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
ActivitiesHospital
SubsectionCharitable Organization
Ruling Date11/1948
DeductibilityContributions are deductible
FoundationPrivate non-operating foundation
OrganizationCorporation
Exempt Organization StatusUnconditional Exemption
Tax Period12/2012
Assets$100,000 to $499,999
Income$25,000 to $99,999
Filing Requirement990 - Not required to file (all other) (990-PF required)
Asset Amount$218,420
Amount of Income$64,700
Form 990 Revenue Amount$61,128


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Financial snapshot ($)

Revenue for 2011

Assets for 2011

Analysis of Revenue and Expenses (for 2011)
Revenue and expenses per booksNet investment incomeAdjusted net incomeDisbursements for charitable purposes (cash basis only)
Total revenue$61,128$5$61,128
Contributions, gifts, grants, etc., received$0
Interest on savings and temporary cash investments$5
Dividends and interest from securities$0
Gross rents$61,123
Gross profit from sales of goods$0
Other income$0
Total expenses and disbursements$53,334$0$51,794$47,445
Compensation of officers, directors, trustees, etc.$0
Total operating and administrative expenses$53,334$0$47,445
Contributions, gifts, grants paid$0
Excess of revenue over expenses and disbursements$7,794
Net investment income$5
Adjusted net income$9,334
Balance Sheets (for 2011)
Book ValueFair Market Value
Total assets$205,011$236,594
Cash - non-interest-bearing$16,270
Investments-U.S. and state government obligations$0
Investments-corporate stock$0
Investments-corporate bonds$0
Investments-mortgage loans$0
Investments-other$0
Other$188,741
Total liabilities$1
Mortgages and other notes payable$0
Other$1
Total liabilities and net assets/fund balances$205,011
Capital Gains and Losses for Tax on Investment Income (for 2011)
Capital gain net income$0
Net capital loss$0
Excise Tax Based on Investment Income (for 2011)
Domestic foundations that meet the section 4940(e) requirements (for Reduced Tax on Net Investment Income)No
Tax based on investment income$0
Total credits and payments$0
Any penalty for underpayment of estimated tax$0
Tax due$0
Amount to be credited to 2012 estimated tax$0
Statements Regarding Activities (for 2011)
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?No
Was there a liquidation, termination, dissolution, or substantial contraction during the year?No
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3) or 4942(j)(5) for calendar year 2011 or the taxable year beginning in 2011?No
Statements Regarding Activities for Which Form 4720 May Be Required (for 2011)
During the year did the foundation (either directly or indirectly):
Engage in the sale or exchange, or leasing of property with a disqualified person?No
Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person?No
Furnish goods, services, or facilities to (or accept them from) a disqualified person?No
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?No
Transfer any income or assets to a disqualified person (or make any of either available for the benefit or use of a disqualified person)?No
Agree to pay money or property to a government official?No
At the end of tax year 2011, did the foundation have any undistributed income for tax year(s) beginning before 2011?No
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year?No
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?No
During the year did the foundation pay or incur any amount to:
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?No
Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive?No
Provide a grant to an individual for travel, study, or other similar purposes?No
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)?No
Provide for any purpose other than religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals?No
Minimum Investment Return (for 2011)
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes$230,833
Net value of noncharitable-use assets$227,380
Minimum investment return$11,369
Distributable Amount (for 2011)
Distributable amount$11,369
Undistributed Income (for 2011)
Distributable amount for 2011$11,369
Undistributed income for 2011. This amount must be distributed in 2012$0
Private Operating Foundations (for 2011)
2011201020092008Total
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
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