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.") .. | 68,644 | 47,867 | 52,918 | 62,959 | 63,855 | 296,243 |
| 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 | 68,644 | 47,867 | 52,918 | 62,959 | 63,855 | 296,243 |
| 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).. | 11,889 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 284,354 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 68,644 | 47,867 | 52,918 | 62,959 | 63,855 | 296,243 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,437 | 1,492 | 1,533 | 1,386 | 966 | 6,814 |
| 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.).. | 42,010 | 40,397 | 33,646 | 47,193 | 25,000 | 188,246 |
| 11 | Total support. Add lines 7 through 10 | 491,303 | |||||
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) |
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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 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. |
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| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | FUNDRAISING INCOME |
| 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 2 | MIMI HERRINGTON AND SHELLEY HERRINGTON HAVE A FAMILY RELATIONSHIP. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE FOUNDATION WAS HURON MEMORIAL HEALTHCARE CORPORATION UNTIL MAY 1, 2018 WHEN IT MERGED WITH HURON MEMORIAL HOSPITAL, THE SURVIVING ENTITY. AFTER THE MERGER, HURON MEMORIAL HOSPITAL WAS THE SOL MEMBER OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE SOLE MEMBER ELECTS THE TRUSTEES OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE FOLLOWING ACTIONS MAY BE TAKEN BY THE FOUNDATION AND ITS BOARD OF TRUSTEES ONLY UPON PRIOR WRITTEN APPROVAL OF THE SOLE MEMBER: A. ADOPTION, AMENDMENT, OR OTHER MODIFICATION OF THE BYLAWS OR ARTICLES OF INCORPORATION OF THIS CORPORATION. B. ANY MERGER, CONSOLIDATION, REORGANIZATION, OR OTHER CHANGE IN THE CORPORATE STRUCTURE OF THIS CORPORATION, OR THE CREATION OF ANY CORPORATE SUBSIDIARY THEREOF. C. THE PARTICIPATION OF THIS CORPORATION IN ANY PARTNERSHIP, LIMITED PARTNERSHIP, CORPORATION, ASSOCIATION, OR OTHER FORM OF JOINT VENTURE OR SHARED SERVICE WITH ANY OTHER PARTY OR ORGANIZATION. D. CREATION, INCURRENCE, OR ASSUMPTION OF INDEBTEDNESS, COMMITMENTS, OR ANY CONTRACTUAL OBLIGATIONS WITH RESPECT TO BORROWED MONEY, GUARANTEES, ENDORSEMENTS, LEASES, OR OTHER TYPE OF DIRECT OR CONTINGENT LIABILITIES, IN EXCESS OF $50,000 FOR ANY ONE ITEM. E. CREATION, INCURRENCE, OR ASSUMPTION OF ANY MORTGAGE, PLEDGE, SECURITY AGREEMENT, ENCUMBRANCE, OR OTHER LIEN OF ANY KIND IN ANY PROPERTY OR ASSETS OF THIS CORPORATION. F. ACQUISITION, BY PURCHASE, LEASE, OR BY ANY OTHER METHOD, OF ANY REAL ESTATE, CAPITAL IMPROVEMENTS, OR EQUIPMENT IN EXCESS OF A VALUE OF $50,000 FOR ANY ONE SUCH ITEM. G. ANY CONTRIBUTIONS OF ENDOWMENT PRINCIPAL. H. ANY SINGLE CONTRIBUTION TO HURON MEMORIAL HOSPITAL IN EXCESS OF $5,000.00 AND ANY AGGREGATE CONTRIBUTIONS IN EXCESS OF $10,000.00 DURING ANY FISCAL YEAR OF HURON MEMORIAL HOSPITAL. I. ANY CHANGE IN THE SERVICES OR PROGRAMS OF THIS CORPORATION, INCLUDING THE TERMINATION OF EXISTING SERVICES, THE ADDITION OF NEW SERVICES, OR ANY MAJOR EXPANSION OR CONSTRUCTION OF EXISTING SERVICES OR PROGRAMS. J. ADOPTION, OR FORMAL AMENDMENT OR MODIFICATION OF THE ANNUAL OPERATING AND CAPITAL BUDGETS OF THIS CORPORATION. K. ADOPTION, AMENDMENT, OR MODIFICATION OF THE MISSION AND GOALS OF THIS CORPORATION, AND ITS LONG RANGE OR SHORT RANGE STRATEGIC PLANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 DATA IS PREPARED INTERNALLY AND SUBMITTED TO OUR AUDITING FIRM FOR RETURN PREPARATION. ONCE THE RETURNS HAVE BEEN COMPLETED, THE FORMS ARE REVIEWED BY ENTITY CFO AND THE FINANCE LEADERSHIP OF MCLAREN HEALTH CARE (MHC). COPIES OF DRAFT RETURNS ARE MADE AVAILABLE TO THE MHC BOARD MEMBERS, WHO SERVE AS THE OVERALL GOVERNING BOARD. RETURNS ARE AVAILABLE FOR ALL CORPORATIONS OF WHICH MHC IS THE SOLE MEMBER AS WELL AS OTHER RELATED ENTITIES OF THOSE CORPORATIONS FOR REVIEW RATHER THAN HAVING THE LOCAL BOARDS REVIEW THE RETURNS. THE BOARD OF MHC IS THE ULTIMATE ACCOUNTABLE ORGANIZATION FOR THE SYSTEM; AS SUCH IT IS THE OVERALL GOVERNING BOARD OF THE SYSTEM, WHOSE RESPONSIBILITIES INCLUDE BUT ARE NOT LIMITED TO: APPROVING ALL SUBSIDIARY BOARD MEMBERS, FINANCIAL BUDGETS, AND ISSUANCE OF DEBT. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CORPORATE COMPLIANCE DEPARTMENT, IN ACCORDANCE WITH THE MCLAREN HEALTH CARE (MHC) BOARD CONFLICT OF INTEREST POLICY, ANNUALLY DISTRIBUTES THE CONFLICT OF INTEREST DISCLOSURE SURVEY TO ALL MHC CORPORATE AND SUBSIDIARY ORGANIZATION BOARD MEMBERS, EXECUTIVES AND OTHER LEADERSHIP EMPLOYEES. THE CORPORATE COMPLIANCE DEPARTMENT THROUGH THE GOVERNANCE COMMITTEE, COMPILES AND ANALYZES SURVEY DATA BY ORGANIZATION, INVESTIGATES AND REVIEWS POTENTIAL CONFLICTS WITH THE ORGANIZATION'S CEO AND BOARD CHAIR, AND WHEN NECESSARY, RECOMMENDS ACTIONS TO BE TAKEN TO RESOLVE IDENTIFIED CONFLICTS. A COMPLETE REPORT OF ALL CORPORATE AND SUBSIDIARY BOARD MEMBER AND EXECUTIVE DISCLOSURES, CONFLICTS IDENTIFIED AND ACTIONS TAKEN IS REVIEWED BY THE MHC GOVERNANCE COMMITTEE AND EACH SUBSIDIARY CEO AND BOARD CHAIR RECEIVES A REPORT SPECIFIC TO THEIR ORGANIZATION'S BOARD MEMBERS AND EXECUTIVES. CONFLICTS ARE DISCLOSED TO THE FULL BOARD AND BOARD COMMITTEES SO APPROPRIATE ACTIONS CAN BE TAKEN. ACTIONS MAY INCLUDE PROHIBITING A BOARD MEMBER FROM PARTICIPATING IN DELIBERATIONS INVOLVING TRANSACTIONS WITH A COMPANY WITH WHICH THEY CONDUCT FINANCIAL TRANSACTIONS; BOARD MEMBERS FAILING TO COMPLETE A DISCLOSURE SURVEY OR INTENTIONALLY FAILING TO REPORT A KNOWN CONFLICT OF INTEREST ARE RELIEVED OF THEIR SERVICE TO MHC. |
| FORM 990, PART VI, SECTION B, LINE 15 | WAGE INFORMATION FROM TRADE GROUPS IS USED TO ESTABLISH BENCHMARKS FOR APPROPRIATE COMPENSATION LEVELS. THE COMPENSATION OF THE CHIEF EXECUTIVE OFFICER IS ANALYZED ANNUALLY BY THE BOARD OF DIRECTORS. THE BOARD REVIEWS THE STATED GOALS FOR THE YEAR AND DETERMINES IF SUCH GOALS HAVE BEEN MET AND DETERMINES THE AMOUNT OF A COMPENSATION INCREASE OR BONUS, IF ANY. OTHER EXECUTIVE COMPENSATION IS APPROVED BY THE CEO AS AUTHORIZED BY THE BOARD AND IS BASED ON EXECUTIVE COMPENSATION SURVEYS COMPLETED BY HUMAN RESOURCES. THIS PROCESS WAS LAST UNDERTAKEN IN 2017. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE PROCESS FOR SELECTION AND OVERSIGHT USED BY THE FOUNDATION IS THE SAME AS THE PROCESS THAT IS USED BY HURON MEDICAL CENTER, A RELATED ORGANIZATION. THE PROCESS HAS NOT CHANGED FROM THE PROCESS USED IN PRIOR YEARS. |
| Software ID: | |
| Software Version: |