Exempt Organization Business Income Tax Return. (and proxy tax under section 6033(e)) 08/01/15 07/31/16

Transcription

1 Form A B 990-T Department of the Treasry Internal Revene Service Check box if Exempt Organization Bsiness Income Tax Retrn (and proxy tax nder section 6033(e)) 08/01/15 07/31/16 For calendar year 2015 or other tax year beginning , and ending Information abot Form 990-T and its instrctions is available at Do not enter SSN nmbers on this form as it may be made pblic if yor organization is a 501(c) D Employer identification nmber Pblic Phoebe Ptney Inspection Memorial Hospital, Copy address changed Exempt nder section X 501( C ) ( 3 ) Print Inc. 408(e) 220(e) or Nmber, street, and room or site no. If a P.O. box, see instrctions. 408A 529(a) 530(a) Type E Unrelated bsiness activity codes (See instrctions.) C Book vale of all assets at end of year F Grop exemption nmber (See instrctions.) 617,736,079 G Check organization type X 501(c) corporation 501(c) trst 401(a) trst Other trst H Describe the organization's primary nrelated bsiness activity. Landry Services; Reference Lab; Retail Sales I Dring the tax year, was the corporation a sbsidiary in an affiliated grop or a parent-sbsidiary controlled grop? Yes X No If "Yes," enter the name and identifying nmber of the parent corporation. J The books are in care of Brian Chrch, CFO Telephone nmber Part I Unrelated Trade or Bsiness Income (A) Income (B) Expenses (C) Net 1a Gross receipts or sales 611,131 b Less retrns and allowances c Balance c 611,131 2 Cost of goods sold (Schedle A, line 7) Gross profit. Sbtract line 2 from line 1c , ,131 4a Capital gain net (attach Schedle D) a b Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797) b c Capital loss dedction for trsts c 5 5 Income (loss) from partnerships and S corporations (attach statement) Rent (Schedle C) Unrelated debt-financed (Schedle E) Interest, annities, royalties, and rents from controlled organizations (Schedle F) Investment of a section 501(c)(7), (9), or (17) organization (Schedle G) Exploited exempt activity (Schedle I) Advertising (Schedle J) Other (See instrctions; attach schedle) Total. Combine lines 3 throgh , ,131 Part II Dedctions Not Taken Elsewhere (See instrctions for limitations on dedctions.) (Except for contribtions, dedctions mst be directly connected with the nrelated bsiness.) 14 Compensation of officers, directors, and trstees (Schedle K) Salaries and wages , Repairs and maintenance , Bad debts Interest (attach schedle) Taxes and licenses Charitable contribtions (See instrctions for limitation rles) Depreciation (attach Form 4562) Less depreciation claimed on Schedle A and elsewhere on retrn a 22b Depletion Contribtions to deferred compensation plans Employee benefit programs Excess exempt expenses (Schedle I) Excess readership costs (Schedle J) Other dedctions (attach schedle) Total dedctions. Add lines 14 throgh Unrelated bsiness taxable before net operating loss dedction. Sbtract line 29 from line Net operating loss dedction (limited to the amont on line 30) Unrelated bsiness taxable before specific dedction. Sbtract line 31 from line Specific dedction (Generally $1,000, bt see line 33 instrctions for exceptions) Unrelated bsiness taxable. Sbtract line 33 from line 32. If line 33 is greater than line 32, enter the smaller of zero or line For Paperwork Redction Act Notice, see instrctions. Name of organization ( Check box if name changed and see instrctions.) P.O. Box 3770 City or town, state or province, contry, and ZIP or foreign postal code 34 OMB No Open to Pblic Inspection for 501(c) Organizations Only (Employees' trst, see instrctions.) Albany GA ,179 See Statement 1 932,033 1,008,888 1,000

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3 Page 3 Schedle C Rent Income (From Real Property and Personal Property Leased With Real Property) (see instrctions) 1. Description of property Total Pblic Inspection Copy 2. Rent received or accred Total (c) Total. Add totals of colmns 2(a) and 2(b). Enter here and on page 1, Part I, line 6, colmn (A) Schedle E Unrelated Debt-Financed Income (see instrctions) (b) Total dedctions. Enter here and on page 1, Part I, line 6, colmn (B) Part I, line 7, colmn (A). Part I, line 7, colmn (B). Totals Total dividends-received dedctions inclded in colmn Schedle F Interest, Annities, Royalties, and Rents From Controlled Organizations (see instrctions) Exempt Controlled Organizations (a) From personal property (if the percentage of rent (b) From real and personal property (if the 3(a) Dedctions directly connected with the for personal property is more than 10 bt not percentage of rent for personal property exceeds in colmns 2(a) and 2(b) (attach schedle) more than 50) Nonexempt Controlled Organizations 50 or if the rent is based on profit or ) 2. Gross from or 1. Description of debt-financed property allocable to debt-financed 4. Amont of average 5. Average adjsted basis acqisition debt on or of or allocable to allocable to debt-financed debt-financed property property (attach schedle) (attach schedle) Phoebe Ptney Memorial Hospital, Name of controlled 2. Employer organization identification nmber property 6. Colmn 4 divided by colmn 5 3. Dedctions directly connected with or allocable to (a) Straight line depreciation (attach schedle) 7. Gross reportable (colmn 2 x colmn 6) debt-financed property (b) Other dedctions (attach schedle) 8. Allocable dedctions (colmn 6 x total of colmns 3(a) and 3(b)) 3. Net nrelated 4. Total of specified 5. Part of colmn 4 that is 6. Dedctions directly (loss) (see instrctions) payments made inclded in the controlling connected with organization's gross inc. in colmn 5 7. Taxable Income 8. Net nrelated 9. Total of specified (loss) (see instrctions) payments made 10. Part of colmn 9 that is 11. Dedctions directly inclded in the controlling connected with in organization's gross colmn 10 Totals Add colmns 5 and 10. Add colmns 6 and 11. Part I, line 8, colmn (A). Part I, line 8, colmn (B).

4 Phoebe Ptney Memorial Hospital, Page 4 Schedle G Investment Income of a Section 501(c)(7), (9), or (17) Organization (see instrctions) Pblic Inspection Copy Part I, line 9, colmn (A). Part I, line 9, colmn (B). Totals Schedle I Exploited Exempt Activity Income, Other Than Advertising Income (see instrctions) Totals Schedle J Advertising Income (see instrctions) Part I Income From Periodicals Reported on a Consolidated Basis Totals (carry to Part II, line (5))... Part II Income From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in colmns 2 throgh 7 on a line-by-line basis.) Totals from Part I Totals, Part II (lines 1-5) Schedle K Compensation of Officers, Directors, and Trstees (see instrctions) Total. Enter here and on page 1, Part ll, line Dedctions 5. Total dedctions 1. Description of 2. Amont of directly connected 4. Set-asides and set-asides (col Description of exploited activity 1. Name of periodical 1. Name of periodical 2. Gross 3. Expenses nrelated directly bsiness connected with prodction of from trade or nrelated bsiness bsiness (attach schedle) (attach schedle) pls col.4) 4. Net (loss) from nrelated trade or bsiness (colmn 2 mins colmn 3). If a gain, compte cols. 5 throgh Gross from activity that is not nrelated bsiness 7. Excess exempt 6. Expenses expenses attribtable to (colmn 6 mins colmn 5 colmn 5, bt not more than colmn 4). Enter here and on Enter here and on Enter here and page 1, Part I, page 1, Part I, on page 1, line 10, col. (A). line 10, col. (B). Part ll, line Advertising 7. Excess readership 2. Gross gain or (loss) (col. costs (colmn 6 advertising 3. Direct 5. Circlation 6. Readership 2 mins col. 3). If mins colmn 5, bt advertising costs costs a gain, compte not more than cols. 5 throgh 7. colmn 4). 2. Gross advertising 3. Direct advertising costs 4. Advertising gain or (loss) (col. 2 mins col. 3). If a gain, compte cols. 5 throgh 7. Enter here and on Enter here and on Enter here and page 1, Part I, page 1, Part I, on page 1, line 11, col. (A). line 11, col. (B). Part ll, line Name 2. Title 5. Circlation 3. Percent of time devoted to bsiness 6. Readership costs 7. Excess readership costs (colmn 6 mins colmn 5, bt not more than colmn 4). 4. Compensation attribtable to nrelated bsiness

5 Phoebe Ptney Memorial Hospital, Federal Statements FYE: 7/31/2016 Pblic Statement 1 - Form Inspection 990-T, Part II, Line 28 - Other Dedctions Copy Description Amont Spplies - Reference Lab $ 5,319 Direct Dept Cost - Lab 1,624 Indirect Dept Cost - Lab 6,732 Direct Dept Costs - Lndry 36,528 Indirect Dept Costs-Lndry 728,087 DME - New Fondation 80,814 Direct Dept Costs - NF 18,061 Indirect Dept Costs - NF 54,868 Total $ 932,033 1