Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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 | |||||||||
| 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.") .... | 420,559 | 637,520 | 229,596 | 300,455 | 264,455 | 1,852,585 |
| 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.. | 420,559 | 637,520 | 229,596 | 300,455 | 264,455 | 1,852,585 |
| 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).. | 1,303,197 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | 549,388 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 420,559 | 637,520 | 229,596 | 300,455 | 264,455 | 1,852,585 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 14,000 | 18,225 | 16,544 | 10,679 | 5,192 | 64,640 |
| 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.. | 107 | 107 | ||||
| 11 | Total support (Add lines 7 through 10). | 1,917,332 | |||||






| 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.) | 0 | |||||
| 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.). | ||||||




| Facts And Circumstances Test |
|---|
| PT II LINE 17A: VOLUNTEERS IN MEDICINE INSTITUTE, INC. IS A NOT-FOR-PROFIT; ORGANIZATION WHOSE TAX-EXEMPT SECTION 501(C)(3) STATUS WAS RECOGNIZED BY THE INTERNAL; REVENUE SERVICE IN 1996. IN ADDITION, SINCE ITS INCEPTION, THE ORGANIZATION HAS CONTINUED; TO BE CLASSIFIED AS A PUBLICLY SUPPORTED ORGANIZATION (A "PUBLIC CHARITY") AS DESCRIBED; IN SECTIONS 170(B)(1)(A)(VI) AND 509(A)(1) OF THE INTERNAL REVENUE CODE DESPITE THE FACT; THAT ITS LEVEL OF PUBLIC SUPPORT HAS RECENTLY FALLEN SHORT OF THE ONE-THIRD LEVEL OF; SUPPORT NORMALLY REQUIRED FOR SUCH CLASSIFICATION. THE ORGANIZATION BELIEVES ITSELF TO; CONTINUE TO QUALIFY AS A PUBLICLY SUPPORTED ORGANIZATION HOWEVER, BY VIRTUE OF THE "FACTS; AND CIRCUMSTANCES" TEST OUTLINED IN REGS. SEC. 1.170A-9(E)(3) IN VIEW OF ITS CONTINUING; DEVELOPMENT EFFORTS WHICH ARE DESIGNED TO ATTRACT MORE BROAD-BASED SUPPORT FOR THE; ORGANIZATION AND TO BROADEN ITS COMMUNITY OUTREACH. IN ADDITION, THE ORGANIZATION'S; GOVERNING BOARD IS COMPRISED OF A DIVERSE GROUP OF INDIVIDUALS DRAWN FROM THE PUBLIC AT; LARGE, WITH EACH MEMBER OFFERING A UNIQUE SET OF SKILLS AND CAPABILITIES TO THE; ORGANIZATION. FINALLY, THE ORGANIZATION'S MISSION IS DEDICATED TO DEVELOPING FREE; HEALTH CLINICS FOR THE UNINSURED, A GROUP WHICH FREQUENTLY CONSISTS OF LOWER-INCOME; FAMILIES, A TRADITIONALLY UNDERSERVED SEGMENT OF THE GENERAL PUBLIC.; OTHER INCOME PART II, LINE 10; DESCRIPTION: MISCELLANEOUS; 2009: 107.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | Each Board member receives an electronic version of the tax return, and within 3 | |
| days, notifies the VIM office of his/her vote to accept or amend the tax return. | ||
| The Board votes are compiled prior to submitting the return to the IRS. | ||
| Pt VI-B, Line 12c | In keeping with the Conflict of Interest policy set by the Board of | |
| Directors, each Board member is required annually to sign a conflict of interest | ||
| acknowledgment form, after reviewing the policy. The policy is | ||
| reviewed and updated annually by the Board of Directors. | ||
| Pt VI-C, Line 19 | If a request were received for the Organization's By-laws, financial statements, | |
| conflict of interest policy, or Articles of Incorporation, these | ||
| documents would be made available in a paper or PDF electronic format. | ||
| Form 990EZ, Part I, Line 8 | MISCELLANEOUS | |
| Form 990EZ, Part I, Line 16 | INSURANCE MEETINGS MISCELLANEOUS OFFICE EXPENSE TRAVEL | |
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE 417. PREPAID EXPENSES 2602. FURNITURE & EQUIPMENT, BOOK VALUE 2072. | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES 5853. |
| Software ID: | 10000104 |
| Software Version: |