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
North Carolina Alliance of Public Health Agencies Inc
Employer identification number
56-1916473
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(A)
NC Dept of Health & Human Resources
561636462
6
No
No
No
0
(B)
Yancey County Health Department
561272202
6
No
No
No
0
(C)
Yadkin County Health Department
566000352
6
No
No
No
0
(D)
Wilson County Health Department
566000351
6
No
No
No
0
(E)
Wilkes County Health Department
566000350
6
No
No
No
0
(F)
Wayne County Health Department
566001520
6
No
No
No
0
(G)
Watauga County Health Department
566001534
6
No
No
No
0
(H)
Washington County Health Department
561066387
6
No
No
No
0
(I)
Warren County Health Department
566000348
6
No
No
No
0
(J)
Wake County Health Department
566000347
6
No
No
No
0
(K)
Vance County Health Department
561060453
6
No
No
No
0
(L)
Union County Health Department
566000345
6
No
No
No
0
(M)
Tyrrell County Health Dept
561066387
6
No
No
No
0
(N)
Transylvania County Health Dept
566000343
6
No
No
No
0
(O)
Swain County Health Dept
561829153
6
No
No
No
0
(P)
Surry County Health & Nutrition Cen
566000341
6
No
No
No
0
(Q)
Stokes County Health Department
566000340
6
No
No
No
0
(R)
Stanly County Health Department
566001537
6
No
No
No
0
(S)
Scotland County Health Department
566000339
6
No
No
No
0
(T)
Sampson County Health Department
566000338
6
No
No
No
0
(U)
Rutherford County Health Dept
566000900
6
No
No
No
0
(V)
Rowan County Health Dept
566000336
6
No
No
No
0
(W)
Rockingham County Health Department
566001527
6
No
No
No
0
(X)
Robeson County Health Department
566000335
6
No
No
No
0
(Y)
Richmond County Health Dept
566000334
6
No
No
No
0
(Z)
Randolph County Health Dept
566001526
6
No
No
No
0
(AA)
Polk County Health Department
566000900
6
No
No
No
0
(AB)
Pitt County Health Department
566000332
6
No
No
No
0
(AC)
Person County Health Department
566000331
6
No
No
No
0
(AD)
Perquimans County Health Dept
566000798
6
No
No
No
0
(AE)
Pender County Health Dept
566000329
6
No
No
No
0
(AF)
Pasquotank County Health Dept
566000798
6
No
No
No
0
(AG)
Pamlico County Health Department
566000949
6
No
No
No
0
(AH)
Orange County Health Department
566000327
6
No
No
No
0
(AI)
Onslow County Health Department
566000326
6
No
No
No
0
(AJ)
Northampton County Health Departmen
566000325
6
No
No
No
0
(AK)
New Hanover County Health Departmen
566000324
6
No
No
No
0
(AL)
Nash County Health Department
566000323
6
No
No
No
0
(AM)
Moore County Health Department
566000322
6
No
No
No
0
(AN)
Montgomery County Health Department
566000321
6
No
No
No
0
(AO)
Mecklenburg County Department of He
566000319
6
No
No
No
0
(AP)
McDowell County Health Department
566000900
6
No
No
No
0
(AQ)
Martin County Health Department
561066387
6
No
No
No
0
(AR)
Madison County Health Department
566000316
6
No
No
No
0
(AS)
Macon County Health Department
566000930
6
No
No
No
0
(AT)
Lincoln County Health Department
566000315
6
No
No
No
0
(AU)
Lenoir County Health Department
566000627
6
No
No
No
0
(AV)
Lee County Health Department
566000313
6
No
No
No
0
(AW)
Jones County Health Department
566000312
6
No
No
No
0
(AX)
Johnston County Health Department
566000311
6
No
No
No
0
(AY)
Jackson County Health Department
566000310
6
No
No
No
0
(AZ)
Iredell County Health Department
566000309
6
No
No
No
0
(BA)
Hyde County Health Department
566000308
6
No
No
No
0
(BB)
Hoke County Health Department
566001525
6
No
No
No
0
(BC)
Hertford County Public Health Autho
201073639
6
No
No
No
0
(BD)
Henderson County Health Department
566000307
6
No
No
No
0
(BE)
Haywood County Health Department
566001524
6
No
No
No
0
(BF)
Harnett County Health Depatment
566000306
6
No
No
No
0
(BG)
Halifax County Health Dept
566001836
6
No
No
No
0
(BH)
Guilford County Health Department
566000305
6
No
No
No
0
(BI)
Greene County Health Department
566000304
6
No
No
No
0
(BJ)
Granville County Health Department
561060453
6
No
No
No
0
(BK)
Graham County Health Department
566000302
6
No
No
No
0
(BL)
Gates County Health Department
566000798
6
No
No
No
0
(BM)
Gaston County Health Department
566000300
6
No
No
No
0
(BN)
Franklin County Health Department
566000299
6
No
No
No
0
(BO)
Forsyth County Health Department
566000450
6
No
No
No
0
(BP)
Edgecombe County Health Department
566000298
6
No
No
No
0
(BQ)
Durham County Health Department
566000297
6
No
No
No
0
(BR)
Duplin County Health Department
566000296
6
No
No
No
0
(BS)
Davie County Health Department
566000295
6
No
No
No
0
(BT)
Davidson County Health Department
566000294
6
No
No
No
0
(BU)
Dare County Dept of Public Health
566000293
6
No
No
No
0
(BV)
Currituck County Health Department
566000798
6
No
No
No
0
(BW)
Cumberland County Health Department
566000291
6
No
No
No
0
(BX)
Craven County Health Department
566000290
6
No
No
No
0
(BY)
Columbus County Health Dept
566000289
6
No
No
No
0
(BZ)
Cleveland County Health Department
566000288
6
No
No
No
0
(CA)
Clay County Health Department
566000287
6
No
No
No
0
(CB)
Chowan County Health Department
566000798
6
No
No
No
0
(CC)
Cherokee County Health Department
566000285
6
No
No
No
0
(CD)
Chatham County Health Department
566000284
6
No
No
No
0
(CE)
Catawba County Health Department
566001814
6
No
No
No
0
(CF)
Caswell County Health Department
566000283
6
No
No
No
0
(CG)
Carteret County Health Department
566001522
6
No
No
No
0
(CH)
Camden County Health Department
566000798
6
No
No
No
0
(CI)
Caldwell County Health Department
566001967
6
No
No
No
0
(CJ)
Cabarrus County Health Department
562016594
6
No
No
No
0
(CK)
Buncombe County Health Department
566000279
6
No
No
No
0
(CL)
Brunswick County Health Department
566000278
6
No
No
No
0
(CM)
Bladen County Health Department
566000277
6
No
No
No
0
(CN)
Bertie County Health Department
566000798
6
No
No
No
0
(CO)
Beaufort County Health Department
566001521
6
No
No
No
0
(CP)
Avery County Health Department
561272202
6
No
No
No
0
(CQ)
Ashe County Health Department
566001534
6
No
No
No
0
(CR)
Anson County Health Department
566000273
6
No
No
No
0
(CS)
Alleghany County Health Department
566001534
6
No
No
No
0
(CT)
Alexander County Health Department
566000272
6
No
No
No
0
(CU)
Albemarle Regional Health Services
566000798
6
No
No
No
0
(CV)
Alamance County Health Department
566000271
6
No
No
No
0
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
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
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:
12000229
Software Version:
2012v2.0
-
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
North Carolina Alliance of Public Health Agencies Inc
Employer identification number
56-1916473
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The organization's governing documents and three most recent Forms 990 (including financial information) are available to the public upon request.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
The Executive Director's compensation is determined by several factors. In the past, when she received a significant increase it was reviewed and approved by the Board of Directors (as are all salary increases). The amount of the raise was determined after careful consideration of salary data found in multiple salary surveys. Other increases are approved by the Board of Directors and implemented on the employee's service anniversary date. All discussions are documented in the meeting minutes.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
Conflicts of interest are monitored and documented in the meeting minutes. If there is a conflict, the person recuses themselves from the discussion and vote.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
Prior to filing, the Form 990 will be reviewed by the bookkeeper, Finance Director and Executive Director. It will then be e-mailed to the Board Members for review.
Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders
Except for the initial directors, election to the Board of Directors is by plurality vote of a quorum of the members of the organization. The presence in person or by proxy of one-third of the members of record entitled to vote on the matter before the meeting shall constitute a quorum. The Board of Directors alone, without approval of the members, has the power to make, adopt, alter, amend and repeal from time to time bylaws of the organization.
Form 990, Part VI, Line 7a
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body
Except for the initial directors, election to the Board of Directors is by plurality vote of a quorum of the members of the organization. The presence in person or by proxy of one-third of the members of record entitled to vote on the matter before the meeting shall constitute a quorum.
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
The members of the organization consist of those North Carolina Division of Public Health, the North Carolina Division of Environmental Health, and those North Carolina county home health agencies, those North Carolina county health departments, those North Carolina multi-county district health departments, and those North Carolina public hospitals and hospital authorities (1) that provide Medicare certified home health services, or that provide clinical health services, or that provide other essential public health services, (2) that apply for membership in the organization and are accepted, and (3) that pay the membership fee as established by the organization's Board of Directors. No private person, private corporation, private party or entity that is or may be liable for income tax may be a member of the organization.
Form 990, Part VI, Line 4
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents
The filing organization's articles of incorporation were amended as follows: [1] members no longer need to apply and be accepted, but instead all of the instrumentalities listed in the articles are members as a function of their existence and no application is needed; [2] the purpose of the filing organization is to be operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more organizations described in Code Sections 509(a)(1) or 509(a)(2), specifically including the member organizations of the filing organization that offer public health services to members of the general population of North Carolina.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.