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
SETTLEMENT HEALTH SETTLEMENT HEALTH & MEDICAL SERVICES
Employer identification number
13-2957943
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.") ....
2,636,644
2,545,884
2,584,119
3,282,444
3,037,471
14,086,562
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..
2,636,644
2,545,884
2,584,119
3,282,444
3,037,471
14,086,562
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.
14,086,562
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..
2,636,644
2,545,884
2,584,119
3,282,444
3,037,471
14,086,562
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
306,352
341,170
303,601
126,632
68,897
1,146,652
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..
24,412
52,521
60,152
39,289
61,662
238,036
11
Total support (Add lines 7 through 10).
15,471,250
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
91.050 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
90.600 %
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, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MISCELLANEOUS
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
SETTLEMENT HEALTH SETTLEMENT HEALTH & MEDICAL SERVICES
Employer identification number
13-2957943
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
PROCEDURE 1: THE FISCAL DEPARTMENT PROVIDES ALL NECESSARY FINANCIAL DATA TO THE AUDIT FIRM FOR THE PURPOSES OF PREPARING FORM 990 FOR THE PERIOD ENDED DECEMBER 31, 2010 2: THE AUDIT FIRM PREPARES THE FORM 990 AND SUBMITS BACK TO THE ORGANIZATION FOR REVIEW AND APPROVAL 3: AT THE APPROPRIATE MONTHLY BOARD OF DIRECTORS MEETING THE PREPARED FORM 990 IS PRESENTED TO THE BOD FOR FINAL REVIEW 4: BOARD OF DIRECTORS APPROVES THE FORM 990 5: ONCE THE BOD APPROVES THE FORM 990, THE FORM IS SUBMITIED TO THE INTERNAL REVENUE SERVICE (IRS) 6: THE APPROVED FORM 990 SUBMITTED TO THE IRS THEN BECOMES PUBLIC INFORMATION UPON REQUEST.
FORM 990, PART VI, SECTION B, LINE 12C
SETTLEMENT HEALTH RECOGNIZES AND RESPECTS THE RIGHT OF ITS EMPLOYEES TO ENGAGE IN OUTSIDE ACTIVITIES WHICH THEY DEEM PROPER AND DESIRABLE, PROVIDED THESE ACTIVITIES DO NOT IMPAIR OR INTERFERE WITH THE CONSCIENTIOUS PERFORMANCE OF SETTLEMENT HEALTH, DO NOT INVOLVE THE MISUSE OF SETTLEMENT HEALTH'S INFLUENCE, FACILITIES, INFORMATION OR OTHER RESOURCES, DO NOT DIVERT OPPORTUNITIES FROM SETTLEMENT HEALTH, AND DO NOT REFLECT DISCREDIT UPON THE NAME AND REPUTATION OF SETTLEMENT HEALTH. ACCORDINGLY, FOR ALL BUSINESS RELATIONSHIPS WITH OUTSIDE INDIVIDUALS, COMPANIES AND ORGANIZATIONS AND FOR ALL PERSONAL UNDERTAKINGS, EMPLOYEES ARE REQUIRED TO 1: ACT IN ACCORDANCE WITH THE LAW 2: CONSIDER THAT EMPLOYMENT WITH SETTLEMENT HEALTH, UNLESS EXPRESSLY AGREED OTHERWISE, IS FULL-TIME AND OUTSIDE EMPLOYMENT/ACTIVITIES MUST NOT AFFECT JOB PERFORMANCE 3: PROTECT THE REPUTATION AND INTERESTS OF SETTLEMENT HEALTH AGAINST ACTUAL OR POTENTIAL CONFLICTING INTERESTS WITH OUTSIDE PARTIES 4: CONSIDER THE RIGHTS,INTERESTS AND RESPONSIBILITIES OF THE OUTSIDE INDIVIDUALS, COMPANIES AND ORGANIZATIONS, AND THEMSELVES 5: AVOID PERSONAL TRANSACTIONS OR SITUATIONS IN WHICH PERSONAL INTERESTS CONFLICT OR, MIGHT BE PERCEIVED TO CONFLICT, WITH THOSE OF SETTLEMENT HEALTH 6: BE AWARE THAT THE USE OF COMPANY UNIFORMS, EQUIPMENT AND/OR SUPPLIES WHILE EMPLOYED OUTSIDE SETTLEMENT HEALTH IS STRICTLY PROHIBITED. NO EMPLOYEE MAY DIRECTLY OR INDIRECTLY BUY, SELL OR LEASE ANY PROPERTY, FACILITIES, SERVICES, OR EQUIPMENT FROM OR TO SETTLEMENT HEALTH FOR PERSONAL BENEFITS, EXCEPT WITH FULL DISCLOSURE AND THE APPROVAL OF THE CHIEF EXECUTIVE OFFICER. PERSONAL GAIN MAY RESULT NOT ONLY IN CASES WHERE AN EMPLOYEE OR RELATIVE HAS A SIGNIFICANT OWNERSHIP IN A FIRM WITH WHICH SETTLEMENT HEALTH DOES BUSINESS, BUT ALSO WHEN AN EMPLOYEE OR RELATIVE RECEIVES ANY KICKBACK, BRIBE, SUBSTANTIAL GIFT, OR SPECIAL CONSIDERATION AS A RESULT OF ANY TRANSACTION OR BUSINESS DEALINGS INVOLVING SETTLEMENT HEALTH IN THIS CONNECTION, EVERY EMPLOYEE SHALL DISCLOSE PROMPTLY, IN WRITING, ANY PERSONAL SITUATION OR TRANSACTION, WHICH IS, OR MAYBE IN CONFLICT WITH, THE INTENT OF THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15
THE CEO IS COMPENSATED FOR THE FOLLOWING: SINCE SETTLEMENT HEALTH IS A NON-FOR-PROFLT ORGANIZATION THE CEO IS NOT COMPENSATED AS OTHER FOR-PROFIT ORGANIZATIONS. YEARLY, LIKE EVERY OTHER SETTLEMENT HEALTH EMPLOYEE, THE CEO IS COMPENSATED A 3% COST OF LIVING ALLOWANCE WHICH IS BUILT INTO THE 330 GRANT. 1: CEO IS EVALUATED ON A YEARLY BASIS 2: THE BOARD OF DIRECTORS SET FORTH THE ANNUAL GOALS FOR THE ORGANIZATION 3: IF THE GOALS WHICH THE BOARD OF DIRECTORS HAVE SET FORTH, THIS IS TAKEN INTO ACCOUNT IF COMPENSATION IS BEING DISCUSSED WITH THE CEO 4: PERFORMANCE RESULTS OF THE ORGANIZATION'S ANNUAL AUDIT ARE SEEN AS A POSITIVE BAROMETER IF COMPENSATION IS MERITED. THE BOARD OF DIRECTORS EXECUTIVE COMMITTEE ON BEHALF OF THE FULL BOARD IS RESPONSIBLE FOR REVIEWING THE TOTAL COMPENSATION FOR THE CEO FISCAL MANAGER COMPENSATION 1: SINCE THE FISCAL MANAGER REPORTS TO THE CEO HE IS THE PARTY RESPONSIBLE FOR ANY COMPENSATION DUE EMPLOYEES AS AUTHORIZED BY THE BOD, WHO HAVE DELEGATED THAT RESPONSIBILITY TO THE CEO
FORM 990, PART VI, SECTION C, LINE 19
PROVIDING COPIES UPON REQUEST.
FORM 990, PART XI, LINE 2C:
THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF INDEPENDENT ACCOUNTANTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.