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 | |||||
| (A)
Community Health Association of Spokane |
911641797 | 7 | Yes | 0 | 725,593 | |
|
Total 1
|
0 | 725,593 | ||||
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 | 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)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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): |
|||||
| 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 |
|---|---|
| Part I, Line 12g(A), Column (vi): | The Foundation provides direct support to CHAS Health patients including both cash and non-cash items such as winter clothing purchased in bulk to distribute to unhoused patients, fuel and laundry assistance, transportation for appointments, specialty medical and dental services, and medication storage assistance. This also includes assistance to other organizations that support the mission of CHAS Health. |
| Part IV, Section A, Line 6: | CHAS Health Foundation provided cash assistance to organizations other than its supported organization. This assistance was in support of meeting social and health needs of the CHAS Health patient population outside of the scope of CHAS Health services and totaled approximately $165,431. |
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| Return Reference | Explanation |
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| Form 990, Part V, Line 2: | The Foundation does not have employees and therefore, no W-2s are issued by the Foundation. The Foundation reimburses CHAS Health a portion of employee wages and benefits provided on its behalf. These amounts are reported on Part IX, Lines 5-10. |
| Form 990, Part VI, Section A, line 2 | A Business relationship exists in which board members also serve as board members of a related tax-exempt organization. |
| Form 990, Part VI, Section A, line 4 | Major changes include the addition of the following from 2022 version to current: ARTICLE 6. ADMINISTRATION 6.1 Executive Director. In consultation with the Corporation, the Chief Executive Officer of the Corporate Member shall appoint a qualified Director and shall determine the conditions of his or her employment. The Director shall be directly responsible for the management of the Corporation and may not serve as the Chair of the Board of Directors. Performance evaluations of the Director shall be performed by the Chief Executive Officer of the Corporate Member, in consultation with the Board of the Corporation and in accordance with the policies of the Corporate Member. 6.2 Authority and Duties. The Executive Director is accountable to the Board of Directors of the Corporation and to the Chief Executive Officer of the Corporate Member. The Executive Director shall serve as the representative of the Board for the purpose of communication between the organizations. The Executive Director, in keeping with sound principles of management and the Corporate Member's position description for the Director, is responsible to: 6.2.1 Provide leadership in carrying out the philosophy and mission of the Corporation and the Corporate Member; 6.2.2 Provide leadership in strategic planning and organization; 6.2.3 Provide leadership in financial planning and budgeting; 6.2.4 Direct the operations of the Corporation in a manner consistent with the Corporate Member's position description for Executive Director and with the Corporate Member's philosophy, mission, values, and policies; 6.2.5 Direct and facilitate organizational communications; and 6.2.6 Provide leadership in evaluating the performance of the Corporation. 6.3 Discharge, Suspension, Disciplinary Action. Subject to the terms of any applicable contract, the Chief Executive Officer of the Corporate Member, in consultation with the Boards of the Corporation and the Corporate Member, has authority to effect formal disciplinary action, suspension or discharge of the Executive Director of the Corporation. And adding term limits 4.1 Election Term of Office. The directors must be appointed, approved, or ratified by the governing board of CHAS Health. Directors shall serve a term of three (3) years commencing from the date of election to the Board, subject to the provisions of section 4.9. No director shall serve more than two (2) consecutive terms, but may be reelected as a director one year or more after his or her last term has expired. Any vacancy occurring on the Board of Directors will be filled by appointment, subject to approval of the Corporate Member. |
| Form 990, Part VI, Section A, line 6 | The sole member of the Corporation is CHAS Health. |
| Form 990, Part VI, Section A, line 7a | The CHAS Health Board of Directors has the power to appoint or remove any officer or director of the CHAS Health Foundation. |
| Form 990, Part VI, Section A, line 7b | The following powers are reserved exclusively to CHAS Health (Corporate Member) in relation to CHAS Health Foundation (the Corporation): (a) To amend, alter, modify, repeal, or restate the Articles of Incorporation or the Bylaws of the Corporation; (b) To appoint or remove any officer or director of the Corporation; (c) To adopt a plan of merger, consolidation, or liquidation; (d) To authorize a sale, lease, or exchange of substantially all the property and assets of the Corporation not in the ordinary course of business; (e) To authorize a voluntary dissolution of the Corporation and direct the transfer of the Corporation's property and assets to CHAS Health or another qualified charity; (f) To approve the acceptance of any gift that carries conditions or limitations or any gift restricted to services, programs, or facilities not currently offered or approved to be offered by the Corporate Member; and (g) To provide approval of any key decisions of the Corporation, including investment policies and or guidelines, changes to the mission and other governance items not related to the day-to-day operations of the Corporation. |
| Form 990, Part VI, Section A, line 8b | There are no committees with broad authority to act on behalf of the governing board. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared by an independent accounting firm based on organization provided financial statements. Prior to filing, a review of the final Form 990 draft is presented by key accounting staff to the Board of Directors and Finance Committee. |
| Form 990, Part VI, Section B, line 12c | A conflict of interest can be considered to exist whenever the Director's access to information and actions on behalf of the Foundation provides opportunity for obtaining an improper financial gain or other advantage. Conversely, it exists whenever a competing involvement might have an adverse effect on the interests of the Foundation. It may be "real," "potential, or "perceived, and the same duty to disclose applies in each case. It is the duty of the Board Chair to review and administer conflict of interest documentation. The Board Chair retains the right to approach any Director when he/she feels that an upcoming Board discussion or action may involve a conflict of interest. It is the responsibility of all Directors who are aware of a fellow Director's conflict of interest to raise this issue. At a minimum, this communication should always include the Board Chair as well as the Director in question. A Director who has a potential conflict of interest may participate in the early stages of discussion of the particular issue, so that he/she might contribute the benefit of his/her specific knowledge and insights. However, once viable alternatives begin to be assessed on their own merits, this Director should refrain from all further discussion, non-verbal communication and voting on the issue. The Board retains the right to resolve the issue with this Director temporarily absent from the meeting. |
| Form 990, Part VI, Section B, line 15 | The Foundation does not have any employees. Officer compensation is determined by CHAS Health, the supported organization |
| Form 990, Part VI, Section C, line 19 | All referenced documents are made available to view on-site upon request. |
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