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
PARTNERS IN HOME CARE INC
Employer identification number
81-0425934
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.") .
131,669
228,712
285,415
240,229
110,415
996,440
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......
8,498,085
9,194,043
7,291,922
9,072,761
9,516,823
43,573,634
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.
8,629,754
9,422,755
7,577,337
9,312,990
9,627,238
44,570,074
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.)
44,570,074
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...
8,629,754
9,422,755
7,577,337
9,312,990
9,627,238
44,570,074
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
49,591
9,526
5,419
11,506
16,025
92,067
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
49,591
9,526
5,419
11,506
16,025
92,067
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.)
33,255
104,950
43,144
44,598
54,558
280,505
13
Total support (Add lines 9, 10c, 11 and 12.).
8,712,600
9,537,231
7,625,900
9,369,094
9,697,821
44,942,646
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
99.170 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
99.070 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.200 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
0.260 %
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 12, EXPLANATION OF OTHER INCOME: OTHER INCOME
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
PARTNERS IN HOME CARE INC
Employer identification number
81-0425934
Identifier
Return Reference
Explanation
FORM 990, PART VI
FORM 990, SECTION A, LINE 9: THE FOLLOWING INDIVIDUALS CANNOT BE REACHED AT THE ORGANIZATION'S MAILING ADDRESS: MICHELLE (SHELLY) ROY ST. PATRICK HOSPITAL AND HEALTH SCIENCES CENTER 500 W. BROADWAY MISSOULA, MT 59802 RONALD PREMUROSO MONTANA SCHOOL OF BUSINESS GALLAGHER BUSINESS BUILDING, ROOM 341 32 CAMPUS DRIVE MISSOULA, MT 59812 JANELLE HUSTON ST. PATRICK HOSPITAL 500 W BROADWAY MISSOULA, MT 59802 JAN PERRY COMMUNITY MEDICAL CENTER 2827 FORT MISSOULA ROAD MISSOULA, MT 59804 JAYNE LUX COORDINATOR OF HOME & COMMUNITY BASED SERVICES 2685 PALMER STREET, SUITE D MISSOULA, MT 59808 JOYCE DOMBROUSKI ST. PATRICK HOPSITAL 500 W BROADWAY MISSOULA, MT 59802 DAVID RICHHART COMMUNITY MEDICAL CENTER 2827 FORT MISSOULA ROAD MISSOULA, MT 59804 KIRK BODLOVIC ST. PATRICK HOSPITAL & HEALTH SCIENCES CENTER 500 W. BROADWAY MISSOULA, MT 59802
FORM 990, PART VI, SECTION A, LINE 6
PARTNERS IN HOME CARE, INC., HAS ONE MEMBER: MISSOULA HOSPITAL ALLIANCE, INC. THE RIGHTS OF THE MEMBER ARE EXERCISED BY THE BOARD OF DIRECTORS OF MISSOULA HOSPITAL ALLIANCE, INC.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBER HAS THE RIGHT TO ELECT AND REMOVE MEMBERS OF THE BOARD OF DIRECTORS OF PARTNERS IN HOME CARE, INC.
FORM 990, PART VI, SECTION A, LINE 7B
THE MEMBER HAS THE RIGHT OF APPROVAL OF: 1. THE MISSION STATEMENT OF PARTNERS IN HOME CARE (PIHC). 2. THE SELECTION AND REMOVAL OF THE EXECUTIVE DIRECTOR. 3. THE OPERATING, CASH-FLOW AND CAPITAL BUDGETS FOR PIHC. THE APPROPRIATE BUDGET MUST CONTAIN LONG-TERM BORROWING AND TRANSFERS OF REAL OR PERSONAL PROPERTY. THE BOARD OF DIRECTORS WILL SUBMIT ALL BUDGETS TO THE MEMBER AT THE ANNUAL MEETING. UNTIL APPROVAL BY THE MEMBER, NEITHER THE DIRECTORS NOR OFFICERS OF PIHC HAVE THE AUTHORITY TO EXPEND MONEY FOR ITEMS CONTAINED IN THE BUDGETS. 4. MAJOR NEW SERVICES APPROVED BY THE BOARD OF DIRECTORS. 5. CHANGES TO THE ARTICLES OF INCORPORATION AND BY-LAWS.
FORM 990, PART VI, SECTION B, LINE 11
THE CEO AND THE CONTROLLER REVIEWED THE FORM 990 BEFORE SUBMITTING IT TO THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
POLICY: ALL STAFF, VOLUNTEERS, AND MEMBERS OF THE BOARD OF DIRECTORS AND PROFESSIONAL ADVISORY COMMITTEE OF THE AGENCY WILL DISCLOSE ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST. DEFINITION: A CONFLICT OF INTEREST MAY EXIST WHEN AN INDIVIDUAL WILL DERIVE ANY PROFIT OR GAIN DIRECTLY OR INDIRECTLY BY REASON OF HIS/HER ROLE IN THE AGENCY, AND THE OBJECTIVITY OR LOYALTY OF THAT INDIVIDUAL COULD BE QUESTIONED. PROCEDURE-BOARD OF DIRECTORS: 1. IF A MATTER ARISES IN WHICH A MEMBER OF THE BOARD HAS A CONFLICT OF INTEREST, THIS SHALL BE PROMPTLY DISCLOSED BY THE BOARD MEMBER TO THE BOARD OF DIRECTORS. 2. IN MATTERS INVOLVING A CONFLICT OF INTEREST, A BOARD OF DIRECTORS MEMBER MUST DISCLOSE ANY KNOWN SIGNIFICANT REASONS WHY A TRANSACTION MIGHT NOT BE IN THE BEST INTEREST OF THE AGENCY AND A BOARD MEMBER SHALL NOT PARTICIPATE IN DISCUSSION NOR VOTE ON THE RELATED TRANSACTIONS. 3. ALL BOARD MEMBERS OF AGENCY WILL DISCLOSE ANY DUALITY OF INTEREST OR POTENTIAL CONFLICT OF INTEREST. PROCEDURE-STAFF AND VOLUNTEERS: 1. ANY EMPLOYEE, CONTRACTED STAFF MEMBER, OR VOLUNTEER (INCLUDING A NON-EMPLOYEE MEMBER OF THE PROFESSIONAL ADVISORY COMMITTEE) THAT COULD, OR WOULD DERIVE ANY PROFIT OR GAIN DIRECTLY OR INDIRECTLY BY A RELATIONSHIP WITH ANOTHER AGENCY, MUST MAKE THE CONFLICT KNOWN TO THE SUPERVISOR OR COMPLIANCE OFFICER. IF A STAFF MEMBER HAS TIES TO OR OWNERSHIP IN AN UNRELATED COMPANY, HE/SHE WILL NOTIFY THE SUPERVISOR, SO AS NOT TO BE PLACED IN A COMPROMISING POSITION. FOR EXAMPLE, A STAFF MEMBER WHO IS ALSO AN EMPLOYEE OF A HOSPITAL THAT GIVES REFERRALS TO THE AGENCY OR A STAFF MEMBER WHO HAS OWNERSHIP IN A MEDICAL SUPPLY COMPANY THAT PROVIDES MEDICAL SUPPLIES TO THE AGENCY. THE SUPERVISOR, IN CONJUNCTION WITH THE LEADERS OF THE AGENCY, WILL DETERMINE APPROPRIATE ACTIONS. 2. THE NATURE OF OUTSIDE INTERESTS MAY BE DETERMINED AS OWNERSHIP, ENTERTAINMENT, GIFTS, LOANS, EMPLOYMENT STATUS, OR RELATED STAFF MEMBERS OR VOLUNTEERS. 3. IT IS THE RESPONSIBILITY OF ALL STAFF MEMBERS AND VOLUNTEERS TO INFORM HIS/HER IMMEDIATE SUPERVISOR IF HE/SHE CONCURRENTLY WORKS FOR A COMPETITOR OF THE AGENCY. IT IS THE EMPLOYEE'S RESPONSIBILITY TO NOTIFY HIS/HER SUPERVISOR OF ANY CHANGES IN EMPLOYMENT STATUS.
FORM 990, PART VI, SECTION B, LINE 15
THE CEO'S COMPENSATION IS DETERMINED BY THE BOARD OF DIRECTORS AND FOR ALL OTHER EMPLOYEES, WAGES ARE BASED ON A REGIONAL SALARY MARKET SURVEY. THE LAST SURVEY WAS PERFORMED SPRING OF 2010.
FORM 990, PART VI, SECTION C, LINE 19
PARTNERS IN HOME CARE MAKE THEIR GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.