TRINITY HOSPITAL TWIN CITY FOUNDATION INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: TRINITY HOSPITAL TWIN CITY FOUNDATION INC (EIN 34-1968676)
Tax period: 2012-01-01 to 2012-12-31
Filed: 2013-11-12
IRS object ID: 201313169349305036
Schema version: 2012v2.3
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
Form 990
Schedule A
Schedule B
Schedule I
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-11-12T15:39:16-06:00	Timestamp
Tax Period End Date	2012-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	WILLOUGHBY & COMPANY INC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	216 NORTH BROADWAY	AddressLine1
City	NEW PHILADELPHIA	City
State	OH	State
ZIP Code	44663	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2012-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	341968676	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	TRINITY HOSPITAL TWIN CITY	BusinessNameLine1
Business Name Line2	FOUNDATION INC	BusinessNameLine2

Field	Value	IRS element (for citing)
Name Control	TRIN	NameControl
Phone	7409221242	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 7	AddressLine1
City	DENNISON	City
State	OH	State
ZIP Code	44621	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	BLAIR HILLYER	Name
Title	PRESIDENT	Title
Phone	7409221242	Phone
Date Signed	2013-11-05	DateSigned
Authorize Third Party	false	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	KEITH A WILLOUGHBY CPA	Name
Phone	3306021322	Phone
Date Prepared	2013-11-08	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	BLAIR HILLYER	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	819 NORTH FIRST STREET	AddressLine1
City	DENNISON	City
State	OH	State
ZIP Code	44621	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	63511	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.TCHFOUNDATION.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Activity Or Mission Description	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	14	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	17	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	74895	ContributionsGrantsPriorYear
Contributions Grants Current Year	63511	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Current Year	0	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	74895	TotalRevenuePriorYear
Total Revenue Current Year	63511	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	2500	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	87467	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Current Year	0	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	1710	OtherExpensePriorYear
Other Expenses Current Year	4551	OtherExpensesCurrentYear
Total Expenses Prior Year	4210	TotalExpensesPriorYear
Total Expenses Current Year	92018	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	70685	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-28507	RevenuesLessExpensesCY
Total Assets BOY	94418	TotalAssetsBOY
Total Assets EOY	65911	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	94418	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	65911	NetAssetsOrFundBalancesEOY
Mission Description	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	87467	Expense
Grants	87467	Grants
Revenue	63511	Revenue
Description	TO SUPPORT THE TRINITY HOSPITAL TWIN CITY AND/OR OTHER HEALTHCARE OR HEALTHCARE RELATED PURPOSED WITHIN THE TRINITY HOSPITAL TWIN CITY SERVICE AREA.	Description
Total Program Service Expense	87467	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	false	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	false	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	14	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	false	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	false	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	false	RegularMonitoringEnforcement
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	OH	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	RICK RIEGER	NamePerson
Telephone Number	3303657651	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	819 N FIRST STREET	AddressLine1
City	DENNISON	City
State	OH	State
ZIP Code	44621	ZIPCode

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

Form990 Part VII Section A Form990PartVIISectionA (14 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer
BARB BESOZZI
BOARD MEMBER	1.00	X	0	0	0
ROGER BOND
BOARD MEMBER	1.00	X	0	0	0
TERRY CULBERTSON
BOARD MEMBER	1.00	X	0	0	0
RYAN DELANEY
BOARD MEMBER	1.00	X	0	0	0
REV DAVID KOCH
BOARD MEMBER	1.00	X	0	0	0
ROSS LINDSEY IV
BOARD MEMBER	1.00	X	0	0	0
REV MARK UNRUE
BOARD MEMBER	1.00	X	0	0	0
MARK WILLARD
BOARD MEMBER	1.00	X	0	0	0
CHRISTY BLOOM
BOARD MEMBER	1.00	X	0	0	0
JAN THOMAS
BOARD MEMBER	1.00	X	0	0	0
BLAIR HILLYER
PRESIDENT	1.00		0	0	0	X
ED LEE
VICE PRESIDE	1.00		0	0	0	X
EMILLIE BLACKWOOD
SECRETARY	1.00		0	0	0	X
RICK RIEGER
TREASURER	1.00		0	0	0	X

Field	Value	IRS element (for citing)
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	63511	AllOtherContributions
Total Contributions	63511	TotalContributions

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	63511	TotalRevenueColumn

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	87467	Total
Program Services	87467	ProgramServices

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1815	Total
Management And General	1815	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1205	Total
Management And General	1205	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Management And GeneralManagementAndGeneral
INSURANCE	917	917
OFFICE EXPENSE	494	494
POSTAGE	70	70
FILING FEE	50	50

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	92018	Total
Program Services	87467	ProgramServices
Management And General	4551	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	94418	BOY
EOY	65911	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	94418	BOY
EOY	65911	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	94418	BOY
EOY	65911	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	94418	BOY
EOY	65911	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	94418	BOY
EOY	65911	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-28507	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1881	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4143	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4736	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	14895	CurrentTaxYearMinus1Year
Current Tax Year	16236	CurrentTaxYear
Total	41891	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	1881	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	4143	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	4736	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	14895	CurrentTaxYearMinus1Year
Current Tax Year	16236	CurrentTaxYear
Total	41891	Total

Field	Value	IRS element (for citing)
Public Support Total170	41891	PublicSupportTotal170
Total Support	41891	TotalSupport
Public Support Pertcentage170	1.00000	PublicSupportPertcentage170
Public Support Pertcent Prior Year	1.00000	PublicSupportPertcentPriorYear
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

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

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	TRINITY HOSPITAL TWIN CITY	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	819 NORTH 1ST STREET	AddressLine1
City	DENNISON	City
State	OH	State
ZIP Code	44621	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	275401105	EINOfRecipient
IRC Section	501C3	IRCSection
Amount Of Cash Grant	87467	AmountOfCashGrant
Purpose Of Grant	SUPPORT WELLNESS	PurposeOfGrant

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS	FORM 990, PAGE 1, PART I, LINE 6	VOLUNTEER BOARD OF DIRECTORS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	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.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	GOVERNING DOCUMENTS ARE AVAILABLE TO PUBLIC UPON REQUEST.