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
2011
Open to Public Inspection
Name of the organization
International Association for Hospice & Palliative Care Inc
Employer identification number
76-0674392
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.") ....
324,519
367,580
434,762
364,668
760,633
2,252,162
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
324,519
367,580
434,762
364,668
760,633
2,252,162
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)..
880,956
6
Public Support. Subtract line 5 from line 4.
1,371,206
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
324,519
367,580
434,762
364,668
760,633
2,252,162
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
5,889
3,809
601
1,110
11,409
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
2,587
2,965
2,460
1,396
1,075
10,483
11
Total support (Add lines 7 through 10).
2,274,054
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
60.300 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
36.410 %
16a
33 1/3% support test—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 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.)
Section B. Total Support
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.).
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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
Additional Data
Software ID:
11000144
Software Version:
2011v1.2
-
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
2011
Open to Public Inspection
Name of the organization
International Association for Hospice & Palliative Care Inc
Employer identification number
76-0674392
Identifier
Return Reference
Explanation
Method of accounting-page 12
For certain restricted donations, which will be spent in full or in part in a later fiscal period, the taxpayer accrues the expenses and grants to be paid pursuant to the restricted donation in the year of the donation. Otherwise, the taxpayer generally uses the cash method of accounting, recognizing income when received and expenses when paid. Investments are stated at their Fair Market Value.
Form 990, Part VI, Line 9-Directors
Zipporah V. Ali, MDNational Coordinator Kenya Hospices and Palliative Care Association (KEHPCA)P.O. Box 2491-00202 KNHNairobi KENYAMichael Bennett, MDProfessor of Palliative MedicineLancaster University3 St Helen's CroftAdel, Leeds LS168JY UKFraser Black, MDMedical DirectorVictoria Hospice Society and Associate Director INCTR PAX Program21 Cambridge Street.Victoria, BC V8V 4A7 CANADAEduardo Bruera, MDProfessor and HeadDept. of Palliative Care and Rehabilitation Medicine UT MD Anderson Cancer Center1515 Holcombe Blvd. Box 08Houston TX 77030 USAKin-Sang Chan, MDChairman Hong Kong Society of Palliative MedicineChief of Service Pulmonary and Palliative Care UnitHaven of Hope HospitalHaven of Hope RoadTseung Kwan O Kowloon HONG KONGJames Cleary, MDUW Paul P. Carbone Comprehensive Cancer Center K6/546 Clinical Science Center 600 Highland Ave Madison, WI 53792 USADavid Currow, MDProfessor of Palliative and Supportive ServicesFlinders University DirectorInternational Institute of Palliative and Supportive StudiesDaw House700 Goodwood RdDaw ParkSouth Australia AUSTRALIA 5041Derek Doyle, MD, FRCSEHonorary Vice PresidentNational Hospice Council Scotland7 Kaimes RoadEdinburgh, EH 12 6JR Scotland UKWilliam Farr, MDSenior Editor IAHPC Newsletter764 Liberty RoadMilner GA 30257 USAFrank D. Ferris, MDDirector, International ProgramsSan Diego Hospice & Palliative Care4311 Third AvenueSan Diego, CA 92103-1407 USAKathleen Foley, MDPain and Palliative Care ServiceMemorial Sloan-Kettering Cancer Center1275 York Avenue Box 52New York, NY 10021 USAPeter Hudson, PhDAssociate Professor and DirectorCentre for Palliative Care Education & Research St Vincent's & The University of MelbournePostal: PO Box 2900, Fitzroy Victoria 3065 AUSTRALIAEric Krakauer, MDDirector, International ProgramsHarvard Medical School Center for Palliative Care641 Huntington AvenueBoston, MA 02459 USABernard Lapointe, MDDirector Palliative CareMc Gill UniversityMontreal CANADAMhoiral Leng, MD"Head of Palliative CareMakerere University and Mulago HospitalKampalaUGANDA"Arthur Lipman PharmDProfessor of Pharmacotherapy and AnesthesiologyDirector of Clinical PharmacologyUniversity of Utah Health Science Center30 S 2000 E RM 258Salt Lake City UT 84112-5820 USAYvonne Luxford, PhdChief Executive Officer, Palliative Care AustraliaPO Box 24Deakin West ACT 2600 AUSTRALIAScott Murray, MDSt Columbas Hospice Chair of Primary Palliative CareSchool of Clinical Sciences and Community HealthUniversity of EdinburghDoorway 3, Medical SchoolEdinburgh EH8 9AG Scotland UKFaith Mwangi-Powell, PhDExecutive DirectorAfrican Palliative Care AssociationPlot 850, Dr. Gibbons Road, MakindyePO Box 72518 Kampala UGANDAGayatri Palat, MDProgram DirectorPalliative Care Access Program- India, INCTRAssociate ProfessorMNJ Institute of Oncology and RCCHyderabad INDIALukas Radbruch, MDChair of Palliative MedicineDirector of the Department of Palliative MedicineUniversity Hospital, BonnDirector of the Centre of Palliative MedicineMalteser Hospital, Bonn / Rhein-Sieg GERMANYFlorian Strasser, MDDept. Internal Medicine and Palliative Care Center,Cantonal HospitalRorschacherstrasse, 9007 St.Gallen SWITZERLANDRoberto Wenk, MDDirector Programa Argentino de Medicina Paliativa Fundacion FEMEBABelgrano 5852900 San Nicolas ARGENTINARoger Woodruff, MDIAHPC Bookshop Editor210 Burgundy St, Suite 9Heidelberg, Victoria 3084 AUSTRALIA
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
On the website and upon request.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
Board members are required to submit an updated Conflict of Interest statement annually.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
The 990 is first reviewed by the Executive Director and the Financial Director. It is then submitted to the Financial Committee of the Board of Directors which in turn submits it to the Board.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: Travelling FellowshipProvides financial assistance to palliative care professionals who accept invitations to teach for a period of one to two weeks in developing countries. Applicants must be willing and able to travel and have received an invitation from a sponsoring host organization. OTHER PROGRAM SERVICES 5: Faculty Development ProgramThe main objective of this program is to promote the development of palliative care in health care institutions by supporting faculty palliative care positions for nurses or physicians in developing countries. Through this program, IAHPC provides funding to pay for the cost of the salary of the physician/nurse for a period of five years, decreasing by 25% each year. Funding is contingent to the completion of set goals and outcome measures. A Board committee oversees the selection and monitoring of the programs. OTHER PROGRAM SERVICES 6: Access to Palliative Care Research InformationThis program provides access to IAHPC Members to the CINAHL (EBSCO) database. This database includes online full access to hundreds of peer-reviewed scientific journals, including palliative care journals and publications. Access is provided through an entry point using a log in and password.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.