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)
COPLEY MEMORIAL HOSPITAL INC |
362170840 | 3 | Yes | 0 | 0 | |
| (B)
COPLEY VENTURES INC |
363370216 | 3 | Yes | 0 | 0 | |
| (C)
RUSH COPLEY FOUNDATION |
363093877 | 7 | Yes | 0 | 0 | |
|
Total 3
|
0 | 0 | ||||
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)
![]() |
(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) |
||||
| 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 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. |
||||
| 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) |
||||
| 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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 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 I, Line 12g PART I, LINE 12G | RUSH COPLEY MEDICAL CENTER ("RCMC") SERVES AS A SUPPORTING ORGANIZATION, ORGANIZED AND OPERATED FOR THE BENEFIT OF ITS SUPPORTED ORGANIZATIONS, COPLEY MEMORIAL HOSPITAL, COPLEY VENTURES, AND RUSH COPLEY FOUNDATION. ALL EXPENSES INCURRED BY RCMC ARE FOR THE DIRECT BENEFIT AND SUPPORT OF ITS SUPPORTED ORGANIZATIONS. |
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |
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 15 PART VI, LINE 15 | THE CEO/VPS OF THE ORGANIZATION AND KEY SENIOR MANAGEMENT ARE COMPENSATED BY CMH. CMH FOLLOWS A COMPENSATION APPROVAL PROCEDURE ANNUALLY THAT INVOLVES APPROVAL OF PROPOSED AND FINAL COMPENSATION ARRANGEMENTS BY ITS COMPENSATION COMMITTEE AND FULL BOARD OF DIRECTORS USING COMPARABILITY DATA, AS WELL AS CONTEMPORANEOUS DOCUMENTATION OF COMPENSATION DECISIONS IN MINUTES. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | MANY OF THE PERSONS LISTED IN PART VII HAVE A "BUSINESS RELATIONSHIP" WITH EACH OTHER BY VIRTUE OF SITTING ON RELATED RUSH COPLEY MEDICAL CENTER ENTITY BOARDS. - Business relationship |
| Form 990, Part VI, Line 3 Delegation of management duties | RESERVED POWERS OVER CERTAIN MANAGEMENT DUTIES HAVE BEEN DELEGATED TO RUSH SYSTEM FOR HEALTH ("RSH") AS THE PARENT ENTITY FOR THE RUSH SYSTEM. THESE DUTIES INCLUDE APPROVING VARIOUS RCMC ACTIONS, INCLUDING RCMC'S OPERATING BUDGET AND CERTAIN TRANSACTIONS, APPOINTMENT OF CERTAIN RCMC EXECUTIVES, APPOINTMENT OF RCMC'S BOARD MEMBERS, ETC. |
| Form 990, Part VI, Line 4 Significant changes to organizational documents | BYLAWS WERE UPDATED TO REQUIRE THAT ANY NEW OFFICER OR EXECUTIVE LEVEL POSITION MUST BE APPOINTED BY THE CEO, WITH A SPECIFIC BUSINESS JUSTIFICATION, AND APPROVED BY THE BOARD SO LONG AS THE CEO AND BOARD DETERMINE THAT ANY NEW APPOINTMENT EFFICIENTLY AND EFFECTIVELY SUPPORTS RCMC'S MISSION AND VISION. UPDATES ALSO REFLECT THAT ALL CORPORATE OFFICERS MUST BE APPROVED ANNUALLY BY THE NOMINATING COMMITTEE, THE EXECUTIVE COMMITTEE, OR THE BOARD OF DIRECTORS. THE UPDATED BYLAWS ALSO REFLECT THAT THE CEO HAS A RESPONSIBILITY TO MAINTAIN A CORPORATE ORGANIZATIONAL CHART IDENTIFYING RCMC'S OFFICERS, EXECUTIVES AND DEPARTMENTS. THE CEO MAY APPOINT SUCH NUMBER OF ASSOCIATE AND ASSISTANT VICEPRESIDENTS AS HE OR SHE SHALL FROM TIME TO TIME CONSIDER REASONABLE AND NECESSARY. THE UPDATED BYLAWS REMOVE THE REQUIREMENT THAT THERE BE A PRESIDENT IN ADDITION TO THE CEO, AND REMOVE THE REQUIREMENT FOR A TREASURER, ASSISTANT TREASURER AND ASSISTANT SECRETARY POSITION. ORGANIZATION CHANGED NAME TO RUSH COPLEY MEDICAL CENTER FROM RUSH COPLEY MEDICAL CENTER, INC. |
| Form 990, Part VI, Line 6 Classes of members or stockholders | RUSH SYSTEM FOR HEALTH ("RSH") IS THE SOLE CORPORATE MEMBER OF RUSH COPLEY MEDICAL CENTER ("RCMC"). |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | AS THE SOLE CORPORATE MEMBER OF RCMC, RSH HAS THE RESERVED POWER TO APPROVE THE APPOINTMENT OF MEMBERS TO THE RCMC BOARD OF DIRECTORS, THE ORGANIZATION'S GOVERNING BODY (THE "RCMC BOARD"). |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | AS THE SOLE CORPORATE MEMBER OF RCMC AND RUSH UNIVERSITY MEDICAL CENTER ("RUMC"), AND THE PARENT ENTITY OF THE RUSH SYSTEM, RSH HOLDS CERTAIN RESERVED POWERS OVER RCMC AND RUMC IN ORDER TO ENSURE A UNIFORM VISION AND STRATEGY ACROSS THE RUSH SYSTEM. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | THE FORM 990 TAX RETURN IS PREPARED BY OUR ORGANIZATION AND REVIEWED BY OUR EXTERNAL TAX ADVISOR. A DRAFT OF THE FORM 990 IS PROVIDED TO MANAGEMENT FOR REVIEW AND COMMENT. THE BOARD OF DIRECTORS IS PROVIDED WITH AN APPROVED COPY OF THE FORM 990 BEFORE IT IS FILED. |
| Form 990, Part VI, Line 12c Conflict of interest policy | ANNUALLY, BOARD MEMBERS, DIRECTORS, MANAGEMENT TEAM (ADMINISTRATION, DIRECTORS AND MANAGERS) AND OTHER KEY EMPLOYEES OF RUSH COPLEY MEDICAL CENTER AND SUBSIDIARIES ("RCMC") ARE REQUIRED TO SUBMIT A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO DISCLOSE ANY PERSONAL OR BUSINESS INTERESTS THAT MAY GIVE RISE TO A CONFLICT WITH THE WORK THEY DO FOR RCMC. THE DISCLOSURES ARE SUBMITTED AND REVIEWED BY THE CORPORATE INTEGRITY OFFICER, WHO IS AN EMPLOYEE OF COPLEY MEMORIAL HOSPITAL BUT REPRESENTS RUSH COPLEY MEDICAL CENTER AND SUBSIDIARIES, AND A REPORT IS SUBMITTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS OF RCMC. THOSE KEY PERSONNEL WITH CONFLICTS ARE ADVISED TO RECUSE THEMSELVES FROM PARTICIPATING IN DECISION-MAKING RELATED TO THE CONFLICT. |
| Form 990, Part VI, Line 19 Required documents available to the public | FORM 990 IS AVAILABLE UPON REQUEST. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. COPIES OF THE FINANCIAL STATEMENTS (WHETHER OR NOT AUDITED) ARE PROVIDED UPON REASONABLE REQUEST, SUCH AS FOR A BANK LOAN OR TO A BOND RATING AGENCY. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE ON THE ATTORNEY GENERAL'S WEBSITE. |
| Form 990, Part XI, Line 9 Other changes in net assets or fund balances | Other Change in Net Assets - -73654123; |
| Form 990, Part XII, Line 2a PART XII, LINE 2 | ALTHOUGH THE ORGANIZATION DOES NOT RECEIVE STAND ALONE GAAP FINANCIAL STATEMENTS, IT DOES RECEIVE, ON AN ANNUAL BASIS FROM INDEPENDENT AUDITORS, CONSOLIDATED RUSH SYSTEM FOR HEALTH AUDITED GAAP FINANCIAL STATEMENTS . |
| Software ID: | 21014044 |
| Software Version: | 2021v4.2 |