Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEIGHBORHOOD HEALTH CARE NETWORK
Employer identification number
41-0990979
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
(1)
ANNEX TEEN CLINIC
237236943
3
No
Yes
Yes
39,143
(2)
COMMUNITY UNIVERSITY HEALTH CENTER
416007513
3
No
Yes
Yes
135,298
(3)
FACE TO FACE HEALTH AND COUNSELING
410986780
3
No
Yes
Yes
46,240
(4)
FAMILY TREE CLINIC
237133742
3
No
Yes
Yes
46,240
(5)
INDIAN HEALTH BOARD OF MINNEAPOLIS INC
410977740
3
No
Yes
Yes
147,080
(6)
NATIVE AMERICAN COMMUNITY CLINIC
030445789
3
No
Yes
Yes
23,654
(7)
NEIGHBORHOOD HEALTH SOURCE
411236054
3
No
Yes
Yes
287,888
(8)
NEIGBORHOOD INVOLVEMENT PROGRAM (NIP) COMMUNITY CLINIC
410956858
3
No
Yes
Yes
39,143
(9)
NORTH METRO PEDIATRICS
201773869
3
No
Yes
Yes
18,923
(10)
NORTH POINT HEALTH AND WELLNESS
200898277
3
No
Yes
Yes
132,299
(11)
OPEN CITIES HEALTH CENTER
363381598
3
No
Yes
Yes
170,361
(12)
PLANNED PARENTHOOD OF MINNESOTASD & ND
410948382
3
No
Yes
Yes
34,413
(13)
SOUTHSIDE COMMUNITY HEALTH SERVICES
237113799
3
No
Yes
Yes
203,879
(14)
TEEN AGE MEDICAL SERVICES
411754276
3
No
Yes
Yes
74,418
(15)
WEST SIDE COMMUNITY HEALTH SERVICES
237156236
3
No
Yes
Yes
197,138
(16)
WEST SUBURBAN TEEN CLINIC
237152735
3
No
Yes
Yes
39,143
Total
1,635,260
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
NEIGHBORHOOD HEALTH CARE NETWORK
Employer identification number
41-0990979
Identifier
Return Reference
Explanation
NEW PROGRAM SERVICES
FORM 990, PART III, LINE 2
THE ORGANIZATION ENTERED A COLLABORATIVE ARRANGEMENT WITH STRATIS HEALTH FOR THE HIT DIRECTOR TO ASSIST IN REACH (REGIONAL EDUCATION AND ASSISTANCE CENTER FOR HEALTH INFORMATION TECHNOLOGY) ACTIVITIES IN MINNESOTA. THESE SERVICES HELP ALL NHCN MEMBERS, FQHC AND GENERAL, ASSESS THEIR READINESS FOR EHR, SELECT AND IMPLEMENT AN EHR SYSTEM, AND ACHIEVE THE MEANINGFUL USE INCENTIVES.
CHANGES IN PROGRAM SERVICES
FORM 990, PART III, LINE 3
THIS WAS A YEAR OF SIGNIFICANT EFFORT AND GROWTH IN EHR HOSTING AND SUPPORT, AS THE ORGANIZATION IMPLEMENTED GE CENTRICITY ACROSS FOUR MEMBER CLINICS AND 27 SITES, WITH ONLY ONE SITE REMAINING TO BE COMPLETED IN 2011. IN SEPTEMBER 2010, FUNDING FROM THE MINNESOTA DEPARTMENT OF HUMAN SERVICES WHICH BEGAN IN 2009 ENDED FOR SUPPORT OF A HEALTH CARE HOME COLLABORATIVE ACROSS SEVEN MEMBER CLINICS. TWO MEMBERS ARE ALREADY CERTIFIED AS HEALTH CARE HOMES, AND SEVERAL OTHERS HAVE APPLIED. WE CONTINUE TO SUPPORT THESE EFFORTS AS RESOURCES ALLOW. FINALLY, IN SEPTEMBER, THE ORGANIZATION CEASED OPERATION OF A CENTRAL BUSINESS OFFICE, WITH OUR EMPLOYEE BECOMING AN INDEPENDENT CONTRACTOR FOR THE MEMBER WHO WAS PURCHASING THESE SERVICES. TWO NEW MEMBERS JOINED NHCN IN 2010, BRINGING OUR TOTAL TO 16.
FORM 990, PART VI, SECTION A, LINE 1
THE ORGANIZATION'S EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, VICE CHAIR, TREASURER/SECRETARY AND THE EXECUTIVE DIRECTOR. EXCEPT FOR THE POWER TO AMEND THE GOVERNING DOCUMENTS, THE EXECUTIVE COMMITTEE HAS THE FULL AUTHORITY OF THE BOARD OF DIRECTORS IN THE INTERVALS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, AND IS SUBJECT TO THE DIRECTION AND CONTROL OF THE FULL BOARD.
FORM 990, PART VI, SECTION A, LINE 4
THE ORGANIZATION REVISED ITS ARTICLES OF INCORPORATION AND BY-LAWS IN JULY, 2010. THE ARTICLES OF INCORPORATION WERE AMENDED AS FOLLOWS: EXISTING ARTICLE X - MEMBERS, IS DELETED IN ITS ENTIRETY AND THE FOLLOWING NEW LANGUAGE SHALL BE INSERTED: ARTICLE X - MEMBERS THIS CORPORATION SHALL HAVE TWO CLASSES OF MEMBERS: FQHC MEMBERS AND GENERAL MEMBERS. THE MEMBERS OF THE CORPORATION SHALL MEET THE QUALIFICATIONS AS PROVIDED FOR IN THE RESTATED BYLAWS OF THE CORPORATION. THE MEMBERS SHALL HAVE VOTING RIGHTS AS PROVIDED FOR AND SUBJECT TO MINNESOTA STATUTES SECTION 317A AND THE RESTATED BYLAWS OF THE CORPORATION AS EFFECTIVE JULY 26, 2010. EXISTING ARTICLE XI - DIRECTORS, IS DELETED IN ITS ENTIRETY AND THE FOLLOWING NEW LANGUAGE SHALL BE INSERTED: ARTICLE XI - DIRECTORS AND OFFICER THE ORGANIZATION'S BOARD SHALL BE COMPRISED OF NINE DIRECTORS. NO MORE THAN SEVEN DIRECTORS SHALL BE REPRESENTATIVES OF THE FQHC MEMBERS AND NO MORE THAN THREE DIRECTORS SHALL BE REPRESENTATIVES OF THE GENERAL MEMBERS. THE OFFICERS OF THE COMPANY SHALL BE A CHAIRPERSON OF THE BOARD, (WHO SHALL FULFILL THE ROLE OF "PRESIDENT" AS REQUIRED IN MN STATUTE 317A.301), VICE - CHAIRPERSON AND THE SECRETARY/TREASURER. THE BY-LAWS WERE AMENDED AS FOLLOWS: ARTICLE 1.2: EXPLICITLY CLARIFY THAT NON-MEMBERS MAY NOT RECEIVE SERVICES FROM THE ORGANIZATION. ARTICLE 2.1: CLASSES OF MEMBERSHIP CHANGES - FQHC MEMBERS ARE NO LONGER REFERRED TO AS "INTEGRATED"; AND CLARIFIED MEMBERSHIP REQUIREMENTS; GENERAL MEMBERS ARE DEFINED AS OTHER NON-PROFIT COMMUNITY CLINICS OR SAFETY NET PROVIDERS AND CLARIFIED MEMBERSHIP REQUIREMENTS; ASSOCIATE MEMBER CLASS WAS REMOVED; A SEPARATE COMMUNITY MEMBER CATEGORY IS NOT NECESSARY, BUT ADDED LANGUAGE TO ALLOW THE BOARD TO CREATE A NEW CLASS AT THEIR DISCRETION. ARTICLE 2.2: PROVISIONAL LANGUAGE REMOVED AS SUFFICIENT SAFEGUARDS ELSEWHERE FOR REMOVAL OF EITHER NEW OR LONG-TERM MEMBERS. ARTICLE 2.4: FQHC AND GENERAL MEMBERS EACH HAVE ONE VOTE; VOTING IS NO LONGER WEIGHTED 2:1 FQHC:GENERAL. ARTICLE 3.1: EXECUTIVE DIRECTORS FOR FQHC MEMBERS ARE NO LONGER AUTOMATIC MEMBERS OF THE BOARD OF DIRECTORS. DIRECTORS ARE SELECTED BY THE NOMINATING COMMITTEE AS SET FORTH BY ARTICLE 5.2. ARTICLE 3.2: THE VICE CHAIRPERSON'S DUTIES NOW REPLACE THE SECRETARY/TREASURER IN THE LINE OF SUCCESSION. ARTICLE 3.3: VACANCIES IN THE BOARD OF DIRECTORS MUST BE ELECTED BY MAJORITY VOTE OF THE MEMBERS. ARTICLE 3.4: REMOVALS OF DIRECTORS MUST BE APPROVED BY A 66% VOTE OF THE MEMBERS. ARTICLE 4.1: THE MEMBERS ARE REQUIRED TO ELECT DIRECTORS AS RECOMMENDED BY THE NOMINATING COMMITTEE. ARTICLE 5.2: ESTABLISHED A STANDING EXECUTIVE COMMITTEE AND NOMINATING COMMITTEE AMONG OTHER COMMITTEES. ARTICLE 11.1: EXPANDED SO THAT THE BOARD MAY AMEND BOTH THE ARTICLES OF INCORPORATION AND THE BY-LAWS AT ANY TIME BY 2/3 MAJORITY VOTE.
FORM 990, PART VI, SECTION A, LINE 6
INTEGRATED MEMBERS ARE NON-PROFIT, COMPREHENSIVE PRIMARY CARE CLINICS WITH FEDERALLY QUALIFIED HEALTH CENTER (FQHC) STATUS; AND GENERAL MEMBERS ARE NON-FQHC, NON-PROFIT COMMUNITY HEALTH CARE CLINICS.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERSHIP AT LARGE ANNUALLY ELECT THE NINE DIRECTORS. UP TO SEVEN DIRECTORS MAY BE FROM AN FQHC MEMBER, AND UP TO THREE DIRECTORS MAY BE FROM A GENERAL MEMBER. THE CURRENT COMPOSITION IS 7:2.
FORM 990, PART VI, SECTION B, LINE 11
THE FINANCE COMMITTEE WILL CONDUCT A DETAILED REVIEW OF A DRAFT OF THE FORM 990, AND RECOMMEND APPROVAL BY THE FULL BOARD. BOARD MEMBERS WILL EACH RECEIVE A DRAFT COPY OF THE FORM 990 AND BE ASKED FOR COMMENTS AND QUESTIONS PRIOR TO FINANCE COMMITTEE APPROVAL. UPON FINAL APPROVAL FROM THE FINANCE COMMITTEE AND THE FULL BOARD, THE FORM 990 WILL BE FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
MANY OF THE GRANT DISTRIBUTIONS CARRY AN INHERENT CONFLICT SINCE BOARD MEMBERS HAVE TO DECIDE FORMULAS TO DISTRIBUTE THE WHOLE, AND EACH OF THEIR CLINICS ARE THE BENEFICIARY OF A PART OF THE WHOLE. ANNUALLY, BOARD MEMBERS SIGN A STATEMENT THAT THEY HAVE READ THE CONFLICT OF INTEREST POLICY AND AGREE TO ABIDE BY IT. ADDITIONALLY, THE CONFLICT OF INTEREST POLICY REQUIRES MEMBERS AGREE TO DISCLOSE ALL ACTUAL OR APPARENT CONFLICTS OF INTEREST, THEIR INVOLVEMENTS WITH OTHER ORGANIZATIONS, VENDORS, OR ANY OTHER ASSOCIATIONS THAT MAY PRODUCE CONFLICT IN THEIR ROLE AS MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS. MEMBERS MUST ALSO AGREE TO ABSENT THEMSELVES FROM DELIBERATIONS AND ANY VOTE ON ISSUES ABOUT WHICH THE MEMBER HAS AN UNAVOIDABLE CONFLICT OF INTEREST. DETERMINATIONS ON DISLOSED RELATIONSHIPS ARE MADE BY THE REMAINING INDEPENDENT BOARD MEMBERS. ALL PROCEEDINGS RELATED TO CONFLICTS OF INTEREST ARE DOCUMENTED IN THE MEETING MINUTES.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTERST POLICY, OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.