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
UNITY HEALTH CARE INC
Employer identification number
52-1572431
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.") .
45,054,194
51,111,755
51,357,071
4,271,795
24,284,725
176,079,540
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......
31,308,703
36,001,913
34,009,082
82,550,213
75,760,017
259,629,928
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.
76,362,897
87,113,668
85,366,153
86,822,008
100,044,742
435,709,468
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.)
435,709,468
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...
76,362,897
87,113,668
85,366,153
86,822,008
100,044,742
435,709,468
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
587,222
841,550
49,991
29,159
32,794
1,540,716
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
587,222
841,550
49,991
29,159
32,794
1,540,716
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.)
238,614
58,961
326,266
289,860
356,229
1,269,930
13
Total support (Add lines 9, 10c, 11 and 12.).
77,188,733
88,014,179
85,742,410
87,141,027
100,433,765
438,520,114
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
99.359 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
99.130 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
0.351 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
0.470 %
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
UNITY HEALTH CARE INC
Employer identification number
52-1572431
Identifier
Return Reference
Explanation
FORM 990 REVIEWING
PART VI, SECTION B, LINE 11B
A MEETING IS SCHEDULED WITH THE CHIEF FINANCIAL OFFICER (CFO), CHIEF EXECUTIVE OFFICER (CEO) AND THE EXECUTIVE COMMITTEE OF THE BOARD TO REVIEW THE FORM 990 BEFORE IT IS FILED WITH THE IRS. AT THE MEETING, THE CFO CONDUCTS A DETAILED REVIEW OF THE FORM 990 AND ANSWERS ANY QUESTIONS ASKED.
CONFLICT OF INTEREST MONITORING
PART VI, SECITON B, LINE 12C
UNITY HEALTH CARE INC. REGULARLY AND CONSISTENTLY MONITORS AND ENFORCE COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY THROUGH EDUCATION, DISCLOSURE AND INVESTIGATION IN ACCORDANCE WITH ITS CORPORATE COMPLIANCE PROGRAM. UNITY'S CONFLICT OF INTEREST POLICY IS ENCOMPASSED WITHIN ITS STANDARDS OF CONDUCT. THE STANDARDS OF CONDUCT ARE PART OF UNITY HEALTH CARE'S EMPLOYEE HANDBOOK. OFFICERS, DIRECTORS, BOARD MEMBERS, KEY EMPLOYEES AND NEW EMPLOYEES OF UNITY HEALTH CARE ARE TRAINED ON THE EXISTENCE OF THE CONFLICT OF INTEREST POLICY AS PART OF THEIR TRAINING ON UNITY HEALTH CARE'S STANDARDS OF CONDUCT. EMPLOYEES ARE ALSO TRAINED TO REFER ANY CONCERNS REGARDING A VIOLATION OF THE STANDARDS OF CONDUCT TO UNITY'S CORPORATE COMPLIANCE PROGRAM VIA THE CORPORATE COMPLIANCE HOTLINE OR OTHERWISE. AT THE TIME OF EACH EMPLOYEE'S ANNUAL PERFORMANCE VALUATION, THE EMPLOYEE IS REQUIRED TO SIGN AN ACKNOWLEDGMENT THAT HE/SHE IS AWARE OF THAT ANY POTENTIAL VIOLATION SHOULD BE REFERRED TO THE CORPORATE COMPLIANCE PROGRAM AND IS AGAIN INSTRUCTED ON HOW TO MAKE SUCH A REFERRAL. ON AN ANNUAL BASIS, UNITY HEALTH CARE REQUIRES OFFICERS, DIRECTORS, BOARD MEMBERS, KEY EMPLOYEES TO COMPLETE A DISCLOSURE FORM CONCERNING BOARD MEMBER CONFLICT OF INTEREST. IN THIS FORM, OFFICERS, DIRECTORS, BOARD MEMBERS, KEY EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST THAT EACH RESPECTIVE OFFICER, DIRECTOR, BOARD MEMBES, AND KEY EMPLOYEE (OR MEMBER OF A BOARD MEMBER'S IMMEDIATE FAMILY) WITH THE BOARD MEMBER'S DUTIES TO UNITY HEALTH CARE. THE DISCLOSURE FORM ALSO CONTAINS A CERTIFICATION THAT EACH BOARD MEMBER MUST COMPLETE. IF ANY CONFLICT OF INTEREST CONCERN ARISES AT UNITY HEALTH CARE REGARDING ANY DIRECTOR, BOARD MEMBER, KEY EMPLOYEE, THE CONCERN IS IMMEDIATELY REFERRED TO UNITY'S CORPORATE COMPLIANCE OFFICER AND INVESTIGATED. IF, UPON INVESTIGATION, IT IS DETERMINED THAT AN EMPLOYEE OR BOARD MEMBER HAS ENGAGED IN ACTIVITY THAT REPRESENTS A CONFLICT OF INTEREST THAT HAS NOT BE OTHERWISE DISCLOSED AND MANAGED BY THE ORGANIZATION, UNITY HEALTH CARE WILL TAKE ACTION AGAINST THE EMPLOYEE OR BOARD MEMBER UP TO AND INCLUDING TERMINATION FROM EMPLOYMENT OR REMOVAL FROM THE BOARD OF DIRECTORS, AS NECESSARY.
COMPENSATION DETERMINATION
PART VI, SECTION B, LINE 15
UNITY CONTRACTS WITH AN INDEPENDENT CONSULTANT WHO PERFORMS THE MARKET SURVEY/STUDY. UPON COMPLETION OF THE SURVEY/STUDY, THE ANALYSIS AND RECOMMENDATION IS PRESENTED TO THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS THEN DELIBERATE AND AGREE ON THE CEO'S COMPENSATION AND AN EMPLOYMENT CONTRACT IS DRAWN.
MAKING DOCUMENTS AVAILABLE
PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS
PART XI, LINE 5
INCREASE IN TEMPORARILY RESTRICTED ASSETS 383,131
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Franklyn Baker TITLE:CHAIR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Gelinda Allen TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Vivian Whitaker TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Althea Felder TITLE:SECRETARY HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Jacqueline Francis, MD TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Rochelle Archuleta TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Michael Crawford TITLE:TREASURER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Raphael Famakinwa TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Charlotte Williams TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Ann Wicker TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Louie Byrd TITLE:VICE CHAIR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Jim Moss TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Marlene Kelley, MD TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Connie Johnson TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Robert Ray TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Dr. Judy Walton TITLE:DIRECTOR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Kate Raftery TITLE:Director HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Vincent Keane TITLE:President & CEO HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Ardell Butler TITLE:CFO HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Alice Goetcheus TITLE:Chief Medical Officer HOURS: