Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FOUNDATION FOR PHYSICAL THERAPY INC
Employer identification number
13-6161225
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2,029,850
2,283,609
1,644,460
1,455,973
2,203,550
9,617,442
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......
238,614
224,649
182,373
157,591
22,085
825,312
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.
2,268,464
2,508,258
1,826,833
1,613,564
2,225,635
10,442,754
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
555,290
758,515
774,827
557,481
1,198,025
3,844,138
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.
0
c
Add lines 7a and 7b..
555,290
758,515
774,827
557,481
1,198,025
3,844,138
8
Public support (Subtract line 7c from line 6.)
6,598,616
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
2,268,464
2,508,258
1,826,833
1,613,564
2,225,635
10,442,754
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
105,443
108,070
107,481
121,247
143,524
585,765
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
105,443
108,070
107,481
121,247
143,524
585,765
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.)
..
9,951
1,486
2,436
5,093
2,795
21,761
13
Total support. (Add lines 9, 10c, 11, and 12.)..
2,383,858
2,617,814
1,936,750
1,739,904
2,371,954
11,050,280
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
59.710 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
70.130 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
5.300 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
5.650 %
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
SCHEDULE A, PART II, LINE 12, EXPLANATION OF OTHER INCOME: UNEXPENDED GRANT FUNDS - 2008 AMOUNT: $ 7,507. MISCELLANEOUS INCOME - 2008 AMOUNT: $ 2,444. 2009 AMOUNT: $ 1,486. 2010 AMOUNT: $ 2,436. 2011 AMOUNT: $ 5,093. 2012 AMOUNT: $ 2,795.
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
FOUNDATION FOR PHYSICAL THERAPY INC
Employer identification number
13-6161225
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 3
PERSONNEL FROM AMERICAN PHYSICAL THERAPY ASSOCIATION HAVE A ROLE IN THE MANAGEMENT OF THE FOUNDATION FOR PHYSICAL THERAPY.
FORM 990, PART VI, SECTION A, LINE 4
THE FOUNDATION MADE THE FOLLOWING CHANGES TO THE BYLAWS SINCE THE 2011 FORM 990 WAS FILED: 1- THE MAXIMUM NUMBER OF ALLOWABLE BOARD MEMBERS INCREASED FROM 12 TO 16. 2- PURPOSE STATEMENT CHANGED FROM "THE PURPOSE OF THE FOUNDATION FOR PHYSICAL THERAPY, INC. (THE "FOUNDATION") IS TO ADVANCE THE PRACTICE AND ART OF PHYSICAL THERAPY BY SUPPORTING AND CONDUCTING RESEARCH." TO "THE PURPOSE OF THE FOUNDATION FOR PHYSICAL THERAPY, INC. (THE "FOUNDATION") IS AS PROVIDED FOR IN THE FOUNDATION'S ARTICLES OF INCORPORATION." 3- OFFICER POSITION OF PRESIDENT-ELECT CHANGED TO VICE PRESIDENT. 4- CHANGED TERMS FOR ALL OFFICERS FROM TWO YEARS TO ONE YEAR.
FORM 990, PART VI, SECTION A, LINE 7B
ANY CHANGE TO THE FOUNDATION'S GOVERNING DOCUMENTS IS REQUIRED TO BE RATIFIED BY THE BOARD OF DIRECTORS FOR THE AMERICAN PHYSICAL THERAPY ASSOCIATION.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 OF THE FOUNDATION FOR PHYSICAL THERAPY IS MADE AVAILABLE TO THE GOVERNING BODY FOR REVIEW PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
ANY POSSIBLE CONFLICT OF INTEREST ON THE PART OF ANY MEMBER OF THE BOARD OF TRUSTEES, OFFICER, OR EMPLOYEE OF THE FOUNDATION, SHALL BE DISCLOSED IN WRITING TO THE BOARD AND MADE A MATTER OF RECORD THROUGH AN ANNUAL PROCEDURE AND ALSO WHEN THE INTEREST INVOLVES A SPECIFIC ISSUE BEFORE THE BOARD. FOLLOWING FULL DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST, THE BOARD OF DIRECTORS SHALL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS AND, IF SO THE BOARD SHALL VOTE TO AUTHORIZE OR REJECT THE TRANSACTION OR TAKE ANY OTHER ACTION DEEMED NECESSARY TO ADDRESS THE CONFLICT AND PROTECT THE FOUNDATIONS BEST INTERESTS. BOTH VOTES SHALL BE BY A MAJORITY VOTE WITHOUT COUNTING THE VOTE OF ANY INTERESTED DIRECTOR, EVEN IF THE DISINTERESTED DIRECTORS ARE LESS THAN A QUORUM PROVIDED THAT AT LEAST ONE CONSENTING DIRECTOR IS DISINTERESTED. THE MINUTES OF THE MEETING SHALL REFLECT THAT A DISCLOSURE WAS MADE, THE ABSTENTION FROM VOTING, AND THE ACTUAL VOTE ITSELF. EVERY NEW MEMBER OF THE BOARD WILL BE ADVISED OF THIS POLICY UPON ENTERING THE DUTIES OF HIS OR HER OFFICE, AND SHALL SIGN A STATEMENT ACKNOWLEDGING, UNDERSTANDING OF, AND AGREEMENT TO THIS POLICY.
FORM 990, PART VI, SECTION B, LINE 15A
THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED IN CONJUNCTION WITH THE FOUNDATION'S BOARD AND WITH THE AMERICAN PHYSICAL THERAPY ASSOCIATION. THE EXECUTIVE DIRECTOR'S COMPENSATION MUST BE IN A RANGE THAT IS CONSISTENT WITH OTHER EMPLOYEES OF THE AMERICAN PHYSICAL THERAPY ASSOCIATION, HOWEVER THE FOUNDATION'S BOARD SETS THE COMPENSATION WITHIN THE ALLOWABLE RANGE. THE EXECUTIVE DIRECTOR'S COMPENSATION WAS LAST REVIEWED IN DECEMBER 2012.
FORM 990, PART VI, SECTION C, LINE 19
COPIES OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC BY REQUEST.
FORM 990, PART V, LINE 2B: THE FOUNDATION PAYS OFFICER AND EMPLOYEE SALARIES. THROUGH A MANAGEMENT SERVICES AGREEMENT, FOUNDATION PERSONNEL ARE DEEMED AMERICAN PHYSICAL THERAPY ASSOCIATION (APTA) EMPLOYEES FOR PAYROLL AND BENEFIT PURPOSES ONLY; AS SUCH, FORM W-2S ARE ISSUED BY APTA UNDER THEIR RESPECTIVE TAX IDENTIFICATION NUMBER.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.