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CASA GRANDE COMMUNITY HOSPITAL FOUNDATION INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
CASA GRANDE COMMUNITY HOSPITAL FOUNDATION INC (EIN 31-1726569)
Tax period
2017-01-01 to 2017-12-31
Filed
2018-09-15
IRS object ID
201812589349300016
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-09-15T18:03:02-05:00ReturnTs
Tax Period End2017-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN910189318PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line13121 W MARCH LN STE 200AddressLine1Txt
CitySTOCKTONCityNm
State AbbreviationCAStateAbbreviationCd
ZIP952192367ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN311726569EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CASA GRANDE COMMUNITY HOSPITALBusinessNameLine1Txt
Business Name Line2FOUNDATION INCBusinessNameLine2Txt
FieldValueIRS element (for citing)
Business Name ControlCASABusinessNameControlTxt
Phone5203816541PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line11800 E FLORENCE BLVDAddressLine1Txt
CityCASA GRANDECityNm
State AbbreviationAZStateAbbreviationCd
ZIP85122ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAVID FITZGIBBONS IIIPersonNm
Person TitleCHAIRMANPersonTitleTxt
Phone5203816541PhoneNum
Signature2018-09-10SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTRACY S PAGLIAPreparerPersonNm
PTINP00366884PTIN
Phone2099556100PhoneNum
Preparation2018-09-10PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address12.129.7.100IPv4AddressTxt
FieldValueIRS element (for citing)
IP2018-09-10IPDt
IP Tm12:55:24IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdDA39A3EE5E6B4B0D3255BFEF95601890AFD80709AtSubmissionCreationDeviceId
At Submission Filing Device IdBE861C6778D90A5D3E7861ABDDE45BE6309F51A4AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2018-06-14 16:35:46ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDAVID FITZGIBBONS IIIPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line11800 E FLORENCE BLVDAddressLine1Txt
CityCASA GRANDECityNm
State AbbreviationAZStateAbbreviationCd
ZIP85122ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$301,189GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.BANNERHEALTH.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2003FormationYr
Legal Domicile StateAZLegalDomicileStateCd
Activity Or MissionTO SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER.ActivityOrMissionDesc
Voting Members Governing Body16VotingMembersGoverningBodyCnt
Voting Members Independent16VotingMembersIndependentCnt
Total Employee0TotalEmployeeCnt
Total Volunteers377TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$193,807PYContributionsGrantsAmt
CY Contributions Grants$250,747CYContributionsGrantsAmt
PY Program Service Revenue$0PYProgramServiceRevenueAmt
CY Program Service Revenue$0CYProgramServiceRevenueAmt
PY Investment Income$19,482PYInvestmentIncomeAmt
CY Investment Income$0CYInvestmentIncomeAmt
PY Other Revenue-$7,749PYOtherRevenueAmt
CY Other Revenue-$16,936CYOtherRevenueAmt
PY Total Revenue$205,540PYTotalRevenueAmt
CY Total Revenue$233,811CYTotalRevenueAmt
PY Grants And Similar Paid$151,927PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$301,268CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$0PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$0CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$20,389PYOtherExpensesAmt
CY Other Expenses$21,743CYOtherExpensesAmt
PY Total Expenses$172,316PYTotalExpensesAmt
CY Total Expenses$323,011CYTotalExpensesAmt
PY Revenues Less Expenses$33,224PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$89,200CYRevenuesLessExpensesAmt
Total Assets BOY$1,790,739TotalAssetsBOYAmt
Total Assets EOY$1,722,659TotalAssetsEOYAmt
Total Liabilities BOY$494,872TotalLiabilitiesBOYAmt
Total Liabilities EOY$441,574TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,295,867NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,281,085NetAssetsOrFundBalancesEOYAmt
MissionTHE PRIMARY EXEMPT PURPOSE OF THE CASA GRANDE COMMUNITY HOSPITAL FOUNDATION, INC. IS TO SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$293,165ExpenseAmt
Grant$293,165GrantAmt
Revenue$0RevenueAmt
DescTHE FOUNDATION SEEKS TO PROMOTE PHILANTHROPY IN THE COMMUNITY THAT WILL SUPPORT THE CASA GRANDE REGIONAL MEDICAL CENTER. THE FOUNDATION'S WORK WILL ENHANCE THE QUALITY OF LIFE FOR THE ENTIRE COMMUNITY THROUGH ITS STEWARDSHIP OF THE CHARITABLE GIFTS ENTRUSTED TO IT.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$8,103ExpenseAmt
Grant$8,103GrantAmt
DescFREE BREAST HEALTH SCREENING FOR FINANCIALLY NEEDY WOMEN SERVING APPROXIMATELY 28 WOMEN.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$18,280ExpenseAmt
DescANNUITY PAYMENTSDesc
FieldValueIRS element (for citing)
Total Program Service Expenses$319,548TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent Endowments0TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising ActivitiesYes (1)FundraisingActivitiesInd
Gaming ActivitiesYes (1)GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To IndividualsYes (1)GrantsToIndividualsInd
Schedule J Required0ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash ContriYes (1)DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl EntYes (1)RelatedOrganizationCtrlEntInd
Transaction With Control Ent0TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document9IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee0EmployeeCnt
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo ContributionsYes (1)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (1)QuidProQuoContriDisclInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members16GoverningBodyVotingMembersCnt
Independent Voting Member16IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldAZStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1LISA DAVISBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone6027474000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12901 N CENTRAL AVENUE SUITE 160AddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85012ZIPCd
FieldValueIRS element (for citing)
No Listed Persons CompensatedYes (X)NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmt
DAVID FITZGIBBONS III
DIRECTOR/CHAIRMAN4.00Yes (X)Yes (X)$0$0$0
JOHN R MCEVOY
SECRETARY/TREASURER/DIRECTOR4.00Yes (X)Yes (X)$0$0$0
CHERIE MCGLYNN
DIRECTOR/NOMINATING COMMITTEE CHAIRMAN0.50Yes (X)$0$0$0
CHUCK GOODMILLER
DIRECTOR/VICE CHAIRMAN4.00Yes (X)Yes (X)$0$0$0
AJAY BHATNAGER PHD
DIRECTOR0.50Yes (X)$0$0$0
COLLEEN BECHTEL
DIRECTOR0.50Yes (X)$0$0$0
FERNANDO CORNEJO
DIRECTOR0.50Yes (X)$0$0$0
THOMAS ERICKSON MD
DIRECTOR0.50Yes (X)$0$0$0
RAMON MOURELO MD
DIRECTOR0.50Yes (X)$0$0$0
LOUIE SANCHEZ
DIRECTOR0.50Yes (X)$0$0$0
TERRY STRAIN
DIRECTOR0.50Yes (X)$0$0$0
JANET WARREN
DIRECTOR0.50Yes (X)$0$0$0
FRANK DAVIDSON
DIRECTOR (THRU 5/1/17)0.50Yes (X)$0$0$0
TOM LEEDS
DIRECTOR0.50Yes (X)$0$0$0
BARBARA WRIGHT EDD
DIRECTOR0.50Yes (X)$0$0$0
BRETT STEWART DC
DIRECTOR0.50Yes (X)$0$0$0
DEE CHAPPELL
DIRECTOR0.50Yes (X)$0$0$0
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K0TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd
Cntrct Rcvd Greater Than100 K0CntrctRcvdGreaterThan100KCnt
Fundraising$49,121FundraisingAmt
All Other Contributions$201,626AllOtherContributionsAmt
Noncash Contributions$33,399NoncashContributionsAmt
Total Contributions$250,747TotalContributionsAmt
Fundraising Gross Income$10,752FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$49,121ContriRptFundraisingEventAmt
Fundraising Direct Expenses$25,154FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$14,402TotalRevenueColumnAmt
Exclusion-$14,402ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$39,690GamingGrossIncomeAmt
Gaming Direct Expenses$42,224GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column-$2,534TotalRevenueColumnAmt
Exclusion-$2,534ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$233,811TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion-$16,936ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$286,165TotalAmt
Program Services$286,165ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$15,103TotalAmt
Program Services$15,103ProgramServicesAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$703TotalAmt
Management And General$703ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$1,097TotalAmt
Management And General$1,097ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (2 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
ANNUITY PAYMENTS$18,280$18,280
DUES & SUBSCRIPTIONS$701$701

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$962TotalAmt
Management And General$962ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$323,011TotalAmt
Program Services$319,548ProgramServicesAmt
Management And General$3,463ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,220,288BOYAmt
EOY$1,105,882EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$14,042BOYAmt
EOY$4,230EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$57,405LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$2,336LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$55,069BOYAmt
EOY$55,069EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$501,340BOYAmt
EOY$557,478EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$1,790,739BOYAmt
EOY$1,722,659EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$494,872BOYAmt
EOY$441,574EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$494,872BOYAmt
EOY$441,574EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$76,511BOYAmt
EOY$61,729EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,219,356BOYAmt
EOY$1,219,356EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,295,867BOYAmt
EOY$1,281,085EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,790,739BOYAmt
EOY$1,722,659EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$89,200ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst$74,418NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS Audited0FSAuditedInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Public Organization170Yes (X)PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$106,920CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$148,612CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$120,850CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$193,807CurrentTaxYearMinus1YearAmt
Current Tax Year$250,747CurrentTaxYearAmt
Total$820,936TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$106,920CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$148,612CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$120,850CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$193,807CurrentTaxYearMinus1YearAmt
Current Tax Year$250,747CurrentTaxYearAmt
Total$820,936TotalAmt
FieldValueIRS element (for citing)
Public Support Total170$820,936PublicSupportTotal170Amt

Gross Investment Income170 GrossInvestmentIncome170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$26,046CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$752CurrentTaxYearMinus3YearsAmt
Total$26,798TotalAmt

Unrelated Business Net Incm170 UnrelatedBusinessNetIncm170Grp

FieldValueIRS element (for citing)
Current Tax Year Minus3 Years$26,743CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus1 Year$955CurrentTaxYearMinus1YearAmt
Current Tax Year$0CurrentTaxYearAmt
Total$27,698TotalAmt
FieldValueIRS element (for citing)
Total Support$875,432TotalSupportAmt
Gross Receipts Rltd Activities$135,722GrossReceiptsRltdActivitiesAmt
Public Support CY1700.93770PublicSupportCY170Pct
Public Support PY1700.90290PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170Yes (X)ThirtyThrPctSuprtTestsCY170Ind

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Investment Cost Or Other Basis$55,069InvestmentCostOrOtherBasisAmt
Book Value$55,069BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,336OtherCostOrOtherBasisAmt
Depreciation$2,336DepreciationAmt
Book Value$0BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$55,069TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
DUE TO AFFILIATE$228,218
LIABILITY TO BENEFICIARIES UNDER SPLIT INTEREST AGREEMENTS$213,356
FieldValueIRS element (for citing)
Total Liability$441,574TotalLiabilityAmt

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1GOLF TOURNAMENTEvent1Nm
Gross Receipts Event1$31,683GrossReceiptsEvent1Amt
Charitable Contri Event1$20,931CharitableContriEvent1Amt
Gross Revenue Event1$10,752GrossRevenueEvent1Amt
Non Cash Prizes Event1$514NonCashPrizesEvent1Amt
Rent Facility Costs Event1$3,120RentFacilityCostsEvent1Amt
Food And Beverage Event1$6,913FoodAndBeverageEvent1Amt
Other Direct Expenses Event1$4,951OtherDirectExpensesEvent1Amt
Event2ANNUAL 5KEvent2Nm
Gross Receipts Event2$28,190GrossReceiptsEvent2Amt
Charitable Contri Event2$28,190CharitableContriEvent2Amt
Other Direct Expenses Event2$9,656OtherDirectExpensesEvent2Amt
Gross Receipts Total$59,873GrossReceiptsTotalAmt
Charitable Contributions Tot$49,121CharitableContributionsTotAmt
Gross Revenue Total Events$10,752GrossRevenueTotalEventsAmt
Non Cash Prizes Total Events$514NonCashPrizesTotalEventsAmt
Rent Fclty Costs Total Events$3,120RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$6,913FoodAndBeverageTotalEventsAmt
Oth Direct Expnss Total Events$14,607OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$25,154DirectExpenseSummaryEventsAmt
Net Income Summary-$14,402NetIncomeSummaryAmt

Gaming Information GamingInformationGrp

FieldValueIRS element (for citing)
Gross Revenue Other Gaming$39,690GrossRevenueOtherGamingAmt
Cash Prizes Other Gaming$6,700CashPrizesOtherGamingAmt
Non Cash Prizes Other Gaming$34,398NonCashPrizesOtherGamingAmt
Oth Direct Expnss Other Gaming$1,126OthDirectExpnssOtherGamingAmt
Volunteer Labor Other Gaming0VolunteerLaborOtherGamingInd
Gross Revenue Total Gaming$39,690GrossRevenueTotalGamingAmt
Cash Prizes Total Gaming$6,700CashPrizesTotalGamingAmt
Non Cash Prizes Total Gaming$34,398NonCashPrizesTotalGamingAmt
Oth Direct Expnss Total Gaming$1,126OthDirectExpnssTotalGamingAmt
Direct Expense Summary Gaming$42,224DirectExpenseSummaryGamingAmt
Net Gaming Income Summary-$2,534NetGamingIncomeSummaryAmt
FieldValueIRS element (for citing)
States Where Gaming ConductedAZStatesWhereGamingConductedCd
Licensed0LicensedInd
Explanation If NoTHE RAFFLE WAS HELD FOR THE PURPOSE OF RAISING FUNDS TO SUPPORT THE HOSPITAL'S BREAST CENTER TO PROVIDE FUNDING FOR MAMMOGRAMS AND DIAGNOSTIC TESTING FOR WOMEN WITH NO MEANS TO PAY FOR THE TESTING. THE MONEY IS TRANSFERRED TO THE HOSPITAL, WHICH IS A 501(C)(3) ORGANIZATION, FOR THIS PURPOSE. THE MONEY RAISED IS NOT USED FOR ANY NON TAX-EXEMPT PURPOSE. THE RAFFLE WAS ALSO HELD TO SUPPORT THE STANFIELD FREE CLINIC.ExplanationIfNoTxt
License Suspended Etc0LicenseSuspendedEtcInd
Gaming With Nonmembers0GamingWithNonmembersInd
Member Of Other Entity0MemberOfOtherEntityInd
Gaming Own Facility0.00000GamingOwnFacilityPct
Gaming Other Facility1.00000GamingOtherFacilityPct
Individual With BooksKAITEE DOLL-BELLIndividualWithBooksNm

Persons With Books US Address PersonsWithBooksUSAddress

FieldValueIRS element (for citing)
Address Line11800 E FLORENCE BLVDAddressLine1Txt
CityCASA GRANDECityNm
State AbbreviationAZStateAbbreviationCd
ZIP85122ZIPCd
FieldValueIRS element (for citing)
Cntrct With3rd Prty For Game Rev0CntrctWith3rdPrtyForGameRevInd
Gaming Manager PersonKAITEE DOLL-BELLGamingManagerPersonNm
Gaming Manager Services ProvKAITEE PROVIDES COORDINATION OF THE EVENT, TRACKS THE CONTRIBUTIONS, TRACKS THE TICKETS SOLD, DESIGNS AND PRINTS ANY ADVERTISING OF THE EVENT, COORDINATES THE RAFFLE AND ENSURE PRIZES ARE DISTRIBUTED TO THE WINNERS. NO COMPENSATION IS PAID FOR THESE SERVICES.GamingManagerServicesProvTxt
Charitable Distribution Rqr0CharitableDistributionRqrInd

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (1)GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1BANNER HEALTHBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line12901 NORTH CENTRAL AVENUE STE 160AddressLine1Txt
CityPHOENIXCityNm
State AbbreviationAZStateAbbreviationCd
ZIP85012ZIPCd
FieldValueIRS element (for citing)
Recipient EIN450233470RecipientEIN
IRC Section501(C)(3)IRCSectionDesc
Cash Grant$286,165CashGrantAmt
Purpose Of GrantGENERAL SUPPORTPurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntCash GrantCashGrantAmt
SCHOLARSHIPS14$7,000
FREE BREAST HEALTH SCREENING28$8,103

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 2:FormAndLineReferenceDesc
ExplanationWHEN THE GRANTEE ORGANIZATION PROVIDES A FREE SCREENING TO AN ELIGIBLE PERSON, THE GRANTEE SUBMITS THE INVOICE TO THE FOUNDATION WHO THEN PAYS THE GRANTEE. PAYMENTS ARE NOT ISSUED UNTIL INVOICES ARE RECEIVED.ExplanationTxt

Schedule M IRS990ScheduleM

Collectibles CollectiblesGrp

FieldValueIRS element (for citing)
Non Cash CheckboxYes (X)NonCashCheckboxInd
Contribution7ContributionCnt
Noncash Contributions Rpt F990$806NoncashContributionsRptF990Amt
Method Of Determining RevenuesCOST/SELLING PRICEMethodOfDeterminingRevenuesTxt

Other Non Cash Contri Table OtherNonCashContriTableGrp (4 entries)

Non Cash CheckboxNonCashCheckboxIndDescDescContributionContributionCntNoncash Contributions Rpt F990NoncashContributionsRptF990AmtMethod Of Determining RevenuesMethodOfDeterminingRevenuesTxt
Yes (X)GENERAL MERCHANDISE83$13,621COST/SELLING PRICE
Yes (X)ENTERTAINMENT PACKAGES31$9,865COST/SELLING PRICE
Yes (X)SPORTING TICKETS22$5,293COST/SELLING PRICE
Yes (X)GIFT CARDS103$5,185COST/SELLING PRICE
FieldValueIRS element (for citing)
Form8283 Received0Form8283ReceivedCnt
Any Property That Must Be Held0AnyPropertyThatMustBeHeldInd
Review Process Unusual NC GiftsYes (1)ReviewProcessUnusualNCGiftsInd
Third Parties Used0ThirdPartiesUsedInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, COLUMN (B):0
PART I, LINE 33:N/A

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 6THE SOLE VOTING MEMBER OF CASA GRANDE COMMUNITY HOSPITAL FOUNDATION IS BANNER HEALTH, AN ARIZONA NONPROFIT CORPORATION EXEMPT FROM TAX AS AN ENTITY DESCRIBED UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE.
FORM 990, PART VI, SECTION A, LINE 7ABANNER HEALTH, THE SOLE MEMBER OF CASA GRANDE COMMUNITY HOSPITAL FOUNDATION, HAS THE POWER TO ELECT DIRECTORS OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 7BTHE SOLE MEMBER SHALL HAVE CONTROL OVER THE FOUNDATION AND IT AFFAIRS WHICH SHALL BE PARAMOUNT TO THE RIGHT OF THE BOARD IN EVERY RESPECT. THE FOLLOWING ACTIONS OF THE BOARD SHALL NOT BE EFFECTIVE UNTIL APPROVED BY THE MEMBER: 1) THE REPEAL, ALTERATION OR AMENDMENT OF THE BYLAWS. 2) THE ELECTION OF DIRECTORS. 3) THE ELECTION OF OFFICERS.
FORM 990, PART VI, SECTION B, LINE 11BTHE CEO OF BANNER CASA GRANDE MEDICAL CENTER AND BANNER HEALTH TAX DEPARTMENT REVIEWS THE FORM 990 PRIOR TO FILING. THE CEO WILL PROVIDE AN OVERVIEW AFTER FILING TO THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12CTHE BANNER HEALTH INTERNAL AUDIT DEPARTMENT PROVIDES EACH PARTY WITH A DISCLOSURE QUESTIONNAIRE. THE INTERNAL AUDIT DEPARTMENT PREPARES A SUMMARY FOR THE TAX DEPARTMENT. THIS SUMMARY IS ALSO PRESENTED TO THE AUDIT COMMITTEE. THE TAX DEPARTMENT PREPARES THE FORM 990 DISCLOSURE. THIS DISCLOSURE IS PRESENTED TO THE LEGAL DEPARTMENT FOR REVIEW. PURSUANT TO BANNER'S CONFLICT OF INTEREST POLICY, ALL BOARD MEMBERS, OFFICERS AND THE DIRECTOR OF AUDIT SERVICES MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST THAT MAY GIVE RISE TO A CONFLICT OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15THIS ORGANIZATION DOES NOT PAY COMPENSATION TO THE CEO, OFFICERS OR KEY EMPLOYEES, SO THE QUESTIONS HAVE BEEN ANSWERED "NO" AS THEY DO NOT APPLY.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND TAX RETURNS ARE AVAILABLE UPON REQUEST. COPIES ARE MAINTAINED AT EACH ADMINISTRATIVE OFFICE AND IN THE LEGAL AND TAX DEPARTMENTS.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationIndBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Txt
BANNER HEALTH
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012450234470HOSPITALAZ501(C)(3)LINE 3N/A0
BANNER ALZHEIMER'S FOUNDATION
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012204862361SUPPORTAZ501(C)(3)LINE 70BANNER HEALTH
BANNER HEALTH FOUNDATION
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012942545356SUPPORTAZ501(C)(3)LINE 70BANNER HEALTH
BANNER MEDICAL GROUP
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012900532830MEDICAL SERVICESAZ501(C)(3)LINE 30BANNER HEALTH
BANNER MEDICAL GROUP COLORADO
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012900532831MEDICAL SERVICESCO501(C)(3)LINE 30BANNER HEALTH
BANNER--UNIVERSITY MEDICAL GROUP
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012942958258MEDICAL SERVICESAZ501(C)(3)LINE 30BANNER HEALTH
THE UNIVERSITY OF ARIZONA HEALTH PLANS - FAMILY CARE
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012463766901HEALTH INSURANCEAZ501(C)(3)LINE 100BANNER HEALTH
THE UNIVERSITY OF ARIZONA HEALTH PLANS - UCA
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012463757358HEALTH INSURANCEAZ501(C)(3)LINE 100BANNER HEALTH

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACd
PARTNERS IN INTEGRATED HEALTH LLC
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012611700965MANAGEMENT SERVICESAZN/A
BANNER ARIZONA ASC LLC
525 W BROWN ROADMESAAZ85201900532830OUT-PATIENT SURGERY CENTERTNN/A
DGV ENHANCED US EQUITY FUND LLC
10 SECOND STREET NE SUITE 200MINNEAPOLISMN55413472398930INVESTMENTSMNN/A
BANNER UNION HILLS SURGERY CENTER LLC
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012901164193MEDICAL SERVICESAZN/A
BHSM REHABILITATION LLC
2901 N CENTRAL AVENUE SUITE 160PHOENIXAZ85012823481322MEDICAL SERVICESDEN/A

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCd
BANNER PLAN ADMINISTRATION INC
445 W 5TH PLACE SUITE 101MESAAZ852018608002463RD PARTY ADMINISTRATIONAZN/AC0
BANNER INDEMNITY LTD
450233470INVESTMENTSN/AC0PO BOX 1051GRAND CAYMANBRITISH WEST INDICJCJ
BANNER HEALTH NETWORK
2901 N CENTRAL AVE SUITE 160PHOENIXAZ85012900750689ACCOUNTABLE CARE ORGANIZATIONAZN/AC0
THE UNIVERSITY OF ARIZONA HEALTH PLANS-UNIVERSITY HEALTHCARE INC
2901 N CENTRAL AVE SUITE 160PHOENIXAZ85012454370907HEALTH INSURANCEAZN/AC0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgYes (1)GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd