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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 8,300,000 | 585,081 | 4,894,562 | 13,779,643 | ||
| 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 | 8,300,000 | 585,081 | 4,894,562 | 13,779,643 | ||
| 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. | 13,779,643 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 8,300,000 | 585,081 | 4,894,562 | 13,779,643 | ||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 17,736 | 258,167 | 295,812 | 571,715 | ||
| 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 | 14,351,358 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 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 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| 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 2 | THE HEALTHY LAKEWOOD FOUNDATION INITIATED ITS FIRST YEAR OF GRANTMAKING BY AWARDING 334,500 TO 10 SEPARATE ORGANIZATIONS TO ADDRESS COMMUNITY NEEDS STEMMING FROM THE OUTBREAK OF THE COVID-19 CRISIS. |
| FORM 990, PAGE 2, PART III, LINE 3 | WE'VE ASKED EACH ORGANIZATION TO REPORT ON THE IMPACT OF EACH PROGRAM IN OUR EFFORT TO HELP ADDRESS THE PANDEMIC. |
| FORM 990, PAGE 2, PART III, LINE 4A | THE VISION OF HEALTHY LAKEWOOD FOUNDATION IS "LAKEWOOD IS A PLACE WHERE ALL PEOPLE ACHIEVE THEIR FULLEST HEALTH POTENTIAL". THE GUIDING PRINCIPLES OF THE HEALTHY LAKEWOOD FOUNDATION ARE AS FOLLOWS: - THE STEWARDSHIP OF RESOURCES IS ROOTED IN HUMILITY, INTEGRITY, AND COMMUNITY VOICE. - ORGANIZATIONAL PRACTICES SHOULD BE TRANSPARENT AND INFORMED BY AUTHENTIC DIALOGUE AND ENGAGEMENT. - HEALTH AND WELLNESS CAN BE PROMOTED IN WAYS THAT ARE BOTH INNOVATIVE AND EVIDENCE-BASED. - OPPORTUNITIES, STRATEGIES, AND INITIATIVES SHOULD LEVERAGE NEW AND EXISTING RESOURCES THAT RESULT IN SUSTAINABLE IMPACT. - POSITIVE CHANGE IS DRIVEN BY SHARED PRIORITIES, COORDINATED EFFORTS, AND TRUST. EARLY IN 2020, HLF APPOINTED OFFICERS AND ELECTED LEADERSHIP. THE STRATEGIC FRAMEWORK, WHICH SET GUIDELINES AND PRIORITIES FOR FUNDING OVER THE NEXT THREE YEARS AND INCLUDES OTHER GUIDING PRINCIPLES WAS ADOPTED. AS PART OF THE STRATEGIC FRAMEWORK, HLF DECIDED TO OPERATE IN PERPETUITY TO SERVE THE LAKEWOOD COMMUNITY. DUE TO THE COVID-19 CRISIS, IN MARCH HLF DECIDED TO PIVOT ITS FUNDING PLANS AND PRIORITIES. HLF IDENTIFIED ORGANIZATIONS THAT COULD QUICKLY MEET THE DEMANDS OF OUR COMMUNITY MEMBERS MOST IN NEED, AND MADE THE INITIAL ROUND OF GRANTS IN MARCH. FOR THE 2020 GRANTMAKING CYCLE, HLF IS COMMITTED TO PROVIDING PROACTIVE FUNDING TO MEET COMMUNITY NEEDS RELATED TO THE COVID-19 CRISIS. GRANTS AWARDED 2020 25,000 TO THE LEGAL AID SOCIETY OF CLEVELAND FOR SERVICES AND OUTREACH TO LAKEWOOD RESIDENTS. 25,000 TO THE YMCA OF GREATER CLEVELAND, TO SUPPORT ITS EXPANSION OF CAPACITY TO PROVIDE SCHOOL-DAY CARE TO SCHOOL-AGE CHILDREN WHILE LEARNING IS REMOTE. 85,000 TO THE LAKEWOOD COMMUNITY SERVICES CENTER, FOR FOOD DISTRIBUTION TO LAKEWOOD RESIDENTS. 32,000 TO THE LAKEWOOD CITY SCHOOLS, FOR DIGITAL CONNECTIVITY FOR FAMILIES WITH SCHOOL-AGE CHILDREN . 10,000 TO THE LAKEWOODALIVE, FOR HOUSING OUTREACH FOR SENIORS AND LOW- MODERATE INCOME RESIDENTS. 25,000 TO THE DEPARTMENT OF HUMAN SERVICES, CITY OF LAKEWOOD TO BE USED FOR FOOD ASSISTANCE, GROCERY/DRUG STORE GIFT CARDS FOR DISTRIBUTION TO RESIDENTS IN NEED, RTA FARE CARDS, PRESCRIPTION ASSISTANCE AND/OR OTHER TRANSPORTATION ASSISTANCE. 50,000 TO LAKEWOOD COMMUNITY SERVICES CENTER TO BE USED FOR FOOD DISTRIBUTION. 57,500 TO HFLA OF NORTHEAST OHIO TO ESTABLISH A POOL OF COVID-19 EMERGENCY LOANS EXCLUSIVELY FOR LAKEWOOD RESIDENTS. 15,000 TO ASIAN SERVICES IN ACTION, INC. (ASIA, INC.) TO MEET THE EMERGENCY NEEDS OF REFUGEE AND IMMIGRANT FAMILIES IN LAKEWOOD. 60,000 TO THE DEPARTMENT OF HUMAN SERVICES, CITY OF LAKEWOOD FOR RESIDENT EMERGENCY NEEDS. COVID-19 RESPONSE 2020 GRANTMAKING WILL FOCUS ON COMMUNITY NEEDS STEMMING FROM THE OUTBREAK OF THE COVID-19 CRISIS. THE FOUNDATION WILL BE TAKING A PHASED APPROACH FOR THE REMAINDER OF THE YEAR TO RESPOND WITH ADDITIONAL GRANTS TO MEET NEEDS IN THE COMMUNITY AS THE CRISIS UNFOLDS. GRANTMAKING FOCUS AREA GRANTS ARE LIMITED TO PROJECTS AND EFFORTS THAT ADDRESS THE NEEDS OF LAKEWOOD RESIDENTS. THE PROJECTS AND EFFORTS SHOULD PRIMARILY SERVE THE FOLLOWING VULNERABLE POPULATIONS: SINGLE-PARENT HEADS OF HOUSEHOLD OF MINOR CHILDREN; CHILDREN/YOUTH; SENIORS; REFUGEES/IMMIGRANTS FUTURE GRANTMAKING REMAINING GRANT FUNDS FOR 2020 WILL BE DEDICATED TO MEETING COMMUNITY NEEDS STEMMING FROM THE COVID-19 CRISIS. THESE WILL BE SELECTED THROUGH PROACTIVE OUTREACH TO COMMUNITY GOVERNMENT LEADERS AND NONPROFIT LEADERSHIP. DETAILS FOR GRANTMAKING IN 2021 WILL BE AVAILABLE AT A LATER TIME. HLF INTENDS TO LAUNCH AN OPEN APPLICATION PROCESS FOR GRANTS IN 2021 AND HOPES TO PROVIDE A COMBINATION OF OPPORTUNITY, COMMUNITY, AND SYSTEMS CHANGE GRANTS. |
| FORM 990, PAGE 6, PART VI, LINE 7A | AS LONG AS THE CLEVELAND CLINIC IS FUNDING HEALTHY LAKEWOOD FOUNDATION, THEY HAVE THE ABILITY TO APPOINT 2 OF THE 17 BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | AFTER PREPARATION BY THE TERASURER, THE FORM 990 WAS REVIEWED BY AN ATTORNEY AND AN INDEPENDENT CPA. HEALTHY LAKEWOOD FOUNDATION THEN CIRCULATED A COPY OF THE FORM 990 TO ITS DIRECTORS BY WAY OF ITS GOOGLE DOCUMENTS EMAIL FOR REVIEW BY EACH AND EVERY BOARD MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 12C | BOARD MEMBERS ARE REQUIRED TO ANNUALLY DISCLOSE INTERESTS THAT MAY CREATE A CONFLICT. THE BOARD REVIEWS ANY DISCLOSED CONFLICTS AND DECIDES IF ANY FURTHER ACTION NEED BE TAKEN. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATIONAL DOCUMENTS FOR HEALTHY LAKEWOOD FOUNDATION CAN BE FOUND AT HEALTHYLAKEWOODFOUNDATION.ORG. |
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