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.") .. | 7,023,461 | 9,797,687 | 4,562,227 | 5,341,344 | 6,746,770 | 33,471,489 |
| 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 | 7,023,461 | 9,797,687 | 4,562,227 | 5,341,344 | 6,746,770 | 33,471,489 |
| 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).. | 8,101,388 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 25,370,101 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 7,023,461 | 9,797,687 | 4,562,227 | 5,341,344 | 6,746,770 | 33,471,489 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 106,963 | 99,310 | 162,681 | 171,170 | 160,053 | 700,177 |
| 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 | 34,171,666 | |||||
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) |
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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): |
|||||
| 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, PART V, LINE 2 | TRINITAS HEALTH FOUNDATION IS AN AFFILIATE IN A GROUP OF WHICH TRINITAS REGIONAL MEDICAL CENTER, (EIN 22-3601678) IS CONSIDERED A COMMON PAY AGENT FOR W-2 REPORTING. TRINITAS REGIONAL MEDICAL CENTER REPORTS ALL EMPLOYEES ON ITS FORM W-3; HOWEVER, EACH AFFILIATE HAS EMPLOYEES ALLOCATED TO THAT ENTITY. PER IRS INSTRUCTIONS, EMPLOYEES LISTED ON PART V LINE 2 ARE THOSE WHO HAVE BEEN DEEMED TO BE EMPLOYEES OF THIS ORGANIZATION. TRINITAS HEALTH FOUNDATION DOES NOT REPORT THESE EMPLOYEES ON A SEPARATE W-3 UNDER ITS OWN EIN. |
| FORM 990, PART VI, SECTION A, LINE 6 | TRINITAS HEALTH IS THE SOLE MEMBER OF TRINITAS HEALTH FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | TRINITAS HEALTH IS THE SOLE MEMBER OF TRINITAS HEALTH FOUNDATION. THERE ARE CLASS A AND CLASS B MEMBERS OF TRINITAS HEALTH. THEY HAVE EQUAL RIGHTS TO THE ELECTION AND REMOVAL OF TRUSTEES OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | TRINITAS HEALTH IS THE SOLE MEMBER OF TRINITAS HEALTH FOUNDATION. THERE ARE CLASS A AND CLASS B MEMBERS. THEY HAVE EQUAL RIGHTS TO: I) THE AMENDMENT OF THE CERTIFICATE OF INCORPORATION OR THE BYLAWS OF THE FOUNDATION; II) THE MERGER OR CONSOLIDATION OF THE FOUNDATION WITH ANY OTHER CORPORATION; III) VOLUNTARY DISSOLUTION OR VOLUNTARY LIQUIDATION OF THE FOUNDATION OR THE SALE, LEASE, TRANSFER OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF ITS PROPERTY OR ASSETS; IV) THE SALE, LEASE, TRANSFER, EXCHANGE, OR ENCUMBRANCE OF ANY LAND, BUILDINGS OR OTHER IMMOVABLE GOODS OR FIXED ASSETS OF THE FOUNDATION OR IN WHICH THE FOUNDATION HAS OR WILL HAVE EQUITABLE OR LEGAL TITLE IN EXCESS OF $3,000,000 (DOLLAR AMOUNTS IN ACCORDANCE WITH THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS REGULATIONS); V) THE INCURRENCE OF ANY DEBT (INCLUDING CAPITAL LEASES AND ANY REFINANCING INDEBTEDNESS) IN EXCESS OF $3,000,000 (DOLLAR AMOUNTS IN ACCORDANCE WITH THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS REGULATIONS); VI) THE APPOINTMENT OR REMOVAL OF THE FOUNDATION'S OFFICERS, AND; VII) ANY OTHER MATTER THAT REQUIRES THE APPROVAL OF THE MEMBERS OF A NONPROFIT CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | A COPY OF THE FORM 990 WAS PROVIDED TO EACH MEMBER OF THE EXECUTIVE COMMITTEE OF THE TRINITAS REGIONAL MEDICAL CENTER BOARD OF TRUSTEES PRIOR TO ITS FILING WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 WAS PRESENTED IN DETAIL TO THE EXECUTIVE COMMITTEE BY THE MEDICAL CENTER'S TAX PREPARER. COMMENTS, QUESTIONS, AND/OR SUGGESTIONS FROM THAT MEETING WERE INCORPORATED INTO THE FINAL FORM 990 PRIOR TO ITS FILING. AN OVERVIEW ON THE FINAL VERSION OF THE FORM 990 WAS PRESENTED TO THE FULL BOARD OF TRUSTEES. THE EXECUTIVE COMMITTEE APPROVED THE FORM 990 FOR FILING AFTER A FINAL REVIEW OF THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS, DIRECTORS, KEY EMPLOYEES, AND PERSONNEL THAT ENGAGE IN ACTIVITIES ON BEHALF OF THE FOUNDATION ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY OF THE PARENT ORGANIZATION, TRINITAS REGIONAL MEDICAL CENTER. AS PART OF EMPLOYMENT (OR BOARD SERVICE) WITH THE MEDICAL CENTER, EACH EMPLOYEE IS REQUIRED TO ANNUALLY DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO A CONFLICT, WHETHER THE SERVICES THEY RENDER ARE TO THE FOUNDATION OR TO THE MEDICAL CENTER ITSELF. COMPLIANCE WITH THE POLICY IS MONITORED BY TRINITAS REGIONAL MEDICAL CENTER THROUGH ITS COMPLIANCE OFFICE TO ENSURE THAT NO MATERIAL CONFLICTS EXIST. TO THE EXTENT THAT ANY CONFLICTS ARE DISCOVERED, THEY ARE RESOLVED EXPEDITIOUSLY. ANY BOARD MEMBER OR OFFICER HAVING AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST SHALL NOT BE PRESENT DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER THE CIRCUMSTANCES NOT GIVING RISE TO A CONFLICT OF INTEREST, THE GOVERNING BOARD SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER THE PROPOSED TRANSACTION IS FAIR AND REASONABLE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AND AT MANAGEMENT'S DISCRETION. |
| FORM 990, PART XI, LINE 9: | CHANGE IN VALUE OF SPLIT-INTEREST AGREEMENT -287. |
| FORM 990, PART VI, SECTION B, LINES 13 AND 14 | THE TRINITAS HEALTH FOUNDATION OPERATES UNDER THE WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES OF ITS RELATED ORGANIZATION, TRINITAS REGIONAL MEDICAL CENTER. COMPLIANCE WITH BOTH POLICIES FOR ALL PERSONNEL ENGAGED IN ACTIVITIES ON BEHALF OF THE FOUNDATION IS MANDATORY. |
| Software ID: | |
| Software Version: |