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 |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 474,930 | 279,257 | 243,580 | 287,274 | 279,300 | 1,564,341 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 474,930 | 279,257 | 243,580 | 287,274 | 279,300 | 1,564,341 |
| 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) .. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,564,341 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 474,930 | 279,257 | 243,580 | 287,274 | 279,300 | 1,564,341 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 16,310 | 2,853 | 287,341 | -304,241 | 216,650 | 218,913 |
| 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.).. | 72,100 | 102,551 | 36,014 | 210,665 | ||
| 11 | Total support. Add lines 7 through 10 | 1,993,919 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|
| Software ID: | 22015553 |
| Software Version: | 2022v5.0 |
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 Barlow Group, a California nonprofit public benefit corporation is the only member. The Barlow Group also serves as the only member of the Barlow Foundation which is the fund raising arm for Barlow Respiratory Hospital. |
| Form 990, Part VI, Section A, Line 7a | There are two categories of directors- Designated directors and Selected directors.Designated Directors of which there shall be no more than five (5), shall be the individuals serving in the positions enumerated below:(a)President of Barlow Group;(b)President of the corporation;(c)Medical Director of the Hospital;(d)Chief of the medical staff of the Hospital (the Medical Staff) (duly elected by the Medical Staff).(e)Chairperson of the Board of Barlow Foundation, or another member of the Board of Barlow Foundation as designated by the Barlow Foundation and approved by the Board of Barlow Group.Each Designated Director shall serve on the Board so long as he or she holds at least one of the positions enumerated above.All directors other than the Designated Directors shall be Selected Directors. Pursuant to Section 5220(d) of the California Nonprofit Public Benefit Corporation Law, all Selected Directors shall be designated by the Member and shall serve at the pleasure of the Member. All directors of the corporation shall be individuals also serving on the Members Board of Directors. Selected Directors shall serve for the same term as the Selected Director serves on the Members Board of Directors.Notwithstanding any other provision of these Bylaws, at no time shall the Board include in the aggregate more than forty-nine percent (49%) interested persons as defined by Section 5227 of the California Nonprofit Public Benefit Corporation Law. |
| Form 990, Part VI, Section A, Line 7b | Each of the following powers may be executed only with the prior written approval of the Member:(a)To retain an attorney or firm of attorneys to provide legal services for the corporation and to fix the amount of compensation for such services, except in such a case where the retention of an attorney or firm of attorneys concerns a non-routine situation, such as, by way of example only, the existence of a conflict of interest that requires the use of an attorney or firm of attorneys not previously consented to;(b)To retain an accountant or firm of accountants to provide accounting and auditing services for the corporation and to fix the amount of compensation for such services;(c) To authorize any unbudgeted expenditure in excess of $100,000 for capital improvements to the properties owned or leased by the corporation and not approved by a budget procedure;(d)To establish any programs with respect to marketing and/or public relations, which relate to strategic planning on a system-wide basis for the Barlow Group and its affiliates and to retain any consultants at a cost in excess of $250,000 with respect thereto;(e)To incur or guarantee indebtedness, as so defined in accordance with Generally Accepted Accounting Principles;(f)To mortgage, pledge or otherwise encumber any real property of the corporation, and to mortgage, pledge or otherwise encumber property or assets, other than real property, of the corporation with a value in excess of $50,000;(g)To sell, lease, assign or otherwise transfer any real property of the corporation, and to sell, lease, assign or otherwise transfer property or assets, other than real property, of the corporation with a value in excess of $50,000;(h)To adopt or modify an annual budget and an annual business plan for this corporation;(i)To form a subsidiary or enter into an agreement to act as a general partner;(j)To remove the President, the Chief Financial Officer or the Medical Director from office; and(k)To amend or repeal the Bylaws. |
| Form 990, Part VI, Section B, Line 11b | The Chief Financial Officer and the Finance Department staff will prepare and file the returns. When it is deemed appropriate, consultative support and /or review will be solicited from an external public accounting firm. Prior to filing, the return for each of the Barlow Organizations will be distributed to the Barlow Group Board of Directors for their review. |
| Form 990, Part VI, Section B, Line 12c | The Barlow Foundation has a Board of Director Conflict of Interest Policy that all Board members must complete and sign at least every two (2) years. The policy requires every director to complete and return the Conflict of Interest Disclosure Questionnaire. The policy requires that In connection with any actual or possible conflict of interest, an interested person must disclose the existence and nature of his or her financial interest to the directors and members of committees with board delegated powers considering the proposed transaction or arrangement. After disclosure of the financial interest, the interested person shall not participate in the discussion of that item and shall not vote on the issue or shall leave the board or committee meeting while the financial interest is discussed and voted upon... |
| Form 990, Part VI, Section C, Line 19 | The audited financial statements, governing/organizing documents, and conflict of interest policy are all available upon request. In addition, form 990's are available in the Foundation page on BARLOWHOSPITAL.ORG |
| Form 990, Part XI, Line 9 | Net asset transfers = -$628190 |
| Form 990, Part I and Part III, Line 1 - Organization Mission | Barlow Foundation's mission is to generate funds to support Barlow Respiratory Hospital with funding which will help to sustain the hospital's ability to provide specialized treatment in the area of respiratory medicine. The hospital currently operates in a building that was built in 1927 and must be retrofitted to meet mandated current seismic safety requirements and remodeled to provide a current state care setting for our patients and clinicians. The Foundation's current activities are devoted to soliciting funds to support this building upgrade as well as establishing a donor base that will continue to the support the hospital in the future. |
| Form 990, Part IX, Line 5 & 7- Compensation of director and employees | Director and employees are employed and compensated by Barlow Respiratory Hospital(BRH). BRH reports 100% of the individual's compensation on W-2's issued by BRH. However, some of these employees are assigned duties to other related organizations (See Schedule R for additional information regarding the related organizations). As a result of these assignments, wage and benefit costs are allocated to related organizations. The wage and benefit costs allocated to each organization are reported on Form 990, Part IX, Statement of Functional Expenses for each individual as being compensated directly by the filing organization and the balance of compensation is reported as compensation paid by related organizations. |
| Form 990, Part VII - Compensation Explanation, David R. Nelson, M.D. | Dr.David Nelson received compensation was for his Medical Director services of Barlow Respiratory Hospital and not for his services as a member of the board of directors. |
| Software ID: | 22015553 |
| Software Version: | 2022v5.0 |