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.") .. | ||||||
| 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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 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, SECTION A, LINE 1A | THE BOARD OF TRUSTEES OF THE REPORTING ORGANIZATION (THE "FOUNDATION") ESTABLISHED AN EXECUTIVE COMMITTEE (THE "COMMITTEE") TO ASSIST THE BOARD IN FULFILLING ITS OVERSIGHT RESPONSIBILITY FOR THE OPERATIONS OF THE ORGANIZATION AND ITS AFFILIATES. THE COMMITTEE HAS THE POWER TO CONDUCT THE BUSINESS OF THE FOUNDATION DURING THE PERIOD BETWEEN MEETINGS OF THE BOARD, IN ACCORDANCE WITH THE POLICIES AND EXPRESSED WISHES OF THE BOARD AND ESTABLISHED PROTOCOL. THE COMMITTEE IS AUTHORIZED TO SECURE SUCH RESOURCES AS IT REASONABLY NEEDS TO FULFILL ITS RESPONSIBILITIES, INCLUDING OUTSIDE CONSULTANTS, AS APPROPRIATE. THE CHIEF EXECUTIVE OFFICER OF THE FOUNDATION, OR AN APPOINTED REPRESENTATIVE, SERVES AS THE COMMITTEE'S STAFF LIAISON. THE COMMITTEE ALSO CONSISTS OF THREE ELECTED GOVERNING BOARD OFFICERS: CHAIR, VICE CHAIR AND SECRETARY, THE PAST CHAIR OF THE FOUNDATION, THE CHAIR OF THE BOARD OF GOVERNORS, AND ONE TO THREE AT LARGE MEMBERS FROM THE BOARD OF THE FOUNDATION. ALL COMMITTEE MEMBERS ARE GOVERNING BOARD MEMBERS, MUST BE INDEPENDENT OF MANAGEMENT, AND RECEIVE NO COMPENSATION FROM THE FOUNDATION. THE BOARD OF TRUSTEES HAS ADOPTED A SET OF CENTRAL GOVERNANCE PRINCIPLES TO PROVIDE A SPECIFIC FRAMEWORK FOR THE DECISION-MAKING AND GOVERNANCE ACTIVITIES OF THE COMMITTEE. |
| FORM 990, PART VI, SECTION A, LINE 7B | BOARD DECISION MATTERS ARE DELEGATED BY THE FOUNDATION BOARD AS FOLLOWS: DECISIONS ON CAPITAL BUDGET AND OPERATING BUDGET TRANSFERS OF AMOUNTS OF 2.5% OR LESS OF THE TOTAL GRANTS BUDGET ARE DELEGATED TO THE CHIEF EXECUTIVE OFFICER. FINAL AUTHORITY FOR GRANTS OF BETWEEN $1,000,000 AND $2,000,000 IS DELEGATED TO THE COMMUNITY INVESTMENT COMMITTEE; FINAL AUTHORITY FOR GRANTS OF LESS THAN $1,000,000 IS DELEGATED TO THE EXECUTIVE VICE PRESIDENT OF COMMUNITY INVESTMENTS; AND FINAL AUTHORITY FOR GRANTS OF LESS THAN $250,000 IS DELEGATED TO THE CHIEF IMPACT AND METRICS OFFICER. DECISIONS ON CONTRACTS AND EXPENDITURES OF AMOUNTS OF $250,000 OR LESS ARE DELEGATED TO THE CHIEF EXECUTIVE OFFICER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE REPORTING ORGANIZATION'S TAX AND AUDIT COMMITTEE REVIEWS A DRAFT OF THE FORM 990 IN DETAIL PRIOR TO IT BEING FINALIZED. A FINAL VERSION OF FORM 990 IS SENT TO THE TRUSTEES PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE REPORTING ORGANIZATION ANNUALLY VERIFIES COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY. THE INDIVIDUALS COVERED BY THIS POLICY INCLUDE THE OFFICERS AND TRUSTEES. THE PERSONS COVERED BY THIS POLICY ARE REQUIRED TO ANNUALLY DISCLOSE OR UPDATE THE CHAIRMAN OF THE BOARD OF TRUSTEES ON A FORM PROVIDED BY THE ORGANIZATION THEIR INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST. FOR EACH INTEREST DISCLOSED TO THE CHAIRMAN OF THE BOARD OF TRUSTEES OF THE FOUNDATION, THE CHAIRMAN WILL DETERMINE WHETHER TO: (A) TAKE NO ACTION; (B) ASSURE FULL DISCLOSURE TO THE BOARD OF TRUSTEES OF THE FOUNDATION AND OTHER INDIVIDUALS COVERED BY THIS POLICY; (C) ASK THE PERSON TO RECUSE FROM PARTICIPATION IN RELATED DISCUSSIONS OR DECISIONS WITHIN THE ORGANIZATION; OR (D) ASK THE PERSON TO RESIGN FROM HIS OR HER POSITION IN THE ORGANIZATION OR, IF THE PERSON REFUSES TO RESIGN, BECOME SUBJECT TO POSSIBLE REMOVAL IN ACCORDANCE WITH THE ORGANIZATION'S REMOVAL PROCEDURES. THE ORGANIZATION'S CEO WILL MONITOR PROPOSED OR ONGOING TRANSACTIONS FOR CONFLICTS OF INTEREST AND DISCLOSE THEM TO THE CHAIRMAN OF THE BOARD OF TRUSTEES IN ORDER TO DEAL WITH POTENTIAL OR ACTUAL CONFLICTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS, OTHER OFFICERS, AND KEY EMPLOYEES, THE FOUNDATION USED THE REPORT OF AN INDEPENDENT COMPENSATION CONSULTANT. THE REPORT WAS PREPARED IN 2018. WITHOUT PARTICIPATION OF THE OFFICER, DIRECTOR OR OTHER TOP MANAGEMENT OFFICIAL UNDER CONSIDERATION, THE COMPENSATION COMMITTEE DETERMINED AND APPROVED COMPENSATION BASED ON THE INDEPENDENT CONSULTANT'S REPORT. THIS PROCESS WAS UNDERTAKEN FOR THE FOLLOWING OFFICERS, DIRECTORS, AND KEY EMPLOYEES FOR 2021 COMPENSATION ON NOVEMBER 9, 2020: BLAKE HOLMAN, CIO F. XAVIER PENA, EVP AMY VAUGHAN, CFO CATHY IBERG, VP OF INVESTMENTS SHAILEE GUPTA, CLINICAL DIRECTOR AND THIS PROCESS WAS UNDERTAKEN FOR THE FOLLOWING OFFICERS FOR 2021 COMPENSATION ON DECEMBER 7, 2020: EDWARD BURGER, PRESIDENT & CEO BECKY PASTNER, VP |
| FORM 990, PART VI, SECTION C, LINE 19 | THE REPORTING ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. PLEASE CONTACT THE CFO AT 512-879-6600. |
| OFFICER COMPENSATION OF RELATED ORGANIZATIONS: | ST. DAVID'S FOUNDATION (THE "FOUNDATION") OWNS A GENERAL PARTNER INTEREST IN ST. DAVID'S HEALTHCARE PARTNERSHIP, LP, LLP (THE "PARTNERSHIP"). THE AMOUNTS BELOW REPRESENT THE FOUNDATION'S SHARE OF COMPENSATION PAID BY THE PARTNERSHIP DURING 2021. SHARI COLLIER, CFO SALARY $123,733 EMPLOYEE BENEFITS $ 7,900 C. DAVID HUFFSTUTLER, CEO SALARY $227,773 EMPLOYEE BENEFITS $ 22,189 |
| Software ID: | |
| Software Version: |