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
GATEWAY HEALTHCARE INC
Employer identification number
05-0309043
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.") .
11,173,920
8,839,870
8,294,399
6,076,891
9,655,331
44,040,411
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......
34,604,459
33,827,414
32,906,920
31,876,602
30,700,269
163,915,664
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
433,500
433,500
433,500
433,500
433,500
2,167,500
6
Total. Add lines 1 through 5.
46,211,879
43,100,784
41,634,819
38,386,993
40,789,100
210,123,575
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public support (Subtract line 7c from line 6.)
210,123,575
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...
46,211,879
43,100,784
41,634,819
38,386,993
40,789,100
210,123,575
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
26,520
-19,946
103,462
22,553
7,999
140,588
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
26,520
-19,946
103,462
22,553
7,999
140,588
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
1,421,059
2,280,339
3,378,771
3,804,200
2,069,569
12,953,938
13
Total support. (Add lines 9, 10c, 11, and 12.)..
47,659,458
45,361,177
45,117,052
42,213,746
42,866,668
223,218,101
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
94.134 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
94.850 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.063 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
0.090 %
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 (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
GATEWAY HEALTHCARE INC
Employer identification number
05-0309043
Identifier
Return Reference
Explanation
ORGANIZATION MISSION
PART I, LINE 1
GATEWAY OFFERS AN EXTENSIVE CONTINUUM OF SERVICES THAT SUPPORTS ITS MISSION OF PROMOTING RESILIENCY AND ASSISTING INDIVIDUALS IN THEIR RECOVERY. THESE INCLUDE AROUND-THE-CLOCK PSYCHIATRIC EMERGENCY SERVICES, PSYCHIATRIC MEDICATION THERAPY SERVICES, OUTPATIENT COUNSELING FOR INDIVIDUALS AND FAMILIES, SPECIALIZED RESIDENTIAL CARE FOR CHILDREN AND ADOLESCENTS, PERMANENT AFFORDABLE HOUSING FOR ADULTS, SUPERVISED ADULT RESIDENTIAL SERVICES, ADULT SUPPORTED HOUSING SERVICES, MENTAL HEALTH SERVICES FOR ADULTS WITH PERSISTENT MENTAL HEALTH ISSUES, A LICENSED SCHOOL FOR CHILDREN WITH EMOTIONAL AND BEHAVIORAL DIFFICULTIES, NATIONALLY RECOGNIZED VOCATIONAL AND OCCUPATIONAL REHABILITATION SERVICES, A THERAPEUTIC OUTDOOR RECREATION PROGRAM FOR CHILDREN AND ADOLESCENTS, A HOMELESS SHELTER FOR FAMILIES, RESIDENTIAL SUBSTANCE ABUSE SERVICES, AS WELL AS INDIVIDUAL AND CASE MANAGEMENT SERVICES FOR ADULTS AND CHILDREN.
DONOR ACKNOWLEDGEMENTS
PART V, LINE 7B
THE AGENCY HAD SENT OUT DONOR ACKNOWLEDGEMENT LETTERS TO THE VARIOUS CONTRIBUTORS OF THE EVENTS, HOWEVER THE LETTERS DID NOT CONTAIN THE RECOGNIZED TAX DEDUCTIBLE INFORMATION. EFFECTIVE JANUARY 1, 2014, THE AGENCY HAS IMPLEMENTED POLICIES AND PROCEDURES RELATED TO THE ISSUANCE OF ACKNOWLEDGEMENTS AS REQUIRED BY INTERNAL REVENUE CODE 6115.
BUSINESS RELATIONSHIPS
PART VI, SECTION A, LINE 2
SCOTT DICHRISTOFERO, VP OF FINANCE, AND KATHERINE POWELL, VP OF CHILDREN'S SERVICES ARE EMPLOYED BY GATEWAY HEALTHCARE, INC. AND ARE ALSO OFFICERS OF GATEWAY PROFESSIONAL GROUP, A RELATED FOR PROFIT CORPORATION.
FORM 990 REVIEW PROCESS
PART VI, SECTION B, LINE 11B
THE PREPARATION AND FILING OF THE FORM 990 AND SUPPORTING SCHEDULES IS THE RESPONSIBILITY OF THE CHIEF FINANCIAL OFFICER AND GATEWAY'S FINANCE DEPARTMENT, WITH REVIEW BY GATEWAY'S TAX ADVISORS, KPMG LLP. PRIOR TO FILING FORM 990 WITH THE INTERNAL REVENUE SERVICE, THE EVP & CFO OF LIFESPAN CORPORATION WILL COORDINATE A VIDEO PRESENTATION TO THE BOARD OF DIRECTORS TO REVIEW THE RETURN AND DISCUSS THE HIGHLIGHTS THAT OCCURRED DURING THE YEAR. AFTER THIS PRESENTATION ANY QUESTIONS AND COMMENTS WILL BE ADDRESSED AND ANY CHANGES, IF NECESSARY, BASED ON COMMENTS FROM THE BOARD ARE INCLUDED IN THE RETURN. ONCE THE FORM 990 IS COMPLETE AND READY TO BE FILED, THE MEMBERS OF THE BOARD ARE NOTIFIED VIA EMAIL THAT A COPY OF THE FINAL VERSION OF THE FORM 990 IS ACCESSIBLE THROUGH A PASSWORD PROTECTED WEBSITE PORTAL. THE CHIEF FINANCIAL OFFICER IS THEN AUTHORIZED TO FILE THE FORM 990.
CONFLICT OF INTEREST POLICY
PART VI, SECTION B, LINE 12C
GATEWAY HEALTHCARE, INC. (GATEWAY) HAS A CONFLICT OF INTEREST POLICY THAT IS APPLICABLE TO ALL GATEWAY HEALTHCARE AFFILIATES AND IS ADMINISTERED BY GATEWAY'S BOARD CHAIRPERSON. THE PRESIDENT/CEO ANNUALLY DISTRIBUTES CONFLICT OF INTEREST DISCLOSURE FORMS TO BOARD MEMBERS, LEADERSHIP, AND OTHERS AS DETERMINED BY THE BOARD. ALL RECEIVING THESE DISCLOSURE FORMS ARE TO COMPLETE AND RETURN THEM AS DIRECTED. WHEN A CONFLICT OR POTENTIAL CONFLICT IS DISCLOSED, THE BOARD CHAIR AND/OR PRESIDENT/CEO ARE TO DETERMINE THE APPROPRIATE RESPONSE TO THE DISCLOSURE, CONSULTING WITH LEGAL COUNSEL AS NECESSARY AND REPORTING THE CONFLICT AND RESPONSE TO THE BOARD AND TO OTHERS, INCLUDING PROVIDERS WHEN DEEMED APPROPRIATE. AT ANYTIME THAT A BOARD OR LEADERSHIP MEMBER HAS KNOWLEDGE OF A REAL OR POTENTIAL CONFLICT OF INTEREST AS DEFINED IN GATEWAY'S BYLAWS, HE/SHE IS TO DISCLOSE SUCH TO THE BOARD CHAIR OR PRESIDENT/CEO AND IS NOT TO VOTE OR IN OTHER WAYS MAKE DECISIONS THAT RELATE TO THE AREA OF CONFLICT.
COMPENSATION POLICY
PART VI, SECTION B, LINE 15
THE COMPENSATION OF THE PRESIDENT/CEO IS DETERMINED BY THE GATEWAY HEALTHCARE, INC. BOARD OF DIRECTORS AND IS REVIEWED ANNUALLY FOLLOWING THE ANNUAL PERFORMANCE EVALUATION PROCESS. THE EXECUTIVE COMMITTEE OF THE BOARD WHO IS INDEPENDENT OF MANAGEMENT AND FREE OF ANY CONFLICTS OF INTEREST THAT WOULD INTERFERE WITH THEIR EXERCISE OF INDEPENDENT JUDGMENT SERVES AS A COMPENSATION COMMITTEE AND APPROVES THE COMPENSATION DECISION IN ADVANCE OF PAYMENT. THE COMMITTEE REVIEWS THE CURRENT SALARY AND COMPARES IT TO AVAILABLE COMPENSATION DATA FOR LOCAL NON-PROFITS AND REGIONAL BEHAVIORAL HEALTH PROVIDERS. THE COMMITTEE ADEQUATELY DOCUMENTS THE BASIS FOR ITS DETERMINATION CONCURRENTLY UPON MAKING THE COMPENSATION DECISION.
PUBLIC DISCLOSURE
PART VI, SECTION B, LINE 19
THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND 990 RETURNS AVAILABLE UPON REQUEST. THE ORGANIZATION WILL PROVIDE COPIES TO THOSE WHO COME TO THE ADMINISTRATIVE OFFICE DURING NORMAL BUSINESS HOURS OR REQUEST A COPY BY US MAIL. THE 990 REPORT IS ALSO AVAILABLE ON WWW.GUIDESTAR.ORG.
OTHER CHANGES IN NET ASSETS
PART XI, LINE 9
LIABILITIES OF MERGED ENTITIES $ (3,907,643)
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.