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)
SPECTRUM HEALTH SERVICES INC |
231686225 | 10 | Yes | 0 | 0 | |
| (B)
SHS COMMUNITY HEALTH INC |
300713501 | 10 | Yes | 0 | 0 | |
|
Total 2
|
0 | 0 | ||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 2024 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-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, 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 2024. 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 2025. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART VI, SECTION A, LINE 6 | THE FOUNDATION HAS ONE MEMBER. THE SOLE MEMBER IS SPECTRUM HEALTH SERVICES, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE FOUNDATION'S BOARD SHALL CONSIST OF DIRECTORS, INCLUDING THE FOLLOWING EX OFFICIO REPRESENTATIVES OF THE MEMBER: (1) THE PRESIDENT AND CHIEF EXECUTIVE OFFICER; (2) THE CHIEF FINANCIAL OFFICER; AND (3) THE CHAIR OF THE MEMBER'S BOARD OF DIRECTORS (THE "EX OFFICIO DIRECTORS"). THE REMAINING APPOINTED DIRECTORS SHALL BE APPOINTED BY THE MEMBER AT THE ANNUAL MEETING OF THE MEMBER. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE APPROVAL OF THE SOLE MEMBER, SPECTRUM HEALTH SERVICES, INC., SHALL BE REQUIRED FOR THE FOLLOWING ACTIONS BY THE FOUNDATION: A. AMENDMENT TO THE FOUNDATION'S ARTICLES OFLNCORPORATION OR BYLAWS; B. THE AUTHORIZATION OF A PLAN OF VOLUNTARY DISSOLUTION OR THE REVOCATION OF A PLAN OF DISSOLUTION PREVIOUSLY APPROVED BY THE MEMBER; C. THE ADOPTION OF AN AGREEMENT OR PLAN OF MERGER, CREATION OF ANY SUBSIDIARY ORGANIZATION OR AFFILIATION OF THE FOUNDATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS WHETHER IN THE FORM OF PARTICIPATION IN A CORPORATION (EITHER THROUGH THE HOLDING OF STOCK OR BY MEMBERSHIP), PARTNERSHIP, JOINT VENTURE, CO-TENANCY OR ANY OTHER FORM OF OWNERSHIP OR CONTROL; D. THE SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF THE FOUNDATION'S ASSETS; E. THE SALE, MORTGAGE, LEASE OR OTHER DISPOSITION OF THE FOUNDATION'S REAL PROPERTY; F. SUBSTANTIAL CHANGES TO THE CHARITABLE MISSION OF THE FOUNDATION; G. THE PURCHASE OF REAL PROPERTY; H. THE APPROVAL OF THE ANNUAL BUDGET OF THE FOUNDATION; I. THE APPROVAL OF THE TAX AND/OR REGULATORY FILINGS OF THE FOUNDATION; J. THE APPROVAL OF THE REVIEWED OR AUDITED FINANCIAL STATEMENTS OF THE FOUNDATION; K. THE APPROVAL OF EXPENDITURES IN EXCESS OF A TEN PERCENT (10%) VARIANCE IN THE TOTAL ANNUAL BUDGET; I. MAJOR STRATEGIC DECISIONS; M. TO CHANGE THE FISCAL YEAR OF THE FOUNDATION; N. TO SELECT AN AUDITOR FOR THE PREPARATION OF ANNUAL FINANCIAL STATEMENTS; O. TO PURCHASE INSURANCE OTHER THAN AS PART OF THE MEMBER'S GROUP OF INSUREDS; P. TO TAKE ANY ACTION WHICH WOULD AFFECT THE NONPROFIT, TAX-EXEMPT STATUS OF THE FOUNDATION; Q. TO INTERVENE IF THE MEMBER DETERMINES THAT THE FOUNDATION'S STANDARD OF CARE IS MAINTAINED AT A LEVEL WHICH VARIES MATERIALLY FROM THE MEMBER'S GENERAL QUALITY STANDARD OF CARE; R. TO APPROVE THE INCURRENCE OR GUARANTY OF ANY INDEBTEDNESS; S. TO APPROVE SUBMISSION OF AN APPLICATION FOR ANY GRANT, LOAN OR LICENSE FROM ANY GOVERNMENTAL AGENCY OR OTHER AUTHORITY WHICH MIGHT RESULT IN THE IMPOSITION OF ANY CONDITIONS OR REQUIREMENTS POTENTIALLY INCONSISTENT WITH THE PHILOSOPHY AND MISSION OF THE MEMBER; T. TO HIRE OR TERMINATE AND TO DETERMINE THE COMPENSATION OF ANY OFFICER OF THE FOUNDATION, GIVING CONSIDERATION TO THE RECOMMENDATION OF THE CHAIR AND THE BOARD; U. TO APPROVE THE EXERCISE OF ANY OF THE FOREGOING POWERS WHICH THE FOUNDATION MAY HAVE DIRECTLY OR INDIRECTLY, AS A MEMBER, STOCKHOLDER OR CONTROLLING ENTITY OF ANOTHER CORPORATION OR PARTICIPANT IN ANY LEGAL PARTNERSHIP, JOINT VENTURE, OR OTHER ENTITY; AND V. TO MODIFY OR RESCIND ANY DELEGATION OF POWER BY THE MEMBER TO THE BOARD, AND TO RESERVE SUCH ADDITIONAL POWERS AS THE MEMBER SHALL FROM TIME TO TIME DETERMINE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION'S RELATED ORGANIZATION, SPECTRUM HEALTH SERVICES, INC. THE 990 IS REVIEWED WITH THE CFO AND CEO OF SPECTRUM HEALTH SERVICES, INC. THE FINAL 990 IS PROVIDED TO THE FULL BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION FOLLOWS THE CONFLICT OF INTEREST POLICY OF ITS SUPPORTED ORGANIZATION, SPECTRUM HEALTH SERVICES, INC. WHICH IS MONITORED AS FOLLOWS: MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE PURPOSE OF THE CONFLICT OF INTEREST POLICY IS TO PROTECT THE CORPORATION'S INTEREST WHEN IT IS CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF AN OFFICER OR DIRECTOR OF THE CORPORATION. ANY DIRECTOR, OFFICER, MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS, EMPLOYEE OR AGENT WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST IS AN INTERESTED PERSON. AN INTERESTED PERSON HAS A DUTY TO DISCLOSE ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. THEY MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. FAMILY AND BUSINESS RELATIONSHIPS ARE EXPRESSLY MENTIONED AS POTENTIAL SOURCES OF CONFLICT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD, BUT AFTER SUCH PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT THAT RESULTS IN THE CONFLICT OF INTEREST. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, THE BOARD SHALL INFORM THE INDIVIDUAL OF THE BASIS FOR SUCH BELIEF AND AFFORD THE MEMBER OPPORTUNITY TO EXPLAIN. IF THE BOARD DETERMINES THAT THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. |
| 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. |
| Software ID: | |
| Software Version: |