Chamberlain Memorial Hospital in Rockwood, Tennessee (TN)

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Chamberlain Memorial Hospital
Employer Identification Number (EIN)620475674
Name of OrganizationChamberlain Memorial Hospital
In Care of NameJennifer E Raby
Address405 W Rockwood St, Rockwood, TN 37854-2247
SubsectionCharitable Organization
Ruling Date11/1948
DeductibilityContributions are deductible
FoundationPrivate non-operating foundation
Exempt Organization StatusUnconditional Exemption
Tax Period12/2013
Assets$100,000 to $499,999
Income$25,000 to $99,999
Filing Requirement990 - Not required to file (all other)
Asset Amount$207,202
Amount of Income$39,838
Form 990 Revenue Amount$61,128

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Financial snapshot ($)

Revenue for 2013

Assets at the end of 2013

Expenses for 2013

Analysis of Revenue and Expenses (for 2013)
Revenue and expenses per booksNet investment incomeAdjusted net incomeDisbursements for charitable purposes (cash basis only)
Total revenue$39,838$0$39,838
Contributions, gifts, grants, etc., received$0
Interest on savings and temporary cash investments$0
Dividends and interest from securities$0
Gross rents$37,200
Gross sales price for all assets$0
Gross profit from sales of goods$0
Other income$2,638
Total expenses and disbursements$51,056$0$39,838$9,554
Compensation of officers, directors, trustees, etc.$0
Pension plans, employee benefits$0
Legal fees$0
Accounting fees$1,595
Travel, conferences, and meetings$0
Printing and publications$0
Total operating and administrative expenses$51,056$0$9,554
Contributions, gifts, grants paid$0
Excess of revenue over expenses and disbursements$-11,218
Net investment income$0
Adjusted net income$0
Balance Sheets
Book ValueFair Market ValueBook ValueFair Market ValueBook ValueFair Market Value
Total assets$205,011$236,594$218,420$256,307$207,202$302,354
Cash - non-interest-bearing$16,270$35,987$31,035
Investments-U.S. and state government obligations$0$0$0
Investments-corporate stock$0$0$0
Investments-corporate bonds$0$0$0
Investments-mortgage loans$0$0$0
Other assets$0$0
Total liabilities$1$1$1
Mortgages and other notes payable$0$0$0
Other liabilities$0$0
Total liabilities and net assets/fund balances$205,011$218,420$207,202
Capital Gains and Losses for Tax on Investment Income
Capital gain net income$0$0$0
Net capital loss$0$0$0
Excise Tax Based on Investment Income
Domestic foundations that meet the section 4940(e) requirements (for Reduced Tax on Net Investment Income)NoNoNo
Tax based on investment income$0$0$0
Total credits and payments$0$0$0
Any penalty for underpayment of estimated tax$0$0$0
Tax due$0$0
Amount to be credited to next year's estimated tax$0$0$0
Statements Regarding Activities
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did it participate or intervene in any political campaign?NoNoNo
Has the foundation engaged in any activities that have not previously been reported to the IRS?NoNo
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles of incorporation, or bylaws, or other similar instruments?NoNo
Has the foundation filed a tax return on Form 990-T for this year?YesYes
Was there a liquidation, termination, dissolution, or substantial contraction during the year?NoNoNo
Has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state?YesYes
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for current calendar year or the taxable year beginning in this year?NoNoNo
Did any persons become substantial contributors during the tax year?NoNo
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges?NoNo
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?YesYes
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041NoNo
Statements Regarding Activities for Which Form 4720 May Be Required
During the year did the foundation (either directly or indirectly):
Engage in the sale or exchange, or leasing of property with a disqualified person?NoNoNo
Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person?NoNoNo
Furnish goods, services, or facilities to (or accept them from) a disqualified person?NoNoNo
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?NoNoNo
Transfer any income or assets to a disqualified person (or make any of either available for the benefit or use of a disqualified person)?NoNoNo
Agree to pay money or property to a government official?NoNoNo
Did any of the acts fail to qualify under the exceptions described in Regulations section 53.4941(d)-3 or in a current notice regarding disaster assistance?NoNo
Did the foundation engage in a prior year in any of the acts, other than excepted acts, that were not corrected before the first day of the tax year beginning in this year?NoNo
At the end of this tax year, did the foundation have any undistributed income for tax year(s) beginning before this year?NoNoNo
Are there any years listed above for which the foundation is not applying the provisions of section 4942(a)(2) (relating to incorrect valuation of assets) to the year's undistributed income?NoNo
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year?NoNoNo
Did the foundation have excess business holdings in this year as a result of (1) any purchase by the foundation or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3) the lapse of the 10-, 15-, or 20-year first phase holding period?NoNoNo
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?NoNoNo
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in this year?NoNo
During the year did the foundation pay or incur any amount to:
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?NoNoNo
Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive?NoNoNo
Provide a grant to an individual for travel, study, or other similar purposes?NoNoNo
Provide a grant to an organization other than a charitable, etc., organization described in section 509(a)(1), (2), or (3), or section 4940(d)(2)?NoNoNo
Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals?NoNoNo
Did any of the transactions fail to qualify under the exceptions described in Regulations section 53.4945 or in a current notice regarding disaster assistance?NoNo
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?NoNo
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?NoNo
Minimum Investment Return
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes$230,833$226,991$208,024
Net value of noncharitable-use assets$223,586$204,904
Minimum investment return$11,369$11,179$10,245
Distributable Amount
Distributable amount$11,369$11,179$10,245
Undistributed Income
Distributable amount for this year$11,369$11,179$10,245
Undistributed income for this year. This amount must be distributed in the next year$0$0$0
Private Operating Foundations (for 2010 - 2013)
The lesser of the adjusted net income or the minimum investment return$0$0$0$0$0
Qualifying distributions made directly for active conduct of exempt activities$0$0$0$0$0
Value of all assets$0$0$0$0$0
Value of assets qualifying under section 4942(j)(3)(B)(i)$0$0$0$0$0
2/3 of minimum investment return$0$0$0$0$0
Total support other than gross investment income (interest, dividends, rents, payments on securities loans (section 512(a)(5)), or royalties)$0$0$0$0$0
Support from general public and 5 or more exempt organizations as provided in section 4942(j)(3)(B)(iii)$0$0$0$0$0
Gross investment income$0$0$0$0$0
Supplementary Information (for 2013)
Grants approved for future payment$0
Analysis of Income-Producing Activities (for 2013)
AmountRelated or exempt function income
Program service revenue
Fees and contracts from government agencies$0$0
Membership dues and assessments$0$0
Interest on savings and temporary cash investments$0$0
Dividends and interest from securities$0$0
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (for 2013)
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Transfers from the reporting foundation to a noncharitable exempt organization of:
Other assetsNo
Other transactions:
Sales of assets to a noncharitable exempt organizationNo
Purchases of assets from a noncharitable exempt organizationNo
Rental of facilities, equipment, or other assetsNo
Reimbursement arrangementsNo
Loans or loan guaranteesNo
Performance of services or membership or fundraising solicitationsNo
Sharing of facilities, equipment, mailing lists, other assets, or paid employeesNo
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