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 | 14,163,911 | 15,466,543 | 29,803,014 | 35,752,647 | 38,359,808 | 133,545,923 |
| 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 | 14,163,911 | 15,466,543 | 29,803,014 | 35,752,647 | 38,359,808 | 133,545,923 |
| 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.) | 133,545,923 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 14,163,911 | 15,466,543 | 29,803,014 | 35,752,647 | 38,359,808 | 133,545,923 |
| 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.).. | 14,163,911 | 15,466,543 | 29,803,014 | 35,752,647 | 38,359,808 | 133,545,923 |
| 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 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) |
||||
| 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 6, PART VI, LINE 6 | THE ORGANIZATION HAS A SOLE MEMBER, COMMUNITY HEALTH SYSTEMS, INC., A NONPROFIT GEORGIA CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 7A | UNDER THE ORGANIZATION'S BYLAWS, WHILE IT IS THE SOLE MEMBER OF THE ORGANIZATION, COMMUNITY HEALTH SYSTEMS, INC., AS A TYPE I SECTION 509(A)(3) AND SECTION 501(C)(3) SUPPORTING ORGANIZATION, HAS THE SOLE RIGHT TO ELECT,REPLACE AND TO REMOVE THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS AND SHALL ENSURE THAT AT ALL TIMES, A MAJORITY OF THE MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS SHALL BE COMPOSED OF PERSONS WHO ARE CONCURRENTLY SERVING AS MEMBERS OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SYSTEMS, INC. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THIS PROCESS INVOLVES THE ELECTRONIC POSTING OF THE DRAFT FORM 990 WITH ALL ITS SCHEDULES FOR THE ORGANIZATION'S BOARD OF DIRECTORS TO REVIEW FOLLOWED, AFTER A SUFFICIENT REVIEW PERIOD, BY A MEETING OF THE BOARD AT WHICH BOARD MEMBERS WILL HAVE THE OPPORTUNITY TO ASK QUESTIONS OF MANAGEMENT AND THE OUTSIDE TAX ADVISORS INVOLVED IN THE PREPARATION OF THE FORM 990. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICTS OF INTEREST POLICY. SUCH COMPLIANCE IS EFFECTUATED THROUGH THE ORGANIZATION'S BOARD OF DIRECTORS' REVIEW OF ANNUAL CONFLICT DISCLOSURE STATEMENTS FROM THE DIRECTORS AS WELL AS RECEIPT AND REVIEW OF CONFLICT DISCLOSURE STATEMENTS WITH RESPECT TO CERTAIN PROPOSED TRANSACTIONS OR ARRANGEMENTS THE ORGANIZATION IS CONSIDERING PRIOR TO ANY BOARD ACTION WITH RESPECT TO SUCH MATTERS. THE CONFLICTS POLICY OUTLINES THE SPECIFIC PROCEDURE TO BE FOLLOWED TO DETERMINE WHETHER INTERESTED PERSONS HAVE ACTUAL CONFLICTS OF INTEREST. IF IT IS DETERMINED THAT A BOARD MEMBER HAS AN ACTUAL CONFLICT OF INTEREST, THEN SUCH BOARD MEMBER IS NOT ALLOWED TO PARTICIPATE IN THE BOARD DELIBERATIONS ON THE SPECIFIC MATTER AND IS EXCUSED FROM, AND IS NOT ALLOWED TO PARTICIPATE IN ANY BOARD VOTE ON THE MATTER. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ORGANIZATION COMPLIES WITH THE COMPENSATION APPROVAL PROCESS WHICH IS PART OF ITS CONFLICT OF INTEREST POLICY. EVERY TWO TO THREE YEARS, ON AVERAGE, THE ORGANIZATION PARTICIPATES IN A COMPREHENSIVE PROCESS CONDUCTED ON ITS BEHALF BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SYSTEMS, INC., ITS SOLE MEMBER AND PARENT OF THE INTEGRATED HEALTH CARE DELIVERY SYSTEM IN WHICH THE ORGANIZATION IS A MEMBER. THIS PROCESS INVOLVES REVIEW OF THE COMPARABILITY DATA COMPILED BY AN INDEPENDENT THIRD-PARTY COMPENSATION CONSLUTANT. COMPARABILITY DATA IS GATHERED FOR THE ORGANIZATION'S SENIOR MANAGEMENT, AND ON OCCASION, KEY OR HIGHLY COMPENSATED EMPLOYEES, AND, BASED ON THE SAME, THE CONSULTANT ISSUES A WRITTEN REPORT REFLECTING THE CONSULTANT'S OPINION CONCERNING WHETHER THE PROPOSED COMPENSATION ARRANGEMENTS CONSTITUTE RESONABLE COMPENSATION UNDER SECTION 4958 OF THE CODE. THIS PROCESS IS CONDUCTED BY THE COMPENSATION COMMITTEE, WHICH THEN MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS ALSO PROVIDED WITH MATERIALS REGARDING THE COMPENSATION REVIEW, INCLUDING COPIES OF THE CONSULTANT'S REPORT. THE BOARD THEN VOTES AS TO THE REASONABLENESS OF EACH OF THE INDIVIDUAL COMPENSATION ARRANGEMENTS (IF ANY DISQUALIFIED OR OTHERWISE CONFLICTED INDIVIDUALS ARE PRESENT AT THE MEETING, THEY DO NOT PARTICIPATE IN THE DELIBERATIONS AND ARE EXCUSED FROM THE ROOM DURING THE VOTE). THE PROCESS IS DESIGNED AND CARRIED OUT BY THE BOARD OF DIRECTORS IN A MANNER DESIGNED TO SATISFY ALL THREE OF HTE REQUIREMENTS NECESSARY TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS WITH RESPECT TO COMPENSATION ARRANGEMENTS FOR DISQUALIFIED PERSONS UNDER SECTION 53.4958-6 OF THE REGULATIONS. AS PART OF THIS PROCESS, OUTSIDE COUNSEL IS RETAINED TO FURTHER ADVISE THE BOARD ON THE REBUTTABLE PRESUMPTION PROCESS AND TO PROVIDE THE BOARD WITH A LEGAL OPINION REGARDING THE SAME. AS A FINAL STEP, EACH PART OF THE PROCESS REQUIRED TO ESTABLISH THE REBUTTABLE PRESUMPTION IS DOCUMENTED USING THE REBUTTABLE PRESUMPTION CHECKLIST RELEASED BY THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE ORGANIZATION REGULARLY AND CONSISTENTLY COMPLIES WITH THE COMPENSATION APPROVAL PROCESS WHICH IS PART OF ITS CONFLICTS OF INTEREST POLICY. EVERY TWO TO THREE YEARS, ON AVERAGE, THE ORGANIZATION PARTICIPATES IN A COMPREHENSIVE PROCESS CONDUCTED ON ITS BEHALF BY THE COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS OF COMMUNITY HEALTH SYSTEMS, INC., ITS SOLE MEMBER AND PARENT OF THE INTEGRATED HEALTH CARE DELIVERY SYSTEM IN WHICH THE ORGANIZATION IS A MEMBER. THIS PROCESS INVOLVES REVIEW OF COMPARABILITY DATA COMPILED BY AN INDEPENDENT THIRD-PARTY COMPENSATION CONSULTANT. COMPARABILITY DATA IS GATHERED FOR THE ORGANIZATION'S SENIOR MANAGEMENT, AND ON OCCASION, KEY OR HIGHLY COMPENSATED EMPLOYEES, AND, BASED ON THE SAME, THE CONSULTANT ISSUES A WRITTEN REPORT REFLECTING THE CONSULTANT'S OPINION CONCERNING WHETHER THE PROPOSED COMPENSATION ARRANGEMENTS CONSTITUTE REASONABLE COMPENSATION UNDER SECTION 4958 OF THE CODE. THIS PROCESS IS CONDUCTED BY THE COMPENSATION COMMITTEE, WHICH THEN MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS IS ALSO PROVIDED WITH MATERIALS REGARDING THE COMPENSATION REVIEW, INCLUDING COPIES OF THE CONSULTANT'S REPORT. THE BOARD THEN VOTES AS TO THE REASONABLENESS OF EACH OF THE INDIVIDUAL COMPENSATION ARRANGEMENTS (IF ANY DISQUALIFIED OR OTHERWISE CONFLICTED INDIVIDUALS ARE PRESENT AT THE MEETING, THEY DO NOT PARTICIPATE IN THE DELIBERATIONS AND ARE EXCUSED FROM THE ROOM DURING THE VOTE). THE PROCESS IS DESIGNED AND CARRIED OUT BY THE BOARD OF DIRECTORS IN A MANNER DESIGNED TO SATISFY ALL THREE OF THE REQUIREMENTS NECESSARY TO ESTABLISH THE REBUTTABLE PRESUMPTION OF REASONABLENESS WITH RESPECT TO COMPENSATION ARRANGEMENTS FOR DISQUALIFIED PERSONS UNDER SECTION 53.4958-6 OF THE REGULATIONS. AS PART OF THIS PROCESS, OUTSIDE COUNSEL IS RETAINED TO FURTHER ADVISE THE BOARD ON THE REBUTTABLE PRESUMPTION PROCESS AND TO PROVIDE THE BOARD WITH LEGAL OPINION REGARDING THE SAME. AS A FINAL STEP, EACH PART OF THE PROCESS REQUIRED TO ESTABLISH THE REBUTTABLE PRESUMPTION IS DOCUMENTED USING THE REBUTTABLE PRESUMPTION CHECKLIST RELEASED BY THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST IN ACCORDANCE WITH THE SECTION 6104(D) DISCLOSURE REQUIREMENTS. |
| FORM 990, PART XI, LINE 9 | CONTRIBUTION OF NET ASSETS 601,461 |
| Software ID: | |
| Software Version: |