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 | |||||
| (A)
ASPIRUS MEDFORD HOSPITAL & CLINICS INC |
390964813 | 3 | No | 125,000 | 0 | |
|
Total 1
|
125,000 | 0 | ||||
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 | ||||||
| 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 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) |
||||
| 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. |
||||
|
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. |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SECTION A, LINE 1 | MEMORIAL MEMBER ASSOCIATION'S GOVERNING DOCUMENTS DO NOT LIST ASPIRUS MEDFORD FOUNDATION, INC; HOWEVER, THE GOVERNING DOCUMENTS INDICATE MEMORIAL MEMBER ASSOCIATION MAY SUPPORT OTHER ORGANIZATIONS EXEMPT FROM TAXATION AND QUALIFIED AS NON-PRIVATE FOUNDATIONS AS MAY BE AFFILIATED WITH MEMORIAL MEMBER ASSOCIATION. THE PURPOSES OF MEMORIAL MEMBER ASSOCIATION INCLUDES BUT IS NOT LIMITED TO: - ORGANIZED AND OPERATED FOR THE BENEFIT OF, PERFORM THE FUNCTIONS OF, AND CARRY OUT THE PURPOSES OF ASPIRUS MEDFORD HOSPITAL & CLINICS, INC., A TAX EXEMPT ORGANIZATION. - SOLICIT, RECEIVE, OR OTHERWISE ACQUIRE, HOLD, MANAGE, INVEST, AND EXPEND ENDOWMENT FUNDS AND OTHER GIFTS, GRANTS AND BEQUESTS, WHETHER CONSISTING OF REAL ESTATE OR PERSONAL PROPERTY, AND WHETHER SUBJECT TO DIRECTIONS OR CONDITIONS IMPOSED BY THE DONOR, EXCLUSIVELY FOR THE BENEFIT AND ADVANCEMENT OF THE SUPPORTED ORGANIZATIONS, AND SUCH OF ITS RESEARCH, EDUCATION, CHARITABLE PROGRAMS, OR ACTIVITIES AS THE BOARD OF DIRECTORS OF THIS CORPORATION FROM TIME TO TIME DEEM TO BE SUITABLE AND APPROPRIATE. |
| PART IV, SECTION C, LINE 1 | ALTHOUGH THE ORGANIZATION'S DIRECTORS DURING THE TAX YEAR WERE NOT ALSO A MAJORITY OF THE DIRECTORS OF THE FOUNDATION, AS THE SOLE MEMBER OF ASPIRUS MEDFORD FOUNDATION, INC., MEMORIAL MEMBER ASSOCIATION RETAINS THE POWER TO DO THE FOLLOWING: TO REVIEW AND APPROVE AUDITED FINANCIAL REPORTS OF THE FOUNDATION; TO APPROVE THE TRANSFER, MERGER OR DISSOLUTION OF THE FOUNDATION OR SALE, LEASE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE FOUNDATION; TO SELECT THE INDEPENDENT AUDITING FIRM; TO APPROVE ANY ACTION WHICH WOULD CHANGE THE CHARACTER OF THE FOUNDATION; TO APPROVE ALL AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS OF THE FOUNDATION; TO APPROVE THE APPOINTMENT OR TERMINATION OF THE EXECUTIVE DIRECTOR OF THE FOUNDATION; TO APPROVE LONG-TERM BORROWING OF MONEY AND OTHER FORMS OF LONG-TERM INDEBTEDNESS; TO APPOINT AND REMOVE ALL MEMBERS OF THE BOARD OF DIRECTORS OF THE FOUNDATION. |
| SECTION A, LINE 6 | COMMUNITY INVESTMENT FUNDING REQUESTS CAN APPLY TO EITHER MEMORIAL MEMBER ASSOCIATION, INC. (MMA) OR THE ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. (AMHC) COMMUNITY BENEFIT PROGRAM. THE COMMUNITY BENEFIT PROGRAM TYPICALLY ADDRESSES ANY REQUESTS UNDER $25,000 AND IS CONSISTENT WITH THE TOP THREE HEALTH NEEDS IDENTIFIED BY AMHC'S COMMUNITY HEALTH NEEDS ASSESSMENT. MMA ADDRESSES THE REQUESTS OVER $25,000 AND EXCEPTIONS TO APPROVE FUNDING ABOVE THE SPENDING POLICY CAN BE MADE WITH APPROVAL OF THE MMA BOARD. THE REVIEW COMMITTEE CONSISTS OF MMA BOARD REPRESENTATIVE(S) AND THE COMMUNITY BENEFIT PROGRAM DIRECTOR (AMHC). |
| 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 3 | MEMORIAL MEMBER ASSOCIATION DELEGATES CONTROL OF MANAGEMENT DUTIES TO ASPIRUS MEDFORD HOSPITAL & CLINICS, INC., A 501(C)(3) ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS THREE CLASSES OF MEMBERSHIP (1) MEMBERS ADMITTED BY APPLICATION (NO DUES REQUIRED) - INCLUDING BONA FIDE CIVIC, CHARITABLE, FRATERNAL, VETERANS, TRADE, AND PROFESSIONAL ORGANIZATIONS, (2) MEMBERS ADMITTED BY PAYMENT OF MEMBERSHIP FEE - THOSE WHO CONTRIBUTE $500 OR MORE TO THE ORGANIZATION OR TO ASPIRUS MEDFORD HOSPITAL & CLINICS, INC., ARE CONSIDERED LIFE MEMBERS WITH LIFETIME VOTING RIGHTS, YEAR-LONG MEMBERSHIP IS GRANTED FOR $5 DONATED TO THE ORGANIZATION, AND (3) SPECIAL MEMBERSHIP - ALL MEMBERS OF THE AMHC VOLUNTEERS MEMBERSHIP CRITERIA IS FURTHER DEFINED BY THE ORGANIZATION'S BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEMBERS ELECT THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS MUST APPROVE ALL AMENDMENTS TO, OR RESTATEMENTS OF, THE ARTICLES OF INCORPORATION AND THE BYLAWS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ACCOUNTING DEPARTMENT ACCUMULATES ALL 990 INFORMATION. THESE DOCUMENTS ARE REVIEWED BY THE CFO. THE 990 IS REVIEWED BY OTHER SENIOR MANAGEMENT PRIOR TO SUBMISSION TO THE INTERNAL REVENUE SERVICE AND ARE MADE AVAILABLE TO THE BOARD OF DIRECTORS THROUGH DIRECTOR'S DESK OR OTHER MEANS OF ELECTRONIC RETRIEVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OR COMMITTEE TO WHICH SUCH DISCLOSURE IS MADE SHALL THEREUPON DETERMINE, BY MAJORITY VOTE, WHETHER THE DISCLOSURE SHOWS THAT A CONFLICT OF INTEREST EXISTS OR CAN REASONABLY BE CONSTRUED TO EXIST. IF A CONFLICT IS DEEMED TO EXIST, SUCH PERSON SHALL NOT VOTE ON, NOR USE PERSONAL INFLUENCE ON, OR PARTICIPATE (OTHER THAN TO PRESENT FACTUAL INFORMATION TO OR RESPOND TO QUESTIONS) IN THE DISCUSSIONS AND DELIBERATIONS WITH RESPECT TO SUCH CONTRACT OR TRANSACTIONS. SUCH PERSON MAY BE COUNTED IN DETERMINING THE EXISTENCE OF A QUORUM AT ANY MEETING WHERE THE CONTRACT OR TRANSACTION IS UNDER DISCUSSIONS OR IS BEING VOTED UPON. THE MINUTES OF THE MEETING SHALL REFLECT THE DISCLOSURE MADE, THE VOTE THEREON AND, WHERE APPLICABLE, THE ABSTENTION FROM VOTING AND PARTICIPATION, AND WHETHER A QUORUM WAS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | FOR PURPOSES OF DETERMINING COMPENSATION, MEMORIAL MEMBER ASSOCIATION, INC. RELIED ON RELATED ORGANIZATIONS TO ESTABLISH THE COMPENSATION OF THE CEO, OTHER OFFICERS, AND KEY EMPLOYEES. THE RELATED ORGANIZATIONS USED THE FOLLOWING PRACTICES FOR ESTABLISHING COMPENSATION FOR SUCH INDIVIDUALS: COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY, GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VI, SECTION A, LINE 3: | AT THE OPTION OF THE BOARD OF DIRECTORS, AN EXECUTIVE COMMITTEE MAY BE CREATED, TO CONSIST OF THE CHAIRMAN, VICE CHAIRMAN, SECRETARY, AND TREASURER OF THE CORPORATION IF ESTABLISHED, THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE PERIOD BETWEEN THE MEETINGS OF THE BOARD OF DIRECTORS, SUBJECT TO ANY PRIOR LIMITATIONS IMPOSED BY THE BOARD OF DIRECTORS. IN ADDITION, THE EXECUTIVE COMMITTEE SHALL RECOMMEND TO THE FULL BOARD OF DIRECTORS THE APPOINTMENT OF A PERSON OR PERSONS TO FILL ANY VACANCY AMONG THE DIRECTORS OF ASPIRUS MEDFORD HOSPITAL & CLINICS, INC. THAT ARE APPOINTED BY THE CORPORATION. |
| FORM 990, PART VII, SECTION A | ALL MEMBERS OF MEMORIAL MEMBER ASSOCIATION, INC.'S BOARD OF DIRECTORS SERVE ON THE BOARD OF CEDAR COURT APARTMENTS, INC. MATTERS INVOLVING CEDAR COURT APARTMENTS, INC. ARE RESOLVED DURING REGULARLY SCHEDULED MEETINGS OF MEMORIAL MEMBER ASSOCIATION, INC.'S BOARD, AS SUCH, NO ADDITIONAL TIME HAS BEEN ALLOCATED TO THE RELATED ORGANIZATION. |
| FORM 990, PART XI, LINE 9: | EQUITY ADJUSTMENT - AMH 6,997,070. EQUITY ADJUSTMENT - AES -194,348. EQUITY ADJUSTMENT - AMF -105,213. |
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| Software Version: |