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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 3,332,230 | 3,369,063 | 3,896,546 | 4,031,654 | 3,601,410 | 18,230,903 |
| 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.. | 3,332,230 | 3,369,063 | 3,896,546 | 4,031,654 | 3,601,410 | 18,230,903 |
| 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. | 18,230,903 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,332,230 | 3,369,063 | 3,896,546 | 4,031,654 | 3,601,410 | 18,230,903 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 8 | 4,580 | 4,588 | |||
| 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.. | 3,582,679 | 3,944,741 | 2,915,955 | 3,325,060 | 3,809,044 | 17,577,479 |
| 11 | Total support (Add lines 7 through 10). | 35,812,970 | |||||






| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: OTHER; 2007: 2180.; 2008: 289.; 2009: 0.; 2010: 0.; DESCRIPTION: HEALTH CARE SERVICES REVENUES; 2007: 3580499.; 2008: 3599452.; 2009: 2915955.; 2010: 3325060.; 2011: 3809044.; DESCRIPTION: DONATED PROPERTY; 2007: 0.; 2008: 345000.; 2009: 0.; 2010: 0.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | After the Form 990 is prepared, the Organization presents it | |
| to the Finance Committee for review, and if approved, then | ||
| the Organization files the Form 990 to IRS. | ||
| Pt VI, Line 12c | The Organization states in the Conflict of Interest policy | |
| that employees are required to disclose to their supervisors | ||
| and the Exec. Dir. any personal business situation of transaction | ||
| that is in conflict with the interest or pupose of the Clinic. | ||
| Pt VI, Line 15 | The CEO salary is determined by an evaluation of the Board of Directors, | |
| Whereby the results are voted upon by the full Board of Directos based on the | ||
| availability of funding. Compensation is determined in accordance with hospital and healthcare | ||
| compensation services. | ||
| All other officers or key employeess receive an annual evaluation based on the availability of funding. | ||
| All other officers or key employeess receive an annual evaluation based on the availability of funding. | ||
| compensation reference guide and GMHC policies and procedures. | ||
| Pt VI, Line 7a | The Board of Directors may elect other members of the | |
| Board of Directors. | ||
| Pt VI, Line 7b | Decisions of the governing body is subject to the approval of | |
| of majority of the members of the governing body. | ||
| Pt VI, Line 6 | The Organization has a Board of Directors which consists | |
| of members. | ||
| Part XI, Line 5 | To write off Captial lease obligation in the amount of $136,731. | |
| To record the Lease purchase of Building acquired in prior years | ||
| in the amount of $275,000. |
| Software ID: | 11000175 |
| Software Version: |