Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 10-01-2012 , 2012, and ending 09-30-2013
BCheck if applicable:
CName of organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Doing Business As
THE IMMUNIZATION PARTNERSHIP
 
Number and street (or P.O. box if mail is not delivered to street address)
3000 RICHMOND STE 200B
 
Room/suite
City or town, state or country, and ZIP + 4
HOUSTON, TX77098
D Employer identification number

76-0695612
E Telephone number

G Gross receipts $ 1,184,520
F Name and address of principal officer:
ANNA C DRAGSBAEK
3000 RICHMOND AVE STE 200B
HOUSTON,TX77098
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.IMMUNIZEUSA.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 2001
M State of legal domicile: TX
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: OUR MISSION IS TO ERADICATE VACCINE-PREVENTABLE DISEASES BY EDUCATING THE COMMUNITY, ADVOCATING FOR EVIDENCE-BASED PUBLIC POLICY AND SUPPORTING IMMUNIZATION BEST PRACTICES.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 16
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 13
6 Total number of volunteers (estimate if necessary) ............. 6 62
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b  
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 762,874 1,164,582
9 Program service revenue (Part VIII, line 2g) ......... 17,175 0
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 390 530
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) -4,440 -25,756
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 775,999 1,139,356
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 4,500 40,100
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 420,777 534,940
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet113,706    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 294,129 254,861
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 719,406 829,901
19 Revenue less expenses. Subtract line 18 from line 12....... 56,593 309,455
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 424,264 699,818
21 Total liabilities (Part X, line 26)............. 62,472 35,267
22 Net assets or fund balances. Subtract line 21 from line 20..... 361,792 664,551
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: OUR MISSION IS TO ERADICATE VACCINE-PREVENTABLE DISEASES BY EDUCATING THE COMMUNITY, ADVOCATING FOR EVIDENCE-BASED PUBLIC POLICY AND SUPPORTING IMMUNIZATION BEST PRACTICES.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 227,404 including grants of $   ) (Revenue $   )
EDUCATION - TIP CONDUCTS COMMUNITY FORUMS, OR LUNCH & LEARNS, WHERE EXPERTS SHARE INFORMATION ON CURRENT TOPICS IN IMMUNIZATIONS. WHILE GEARED SPECIFICALLY TOWARD FRONT-LINE IMMUNIZERS (REGISTERED NURSES, MEDICAL ASSISTANTS, ETC.),THESE EVENTS ARE FREE AND OPEN TO ALL WHO ARE INTERESTED IN THE TOPIC. THIS PAST YEAR, TIP HELD TWO FORUMS: ADULT VACCINES & VACCINES IN PREGNANCY, AND PRACTICAL STRATEGIES TO IMPROVE HPV VACCINATION COVERAGE. BOTH FORUMS WERE WELL-ATTENDED WITH ROUGHLY 133 MEMBERS OF THE IMMUNIZATION STAKEHOLDER COMMUNITY PRESENT, INCLUDING: HEALTHCARE PROFESSIONALS, SCHOOL OFFICIALS AND PUBLIC HEALTH PROFESSIONALS. SEE SCHEDULE O FOR MORE INFORMATION ON EDUCATION EDUCATION, CONTINUED POST-EVENT SURVEYS SHOWED AN OVERWHELMING MAJORITY OF PARTICIPANTS RESPONDED THAT THEY LEARNED SOMETHING NEW DURING THE FORUMS AND WOULD ATTEND MORE EVENTS HOSTED BY TIP. THE COMMUNITY IMMUNITY EXERCISE IS AN INTERACTIVE DEMONSTRATION OF HOW ONE'S VACCINATION STATUS CAN CONTRIBUTE TO HOW FAR AND HOW QUICKLY THE FLU CAN SPREAD THROUGH A COMMUNITY. THE ENTIRE EXERCISE TAKES ABOUT 10 MINUTES WITH MINIMAL MATERIALS AND CAN BE DONE WITH GROUPS AS SMALL AS 20 PEOPLE. WITH THE HELP OF SEVEN NEW VOLUNTEERS, KNOWN AS AMBASSADORS, TIP PRESENTED THE ACTIVITY TO AN ESTIMATED 700 PARTICIPANTS DURING THE 2012/2013 FISCAL YEAR. IN ORDER TO MAXIMIZE THE EXERCISE'S IMPACT, TIP IS UNDERGOING A QUALITY IMPROVEMENT PROJECT TO STREAMLINE THE VOLUNTEER TRAINING PROCESS, AS WELL AS PROVIDE A MORE DATA-DRIVEN STRUCTURE TO DETERMINE WHERE AND TO WHOM THE EXERCISE SHOULD BE PRESENTED. THE NEW PROJECT WILL BE KNOWN AS VACFLU, AND A PILOT OF THE PROJECT WILL BE CONDUCTED IN EARLY 2014.
4b (Code:   ) (Expenses $ 197,085 including grants of $ 100 ) (Revenue $   )
ADVOCACY - TIP KICKED OFF THE 83RD LEGISLATIVE SESSION WITH ITS SECOND TIP LEGISLATIVE DAY AT THE CAPITOL IN AUSTIN. THE EVENT WAS A TREMENDOUS SUCCESS. TWENTY-FOUR (24) STAKEHOLDERS TRAVELED FROM SEVEN CITIES ACROSS TEXAS TO ADVOCATE ON BEHALF OF CRITICAL ISSUES. AFTER AN INFORMATIVE BRIEFING AND INSPIRING KEYNOTE ADDRESSES BY REPRESENTATIVES DONNA HOWARD AND JOHN ZERWAS, OUR PARTNERS WALKED THE CAPITOL, CONDUCTING OVER 80 VISITS IN FOUR HOURS. THE PARTICIPANTS COMPLETED THE DAY WITH A POST-LEGISLATIVE DAY CELEBRATION. OVERALL, PARTICIPANTS FELT THE EVENT WAS WELL-PLANNED AND REWARDING. SEE SCHEDULE O FOR MORE INFORMATION ON ADVOCACY. ADVOCACY, CONTINUED IN COLLABORATION WITH OUR COMMUNITY PARTNERS, TIP WORKED THROUGHOUT THE 83RD TEXAS LEGISLATIVE SESSION TO PROMOTE EVIDENCE-BASED LEGISLATION TO IMPROVE ACCESS TO IMMUNIZATIONS, SAVE LIVES, AND ENSURE THAT WE PROTECT THOSE MOST AT RISK FROM VACCINE-PREVENTABLE DISEASES. TIP STAFF COMPILED AND DISTRIBUTED SEVEN ALERTS, PREPARED AND DELIVERED 11 TESTIMONIES AND PRESENTATIONS, AND CONDUCTED APPROXIMATELY 300 LEGISLATIVE VISITS IN SUPPORT OF LEGISLATION. TIP ACTIVELY ADVOCATED FOR FOUR PIECES OF LEGISLATION, OF WHICH THREE SUCCESSFULLY PASSED BOTH HOUSES AND WERE SIGNED BY THE GOVERNOR FOR IMMEDIATE EXECUTION. THANKS TO THE PASSAGE OF SENATE BILL 62, COLLEGE STUDENTS WILL CONTINUE TO BE PROTECTED AGAINST BACTERIAL MENINGITIS. THE BILL REVISED THE JAMIE SCHANBAUM AND NICOLIS WILLIAMS ACT, IN ORDER TO ALIGN STATE POLICY WITH FEDERAL RECOMMENDATIONS AND STREAMLINE THE PROCESS BY WHICH EXEMPTIONS CAN BE CLAIMED. IN ORDER TO PROTECT CHILDREN FROM VACCINE-PREVENTABLE DISEASES THAT ARE EASILY TRANSMITTED FROM ADOLESCENTS AND ADULTS, THE TEXAS LEGISLATURE TOOK DECISIVE ACTION TO BROADEN THE CATEGORIES OF INDIVIDUALS WHO CAN CONSENT TO IMMUNIZATIONS TO INCLUDE PREGNANT TEENS OR MINORS WITH CHILDREN (SENATE BILL 63). TIP ALSO JOINED STATE MEDICAL AND HEALTH ASSOCIATIONS TO ENSURE THAT ALL LICENSED CHILDCARE FACILITIES HAVE POLICIES IN PLACE REGARDING CHILDCARE PROVIDER VACCINATION (SENATE BILL 64). IN ADDITION TO RIGOROUS ADVOCACY DURING THE LEGISLATIVE SESSION, TIP CONTINUED AFTER THE SESSION TO SERVE AS A RESOURCE FOR STAKEHOLDERS TO MONITOR THE COMPREHENSIVE PROMOTION AND SEAMLESS IMPLEMENTATION OF IMMUNIZATION-RELATED LEGISLATION. WITH RESPECT TO SENATE BILL 62 PROTECTING COLLEGE STUDENTS FROM MENINGITIS, TIP HOSTED REGULAR CONFERENCE CALLS WITH MEMBERS OF COMMUNITY COLLEGES AND STATE UNIVERSITIES TO PROVIDE A FORUM TO SHARE CHALLENGES AND BEST PRACTICES. TIP'S EFFORTS CONTINUE TO FOCUS ON THE GOAL OF HELPING STUDENTS NAVIGATE THE NEW REQUIREMENT AND GET THE VACCINE THEY NEED TO STAY HEALTHY. TIP STAFF ALSO SERVE AS SUBJECT MATTER EXPERTS FOR STAKEHOLDERS AT THE LOCAL, STATE, AND NATIONAL LEVEL. THIS YEAR, TIP PROVIDED LEGISLATIVE UPDATES AND ADVOCACY PRIMERS FOR THE TRAVIS COUNTY IMMUNIZATION COLLABORATIVE, IMMUNIZE SAN ANTONIO, IMMUNIZATION COLLABORATION OF TARRANT COUNTY, ANDREWS COUNTY HEALTH DEPARTMENT, THE IDAHO IMMUNIZATION COALITION, THE SABIN VACCINE INSTITUTE AND MANY OTHERS. THROUGH ITS BUILDING COALITIONS ACROSS TEXAS (BCAT), TIP CONTINUES TO PROVIDE TECHNICAL ASSISTANCE TO LOCAL IMMUNIZATION COALITIONS, IN AN EFFORT TO BUILD THEIR CAPACITY TO PROMOTE IMMUNIZATION THROUGH EDUCATION AND ADVOCACY. THIS YEAR, TIP IMPLEMENTED TWO INFORMATIONAL WEBINARS FOR PARTICIPATING COALITIONS AND PARTNERS. THE FIRST WEBINAR, ENTITLED "WHAT'S NEW WITH TEXAS IMMUNIZATION LAWS AND HOW CAN YOU MAKE A DIFFERENCE?," FEATURED ADVOCACY EXPERTS, JASON SABO (FRONTERA STRATEGY) AND NIDHI M. NAKRA (THE IMMUNIZATION PARTNERSHIP). THE OBJECTIVES OF THE WEBINAR WERE TO REVIEW NEW IMMUNIZATION LEGISLATION IN TEXAS, IDENTIFY MISSED OPPORTUNITIES AND ONGOING CHALLENGES IN THE LEGISLATIVE ENVIRONMENT, AND PROVIDE STAKEHOLDERS WITH OPPORTUNITIES TO ENGAGE IN IMMUNIZATION ADVOCACY. OVER 150 STAKEHOLDERS FROM ACROSS TEXAS PARTICIPATED IN THE WEBINAR. OF PARTICIPANTS, 100% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR WAS RELEVANT TO THEIR WORK AND/OR INTERESTS AND THAT THE WEBINAR HELPED THEM UNDERSTAND KEY CHANGES TO IMMUNIZATION LAWS IN TEXAS. THE SECOND WEBINAR, "IMMUNIZATION & HEALTH REFORM: EXPLORING OPPORTUNITIES AND CHALLENGES," FEATURED IMMUNIZATION AND POLICY EXPERTS, LITJEN TAN, MS, PHD (IMMUNIZATION ACTION COALITION) AND PATRICIA GRAY, JD, LLM (UNIVERSITY OF HOUSTON LAW CENTER). THE OBJECTIVES OF THE WEBINAR WERE TO REVIEW MAJOR CHANGES TO IMMUNIZATION ACCESS THROUGH HEALTHCARE REFORM, DISCUSS IMPLEMENTATION AND COVERAGE CHALLENGES IN STATES WITHOUT MEDICAID EXPANSION, AND PROVIDE STAKEHOLDERS WITH RESOURCES THAT HELP THEM REINFORCE THE PREVENTIVE ROLE OF IMMUNIZATION. OVER 350 STAKEHOLDERS FROM ACROSS THE NATION PARTICIPATED ON THE CALL. OF PARTICIPANTS, 95% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR WAS RELEVANT TO THEIR WORK AND/OR INTERESTS AND 93% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR HELPED THEM UNDERSTAND KEY CHANGES TO IMMUNIZATION ACCESS UNDER THE AFFORDABLE CARE ACT. TIP'S EXPERIENCES WITH BCAT HAVE REVEALED TO US THE VALUE THAT IMMUNIZATION COALITIONS HAVE IN IMPROVING IMMUNIZATION COVERAGE AND PROMOTING POSITIVE IMMUNIZATION POLICIES. OVER THE NEXT YEAR, TIP WILL EXPAND ITS SCOPE AND OFFER MORE IN- DEPTH TECHNICAL ASSISTANCE VIA ON-SITE CAPACITY-BUILDING ASSESSMENTS, INTERVIEWS AND SURVEYS WITH COALITION LEADERS AND CONSTITUENTS.
4c (Code:   ) (Expenses $ 236,335 including grants of $ 40,000 ) (Revenue $   )
SUPPORT OF IMMUNIZATION BEST PRACTICES - THANKS TO GENEROUS SUPPORT OF THE GE FOUNDATION, THE ROCKWELL FUND AND ST. LUKE'S EPISCOPAL HEALTH CHARITIES, TIP WAS ABLE TO NEARLY DOUBLE ITS SUPPORT OF BEST PRACTICES IN COMMUNITY CLINICS, IMPLEMENTING 13 PROJECTS TO RAISE IMMUNIZATION RATES IN PEDIATRIC, ADOLESCENT AND ADULT POPULATIONS. THIS INNOVATIVE PROCESS IMPROVEMENT PROGRAM ACHIEVES HIGHER IMMUNIZATION RATES BY TRAINING AN "IMMUNIZATION CHAMPION" (EITHER A STUDENT OR EXISTING STAFF MEMBER) TO IMPLEMENT A REMINDER/RECALL SYSTEM TO ENCOURAGE PATIENTS TO RETURN TO CLINICS FOR OVERDUE IMMUNIZATIONS. SEE SCHEDULE O FOR MORE ABOUT OUR SUPPORT OF IMMUNIZATION BEST PRACTICES. SUPPORT OF IMMUNIZATION BEST PRACTICES, CONTINUED TIP ADDITIONALLY CROSS-TRAINS CLINIC STAFF TO ENSURE THE SUSTAINABILITY OF THE PROGRAM ONCE THE IMMUNIZATION CHAMPIONS PROJECT HAS CONCLUDED. AN IMPORTANT COMPONENT OF THE IMMUNIZATION CHAMPIONS PROJECT IS THE ADVANCED TRAINING ON BEST PRACTICES PROVIDED TO CLINIC STAFF AND STUDENT INTERNS. TIP PROVIDES TRAINING ON COMBINATION VACCINES, VACCINE MINIMUM INTERVALS, VACCINE STORAGE AND HANDLING ISSUES, VACCINE SAFETY QUESTIONS, IMPLEMENTATION OF NEW VACCINES, QUESTIONS PERTAINING TO THE VACCINES FOR CHILDREN PROGRAM (VFC), AND NATIONAL IMMUNIZATION SURVEY (NIS) REPORTING. TIP HAS INTRODUCED CLINICS TO ADDITIONAL BEST PRACTICES, SUCH AS THE IMPORTANCE OF REQUESTING VACCINE RECORDS FOR ALL CHILDREN FROM ARENTS/ GUARDIANS, ASSURING IMMTRAC CONSENT IS OBTAINED FOR CHILDREN AND ADULTS AND REINFORCING THE RECOMMENDATIONS POSTED ON THE TEXAS VFC WEBSITE. THIS YEAR, TIP REDESIGNED IMMUNIZATION CHAMPIONS TO SYNCHRONIZE THE PROJECT WITH OTHER INITIATIVES THAT THE CLINICS HAD PRIORITIZED TO MEET QUALITY METRICS FOR MEDICAID, PATIENT CENTERED MEDICAL HOME CERTIFICATION (PCMH) AND MEANINGFUL USE REQUIREMENTS FOR THE HITECH ACT. FOR INSTANCE, SEVERAL OF THE CLINICS WERE WORKING TO ENSURE THAT THEY PROVIDED COMPREHENSIVE TREATMENT OF CHRONIC DISEASES, SUCH AS DIABETES, SO THEIR IMMUNIZATION CHAMPION PROJECT FOCUSED ON HEPATITIS B VACCINATION FOR ADULTS WITH DIABETES. OTHER FOCUSED PROJECTS INCLUDED MENINGITIS VACCINE FOR 16 YEAR OLDS, HPV VACCINATION OF ADOLESCENTS AND RECALLING INFANTS AND TODDLERS NEEDING ADDITIONAL DOSES OF INFLUENZA VACCINE. THE RESULTS WERE DRAMATIC AND IMPRESSIVE, WITH CLINICS REPORTING 20 TO 85 PERCENTAGE POINT INCREASES IN THEIR FOCUS POPULATIONS. OVER 15,000 RECORDS WERE REVIEWED THIS YEAR BRINGING THE TOTAL RECORDS REVIEWED OVER THE COURSE OF THIS PROJECT TO OVER 54,000. OVER 3,400 INDIVIDUALS OVERDUE FOR IMMUNIZATIONS WERE RECALLED TO THE COMMUNITY CLINICS. THIS MORE STRUCTURED, FOCUSED APPROACH HAS BEEN HIGHLY SUCCESSFUL AND FORMS THE FOUNDATION OF INNOVATIVE CHANGES IN STORE FOR THE IMMUNIZATION CHAMPIONS PROJECT.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet660,824
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part IIIClick to see attachment............................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IVClick to see attachment..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment...................
11a
 
No
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIIClick to see attachment.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IXClick to see attachment............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII Click to see attachment.................
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
 
No
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions).... Click to see attachment
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............ Click to see attachment
18
Yes
 
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III................... Click to see attachment
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return?
20b
 
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J.......................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................
34
 
No
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2...
35b
 
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
22
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
13
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
Yes
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
Yes
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
No
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
No
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
16
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
16
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
 
No
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
 
No
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
 
No
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletANNA DRAGSBAEK3000 RICHMOND STE 200BHOUSTONTX77098 (281) 400-3689
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) KAY TITTLE........................................................................
BOARD CHAIR
 5.00
.......................   		X   X       0 0 0
(2) JACQUELYN COX........................................................................
INCOMING CHA
 5.00
.......................   		X   X       0 0 0
(3) KEVIN BURNS........................................................................
TREASURER
 5.00
.......................   		X   X       0 0 0
(4) AILEEN MCCORMICK........................................................................
SECRETARY
 5.00
.......................   		X   X       0 0 0
(5) GWEN EMMETT........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(6) LINDY MCGEE........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(7) VICKY ILLANE........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(8) MICHELLE BOHREER........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(9) BARRON BOGATTO........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(10) WALTER BRUCE........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(11) TAMARA TURK........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(12) SUSAN WOOTEN........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(13) CRAIG CORDOLA........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(14) JAMES HOYLE........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(15) CATHERINE MCCOIN........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(16) KIM COLNER DAVID........................................................................
BOARD MEMBER
 2.00
.......................   		X           0 0 0
(17) ANNA C DRAGSBAEK........................................................................
PRESIDENT/CE
 60.00
.......................   		    X       126,283 0 0
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;


























1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 126,283    
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet1
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet  
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c 183,989
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		980,593
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 1,164,582
Program Service Revenue Business Code
2a
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet  
Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 530 530    
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory    
b Less: cost or other basis and sales expenses    
c Gain or (loss)    
d Net gain or (loss)..........MediumBullet        
8a Gross income from fundraising events (not including
$ 183,989
of contributions reported on line 1c). See Part IV, line 18 ..
a 19,408
b Less: direct expenses ...b 45,164
c Net income or (loss) from fundraising events..MediumBullet -25,756    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a            
b            
c            
d All other revenue ....        
e Total. Add lines 11a–11d ...... MediumBullet  
12 Total revenue. See Instructions......MediumBullet 1,139,356 530    
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 40,100 40,100
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 126,283 107,341 10,103 8,839
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 328,206 262,770 23,938 41,498
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....        
9 Other employee benefits ....... 47,985 38,648 3,281 6,056
10 Payroll taxes ........... 32,466 26,446 2,449 3,571
11 Fees for services (non-employees):        
a Management ......        
b Legal .........        
c Accounting ........... 12,872 10,426 901 1,545
d Lobbying ...........        
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........        
12 Advertising and promotion ....        
13 Office expenses ....... 49,996 40,291 3,453 6,252
14 Information technology ...... 6,794 5,994 295 505
15 Royalties ..        
16 Occupancy ........... 43,912 37,020 2,526 4,366
17 Travel ............ 35,480 16,194 2,857 16,429
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 10,499 9,392 163 944
20 Interest ...........        
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .....        
23 Insurance .............. 2,946 2,386 206 354
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a CONTRACT LABOR 53,015 26,912 3,918 22,185
b CONSULTING 26,899 26,628   271
c OTHER EXPENSES 12,448 10,276 1,281 891
d
e All other expenses        
25 Total functional expenses. Add lines 1 through 24e 829,901 660,824 55,371 113,706
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 113,569 1 131,055
2 Savings and temporary cash investments ......... 205,000 2 280,920
3 Pledges and grants receivable, net ........... 103,763 3 273,533
4 Accounts receivable, net .............   4  
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5  
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ..........   9 11,378
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a  
b Less: accumulated depreciation ..... 10b     10c  
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 .....   12  
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 1,932 15 2,932
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 424,264 16 699,818
Liabilities 17 Accounts payable and accrued expenses ......... 62,472 17 35,267
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................   25  
26 Total liabilities. Add lines 17 through 25......... 62,472 26 35,267
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 361,792 27 279,551
28 Temporarily restricted net assets ...........   28 385,000
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 361,792 33 664,551
34 Total liabilities and net assets/fund balances ........ 424,264 34 699,818
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
1,139,356
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
829,901
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
309,455
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
361,792
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-6,696
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
664,551
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
 
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
 
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
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
f
g
(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) right arrow (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.") .... 337,494 524,552 637,287 730,869 1,164,582 3,394,784
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 3 337,494 524,552 637,287 730,869 1,164,582 3,394,784
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)..           761,021
6 Public support. Subtract line 5 from line 4.           2,633,763
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4.. 337,494 524,552 637,287 730,869 1,164,582 3,394,784
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... 2,423 1,016 515 390 530 4,874
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).           3,399,658
12
12
19,938
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........................................right arrow
Section C. Computation of Public Support Percentage
14
14
77.470 %
15
15
79.800 %
16a
b
17a
b
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 ..................................................... right arrow
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) right arrow (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) right arrow (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
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
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:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC 		Employer identification number

76-0695612
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC 		Employer identification number

76-0695612
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions) 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC 		Employer identification number

76-0695612
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...... 5,918  
b Total lobbying expenditures to influence a legislative body (direct lobbying) ....... 21,963  
c Total lobbying expenditures (add lines 1a and 1b) ................... 27,881  
d Other exempt purpose expenditures ........................ 746,649  
e Total exempt purpose expenditures (add lines 1c and 1d) ............... 774,530  
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 141,180  
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) ................. 35,295  
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount 83,581 109,858 119,294 141,180 453,913
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		        680,870
             
c Total lobbying expenditures 6,905 26,553 29,374 27,881 90,713
             
d Grassroots nontaxable amount 20,895 27,465 29,824 35,295 113,479
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		         170,219
             
f Grassroots lobbying expenditures 6,905 5,636 6,235 5,918 24,694
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
 
 
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................        
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet  
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 1,184,520
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d 45,164
e Add lines 2a through 2d ..................... 2e 45,164
3 Subtract line 2e from line 1..................... 3 1,139,356
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 1,139,356
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1 875,065
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d 45,164
e Add lines 2a through 2d...................... 2e 45,164
3 Subtract line 2e from line 1..................... 3 829,901
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 829,901
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
REVENUE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XI, LINE 2D FUNDRAISING EXPENSES 45,164
EXPENSE AMOUNTS INCLUDED IN FINANCIALS - OTHER SCHEDULE D, PAGE 4, PART XII, LINE 2D FUNDRAISING EXPENSES 45,164
Schedule D (Form 990) 2012

Additional Data


Software ID:  
Software Version:  




SCHEDULE G (Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Form 990-EZ filers are not required to complete this part. right arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total .................right arrow      
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1

SPRING LUNCHEON
(event type) 		(b) Event #2

FALL EVENT
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 128,489 74,908   203,397
2 Less: Contributions . . 120,397 63,592   183,989
3 Gross income (line 1
minus line 2) . . . 		8,092 11,316   19,408
VerticalDirectExpenses 4 Cash prizes . . .        
5 Noncash prizes . .        
6 Rent/facility costs . .   6,722   6,722
7 Food and beverages . 11,786 5,148   16,934
8 Entertainment . . .   4,901   4,901
9 Other direct expenses . 12,046 4,561   16,607
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 45,164
11 Net income summary. Combine line 3, column (d), and line 10. .......... right arrow -25,756
Part III
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," explain:
 
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page 3
11
Does the organization operate gaming activities with nonmembers? .................
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? ..........................
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data


Software ID:  
Software Version:  
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number
76-0695612
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) SPRING BRANCH COMMUNITY HEALTH CTR
1615 HILLENDAHL STE 100
HOUSTON,TX77055 		30-0198705 501C3 6,000   CASH   IMMUNIZATION CHAMPIO
(2) VECINO HEALTH CENTERS
424 HAHLO STREET
HOUSTON,TX770203022 		76-0622208 501C3 6,000   CASH   IMMUNIZATION CHAMPIO




















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
10
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
3
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES SCHEDULE I, PAGE 1, PART I, LINE 2 THESE GRANT FUNDS ARE GIVEN FOR THE COMPLETION OF THE IMMUNIZATION CHAMPIONS PROJECTS. TIP PROJECT COORDINATORS OPERATE, COORDINATE, AND OVERSEE THESE PROJECTS IN THE CLINICS. THE PROJECT COORDINATOR CLOSELY MONITOR PROJECT ACTIVITY AND THE HOURS USED TO ASSURE COMPLIANCE WITH GRANT GUIDELINES.
Schedule I (Form 990) 2012


Additional Data


Software ID:  
Software Version:  


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.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
HOUSTON-HARRIS COUNTY IMMUNIZATION
REGISTRY INC
Employer identification number

76-0695612
Identifier Return Reference Explanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS FORM 990, PAGE 1, PART I, LINE 6 VOLUNTEERS INCLUDED THE BOARD OF TRUSTEES, THE ADVISORY BOARD, AND COMMUNITY IMMUNITY AMBASSADORS; THEY ALSO ASSISTED TIP AT COMMUNITY FORUMS AND AT THE YEARLY LUNCHEON.
FIRST ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4A EDUCATION, CONTINUED POST-EVENT SURVEYS SHOWED AN OVERWHELMING MAJORITY OF PARTICIPANTS RESPONDED THAT THEY LEARNED SOMETHING NEW DURING THE FORUMS AND WOULD ATTEND MORE EVENTS HOSTED BY TIP. THE COMMUNITY IMMUNITY EXERCISE IS AN INTERACTIVE DEMONSTRATION OF HOW ONE'S VACCINATION STATUS CAN CONTRIBUTE TO HOW FAR AND HOW QUICKLY THE FLU CAN SPREAD THROUGH A COMMUNITY. THE ENTIRE EXERCISE TAKES ABOUT 10 MINUTES WITH MINIMAL MATERIALS AND CAN BE DONE WITH GROUPS AS SMALL AS 20 PEOPLE. WITH THE HELP OF SEVEN NEW VOLUNTEERS, KNOWN AS AMBASSADORS, TIP PRESENTED THE ACTIVITY TO AN ESTIMATED 700 PARTICIPANTS DURING THE 2012/2013 FISCAL YEAR. IN ORDER TO MAXIMIZE THE EXERCISE'S IMPACT, TIP IS UNDERGOING A QUALITY IMPROVEMENT PROJECT TO STREAMLINE THE VOLUNTEER TRAINING PROCESS, AS WELL AS PROVIDE A MORE DATA-DRIVEN STRUCTURE TO DETERMINE WHERE AND TO WHOM THE EXERCISE SHOULD BE PRESENTED. THE NEW PROJECT WILL BE KNOWN AS VACFLU, AND A PILOT OF THE PROJECT WILL BE CONDUCTED IN EARLY 2014.
SECOND ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4B ADVOCACY, CONTINUED IN COLLABORATION WITH OUR COMMUNITY PARTNERS, TIP WORKED THROUGHOUT THE 83RD TEXAS LEGISLATIVE SESSION TO PROMOTE EVIDENCE-BASED LEGISLATION TO IMPROVE ACCESS TO IMMUNIZATIONS, SAVE LIVES, AND ENSURE THAT WE PROTECT THOSE MOST AT RISK FROM VACCINE-PREVENTABLE DISEASES. TIP STAFF COMPILED AND DISTRIBUTED SEVEN ALERTS, PREPARED AND DELIVERED 11 TESTIMONIES AND PRESENTATIONS, AND CONDUCTED APPROXIMATELY 300 LEGISLATIVE VISITS IN SUPPORT OF LEGISLATION. TIP ACTIVELY ADVOCATED FOR FOUR PIECES OF LEGISLATION, OF WHICH THREE SUCCESSFULLY PASSED BOTH HOUSES AND WERE SIGNED BY THE GOVERNOR FOR IMMEDIATE EXECUTION. THANKS TO THE PASSAGE OF SENATE BILL 62, COLLEGE STUDENTS WILL CONTINUE TO BE PROTECTED AGAINST BACTERIAL MENINGITIS. THE BILL REVISED THE JAMIE SCHANBAUM AND NICOLIS WILLIAMS ACT, IN ORDER TO ALIGN STATE POLICY WITH FEDERAL RECOMMENDATIONS AND STREAMLINE THE PROCESS BY WHICH EXEMPTIONS CAN BE CLAIMED. IN ORDER TO PROTECT CHILDREN FROM VACCINE-PREVENTABLE DISEASES THAT ARE EASILY TRANSMITTED FROM ADOLESCENTS AND ADULTS, THE TEXAS LEGISLATURE TOOK DECISIVE ACTION TO BROADEN THE CATEGORIES OF INDIVIDUALS WHO CAN CONSENT TO IMMUNIZATIONS TO INCLUDE PREGNANT TEENS OR MINORS WITH CHILDREN (SENATE BILL 63). TIP ALSO JOINED STATE MEDICAL AND HEALTH ASSOCIATIONS TO ENSURE THAT ALL LICENSED CHILDCARE FACILITIES HAVE POLICIES IN PLACE REGARDING CHILDCARE PROVIDER VACCINATION (SENATE BILL 64). IN ADDITION TO RIGOROUS ADVOCACY DURING THE LEGISLATIVE SESSION, TIP CONTINUED AFTER THE SESSION TO SERVE AS A RESOURCE FOR STAKEHOLDERS TO MONITOR THE COMPREHENSIVE PROMOTION AND SEAMLESS IMPLEMENTATION OF IMMUNIZATION-RELATED LEGISLATION. WITH RESPECT TO SENATE BILL 62 PROTECTING COLLEGE STUDENTS FROM MENINGITIS, TIP HOSTED REGULAR CONFERENCE CALLS WITH MEMBERS OF COMMUNITY COLLEGES AND STATE UNIVERSITIES TO PROVIDE A FORUM TO SHARE CHALLENGES AND BEST PRACTICES. TIP'S EFFORTS CONTINUE TO FOCUS ON THE GOAL OF HELPING STUDENTS NAVIGATE THE NEW REQUIREMENT AND GET THE VACCINE THEY NEED TO STAY HEALTHY. TIP STAFF ALSO SERVE AS SUBJECT MATTER EXPERTS FOR STAKEHOLDERS AT THE LOCAL, STATE, AND NATIONAL LEVEL. THIS YEAR, TIP PROVIDED LEGISLATIVE UPDATES AND ADVOCACY PRIMERS FOR THE TRAVIS COUNTY IMMUNIZATION COLLABORATIVE, IMMUNIZE SAN ANTONIO, IMMUNIZATION COLLABORATION OF TARRANT COUNTY, ANDREWS COUNTY HEALTH DEPARTMENT, THE IDAHO IMMUNIZATION COALITION, THE SABIN VACCINE INSTITUTE AND MANY OTHERS. THROUGH ITS BUILDING COALITIONS ACROSS TEXAS (BCAT), TIP CONTINUES TO PROVIDE TECHNICAL ASSISTANCE TO LOCAL IMMUNIZATION COALITIONS, IN AN EFFORT TO BUILD THEIR CAPACITY TO PROMOTE IMMUNIZATION THROUGH EDUCATION AND ADVOCACY. THIS YEAR, TIP IMPLEMENTED TWO INFORMATIONAL WEBINARS FOR PARTICIPATING COALITIONS AND PARTNERS. THE FIRST WEBINAR, ENTITLED "WHAT'S NEW WITH TEXAS IMMUNIZATION LAWS AND HOW CAN YOU MAKE A DIFFERENCE?," FEATURED ADVOCACY EXPERTS, JASON SABO (FRONTERA STRATEGY) AND NIDHI M. NAKRA (THE IMMUNIZATION PARTNERSHIP). THE OBJECTIVES OF THE WEBINAR WERE TO REVIEW NEW IMMUNIZATION LEGISLATION IN TEXAS, IDENTIFY MISSED OPPORTUNITIES AND ONGOING CHALLENGES IN THE LEGISLATIVE ENVIRONMENT, AND PROVIDE STAKEHOLDERS WITH OPPORTUNITIES TO ENGAGE IN IMMUNIZATION ADVOCACY. OVER 150 STAKEHOLDERS FROM ACROSS TEXAS PARTICIPATED IN THE WEBINAR. OF PARTICIPANTS, 100% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR WAS RELEVANT TO THEIR WORK AND/OR INTERESTS AND THAT THE WEBINAR HELPED THEM UNDERSTAND KEY CHANGES TO IMMUNIZATION LAWS IN TEXAS. THE SECOND WEBINAR, "IMMUNIZATION & HEALTH REFORM: EXPLORING OPPORTUNITIES AND CHALLENGES," FEATURED IMMUNIZATION AND POLICY EXPERTS, LITJEN TAN, MS, PHD (IMMUNIZATION ACTION COALITION) AND PATRICIA GRAY, JD, LLM (UNIVERSITY OF HOUSTON LAW CENTER). THE OBJECTIVES OF THE WEBINAR WERE TO REVIEW MAJOR CHANGES TO IMMUNIZATION ACCESS THROUGH HEALTHCARE REFORM, DISCUSS IMPLEMENTATION AND COVERAGE CHALLENGES IN STATES WITHOUT MEDICAID EXPANSION, AND PROVIDE STAKEHOLDERS WITH RESOURCES THAT HELP THEM REINFORCE THE PREVENTIVE ROLE OF IMMUNIZATION. OVER 350 STAKEHOLDERS FROM ACROSS THE NATION PARTICIPATED ON THE CALL. OF PARTICIPANTS, 95% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR WAS RELEVANT TO THEIR WORK AND/OR INTERESTS AND 93% EITHER AGREED OR STRONGLY AGREED THAT THE WEBINAR HELPED THEM UNDERSTAND KEY CHANGES TO IMMUNIZATION ACCESS UNDER THE AFFORDABLE CARE ACT. TIP'S EXPERIENCES WITH BCAT HAVE REVEALED TO US THE VALUE THAT IMMUNIZATION COALITIONS HAVE IN IMPROVING IMMUNIZATION COVERAGE AND PROMOTING POSITIVE IMMUNIZATION POLICIES. OVER THE NEXT YEAR, TIP WILL EXPAND ITS SCOPE AND OFFER MORE IN- DEPTH TECHNICAL ASSISTANCE VIA ON-SITE CAPACITY-BUILDING ASSESSMENTS, INTERVIEWS AND SURVEYS WITH COALITION LEADERS AND CONSTITUENTS.
THIRD ACCOMPLISHMENT DESCRIPTION FORM 990, PAGE 2, PART III, LINE 4C SUPPORT OF IMMUNIZATION BEST PRACTICES, CONTINUED TIP ADDITIONALLY CROSS-TRAINS CLINIC STAFF TO ENSURE THE SUSTAINABILITY OF THE PROGRAM ONCE THE IMMUNIZATION CHAMPIONS PROJECT HAS CONCLUDED. AN IMPORTANT COMPONENT OF THE IMMUNIZATION CHAMPIONS PROJECT IS THE ADVANCED TRAINING ON BEST PRACTICES PROVIDED TO CLINIC STAFF AND STUDENT INTERNS. TIP PROVIDES TRAINING ON COMBINATION VACCINES, VACCINE MINIMUM INTERVALS, VACCINE STORAGE AND HANDLING ISSUES, VACCINE SAFETY QUESTIONS, IMPLEMENTATION OF NEW VACCINES, QUESTIONS PERTAINING TO THE VACCINES FOR CHILDREN PROGRAM (VFC), AND NATIONAL IMMUNIZATION SURVEY (NIS) REPORTING. TIP HAS INTRODUCED CLINICS TO ADDITIONAL BEST PRACTICES, SUCH AS THE IMPORTANCE OF REQUESTING VACCINE RECORDS FOR ALL CHILDREN FROM ARENTS/ GUARDIANS, ASSURING IMMTRAC CONSENT IS OBTAINED FOR CHILDREN AND ADULTS AND REINFORCING THE RECOMMENDATIONS POSTED ON THE TEXAS VFC WEBSITE. THIS YEAR, TIP REDESIGNED IMMUNIZATION CHAMPIONS TO SYNCHRONIZE THE PROJECT WITH OTHER INITIATIVES THAT THE CLINICS HAD PRIORITIZED TO MEET QUALITY METRICS FOR MEDICAID, PATIENT CENTERED MEDICAL HOME CERTIFICATION (PCMH) AND MEANINGFUL USE REQUIREMENTS FOR THE HITECH ACT. FOR INSTANCE, SEVERAL OF THE CLINICS WERE WORKING TO ENSURE THAT THEY PROVIDED COMPREHENSIVE TREATMENT OF CHRONIC DISEASES, SUCH AS DIABETES, SO THEIR IMMUNIZATION CHAMPION PROJECT FOCUSED ON HEPATITIS B VACCINATION FOR ADULTS WITH DIABETES. OTHER FOCUSED PROJECTS INCLUDED MENINGITIS VACCINE FOR 16 YEAR OLDS, HPV VACCINATION OF ADOLESCENTS AND RECALLING INFANTS AND TODDLERS NEEDING ADDITIONAL DOSES OF INFLUENZA VACCINE. THE RESULTS WERE DRAMATIC AND IMPRESSIVE, WITH CLINICS REPORTING 20 TO 85 PERCENTAGE POINT INCREASES IN THEIR FOCUS POPULATIONS. OVER 15,000 RECORDS WERE REVIEWED THIS YEAR BRINGING THE TOTAL RECORDS REVIEWED OVER THE COURSE OF THIS PROJECT TO OVER 54,000. OVER 3,400 INDIVIDUALS OVERDUE FOR IMMUNIZATIONS WERE RECALLED TO THE COMMUNITY CLINICS. THIS MORE STRUCTURED, FOCUSED APPROACH HAS BEEN HIGHLY SUCCESSFUL AND FORMS THE FOUNDATION OF INNOVATIVE CHANGES IN STORE FOR THE IMMUNIZATION CHAMPIONS PROJECT.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B THE INITAL REVIEW OF THE 990 IS CONDUCTED BY THE TREASURER AND CEO. A COPY OF THE ENTIRE 990 IS DISTRIBUTED ELECTRONICALLY BY THE CEO TO ALL MEMBERS OF THE BOARD OF DIRECTORS. AFTER ALL COMMENTS HAVE BEEN CONSIDERED, THE BOARD APPROVES THE 990 FOR FILING.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C BOARD MEMBERS SIGN ANNUAL CONFLICT OF INTEREST STATEMENTS TO DETERMINE POSSIBLE CONFLICTS OF INTEREST. IT IS THE POLICY OF THE BOARD THAT THE EXISTENCE OF ANY CONFLICTS BE DISCLOSED TO THE EXECUTIVE DIRECTOR OR TO THE BOARD CHAIR BEFORE ANY TRANSACION IS CONSUMMATED. ONCE A CONFLICT IS IDENTIFIED, THE PERSON WITH THE CONFLICT OF INTERESTS IS EXCLUDED FROM THE DISCUSSION AND APPROVAL OF THE TRANSACTION. COMPETITIVE BIDS ON COMPARABLE VALUATIONS ARE EXAMINED, AND THE REMAINDER OF THE BOARD DETERMINES WHETHER THE CONTEMPLATED TRANSACTION MAY BE AUTHORIZED.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A ANNUALLY, THE EXECUTIVE BOARD OF THE ORGANIZATION MEETS TO CONSIDER THE COMPENSATION PACKAGE TO BE PAID TO THE EXECUTIVE DIRECTOR IN THE UPCOMING YEAR. THE ACHIEVEMENT OF PRIOR YEAR GOALS IS REVIEWED, AND A LEVEL OF COMPENSATION AND BENEFITS IS DETERMINED. COMPENSATION PACKAGES OF EXECUTIVE DIRECTORS FROM OTHER SIMILAR SIZED ORGANIZATIONS WITH SIMILAR INTERESTS IN THE HOUSTON AREA ARE REVIEWED AND COMPARED TO THE RECOMMENDED LEVEL OF COMPENSATION AND BENEFITS IN ORDER TO DETERMINE REASONABLENESS OF THE ENTIRE COMPENSATION PACKAGE BEFORE THE COMPENSATION IS APPROVED.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
RECONCILIATION OF CHANGES - OTHER FORM 990, PART XI, LINE 9 FUNDRAISING EXPENSES 45,164 FUNDRAISING EXPENSES -45,164
OTHER CHANGES IN NET ASSETS EXPLANATION FORM 990, PART XI, LINE 9 PRIOR PERIOD ADJUSTMENTS 6,696 ADJUSTMENTS MADE TO PRIOR YEAR RECEIPTS AND EXPENSES
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

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