A COMMITTEE THEREOF SHALL MAKE A PROMPT AND FULL DISCLOSURE OF THE INTEREST TO THE BOARD OF TRUSTEES OR COMMITTEE PRIOR TO ITS ACTING ON SUCH CONTRACT OR TRANSACTION. THE BOARD OF TRUSTEES OR COMMITTEE TO WHICH DISCLOSURE OF A POTENTIAL CONFLICT OF INTEREST IS MADE SHALL DETERMINE, BY A MAJORITY VOTE, WHETHER A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, THE INTERESTED PERSON SHALL NOT VOTE ON, NOR USE PERSONAL INFLUENCE ON, NOR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION OR TO RESPOND TO QUESTIONS) IN THE DISCUSSIONS OR DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTION. SUCH PERSON MAY BE COUNTED IN DETERMINING WHETHER A QUORUM IS PRESENT BUT MAY NOT BE COUNTED WHEN THE BOARD OF TRUSTEES OR A COMMITTEE OF THE BOARD OF TRUSTEES TAKES ACTION ON THE TRANSACTION. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE THEREON AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. THE FULL BOARD MONITORS THE CONFLICT OF INTEREST POLICY AND WORKS WITH ORGANIZATION PERSONNEL TO ENSURE THAT ALL BOARD MEMBERS COMPLETE THE ANNUAL STATEMENTS. FOLLOW-UP IS PROVIDED BY LEGAL COUNSEL, IF NECESSARY. WHILE THE CONFLICT OF INTEREST POLICY DOES NOT EXPLICITLY STATE FAMILY AND BUSINESS RELATIONSHIPS, IT IS UNDERSTOOD THAT THESE RELATIONSHIPS MAY BE A SOURCE OF POTENTIAL CONFLICTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | AN INDEPENDENT COMPENSATION CONSULTANT, SULLIVAN, COTTER, AND ASSOCIATES, PROVIDES ANNUAL COMPENSATION SURVEY RESULTS TO THE ORGANIZATION. THE EXECUTIVE COMMITTEE (BOARD CHAIR, VICE-CHAIR, AND TREASURER) AND THE CHAIR OF THE PEOPLE COMMITTEE COMPOSE THE "AUTHORIZED BODY" WHICH HAS OVERSIGHT OF EXECUTIVE COMPENSATION ISSUES. THEY EVALUATE AND DETERMINE CEO COMPENSATION. THE SURVEY RESULTS ENSURE THAT COMPENSATION WILL BE WITHIN FAIR MARKET VALUE RANGE FOR THE INDUSTRY. USING THE SAME SURVEY, THE CEO DETERMINES COMPENSATION FOR THE REMAINING MANAGEMENT EXECUTIVES. ALL BOARD LEVEL DISCUSSIONS ARE DOCUMENTED IN BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION WILL MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | PENSION LIABILITY ADJUSTMENT -1,791,277. EQUITY TRANSFER TO RELATED ENTITY -1,518,985,081. |
| FORM 990, PART V, LINES 2A & 2B | THE FILING ENTITY IS AN AFFILIATE IN A GROUP OF WHICH PARKER HEALTH GROUP, INC.(EIN 81-5241497) IS CONSIDERED A COMMON PAY AGENT FOR W-2 REPORTING. PARKER HEALTH GROUP REPORTS ALL EMPLOYEES ON ITS FORM W-3, HOWEVER, EACH AFFILIATE HAS EMPLOYEES ALLOCATED TO THAT ENTITY. PER IRS INSTRUCTIONS, EMPLOYEES LISTED ON PART V, LINE 2A ARE THOSE WHO HAVE BEEN DEEMED TO BE EMPLOYEES OF THIS ORGANIZATION. THE FRANCIS E PARKER MEMORIAL HOME DOES NOT, HOWEVER, REPORT THESE EMPLOYEES ON A SEPARATE W-3 UNDER ITS OWN EIN. |
| FORM 990, SCHEDULE A, LINE 3 | THE ORGANIZATION PROVIDES MEDICAL CARE TO RESIDENTS WHICH RISES TO THE LEVEL OF BEING DISTINGUISHED AS A HOSPITAL FOR PURPOSES OF ESTABLISHING A PUBLIC CHARITY STATUS. THE ORGANIZATION IS NOT, HOWEVER, LICENSED AS A HOSPITAL WITH THE STATE AND AS SUCH IS NOT REQUIRED TO COMPLETE A SCHEDULE H IN ITS FILING. |
| FORM 990, SCHEDULE J, PART II: | THE ORGANIZATION HAS A PENSION WHICH IS AVAILABLE TO ALL EMPLOYEES. THE PENSION CONTRIBUTIONS ARE DERIVED FROM ACTUARIAL FORMULAS WHICH TAKE INTO CONSIDERATION ALL EMPLOYEES; THE CALCULATIONS ARE NOT BASED ON INDIVIDUALS NOR ARE THE ORGANIZATION'S CONTRIBUTIONS SET ASIDE FOR SPECIFIC EMPLOYEES. SUBSEQUENTLY, NO PENSION OR DEFERRED INCOME IS REFLECTED IN SCHEDULE J, PART VII, COLUMN C. |
| Software ID: | |
| Software Version: |