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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
DOCTORS OF THE WORLD - USA INC
Employer identification number
35-2426718
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
15,100
477,434
1,136,631
1,629,165
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
15,100
477,434
1,136,631
1,629,165
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)..
1,011,993
6
Public support. Subtract line 5 from line 4.
617,172
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
15,100
477,434
1,136,631
1,629,165
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
79
79
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.)..
100
100
11
Total support (Add lines 7 through 10).
1,629,344
12
Gross receipts from related activities, etc. (see instructions)
..................
12
10,000
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
DOCTORS OF THE WORLD - USA INC
Employer identification number
35-2426718
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
IN MAY 2013, THE ORGANIZATION AMENDED ITS BYLAWS TO INCREASE TOTAL BOARD MEMBERS.
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS ONE MEMBER ORGANIZATION: MEDECINS DU MONDE FRANCE (MDM).
FORM 990, PART VI, SECTION A, LINE 7A
MEDECINS DU MONDE FRANCE (MDM) HAS THE ABILITY TO APPOINT THREE (3) OF THE TEN (10) BOARD MEMBERS OF DOCTORS OF THE WORLD, USA, INC.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 WAS PREPARED BY THE OUTSIDE ACCOUNTANT AND REVIEWED BY SENIOR MANAGEMENT. THE 990 WAS PROVIDED TO THE BOARD BEFORE IT WAS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12
THE CORPORATION MAY ACQUIRE GOODS OR SERVICES FROM, OR OTHERWISE TRANSACT BUSINESS WITH, AN INTERESTED PARTY IF THE BOARD DETERMINES IN ITS JUDGMENT THAT THE GOODS OR SERVICES PROVIDED TO THE CORPORATION ARE, OR THE TRANSACTION IS, ON TERMS NO LESS ADVANTAGEOUS TO THE CORPORATION THAN THE TERMS THAT ARE AVAILABLE TO THE CORPORATION FROM THIRD PARTIES. IF AN INTERESTED PARTY OFFERS TERMS WHICH ARE AS ADVANTAGEOUS TO THE CORPORATION AS TERMS OFFERED BY ANOTHER VENDOR, THE CORPORATION MAY, BUT IS NOT REQUIRED TO, CONSIDER OTHER BENEFITS DERIVED BY IT FROM THE INTERESTED PARTY (E.G., PAST OR ANTICIPATED SERVICES RENDERED OR FINANCIAL SUPPORT) IN SELECTING BETWEEN OTHERWISE EQUALLY DESIRABLE VENDORS. WHENEVER THE CORPORATION IS CONSIDERING ACQUIRING GOODS OR SERVICES FROM, OR ENTERING INTO A TRANSACTION WITH, AN INTERESTED PARTY, THE DETAILS THAT CREATE THE INTERESTED PARTY RELATIONSHIP ARE DISCLOSED TO THE CORPORATION IN WRITING. A COPY OF THE DISCLOSURE IS SUPPLIED TO THE BOARD. THE CORPORATION ENTERS INTO A TRANSACTION WITH AN INTERESTED PARTY (AN "INTERESTED PARTY TRANSACTION") ONLY IF THE BOARD IS MADE AWARE OF THE INFORMATION REGARDING THE TRANSACTION AND THE MAJORITY OF THE DIRECTORS THEN SERVING APPROVE THE TRANSACTION AS BEING FAIR AND IN THE BEST INTERESTS OF THE CORPORATION. ANY DIRECTOR WHO IS (OR HAS AN INTEREST IN OR IS RELATED TO) THE INTERESTED PARTY THAT IS A PARTY TO A PROPOSED TRANSACTION IS NOT CONSIDERED A DIRECTOR (INCLUDING, WITHOUT LIMITATION, FOR THE PURPOSE OF DETERMINING A QUORUM), WILL NOT PARTICIPATE IN THE VOTE ON THE TRANSACTION, AND WILL NOT ATTEND ANY MEETING WHILE THE APPROVAL OF THE TRANSACTION IS CONSIDERED. NOT WITHSTANDING THE FOREGOING, HOWEVER, PRIOR APPROVAL OF THE BOARD OF DIRECTORS IS NOT REQUIRED IF THE TRANSACTION FALLS BELOW A DE MINIMIS THRESHOLD ESTABLISHED BY THE BOARD. THE BOARD OF DIRECTORS PLANS TO CREATED A CONFLICT OF INTEREST COMMITTEE CONSISTING OF MEMBERS OF THE BOARD OF DIRECTORS TO WHICH IT DELEGATES RESPONSIBILITIES TO: A. DEVELOP PROCEDURES AND GUIDELINES (COLLECTIVELY CALLED "POLICIES") REGARDING INTERESTED PARTY TRANSACTIONS. SUCH POLICIES ARE ADOPTED BY THE VOTE OF A MAJORITY OF THE CONFLICT OF INTEREST COMMITTEE PRESENT AT THE TIME OF A VOTE, PROVIDED A QUORUM IS PRESENT AT THE TIME, AND ARE REPORTED TO THE BOARD. POLICIES ADOPTED BY THE CONFLICT OF INTEREST COMMITTEE ARE BINDING UPON THE CORPORATION UNLESS DISAPPROVED BY THE BOARD; B. MONITOR TRANSACTIONS WITH INTERESTED PARTIES; C. MAKE SUCH RECOMMENDATIONS AS IT MAY DEEM APPROPRIATE FROM TIME TO TIME FOR ACTIONS TO BE TAKEN BY THE BOARD WITH RESPECT TO INTERESTED PARTY TRANSACTIONS; D. INTERPRET THE ARTICLES OF INCORPORATION, BYLAWS, RELATING TO CONFLICTS OF INTEREST; E. ESTABLISH SUCH CRITERIA AS IT DEEMS APPROPRIATE FOR DE MINIMIS TRANSACTIONS THAT NEED NOT BE APPROVED; AND F. REPORT AT LEAST ONCE IN EACH CALENDAR YEAR TO THE BOARD ON THE ACTIVITIES OF THE CONFLICT OF INTEREST COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15A
COMPENSATION OF THE ORGANIZATION'S TOP MANAGEMENT OFFICIALS IS DETERMINED BASED ON THE UTILIZATION OF BENCHMARKING DATA FROM THREE COMPARABLE ORGANIZATIONS, BASED ON BUDGET SIZE AND NUMBER OF EMPLOYEES/PROGRAMS, WITH JOBS SIMILAR IN RESPONSIBILITIES AND DUTIES IN THE NOT-FOR-PROFIT, HUMANITARIAN SECTOR IN NEW YORK CITY. BENCHMARKING DATA WAS COLLECTED BY A THIRD-PARTY, INDEPENDENT EXECUTIVE RECRUITER (PATRICK SHIELDS OF GLOBAL RECRUITMENT SPECIALISTS) WITH EXTENSIVE HUMAN RESOURCE EXPERIENCE IN THE HUMANITARIAN AND INTERNATIONAL DEVELOPMENT SPACE. DATA IS THEN REVIEWED, APPROVED AND ADOPTED BY THE EXECUTIVE COMMITTEE OF THE MDM USA BOARD OF DIRECTORS. THE COMPENSATION PROCESS WAS DOCUMENTED AND THE LAST REVIEW TOOK PLACE IN AUGUST 2012.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.