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
MORTON COMPREHENSIVE HEALTH SERVICES INC
Employer identification number
73-1177858
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.") .
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:
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
MORTON COMPREHENSIVE HEALTH SERVICES INC
Employer identification number
73-1177858
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART I, LINE 1
WE HAVE BEEN PROVIDING PREMIUM MEDICAL HEALTH CARE TO THE COMMUNITY SINCE 1921. AS A FEDERALLY QUALIFIED HEALTH CENTER WE SERVE FULLY INSURED, MEDICARE AND MEDICAID PATIENTS, ALONG WITH THE UNINSURED, HIGH-RISK, AND SUSCEPTIBLE POPULATION OF NORTHEASTERN OKLAHOMA. OUR MISSION IS TO SAVE LIVES THROUGH QUALITY HEALTH CARE.
PROGRAM SERVICES
FORM 990, PART III, LINE 4D
THE ORGANIZATION PROVIDES NUMEROUS OTHER SERVICES TO ITS PATIENTS INCLUDING: -WOMEN'S HEALTH CARE INCLUDING OBSTETRICS AND GYNECOLOGY -LABORATORY AND RADIOLOGY SERVICES -PHARMACY -OPTOMETRY -NUTRITION COUNSELING -COMPLETE PHYSICAL EXAMINATIONS AND IMMUNIZATIONS -TREATMENT OF FLU AS WELL AS BROKEN BONES, SPRAINS AND OTHER INJURIES -COMMUNITY, HEALTH EDUCATION, AND OUTREACH -TRANSPORTATION
IRS FILING - 1098-C
FORM 990, PART V, LINE 7H
DURING THE FISCAL YEAR, THE ORGANIZATION RECEIVED VEHICLE DONATIONS FROM A GOVERNMENT ENTITY. AS THE VEHICLE DONATIONS WERE GOVERNMENT SPONSORED, 1098-C'S WERE NOT REQUIRED TO BE FURNISHED.
REVIEW PROCESS OF THE FORM 990
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. THE ORGANIZATION'S CEO, CFO, AND CONTROLLER REVIEW THE FORM 990 IN DETAIL. THEN, A COPY WILL BE PROVIDED TO THE FULL BOARD PRIOR TO FILING.
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
EACH DIRECTOR OF THE ORGANIZATION MUST PLEDGE HIS OR HER LOYALTY TO THE CORPORATION AND ACKNOWLEDGE THAT HIS OR HER PERSONAL INTERESTS CANNOT BE FURTHERED AT THE EXPENSE OF THE CORPORATION. AT THE BEGINNING OF EACH TERM OF OFFICE, DIRECTORS WILL PROVIDE THE PRESIDENT AND THE CEO WITH WRITTEN NOTIFICATION OF EVERY DIRECT OR INDIRECT FINANCIAL INTEREST HE OR SHE MAY HAVE WITH ANY ENTITY IN THE HEALTH CARE SYSTEM OR ANY ENTITY WITH WHICH THE CORPORATION PRESENTLY HAS A BUSINESS RELATIONSHIP. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER PERSONAL OR FINANCIAL INTEREST TO THE BOARD AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING A PROPOSED TRANSACTION OR ARRANGEMENT. NO PERSON SHALL PROVIDE ANY GOODS, EQUIPMENT, OR SUPPLIES TO THE CORPORATION WHO HAS AN IMMEDIATE FAMILY MEMBER EMPLOYED BY THE CORPORATION. NO DIRECTOR, OFFICER OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ATTEMPT TO INFLUENCE OR PROMOTE A TRANSACTION OR OTHER BUSINESS ARRANGEMENT BETWEEN THE CORPORATION AND AN ENTITY WITH WHICH THE DIRECTOR, OFFICER OR COMMITTEE MEMBER IS AN INTERESTED PERSON. NO OFFICER OR BOARD MEMBER WILL INFLUENCE MANAGEMENT OR PROMOTE EMPLOYMENT FOR ANYONE WITH WHOM HE OR SHE IS HAVING AN EMPLOYMENT RELATIONSHIP WHETHER AS EMPLOYEE, CONSULTANT, PARTNER, OR A CANDIDATE FOR EMPLOYMENT SEEKING ACTIVE EMPLOYMENT OR BUSINESS ENGAGEMENT WITH THE CORPORATION. KNOWLEDGE OF THIS TYPE OF EMPLOYMENT INTEREST THAT COULD CREATE DIVIDED LOYALTY, OR THE APPEARANCE THEREOF, MUST BE DISCLOSED TO THE ENTIRE BOARD. IMMEDIATELY UPON EXPIRATION OF TERM OR RESIGNATION FROM THE BOARD, A FORMER BOARD MEMBER CONSIDERING EMPLOYMENT WITH THE CORPORATION MUST WAIT AT LEAST ONE (1) YEAR TO APPLY FOR EMPLOYMENT WITH THE CORPORATION, AND CONVERSELY, ANY EMPLOYEE OF THE CORPORATION INTERESTED IN SERVING AS A DIRECTOR OF THE CORPORATION MUST BE OFF OF THE CORPORATION'S PAYROLL FOR AT LEAST ONE (1) YEAR. COMPLETION OF SUCH WAITING PERIODS SHALL BE A REQUIRED QUALIFICATION FOR SUCH PERSON(S) SUBSEQUENT APPROVAL/HIRING AS A DIRECTOR OR EMPLOYEE OF THE CORPORATION, AS APPLICABLE. NO EMPLOYEE, AGENT, OR DIRECTOR SHALL PARTICIPATE DIRECTLY OR INDIRECTLY IN THE SELECTION, AWARD OR ADMINISTRATION OF ANY CONTRACT SHOULD A CONFLICT, REAL OR APPARENT BECOME EVIDENT. A CONFLICT WILL ARISE WHEN A FINANCIAL OR OTHER INTEREST IN A VENDOR OR FIRM SELECTED, INVOLVES AN EMPLOYEE, OFFICER OR AGENT OF THE CORPORATION IN SECURING THE AWARD, OR ANY ONE RELATED BY THIRD DEGREE CONSANGUINITY OR MARRIAGE, OR ANY BUSINESS PARTNER AND/OR ORGANIZATION WHICH EMPLOYS ANY OF THE ABOVE DESCRIBED INDIVIDUALS OR INSTITUTIONS. WHENEVER A CONFLICT OF INTEREST IS FOUND TO EXIST WITH RESPECT TO ANY DIRECTOR, SUCH DIRECTOR SHALL ABSTAIN FROM VOTING ON SUCH MATTER. FOR THE PURPOSES OF OBTAINING A QUORUM FOR THE CONDUCT OF BUSINESS REGARDING SUCH ISSUES BEFORE THE BOARD, NO DIRECTOR WITH THE AFOREMENTIONED TYPE OF INTEREST SHALL BE COUNTED AMONG BOARD MEMBERS PRESENT AND ELIGIBLE TO VOTE ON THE PARTICULAR ISSUE. AFTER DISCOVERY OR DISCLOSURE OF ANY INTERESTED PERSON SERVING ON THE BOARD OR A COMMITTEE, THE INTERESTED PERSON SHALL LEAVE ANY BOARD OR COMMITTEE MEETING IN WHICH THE RELEVANT ARRANGEMENT OR TRANSACTION IS DISCUSSED, INVESTIGATED AND VOTED UPON. THE DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF THE DISINTERESTED MEMBERS DETERMINE A CONFLICT OF INTEREST EXISTS, THEY MUST PROCEED IN A MANNER CONSISTENT WITH THE BEST INTERESTS OF THE CORPORATION. POTENTIAL PROCEDURES TO ADDRESS THE CONFLICT OF INTEREST MAY INCLUDE, BUT NOT NECESSARILY BE LIMITED TO, THE FOLLOWING: THE PRESIDENT OR A COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS PRESENT AT ANY REGULAR OR SPECIAL MEETING CALLED FOR THAT PURPOSE, AS APPLICABLE, WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTERESTS OF THE CORPORATION AND FOR ITS SOLE BENEFIT, WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, OR BELIEVES THAT AN INTERESTED PERSON HAS IMPROPERLY ATTEMPTED TO INFLUENCE A TRANSACTION OR ARRANGEMENT, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND ALLOW THE MEMBER AN OPPORTUNITY TO EXPLAIN SUCH ACTS OR OMISSIONS. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, OR DETERMINES THAT AN INTERESTED PERSON HAS IMPROPERLY ATTEMPTED TO INFLUENCE A TRANSACTION OR ARRANGEMENT, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, INCLUDING, BUT NOT LIMITED TO, TERMINATION OF MEMBERSHIP. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN THE FOLLOWING: THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO BE INTERESTED PERSONS IN CONNECTION WITH ANY POTENTIAL TRANSACTION OR ARRANGEMENT, THE NATURE OF THE PERSONAL OR FINANCIAL INTEREST, AND ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH.
EXECUTIVE COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15A
THE EXECUTIVE BOARD OF MORTON COMPREHENSIVE HEALTH SERVICES REVIEWS THE CEO SALARY ANNUALLY BASED ON THE HEALTH CENTER COMPENSATION & BENEFITS REPORT SET, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND HOSPITAL & HEALTHCARE COMPENSATION SERVICES, ALONG WITH PERFORMANCE MEASURES SET BY THE FULL BOARD. THIS REVIEW WAS COMPLETED IN MARCH 2012.
DOCUMENT DISCLOSURE
FORM 990, PART VI, SECTION C, LINE 19
BOARD BYLAWS, ARTICLES OF INCORPORATION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE DISCUSSED IN AN OPEN BOARD OF DIRECTORS MEETING THE FOURTH TUESDAY OF EVERY MONTH. THIS NOTICE IS POSTED BY CITY AND COUNTY COURT CLERKS FOR PUBLIC NOTICE PER THE OPENING MEETINGS ACT MONTHLY.
OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
$ 1,059 UNREALIZED GAIN ON INVESTMENTS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.