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.") .. | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 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 | 21,341,729 | 22,169,307 | 22,711,497 | 23,745,380 | 23,909,156 | 113,877,069 |
| 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 | 21,341,729 | 22,169,307 | 22,711,497 | 23,745,380 | 23,909,156 | 113,877,069 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 113,877,069 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 21,341,729 | 22,169,307 | 22,711,497 | 23,745,380 | 23,909,156 | 113,877,069 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 68,591 | 65,310 | 70,643 | 92,652 | 255,226 | 552,422 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 68,591 | 65,310 | 70,643 | 92,652 | 255,226 | 552,422 |
| 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.) .. | 309,584 | 37,727 | 224,087 | 89,612 | 44,160 | 705,170 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 21,719,904 | 22,272,344 | 23,006,227 | 23,927,644 | 24,208,542 | 115,134,661 |
| 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 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) |
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| 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 |
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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 7A | ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF UNITYPOINT HEALTH TRINITY, ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF UNITYPOINT HEALTH METHODIST/PROCTOR, ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF OSF HEALTHCARE SYSTEMS, AND ONE MEMBER IS ELECTED BY THE BOARD OF DIRECTORS OF OSF SAINT FRANCIS MEDICAL CENTER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION PROVIDES A COPY OF FORM 990 TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE OF THE CONFLICT OF INTEREST POLICY. EACH BOARD MEMBER ANNUALLY COMPLETES A CONFLICT OF INTEREST STATEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD REVIEWS COMPARABLE DATA AND THE SPECIFIC PERFORMANCE OF THE EXECUTIVE DIRECTOR IN DETERMINING COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 24E | BANK SERVICE CHARGES: PROGRAM SERVICE EXPENSES 107,280. MANAGEMENT AND GENERAL EXPENSES 111,779. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 219,059. EDUCATION & TRAINING: PROGRAM SERVICE EXPENSES 183,000. MANAGEMENT AND GENERAL EXPENSES 31,093. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 214,093. FRANCHISE FEES: PROGRAM SERVICE EXPENSES 165,142. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 165,142. UNIFORMS: PROGRAM SERVICE EXPENSES 81,660. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 81,660. SUBCONTRACTOR SERVICES: PROGRAM SERVICE EXPENSES 58,750. MANAGEMENT AND GENERAL EXPENSES 20,425. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 79,175. ADMINISTRATIVE EXPENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 68,562. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 68,562. MISCELLANEOUS EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 51,394. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 51,394. COMMUNITY PARTNERING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,904. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,904. COMMUNICATIONS: PROGRAM SERVICE EXPENSES -4,007. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -4,007. |
| FORM 990, PART XII, LINE 2C | THE PROCESS FOR OVERSEEING THE AUDIT AND SELECTING AN INDEPENDENT AUDITOR HAS NOT CHANGED FROM THE PRIOR YEAR. |
| FORM 990, PART IV, LINE 12 AND PART XII, LINE 2C | THE ORGANIZATION HAS AUDITED FINANCIAL STATEMENTS THAT ARE PREPARED ON A CONSOLIDATED BASIS. |
| FORM 5471, SCHEDULE O, PART I | THE OFFICERS AND/OR DIRECTORS OF THE FOREIGN CORPORATION FILE FORM 5471 AS CATEGORY 2 FILERS IN ACCORDANCE WITH TREASURY REGULATION SECTION 1.6046-1(A)(2)(I)(C). THERE WERE NO 10% ACQUISITIONS BY UNITED STATES PERSONS DURING THE CURRENT YEAR. EACH SHAREHOLDER WITH RESPECT TO WHOM THE CATEGORY 2 FORMS ARE FILED IS A UNITED STATES SHAREHOLDER UNDER SECTION 953(C) AND HAS PROVIDED THE INFORMATION REQUIRED BY TREASURY REGULATION SECTION 1.6046-1(A)(2)(II)(A) TO THE IRS ON FORM 5471 ATTACHED TO THEIR RESPECTIVE INCOME TAX RETURN. |
| FORM 5471, SCHEDULE B | NO U.S. PERSON OWNED (AT ANY TIME DURING THE ACCOUNTING PERIOD), DIRECTLY OR INDIRECTLY, 10% OR MORE IN VALUE OR VOTE OF ANY CLASS OF THE CORPORATION'S OUTSTANDING STOCK. |
| FORM 5471, SCHEDULE O, PART II, SECTION C & D | THE FILER IS A CATEGORY 3 FILER FOR FORM 5471 PURPOSES BECAUSE IT IS A UNITED STATES SHAREHOLDER OF THE FOREIGN CORPORATION UNDER IRC SECTION 953(C). THEREFORE, THE FILER IS REQUIRED TO COMPLETE SCHEDULE O EVEN IF IT NEITHER ACQUIRED NOR DISPOSED OF STOCK IN THE FOREIGN CORPORATION. |
| FORM 5471, SCHEDULE O, PART II, SECTION F | THE FOREIGN CORPORATION FILED FORM 1120-F, U.S. INCOME TAX RETURN OF A FOREIGN CORPORATION, FOR ITS TAX YEARS ENDED MAY 31, 2016, 2017, AND 2018. THE FOREIGN CORPORATION HAD NO TAXABLE INCOME AND NO TAX DUE ON THE RETURN. ADDITIONAL FILING REQUIREMENTS FOR CATEGORY 3 FILERS: 1. THE AMOUNT AND TYPE OF ANY INDEBTEDNESS THE FOREIGN CORPORATION HAS WITH THE RELATED PERSONS DESCRIBED IN REGULATION SEC. 1.6046-1(B)(11). N/A - THERE IS NO INDEBTEDNESS BETWEEN CATALYST INSURANCE, LTD. AND RELATED PARTIES. 2. THE NAME, ADDRESS, INDENTIFYING NUMBER AND NUMBER OF SHARES SUBSCRIBED TO BY EACH SUBSCRIBER TO THE FOREIGN CORPORATION'S STOCK. N/A - THERE ARE CURRENTLY NO SUBSCRIPTIONS FOR ANY OF CATALYST INSURANCE, LTD.'S STOCK. |
| FORM 5471, SCHEDULE E, PART I THROUGH III; AND SCHEDULE E-1 | THE CONTROLLED FOREIGN CORPORATION FOR WHICH THIS INFORMATIONAL RETURN IS BEING FILED IS A TAX RESIDENT IN THE CAYMAN ISLANDS AND AS A CORPORATION ORGANIZED UNDER THE LAWS OF THE CAYMAN ISLANDS, THE CONTROLLED FOREIGN CORPORATION IS NOT SUBJECT TO TAXATION AS THE CAYMAN ISLANDS DOES NOT IMPOSE ANY FORM OF TAXATION ON RECEIPTS, DIVIDENDS, CAPITAL GAINS, GIFTS OR NET INCOME. SCHEDULE E, WHICH REPORTS FOREIGN TAXES PAID OR ACCRUED AND IS REQUIRED TO BE ATTACHED TO THIS RETURN, IS BEING FILED BUT DOES NOT HAVE ANY AMOUNTS SHOWN BECAUSE NO FOREIGN TAXES WERE PAID OR ACCRUED. |
| Software ID: | |
| Software Version: |