Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
HUNTER HEALTH CLINIC INC
Employer identification number
48-0908355
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
4,379,698
4,256,659
5,061,592
1,573,327
639,409
15,910,685
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..
4,379,698
4,256,659
5,061,592
1,573,327
639,409
15,910,685
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)..
2,094,768
6
Public Support. Subtract line 5 from line 4.
13,815,917
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..
4,379,698
4,256,659
5,061,592
1,573,327
639,409
15,910,685
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
12,356
7,158
5,837
3,910
1,509
30,770
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..
30,288
110,427
67,285
131,060
223,465
562,525
11
Total support (Add lines 7 through 10).
16,503,980
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
27,073,799
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
83.713 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
73.110 %
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
HUNTER HEALTH CLINIC INC
Employer identification number
48-0908355
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
THE US DEPT OF HEALTH AND HUMAN SERVICES (DHHS) AND INDIAN HEALTH SERVICES (IHS) PROVIDE SUBSTANTIAL SUPPORT TO THE CENTER. THE CENTER IS OBLIGATED UNDER THE TERMS OF THE GRANTS TO COMPLY WITH SPECIFIED CONDITIONS AND PROGRAM REQUIREMENTS SET FOR THE GRANTOR. PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A MOST OF THE PATIENTS HAD NO PUBLIC OR PRIVATE INSURANCE AND MANY REQUIRE INTERPRETATION SERVICES. THE PATIENT POPULATION AT HUNTER HEALTH CLINIC IS DIVERSE: 37% CAUCASIAN, 28% HISPANIC/LATINO, 18% AFRICAN AMERICAN, 13% NATIVE AMERICAN AND 4% ASIAN. OTHER PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4D OTHER FEDERAL/STATE/PRIVATE GRANTS & CONTRACTS
FORM 990 REVIEW
FORM 990, PART VI, SECTION B, LINE 11B
THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO MANAGEMENT FOR REVIEW AND ANY QUESTIONS OR MODIFICATIONS ARE ADDRESSED. A COPY OF THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD PRIOR TO FILING WITH THE IRS.
CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
HUNTER HEALTH CLINIC HAS A FORMAL CONFLICT OF INTEREST POLICY THAT SERVES AS A GUIDE IN THE ORGANIZATION'S MANAGEMENT OF POTENTIAL CONFLICTS OF INTEREST. HUNTER'S POLICY FOCUSES ON A BROAD CLASS OF TRANSACTIONS AND ALL OFFICERS, DIRECTORS, BOARD MEMBERS AND KEY EMPLOYEES ARE REQUIRED TO REVIEW THE POLICY, MAKE ANY RELATED DISCLOSURES AND TO SIGN ACKNOWLEDGEMENT OF THE POLICY ANNUALLY. EACH BOARD MEMBER IS RESPONSIBLE FOR SELF-REPORTING ANY POTENTIAL CONFLICTS OF INTEREST TO THE FULL BOARD. THE BOARD AS A WHOLE WILL DETERMINE WHETHER A CONFLICT DOES, IN FACT, EXIST. A CONFLICTED BOARD MEMBER WILL ABSTAIN FROM VOTING ON THE MATTER OF CONFLICT.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINES 15A & 15B
COMPENSATION FOR OFFICERS, DIRECTORS, AND KEY EMPLOYEES IS SET IN ADVANCE USING APPROPRIATE COMPARABILITY DATA. REASONABLE COMPENSATION IS DETERMINED BY USING DATA FROM LIKE SERVICES/INDUSTRIES, LIKE ENTERPRISES (TAXABLE OR TAX EXEMPT), AND UNDER LIKE CIRCUMSTANCES, AMONG OTHER DATA ELEMENTS. THE BOARD OF DIRECTORS SETS THE SALARY FOR THE CHIEF EXECUTIVE OFFICER AND POLICIES DICTATE THAT NO ONE INVOLVED IN SETTING SALARIES HAS A CONFLICT OF INTEREST. THE DELIBERATION AND DECISION SURROUNDING COMPENSATION IS DOCUMENTED AND FILED IN THE PERSONNEL FILES. THE CHIEF EXECUTIVE OFFICER SETS THE SALARY FOR OTHER OFFICERS, DIRECTORS, AND KEY EMPLOYEES BASED ON LOCAL MARKET CONDITIONS.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, SECTION C, LINE 19
IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS, THE ORGANIZATION MAKES ITS BOARD MEETING MINUTES AVAILABLE UPON REQUEST AT THE PRINCIPAL OFFICE OF THE CORPORATION. HOWEVER, THE ORGANIZATION GENERALLY DOES NOT MAKE ITS OTHER GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.