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.") .. | 901,445 | 917,757 | 1,434,902 | 1,130,836 | 1,311,255 | 5,696,195 |
| 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 | 901,445 | 917,757 | 1,434,902 | 1,130,836 | 1,311,255 | 5,696,195 |
| 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).. | 416,534 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 5,279,661 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 901,445 | 917,757 | 1,434,902 | 1,130,836 | 1,311,255 | 5,696,195 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 130,962 | 55,221 | 64,401 | 72,016 | 88,764 | 411,364 |
| 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 | 6,199,865 | |||||
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): |
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| 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, PAGE 2, PART III, LINE 4A | RONALD MCDONALD HOUSE OF WINSTON-SALEM OWNS AND OPERATES A 35-BEDROOM FACILITY THAT PROVIDES TEMPORARY LODGING FOR FAMILIES OF SERIOUSLY ILL CHILDREN WHO MUST LEAVE THEIR HOME COMMUNITY TO SEEK MEDICAL CARE FOR THEIR CHILDREN. MOST CHILDREN ARE PATIENTS AT BRENNER CHILDREN'S HOSPITAL AT WAKE FOREST BAPTIST HEALTH AND FORSYTH MEDICAL CENTER, ALTHOUGH ANY MEDICAL FACILITY IN FORSYTH COUNTY MAY REFER PATIENTS. MORE THAN A PLACE TO STAY, THE RONALD MCDONALD HOUSE OFFERS ITS GUESTS CHEERFUL BEDROOMS, NOURISHING HOME-COOKED MEALS, LAUNDRY FACILITIES, PARKING, AREAS FOR RECREATION, AND THE SUPPORT OF A PROFESSIONAL STAFF AND OTHER GUESTS IN SIMILAR CIRCUMSTANCES. IN 2018, THE HOUSE SERVED 1,056 FAMILIES FROM 65 NORTH CAROLINA COUNTIES AND 8 OTHER STATES. FAMILIES ARE ASKED FOR A RENTAL DONATION OF 10.00 PER NIGHT, WHICH CAN BE WAIVED IF NECESSARY AS 62% OF OUR GUESTS CANNOT PAY THIS SMALL FEE. THE DIFFERENCE BETWEEN THE COST TO OPERATE EACH ROOM AND THE AMOUNT PAID BY OUR FAMILIES IS FUNDED BY COMMUNITY DONATIONS. CIVIC GROUPS, CHURCHES AND INDIVIDUALS PARTICIPATE IN PROVIDING FUNDING FOR THE HOUSE. IN-KIND GOODS WORTH THOUSANDS OF DOLLARS ARE DONATED TO THE RONALD MCDONALD HOUSE EACH YEAR. THESE DONATIONS ALLOW THE HOUSE TO ENHANCE THE SERVICES PROVIDED TO THE FAMILIES AND TO REDUCE EXPENDITURES IN PROGRAM, ADMINISTRATIVE AND FUNDRAISING AREAS. SOME EXAMPLES OF MAJOR IN- KIND GIFTS INCLUDE YARD WORK AND LANDSCAPING, 423 HOME-COOKED MEALS, SOFT DRINKS, FOOD, LAUNDRY SERVICE, TOYS, AND PAPER GOODS. 4,273 VOLUNTEERS GIVING 17,502 HOURS SUPPORT THE STAFF AND FAMILIES IN THE HOUSE ON A REGULAR BASIS BY ASSISTING IN GUEST RELATIONS, SPECIAL EVENTS, OFFICE AND HOUSEKEEPING DUTIES. ADDITIONALLY, 400+ MEMBERS OF THE FRIENDS OF THE RONALD MCDONALD HOUSE AND OVER 600 VOLUNTEERS ARE INVOLVED IN PROMOTING THE HOUSE AND IMPLEMENTING THE HOUSE'S ANNUAL LUMINARY FUNDRAISING PROJECT. |
| FORM 990, PAGE 2, PART III, LINE 4C | RONALD MCDONALD HOUSE OF WINSTON-SALEM FAMILY SUPPORT PROGRAM PROVIDES ASSISTANCE, EDUCATION, AND REFERRAL SERVICES NECESSARY TO PROMOTE THE WELL BEING OF THE WHOLE FAMILY. THE PROGRAM HELPS FAMILIES ADJUST TO THEIR CHILD'S ILLNESS BY OFFERING SERVICES THAT ENRICH PARENTING AND COPING SKILLS. SUPPORT SERVICES ARE OFFERED THROUGH DAILY VISITS WITH FAMILIES AT THE HOSPITAL BY THE FAMILY SUPPORT SERVICES MANAGER AND VOLUNTEERS, INFORMAL SUPPORT GROUPS, RELAXATION AND STRESS MANAGEMENT SESSIONS, RECREATIONAL ACTIVITIES FOR SIBLINGS, FAMILY MEMBER BIRTHDAYS, HOLIDAY CELEBRATIONS, PET THERAPY, AND BINGO. EDUCATIONAL RESOURCES INCLUDE ONE-ON-ONE TRAINING, PARENTING WORKSHOPS, AND QUESTION AND ANSWER SESSIONS WITH DOCTORS. ALSO AVAILABLE IS A FAMILY RESOURCE LIBRARY WITH BOOKS, VIDEOS, A COMPUTER FOR DOING RESEARCH OR SIMPLY CHECKING EMAILS, AND EDUCATIONAL MATERIALS. TRANSPORTATION TO MEDICAL APPOINTMENTS AND FACILITIES, AND ASSISTANCE WITH ACCESS TO COMMUNITY RESOURCES IS AVAILABLE. A CORE GROUP OF 41 VOLUNTEERS PROVIDING 1,046 VOLUNTEER HOURS HELP MAKE FAMILY SUPPORT PROGRAM SERVICES POSSIBLE. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE FRIENDS OF THE RONALD MCDONALD HOUSE IS AN AUXILARY ORGANIZATION OF RONALD MCDONALD HOUSE OF WINSTON-SALEM FOR WHICH MEMBERS PAY DUES. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THE MEMBERS OF FRIENDS OF RONALD MCDONALD HOUSE ELECT THE PRESIDENT OF THE FRIENDS OF RONALD MCDONALD HOUSE. THE PRESIDENT SERVES ON THE BOARD OF RONALD MCDONALD HOUSE AND HAS VOTING RIGHTS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE EXECUTIVE DIRECTOR AND A MEMBER OF THE EXECUTIVE COMMITTEE THOROUGHLY REVIEW THE FORM 990 AND AFTERWARDS THE FORM 990 IS EMAILED TO BOARD MEMBERS FOR COMMENTS BEFORE FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ANNUALLY, EACH MEMBER OF THE BOARD OF DIRECTORS AND BOARD COMMITTEES SIGNS THE CONFLICT OF INTEREST FORM. THEY ARE FILED WITH THE EXECUTIVE DIRECTOR WHO REVIEWS EACH ONE TO DETERMINE IF THERE ARE ANY POTENTIAL CONFLICTS THAT MIGHT INFLUENCE DECISION MAKING. |
| FORM 990, PAGE 6, PART VI, LINE 15A | FOR THE EXECUTIVE DIRECTOR POSITION, THE BOARD DESIGNATES THE HUMAN RESOURCE COMMITTEE TO GATHER BOARD COMMENTS AND COMPARABLE DATA AND TO RECOMMEND COMPENSATION BASED UPON THIS DATA AND COMPARABILITY FACTORS INCLUDING BUT NOT LIMITED TO THE SIZE OF THE ORGANIZATION, THE GEOGRAPHICAL LOCATION OF THE ORGANIZATION AND THE EMPLOYEE'S LENGTH OF SERVICE. THE BOARD DESIGNATES THE EXECUTIVE COMMITTEE TO REVIEW THE COMMENTS AND THE RECOMMENDATIONS FROM THE HUMAN RESOURCE COMMITTEE AND TO SET THE COMPENSATION PACKAGE FOR THE EXECUTIVE DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE DIRECTOR REVIEWS THE COMPENSATION OF KEY EMPLOYEES AND SUBMITS COMPENSATION RECOMMENDATIONS TO THE FINANCE COMMITTEE AS PART OF THE ANNUAL BUDGET PROCESS. THE ANNUAL BUDGET IS APPROVED BY THE FULL BOARD. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE ON THE ORGANIZATION'S WEBSITE AND OFFICE UPON REQUEST. CONFLICT OF INTEREST POLICY IS AVAILABLE AT THE ORGANIZATIONS'S OFFICE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | USE OF LEASED VEHICLE 8,645 FUNDRAISING 79,542 USE OF LEASED VEHICLE -8,645 FUNDRAISING -79,542 |
| Software ID: | |
| Software Version: |