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
NATIONAL PERINATAL INFORMATION CENTER
Employer identification number
05-0415082
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)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
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
Total
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......
1,229,717
1,380,244
1,488,647
1,643,433
1,790,552
7,532,593
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.
1,229,717
1,380,244
1,488,647
1,643,433
1,790,552
7,532,593
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
7,532,593
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...
1,229,717
1,380,244
1,488,647
1,643,433
1,790,552
7,532,593
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
4,330
12,938
11,534
10,188
4,343
43,333
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
4,330
12,938
11,534
10,188
4,343
43,333
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.)
500
701
1,555
2,756
13
Total support (Add lines 9, 10c, 11 and 12.).
1,234,047
1,393,182
1,500,681
1,654,322
1,796,450
7,578,682
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
99.390 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.320 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.570 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.660 %
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
NATIONAL PERINATAL INFORMATION CENTER
Employer identification number
05-0415082
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE DIRECTOR OF ACCOUNTING DOES AN INITIAL REVIEW OF THE DRAFT 990 TO ENSURE ACCURACY. IF REVISIONS ARE REQUIRED, THE FORM 990 IS RETURNED TO THE ENGAGED ACCOUNTING FIRM FOR CORRECTIONS. A FINAL DRAFT OF THE FORM 990 IS DISTRIBUTED TO THE BOARD OF DIRECTORS FOR REVIEW. BOARD MEMBERS APPROVE OR REJECT THE FORM 990 EITHER BY EMAIL OR VOTE AT THE ANNUAL MEETING. A MAJORITY APPROVAL VOTE OF THE MEMBERS OF THE BOARD OF DIRECTORS SHALL CONSTITUTE A QUORUM FILE OF THE FORM 990 WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
NPIC REQUIRES OFFICERS, DIRECTORS, AND KEY EMPLOYEES TO DISCLOSE ANNUALLY ANY CONFLICT OF INTEREST THAT COULD GIVE RISE TO CONFLICTS. OFFICERS, DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE WHICH INCLUDES A SIGNED WRITTEN STATEMENT AFFIRMING THEIR UNDERSTANDING AND COMPLIANCE OF THE REQUIRED DISCLOSURE OF KNOWN OR POTENTIAL CONFLICTS OF INTEREST. THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS WILL REVIEW THESE FORMS AND DECIDE THE OUTCOME OF ANY DECLARED CONFLICTS. THIS COMMITTEE WILL REPORT THEIR FINDINGS TO THE BOARD OF DIRECTORS WHO WILL DOCUMENT THE OUTCOME IN THEIR MINUTES TO THEIR MEETINGS.
FORM 990, PART VI, SECTION B, LINE 15
15A. PRESIDENT'S COMPENSATION PROCESS: EVALUATION CRITERIA - THE PRESIDENT RECEIVES A FORMAL EVALUATION OF HIS/HER PERFORMANCE BY THE BOARD OF DIRECTORS ON AN ANNUAL BASIS. THE EVALUATION IS PART OF THE BOARD'S ANNUAL GOVERNANCE WORK BUT MAY BE INITIATED AT ANY TIME BY THE BOARD OR AT THE REQUEST OF THE PRESIDENT. THE EVALUATION IS CARRIED OUT BY THE COMPENSATION AND EVALUATION COMMITTEE AND FOCUSES ON THE FOLLOWING CRITERIA TO EVALUATE PERFORMANCE, REPORT ITS RECOMMENDATION TO THE BOARD: 1. ACCOMPLISHMENT OF THE ORGANIZATION'S MISSION, OBJECTIVES AND STRATEGIC RESULTS FOR WHICH THE PRESIDENT IS RESPONSIBLE. 2. INSURING THAT THE BOARD IS WELL INFORMED ON ISSUES AFFECTING THE CONTINUING RELEVANCE OF THE MISSION AND THE PERFORMANCE AND REPUTATION OF THE ORGANIZATION. 3. THE BOARD AND PRESIDENT WILL AGREE IN ADVANCE ON THE SPECIFIC PERFORMANCE INDICATORS EVIDENCE OF PERFORMANCE - THE BOARD AND PRESIDENT WILL AGREE IN ADVANCE ON HOW INFORMATION ON THE ABOVE CRITERIA WILL BE PROVIDED. THE MEANS OF GATHERING THIS INFORMATION OR DEMONSTRATING ACCOMPLISHMENT WILL INCLUDE: 1. REPORTS FROM THE PRESIDENT ON PROGRESS TOWARDS THE MISSION AND OBJECTIVES OF THE ORGANIZATION AND CURRENT STRATEGIC GOALS. 2. INDEPENDENT VERIFICATION AND OTHER INFORMATION IS GATHERED BY THE COMMITTEE IN RELATION TO THE DETERMINATION OF AN APPROPRIATE LEVEL OF COMPENSATION. FINDINGS AND RECOMMENDATIONS - THE COMMITTEE WILL REPORT TO THE BOARD THE RESULTS OF THEIR ASSESSMENT AND MAKE A RECOMMENDATION REGARDING ADJUSTMENTS IN THE SALARY OR OTHER CONDITIONS OF EMPLOYMENT OF THE PRESIDENT. THE BOARD WILL REVIEW ITS EVALUATION WITH THE PRESIDENT AND REPORT THE OUTCOME IN THEIR BOARD OF DIRECTORS' MINUTES TO THEIR MEETING. B. KEY EMPLOYEE COMPENSATION PROCESS KEY EMPLOYEE COMPENSATION IS DETERMINED BASED ON JOB RESPONSIBILITIES AND INDIVIDUAL PERFORMANCE AND EXTERNAL JOB MARKET DATA. COMPENSATION IS LINKED TO CORE COMPETENCIES AND GOAL ACHIEVEMENT. THE FOLLOWING PROCESS IS USED TO DETERMINE APPROPRIATE LEVELS OF COMPENSATION: JOB DESCRIPTION EACH JOB HAS A WRITTEN DESCRIPTION LISTING THE JOB SUMMARY, EDUCATION REQUIREMENT, EXPERIENCE, JOB SPECIFICATIONS, ADA REQUIREMENTS AND AGE COMPETENCY FOR THE POSITION IF APPLICABLE. JOB EVALUATION EACH JOB IS GIVEN A NUMERICAL SCORE DETERMINED BY THE TOTAL POINTS ASSIGNED TO ELEVEN FACTORS; EDUCATION, EXPERIENCE, EXERCISE OF JUDGMENT, RESPONSIBILITY, ACCOUNTABILITY, CONTACT WITH OTHERS, CONFIDENTIAL INFORMATION, DIRECTION OF OTHERS, WORKING CONDITION, SOCIAL/PSYCHOLOGICAL CONDITIONS, EFFORT. JOB GRADES THE PROCESS OF JOB CONTENT EVALUATION ESTABLISHES GROUPS OF JOBS OF SIMILAR VALUE INTO JOB GRADES. PAY RANGES ARE ESTABLISHED FOR EACH JOB GRADE ACCORDING TO THE STRUCTURE CLASSIFICATION AND SERVE AS THE BASIS FOR ALL PAY DECISIONS. EACH JOB GRADE IS COMPOSED OF A MINIMUM START RATE, MIDPOINT, AND MAXIMUM.
FORM 990, PART VI, SECTION C, LINE 19
NPIC BYLAWS AND CONFLICT OF INTEREST POLICY ARE POSTED ON THE COMPANY WEBSITE. A COPY OF THE AUDITED FINANCIAL STATEMENTS MAY BE REQUESTED VIA THE COMPANY WEBSITE.
RESPONSIBILITY FOR AUDIT
FORM 990, PART XI, LINE 2C
THE AUDIT COMMITTEE OF THE BOARD OF DIRECTORS, CHAIRED BY THE TREASURER, REVIEWS THE FINANCIAL GUIDELINES, RESPONDS TO THE AUDITOR'S COMMUNICATION REGARDING AUDIT ACTIVITIES, PROVIDES A DETAILED REVIEW OF THE AUDIT REPORT TO BRING FORTH ANY ISSUES THAT MAY ARISE, AND ASSISTS THE BOARD WITH THE CHOOSING OF AN AUDITOR.
LEASED EMPLOYEES
FORM 990, PART VII & PART IX
THE ORGANIZATION LEASES ALL OF ITS EMPLOYEES FROM WOMEN & INFANTS HOSPITAL OF PROVIDENCE, RI. ALL OF THE EMPLOYEES ONLY WORK FOR NATIONAL PERINATAL INFORMATION CENTER. THE FEES PAID FOR THE LEASED EMPLOYEES IS THE ACTUAL AMOUNT PAID THE EMPLOYEES AS COMPENSATION AND BENEFITS AS LISTED IN PART IX, LINES 5 AND 24A.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.