TRINITY HOSPITAL TWIN CITY FOUNDATION INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization: TRINITY HOSPITAL TWIN CITY FOUNDATION INC (EIN 34-1968676)
Tax period: 2015-01-01 to 2015-12-31
Filed: 2016-11-14
IRS object ID: 201643199349303579
Schema version: 2015v2.1
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
Schedule A
Schedule B
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2016-11-14T10:06:53-06:00	ReturnTs
Tax Period End	2015-12-31	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	311492752	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WILLOUGHBY & COMPANY INC	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	216 NORTH BROADWAY	AddressLine1Txt
City	NEW PHILADELPHIA	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44663	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2015-01-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	341968676	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	TRINITY HOSPITAL TWIN CITY	BusinessNameLine1Txt
Business Name Line2	FOUNDATION INC	BusinessNameLine2Txt

Field	Value	IRS element (for citing)
Business Name Control	TRIN	BusinessNameControlTxt
Phone	7409221242	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 7	AddressLine1Txt
City	DENNISON	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44621	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	BLAIR HILLYER	PersonNm
Person Title	PRESIDENT	PersonTitleTxt
Phone	7409221242	PhoneNum
Signature	2016-11-01	SignatureDt

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	KEITH A WILLOUGHBY CPA	PreparerPersonNm
PTIN	P00170041	PTIN
Phone	3306021322	PhoneNum
Preparation	2016-11-01	PreparationDt

Field	Value	IRS element (for citing)
Tax	2015	TaxYr
Build TS	2017-02-10 21:41:12Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	BLAIR HILLYER	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1260 DEER HILL ROAD	AddressLine1Txt
City	DENNISON	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44621	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$74,895	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.TCHFOUNDATION.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Activity Or Mission	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	ActivityOrMissionDesc
Voting Members Governing Body	14	VotingMembersGoverningBodyCnt
Voting Members Independent	14	VotingMembersIndependentCnt
Total Employee	0	TotalEmployeeCnt
Total Volunteers	14	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
PY Contributions Grants	$110,914	PYContributionsGrantsAmt
CY Contributions Grants	$74,895	CYContributionsGrantsAmt
CY Program Service Revenue	$0	CYProgramServiceRevenueAmt
CY Investment Income	$0	CYInvestmentIncomeAmt
CY Other Revenue	$0	CYOtherRevenueAmt
PY Total Revenue	$110,914	PYTotalRevenueAmt
CY Total Revenue	$74,895	CYTotalRevenueAmt
PY Grants And Similar Paid	$87,150	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$107,570	CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
CY Salaries Comp Emp Bnft Paid	$0	CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$2,669	PYOtherExpensesAmt
CY Other Expenses	$3,247	CYOtherExpensesAmt
PY Total Expenses	$89,819	PYTotalExpensesAmt
CY Total Expenses	$110,817	CYTotalExpensesAmt
PY Revenues Less Expenses	$21,095	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	-$35,922	CYRevenuesLessExpensesAmt
Total Assets BOY	$121,152	TotalAssetsBOYAmt
Total Assets EOY	$85,230	TotalAssetsEOYAmt
Total Liabilities EOY	$0	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$121,152	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$85,230	NetAssetsOrFundBalancesEOYAmt
Mission	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$107,570	ExpenseAmt
Grant	$107,570	GrantAmt
Revenue	$74,895	RevenueAmt
Desc	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	Desc
Total Program Service Expenses	$107,570	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	false	LobbyingActivitiesInd
Subject To Proxy Tax	false	SubjectToProxyTaxInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	false	ReportLandBuildingEquipmentInd
Report Investments Other Sec	false	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	false	ReportOtherLiabilitiesInd
Include FIN48 Footnote	false	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	false	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	false	OperateHospitalInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	false	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	false	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	0	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Employee	0	EmployeeCnt
Unrelated Bus Incm Over Limit	false	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	14	GoverningBodyVotingMembersCnt
Independent Voting Member	14	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	false	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	false	MembersOrStockholdersInd
Election Of Board Members	false	ElectionOfBoardMembersInd
Decisions Subject To Approva	false	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	false	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	false	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	false	RegularMonitoringEnfrcInd
Whistleblower Policy	false	WhistleblowerPolicyInd
Document Retention Policy	false	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	OH	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	MARK UNRUE	PersonNm
Phone	3303657651	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	819 N FIRST STREET	AddressLine1Txt
City	DENNISON	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44621	ZIPCd

Field	Value	IRS element (for citing)
No Listed Persons Compensated	Yes (X)	NoListedPersonsCompensatedInd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	OfficerOfficerInd
JOANNE OBERMILLER
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
BARB BESOZZI
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
ROGER BOND
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
TERRY CULBERTSON
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
JEFF NEIDIG
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
REV DAVID KOCH
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
ROSS LINDSEY IV
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
MARK WILLARD
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
JAN THOMAS
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
MIKE WADE
BOARD MEMBER	1.00	Yes (X)	$0	$0	$0
BLAIR HILLYER
PRESIDENT	1.00		$0	$0	$0	Yes (X)
ED LEE
VICE PRESIDE	1.00		$0	$0	$0	Yes (X)
EMILLIE BLACKWOOD
SECRETARY	1.00		$0	$0	$0	Yes (X)
REV MARK UNRUE
TREASURER	1.00		$0	$0	$0	Yes (X)

Field	Value	IRS element (for citing)
Former Ofcr Employees Listed	false	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	false	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd
All Other Contributions	$74,895	AllOtherContributionsAmt
Total Contributions	$74,895	TotalContributionsAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$74,895	TotalRevenueColumnAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$107,570	TotalAmt
Program Services	$107,570	ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$375	TotalAmt
Management And General	$375	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$1,313	TotalAmt
Management And General	$1,313	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (3 entries)

DescDesc	TotalTotalAmt	Management And GeneralManagementAndGeneralAmt
INSURANCE	$978	$978
POSTAGE	$431	$431
FILING FEE	$150	$150

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$110,817	TotalAmt
Program Services	$107,570	ProgramServicesAmt
Management And General	$3,247	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$121,152	BOYAmt
EOY	$85,230	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$121,152	BOYAmt
EOY	$85,230	EOYAmt

Total Liabilities TotalLiabilitiesGrp

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

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$121,152	BOYAmt
EOY	$85,230	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$121,152	BOYAmt
EOY	$85,230	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$121,152	BOYAmt
EOY	$85,230	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	-$35,922	ReconcilationRevenueExpnssAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	false	FSAuditedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Public Organization170	Yes (X)	PublicOrganization170Ind

Gifts Grants Contri Rcvd170 GiftsGrantsContriRcvd170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$14,895	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$16,236	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$25,025	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$15,914	CurrentTaxYearMinus1YearAmt
Current Tax Year	$19,895	CurrentTaxYearAmt
Total	$91,965	TotalAmt

Total Calendar Year170 TotalCalendarYear170Grp

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	$14,895	CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years	$16,236	CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years	$25,025	CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year	$15,914	CurrentTaxYearMinus1YearAmt
Current Tax Year	$19,895	CurrentTaxYearAmt
Total	$91,965	TotalAmt

Field	Value	IRS element (for citing)
Public Support Total170	$91,965	PublicSupportTotal170Amt
Total Support	$91,965	TotalSupportAmt
Public Support CY170	1.00000	PublicSupportCY170Pct
Public Support PY170	1.00000	PublicSupportPY170Pct
Thirty Thr Pct Suprt Tests CY170	Yes (X)	ThirtyThrPctSuprtTestsCY170Ind

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 I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	TRINITY HOSPITAL TWIN CITY	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	819 NORTH 1ST STREET	AddressLine1Txt
City	DENNISON	CityNm
State Abbreviation	OH	StateAbbreviationCd
ZIP	44621	ZIPCd

Field	Value	IRS element (for citing)
Recipient EIN	275401105	RecipientEIN
IRC Section	501C3	IRCSectionDesc
Cash Grant	$107,570	CashGrantAmt
Purpose Of Grant	SUPPORT WELLNESS	PurposeOfGrantTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PAGE 1, PART I, LINE 6	VOLUNTEER BOARD OF DIRECTORS.
FORM 990, PAGE 6, PART VI, LINE 11B	ANNUAL ACCOUNTING INFORMATION IS PROVIDED TO OUTSIDE CPA FIRM. CPA FIRM PREPARES FORM 990 BASED ON INFORMATION PROVIDED BY THE ORGANIZATION. FORM 990 IS PROVIDED TO ORGANIZATION FOR REVIEW AND APPROVAL PRIOR TO SUBMISSION TO INTERNAL REVENUE SERVICE.
FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS ARE AVAILABLE TO PUBLIC UPON REQUEST.