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.") .. | 1,490,277 | 216,745 | 117,530 | 127,759 | 153,526 | 2,105,837 |
| 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 | 1,490,277 | 216,745 | 117,530 | 127,759 | 153,526 | 2,105,837 |
| 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. | 2,105,837 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,490,277 | 216,745 | 117,530 | 127,759 | 153,526 | 2,105,837 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1 | 18,820 | 3,838 | 8,864 | 21,789 | 53,312 |
| 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 | 2,159,149 | |||||
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, PART VI, SECTION A, LINE 4 | THE ARTICLE OF INCORPORATION AND BYLAWS WERE REVISED IN 2018. THE ARTICLES WERE REVISED AND NAMED KING'S DAUGHTERS' HEALTH AS THE SOLE MEMBER OF THE KING'S DAUGHTERS' HOSPITAL FOUNDATION, INC. THE BYLAWS WERE RESTATED AND REVISED AS FOLLOWS: SECTION 2.02. RESERVED POWERS OF THE MEMBER: THE CORPORATE MEMBER SHALL HAVE SUCH RIGHTS AND POWERS AS ARE PROVIDED FOR IN THE ARTICLES, THIS CODE OF BYLAWS, AND THE LAWS OF THE STATE OF INDIANA, INCLUDING THE FOLLOWING POWERS: (A) TO MAKE, ALTER, AMEND, OR REPEAL THE CORPORATION'S ARTICLES OR CODE OF BYLAWS; (B) TO APPOINT, UPON A NOMINATION AS SPECIFIED IN SECTION 3.03 OF THIS CODE OF BYLAWS, OR REMOVE, WITH OR WITHOUT CAUSE AND WITH OR WITHOUT A RECOMMENDATION FROM ANY OTHER PARTY, EACH AND ANY MEMBER OF THE CORPORATION'S BOARD OF DIRECTORS; (C) TO APPROVE ANY GRANT, DONATION, GIFT OR OTHER TRANSFER THAT IS NOT TO BE MADE DIRECTLY TO, ON BEHALF OF, OR AT THE REQUEST OF THE CORPORATE MEMBER; (D) TO APPROVE THE ACCEPTANCE OF ANY GRANT, DONATION, GIFT, OR OTHER TRANSFER THAT IMPOSES AN OBLIGATION UPON THE CORPORATE MEMBER OR AFFILIATE OF THE CORPORATE MEMBER; (E) TO APPROVE THE INCURRENCE OF DEBT BY THE CORPORATION; (F) TO APPROVE THE SALE, TRANSFER, OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS AND DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION, CHANGE IN OWNERSHIP, OR CORPORATE REORGANIZATION OF THE CORPORATION; (G) TO APPROVE THE FORMATION OF A SUBSIDIARY ORGANIZATION OF THE CORPORATION, OR THE SALE, TRANSFER, OR SUBSTANTIAL CHANGE IN USE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF A SUBSIDIARY ORGANIZATION OF THE CORPORATION, OR THE DIVESTITURE, DISSOLUTION, CLOSURE, MERGER, CONSOLIDATION OR CHANGE IN CORPORATE MEMBERSHIP OR OWNERSHIP OF A SUBSIDIARY ORGANIZATION OF THE CORPORATION; (H) TO APPROVE THE MATERIAL TRANSFER OR ENCUMBRANCE OF THE CORPORATION'S ASSETS; (I) TO APPROVE THE ANNUAL OPERATING BUDGET, CAPITAL PLAN, STRATEGIC PLAN, AND BUSINESS PLAN FOR THE CORPORATION; J) WITH INPUT FROM THE CORPORATE MEMBER'S CHIEF EXECUTIVE OFFICER, TO APPROVE ANY MATERIAL TRANSACTIONS OF THE CORPORATION WHICH ARE NOT OTHERWISE INCLUDED IN APPROVED OPERATING OR CAPITAL BUDGETS OF THE CORPORATION OR AS OTHERWISE AUTHORIZED IN THIS CODE OF BYLAWS; AND (K) TO APPROVE ANY MANAGEMENT AGREEMENT FOR THE MANAGEMENT OF ALL OR ANY SUBSTANTIAL PART OF THE CORPORATION'S OPERATIONS. SECTION 3.02. NUMBER AND IDENTITY: THE BOARD OF DIRECTORS SHALL CONSIST OF NOT LESS THAN THREE (3) NOR MORE THAN THIRTEEN (13) VOTING DIRECTORS (THE "VOTING DIRECTORS"), AS SHALL FROM TIME TO TIME BE DETERMINED BY A RESOLUTION OF THE CORPORATE MEMBER. IF THE CORPORATE MEMBER DOES NOT ADOPT OR RETAIN IN FORCE A RESOLUTION REGARDING THE NUMBER OF VOTING DIRECTORS, THEN THE BOARD OF DIRECTORS SHALL BE COMPRISED OF SEVEN (7) VOTING DIRECTORS. ADDITIONALLY, THE BOARD OF DIRECTORS AT ALL TIMES SHALL INCLUDE THE PRESIDENT OF THE HOSPITAL AS AN EX OFFICIO, NON-VOTING DIRECTOR (THE "EX OFFICIO DIRECTOR"). SECTION 3.03. ELECTION. ALL VOTING DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER; PROVIDED, HOWEVER, THAT THE BOARD OF DIRECTORS MAY NOMINATE INDIVIDUALS TO SERVE AS VOTING DIRECTORS; AND PROVIDED, FURTHER, THAT THE BOARD OF DIRECTORS AT ALL TIMES SHALL INCLUDE AT LEAST THREE (3) VOTING DIRECTORS WHO ALSO ARE MEMBERS OF THE BETHANY CIRCLE. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE CORPORATE MEMBER, KING'S DAUGHTERS' HEALTH. |
| FORM 990, PART VI, SECTION A, LINE 7A | ALL VOTING DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER (KING'S DAUGHTERS' HEALTH); PROVIDED, HOWEVER, THAT THE BOARD OF DIRECTORS MAY NOMINATE INDIVIDUALS TO SERVE AS VOTING DIRECTORS; AND PROVIDED, FURTHER, THAT THE BOARD OF DIRECTORS AT ALL TIMES SHALL INCLUDE AT LEAST THREE (3) VOTING DIRECTORS WHO ALSO ARE MEMBERS OF THE BETHANY CIRCLE OF KING'S DAUGHTERS OF MADISON, INC. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE PROCESS OF REVIEWING THE FORM 990 ENTAILS A DETAILED REVIEW BY THE ORGANIZATION'S MANAGEMENT. THE BOARD OF MANAGERS RECEIVES A DRAFT COPY OF THE FORM 990 INCLUDING REQUESTED SCHEDULES PRIOR TO FILING WITH THE IRS. IF ANY MODIFICATIONS ARE REQUIRED, THEY ARE MADE AND THEN THE RETURN IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CONFLICT OF INTEREST STATEMENT MUST BE COMPLETED BY EVERY BOARD MEMBER EACH YEAR. AT SUCH TIME AS ANY MATTER COMES BEFORE THE BOARD CONCERNING AN EXISTING OR CONTEMPLATED TRANSACTION OR RELATIONSHIP BETWEEN THE ORGANIZATION AND ANY PARTY IN WHICH A BOARD MEMBER OR THE SPOUSE OR MINOR CHILDREN OF SUCH BOARD MEMBER HAS AN INTEREST OR WHICH OTHERWISE MAY GIVE RISE TO A CONFLICT OF INTEREST BETWEEN THE BOARD MEMBER AND THE ORGANIZATION, THE AFFECTED BOARD MEMBER SHALL MAKE KNOWN THE POTENTIAL CONFLICT, WHETHER DISCLOSED BY HIS OR HER WRITTEN STATEMENT OR NOT, AND AFTER ANSWERING ANY QUESTIONS THAT MIGHT BE ASKED OF HIM OR HER SHALL WITHDRAW FROM THE MEETING FOR SO LONG AS THE MATTER SHALL CONTINUE UNDER DISCUSSION. SHOULD THE MATTER BE BROUGHT TO A VOTE, THE AFFECTED BOARD MEMBER SHALL NOT VOTE ON IT. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST, OR FINANCIAL STATEMENTS ARE NOT AVAILABLE FOR PUBLIC INSPECTION. THE 990 TAX RETURN IS AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | THE AUDIT OF THE FOUNDATION'S FINANCIAL STATEMENTS IS PERFORMED ANNUALLY ON A CONSOLIDATED BASIS WITH THOSE OF THE BETHANY CIRCLE OF KING'S DAUGHTERS' OF MADISON, INDIANA, INC. (D/B/A KING'S DAUGHTERS' HEALTH). KING'S DAUGHTERS' HEALTH ("THE HOSPITAL") ASSUMES THE RESPONSIBILITY OF SELECTING AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTING FIRM TO PERFORM THE CONSOLIDATED AUDIT. THE HOSPITAL'S FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THAT AUDIT PROCESS. |
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| Software Version: |