efile Public Visual Render
ObjectId: 202033219349304073 - Submission: 2020-11-16
TIN: 41-0729979
SCHEDULE C
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities
For Organizations Exempt From Income Tax Under section 501(c) and section 527
Complete if the organization is described below.
Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990
for instructions and the latest information.
OMB No. 1545-0047
20
19
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
NORTH MEMORIAL HEALTH CARE
DBA NORTH MEMORIAL HEALTH
Employer identification number
41-0729979
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.
1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")
2
Political campaign activity expenditures (see instructions)
....................................................................
$
3
Volunteer hours for political campaign activities (see instructions)
..................................................................
Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955
................................
$
2
Enter the amount of any excise tax incurred by organization managers under section 4955
.......................
$
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year?
.........................................
Yes
No
4a
Was a correction made?
......................................................................................................................
Yes
No
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities
.....
$
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities
............................................................................................................................
$
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b
...........
$
4
Did the filing organization file
Form 1120-POL
for this year?
...................................................................
Yes
No
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a)
Name
(b)
Address
(c)
EIN
(d)
Amount paid from filing organization's funds. If none, enter -0-.
(e)
Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2019
Page 2
Schedule C (Form 990 or 990-EZ) 2019
Page
2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A
Check
if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN,
expenses, and share of excess lobbying expenditures).
B
Check
if the filing organization checked box A and "limited control" provisions apply.
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a)
Filing
organization's
totals
(b)
Affiliated group totals
1a
Total lobbying expenditures to influence public opinion (grass roots lobbying)
......................
b
Total lobbying expenditures to influence a legislative body (direct lobbying)
........................
c
Total lobbying expenditures (add lines 1a and 1b)
............................................................
d
Other exempt purpose expenditures
...............................................................................
e
Total exempt purpose expenditures (add lines 1c and 1d)
..................................................
f
Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
If the amount on line 1e, column (a) or (b) is:
The lobbying nontaxable amount is:
Not over $500,000
20% of the amount on line 1e.
Over $500,000 but not over $1,000,000
$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000
$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000
$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000
$1,000,000.
g
Grassroots nontaxable amount (enter 25% of line 1f)
.................................................
h
Subtract line 1g from line 1a. If zero or less, enter -0-.
................................................
i
Subtract line 1f from line 1c. If zero or less, enter -0-.
................................................
j
If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year?
...................................................................................................................
Yes
No
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in)
(a)
2016
(b)
2017
(c)
2018
(d)
2019
(e)
Total
2a
Lobbying nontaxable amount
b
Lobbying ceiling amount
(150% of line 2a, column(e))
c
Total lobbying expenditures
d
Grassroots nontaxable amount
e
Grassroots ceiling amount
(150% of line 2d, column (e))
f
Grassroots lobbying expenditures
Schedule C (Form 990 or 990-EZ) 2019
Page 3
Schedule C (Form 990 or 990-EZ) 2019
Page
3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
|
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers?
...........................................................................................................
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?
........
No
c
Media advertisements?
...................................................................................................
No
d
Mailings to members, legislators, or the public?
.............................................................................
No
e
Publications, or published or broadcast statements?
...........................................................
No
f
Grants to other organizations for lobbying purposes?
..........................................................
Yes
123,000
g
Direct contact with legislators, their staffs, government officials, or a legislative body?
.......................
Yes
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means?
..................
No
i
Other activities?
...................................................................................................................
Yes
2,000
j
Total. Add lines 1c through 1i
....................................................................................................
125,000
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)?
.....
No
b
If "Yes," enter the amount of any tax incurred under section 4912
...........................................
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912
...................
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year?
........................
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members?
...............................................
1
2
Did the organization make only in-house lobbying expenditures of $2,000 or less?
............................................
2
3
Did the organization agree to carry over lobbying and political expenditures from the prior year?
.................................
3
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members
......................................................................
1
2
Section 162(e) nondeductible lobbying and political expenditures
(do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year
.............................................................................................................................
2a
b
Carryover from last year
............................................................................................................
2b
c
Total
...........................................................................................................................................
2c
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues
.
3
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year?
......................................................................................................................
4
5
Taxable amount of lobbying and political expenditures (see instructions)
.........................................
5
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference
Explanation
PART II-B, LINE 1:
CONTACTS AND VISITS WERE MADE WITH STATE LEVEL LEGISLATORS TO PROMOTE HEALTH CARE RELATED ISSUES. LINE 1I INCLUDES THE NON-DEDUCTIBLE PORTION OF MHA DUES.
Schedule C (Form 990 or 990EZ) 2019
Additional Data
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