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 | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 207 | 831 | 965 | 0 | 2,003 | |
| 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 | 38,826 | 7,221 | 20,289 | 101,405 | 167,992 | 335,733 |
| 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 | 39,033 | 7,221 | 21,120 | 102,370 | 167,992 | 337,736 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 337,736 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 39,033 | 7,221 | 21,120 | 102,370 | 167,992 | 337,736 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 6,123 | 11,255 | 9,444 | 12,079 | 10,156 | 49,057 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 6,123 | 11,255 | 9,444 | 12,079 | 10,156 | 49,057 |
| 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.).. | 45,156 | 18,476 | 30,564 | 114,449 | 178,148 | 386,793 |
| 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 2023 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-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, 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 2023. 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 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Return Reference | Explanation |
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| Form 990, Part VI, Section A, line 4 | Effective October 10, 2023, the Articles of Incorporation and the Bylaws of the filing organization were amended and restated. The Articles of Incorporation Article I The filing organization changed its name from "Women's Auxiliary of Fish Memorial Hospital in New Smyrna Beach, Florida, Inc." to "Bert Fish Medical Center Auxiliary, Inc. New Smyrna Beach, Florida, doing business as AdventHealth New Smyrna Beach Auxiliary, New Smyrna Beach, Florida." Article III The statement describing the active membership in the Auxiliary was removed. Instead, the purpose of the filing organization stated in Article II was moved to Article III. Article IV The dissolution clause was added to state that the corporation's assets shall be turned over to AdventHealth New Smyrna Beach which is exempt as an organization described in Section 501(c)(3) and 170(c)(2) of the Internal Revenue Code of 1954 or corresponding sections of any prior or future law or to the Federal, State, or Local Government for exclusive public purpose. In addition, a new statement was included to state that the Corporation will not carry on any other activities not permitted to be carried on by (a) a corporation exempt from Federal Income Tax under section 501(c)(3) of the Internal Revenue Code of 1954 or the corresponding provisions of any further United States Internal Revenue Law or (b) a corporation, contributions to, which are deductible under, section 170(c)(2) of the Internal Revenue Code of 1954 or any other corresponding provisions of any further United States Internal Revenue Law. Article V The outdated names and residences of the subscribers to the filing organization were removed, and Article V stated how the Board of Directors will be elected and appointed. The Board of Directors shall be the five Officers (President, Vice President, Treasurer, Administrative Secretary and Membership Coordinator) as elected by the members, plus the Department Chairpersons whose number shall not exceed thirteen, selected in accordance with the Bylaws. Article VI The original Article VI about how their Board of directors and Officers are elected was restated in Article V, and the "Perpetual Existence" statement was moved from Article IV to Article VI. Article VII The outdated names of the officers were removed, and the Amendment clause was newly included in Article VII. The Bylaws The name of the organization was changed to Bert Fish Medical Center Auxiliary, Inc. New Smyrna Beach, Florida, doing business as AdventHealth New Smyrna Beach Auxiliary, New Smyrna Beach, Florida. In the amended Bylaws there are two classes of members Active Membership and Honorary Membership. The requirements for membership were not substantially changed. The Affiliate Membership category was removed. The process for nominating and electing officers is substantially the same. One significant change was the reduction of the nominating committee from 5 members to 3 and that all members of the committee will be determined by the Board. The provision for Standing Appointments was deleted. |
| Form 990, Part VI, Section A, line 6 | Active membership in the filing organization (the Auxiliary) shall be open to persons who are interested in volunteer service at the Hospital, who have applied for membership prescribed in the Bylaws, and whose application has been approved by the Membership Committee. Active membership shall be limited to persons who have been assigned and will perform duties as required by the Bylaws. An active member is required to devote a minimum of 60 hours of volunteer work per year. |
| Form 990, Part VI, Section A, line 7a | The Board of Directors shall consist of the five Officers and the Department Chairpersons. A Nominating Committee appointed by the Board shall determine the slate of Officers to be presented to the membership at the October membership meeting. Nominations may also be made from the floor. Officers are elected by a majority vote of the membership in attendance at the meeting. The Vice President shall appoint the Chairperson of all departments, subject to approval of the Executive Board, which consists of the five Officers. |
| Form 990, Part VI, Section A, line 7b | Amendments to the Articles of Incorporation may be proposed by a Revision Committee composed of three members appointed by the President and adopted by a majority vote of the Auxiliary members present and voting at any regular or special meeting provided said Articles have been approved by the Auxiliary Board of Directors. |
| Form 990, Part VI, Section B, line 11b | The filing organization's current year Form 990 was reviewed by the President/Director of the filing organization and the CEO and CFO of Southeast Volusia Health Care Corporation (the Hospital) prior to its filing with the IRS. The review conducted by the President/Director of the filing organization and the CEO and CFO of the Hospital did not include the review of any supporting workpapers that were used in preparation of the current year Form 990, but did included a review of the entire Form 990 and all supporting schedules. |
| Form 990, Part VI, Section B, line 12c | The Conflict of Interest Policy of the filing organization applies to any director, principal officer, or member of a committee with governing board delegated powers (to be known as Interested Persons). In connection with any actual or possible conflicts of interest, an Interested Person must disclose the existence of any financial interest with the filing organization and must be given the opportunity to disclose all material facts concerning the financial interest/arrangement to the Board of Directors of the filing organization or to any members of a committee with board delegated powers that is considering the proposed transaction or arrangement. After disclosure of the financial interest and all material facts ,and after any discussion with the interested person, he/she shall leave the governing board or committee meeting while the determination of a conflict of interest is discussed and voted upon. The remaing board or committee members shall decide if a conflict of interest exists. According to the filing organization's Conflict of Interest Policy, an Interested Person may make a presentation to the Board of Directors (or committee with board delegated powers), but after such presentation, shall leave the meeting during the discussion of, and the vote on, the transaction or arrangement that results in a conflict of interest. Each Interested Person is required to adhere to the filing organization's Conflict of Interest Policy and to sign an annual certificate of compliance in regard to the policy. The filing organization's Conflict of Interest Policy also requires that periodic reviews shall be conducted to ensure that the filing organization operates in a manner consistent with its charitable purposes. |
| Form 990, Part VI, Section C, line 19 | The filing organization does not generally make its governing documents or conflict of interest policy available to the public. |
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