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
SOUTHERN HEALTH COMMISSION INC
Employer identification number
64-0839646
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.") ....
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—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.") .
168,846
234,853
283,306
270,653
128,827
1,086,485
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......
4,800
4,675
4,383
13,858
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
1,543,722
1,537,598
1,636,207
1,582,869
1,621,451
7,921,847
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.
1,712,568
1,772,451
1,924,313
1,858,197
1,754,661
9,022,190
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.)
9,022,190
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...
1,712,568
1,772,451
1,924,313
1,858,197
1,754,661
9,022,190
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.).
1,712,568
1,772,451
1,924,313
1,858,197
1,754,661
9,022,190
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
100.000 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
100.000 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0 %
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:
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
2011
Open to Public Inspection
Name of the organization
SOUTHERN HEALTH COMMISSION INC
Employer identification number
64-0839646
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
OUR MISSION IS TO PROVIDE PARTICIPANTS/CLIENTS WITH PREVENTION AND HEALTH DISPARITIES INFORMATION. WE ALSO FUNCTION AS A RESOURCE CENTER FOR HIV AIDS AND OTHER HEALTH DISPARITIES AS WELL AS PROVIDE DIRECT SERVICES IN TERMS OF MORAL AND FINANCIAL SUPPORT. OBESITY, HEART DISEASE & STROKE, HIV/AIDS AND HYPERTENSION IS THREATENING THE SURVIVAL OF YOUNG AFRICAN- AMERICANS. SOUTHERN HEALTH COMMISSION HAS FIVE CORE OBJECTIVES (1) TO EDUCATE THE SOUTHEASTERN REGION ABOUT HIV/AIDS. (2) TO PROVIDE MATERIALS AND TRAINING TO THE COMMUNITY REGARDING OBESITY, HEART DISEASE, STROKE AND HIV/AIDS. (3) TO CONDUCT STRUCTURED HEALTH DISPARITIES WORKSHOPS IN THE COMMUNITY (4) TO ASSIST THE COMMUNITY WITH STRATEGIES TO CHANGE OR MODIFY COMMUNITY NORMS/BEHAVIORS AS THEY RELATE TO HEALTH DISPARITIES. (5) EMERGENCY ASSISTANCE AND REFERRALS FOR HOUSING, UTILITIES, MEDICINE, TRANSPORTATION, AND OTHER SERVICES AS WELL AS A FOOD PANTRY AND CLOTHES CLOSET.
ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURN
FORM 990, PAGE 2, PART III, LINE 2
THE ORGANIZATION CHANGED ITS NAME FROM SOUTHERN AIDS COMMISSION, INC TO SOUTHERN HEALTH COMMISSION, INC ON AUGUST 21, 2011, PROGRAM SERVICES HAVE BEEN EXPANDED TO INCLUDE HEALTH DISPARITIES SUCH AS OBESITY, HYPERTENSION, HEART DISEASE, AND STROKES.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
BUILD MOTIVATION AND SKILLS TO REDUCE THEIR RISKS, AND RECEIVE FEEDBACK FROM OTHERS. NIA SESSIONS ARE NOT CLASSES, LECTURES, OR FORUMS. THEY ARE INTERACTIVE MEETINGS THAT HAVE BOTH AN EDUCATIONAL AND AN ENTERTAINING ASPECT. IN ADDITION, NIA USES FACTORS, SUCH AS GIVING RESPECT, AND MAINTAINING SEXUAL PLEASURE WHILE REDUCING RISK, TO REINFORCE PROCEDURES FOR RISK REDUCTION. NIA IS BASED ON THE IDEA THAT MEN WITH A PURPOSE CAN TAKE CONTROL OF THEIR PERSONAL RISK-TAKING BEHAVIORS AND HELP SOLVE THE PROBLEM OF HIV INFECTION IN THEIR COMMUNITY.
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
PEERS AS WELL AS THEMSELVES ON BEHAVIOR, SOCIAL AND ECONOMICS FACTORS THAT CONTRIBUTE TO THE SPREADING OF THE HIV/AIDS VIRUS.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
MISSISSIPPI DELTA HEALTH IMPROVEMENT INITIATIVE (MDHI) 21,990 --------------------------------------------------------------- THIS GRANT IS FUNDED BY A GRANT FROM THE MISSISSIPPI STATE DEPARTMENT OF HEALTH. THIS PROGRAM IS TO PROVIDE SUPPORT, TRAINING, AND TECHNICAL ASSISTANCE TO WASHINGTON AND SUNFLOWER COUNTY AFRICAN-AMERICAN COMMUNITY MEMBERS IN ADDRESSING THE POOR HEALTH OUTCOMES AROUND NUTRITION, PHYSICAL ACTIVITIES, HIGH BLOOD PRESSURE,AND OBESITY WITHIN THE COMMUNITY. SOCIAL MARKETING CAMPAIGN (SMCP) 27,239 ----------------------------------------- THIS PROGRAM IS FUNDED BY A GRANT FROM THE MISSISSIPPI STATE DEPARTMENT OF HEALTH. THIS PROGRAM WAS DEVELOPED TO EXAMINE THE SOCIAL AND CULTURAL CONTEXT OF HIV TRANSMISSION AND PREVENTION WITHIN THE VARIOUS RATIONAL, GEOGRAPHIC COMMUNITIES IN WASHINGTON COUNTY, MISSISSIPPI SAVVY WOMEN 54,670 ------------------- THIS PROGRAM IS FUNDED PRIMARILY FROM CONTRIBUTIONS FROM BINGO OPERATIONS. THIS PROGRAM STARTED AT THE CONCLUSION OF THE SISTA PROJECTS TO OFFER CONTINUED SUPPORT FOR THE WOMEN WHO PARTICIPATED IN THE SISTA PROGRAM.
POLICIES AND PROCEDURES GOVERNING CHAPTERS
FORM 990, PAGE 6, PART VI, LINE 10B
THE MAIN OFFICE IS LOCATED IN GREENVILLE, MS AND THERE IS A BRANCH OFFICE LOCATED IN JACKSON, MS. ALL ACTIVITIES ARE ADMINISTERED OUT OF THE GREENVILLE, MS OFFICE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF THE 990 BEING FILED ALONG WITH A COPY OF THE ANNUAL INDEPENDENT AUDIT REPORT AND THE ANNUAL REPORTING TO THE MISSISSIPPI SECRETARY OF STATE ARE MAILED TO EACH DIRECTOR PRIOR TO FILING THIS RETURN.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
COMPENSATION IS DETERMINED BY BOARD OF DIRECTORS
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
COMPENSATION IS DETERMINED BY BOARD OF DIRECTORS
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE GENERAL PUBLIC MAY REQUEST COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AT THE CHARITY'S OFFICE LOCATED AT 220 S BROADWAY ST; GREENVILLE, MS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.