Shelton Hospital Association in Shelton, Washington (WA)

Shelton Hospital Association
Employer Identification Number (EIN)	510178579
Name of Organization	Shelton Hospital Association
Address	PO BOX 789, Shelton, WA 98584-0789
Activities	Hospital auxiliary
Subsection	Charitable Organization
Ruling Date	12/1975
Deductibility	Contributions are deductible
Foundation	Private non-operating foundation
Organization	Corporation
Exempt Organization Status	Unconditional Exemption
Tax Period	12/2013
Assets	$500,000 to $999,999
Income	$25,000 to $99,999
Filing Requirement	990 - Not required to file (all other)
Asset Amount	$804,545
Amount of Income	$50,841
Form 990 Revenue Amount	$18,860

Non-representatives - add comments:

Financial snapshot ($)

Revenue for 2013

Assets at the end of 2013

Expenses for 2013

	Revenue and expenses per books	Net investment income	Adjusted net income	Disbursements for charitable purposes (cash basis only)
Analysis of Revenue and Expenses (for 2013)
Total revenue	$40,097	$47,612	$16,848
Contributions, gifts, grants, etc., received	$0
Interest on savings and temporary cash investments	$0
Dividends and interest from securities	$30,764
Gross rents	$0
Gross sales price for all assets	$27,593
Gross profit from sales of goods	$0
Other income	$-7,516
Other	$16,849
Total expenses and disbursements	$80,766	$0	$0	$0
Compensation of officers, directors, trustees, etc.	$0
Pension plans, employee benefits	$0
Legal fees	$0
Accounting fees	$0
Interest	$0
Depreciation	$0
Occupancy	$0
Travel, conferences, and meetings	$0
Printing and publications	$0
Total operating and administrative expenses	$2,766	$0		$0
Contributions, gifts, grants paid	$78,000
Excess of revenue over expenses and disbursements	$-40,669
Net investment income		$47,612
Adjusted net income			$16,848

	2010		2011		2012		2013
Balance Sheets
	Book Value	Fair Market Value	Book Value	Fair Market Value	Book Value	Fair Market Value	Book Value	Fair Market Value
Total assets	$886,658	$1,005,383	$846,681	$991,189	$820,280	$1,043,990	$804,545	$1,196,362
Cash - non-interest-bearing	$0		$0		$0		$0
Investments-U.S. and state government obligations	$0		$0		$0		$0
Investments-corporate stock	$98,761		$72,096		$34,705		$24,200
Investments-corporate bonds	$10,063		$0		$0		$0
Investments-mortgage loans	$0		$0		$0		$0
Investments-other	$765,878		$762,649		$750,745		$736,753
Other assets					$0		$0
Total liabilities	$58,000		$56,000		$53,066		$78,000
Mortgages and other notes payable	$0		$0		$0		$0
Other liabilities					$0		$0
Total liabilities and net assets/fund balances	$828,658		$790,681		$767,214		$726,545

	2010	2011	2012	2013
Capital Gains and Losses for Tax on Investment Income
Capital gain net income	$47,643	$0	$8,836	$16,849
Net capital loss	$0	$-3,601	$0	$0

	2010	2011	2012	2013
Excise Tax Based on Investment Income
Domestic foundations that meet the section 4940(e) requirements (for Reduced Tax on Net Investment Income)	No	No	No	No
Tax based on investment income	$803	$310	$806	$476
Total credits and payments	$1,542	$739	$429	$0
Any penalty for underpayment of estimated tax	$0	$0	$0	$0
Tax due			$377	$476
Overpayment			$0	$0
Amount to be credited to next year's estimated tax	$739	$429	$0	$0

	2010	2011	2012	2013
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?	No	No	No	No
Has the foundation engaged in any activities that have not previously been reported to the IRS?			No	No
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?			No	No
Has the foundation filed a tax return on Form 990-T for this year?			No	No
Was there a liquidation, termination, dissolution, or substantial contraction during the year?	No	No	No	No
Has the foundation furnished a copy of Form 990-PF to the Attorney General (or designate) of each state?			Yes	Yes
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?	No	No	No	No
Did any persons become substantial contributors during the tax year?			No	No
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had advisory privileges?			No	No
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?			Yes	Yes
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041			No	No

	2010	2011	2012	2013
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?	No	No	No	No
Borrow money from, lend money to, or otherwise extend credit to (or accept it from) a disqualified person?	No	No	No	No
Furnish goods, services, or facilities to (or accept them from) a disqualified person?	No	No	No	No
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?	No	No	No	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	No	No	No
Agree to pay money or property to a government official?	No	No	No	No
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?			No	No
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?			No	No
At the end of this tax year, did the foundation have any undistributed income for tax year(s) beginning before this year?	No	No	No	No
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?			No	No
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at any time during the year?	No	No	No	No
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?	No	No	No	No
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?	No	No	No	No
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?			No	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	No	No	No
Influence the outcome of any specific public election (see section 4955); or to carry on, directly or indirectly, any voter registration drive?	No	No	No	No
Provide a grant to an individual for travel, study, or other similar purposes?	No	No	No	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	No	No	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	No	No	No
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?			No	No
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?			No	No
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?			No	No

	2010	2011	2012	2013
Minimum Investment Return
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc., purposes	$904,762	$983,654	$1,013,212	$1,114,532
Net value of noncharitable-use assets			$998,014	$1,097,814
Minimum investment return	$44,560	$48,445	$49,901	$54,891

	2010	2011	2012	2013
Distributable Amount
Distributable amount	$43,757	$48,135	$49,095	$54,415

	2010	2011	2012	2013
Undistributed Income
Distributable amount for this year	$43,757	$48,135	$49,095	$54,415
Undistributed income for this year. This amount must be distributed in the next year	$24,672	$16,807	$12,836	$0

	2013	2012	2011	2010	Total
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	$78,000

	Amount	Related or exempt function income
Analysis of Income-Producing Activities (for 2013)
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	$30,764	$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:
Cash	No
Other assets	No
Other transactions:
Sales of assets to a noncharitable exempt organization	No
Purchases of assets from a noncharitable exempt organization	No
Rental of facilities, equipment, or other assets	No
Reimbursement arrangements	No
Loans or loan guarantees	No
Performance of services or membership or fundraising solicitations	No
Sharing of facilities, equipment, mailing lists, other assets, or paid employees	No

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