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
CMAP EXPRESS
Employer identification number
02-0751416
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
RAPIDES FOUNDATION
720723603
3
Yes
Yes
Yes
0
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
0 %
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.") .
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
0 %
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
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:
11000218
Software Version:
2011.0.0
-
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
CMAP EXPRESS
Employer identification number
02-0751416
Identifier
Return Reference
Explanation
Form 990 Part I
1
also promote other preventive health practices among residents with limited incomes. In 2011 CMAP helped approximately 4,000 patients get 13 million in needed medications. Additionally, CMAP assisted 386 individuals gain access to free medical screenings for breast, colorectal and cervical cancers. CMAPs activities as described are carried out for the benefit of its supported organization, The Rapides Foundation.
Form 990 Part III
1
incomes. In 2011 CMAP helped approximately 4,000 patients get 13 million in needed medications. Additionally, CMAP assisted 386 individuals gain access to free medical screenings for breast, colorectal and cervical cancers. Core Form, Part III, Line 4. Describe the exempt purpose achievements for each of the organizations three largest program services by expenses.
Form 990 Part III
4d
In 2011, in support of its supported organizations The Rapides Foundation Cancer Screening Initiative, CMAPs Cancer Screening Project gave free mammograms, Pap smears, pelvic exams and colorectal cancer tests to uninsured patients who couldnt afford these critical screenings. Its cancer screening van brought these tests to rural areas. The van, which is a partnership between The Rapides Foundation, CMAP, the Feist-Weiller Cancer Center at LSU-Shreveport and the LSU Family Medicine Residency in Alexandria program, saw more than 386 patients in 2011. The mobile van unit completed 139 Pap smears, 182 pelvic exams, 343 mammograms, and 144 clinical diagnostic breast exams. Also, more than 200 women and men received take-home colorectal cancer screening tests.
Form 990 Part III
4d
The CMAP Patient Assistance Program Specialists bring The Rapides Foundations Tobacco Prevention and Control initiative into the same physician offices they support for medication access. By providing training and materials to physicians and their staff about smoking cessation referral resources, the Specialists made it easy for doctors to encourage their patients to stop smoking.
Form 990 Part III
4d
In 2011 CMAP implemented a Healthy Lifestyles program. The Program provides demonstration and education on proper nutrition and physical activity for good health and is designed to fight obesity in Central Louisiana. The goal of this program, through physician referral, community tools, and workplace education, is to provide Central Louisiana residents with resources to lead healthy lifestyles. This program is coordinated by a registered and licensed dietitian.
Form 990 Part III
4d
CMAP Extra, a prescription-savings program designed to help lower families medication costs, is available to everyone regardless of age or income. During 2011, 7,323 individuals were enrolled in the program and 5,243 prescriptions were filled, for a total savings of 230,214.
Form 990 Part VI
11b
A final copy of the CMAP Form 990 is furnished to the Audit Committee of The Rapides Foundation Board TRF, CMAPs supported organization, for review and approval, and a meeting is held to discuss the Form 990 in detail. The meeting is attended by staff that assisted in compiling the form, as well as, representatives of the external accounting firm who compiled the form. All TRF and CMAP Board members receive the final Form 990 copy when it is sent to the Audit Committee, and all Board members are invited to attend the Audit Committee meeting to review the Form in detail if they so choose.
Form 990 Part VI
12c
The Rapides Foundation, CMAPs supported organization, has both a Staff Code of Ethics and Conduct and a Trustee Code of Ethics and Conduct, both of which define and describe actions to be taken in the event of conflicts of interest. CMAP operates under Rapides Foundation policies and procedures. The Staff Code of Ethics and Conduct is monitored and enforced through organizational procedures, controls and daily supervision of employees by the next level of management. The Trustee Code of Ethics and Conduct is monitored at each board meeting, because the first agenda item is one in which board members are asked to disclose any potential conflicts with listed agenda items. A member that has a potential conflict of interest with a matter that comes before the board or committee is required to leave the room before the matter is discussed, and a majority vote of the remaining disinterested board members determine whether a conflict actually exists. If a conflict is determined to exist, then the conflicted member is not allowed to be present during board discussion and vote on the issue creating the conflict. Each year, board members and key employees are required to complete a conflict of interest questionnaire to disclose business and personal relationships that could be potential conflicts of interests.
Form 990 Part VI
15a-15b
The Rapides Foundations CMAPs supported organization Board Compensation Committee, which is composed of the independent members of its Executive Committee, engages a third-party compensation consultant to provide market information concerning pay and benefits and make compensation structure recommendations for all Rapides Foundation positions as well as positions for its supporting organizations. The consultant is provided with job descriptions for all job positions. The consultant then compares those jobs with similar positions at similar types and sizes of organizations. The consultant meets with the Compensation Committee and provides the comparison data, along with their recommendations for pay ranges for each position minimum, midpoint, maximum. Recommendations are based upon market averages of similar types and sizes of organizations. The CEO and two directors of the Rapides Foundation are considered key employees. The CEO recommends the pay for the two directors and a salary budget for the remaining employees of the Rapides Foundation and its supporting organizations to the Compensation Committee for approval. The consultant meets with the Comensation Committee independently to discuss recommendations for CEO pay.
Form 990 Part VI
19
The Rapides Foundation, CMAPs supported organization, makes its Staff Code of Ethics and Conduct, Trustee Code of Ethics and Conduct, and Annual Report including financial statements available on its website at www.rapidesfoundation.org. The CMAP website links to the Rapides Foundation website.
Form 990 Part I Section 1 Line 1 also promote other preventive health practices among residents with limited incomes. In 2011 CMAP helped approximately 4,000 patients get 13 million in needed medications. Additionally, CMAP assisted 386 individuals gain access to free medical screenings for breast, colorectal and cervical cancers. CMAPs activities as described are carried out for the benefit of its supported organization, The Rapides Foundation. Form 990 Part III Line 1 incomes. In 2011 CMAP helped approximately 4,000 patients get 13 million in needed medications. Additionally, CMAP assisted 386 individuals gain access to free medical screenings for breast, colorectal and cervical cancers. Core Form, Part III, Line 4. Describe the exempt purpose achievements for each of the organizations three largest program services by expenses. Form 990 Part III Line 4d In 2011, in support of its supported organizations The Rapides Foundation Cancer Screening Initiative, CMAPs Cancer Screening Project gave free mammograms, Pap smears, pelvic exams and colorectal cancer tests to uninsured patients who couldnt afford these critical screenings. Its cancer screening van brought these tests to rural areas. The van, which is a partnership between The Rapides Foundation, CMAP, the Feist-Weiller Cancer Center at LSU-Shreveport and the LSU Family Medicine Residency in Alexandria program, saw more than 386 patients in 2011. The mobile van unit completed 139 Pap smears, 182 pelvic exams, 343 mammograms, and 144 clinical diagnostic breast exams. Also, more than 200 women and men received take-home colorectal cancer screening tests. Form 990 Part III Line 4d The CMAP Patient Assistance Program Specialists bring The Rapides Foundations Tobacco Prevention and Control initiative into the same physician offices they support for medication access. By providing training and materials to physicians and their staff about smoking cessation referral resources, the Specialists made it easy for doctors to encourage their patients to stop smoking. Form 990 Part III Line 4d In 2011 CMAP implemented a Healthy Lifestyles program. The Program provides demonstration and education on proper nutrition and physical activity for good health and is designed to fight obesity in Central Louisiana. The goal of this program, through physician referral, community tools, and workplace education, is to provide Central Louisiana residents with resources to lead healthy lifestyles. This program is coordinated by a registered and licensed dietitian. Form 990 Part III Line 4d CMAP Extra, a prescription-savings program designed to help lower families medication costs, is available to everyone regardless of age or income. During 2011, 7,323 individuals were enrolled in the program and 5,243 prescriptions were filled, for a total savings of 230,214. Form 990 Part VI Line 11b A final copy of the CMAP Form 990 is furnished to the Audit Committee of The Rapides Foundation Board TRF, CMAPs supported organization, for review and approval, and a meeting is held to discuss the Form 990 in detail. The meeting is attended by staff that assisted in compiling the form, as well as, representatives of the external accounting firm who compiled the form. All TRF and CMAP Board members receive the final Form 990 copy when it is sent to the Audit Committee, and all Board members are invited to attend the Audit Committee meeting to review the Form in detail if they so choose. Form 990 Part VI Line 12c The Rapides Foundation, CMAPs supported organization, has both a Staff Code of Ethics and Conduct and a Trustee Code of Ethics and Conduct, both of which define and describe actions to be taken in the event of conflicts of interest. CMAP operates under Rapides Foundation policies and procedures. The Staff Code of Ethics and Conduct is monitored and enforced through organizational procedures, controls and daily supervision of employees by the next level of management. The Trustee Code of Ethics and Conduct is monitored at each board meeting, because the first agenda item is one in which board members are asked to disclose any potential conflicts with listed agenda items. A member that has a potential conflict of interest with a matter that comes before the board or committee is required to leave the room before the matter is discussed, and a majority vote of the remaining disinterested board members determine whether a conflict actually exists. If a conflict is determined to exist, then the conflicted member is not allowed to be present during board discussion and vote on the issue creating the conflict. Each year, board members and key employees are required to complete a conflict of interest questionnaire to disclose business and personal relationships that could be potential conflicts of interests. Form 990 Part VI Line 15a-15b The Rapides Foundations CMAPs supported organization Board Compensation Committee, which is composed of the independent members of its Executive Committee, engages a third-party compensation consultant to provide market information concerning pay and benefits and make compensation structure recommendations for all Rapides Foundation positions as well as positions for its supporting organizations. The consultant is provided with job descriptions for all job positions. The consultant then compares those jobs with similar positions at similar types and sizes of organizations. The consultant meets with the Compensation Committee and provides the comparison data, along with their recommendations for pay ranges for each position minimum, midpoint, maximum. Recommendations are based upon market averages of similar types and sizes of organizations. The CEO and two directors of the Rapides Foundation are considered key employees. The CEO recommends the pay for the two directors and a salary budget for the remaining employees of the Rapides Foundation and its supporting organizations to the Compensation Committee for approval. The consultant meets with the Comensation Committee independently to discuss recommendations for CEO pay. Form 990 Part VI Line 19 The Rapides Foundation, CMAPs supported organization, makes its Staff Code of Ethics and Conduct, Trustee Code of Ethics and Conduct, and Annual Report including financial statements available on its website at www.rapidesfoundation.org. The CMAP website links to the Rapides Foundation website.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.