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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 359,183 | 352,015 | 352,300 | 278,931 | 457,363 | 1,799,792 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 359,183 | 352,015 | 352,300 | 278,931 | 457,363 | 1,799,792 |
| 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) .. | 106,208 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,693,584 | |||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 359,183 | 352,015 | 352,300 | 278,931 | 457,363 | 1,799,792 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 460,147 | 524,512 | 405,075 | 366,106 | 719,311 | 2,475,151 |
| 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.).. | 66,070 | 66,070 | ||||
| 11 | Total support. Add lines 7 through 10 | 4,341,013 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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): |
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| 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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, LINE 1A | DELEGATION OF AUTHORITY: THE EXECUTIVE COMMITTEE IS AUTHORIZED TO ACT IN THE EVENT AN ACTION IS REQUIRED DURING INTERVALS BETWEEN SCHEDULED BOARD MEETINGS. THE EXECUTIVE COMMITTEE IS REQUIRED TO REPORT ITS ACTIONS TO THE BOARD OF DIRECTORS AT ITS REGULAR MEETING. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OR STOCKHOLDERS: MEMBERSHIP IN THE CORPORATION IS GRANTED TO ANY PERSON WHO IS AN OSTEOPATHIC PHYSICIAN AND WHO MAKES AN ANNUAL FINANCIAL CONTRIBUTION TO THE FOUNDATION, OR WHO MAKES A ONE-TIME CONTRIBUTION OF AT LEAST $250. |
| FORM 990, PART VI, SECTION A, LINE 7A | POWER TO ELECT OR APPOINT ONE OR MORE MEMBERS OF THE GOVERNING BODY: THE CHAIRMAN OF THE BOARD WILL ANNUALLY APPOINT A NOMINATING COMMITTEE COMPOSED OF 3 MEMBERS OF THE ORGANIZATION WHO ARE CURRENTLY SERVING ON THE BOARD OF DIRECTORS. THE NOMINATING COMMITTEE, NOT LESS THAN 90 DAYS PRIOR TO THE ORGANIZATION'S FISCAL YEAR-END, SHALL NOMINATE ONE CANDIDATE TO FILL THE POSITION OF EACH DIRECTOR WHOSE TERM IS EXPIRING. THE NOMINATIONS ARE ANNOUNCED TO ALL MEMBERS OF THE ORGANIZATION 60 DAYS PRIOR TO YEAR-END. A FORM IS MADE AVAILABLE AT THE PRINCIPAL OFFICE OF THE ORGANIZATION FOR WRITE-IN NOMINATIONS. WRITE-IN NOMINATIONS REQUIRE THE AFFIRMATION OF THREE MEMBERS OF THE ORGANIZATION IN ORDER TO BE PLACED ON THE BALLOT. BALLOTS ARE REQUIRED TO BE MAILED TO ALL MEMBERS OF THE CORPORATION. THIS ACTIVITY WAS WAIVED IN 2020 AND ALL BOARD TERMS EXTENDED FOR ONE YEAR. |
| FORM 990, PART VI, SECTION A, LINE 7B | GOVERNANCE DECISIONS: THE AMENDED AND RESTATED BYLAWS OF THE ORGANIZATION RESERVE THE POWER TO AMEND THE BYLAWS TO THE MEMBERSHIP OF THE ORGANIZATION. THE PROCEDURE REQUIRED TO AMEND THE BYLAWS BEGINS WITH THE INITIATION OF THE PROPOSED AMENDMENT BY THE BOARD OF DIRECTORS. AT THE NEXT MEETING OF THE BOARD OF DIRECTORS, SUBSEQUENT TO THE MEETING AT WHICH THE PROPOSED AMENDMENTS WERE PRESENTED, SUCH AMENDMENTS MUST RECEIVE THE AFFIRMATIVE VOTE OF THE MAJORITY OF DIRECTORS IN ORDER TO ADVANCE. IF APPROVED BY THE BOARD OF DIRECTORS, THE PROPOSED AMENDMENTS SHALL BE MAILED TO THE MEMBERS OF THE ORGANIZATION AT LEAST 30 DAYS PRIOR TO THE DATE ESTABLISHED FOR THE BALLOT ON WHICH THEY ARE TO BE CONSIDERED FOR ADOPTION. TO BE EFFECTIVE, AMENDMENTS MUST RECEIVE THE AFFIRMATIVE VOTE OF TWO-THIRDS OF THE MEMBERS REPRESENTED BY ABSENTEE BALLOT OR AT A MEETING OF THE ORGANIZATION AT WHICH A DULY QUALIFIED QUORUM IS PRESENT. |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE COMPLETED 990 IS TRANSMITTED ELECTRONICALLY TO THE FOUNDATION'S BOARD OF DIRECTORS. THE CEO AND FOUNDATION'S INDEPENDENT ACCOUNTANTS MAKE THEMSELVES AVAILABLE TO ANSWER ANY QUESTIONS FROM MEMBERS OF THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS TO MONITOR COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE ORGANIZATION HAS A WRITTEN CONFLICT OF INTEREST POLICY WHICH SERVES TO ASSIST DIRECTORS, OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION TO IDENTIFY SITUATIONS THAT PRESENT POTENTIAL CONFLICTS OF INTEREST AND TO PROVIDE A PROCEDURE WHICH WILL ALLOW A TRANSACTION WHICH IS IN THE BEST INTEREST OF THE CORPORATION TO BE BINDING EVEN THOUGH A DIRECTOR, OFFICER, OR EMPLOYEE MAY HAVE A CONFLICT OF INTEREST IN RESPECT TO THAT TRANSACTION. THE POLICY IS DISTRIBUTED ANNUALLY AT THE FIRST MEETING OF THE BOARD OF DIRECTORS FOLLOWING THE BEGINNING OF THE ORGANIZATION'S FISCAL YEAR. THE POLICY IS REVIEWED DURING THAT MEETING. EACH PERSON SERVING AS A DIRECTOR, OFFICER OR KEY EMPLOYEE OF THE CORPORATION IS REQUIRED TO ANNUALLY COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES IN WHICH HE OR SHE IS INVOLVED THAT HE OR SHE BELIEVES COULD CONTRIBUTE TO A CONFLICT OF INTEREST ARISING. MATERIALS FOR MEETINGS OF THE BOARD OF DIRECTORS ARE DISTRIBUTED ELECTRONICALLY IN ADVANCE OF THE MEETING, GIVING DIRECTORS, OFFICERS AND KEY EMPLOYEES AN OPPORTUNITY TO IDENTIFY ANY PROPOSED ACTION IN WHICH HE OR SHE MAY HAVE A CONFLICT OF INTEREST. FOLLOWING THE CALL TO ORDER AT EACH MEETING OF THE BOARD OF DIRECTORS, A REQUEST FOR DISCLOSURE OF ANY POTENTIAL CONFLICT OF INTEREST IS MADE. AN ABSENCE OF A DECLARATION OF A CONFLICT OF INTEREST AT THAT TIME DOES NOT PRECLUDE THE LATER ANNOUNCEMENT OF A CONFLICT OF INTEREST WHICH IS DETERMINED BY A DIRECTOR, OFFICER OR KEY EMPLOYEE DURING THE MEETING. Process when a conflict arises: Prior to board or committee action on a Contract or Transaction involving a Conflict of Interest, a director or committee member having a Conflict of Interest and who is in attendance at the meeting shall disclose all facts material to the Conflict of Interest. Such disclosure shall be reflected in the minutes of the meeting. A director or committee member who plans not to attend a meeting at which he or she has reason to believe that the board or committee will act on a matter in which the person has a Conflict of Interest shall disclose to the chair of the meeting all facts material to the Conflict of Interest. The chair shall report the disclosure at the meeting and the disclosure shall be reflected in the minutes of the meeting. A person who has a Conflict of Interest shall not participate in or be permitted to hear the board's or committee's discussion of the matter except to disclose material facts and to respond to questions. Such person shall not attempt to exert his or her personal influence with respect to the matter, either at or outside the meeting. A person who has a Conflict of Interest with respect to a Contract or Transaction that will be voted on at a meeting shall not be counted in determining the presence of a quorum for purposes of the vote. The person having a conflict of interest may not vote on the Contract or Transaction and shall not be present in the meeting room when the vote is taken, unless the vote is by secret ballot. Such person's ineligibility to vote shall be reflected in the minutes of the meeting. |
| FORM 990, PART VI, SECTION B, LINE 15A | CEO AND TOP MANAGEMENT OFFICIAL COMPENSATION REVIEW: THE MOST RECENT COMPENSATION REVIEW OF THE FOUNDATION'S CEO WAS COMPLETED IN SEPTEMBER 2013 BY THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE IS COMPOSED OF MEMBERS OF THE EXECUTIVE COMMITTEE PLUS ADDITIONAL MEMBERS OF THE BOARD OF DIRECTORS WHO ARE INVITED BY THE CHAIRMAN DUE TO SPECIALIZED KNOWLEDGE. ALL MEMBERS OF THE COMPENSATION COMMITTEE ARE INDEPENDENT MEMBERS OF THE GOVERNING BODY. THE COMMITTEE DETERMINES, BASED ON BUDGETARY CONSIDERATIONS, WHETHER AN ADJUSTMENT IN COMPENSATION WILL BE CONSIDERED FOR THE YEAR. IF THE DECISION IS AFFIRMATIVE, THE COMMITTEE REVIEWS DATA FROM THE COUNCIL ON FOUNDATIONS ANNUAL SALARY SURVEY WHICH COMPILES SALARY AND BENEFIT INFORMATION FROM MORE THAN 800 FOUNDATIONS NATIONWIDE, STRATIFYING IT GEOGRAPHICALLY, BY ASSET SIZE, AND MANY OTHER VARIABLES. THE COMMITTEE COMPARES THE ORGANIZATION'S CURRENT SALARY FOR THE CEO TO THE MEDIAN SALARY OF SIMILARLY LOCATED, LIKE-SIZED FOUNDATIONS AND DISCUSSES WHETHER AN ADJUSTMENT IN COMPENSATION IS WARRANTED. THE DISCUSSION AND SUBSEQUENT DECISION IS DOCUMENTED BY THE CHAIRMAN AND THE CONCLUSIONS OF THE COMMITTEE PRESENTED TO THE CEO IN A FOLLOW-UP MEETING. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABILITY OF DOCUMENTS: THE ORGANIZATION HAS ALWAYS MADE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND REVIEWED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. WE HAVE ALLOCATED SPACE FOR THESE DOCUMENTS ON THE FOUNDATION'S WEBSITE. |
| FORM 990, PART XI, LINE 9 | $19,199 - Change in beneficial interest in assets held by others |
| Software ID: | |
| Software Version: |