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)
RYANCHELSEA-CLINTON COMMUNITY HEALTH CENTER INC |
133911827 | 10 | Yes | 298,992 | 0 | |
| (B)
WILLIAM F RYAN COMMUNITY HEALTH CENTER INC |
132884976 | 10 | Yes | 3,089,561 | 0 | |
|
Total 2
|
3,388,553 | 0 | ||||
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 | 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 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 |
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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 3 | WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC., A RELATED TAX-EXEMPT ORGANIZATION, PROVIDES GENERAL OVERSIGHT AND FINANCIAL MANAGEMENT SERVICES TO THE FOUNDATION. DURING THE 2020 TAX YEAR, THE FOUNDATION PAID WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC. $120,000 FOR THESE SERVICES. BRIAN MCINDOE AND SCOTT MORGAN WERE PAID BY WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC.. THEIR 2020 COMPENSATION IS REPORTED IN PART VII, SECTION A AND IS ALSO REPORTED ON SCHEDULE J, PART II. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE AFIA FOUNDATION IS A MEMBERSHIP ORGANIZATION. WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC., AND RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER, INC., ACTING THROUGH THEIR INDIVIDUAL BOARDS OF DIRECTORS, ARE THE CORPORATE MEMBERS ("MEMBERS") OF THE FOUNDATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC. AND RYAN/CHELSEA-CLINTON COMMUNITY HEALTH CENTER, INC., ACTING THROUGH THEIR INDIVIDUAL BOARD OF DIRECTORS, ARE THE CORPORATE MEMBERS OF THE FOUNDATION. AT EACH ANNUAL MEETING OF MEMBERS, DIRECTORS SHALL BE ELECTED TO HOLD OFFICE UNTIL THE NEXT ANNUAL MEETING AND UNTIL THEIR SUCCESSORS HAVE BEEN ELECTED AND QUALIFIED. |
| FORM 990, PART VI, SECTION A, LINE 7B | ANY OR ALL OF THE DIRECTORS MAY BE REMOVED FOR CAUSE BY VOTE OF THE MEMBERS, OR BY A VOTE OF THE DIRECTORS, PROVIDED THERE IS A QUORUM OF NOT LESS THAN A MAJORITY OF THE ENTIRE BOARD OF DIRECTORS, PRESENT AT THE MEETING OF DIRECTORS AT WHICH SUCH ACTION IS TAKEN. ANY OR ALL OF THE DIRECTORS MAY BE REMOVED WITHOUT CAUSE BY A VOTE OF THE MEMBERS. THE FOLLOWING ITEMS MUST BE APPROVED FIRST BY MAJORITY VOTE OF THE BOARD OF DIRECTORS AT A MEETING AT WHICH A QUORUM IS PRESENT AND THEN SUBMITTED TO THE MEMBERS FOR APPROVAL: -APPROVAL OF A MERGER OR CONSOLIDATION -APPROVAL OF DISSOLUTION OF THE CORPORATION; AND -APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; PROVIDED THAT, THE SALE, LEASE MORTGAGE, EXCHANGE OR OTHER DISPOSITION OF REAL PROPERTY THAT CONSTITUTES ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION REQUIRES A VOTE BY TWO-THIRDS (2/3) VOTE OF THE ENTIRE BOARD OF DIRECTORS BEFORE SUBMISSION TO THE MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 8B | THE FOUNDATION DID NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 WAS REVIEWED BY THE CHIEF FINANCIAL OFFICER, AND CHIEF OF STRATEGIC DEVELOPMENT OF WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC.. THE CHAIR THEN PRESENTS THE FORM 990 FOR FULL BOARD REVIEW AT THE BOARD OF DIRECTORS MEETING, BEFORE IT IS FILED WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH BOARD MEMBER, OFFICER OR KEY EMPLOYEE SHALL COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE PRIOR TO BECOMING A BOARD MEMBER, OFFICER OR KEY EMPLOYEE AND ANNUALLY THEREAFTER. THE QUESTIONNAIRE SHALL BE IN THE FORM APPROVED BY THE BOARD OF DIRECTORS. EACH BOARD MEMBER, OFFICER OR KEY EMPLOYEE SHALL PROMPTLY ADVISE THE SECRETARY OF THE BOARD OF ANY CHANGES TO THE INFORMATION PROVIDED IN THAT INDIVIDUAL'S LAST COMPLETED CONFLICT OF INTEREST QUESTIONNAIRE. IF DURING THE COURSE OF A BOARD MEETING, DISCUSSION, OR DELIBERATION ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST BECOMES APPARENT TO A BOARD MEMBER, THE BOARD MEMBER MUST DISCLOSE SUCH ACTUAL OR POTENTIAL CONFLICT TO THE BOARD OF DIRECTORS. IF ANOTHER BOARD MEMBER BECOMES AWARE OF ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST, HE OR SHE SHALL DISCLOSE SUCH CONFLICT IF THE CONFLICTED BOARD MEMBER IS ABSENT. IN BOTH CASES, SUCH DISCLOSURE SHALL BE MADE A MATTER OF RECORD. THE SECRETARY WILL ENSURE THAT ALL INDIVIDUALS REQUIRED TO COMPLETE AN ANNUAL DISCLOSURE STATEMENT DO SO IN ACCORDANCE WITH THIS POLICY. IF ANY INDIVIDUAL FAILS TO COMPLY WITH THE POLICY'S DISCLOSURE REQUIREMENTS, THE SECRETARY WILL REPORT SUCH FAILURE TO THE BOARD OF DIRECTORS, WHO SHALL RECOMMEND APPROPRIATE CORRECTIVE ACTION. ALL DISCLOSURES OF INTERESTS IN COMPLETED QUESTIONNAIRES OR SUBSEQUENT ADVICE SHALL BE COMPILED AND REPORTED BY MANAGEMENT TO THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FOUNDATION'S FORM 990 AND FORM 1023 ARE AVAILABLE FOR PUBLIC INSPECTION AS REQUIRED UNDER SECTION 6104 OF THE INTERNAL REVENUE CODE. THE RETURN IS POSTED ON GUIDESTAR.ORG AND OTHER SIMILAR WEBSITE. IN ADDITION, THE FINANCIAL STATEMENTS, ARTICLES OF INCORPORATION, AND BY-LAWS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VII, SECTION A: | BRIAN MCINDOE AND SCOTT MORGAN RECEIVE COMPENSATION IN THEIR RESPECTIVE ROLES AS PRESIDENT/CEO AND CHIEF FINANCIAL OFFICER OF WILLIAM F. RYAN COMMUNITY HEALTH CENTER, INC., A RELATED PARTY. THEIR COMPENSATION IS REPORTED IN PART VII, SECTION A, AND SCHEDULE J, PART II AS REQUIRED. THESE INDIVIDUALS DO NOT RECEIVE COMPENSATION FROM THE FILING ORGANIZATION NOR THE RELATED ORGANIZATION IN THEIR ROLES WITH THE FILING ORGANIZATION. |
| FORM 990, PART XII, LINE 2C: | THE FOUNDATION'S BOARD OF DIRECTORS SHALL BE RESPONSIBLE FOR OVERSEEING THE ACCOUNTING AND FINANCIAL REPORTING PROCESSES OF THE CORPORATION AND THE AUDIT OF THE CORPORATION'S FINANCIAL STATEMENTS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |