Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 07-01-2011 and ending 06-30-2012
BCheck if applicable:
CName of organization
LEGACY COMMUNITY HEALTH SERVICES
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
PO BOX 66308
 
Room/suite
City or town, state or country, and ZIP + 4
HOUSTON, TX772666308
D Employer identification number

76-0009637
E Telephone number

G Gross receipts $ 38,192,954
F Name and address of principal officer:
KATHERINE CALDWELL
PO BOX 66308
HOUSTON,TX772666308
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.LEGACYCOMMUNITYHEALTH.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1982
M State of legal domicile: TX
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE EMPOWER OUR CLIENTS TO LEAD BETTER LIVES BY PROVIDING PREMIUM, COMPASSIONATE PRIMARY HEALTHCARE SERVICES TO A DIVERSE COMMUNITY WHO HAVE TRADITIONALLY FACED PROBLEMS ACCESSING QUALITY HEALTHCARE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 20
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 19
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 326
6 Total number of volunteers (estimate if necessary) .... 6 60
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b 0
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,767,372 11,426,659
9 Program service revenue (Part VIII, line 2g) ......... 17,540,848 26,684,766
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 0 -3,033
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -118,626 -335,361
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 29,189,594 37,773,031
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,139,110 2,765,403
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 15,619,109 19,075,692
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet1,387,287    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 7,423,770 12,462,865
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 27,181,989 34,303,960
19 Revenue less expenses. Subtract line 18 from line 12....... 2,007,605 3,469,071
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 18,382,984 20,038,977
21 Total liabilities (Part X, line 26)............. 4,244,578 3,398,761
22 Net assets or fund balances. Subtract line 21 from line 20..... 14,138,406 16,640,216
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: THE MISSION OF LEGACY COMMUNITY HEALTH SERVICES, INC. IS TO PROVIDE PREVENTATIVE AND PRIMARY HEALTH CARE AND SOCIAL SERVICES TO UNDERSERVED COMMUNITIES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 22,849,968 including grants of $   ) (Revenue $ 22,943,087 )
CLINICAL SERVICES - 35,224 PEOPLE SERVED LEGACY OFFERS AN AFFORDABLE MENU OF SERVICES FOR PRIMARY HEALTHCARE FOR ALL MEN, WOMEN, TRANSGENDERS, AND CHILDREN REGARDLESS OF YOUR FINANCIAL SITUATION. WE UNDERSTAND HOW IMPORTANT IT IS TO FEEL COMFORTABLE WITH YOUR DOCTOR - THAT'S WHY OUR STAFF IS OPEN-MINDED, WARM AND NON-JUDGMENTAL. WE'RE HERE TO RESPECT YOU AND MEET YOUR NEEDS. SEE SCHEDULE O FOR MORE INFORMATION.
4b (Code:   ) (Expenses $ 3,364,925 including grants of $ 2,765,403 ) (Revenue $ 2,822,317 )
FINANCIAL ASSISTANCE - 2,407 PEOPLE SERVED THIS PROGRAM PROVIDES FINANCIAL ASSISTANCE FOR HIV MEDICATIONS FOR THOSE AWAITING APPROVAL FOR THE TEXAS HIV MEDICATION PROGRAM OF THE AIDS DRUG ASSISTANCE PROGRAM, AS WELL AS ANCILLARY MEDICATIONS NOT COVERED BY THESE STATE PROGRAMS. THE PROGRAM ALSO PROVIDES FINANCIAL ASSISTANCE FOR THE PAYMENT OF HEALTH INSURANCE PREMIUMS, CO-PAYS/CO-INSURANCE, AND DEDUCTIBLES TO QUALIFIED INDIVIDUALS LIVING WITH HIV. THESE PROGRAMS ARE AVAILABLE TO HIV POSITIVE PATIENTS WHO QUALIFY THROUGH THE RYAN WHITE CARE ACT. THIS PROGRAM SERVED 2,407 PATIENTS WITH 18,237 TRANSACTIONS DURING THE YEAR.
4c (Code:   ) (Expenses $ 1,491,379 including grants of $   ) (Revenue $ 871,466 )
EDUCATION & PREVENTION - 3,806 PEOPLE SERVED A LARGE PART OF BEING HEALTHY IS BEING INFORMED. AS A PATIENT AT LEGACY, WE WILL HELP YOU MAKE INFORMED-DECISIONS WITH OUR HEALTH PROMOTION AND EDUCATION PROGRAMS. SEE SCHEDULE O FOR MORE INFORMATION.
4d Other program services (Describe in Schedule O.)
(Expenses $ 171,409 including grants of $   ) (Revenue $ 47,896 )
4e Total program service expensesMediumBullet$ 27,877,681
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
Yes
 
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part IClick to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II.......... Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
 
No
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II.........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV .........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV...................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV..
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1.....................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
70
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
326
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
20
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
19
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
BEN GLISAN
PO BOX 66308
HOUSTON,TX772666308
(713) 830-3000
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) RICHARD DAVIDSON
TREASURER
 2.0 X   X       0 0 0
(2) JAMES REEDER JR
CHAIR THRU 12/11, DIRECTOR
 2.0 X   X       0 0 0
(3) LYDIA BAEHR
SECRETARY BEG 12/11
 2.0 X   X       0 0 0
(4) JERI J BROOKS
SECRETARY/VICE CHAIR BEG 12/11
 2.0 X   X       0 0 0
(5) RAMIRO FONSECA
DIRECTOR
 2.0 X           0 0 0
(6) ROBERT HILLIARD
EXECUTIVE COMMITTEE BEG 12/11
 2.0 X   X       0 0 0
(7) NICOLE L MOORE
DIRECTOR
 2.0 X           0 0 0
(8) TRUDY NIX
DIRECTOR
 2.0 X           0 0 0
(9) RAY PURSER
VICE CHAIR/CHAIR BEG 12/11
 2.0 X   X       0 0 0
(10) JOHN SHEPTOR
DIRECTOR
 2.0 X           0 0 0
(11) ANN REID
DIRECTOR
 2.0 X           0 0 0
(12) LEONARD ZWELLING
DIRECTOR
 2.0 X           0 0 0
(13) JANI C LOPEZ
DIRECTOR
 2.0 X           0 0 0
(14) DAVID FOX
DIRECTOR
 2.0 X           0 0 0
(15) IAN ROSENBERG
DIRECTOR
 2.0 X           0 0 0
(16) CYNDY GARZA
DIRECTOR
 2.0 X           0 0 0
(17) GLENN BAUGUSS
DIRECTOR BEG 12/11
 2.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) BETH APOLLO
CFO THRU 10/11, DIRECTOR
 2.0 X   X       74,431 0 2,577
(19) BRYAN HLAVINKA
DIRECTOR BEG 4/12
 2.0 X           0 0 0
(20) ALTON LADAY
DIRECTOR BEG 4/12
 2.0 X           0 0 0
(21) SALIMAH CUMBER
DIRECTOR THRU 12/11
 2.0 X           0 0 0
(22) KATHERINE CALDWELL
EXECUTIVE DIRECTOR
 40.0     X       290,298 0 12,379
(23) BEN GLISAN
CFO BEG 10/2011
 40.0     X       33,242 0 512
(24) DONA C BOYDSTUN
CHIEF DEVELOPMENT OFFICER
 40.0       X     284,651 0 11,727
(25) THOMAS BEECH
CHIEF MEDICAL OFFICER
 40.0       X     263,354 0 13,194
(26) MICHAEL KOPPER
CHIEF STRATEGY OFFICER
 40.0       X     214,526 0 11,361
(27) JO CARCEDO
CHIEF OPERATING OFFICER
 40.0       X     179,431 0 11,136
(28) JEANETTE VALDIVIESO
MEDICAL DIRECTOR OF BEHAV HLTH
 40.0         X   208,930 0 14,074
(29) NATALIE VANEK
PHYSICIAN
 40.0         X   187,106 0 8,435
(30) MARK LEVINE
PHYSICIAN
 40.0         X   173,629 0 10,624
(31) CHAD LEMAIRE
PSYCHIATRIST
 40.0         X   197,189 0 11,599
(32) GWENDOLYN BROBBEY
PHYSICIAN
 40.0         X   167,412 0 9,177
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 2,274,199 0 116,795
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet27
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
LABCORP OF AMERICA
 
  		LAB SERVICES 567,735
WHITAKER MEDICAL
 
  		MEDICAL SERVICES 254,432
ALLIANCE OF CHICAGO
 
  		EHR SUPPORT SERVICES 252,334
PINYON ADVISORS LLC
 
  		BUSINESS CONSULTANT 127,725
BKD LLP
 
  		AUDIT/TAX/CONSULTING 120,884
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet6
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a 199,812
b Membership dues....1b  
c Fundraising events....1c 526,864
d Related organizations...1d  
e Government grants (contributions)1e 7,859,641
f All other contributions, gifts, grants, and
similar amounts not included above1f 		2,840,342
g Noncash contributions included in lines 1a-1f:$ 323,018
h Total. Add lines 1a-1f.......MediumBullet 11,426,659
Program Service Revenue Business Code
2a NET PATIENT SERVICE REVENUE 624,100 25,704,079 25,704,079    
b EHR INCENTIVE REVENUE 624,100 301,348 301,348    
c OTHER 624,100 50,870 50,870    
d LEGACY ENDOWMENT MANAGEMENT FEE 561,000 628,469 628,469    
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 26,684,766
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 244     244
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 3,750  
b Less: rental expenses    
c Rental income or (loss) 3,750  
d Net rental income or (loss).......MediumBullet 3,750     3,750
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses   3,277
c Gain or (loss)   -3,277
d Net gain or (loss)..........MediumBullet -3,277     -3,277
8a Gross income from fundraising events (not including
$ 526,864
of contributions reported on line 1c). See Part IV, line 18 ...
a 77,535
b Less: direct expenses ...b 416,646
c Net income or (loss) from fundraising events..MediumBullet -339,111   -339,111
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 0
12 Total revenue. See Instructions....MediumBullet 37,773,031 26,684,766   -338,394
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 0  
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 2,765,403 2,765,403
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,402,819 1,092,688 231,266 78,865
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 14,732,612 11,348,650 2,515,164 868,798
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 256,204 197,356 43,739 15,109
9 Other employee benefits ....... 1,426,746 1,158,000 216,668 52,078
10 Payroll taxes ........... 1,257,311 1,011,198 172,381 73,732
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 184,782   184,782  
c Accounting ........... 105,839   105,839  
d Lobbying ........... 331,555 331,555    
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 0      
g Other .......... 1,698,829 979,872 590,673 128,284
12 Advertising and promotion .... 304,238 87,281 181,861 35,096
13 Office expenses ....... 4,842,661 4,560,719 281,942  
14 Information technology ...... 281,003 233,887 40,005 7,111
15 Royalties .. 0      
16 Occupancy ........... 1,222,009 1,047,034 140,421 34,554
17 Travel ............ 163,486 64,890 81,518 17,078
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 472,528 373,293 62,889 36,346
20 Interest ........... 66,735 37,993 28,285 457
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 348,281 297,969 38,385 11,927
23 Insurance .............. 86,611 79,498 5,734 1,379
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a BAD DEBT 10,560 10,560    
b LICENSES, DUES & SUBSCRIPTIONS 99,422 52,494 38,119 8,809
c RECRUITING 136,644 60,075 64,569 12,000
d MEDICAL SUPPLIES & DRUGS 2,077,915 2,077,915    
e
f All other expenses 29,767 9,351 14,752 5,664
25 Total functional expenses. Add lines 1 through 24f 34,303,960 27,877,681 5,038,992 1,387,287
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 766,598 1 2,327,964
2 Savings and temporary cash investments ....... 0 2 360,212
3 Pledges and grants receivable, net ......... 1,901,797 3 1,135,658
4 Accounts receivable, net ......... 2,269,992 4 2,208,468
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 0 7 0
8 Inventories for sale or use .............. 0 8 68,934
9 Prepaid expenses and deferred charges ............ 71,893 9 99,973
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 2,524,825
b Less: accumulated depreciation. ..... 10b 1,335,344 746,606 10c 1,189,481
11 Investments—publicly traded securities .......... 0 11 0
12 Investments—other securities. See Part IV, line 11 ...... 0 12 0
13 Investments—program-related. See Part IV, line 11 .. 12,160,679 13 11,636,351
14 Intangible assets ......... 0 14 100,000
15 Other assets. See Part IV, line 11 ........... 465,419 15 911,936
16 Total assets. Add lines 1 through 15 (must equal line 34)... 18,382,984 16 20,038,977
Liabilities 17 Accounts payable and accrued expenses . 3,058,680 17 2,725,352
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 0 19 360,157
20 Tax-exempt bond liabilities .......... 0 20 0
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 1,126,392 23 261,394
24 Unsecured notes and loans payable to unrelated third parties .... 59,506 24 51,858
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 0 25 0
26 Total liabilities. Add lines 17 through 25..... 4,244,578 26 3,398,761
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 1,509,557 27 4,979,619
28 Temporarily restricted net assets ..... 12,628,849 28 11,660,597
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 14,138,406 33 16,640,216
34 Total liabilities and net assets/fund balances ..... 18,382,984 34 20,038,977
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
37,773,031
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
34,303,960
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
3,469,071
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
14,138,406
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-967,261
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
16,640,216
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
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
f
g
(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
(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
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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.") . 12,679,674 13,195,801 11,719,096 11,767,372 11,426,659 60,788,602
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...... 1,911,989 2,718,364 8,179,642 17,540,848 26,684,766 57,035,609
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. 14,591,663 15,914,165 19,898,738 29,308,220 38,111,425 117,824,211
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...         5,000 5,000
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..         5,000 5,000
8 Public Support (Subtract line 7c from line 6.)           117,819,211
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... 14,591,663 15,914,165 19,898,738 29,308,220 38,111,425 117,824,211
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 15,829 15,042 15,000 13,750 3,994 63,615
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 15,829 15,042 15,000 13,750 3,994 63,615
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.). 14,607,492 15,929,207 19,913,738 29,321,970 38,115,419 117,887,826
14
Section C. Computation of Public Support Percentage
15
15
99.942 %
16
16
99.918 %
Section D. Computation of Investment Income Percentage
17
17
0.054 %
18
18
0.082 %
19a
b
20
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
LEGACY COMMUNITY HEALTH SERVICES
  		Employer identification number

76-0009637
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
LEGACY COMMUNITY HEALTH SERVICES
  		Employer identification number

76-0009637
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
LEGACY COMMUNITY HEALTH SERVICES
  		Employer identification number

76-0009637
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ....... 331,555  
c Total lobbying expenditures (add lines 1a and 1b) ................... 331,555  
d Other exempt purpose expenditures ........................ 27,546,126  
e Total exempt purpose expenditures (add lines 1c and 1d) ............... 27,877,681  
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000  
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) ................. 250,000  
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount 974,243 1,000,000 1,000,000 1,000,000 3,974,243
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		        5,961,365
             
c Total lobbying expenditures 83,196 86,549 147,738 331,555 649,038
             
d Grassroots nontaxable amount 243,561 250,000 250,000 250,000 993,561
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		         1,490,342
             
f Grassroots lobbying expenditures 0 0 0 0 0
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
 
 
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
OTHER LOBBYING EXPENSES SCHEDULE C, PART II-A, LINE 1B THE AMOUNT IN SCHEDULE C, PART II-1, LINE 1B INCLUDES THE SALARY AND BENEFITS FOR THE ORGANIZATION'S VICE PRESIDENT OF GOVERNMENT RELATIONS AND PUBLIC AFFAIRS FIELD SPECIALIST. THESE TWO INDIVIDUALS ARE EMPLOYED BY THE ORGANIZATION AND SERVE AS POLICY ADVOCATES FOR THE ORGANIZATION. THEY ARE NOT REGISTERED LOBBYISTS NOR DO THEY PERFORM LOBBYIST ACTIVITIES. THEY PERFORM VARIOUS TASKS, SPECIFICALLY WORKING WITH LEGISLATURES AND OTHERS TO ENSURE THE CONTINUED SUPPORT OF THE ORGANIZATION'S PROGRAMS. THE ORGANIZATION ALSO PAID ANNUAL DUES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 231,015 0 231,015
b Buildings ................ 68,986   5,159 63,827
c Leasehold improvements ............   177,312 132,619 44,693
d Equipment ................   2,047,512 1,197,566 849,946
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,189,481
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) EQUITY INVESTMENT IN LCHE 11,193,418 C
(2) DUE FROM LCHE 442,933 C







Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet 11,636,351
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 37,773,031
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 34,303,960
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 3,469,071
4 Net unrealized gains (losses) on investments .......................... 4  
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -967,261
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -967,261
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 2,501,810
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 37,716,203
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b 490,754
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -967,261
e Add lines 2a through 2d ..................... 2e -476,507
3 Subtract line 2e from line 1..................... 3 38,192,710
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b -419,679
c Add lines 4a and 4b....................... 4c -419,679
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 37,773,031
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 35,214,393
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a 490,754
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d 419,679
e Add lines 2a through 2d...................... 2e 910,433
3 Subtract line 2e from line 1..................... 3 34,303,960
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 34,303,960
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
UNCERTAIN TAX POSITION SCHEDULE D, PART X, LINE 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
OTHER CHANGES IN NEW ASSETS SCHEDULE D, PART XI, LINE 8 $ (967,261) CHANGE IN INTEREST IN N/A OF LEGACY COMM HEALTH ENDOWMENT
OTHER REVENUE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12 SCHEDULE D, PART XII, LINE 2D $ (967,261) CHANGE IN INTEREST IN N/A OF LEGACY COMM HEALTH ENDOWMENT
OTHER REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1 SCHEDULE D, PART XII, LINE 4B $ (416,646) SPECIAL EVENTS EXPENSE ( 3,277) LOSS ON ASSET DISPOSAL 244 INTEREST INCOME ----------- $ (419,679)
OTHER EXPENSES INCLUDED ON LINE 1, BUT NOT ON FORM 990, PART IX, LINE 25 SCHEDULE D, PART XIII, LINE 2D $ 416,646 SPECIAL EVENT EXPENSE 3,277 LOSS ON ASSET DISPOSAL ( 244) INTEREST INCOME ----------- $ 419,679
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,or if the organization entered more than $15,000 on Form 990-EZ, line 6a.right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

CABARET 4ACURE
(event type) 		(b) Event #2

LUNCHEON
(event type) 		(c) Other Events

4
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 247,959 254,038 102,402 604,399
2 Less: Charitable
contributions . . . 		207,959 235,564 83,341 526,864
3 Gross income (line 1
minus line 2) . . . 		40,000 18,474 19,061 77,535
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .   2,000   2,000
7 Food and beverages . . 57,529 18,474   76,003
8 Entertainment . . . 50,000     50,000
9 Other direct expenses . 74,676 46,192 167,775 288,643
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 416,646
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -339,111
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)
Identifier ReturnReference Explanation
CABARET FOR A CURE SCHEDULE G, PART II, COLUMN (A) THE ORGANIZATION CONTRACTED WITH A THIRD PARTY TO HELP PRODUCE THE CABARET FOR A CURE EVENT. IT WAS ORIGINALLY INTENDED FOR LEGACY COMMUNITY HEALTH SERVICES TO BE A BENEFICIARY OF THE NET PROFIT OF THE EVENT. HOWEVER, THROUGHOUT THE PRODUCTION OF THE EVENT, THE ORGANIZATION WAS MORE INVOLVED THAN ORIGINALLY THOUGHT AND PAID A MAJORITY OF EXPENSES, THOUGH THE ORGANIZATION DID NOT HAVE AUTHORITY OF THE CHOICES OF VENDORS AND CONTRACTS SIGNED. THIS RESULTED IN HIGHER THAN NORMAL EXPENSES FOR THIS EVENT THAN WOULD HAVE BEEN SPENT IF THE ORGANIZATION HAD COMPLETE CONTROL OVER THE CHOICES OF VENDORS AND CONTRACTED AMOUNTS.
Schedule G (Form 990 or 990-EZ) 2011
Additional Data


Software ID:  
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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number
76-0009637
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance






















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance
(1) RX DRUGS DSTRBTD TO RYAN WHITE GRANT PATIENTS 1557   1,460,176 FMV PHARMACEUTICALS
(2) INS AND COPMTS PAID FOR RYAN WHITE GRNT PTNTS 850 1,305,227      











Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
GRANT MONITORING SCHEDULE I, PART I, LINE 2 RECIPIENTS OF PHARMACEUTICALS UNDER THE RYAN WHITE GRANT PROGRAM RECEIVE AID BASED ON PROGRAM GUIDELINES AS SET FORTH IN THE GRANT. TO BE ELIGIBLE, PATIENTS MUST BE DIAGNOSED WITH HIV/AIDS AND LIVE IN THE HOUSTON EMA (HARRIS, CHAMBERS, FORT BEND, LIBERTY, MONTGOMERY AND WALLER COUNTIES.) PATIENT INCOME MUST BE 500% OF FEDERAL POVERTY GUIDELINE FOR HIV MEDICATIONS AND 200% OF FEDERAL POVERTY GUIDELINE FOR NON-HIV MEDICATIONS. IN ADDITION, PATIENTS MAY NOT BE PRESENTLY COVERED FOR HIV OR NON-HIV MEDICATIONS UNDER THE STATE ADAP PROGRAM, STATE PHARMACY ASSISTANCE PROGRAM, TEXAS MEDICAID PROGRAM, MEDICARE PART D, OR ANY OTHER THIRD-PARTY PAYER. MEDICATIONS ARE FILLED BY PHARMACIES OR MAIL ORDER AND DISTRIBUTED TO PATIENTS; PATIENTS DO NOT RECEIVE CASH DIRECTLY. RECIPIENTS OF HEALTH INSURANCE AND COST SHARING ASSISTANCE UNDER THE RYAN WHITE GRANT PROGRAM RECEIVE AID BASED ON PROGRAM GUIDELINES AS SET FORTH IN THE GRANT. TO BE ELIGIBLE, PATIENTS MUST BE HIV-INFECTED, RESIDE IN THE HOUSTON EMA AND MEET RPWC APPROVED FINANCIAL ELIGIBILITY GUIDELINES. PAYMENTS ARE MADE DIRECTLY TO THE INSURANCE COMPANIES; PATIENTS DO NOT RECEIVE CASH DIRECTLY. THE ORGANIZATION BELIEVES STRICT RECIPIENT GUIDELINES ENSURE CORRECT USE OF RYAN WHITE GRANT FUNDS.
Schedule I (Form 990) 2011


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
 
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) DONA C BOYDSTUN (i)
(ii)		 207,984
0 		76,667
0 		0
0 		6,068
0 		5,659
0 		296,378
0 		0
0
(2) KATHERINE CALDWELL (i)
(ii)		 230,298
0 		60,000
0 		0
0 		6,655
0 		5,724
0 		302,677
0 		0
0
(3) THOMAS BEECH (i)
(ii)		 252,937
0 		10,417
0 		0
0 		7,512
0 		5,682
0 		276,548
0 		0
0
(4) MICHAEL KOPPER (i)
(ii)		 197,859
0 		16,667
0 		0
0 		5,702
0 		5,659
0 		225,887
0 		0
0
(5) JEANETTE VALDIVIESO (i)
(ii)		 208,930
0 		0
0 		0
0 		6,479
0 		7,595
0 		223,004
0 		0
0
(6) NATALIE VANEK (i)
(ii)		 187,106
0 		0
0 		0
0 		2,500
0 		5,935
0 		195,541
0 		0
0
(7) MARK LEVINE (i)
(ii)		 173,629
0 		0
0 		0
0 		4,965
0 		5,659
0 		184,253
0 		0
0
(8) JO CARCEDO (i)
(ii)		 171,639
0 		7,792
0 		0
0 		5,395
0 		5,741
0 		190,567
0 		0
0
(9) CHAD LEMAIRE (i)
(ii)		 197,189
0 		0
0 		0
0 		5,916
0 		5,683
0 		208,788
0 		0
0
(10) GWENDOLYN BROBBEY (i)
(ii)		 167,412
0 		0
0 		0
0 		3,494
0 		5,683
0 		176,589
0 		0
0






Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 BONUSES ARE DETERMINED BY THE MANAGEMENT TEAM AND THE BOARD OF DIRECTORS AND ARE NOT A GUARANTEED PORTION OF COMPENSATION.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial .. X 1 270,126 FMV
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies . X 1 52,592 COST
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( SUPPLIES ) X 1 300 COST
26 Other Right pointing arrow large image( )
27 Other Right pointing arrow large image( )
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
NUMBER OF CONTRIBUTORS SCHEDULE M, PART I, COLUMN B IN-KIND MEDICAL SUPPLIES DONATED BY ONE ORGANIZATION. OTHER SUPPLIES DONATED BY ONE ORGANIZATION.
METHOD OF DETERMINING NONCASH CONTRIBUTION AMOUNTS SCHEDULE M, PART I, COLUMN D ON MARCH 30, 2012, LEGACY COMMUNITY HEALTH SERVICES ENTERED INTO A MERGER WITH ANOTHER TEXAS NON-PROFIT CORPORATION. THE ORGANIZATION RECOGNIZED THIS MERGER AS A CONTRIBUTION WITH A NET VALUE OF $270,126. THIS AMOUNT IS CALCULATED AS FOLLOWS: CASH $ 327,375 ACCOUNTS REC. 1,000 PREPAID ASSETS 2,669 BUILDING 231,015 LAND 68,986 LIABILITIES (286,576) TRNA ( 74,343) ------------ TOTAL $ 270,126
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
LEGACY COMMUNITY HEALTH SERVICES
 
Employer identification number

76-0009637
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 MISSION: WE EMPOWER OUR CLIENTS TO LEAD BETTER LIVES BY PROVIDING PREMIUM, COMPASSIONATE PRIMARY HEALTHCARE SERVICES. WE ARE COMMITTED TO SERVING A DIVERSE COMMUNITY INCLUDING THOSE PERSONS WHO HAVE TRADITIONALLY FACED PROBLEMS ACCESSING QUALITY HEALTHCARE. THE FIRST PART OF THIS MISSION IS SIMPLE - WE WANT EACH OF OUR EXTRAORDINARY PATIENTS TO RECEIVE EXTRAORDINARY HEALTHCARE WHETHER YOU NEED AN EYE EXAM, WANT TO TALK TO A COUNSELOR ABOUT STD PREVENTION, OR JUST HAVE A COLD, WE TAKE YOUR NEEDS SERIOUSLY AND WE ARE HERE TO HELP. THE SECOND PART OF THIS MISSION IS WHAT SETS LEGACY APART. WE BELIEVE THAT A COMPASSIONATE, NON-JUDGMENTAL ENVIRONMENT IS THE KEY TO GREAT HEALTHCARE. THIS MEANS THAT EVERY PATIENT IS ACCEPTED UNCONDITIONALLY, REGARDLESS OF: CULTURE, RACE OR BACKGROUND, GENDER OR SEXUAL ORIENTATION, FINANCIAL SITUATION, HIV STATUS, STDS OR ANY OTHER ILLNESS. VISION: LEGACY'S VISION IS TO CONTINUE TO SERVE AS A HEALTHCARE HOME BY BUILDING A NETWORK OF COMMUNITY CLINICS WHERE PEOPLE WILL FEEL WELCOMED AND RESPECTED WHILE RECEIVING THE HIGHEST QUALITY HEALTHCARE SERVICES, REGARDLESS OF THEIR ABILITY TO PAY. VALUES: *HEALTHCARE IS A RIGHT NOT A PRIVILEGE - AT LEGACY WE BELIEVE QUALITY COMPREHENSIVE HEALTHCARE IS A FUNDAMENTAL HUMAN RIGHT THAT GROUNDS AN INDIVIDUAL PHYSICALLY, EMOTIONALLY AND SPIRITUALLY. THIS RIGHT PROMOTES BALANCE AND STABILITY FOR OUR PATIENTS, WHICH RESULTS IN A HEALTHIER AND MORE PRODUCTIVE COMMUNITY. *COMPASSIONATE CARE FOR THE WHOLE PERSON - WE PROVIDE HEALTHCARE, EDUCATION AND WELLNESS SERVICES TO ALL. WE TREAT EACH PERSON WITH RESPECT AS AN INDIVIDUAL, CELEBRATING THEIR UNIQUE CULTURE. *EMBRACE THE DIVERSITY OF OUR COMMUNITY - LEGACY VALUES OUR DIVERSE COMMUNITY. WE ENGAGE AND RESPECT EVERYONE. *BOLD LEADERSHIP WITH SOUND FISCAL MANAGEMENT - LEGACY VALUES BOLD AND DRIVEN LEADERSHIP WITH SOUND FINANCIAL MANAGEMENT. WE LOOK TO THE FUTURE WHILE NEVER FORGETTING OUR PAST. *NATIONALLY RECOGNIZED WITH VISIONARY SOLUTIONS - LEGACY VALUES THE INTELLECTUAL CAPACITY OF OUR BOARD AND STAFF TO DEVELOP VISIONARY SOLUTIONS THAT ARE RECOGNIZED ON A NATIONAL LEVEL.
PROGRAM SERVICES FORM 990, PART III, LINE 4A OUR MEN'S HEALTH SERVICES INCLUDE: PHYSICAL EXAMS: REGULAR CHECK-UPS TO MONITOR YOUR HEALTH. PROSTATE AND TESTICULAR EXAMS: TO HELP WITH PREVENTION OF AND EARLY, DETECTION OF DISEASE. STD SCREENING AND TREATMENT : TESTING AND EDUCATION ON HOW TO AVOID STDS. FAMILY PLANNING COUNSELING: PREVENT PREGNANCY AND PROTECT YOUR HEALTH. LABORATORY SERVICES: BLOOD TESTS, VACCINATIONS, AND OTHER SCREENINGS. PRIMARY HEALTHCARE: BASIC CARE FOR ALL YOUR HEALTH NEEDS. X-RAY SERVICES: RADIOLOGY CARE, INCLUDING CHEST X-RAYS, HEPATITIS A AND B TESTING AND VACCINATIONS. WOMEN'S HEALTH: LEGACY OFFERS AN AFFORDABLE MENU OF SERVICES FOR PRIMARY HEALTHCARE FOR, ALL WOMEN, REGARDLESS OF YOUR FINANCIAL SITUATION. OUR DOCTORS AND NURSE PRACTITIONERS ARE SENSITIVE TO THE NEEDS OF WOMEN, HELPING YOU FEEL MORE, COMFORTABLE ABOUT YOUR HEALTH. WE MAINTAIN A FRIENDLY, OPEN, AND NON-JUDGMENTAL ENVIRONMENT WHERE YOU CAN FEEL ACCEPTED AND RESPECTED. OUR WOMEN'S HEALTH SERVICES INCLUDE: PHYSICAL EXAMS: REGULAR CHECK-UPS TO MONITOR YOUR HEALTH. GYNECOLOGICAL SERVICES: PAP SMEARS, BREAST EXAMS, AND OTHER SCREENINGS. OBSTETRIC CARE: PRENATAL, OBSTETRIC, AND POST NATAL CARE. STD SCREENING AND TREATMENT: TESTING AND EDUCATION ON HOW TO AVOID STDS. FAMILY PLANNING COUNSELING: PREVENT PREGNANCY AND PROTECT YOUR HEALTH. MAMMOGRAPHY REFERRALS: ACCESS TO AFFORDABLE PROVIDERS THAT SPECIALIZE IN MAMMOGRAMS. LABORATORY SERVICES: BLOOD TESTS, VACCINATIONS AND OTHER SCREENINGS. PRIMARY HEALTHCARE: BASIC CARE FOR ALL OF YOUR HEALTH NEEDS. X-RAY SERVICES: RADIOLOGY CARE, INCLUDING CHEST X-RAYS. TRANSGENDER SERVICES: LEGACY SPECIALIZES IN ADDRESSING THE UNIQUE PRIMARY HEALTHCARE NEEDS OF TRANSGENDER PATIENTS. AT LEGACY, YOU CAN ACCESS THE HIGHEST QUALITY OF HEALTHCARE IN A WARM AND WELCOMING ENVIRONMENT. OUR STAFF UNDERSTANDS YOUR NEEDS AND OFFERS YOU ACCEPTANCE AND RESPECT. OUR TRANSGENDER HEALTH SERVICES INCLUDE: HORMONE THERAPY: MONITORED DOSAGES OF HORMONES TO AID YOUR TRANSITION. MALE-TO-FEMALE CARE: SPECIALIZED ATTENTION TO YOUR TRANSITIONAL NEEDS. FEMALE-TO-MALE CARE: SPECIALIZED ATTENTION TO YOUR TRANSITIONAL NEEDS. PHYSICAL EXAMS: REGULAR CHECK-UPS TO MONITOR YOUR HEALTH. PROSTATE AND TESTICULAR EXAMS: CAREFUL EXAMINATIONS TO DISCOVER PROBLEMS EARLY. GYNECOLOGICAL SERVICES: PAP SMEARS, BREAST EXAMS, AND OTHER SCREENINGS. STD SCREENING AND TREATMENT: TESTING AND SCREENING ON HOW TO AVOID STDS. FAMILY PLANNING COUNSELING: PREVENT PREGNANCY AND PROTECT YOUR HEALTH. MAMMOGRAPHY REFERRALS: ACCESS TO PROVIDERS THAT SPECIALIZE IN MAMMOGRAMS. LABORATORY SERVICES: BLOOD TESTS, VACCINATIONS, AND OTHER SCREENINGS. PRIMARY HEALTHCARE: BASIC CARE FOR ALL OF YOUR HEALTH NEEDS. X-RAY SERVICES: RADIOLOGY CARE, INCLUDING CHEST X-RAYS. PEDIATRIC SERVICES: LEGACY OFFERS PEDIATRIC CARE FOR CHILDREN. YOU AND YOUR CHILD CAN VISIT THE SAME PLACE TO TAKE CARE OF YOUR HEALTHCARE NEEDS. OUR DOCTORS PROVIDE WELL-CHILD CHECKUPS AND PHYSICAL EXAMINATIONS TO HELP YOUR CHILD GROW UP HEALTHY AND STRONG. WE ALSO OFFER CHILDREN'S IMMUNIZATIONS, WHICH PREVENT SERIOUS CHILDHOOD ILLNESSES AND ARE REQUIRED BY TEXAS SCHOOL DISTRICTS. AND IF YOUR CHILD HAS SPECIAL HEALTH NEEDS, OUR DOCTORS CAN WORK WITH YOU AND PROVIDE REFERRALS TO OUTSIDE SPECIALISTS. IMMUNIZATIONS OFFERED: DTAP (DIPHTHERIA, TETANUS, PERTUSSIS) - RECOMMENDED AT AGES 4-6, BEFORE STARTING SCHOOL. POLIO - RECOMMENDED AT AGES 4-6, BEFORE STARTING SCHOOL. MMR (MEASLES, MUMPS, RUBELLA) - RECOMMENDED AT AGES 4-6, BEFORE STARTING SCHOOL. TETANUS BOOSTER - RECOMMENDED AT AGE 11-12, AND EVERY 10 YEARS, THEREAFTER. PHARMACY SERVICES: YOU CAN NOW MEET ALL OF YOUR MEDICAL NEEDS AND GET YOUR PRESCRIPTIONS FILLED IN ONE PLACE! LEGACY HAS PARTNERED WITH WALGREENS TO OPEN A FULL-SERVICE PHARMACY WITHIN LEGACY'S MAIN LOCATION AT 1415 CALIFORNIA. FOR CLIENTS AT OUR LYONS AVENUE SITE, A WALGREENS PHARMACY IS LOCATED DIRECTLY ACROSS THE STREET AND WILL PROVIDE THE SAME LEVEL OF SERVICE AT OUR AFFORDABLE PRICES. OUR FRIENDLY AND CAPABLE PHARMACISTS CAN ACCOMMODATE YOUR SPECIFIC NEEDS - WHETHER IT'S A SIMPLE ANTIBIOTIC, BIRTH CONTROL, DIABETES OR HIV MEDICATIONS. WE CAN ANSWER YOUR QUESTIONS ABOUT MEDICINES, DRUG INTERACTIONS, DOSAGE INSTRUCTIONS, AND SIDE-EFFECTS. FROST EYE CLINIC: LEGACY OFFERS AFFORDABLE OPTOMETRY AND OPHTHALMOLOGY SERVICES - INCLUDING EXAMINATIONS FOR PRESCRIPTION GLASSES AND CONTACT LENS FITTINGS. IT'S IMPORTANT TO HAVE YOUR EYES EXAMINED REGULARLY. EYE EXAMS CAN DIAGNOSE PROBLEMS SUCH AS GLAUCOMA, DIABETES, MACULAR DEGENERATION, CYTOMEGALOVIRUS RETINITIS, PINK EYE, OR OTHER VISION PROBLEMS. OUR EYE CARE SERVICES ARE AVAILABLE UNDER A NUMBER OF DIFFERENT PROGRAMS, WHICH TAKE INTO ACCOUNT EACH INDIVIDUAL'S FINANCIAL SITUATION AND PROVIDE THESE EXAMS ON A SLIDING FEE SCALE BASED UPON EACH PERSON'S ABILITY TO PAY. LEGACY ALSO ACCEPTS A NUMBER OF THIRD PARTY PAYER SOURCES SUCH AS INSURANCE AND MEDICARE. DENTAL SERVICES: LEGACY'S WELL-ROUNDED APPROACH TO INDIVIDUAL HEALTH ISSUES INCLUDES PROVIDING MUCH NEEDED DENTAL/ORAL CARE FOR OUR PATIENTS, AND THAT EXTENDS TO OUR SPECIALTY IN PEDIATRIC DENTISTRY. THE REGULAR DENTAL HEALTH SCREENINGS OFFERED BY LEGACY HELP DETECT DISEASES SUCH AS ORAL CANCER, DIABETES AND HIV IN THEIR EARLY STAGES.
PROGRAM SERVICES FORM 990, PART III, LINE 4C STD EDUCATION: WE WILL PROVIDE YOU WITH LOW-COST, CONFIDENTIAL STD SCREENING, TREATMENT, PREVENTION COUNSELING, MEDICATION AND FOLLOW UP. DIAGNOSIS AND THE TREATMENT OF MOST STDS OCCUR AT THE TIME OF THE PATIENT VISIT. WE SCREEN FOR THE FOLLOWING STDS: SYPHILIS, HIV, HEPATITIS B, GONORRHEA, AND CHLAMYDIA. HIV EDUCATION: WE PROVIDE COMPREHENSIVE HIV/AIDS PRIMARY CARE SERVICES, UTILIZING HEALTH PRACTITIONERS THAT SPECIALIZE IN HIV HEALTHCARE. OUR PRACTITIONERS PROVIDE REFERRALS TO SPECIALTY CARE PROVIDERS, AS WELL AS MEDICAL CASE MANAGERS AND SERVICE LINKAGE WORKERS TO HELP YOU OBTAIN THE ASSISTANCE NEEDED ON A DAILY BASIS. PROJECT CORRE: LEGACY'S PROJECT CORRE (CYBER OUTREACH RISK REDUCTION EDUCATION) IS ONE OF THE FIRST OF ITS KIND IN TEXAS AND WAS MODELED AFTER SIMILAR PROGRAMS IN SAN FRANCISCO, NEW ORLEANS, AND BOSTON. CYBER OUTREACH IS THE LATEST STRATEGY TO PROVIDE HIV AND STD INFORMATION TO THOSE WITH THE GREATEST RISK DURING A TIME WHEN THEY NEED IT THE MOST. RECENT INFORMATION HAS IDENTIFIED INTERNET CHAT ROOMS AS THE NUMBER ONE WAY FOR GAY AND BISEXUAL MEN TO FIND CASUAL AND ANONYMOUS SEX PARTNERS. PROJECT CORRE USES CHAT ROOMS AND OTHER INTERNET VENUES TO ADDRESS THE HIV/STD PREVENTION NEEDS OF GAY, BISEXUAL AND OTHER MEN WHO HAVE SEX WITH MEN (MSM) ENGAGING IN SEXUAL PRACTICES WITH SEX PARTNERS WHO MET THROUGH THE INTERNET. INTERNET ACTIVITIES ARE CONDUCTED IN A CULTURALLY SENSITIVE MANNER, USING LEGACY'S TRAINED CYBER OUTREACH HEALTH EDUCATORS WHO ARE GAY OR BISEXUAL MEN. THESE CYBER HEALTH EDUCATORS CAN PROVIDE PREVENTION EDUCATION AND RISK REDUCTION COUNSELING, REFERRALS AND SUPPORT TO GAY, BISEXUAL AND OTHER MSM WHO USE THE INTERNET. CYBER HEALTH EDUCATORS ALSO PROMOTE HEALTH AND WELLNESS THROUGH ENCOURAGEMENT OF POSITIVE HEALTH-SEEKING BEHAVIORS, INCLUDING GETTING TESTED FOR STDS AND HIV, GETTING VACCINATED FOR HEPATITIS A AND B, AND ACCESSING PRIMARY CARE SERVICES FOR ILLNESSES. BY PROVIDING ANONYMITY, THE INTERNET ALLOWS THE CYBER HEALTH EDUCATOR TO ANSWER QUESTIONS THAT SOME MEN MIGHT FEEL RELUCTANT TO DISCUSS IN AN HIV COUNSELING SESSION, AT A BAR EVENT OR OTHER PLACES WHERE LEGACY PROVIDES SERVICES. THE INTERNET OFFERS A SAFER, LESS THREATENING SPACE FOR PARTICIPANTS TO OPENLY AND HONESTLY DISCUSS SENSITIVE ISSUES. BODY POSITIVE: THROUGH OUR BODY POSITIVE WELLNESS CENTER, LEGACY OFFERS A COMPREHENSIVE PROGRAM DESIGNED TO IMPROVE YOUR OVERALL HEALTH. OUR MULTI-WEEK PROGRAM INTEGRATES EXERCISE AND NUTRITION AS WELL AS MASSAGE THERAPY AND PHYSICAL THERAPY WHERE NECESSARY. OUR NUTRITIONAL SERVICES: LEGACY'S LICENSED AND REGISTERED DIETITIANS OFFER COUNSELING AND NUTRITION RECOMMENDATIONS TO KEEP YOUR BODY HEALTHY. WE CAN HELP YOU IMPROVE YOUR IMMUNE SYSTEM, MANAGE DIABETES, MAINTAIN AN OPTIMAL WEIGHT, OR AVOID COUNTERACTIONS BETWEEN THE FOODS YOU EAT AND THE MEDICINES YOU TAKE. DURING YOUR NUTRITIONAL COUNSELING SESSIONS, OUR DIETITIANS WILL PERFORM A THOROUGH HISTORY AND MEASURE YOUR BODY FAT PERCENTAGE. WE THEN DEVELOP DIETARY RECOMMENDATIONS TO KEEP YOU AT YOUR HEALTHIEST. VITAMINS AND OTHER NUTRITIONAL SUPPLEMENTS ARE AVAILABLE AS PRESCRIBED BY OUR DIETITIANS OR REFERRING MEDICAL PROVIDERS. PHYSICAL THERAPY & PERSONAL TRAINING: MANY PATIENTS WITH CHRONIC HEALTH CONDITIONS, SUCH AS DIABETES OR HIV/AIDS, ARE PHYSICALLY IMPAIRED BY PAIN OR MUSCLE WEAKNESS THAT CAN RESTRICT THEIR ABILITY TO MOVE AND LIMIT THE PERFORMANCE OF DAILY ACTIVITIES. LEGACY'S FOCUS IS ON PREVENTION AND REHABILITATION THROUGH FITNESS AND PHYSICAL THERAPY TO RESTORE HEALTHY AND ACTIVE LIFESTYLES. WE USE TREATMENT TECHNIQUES THAT PROMOTE THE ABILITY TO MOVE, REDUCE PAIN, RESTORE FUNCTION, AND PREVENT DISABILITY.
990 REVIEW POLICY 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. A DRAFT OF THE ORGANIZATION'S FORM 990 IS FIRST REVIEWED IN DETAIL BY TOP MANAGEMENT AND THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS. ONCE ALL CHANGES ARE MADE, A FINAL DRAFT IS DISTRIBUTED TO THE ENTIRE BOARD FOR COMMENT.
CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12C EACH BOARD MEMBER IS REQUIRED TO ANNUALLY SIGN A CONFLICT OF INTEREST POLICY WHICH REQUIRES THEM TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. THE CHAIRMAN OF THE BOARD, ALONG WITH THE EXECUTIVE DIRECTOR, REVIEWS ANY POTENTIAL CONFLICT. IF THE CONFLICT IS PERTINENT TO A VOTE, THE MEMBER IS REQUIRED TO EXCUSE THEMSELVES FROM THE VOTE. MEMBERS OF THE BOARD MAY NOT BE AN EMPLOYEE OR INDEPENDENT CONTRACTOR, OR THE SPOUSE, SPOUSAL EQUIVALENT, CHILD, PARENT, BROTHER OR SISTER BY BLOOD OR MARRIAGE OR AN EMPLOYEE OR INDEPENDENT CONTRACTOR OF THE CORPORATION. MEMBERS OF THE BOARD, EMPLOYEES AND INDEPENDENT CONTRACTORS OF THE CORPORATION, WHO ALSO WORK FOR A CORPORATION WHICH IS DOING BUSINESS WITH THE CORPORATION MUST DISCLOSE THAT RELATIONSHIP TO THE EXECUTIVE DIRECTOR, OR, IN THE CASE OF A BOARD MEMBER, TO THE BOARD CHAIR. THE CORPORATION RETAINS THE RIGHT TO TAKE STEPS TO PROTECT ITS INTEREST IN SUCH CIRCUMSTANCES. NO BOARD MEMBER OR EMPLOYEE MAY PARTICIPATE IN THE SELECTION, AWARD OR ADMINISTRATION OF A CONTRACT IN WHICH HE/SHE OR HIS/HER IMMEDIATE FAMILY HAS A FINANCIAL INTEREST OR A PROSPECTIVE FINANCIAL ARRANGEMENT. THIS POLICY DOES NOT PROHIBIT OUTRIGHT THE AWARDING OF A CONTRACT TO ANY AGENCY OR FIRM MEETING THE CONDITION CITED ABOVE. RATHER THIS POLICY CALLS FOR THE FULL PROHIBITION OF THE EMPLOYEE OR BOARD MEMBER FROM PARTICIPATING IN THIS AWARD, SELECTION OR ADMINISTRATION OF SUCH A CONTRACT. BOARD MEMBERS SHOULD TAKE CAUTION NOT TO CREATE THE APPEARANCE OF A CONFLICT OF INTEREST IF IN THE PERFORMANCE OF THEIR DUTIES AT THEIR REGULAR PLACE OF EMPLOYMENT THEY ARE CALLED UPON TO NEGOTIATE WITH THE CORPORATION ON THE BEHALF OF THEIR EMPLOYER. BOARD MEMBERS SHOULD, WHENEVER POSSIBLE, ABSTAIN FROM SUCH ACTIVITIES. THE CORPORATION WILL BE SENSITIVE TO, AND WILL SEEK TO AVOID, ORGANIZATIONAL CONFLICTS OF INTEREST AND NON-COMPETITIVE PRACTICES IN THE PROCUREMENT OF GOODS AND SERVICES. IN ADDITION, CORPORATE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS OF INTEREST.
EXECUTIVE DIRECTOR COMPENSATION REVIEW FORM 990, PART VI, SECTION B, LINE 15A A COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR THE REVIEW PROCESS OF THE EXECUTIVE DIRECTOR. THE PROCESS INCLUDES THE USE OF 360 REVIEWS (INCLUDES STAFF AND BOARD MEMBERS) AND SALARY SURVEYS FROM UW AND OTHER SOURCES. THE COMMITTEE THEN RECOMMENDS THE COMPENSATION PACKAGE TO THE BOARD WHO APPROVES IT. THIS REVIEW IS DOCUMENTED IN THE BOARD OF DIRECTOR COMMITTEE MINUTES. A REVIEW OF THE EXECUTIVE DIRECTOR'S COMPENSATION WAS LAST CONDUCTED IN AUGUST 2012.
DOCUMENT DISCLOSURE FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST FOR A LEGITIMATE BUSINESS PURPOSE, AS DETERMINED BY TOP MANAGEMENT. COPIES WILL BE MAILED IF A BUSINESS PURPOSE IS DETERMINED.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES FORM 990, PART XI, LINE 5 (967,261) CHANGE IN INTEREST IN N/A OF LEGACY COMM HEALTH ENDOWMENT
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

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