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 |
||||||
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.") .. | 2,799,516 | 865,190 | 413,968 | 625,400 | 295,279 | 4,999,353 |
| 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 | 2,799,516 | 865,190 | 413,968 | 625,400 | 295,279 | 4,999,353 |
| 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).. | 2,107,560 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 2,891,793 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,799,516 | 865,190 | 413,968 | 625,400 | 295,279 | 4,999,353 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 177,563 | 298,272 | 2,968,367 | 3,054,086 | 2,311,391 | 8,809,679 |
| 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.).. | 4,028 | 46,655 | 37,022 | 8,217 | 95,922 | |
| 11 | Total support. Add lines 7 through 10 | 13,904,954 | |||||
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) |
||||
| 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. |
||||
| 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) |
||||
| 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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
||||
| 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 |
|---|
| FACTS AND CIRCUMSTANCES TEST IN REGULATIONS 1.170A-9(F)(3)MEMORIAL FOUNDATION INC. (THE REPORTING ORGANIZATION) MAINTAINS A STAFF ACTIVELY ENGAGED IN SUPPORT OF ITS MISSION TO ENHANCE COMMUNITY SUPPORT OF PROVIDING EXCEPTIONAL HEALTHCARE AND COMPASSIONATE SERVICES TO THE COMMUNITY SERVED BY ITS AFFILIATE HOSPITALS (PROTESTANT MEMORIAL MEDICAL CENTER, INC.). THE ORGANIZATION PLANS AND CONDUCTS VARIOUS FUNDRAISING ACTIVITIES AND SPONSORS COMMUNITY EDUCATION OPPORTUNITIES. BASED ON ALL OF THE FACTS AND CIRCUMSTANCES, THE ORGANIZATION MEETS THE FACTS AND CIRCUMSTANCES TEST IN REGULATIONS 1.170A-9(F)(3).10% SUPPORT LIMITATIONTHE PERCENTAGE OF SUPPORT NORMALLY RECEIVED BY THE ORGANIZATION FROM GOVERNMENTAL UNITS OR THE GENERAL PUBLIC IS GREATER THAN 10%. FOR THE CURRENT TAX YEAR (2020), THE ORGANIZATION'S PERCENTAGE OF PUBLIC SUPPORT IS 21%.ATTRACTION OF PUBLIC SUPPORTTHE ORGANIZATION SOLICITS FUNDS FROM THE GENERAL PUBLIC, COMMUNITY GROUPS, GOVERNMENTAL UNITS, AND OTHER PUBLIC CHARITIES ON A CONTINUOUS BASIS. SPECIFICALLY, THE ORGANIZATION SOLICITS SUPPORT FROM THE GENERAL PUBLIC BY HAVING A LINK AVAILABLE ON THE ORGANIZATION'S WEBSITE FOR THE GENERAL PUBLIC TO DONATE. ADDITIONALLY, THE ORGANIZATION HAS STAFF, INCLUDING AN EXECUTIVE DIRECTOR WHO IS DEDICATED TO FUNDRAISING FROM THE GENERAL PUBLIC, COMMUNITY GROUPS, GOVERNMENTAL UNITS AND OTHER PUBLIC CHARITIES. FURTHER, IN PRE-COVID YEARS (2019 AND EARLIER), THE ORGANIZATION CONDUCTS SPECIFIC FUNDRAISING EVENTS SUCH AS A GOLF TOURNAMENT AND AN ANNUAL GALA TO SUPPORT ORGANIZATION INITIATIVES. FOR EXAMPLE, THE ORGANIZATION'S ANNUAL GOLF TOURNAMENT RAISES FUNDS FOR NEEDED MEDICAL EQUIPMENT AT THE ORGANIZATION'S AFFILIATE HOSPITAL. DUE TO COVID-19 PANDEMIC AND IN 2020 THE STATE OF ILLINOIS' RESTRICTIONS ON PUBLIC GATHERING, THE ORGANIZATION ADAPTED AND CHANGED ITS GALA TO A VIRTUAL EVENT TO ALLOW FOR CONTINUOUS FUNDRAISING. THE ORGANIZATION CONTINUES TO EXPLORE OPTIONS FOR SOLICITING PUBLIC SUPPORT FROM DONORS OTHER THAN NORMAL IN PERSON EVENTS.PERCENTAGE OF FINANCIAL SUPPORTHISTORICALLY, THE ORGANIZATION HAS BEEN PUBLICLY SUPPORTED. SPECIFICALLY, THE ORGANIZATION'S PUBLIC SUPPORT SINCE 2016 IS AS FOLLOWS:TAX YEAR PERCENTAGE OF PUBLIC SUPPORT2016 59%2017 50%2018* 38%2019 27%2020 21%*IN 2018, THE ORGANIZATION RECEIVED A $100,000,000 EQUITY TRANSFER FROM BJC HEALTH SYSTEM, A 501(C)(3) CHARITABLE NONPROFIT ORGANIZATION AND SUPPORTING ORGANIZATION FOR VARIOUS CHARITABLE NONPROFIT HOSPITALS. SINCE THAT TIME, IN TAX YEARS 2019 AND 2020, THE ORGANIZATION'S PUBLIC SUPPORT HAS DECREASED DUE TO THE INVESTMENT INCOME GENERATED BY THE 2018 CONTRIBUTION.SOURCES OF SUPPORTTHE ORGANIZATION RECEIVES SUPPORT FROM NUMEROUS PERSONS, INCLUDING, BUT NOT LIMITED TO, INDIVIDUALS, BUSINESSES, AND OTHER ORGANIZATIONS. THE ORGANIZATION ANNUALLY HAS OVER 100 DIFFERENT DONORS PROVIDING VARYING LEVELS OF SUPPORT AS IDENTIFIED ON THE ORGANIZATION'S WEBSITE. THE ORGANIZATION APPEALS TO A LARGE PORTION OF THE POPULATION IN SOUTHWESTERN ILLINOIS AS IT SUPPORTS TWO HOSPITALS OWNED BY PROTESTANT MEMORIAL MEDICAL CENTER, INC. AS WELL AS THE SOUTHWESTERN ILLINOIS COMMUNITY.REPRESENTATIVE GOVERNING BODYTHE ORGANIZATION'S BOARD OF DIRECTORS REFLECTS THE BROAD INTERESTS OF THE SOUTHWESTERN ILLINOIS COMMUNITY. SPECIFICALLY, THE ORGANIZATION IS GOVERNED BY A BOARD THAT CONSISTS PRIMARILY OF COMMUNITY LEADERS WITH AN EXPERTISE OR INTEREST IN HEALTHCARE. THE BOARD REPRESENTS A BROAD CROSS-SECTION OF THE VIEWS AND INTEREST OF THE COMMUNITIES SERVED BY THE ORGANIZATION'S AFFILIATE HOSPITALS. TEN OF THE 11 BOARD MEMBERS ARE INDEPENDENT FROM THE ORGANIZATION (I.E. NOT EMPLOYEES OF THE ORGANIZATION OR ITS AFFILIATES). AVAILABILITY OF PUBLIC FACILITIES OR SERVICES; PARTICIPATION IN PROGRAMS OR POLICIESTHE ORGANIZATION PROVIDES SERVICES DIRECTED TO THE BENEFIT OF THE GENERAL PUBLIC ON A CONTINUING BASIS. SPECIFICALLY, THE ORGANIZATION PROVIDES PATIENT SUPPORT FOR HEALING, HEALTH PROFESSIONS EDUCATIONAL SCHOLARSHIPS, SUPPORT FOR HOSPICE PROGRAMS, EDUCATIONAL EVENTS SUCH AS PROVIDING INFORMATION FOR ATHLETIC TRAINERS AT HIGH SCHOOL SPORTING EVENTS, PROVIDING INFORMATION AT HEART HEALTH AWARENESS EVENTS AND OTHER COMMUNITY SUPPORT.ALSO, THE ORGANIZATION FUNDRAISES TO SUPPORT THE GENERAL PUBLIC WITH TWO SPECIFIC FUNDS, THE INDIGENT CARE FUND AND EMERGENCY FUND. THE INDIGENT CARE FUND SUPPORTS PATIENTS THAT MAY NEED FINANCING ASSISTANCE COVERING HOSPITAL EXPENSES. THE EMERGENCY FUND PROVIDES AN OPPORTUNITY TO UNDERWRITE THE COSTS OF EQUIPMENT, SUPPLIES, MATERIALS, SPECIALIZED EDUCATION OR ANY NEED THAT MAY ARISE DURING A DISASTER SITUATION, SUCH AS COVID-19. |
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | BEE FARM - 2016 AMOUNT: $ 0. 2017 AMOUNT: $ 4,028. 2018 AMOUNT: $ 15,860. 2019 AMOUNT: $ 15,296. 2020 AMOUNT: $ 8,007. GRANT RECOVERIES - 2018 AMOUNT: $ 30,795. 2019 AMOUNT: $ 21,726. 2020 AMOUNT: $ 210. |
| SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: | THE BALANCE IS MADE UP OF (1) RECOVERY OF PRIOR YEAR GRANTS $210 AND (2) MEMORIAL FOUNDATION, INC (MFI) RECEIVED A SHARE OF A FARM VIA BEQUEST MANY YEARS AGO. MFI OWNS ONE-THIRD OF THE FARM WITH TWO OTHER TAX EXEMPT ORGANIZATIONS. GRANT RECOVERIES $210 FARM INCOME $8,007 TOTAL $8,217 |
| 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 6 | THE CORPORATE MEMBER OF MEMORIAL FOUNDATION, INC. IS MEMORIAL REGIONAL HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMORIAL REGIONAL HEALTH SERVICES, INC. HAS THE POWER TO ELECT, REMOVE, AND REPLACE ANY DIRECTOR. |
| FORM 990, PART VI, SECTION A, LINE 7B | CHANGES TO BYLAWS OR GOVERNING DOCUMENTS ARE SUBJECT TO APPROVAL BY MEMORIAL REGIONAL HEALTH SERVICES, INC. BOARD OF TRUSTEES AND THE BJC BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION B, LINE 11B | DIRECTORS OF MEMORIAL FOUNDATION, INC. ARE PROVIDED A COPY OF THE TAX RETURN PRIOR TO FILING FOR REVIEW. ANY DISCREPANCIES OR QUESTIONS ARE RESOLVED BY THE VICE PRESIDENT OF FINANCE PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS COMPLIANCE WITH THE POLICY BY ISSUING ANNUALLY A CONFLICT OF INTEREST QUESTIONNAIRE REMINDING COVERED INDIVIDUALS OF THEIR OBLIGATIONS TO DISCLOSE POTENTIAL CONFLICTS AND REQUESTING THAT THEY COMPLETE A CONFLICTS OF INTEREST QUESTIONNAIRE. THE QUESTIONNAIRE REQUIRES THE DISCLOSURE OF CONFLICTS AND AN ATTESTATION TO THEIR CONTINUING OBLIGATION TO DISCLOSE SAID CONFLICTS SHOULD THE NEED ARISE. THE RESULTS OF THE CONFLICT OF INTEREST QUESTIONNAIRE ARE REVIEWED BY A CENTRALIZED COMPLIANCE DEPARTMENT AND APPROPRIATE ACTION IS TAKEN AS NECESSARY. SHOULD THE ORGANIZATION BECOME AWARE OF A CONFLICT NOT PREVIOUSLY REPORTED, ITS GENERAL COUNSEL WOULD INVESTIGATE THE ISSUE AND RESPOND IN ACCORDANCE WITH THE POLICY. |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON FILING FORM 990 AND SUPPORTING SCHEDULES, PUBLIC DISCLOSURE COPIES ARE AVAILABLE FOR PUBLIC INSPECTION IN THE OFFICE OF THE PRESIDENT OF MEMORIAL FOUNDATION, INC. DURING REGULAR BUSINESS HOURS OF 8:30 A.M.-5:00 P.M. COPIES ARE PROVIDED UPON REQUEST FOR A NOMINAL FEE WRITTEN REQUESTS ARE HONORED WITHIN 30 DAYS AND REQUESTS IN PERSON ARE PROVIDED ON THE DAY OF REQUEST, MEMORIAL FOUNDATION, INC. PROVIDES FOR PUBLIC INSPECTIONS THE MOST RECENT THREE YEARS OF FILINGS. MEMORIAL FOUNDATION, INC. DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| FORM 990, PART XI, LINE 9: | MEMORIAL HOSPITAL TRANSFER 302,875. |
| Software ID: | |
| Software Version: |