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
ADVOCATES FOR A HEALTHY COMMUNITY INC
Employer identification number
43-1602701
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.") ....
3,033,924
5,031,511
10,069,255
6,969,915
3,935,735
29,040,340
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..
3,033,924
5,031,511
10,069,255
6,969,915
3,935,735
29,040,340
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.
29,040,340
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..
3,033,924
5,031,511
10,069,255
6,969,915
3,935,735
29,040,340
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
126,008
164,655
66,183
72,441
70,718
500,005
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).
29,540,345
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
52,056,289
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
98.307 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
98.259 %
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 (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
ADVOCATES FOR A HEALTHY COMMUNITY INC
Employer identification number
43-1602701
Identifier
Return Reference
Explanation
ORGANIZATION MISSION
FORM 990, PART III, LINE 1
ADVOCATES FOR A HEALTHY COMMUNITY, INC. EXISTS TO PROVIDE COMPREHENSIVE PRIMARY HEALTHCARE SERVICES, AND TO IMPROVE THE HEALTH OF OUR COMMUNITY BY PROVIDING THE HIGHEST QUALITY PHYSICAL, DENTAL AND MENTAL HEALTH CARE SERVICES TO SPRINGFIELD, MISSOURI, AND THE SURROUNDING AREAS. BY PROVIDING PEOPLE A MEDICAL HOME, WE CAN MORE EFFECTIVELY IMPROVE THE HEALTH OF OUR PATIENTS AND THE COMMUNITY. A MEDICAL HOME PROVIDES A MULTITUDE OF HEALTH SERVICES WITHIN ONE CENTRALIZED LOCATION. IT'S A ONE-STOP-SHOP FOR HEALTHCARE THAT WORKS WITH PATIENTS TO IMPROVE HEALTH OUTCOMES. A MEDICAL HOME ALLOWS QUICK, CONVENIENT ACCESS TO THE CARE THEY NEED. WE HOLD IN HIGH REGARD OUR FIVE CORE VALUES: *TO ASSURE YOU OF A CLEAN AND COMFORTABLE ENVIRONMENT *TO PROMOTE DIVERSITY AND RESPECT FOR ALL HUMAN DIFFERENCES *TO PROVIDE PROMPT, FRIENDLY AND COURTEOUS SERVICE BY A KNOWLEDGEABLE, HIGHLY TRAINED AND COMPASSIONATE STAFF *TO RESPOND IN A RAPID, SENSITIVE AND NON-CONFRONTATIONAL MANNER THAT WILL ENHANCE YOUR HEALTHCARE EXPERIENCE *TO PARTNER WITH AND EMPOWER YOU TO TAKE AN ACTIVE ROLE TO IMPROVE YOUR HEALTH.
PROGRAM SERVICE DETAIL
FORM 990, PART III, LINES 4A-B
MEDICAL SERVICES: MEDICAL PROGRAM SERVICES INCLUDE: FAMILY MEDICINE, PEDIATRIC CARE, INTERNAL MEDICINE, GERIATRIC CARE, PRIMARY & PREVENTIVE HEALTH, IMMUNIZATIONS, CHRONIC DISEASE MANAGEMENT, GYNECOLOGY/WOMEN'S HEALTH (INCLUDING SHOW ME HEALTHY WOMEN), PRENATAL CARE, IN-PATIENT SERVICES FOR NEWBORNS, NURSERY CARE, OUTPATIENT PROCEDURES (CIRCUMCISIONS, COLPOSCOPY, SPIROMETRY, ENDOMETRIAL BIOPSY, EKG & STRESS TESTING, IMPLANON, VASECTOMY, MINOR SKIN PROCEDURES, JOINT INJECTIONS.), DIABETES EDUCATION, DIETARY COUNSELING, WEIGHT MANAGEMENT SUPPORT, IN-SCHOOL PRIMARY CARE, LAB SERVICES, X-RAY AND OPTOMETRY. DENTAL: DENTAL PROGRAM SERVICES INCLUDE: GENERAL DENTISTRY, PEDIATRIC DENTISTRY, ORAL HYGIENE, URGENT DENTAL CARE, ORAL SURGERY, DENTURES AND PARTIALS, MOBILE DENTAL CARE AND IN-SCHOOL PREVENTIVE SERVICES.
SIGNIFICANT CHANGES TO BYLAWS
FORM 990, PART VI, SECTION A, LINE 4
DURING FISCAL YEAR 2011, THE BOARD OF DIRECTORS AMENDED THE ORGANIZATION'S BYLAWS TO INCLUDE OR EXLUDE THE FOLLOWING DUTIES AND QUALIFICATIONS: THE BOARD OF DIRECTORS IS NOW RESPONSIBLE FOR HIRING, SUPERVISING, AND DISMISSING A COMPLIANCE OFFICER. NO LONGER WILL A POTENTIAL DIRECTOR BE DISQUALIFIED TO SERVE ON THE BOARD DUE TO THE FACT THEY DO NOT REPRESENT THE RACE, SEX, AGE, OR ECONOMIC STATUS OF THE INDIVIDUALS ASSISTED BY THE ORGANIZATION. NO LONGER WILL EMPLOYEES OR EMPLOYEES' FAMILY MEMBERS BE PROHIBITED FROM SERVING AS A DIRECTOR.
990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. PRIOR TO FILING, A DRAFT OF THE 990 IS FIRST REVIEWED BY SENIOR MANAGEMENT. AFTER ANY CHANGES ARE MADE, A FINAL DRAFT IS PRESENTED BY THE CFO TO THE BOARD OF DIRECTORS AT A MONTHLY BOARD MEETING.
CONFLICT OF INTEREST POLICY REVIEW
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS EVALUATED WITH ALL EMPLOYEES UPON HIRE AND ON A YEARLY BASIS WITH ALL EMPLOYEES AND BOARD MEMBERS IN CONJUNCTION WITH CORPORATE COMPLIANCE TRAINING. A COPY OF THE CONFLICT OF INTEREST STATEMENT SHALL BE PROVIDED ANNUALLY TO EACH DIRECTOR AND OFFICER TO SIGN FOR THE PURPOSE OF IDENTIFYING POTENTIAL CONFLICTS OF INTEREST. A CONFLICT OF INTEREST SHALL BE CONSIDERED TO ARISE WHEN ANY MATTER UNDER CONSIDERATION BY THE BOARD OF DIRECTORS INVOLVES THE POTENTIAL FOR A SIGNIFICANT OR MATERIAL BENEFIT; OR A COMPENSATION ARRANGEMENT EXISTS TO A DIRECTOR OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY TO ANY BUSINESS, FINANCIAL, OR PROFESSIONAL ORGANIZATION OF WHICH THE DIRECTOR OR ANY MEMBER OF HIS OR HER IMMEDIATE FAMILY IS AN OFFICER, DIRECTOR, MEMBER, OWNER, OR EMPLOYEE WHENEVER ANY MATTER COMES BEFORE THE BOARD OF DIRECTORS WHICH ANY DIRECTOR RECOGNIZES MAY GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OF DIRECTORS SHALL NOT APPROVE ANY ACTION OR TRANSACTION BEARING UPON THE CONFLICT UNLESS THE FOLLOWING PROCEDURES ARE OBSERVED: A) THE AFFECTED DIRECTOR OR OTHER DIRECTOR(S) SHALL MAKE KNOWN THAT A CONFLICT EXISTS AND THE AFFECTED DIRECTOR SHALL WITHDRAW FROM THE MEETING FOR AS LONG AS THE MATTER REMAINS UNDER CONSIDERATION. SHOULD THE MATTER BE BROUGHT TO A VOTE OF THE DIRECTORS, THE AFFECTED DIRECTOR SHALL NEITHER BE PRESENT NOR CAST A VOTE. B) IF THE WITHDRAWAL OF THE AFFECTED DIRECTOR RESULTS IN THE ABSENCE OF A QUORUM, NO ACTION SHALL BE TAKEN ON THE MATTER UNTIL A QUORUM OF DISINTERESTED DIRECTORS IS PRESENT. C) IF A) AND B) DO NOT OCCUR, THE BOARD OF DIRECTORS SHALL NOT GO FORWARD WITH A TRANSACTION OR ARRANGEMENT IN WHICH AN AFFECTED DIRECTOR ACKNOWLEDGES THAT A CONFLICT OF INTEREST EXISTS, OR OTHER DIRECTORS DETERMINE THAT A CONFLICT OF INTEREST EXISTS.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINE 15A
ANNUALLY, THE CHIEF EXECUTIVE OFFICER'S COMPENSATION IS EVALUATED AND VOTED ON BY THE BOARD OF DIRECTORS AFTER REVIEWING PERFORMANCE AND COMPARABILITY DATA OF CEO'S/EXECUTIVE DIRECTORS AT LIKE HEALTH CARE FACILITIES. THE OCCURRENCE OF THIS REVIEW IS DOCUMENTED IN THE EXECUTIVE COMMITTEE BOARD MINUTES.
DOCUMENT DISCLOSURE
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST POLICY AND AUDITED FINANCIAL STATEMENTS, ARE AVAILABLE BY WRITTEN REQUEST AND MAY BE VIEWED AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE.
OFFICERS
FORM 990, PART VII
JENNIFER BUEHLER HELD THE POSITION OF VP OF ADMINISTRATION AFFAIRS BEGINNING 8/2010 THROUGH 5/2011.
FORMER KEY EMPLOYEE
FORM 990, PART VII
DURING THE FISCAL YEAR 2011, DR. CHAN REYES TOOK A LEAVE OF ABSENCE WHICH CAUSED HER REPORTABLE COMPENSATION TO DROP BELOW THE $150,000 THRESHOLD IN DETERMINING A KEY EMPLOYEE. SINCE DR. REYES REPORTABLE COMPENSATION WAS GREATER THAN $100,000 AND SHE WAS REPORTED AS A KEY EMPLOYEE ON AT LEAST ONE OF THE LAST FIVE PRIOR YEAR FORM 990'S SHE HAS BEEN MARKED FORMER ON THE CURRENT YEAR FORM 990.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.