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)
![]() |
(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.") . | 565,406 | 774,830 | 2,421,993 | 1,211,235 | 1,058,483 | 6,031,947 |
| 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 | 6,158,969 | 5,596,841 | 9,260,653 | 6,822,208 | 12,867,268 | 40,705,939 |
| 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 | 6,724,375 | 6,371,671 | 11,682,646 | 8,033,443 | 13,925,751 | 46,737,886 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 43,689 | 365,570 | 77,287 | 17,015 | 229,500 | 733,061 |
| 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.. | 43,689 | 365,570 | 77,287 | 17,015 | 229,500 | 733,061 |
| 8 | Public support. (Subtract line 7c from line 6.) | 46,004,825 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 6,724,375 | 6,371,671 | 11,682,646 | 8,033,443 | 13,925,751 | 46,737,886 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 45,132 | 9,528 | 10,572 | 49,269 | 125,004 | 239,505 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 45,132 | 9,528 | 10,572 | 49,269 | 125,004 | 239,505 |
| 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.) .. | 2,785 | 1,563 | 47,821 | 25,396 | 3,485 | 81,050 |
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 6,772,292 | 6,382,762 | 11,741,039 | 8,108,108 | 14,054,240 | 47,058,441 |
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: | OTHER INCOME - 2019 AMOUNT: $ 2,785. 2020 AMOUNT: $ 1,563. 2021 AMOUNT: $ 47,821. 2022 AMOUNT: $ 25,396. 2023 AMOUNT: $ 3,485. |
| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1A | THE EXECUTIVE COMMITTEE SHALL BE COMPRISED OF NINE PERSONS, INCLUDING THE OFFICERS OF THE BOARD OF DIRECTORS, THE PRESIDENT OF THE CORPORATION, AND FOUR OTHER MEMBERS OF THE BOARD OF DIRECTORS TO BE APPOINTED BY THE CHAIR WITH THE APPROVAL OF THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL BE EMPOWERED TO ACT ON BEHALF OF THE ENTIRE BOARD OF DIRECTORS ON MATTERS THAT REQUIRE ATTENTION AT TIMES WHEN A REGULAR OR SPECIAL MEETING CANNOT BE CALLED. HOWEVER, THE EXECUTIVE COMMITTEE SHALL NOT HAVE THE POWER TO CHANGE THE LOCATION OF THE CORPORATION, AMEND THE BY-LAWS, ELECT OFFICERS OR DIRECTORS TO FILL VACANCIES, REMOVE OFFICERS OR DIRECTORS, OR AUTHORIZE A MERGER |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY A NATIONAL INDEPENDENT ACCOUNTING FIRM FROM INFORMATION PROVIDED BY MANAGEMENT. FINANCIAL MANAGEMENT WILL REVIEW THE FORM 990 WHEN IT IS COMPLETED. ASCENTRIA CARE ALLIANCE, INC.'S (ACA) AUDIT COMMITTEE PROVIDES SECONDARY REVIEW AND APPROVAL PRIOR TO SUBMISSION TO THE IRS. THE COMPLETE FORM 990 IS POSTED TO THE BOARD INTRANET FOR REVIEW BY THE ACA FINANCE COMMITTEE AS WELL AS ALL BOARD MEMBERS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DIRECTOR, OFFICER, EMPLOYEE, COMMITTEE MEMBER, OR VOLUNTEER OF ACA OR ITS SUBSIDIARIES, WHETHER BECAUSE OF HIS/HER EMPLOYMENT, BUSINESS INTERESTS, INVESTMENTS, OR OTHERWISE, WHO HAS INTERESTS THAT DO OR MAY, DIRECTLY OR INDIRECTLY, COMPETE WITH OR BE IN CONFLICT WITH THE INTERESTS OF ACA SHALL PROMPTLY DISCLOSE ALL MATERIAL FACTS OF SUCH CONFLICT OF INTEREST IN WRITING TO THE CHAIRPERSON OF THE BOARD OF DIRECTORS AND/OR TO THE PRESIDENT OF ACA. SUCH PERSON SHALL ALSO ANNOUNCE THE SAME AT ANY MEETING OR DISCUSSION IN WHICH HE/SHE IS A PARTICIPANT AND AT WHICH SUCH CONFLICT ARISES AND SHALL REFRAIN FROM ACTING THEREON. AFTER DISCLOSURE OF A 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 DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. THE CHAIRPERSON OF THE GOVERNING BOARD OR COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER ACA CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN ACA'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION IT SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE COMMITTEE WILL OBTAIN RESEARCH TO MAKE A RECOMMENDATION FOR THE COMPENSATION OF THE CEO. A REVIEW OF COMPARABILITY DATA MAY INCLUDE THE FOLLOWING: COMPENSATION STUDIES BY INDEPENDENT SOURCES, WRITTEN JOB OFFERS FOR POSITIONS AT SIMILAR ORGANIZATION, DOCUMENTED PHONE CALLS ABOUT SIMILAR CEO POSITIONS, AND INFORMATION OBTAINED FROM THE IRS FORM 990 FILING OF SIMILAR ORGANIZATION. THE EXECUTIVE COMMITTEE WILL DOCUMENT ITS DECISIONS IN THE MINUTES OF THE MEETING. THE DOCUMENTATION OF THE CEO'S COMPENSATION INCLUDES: A DISCUSSION OF THE CEO'S RESPONSIBILITIES; ANNUAL PERFORMANCE REVIEW, DESCRIPTION OF THE COMPENSATION, BENEFITS, AND APPROVAL DATE; LIST OF COMMITTEE MEMBERS PRESENT DURING THE DISCUSSION; ACTIONS TAKEN WITH RESPECT TO THE DECISION OF THE COMPENSATION; AND A RECORD OF THE RESULT OF THE COMPENSATION VOTE. COMPENSATION OF THE ORGANIZATION'S OFFICERS OR KEY EMPLOYEES INCLUDE A SIMILAR PROCESS HOWEVER, AMOUNTS ARE APPROVED BY THE CEO. A REVIEW OF COMPARABILITY DATA MAY INCLUDE THE FOLLOWING: COMPENSATION STUDIES BY INDEPENDENT SOURCES, WRITTEN JOB OFFERS FOR POSITIONS AT SIMILAR ORGANIZATION, DOCUMENTED PHONE CALLS ABOUT SIMILAR POSITIONS, AND INFORMATION OBTAINED FROM THE IRS FORM 990 FILING OF SIMILAR ORGANIZATION. THE DOCUMENTATION OF THE OFFICERS AND KEY EMPLOYEES COMPENSATION INCLUDES: A DISCUSSION OF RESPONSIBILITIES; ANNUAL PERFORMANCE REVIEW, DESCRIPTION OF THE COMPENSATION, BENEFITS, AND APPROVAL DATE; ACTIONS TAKEN WITH RESPECT TO THE DECISION OF THE COMPENSATION. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,913. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,913. PAYROLL PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 319,700. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 319,700. CONSULTANTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 964,410. FUNDRAISING EXPENSES 69,110. TOTAL EXPENSES 1,033,520. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 88,037. FUNDRAISING EXPENSES 46,139. TOTAL EXPENSES 134,176. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 193,538. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,538. BENEFIT PROCESSING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 5,607. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,607. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 1,725. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,725. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF EQUITY TO RELATED ORGANIZATIONS -9,998,645. TRANSFER OF EQUITY 15,700,174. |
| Software ID: | |
| Software Version: |