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
HATTIE LARLHAM RESEARCH INSTITUTE
Employer identification number
02-0634814
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.") ....
166,081
184,941
210,548
64,368
176,202
802,140
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..
166,081
184,941
210,548
64,368
176,202
802,140
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.
802,140
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..
166,081
184,941
210,548
64,368
176,202
802,140
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
62
5
3
70
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).
802,210
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
86,179
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
99.991 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.985 %
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
HATTIE LARLHAM RESEARCH INSTITUTE
Employer identification number
02-0634814
Identifier
Return Reference
Explanation
FORM 990 REVIEW PROCESS
PAGE 6, PART VI, SECTION B, #11B
FORM 990 IS REVIEWED BY THE CFO AND PRESENTED TO THE TREASURER'S (FINANCE) COMMITTEE BY THE TAX ACCOUNTANT/PREPARER FOR REVIEW AND APPROVAL. THE BOARD OF DIRECTORS THEN RECEIVES A COPY OF FORM 990 FOR REVIEW/COMMENT PRIOR TO THE TAX RETURN BEING FILED.
MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY
PAGE 6, PART VI, SECTION B, #12C
EACH MEMBER OF THE BOARD OF DIRECTORS RECEIVES TRAINING ON ETHICAL CONDUCT BY THE DIRECTOR OF CORPORATE COMPLIANCE DURING THEIR ORIENTATION TO THE BOARD AND ON AN ANNUAL BASIS. HATTIE LARLHAM DISTRIBUTES TO THE BOARD OF DIRECTORS AT THE ANNUAL MEETING AND DURING ORIENTATION THE CONFLICT OF INTEREST POLICY. EACH BOARD MEMBER HAS AN OBLIGATION TO MAKE FULL DISCLOSURE OF CONFLICTS OF INTEREST EACH YEAR. THEY RECEIVE THE CONFLICT OF INTEREST POLICY AND A DECLARATION STATEMENT TO READ AND SIGN. IF A CONFLICT OF INTEREST IS REPORTED, THE DISCLOSURE IS PLACED ON THE AGENDA OF A BOARD MEETING WHERE A MOTION IS MADE TO ACKNOWLEDGE THE DISCLOSURE AND VOTE TO DETERMINE IF THE SERVICES ARE APPROPRIATE TO THE NEEDS OF THE ORGANIZATION. HATTIE LARLHAM HAS SPECIFIC POLICIES IN REGARDS TO GIFTS AND GRATUITIES AND EMPLOYMENT OF RELATIVES. THE EXECUTIVE STAFF OF HL AGENCIES MUST ALSO REPORT ANY CONFLICT OF INTEREST TO THE CEO IN REGARDS TO GIFTS, GRATUITIES, AND RELATIVES EMPLOYED AT HL UNDER AN EXECUTIVE'S SPAN OF CONTROL. IF A CONFLICT OF INTEREST IS REPORTED TO THE CEO, HE/SHE WILL FOLLOW THE SAME POLICY AS IT APPLIES TO THE BOARD OF DIRECTORS UNDER THE CONFLICT OF INTEREST POLICY. HL HAS A CORPORATE COMPLIANCE COMMITTEE WHICH MEETS MONTHLY TO MONITOR ALL CORPORATE COMPLIANCE ACTIVITIES. A CORPORATE COMPLIANCE EVALUATION IS COMPLETED ON AN ANNUAL BASIS BY THE DIRECTOR OF CORPORATE COMPLIANCE, A VICE PRESIDENT OF ONE OF THE HL AGENCIES, AND THE QUALITY IMPROVEMENT COORDINATOR TO DETERMINE WHICH ACTIVITIES NEED TO BE ADDRESSED.
PROCESS FOR DETERMINING COMPENSATION
PAGE 6, PART VI, SECTION B, #15A & 15B
THE PROCESS OF DETERMINING THE COMPENSATION FOR THE ORGANIZATION'S CEO, VICE PRESIDENT, TOP MANAGEMENT, AND KEY EMPLOYEES IS DONE THROUGH A COMPENSATION COMMITTEE, COMPENSATION SURVEY/STUDY AND APPROVAL BY THE COMPENSATION COMMITTEE.
DOCUMENTS AVAILABLE TO PUBLIC
PAGE 6, PART VI, SECTION C, #19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
ALLOCATION OF HOURS WORKED
page 7, part vii, section a, #1a, column (b)
Hours worked per week are allocated between the filing organization and related organizations as follows for the individuals listed within Part Vii: DARRYL MAST - TOTAL HOURS PER WEEK = 50, SPLIT: HLF - 1.2 HRS HLCCD - 29.6 HRS HLCL - 7.2 HRS HLCS - 11.3 HRS HLHC - 0.1 HRS HLRI - 0.6 HRS MARC RUBINSTEIN - TOTAL HOURS PER WEEK = 49, SPLIT: HLCG - 0.3 HRS HLF - 1.2 HRS HLCCD - 29.1 HRS HLCL - 7.0 HRS HLCS - 11.1 HRS HLHC - 0.1 HRS HLRI - 0.6 HRS MICHELLE ANDERSON - TOTAL HOURS PER WEEK = 42, SPLIT: HLCG - 0.2 HRS HLF - 0.8 HRS HLCCD - 23.3 HRS HLCL - 6.5 HRS HLCS - 10.5 HRS HLHC - 0.1 HRS HLRI - 0.6 HRS DENNIS ALLEN - TOTAL HOURS PER WEEK = 55, SPLIT: HLF - 14.5 HRS HLCCD - 17.9 HRS HLCL - 9.8 HRS HLCS - 6.8 HRS HLHC - 0.1 HRS HLRI - 5.9 HRS DR. RICHARD GROSSBERG - TOTAL HOURS PER WEEK = 40, SPLIT: HLCCD - 38.0 HRS HLRI - 2.0 HRS ED ALLEN - TOTAL HOURS PER WEEK = 40, SPLIT: HLF - 40.0 HRS
MEMBER CLASSES
PAGE 6, PART VI, SECTION A, #6
THE SOLE MEMBER OF THE CORPORATION SHALL BE HATTIE LARLHAM CARE GROUP, A RELATED ORGANIZATION. THERE IS ONLY ONE CLASS OF MEMBERS.
MEMBERS WHO MAY ELECT MEMBERS
PAGE 6, PART VI, SECTION A, #7A
ACTION BY THE MEMBER OF THE CORPORATION SHALL BE REQUIRED, AND SHALL BE SUFFICIENT, FOR THE FOLLOWING MATTERS: A) TO ELECT THE MEMBERS OF THE BOARD OF DIRECTORS (THE "DIRECTORS") AND TO REMOVE THE DIRECTORS; B) TO AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR THE CODE OF REGULATIONS; C) TO DISSOLVE OR TERMINATE THE EXISTENCE OF THE CORPORATION. THE DIRECTORS SHALL BE RELIEVED FROM LIABILITY FOR MANAGERIAL ACTS OR OMISSIONS IMPOSED UPON DIRECTORS BY LAW, TO THE EXTENT THAT, AND AS LONG AS, ANY DISCRETIONARY POWER IN THE MANAGEMENT OF CORPORATE AFFAIRS OF THE CORPORATION IS EXERCISED BY THE MEMBER PURSUANT TO THE CODE OF REGULATIONS, THE ARTICLES OR INCORPORATION, OR APPLICABLE LAW.
GOVERNING BODY DECISION APPROVAL
PAGE 6, PART VI, SECTION A, #7B
THE MEMBER MUST APPROVE THE FOLLOWING ACTIONS OF THE BOARD OF DIRECTORS BEFORE SUCH ACTIONS BECOME EFFECTIVE: A) ANY MERGER OR CONSOLIDATION OF THE CORPORATION AND ANY SALE OF SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS; B) THE CREATION OF ANY SUBSIDIARY ORGANIZATION OR THE AFFILIATION OF THE CORPORATION WITH ANY OTHER ENTITY FOR THE PURPOSE OF THE JOINT CONDUCT OF BUSINESS OR OTHER PROGRAMS, WHETHER IN THE FORM OF PARTICIPATION IN A CORPORATION, PARTNERSHIP, LIMITED LIABILITY COMPANY, JOINT VENTURE, CO-TENANCY OR ANY OTHER FORM OF OWNERSHIP OR CONTROL; C) THE APPROVAL OF THE ANNUAL BUDGET OF THE CORPORATION; D) THE ADOPTION OF ANY NEW OR MATERIALLY REVISED SERVICES TO BE PROVIDED BY THE CORPORATION; E) ANY REQUESTS FOR FUNDING FROM HATTIE LARLHAM FOUNDATION; AND F) ANY OTHER ACT FOR WHICH MEMBERSHIP APPROVAL IS REQUIRED UNDER APPLICABLE LAW, THE ARTICLES OF INCORPORATION, OR THE CODE OF REGULATIONS.
SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS
PAGE 6, PART VI, SECTION A, #4
HATTIE LARLHAM RESEARCH INSTITUTE HAS AMENDED ITS CODE OF REGULATIONS TO ALLOW FOR PROXY VOTE. THE AMENDMENT DEFINES A PROXY AS A PERSON WHO IS ENTITLED TO ATTEND A DIRECTORS' MEETING, TO VOTE THEREAT, OR TO EXECUTE CONSENTS, WAIVERS OR RELEASES, MAY BE REPRESENTED AT SUCH MEETING OR VOTE THEREAT, AND EXECUTE CONSENTS, WAIVERS AND RELEASES, AND EXERCISE ANY OF HIS OTHER RIGHTS, BY PROXY OR PROXIES APPOINTED BY A WRITING SIGNED BY SUCH PERSON.
RECONCILIATION OF NET ASSETS
PAGE 12, PART XI, #5
BOARD APPROVED NET ASSET TRANSFER FROM AFFILIATED ORGANIZATION.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MARC RUBINSTEIN TITLE:TREASURER/CFO HOURS:48
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DR RICHARD GROSSBERG TITLE:VP/PHYSICIAN/MEDICAL DIRECTOR HOURS:38
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DENNIS ALLEN TITLE:CEO HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DARRYL MAST TITLE:VP OF OPERATIONS HOURS:49
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MICHELLE ANDERSON TITLE:COO HOURS:41
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ED ALLEN TITLE:VP OF INSTITUTIONAL ADV-FDN HOURS:40
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.