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) 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.") .. | ||||||
| 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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 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) |
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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 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. |
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| 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) |
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| 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. |
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|
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. |
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7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
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| 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 |
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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 III, line 3 | St. Margaret's Health - Spring Valley ceased operations on Friday, June 16, 2023. On August 31, 2023, the hospital filed a petition for relief under Chapter 11 of the federal bankruptcy law in the United States Bankruptcy Court. |
| Form 990, Part IV, Line 20b: | The audit of St. Margaret's Health - Spring Valley for the year ended September 30, 2022 was started in November 2022. The audit was suspended due to outstanding items and never completed. St. Margaret's Health - Spring Valley ceased operations on Friday, June 16, 2023. On August 31, 2023, the hospital filed a petition for relief under Chapter 11 of the federal bankruptcy law in the United States Bankruptcy Court. The audit for fiscal year ending September 30, 2023 was not completed. The Organization has attached a copy of its most recent audited financial statements for the years ended September 30, 2021 and 2020 to the Form 990 and answered yes to Part IV, line 20b. |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is St. Margaret's Health. |
| Form 990, Part VI, Section A, line 7a | St. Margaret's Health, sole member, has authority to elect and remove, with or without cause, the Board of Directors of the Corporation or any member of the Board of Directors of the Corporation. |
| Form 990, Part VI, Section A, line 7b | St. Margaret's Health, sole member, has exclusive right to: (a) To establish, approve, or modify the philosophy, vision, values and mission according to which the Corporation operates; (b) To lease, sell, encumber or otherwise alienate any real property or interest in real property of the Corporation; To approve any transfer, lease, sale or encumbrance of personal property of the Corporation except in the ordinary course of business; (d) To approve any purchase or other acquisition by the Corporation that is not included in its operating and capital budgets and exceeds $100,000.00; (e) To approve any borrowing or debt financing on behalf of the Corporation, to structure and restructure indebtedness of the Corporation, and to enter into and amend agreements relating to indebtedness of the Corporation; (f) To require a certified audit of the finances of the Corporation and to appoint the certified public accountant to perform any audit; (g) To approve the engagement of and to dismiss any outside legal counsel to represent the Corporation on a regular basis or in connection with any matter deemed by Member to have significance for the Member and/or its affiliates; (h) To elect and remove, with or without cause, the board of directors of the Corporation or any member of the board of directors of the Corporation; (i) To merge or consolidate the Corporation with other entities, to merge other entities into the Corporation, or to dissolve the Corporation, in accordance with applicable law; (j) To amend the bylaws and Articles of Incorporation of the Corporation in accordance with applicable law; (k) To expand, consolidate, terminate or close any of the facilities and services of the Corporation; (l) To hire, appoint, enter into an employment contract with, discipline, remove or terminate the Corporation President & CEO and to appoint and remove the Corporation Chairperson, Vice Chairperson, Secretary and Chief Financial Officer; (m) To approve strategic plan and management objectives for the Corporation, which will be developed by the Corporation and recommended to Member; (n) To adopt or modify the operating budget and capital budget for any fiscal year for the Corporation, which will be developed by the Corporation and recommended to Member; (o) To give preliminary approval prior to the development of, and to give final approval prior to the execution of, all documents to which the Corporation will be a party to joint ventures and other affiliations with third parties, and approve the creation, formation, organization, or termination of any legal entity in which the Corporation will have any ownership interest, membership interest, power to elect or appoint board members or officers, or any other formal participation arrangement, whether acting alone or in conjunction with any other person or entity; (p) To approve appointments to governing bodies of joint ventures between the Corporation and third parties and other legal entities in which the Corporation has any power to elect or appoint board members or officers; and (q) To take any and all actions deemed necessary, in the sole judgment of the Member, to protect and preserve the tax-exempt status and public charity status of the Member and any tax-exempt affiliate of the Member (including federal and state income tax exemptions, property tax exemptions, and sales tax exemptions); provided the Member has given a written request to the Corporation to take action or refrain from taking action, which would have sufficiently protected and preserved such tax-exempt and public charity status, and the Corporation has failed to promptly take such action or refrain from taking such action. |
| Form 990, Part VI, Section A, line 8b | The organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is made available to the Board of Directors. The President & CEO and Vice President of Finance review the Form 990. |
| Form 990, Part VI, Section B, line 12c | Each Director and officer must submit in writing to the Chair of the Board and the President & CEO a list of all business or other organizations of which the individual is an officer, director, trustee, member, owner (either as a sole proprietor or partner), shareholder with a 5% or greater interest in all outstanding voting shares, employee or agent, with which the organization has, or might reasonably in the future enter into, a relationship or a transaction in which the Director would have conflicting interests. Each written statement is resubmitted with any necessary changes each year. The Chair of the Board reviews the statements of the Directors and the Vice Chair of the Board reviews the statement filed by the Chair. When a conflict arises the affected Director makes known the potential conflict, whether disclosed by written statement or not, and after answering any questions, will withdraw from the meeting for as long as the matter continues under discussion. Should the matter be brought to a vote, the affected Director will not vote on it. In the event the Director does not withdraw voluntarily, the Chair of the Board as authority to require the Director to remove himself from the room during both the discussion and vote on the matter. In the event the conflict of interest affects the Chair, the Vice Chair has authority to require the Chairperson remove himself in the same matter. If the matter is the item of business for which a special meeting of the Board was called, the affected Director will not be counted to establish a quorum, and he/she will not participate in the deliberations or vote on it. |
| Form 990, Part VI, Section B, line 15 | The Organization's President & CEO and Vice President of Finance are compensated by SMP Health, a related organization. The compensation process is determined by SMP Health. SMP Health's Board of Trustees directly engages a nationally recognized independent compensation consulting firm to review the total compensation arrangements of the officers and key employees. SMP Health's Board of Trustees approves all compensation based on comparable data and documents their decision in the meeting minutes. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are not available to the public. Financial information is available through the public disclosure copy of the 990. |
| Form 990, Part IX, line 11g | Purchased services: Program service expenses 7,660,839. Management and general expenses 3,877,881. Fundraising expenses 0. Total expenses 11,538,720. Professional fees: Program service expenses 0. Management and general expenses 3,414,064. Fundraising expenses 0. Total expenses 3,414,064. Contract Labor: Program service expenses 2,967,269. Management and general expenses 27,870. Fundraising expenses 0. Total expenses 2,995,139. |
| Form 990, Part XI, line 9: | Equity transfers to affiliates -17,117,703. Change in beneficial interests in assets held by others 11,837. |
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