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.") .. | 816,293 | 676,124 | 743,378 | 547,713 | 544,358 | 3,327,866 |
| 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 | 816,293 | 676,124 | 743,378 | 547,713 | 544,358 | 3,327,866 |
| 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. | 3,327,866 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 816,293 | 676,124 | 743,378 | 547,713 | 544,358 | 3,327,866 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 181,277 | 94,524 | 193,623 | 563,195 | 510,154 | 1,542,773 |
| 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.).. | 69,137 | 322,356 | 181,082 | 25,053 | 106,551 | 704,179 |
| 11 | Total support. Add lines 7 through 10 | 5,574,818 | |||||
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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS REVENUE - 2017 AMOUNT: $ 42,694. 2018 AMOUNT: $ 310,697. 2019 AMOUNT: $ 157,763. 2020 AMOUNT: $ 1,734. 2021 AMOUNT: $ 61,768. LOAN FORGIVENESS - 2017 AMOUNT: $ 26,443. 2018 AMOUNT: $ 11,659. 2019 AMOUNT: $ 23,319. 2020 AMOUNT: $ 23,319. 2021 AMOUNT: $ 23,319. PAYROLL COVID RELIEF - 2021 AMOUNT: $ 21,464. |
| PART II | THE AMOUNTS IN THE 2018 COLUMN ARE FOR THE SHORT PERIOD RETURN FILED FOR JULY 1, 2018 TO DECEMBER 31, 2018 FOR THE CHANGE OF ACCOUNTING PERIOD. FOR PURPOSES OF THE PUBLIC SUPPORT TEST THE SHORT PERIOD IS A TAX YEAR. |
| Software ID: | |
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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 METROHEALTH SYSTEM, A COUNTY HOSPITAL ESTABLISHED AND OPERATED PURSUANT TO CHAPTER 339 OF THE OHIO REVISED CODE, IS THE SOLE MEMBER OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE METROHEALTH SYSTEM, THE SOLE MEMBER, HAS THE POWER TO ELECT/APPROVE MEMBERS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE METROHEALTH SYSTEM, AS THE SOLE MEMBER OF THE CORPORATION, SHALL HAVE THE FOLLOWING RIGHTS: (A) TO APPROVE PEOPLE ELECTED AS DIRECTORS. EX-OFFICIO DIRECTORS, SUCH AS HONORARY DIRECTORS, MAY SERVE WITHOUT MEMBER APPROVAL. (B) TO REMOVE A DIRECTOR AT ANY TIME, AND FOR ANY REASON OR NO REASON; EXCEPT THAT, DURING THE TRANSITION PERIOD THE MEMBER MAY REMOVE A DIRECTOR ONLY FOR CAUSE. (C) TO APPROVE THE APPOINTMENT OF THE CHAIR, PRESIDENT AND ANY VICE CHAIR OF THE CORPORATION. (D) TO TERMINATE THE PRESIDENT. DURING THE TRANSITION PERIOD, THE MEMBER MAY NOT TERMINATE THE PRESIDENT EXCEPT (A) FOR CAUSE OR (II) WITH THE APPROVAL OF THE BOARD OF DIRECTORS. (E) TO APPROVE ALL AMENDMENTS TO THE ARTICLES AND CODE OF REGULATIONS. (F) THE FOLLOWING FINANCIAL OVERSIGHT RIGHTS: (I) TO APPROVE EACH ANNUAL OPERATING AND CAPITAL BUDGET AND STRATEGIC PLAN OF THE CORPORATION. (II) TO APPROVE CONTRACTS OBLIGATING THE CORPORATION TO EXPEND OR REPAY AMOUNTS NOT INCLUDED IN AN ANNUAL BUDGET APPROVED BY THE MEMBER. (III) TO APPROVE ALL INVESTMENTS OF THE CORPORATION AND ITS SUBSIDIARIES NOT INCLUDED IN AN ANNUAL BUDGET APPROVED BY THE MEMBER. (IV) TO APPROVE THE SALE, LEASE, EXCHANGE, MORTGAGE, PLEDGE, DONATION, OR OTHER DISPOSITION OF PROPERTY AND ASSETS OF THE CORPORATION NOT INCLUDED IN AN ANNUAL BUDGET APPROVED BY THE MEMBER. (V) TO APPROVE THE INCURRENCE OF DEBT OR ENCUMBRANCE OF THE CORPORATION'S ASSETS NOT INCLUDED IN AN ANNUAL BUDGET APPROVED BY THE MEMBER. (G) TO APPROVE THE CREATION OF SUBSIDIARIES OR AFFILIATES CONTROLLED OR OWNED BY THE CORPORATION. (H) TO APPROVE THE APPOINTMENT OF INDEPENDENT AUDITORS, THE APPOINTMENT OF INTERNAL AUDITORS, AND ALL ACCOUNTING POLICIES OF THE CORPORATION AND ITS SUBSIDIARIES. (I) TO APPROVE, BEFORE IMPLEMENTATION, ALL NEW WRITTEN POLICIES OF THE CORPORATION'S BOARD OF DIRECTORS. (J) TO APPROVE ALL PLANS OF MERGER, CONSOLIDATION OR VOLUNTARY DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FINANCE DEPARTMENT WORKS WITH THE INDEPENDENT ACCOUNTING FIRM TO PREPARE THE FORM 990. A DRAFT RETURN IS SENT TO THE PRESIDENT, DIRECTOR OF FINANCE AND OPERATIONS, AND MEMBERS OF THE FINANCE AND INVESTMENT COMMITTEE FOR REVIEW BEFORE THE RETURN IS FINALIZED. THE FINANCE AND INVESTMENT COMMITTEE REPORTS TO THE FULL BOARD AND COPIES ARE MADE AVAILABLE TO ALL DIRECTORS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH BOARD MEMBER HAS AN ANNUAL REQUIREMENT TO COMPLETE A QUESTIONNAIRE DISCLOSING WHETHER THEY HAVE A CONFLICT OF INTEREST. THROUGHOUT THE YEAR, MEMBERS ARE REQUIRED TO DISCLOSE ANY CHANGES IN THEIR RELATIONSHIPS THAT MIGHT CREATE A CONFLICT OF INTEREST. IF SUCH A CONFLICT EXISTS, IT IS REVIEWED BY A DISINTERESTED COMMITTEE TO DETERMINE WHETHER IT IS MATERIAL. IF IT IS MATERIAL, THE MEMBER WITH THE CONFLICT WILL ABSTAIN FROM VOTING ON ALL RELATED MATTERS. DUE DILIGENCE TO ENFORCE THIS POLICY IS DONE ON AN ONGOING BASIS. A CONFLICT OF INTEREST IS NOT PERMITTED TO EXIST UNLESS A MAJORITY OF DISINTERESTED BOARD MEMBERS DETERMINE THAT THE ARRANGEMENT IS IN THE ORGANIZATION'S BEST INTEREST AND A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE DIRECTOR OF HUMAN RESOURCES REVIEWS PUBLISHED SALARY GUIDES AND COMPENSATION OF CEOS IN LIKE AGENCIES, IN ORDER TO MAKE A RECOMMENDATION TO THE EXECUTIVE COMMITTEE REGARDING THE COMPENSATION FOR THE PRESIDENT. THE BOARD REVIEWS AND AUTHORIZES THE PRESIDENT'S COMPENSATION VIA AN EXECUTED CONTRACT AND IDENTIFIED DELIVERABLES. A SIMILAR PROCESS IS FOLLOWED FOR THE COMPENSATION OF OTHER KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST, EITHER IN HARD COPY OR PDF FORM, FOR THE SAME PERIOD OF TIME AS SET FORTH IN IRC SECTION 6104(D). |
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