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.") . | 2,061 | 277,331 | 41,219 | 491,751 | 819,785 | 1,632,147 |
| 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 | 2,106,560 | 2,142,985 | 2,241,918 | 2,246,196 | 2,640,264 | 11,377,923 |
| 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 | 2,108,621 | 2,420,316 | 2,283,137 | 2,737,947 | 3,460,049 | 13,010,070 |
| 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. | 941,225 | 940,089 | 1,167,251 | 816,731 | 823,100 | 4,688,396 |
| c | Add lines 7a and 7b.. | 941,225 | 940,089 | 1,167,251 | 816,731 | 823,100 | 4,688,396 |
| 8 | Public support. (Subtract line 7c from line 6.) | 8,321,674 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 2,108,621 | 2,420,316 | 2,283,137 | 2,737,947 | 3,460,049 | 13,010,070 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 43,674 | 42,896 | 43,437 | 44,544 | 52,501 | 227,052 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 43,674 | 42,896 | 43,437 | 44,544 | 52,501 | 227,052 |
| 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.).. | 2,152,295 | 2,463,212 | 2,326,574 | 2,782,491 | 3,512,550 | 13,237,122 |
| 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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| Form 990, Part III, line 2 | The Organization began providing childcare and learning services in 2023 at the Willow Grove Childcare and Learning Center. |
| Form 990, Part VI, Section A, line 1a | The Executive Committee consists of the President, Vice President, Secretary-Treasurer, additional members as the Board appoints, the Chief Executive Officer and any other leadership team members deemed appropriate by the officers of the Board. The Chief Executive Officer and any Leadership Team members do not have the right to vote upon any action being taken. The Executive Committee meets only in the event that the Board is unable to take necessary action, has an agenda for each meeting and keeps minutes of its meetings. The Executive Committee shall meet at least annually to evaluate the Chief Executive Officer's management performance, management company performance, if applicable, and provide a report to the full Board at their regularly scheduled meetings. The Executive Committee shall submit to the Board of Directors minutes of its meeting for responsibilities listed above or any items that required necessary action that the Board was not able to convene and/or address. |
| Form 990, Part VI, Section A, line 2 | Ada Bair, Teresa Smith, and Victoria Kalivoda-Popela, DO have business relationships with each other and the board members as these individuals are compensated by Memorial Hospital Association and there is 100% board overlap with Memorial Hospital Association. |
| Form 990, Part VI, Section A, line 4 | Articles of Amendment were filed for a name change to Hancock County Senior and Childcare Services Association on February 2, 2023. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Corporation is Memorial Hospital Association. |
| Form 990, Part VI, Section A, line 7a | The Directors of the Corporation are also the Directors of Memorial Hospital Association. |
| Form 990, Part VI, Section A, line 7b | The business and affairs of the Corporation shall be managed by or under the direction of the Board of Directors except that the Member has final authority, and the Corporation shall comply and shall cause its Affiliates to comply with directives of the Member, with regard to the following actions: A Adoption of strategic plans for the Corporation and its Affiliates; B. Adoption of business plans for the Corporation and its Affiliates; C. Adoption of operating and capital budgets for the Corporation and its Affiliates; D. Adoption of a plan for internal corporate re-structure which involves the Corporation, a Corporation Affiliate, and/or an affiliate of the Member; E. Incurrence of indebtedness by the Corporation and its Affiliates due to bonds, bank loans, capital leases, or otherwise borrowing money whether or not included in the operating or capital budgets approved by the Member (but not including trade payables incurred in the ordinary course of business in accordance with operating and capital budgets approved by the Member); F. Selection of any new, or removal of any existing, CEO of the Corporation, as well as the administrative reporting relationship of the CEO of the Corporation, provided that selection, removal, and the reporting relationship of the Corporation's CEO is subject to approval by UnityPoint Health; G. The transfer, sale or closure of any facility, department, or function at the Corporation or the Corporation's Affiliates; H. Any amendment to the Articles or Bylaws of the Corporation or its Affiliates; I. Managed care strategy and execution of managed care contracts; however, local managed care contracts may or may not be executed by the Corporation so long as the decision does not negatively impact UPH managed care strategy; and J. Payments or transfer of assets between the Corporation or its Affiliates and UPH, so long as the obligation of the Corporation is proportionate or equitable to other UPH Affiliates. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is provided to the Board of Directors before it is filed. The CFO reviews the Form 990. |
| Form 990, Part VI, Section B, line 12c | Officers and Board members are required to sign a conflict of interest statement upon hiring or becoming a Board member. The disclosure is updated at the annual meeting. Any possible conflict of interest is disclosed to the other Board members and made a matter of record through an annual procedure and also when the interest becomes a matter of Board action. Disclosures are reviewed by the Board of Directors and any Member for whom conflicts have been identified leave the room and abstain from voting. Appropriate documentation of the handling of the conflict is kept to protect the interested party and Hancock County Senior Services Association. Additionally, the Compliance Officer meets with the Compliance Committee of the Board. Any issues identified are logged and followed up by the Compliance Officer. |
| Form 990, Part VI, Section B, line 15 | Compensation for the CEO and CFO is paid through Memorial Hospital Association, a related organization. Memorial Hospital has identified processes in place for determining compensation. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, Conflict of Interest Policy, and financial statements are available to the public upon request. |
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