ASA CHARITABLE FOUNDATION: Form 990EZ, tax year 2016

View the entire original 990 at ProPublica ↗

Organization: ASA CHARITABLE FOUNDATION (EIN 45-4946512)
Tax period: 2016-01-01 to 2016-12-31
Filed: 2017-11-08
IRS object ID: 201743129349201434
Schema version: 2016v3.0
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
Form 990-EZ
Schedule A
Schedule B
Schedule O
Transfer Prsnl Bnft Contracts Decl

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2017-11-08T15:32:49-06:00	ReturnTs
Tax Period End	2016-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	410746749	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CLIFTONLARSONALLEN LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	1301 W 22ND ST STE 1100	AddressLine1Txt
City	OAK BROOK	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	60523	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990EZ	ReturnTypeCd
Tax Period Begin	2016-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	454946512	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ASA CHARITABLE FOUNDATION	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	ASAC	BusinessNameControlTxt
Phone	8475855586	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1061 AMERICAN LANE	AddressLine1Txt
City	SCHAUMBURG	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	601734973	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	ALEXANDER HANNENBERG MD	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	8475855586	PhoneNum
Signature	2017-11-03	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	GREGORY S ADAMS	PreparerPersonNm
PTIN	P00095597	PTIN
Phone	6305738600	PhoneNum
Preparation	2017-10-30	PreparationDt

Filing Security Information FilingSecurityInformation

IP Address IPAddress

Field	Value	IRS element (for citing)
I Pv4 Address	67.137.57.251	IPv4AddressTxt

Field	Value	IRS element (for citing)
IP	2017-11-03	IPDt
IP Tm	16:32:48	IPTm
IP Timezone	CD	IPTimezoneCd
Filing License Type	P	FilingLicenseTypeCd
At Submission Creation Device Id	96D79D528C2215BE6F492FFEF68EA7E177A44A5C	AtSubmissionCreationDeviceId
At Submission Filing Device Id	B0B82EE3E858863B5AFDA9227FC05760300C7D48	AtSubmissionFilingDeviceId

Field	Value	IRS element (for citing)
Tax	2016	TaxYr
Build TS	2018-03-14 21:41:22Z	BuildTS

Form 990-EZ IRS990EZ

Field	Value	IRS element (for citing)
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Website Address	WWW.ASACHARITY.ORG	WebsiteAddressTxt
Organization501c3	Yes (X)	Organization501c3Ind
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Gross Receipts	$124,343	GrossReceiptsAmt
Info In Schedule O Part I	Yes (X)	InfoInScheduleOPartIInd
Contributions Gifts Grants Etc	$124,343	ContributionsGiftsGrantsEtcAmt
Total Revenue	$124,343	TotalRevenueAmt
Grants And Similar Amounts Paid	$91,930	GrantsAndSimilarAmountsPaidAmt
Fees And Other Pymt To Ind Cntrct	$1,928	FeesAndOtherPymtToIndCntrctAmt
Other Expenses Total	$56,814	OtherExpensesTotalAmt
Total Expenses	$150,672	TotalExpensesAmt
Excess Or Deficit For Year	-$26,329	ExcessOrDeficitForYearAmt
Net Assets Or Fund Balances BOY	$129,621	NetAssetsOrFundBalancesBOYAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Net Assets Or Fund Balances EOY	$103,292	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part II	Yes (X)	InfoInScheduleOPartIIInd

Cash Savings And Investments CashSavingsAndInvestmentsGrp

Field	Value	IRS element (for citing)
BOY	$129,595	BOYAmt
EOY	$106,604	EOYAmt

Other Assets Total Detail OtherAssetsTotalDetail

Field	Value	IRS element (for citing)
BOY	$26	BOYAmt
EOY	$26	EOYAmt

Form990 Total Assets Form990TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$129,621	BOYAmt
EOY	$106,630	EOYAmt

Sum Of Total Liabilities SumOfTotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$3,338	EOYAmt

Net Assets Or Fund Balances NetAssetsOrFundBalancesGrp

Field	Value	IRS element (for citing)
BOY	$129,621	BOYAmt
EOY	$103,292	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Primary Exempt Purpose	THE FOUNDATION'S EXEMPT PURPOSE IS TO IMPROVE HEALTH AND MEDICAL CARE IN UNDER-SERVED COMMUNITIES BY ADVANCING THE QUALITY OF ANESTHESIA CARE, TO INCREASE ACCESS TO QUALITY ANESTHESIA CARE, TO SUPPORT THE ANESTHESIOLOGY PROFESSION'S RESPONSE TO DISASTERS AND HEALTH CRISES, AND TO PROMOTE EDUCATIONAL OPPORTUNITIES IN THE ANESTHESIOLOGY FIELD TO EDUCATE AND DEVELOP LEADERS OF THESE EFFORTS IN THE FUTURE.	PrimaryExemptPurposeTxt

Program Srvc Accomplishment ProgramSrvcAccomplishmentGrp

Field	Value	IRS element (for citing)
Description Program Srvc Accom	THE MISSION OF THE LIFEBOX FOUNDATION IS TO SAVE LIVES OF THOUSANDS OF PEOPLE UNDERGOING SURGERY IN UNDER-RESOURCED COUNTRIES THROUGH THE USE OF A PULSE OXIMETER WHICH MEASURES THE LEVEL OF OXYGEN IN A PATIENT'S BLOOD. PULSE OXIMETERS ARE USED AS A STANDARD IN MANY CLINICAL AREAS IN HOSPITALS THROUGHOUT HIGH INCOME COUNTRIES. APPROXIMATELY 70,000 OPERATING ROOMS IN LOW AND MIDDLE INCOME COUNTRIES ARE WITHOUT THESE EXTREMELY IMPORTANT DEVICES.	DescriptionProgramSrvcAccomTxt
Grants And Allocations	$91,930	GrantsAndAllocationsAmt
Program Service Expenses	$0	ProgramServiceExpensesAmt

Field	Value	IRS element (for citing)
Total Program Service Expenses	$0	TotalProgramServiceExpensesAmt

Officer Director Trustee Empl OfficerDirectorTrusteeEmplGrp (6 entries)

TitleTitleTxt	Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt	CompensationCompensationAmt	Employee Benefit ProgramEmployeeBenefitProgramAmt	Expense Account Other AllwncExpenseAccountOtherAllwncAmt
ALEXANDER A HANNENBERG MD
PRESIDENT	4.00	$0	$0	$0
PETER DUNBAR CH B MBA
SECRETARY-TREASURER	2.00	$0	$0	$0
ARTHUR M BOUDREAUXMD
BOARD MEMBER	1.00	$0	$0	$0
KA KELLY MCQUEEN MD MPH
BOARD MEMBER	1.00	$0	$0	$0
MARY DALE PETERSONMD MHA
BOARD MEMBER	1.00	$0	$0	$0
STEVEN LSWEEN MD
BOARD MEMBER	1.00	$0	$0	$0

Field	Value	IRS element (for citing)
Info In Schedule O Part V	Yes (X)	InfoInScheduleOPartVInd
Activities Not Previously Rpt	0	ActivitiesNotPreviouslyRptInd
Chg Made To Orgnzng Doc Not Rpt	0	ChgMadeToOrgnzngDocNotRptInd
Organization Had UBI	0	OrganizationHadUBIInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Organization Dissolved Etc	0	OrganizationDissolvedEtcInd
Direct Indirect Pltcl Expend	$0	DirectIndirectPltclExpendAmt
Made Loans To From Officers	0	MadeLoansToFromOfficersInd
Tax Imposed Under IRC4911	$0	TaxImposedUnderIRC4911Amt
Tax Imposed Under IRC4912	$0	TaxImposedUnderIRC4912Amt
Tax Imposed Under IRC4955	$0	TaxImposedUnderIRC4955Amt
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
Tax Imposed On Organization Mgr	$0	TaxImposedOnOrganizationMgrAmt
Tax Reimbursed By Organization	$0	TaxReimbursedByOrganizationAmt
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
States Where Copy Of Return Is Fld	IL	StatesWhereCopyOfReturnIsFldCd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	DENNIS RIZZO	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1061 AMERICAN LANE	AddressLine1Txt
City	SCHAUMBURG	CityNm
State Abbreviation	IL	StateAbbreviationCd
ZIP	601734973	ZIPCd

Field	Value	IRS element (for citing)
Phone	8472689150	PhoneNum

Field	Value	IRS element (for citing)
Foreign Financial Account	0	ForeignFinancialAccountInd
Foreign Office	0	ForeignOfficeInd
Donor Advised Fnds	0	DonorAdvisedFndsInd
Operate Hospital	0	OperateHospitalInd
Tanning Services Provided	0	TanningServicesProvidedInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
School Operating	0	SchoolOperatingInd
Trnsfr Exmpt Non Chrtbl Rltd Org	Yes (1)	TrnsfrExmptNonChrtblRltdOrgInd
Related Org Sect527 Org	0	RelatedOrgSect527OrgInd
Part VI Of Comp Of Hghst Pd Empl	NONE	PartVIOfCompOfHghstPdEmplTxt
Part VI Hghst Pd Cntrct Prof Srvc	NONE	PartVIHghstPdCntrctProfSrvcTxt
Filed Schedule A	Yes (1)	FiledScheduleAInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Supporting Organization509a3	Yes (X)	SupportingOrganization509a3Ind
Supporting Org Type1	Yes (X)	SupportingOrgType1Ind
IRS Written Determination	Yes (X)	IRSWrittenDeterminationInd
Supported Organizations	1	SupportedOrganizationsCnt

Supported Org Information SupportedOrgInformationGrp

Supported Organization Name SupportedOrganizationName

Field	Value	IRS element (for citing)
Business Name Line1	AMERICAN SOCIETY OF ANESTHESIOLOGISTS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
EIN	362181944	EIN
Organization Type	7	OrganizationTypeCd
Governing Document Listed	0	GoverningDocumentListedInd
Support	$150,672	SupportAmt
Other Support	$0	OtherSupportAmt

Field	Value	IRS element (for citing)
Supported Organizations Total	1	SupportedOrganizationsTotalCnt
Support Sum	$150,672	SupportSumAmt
Other Support Sum	$0	OtherSupportSumAmt

Form990 Sch A Supporting Org Form990SchASupportingOrgGrp

Field	Value	IRS element (for citing)
Listed By Name Governing Doc	Yes (1)	ListedByNameGoverningDocInd
Suprt Org No IRS Determination	0	SuprtOrgNoIRSDeterminationInd
Supported Org Section C456	Yes (1)	SupportedOrgSectionC456Ind
Supported Org Qualified	Yes (1)	SupportedOrgQualifiedInd
Suprt Exclusively Sec170c2 B	Yes (1)	SuprtExclusivelySec170c2BInd
Supported Org Not Organized US	0	SupportedOrgNotOrganizedUSInd
Organization Change Suprt Org	0	OrganizationChangeSuprtOrgInd
Support Non Supported Org	0	SupportNonSupportedOrgInd
Payment Substantial Contribtr	0	PaymentSubstantialContribtrInd
Loan Disqualified Person	0	LoanDisqualifiedPersonInd
Controlled Disqualified Prsn	0	ControlledDisqualifiedPrsnInd
Disqualified Prsn Controll Int	0	DisqualifiedPrsnControllIntInd
Disqualified Prsn Ownr Int	0	DisqualifiedPrsnOwnrIntInd
Excess Business Holdings Rules	0	ExcessBusinessHoldingsRulesInd
Contribution Controller	0	ContributionControllerInd
Contribution Family	0	ContributionFamilyInd
Contribution35 Controlled	0	Contribution35ControlledInd

Form990 Sch A Type1 Suprt Org Form990SchAType1SuprtOrgGrp

Field	Value	IRS element (for citing)
Power Appoint Majority Dir Trst	Yes (1)	PowerAppointMajorityDirTrstInd
Operate Benefit Non Suprt Org	0	OperateBenefitNonSuprtOrgInd

Form990 Schedule A Part VI Form990ScheduleAPartVIGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART IV, SECTION A, LINE 3B:	ASA CHARITABLE FOUNDATION CONFIRMED THAT THE SUPPORTED ORGANIZATION, AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA), IS A 501 (C)(6) TAX EXEMPT ORGANIZATION BY REVIEWING THEIR IRS DETERMINATION LETTER AND ALSO ANNUALLY COMPLETING A PRO FORMA SCHEDULE A, PART III TEST TO CONFIRM THAT ASA SATISFIES THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2).
PART IV,SECTION A, LINCE 3C:	THE ACTIVITIES OF ASACF ARE PERFORMED IN FURTHERANCE OF THEIR EXEMPT PURPOSE WHICH IS TO IMPROVE HEALTH AND MEDICAL CARE IN UNDER-SERVED COMMUNITIES BY ADVANCING THE QUALITY OF ANESTHESIA CARE, TO INCREASE ACCESS TO QUALITY ANESTHESIA CARE, TO SUPPORT THE ANESTHESIOLOGY PROFESSION'S RESPONSE TO DISASTERS AND HEALTH CRISES, AND TO PROMOTE EDUCATIONAL OPPORTUNITIES IN THE ANESTHESIOLOGY FIELD TO EDUCATE AND DEVELOP LEADERS OF THESE EFFORTS IN THE FUTURE. THESE ACTIVITIES ARE ALSO IN FURTHERANCE OF THEIR SUPPORTED ORGANIZATIONS ASA'S EXEMPT PURPOSE OF ADVANCING THE PRACTICE OF AND SECURING THE FUTURE OF ANESTHESIOLOGY. ASACF ENSURES THAT ALL SUPPORT PROVIDED TO ASA IS USED EXCLUSIVELY FOR CHARITABLE PURPOSES BY PERFORMING THESE ACTIVITIES AND FUNCTIONS ON BEHALF OF THEIR OWN MISSION WHICH IN TURN FURTHERS ASA'S MISSION, AS OPPOSED TO TRANSFERRING FUNDS TO THE SUPPORTED ORGANIZATION TO PERFORM THESE FUNCTIONS.

Form And Line ReferenceFormAndLineReferenceDesc

ExplanationExplanationTxt

PART IV, SECTION A, LINE 3B:

ASA CHARITABLE FOUNDATION CONFIRMED THAT THE SUPPORTED ORGANIZATION, AMERICAN SOCIETY OF ANESTHESIOLOGISTS (ASA), IS A 501 (C)(6) TAX EXEMPT ORGANIZATION BY REVIEWING THEIR IRS DETERMINATION LETTER AND ALSO ANNUALLY COMPLETING A PRO FORMA SCHEDULE A, PART III TEST TO CONFIRM THAT ASA SATISFIES THE PUBLIC SUPPORT TESTS UNDER SECTION 509(A)(2).

PART IV,SECTION A, LINCE 3C:

THE ACTIVITIES OF ASACF ARE PERFORMED IN FURTHERANCE OF THEIR EXEMPT PURPOSE WHICH IS TO IMPROVE HEALTH AND MEDICAL CARE IN UNDER-SERVED COMMUNITIES BY ADVANCING THE QUALITY OF ANESTHESIA CARE, TO INCREASE ACCESS TO QUALITY ANESTHESIA CARE, TO SUPPORT THE ANESTHESIOLOGY PROFESSION'S RESPONSE TO DISASTERS AND HEALTH CRISES, AND TO PROMOTE EDUCATIONAL OPPORTUNITIES IN THE ANESTHESIOLOGY FIELD TO EDUCATE AND DEVELOP LEADERS OF THESE EFFORTS IN THE FUTURE. THESE ACTIVITIES ARE ALSO IN FURTHERANCE OF THEIR SUPPORTED ORGANIZATIONS ASA'S EXEMPT PURPOSE OF ADVANCING THE PRACTICE OF AND SECURING THE FUTURE OF ANESTHESIOLOGY. ASACF ENSURES THAT ALL SUPPORT PROVIDED TO ASA IS USED EXCLUSIVELY FOR CHARITABLE PURPOSES BY PERFORMING THESE ACTIVITIES AND FUNCTIONS ON BEHALF OF THEIR OWN MISSION WHICH IN TURN FURTHERS ASA'S MISSION, AS OPPOSED TO TRANSFERRING FUNDS TO THE SUPPORTED ORGANIZATION TO PERFORM THESE FUNCTIONS.

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID	ACTIVITY CLASSIFICATION: PROGRAM GRANTS. GRANTEE NAME: LIFEBOX FOUNDATION. GRANTEE ADDRESS: P.O. BOX 15342 BOSTON, MA 02215. AMOUNT GIVEN: 91,930.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES	DESCRIPTION: OFFICE EXPENSES. AMOUNT: 781. DESCRIPTION: CREDIT CARD FEES. AMOUNT: 1,086. DESCRIPTION: BANK FEES. AMOUNT: 670. DESCRIPTION: TRAVEL EXPENSES. AMOUNT: 15,568. DESCRIPTION: CONFERENCES,CONVENTIONS. AMOUNT: 38,709. TOTAL TO FORM 990-EZ, LINE 16: 56,814.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS	DESCRIPTION: A/R OTHER . BEG. OF YEAR AMOUNT: 26. END OF YEAR AMOUNT: 26.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES	DESCRIPTION: DUE TO ASA . BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 3,338.

Transfer Prsnl Bnft Contracts Decl TransferPrsnlBnftContractsDecl

Field	Value	IRS element (for citing)
Declaration	THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.	DeclarationDesc