Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARTNERS FOR HEALTH INC
Employer identification number
22-3122804
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
302,505
285,697
164,266
120,211
163,783
1,036,462
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
302,505
285,697
164,266
120,211
163,783
1,036,462
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)..
111,762
6
Public support. Subtract line 5 from line 4.
924,700
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
7
Amounts from line 4..
302,505
285,697
164,266
120,211
163,783
1,036,462
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
613,756
609,541
724,234
694,916
733,009
3,375,456
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).
4,411,918
12
Gross receipts from related activities, etc. (see instructions)
..................
12
37,786
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.................................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
20.960 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
24.860 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
PARTNERS FOR HEALTH, INC. RECEIVES MORE THAN 10% OF ITS SUPPORT FROM THE GENERAL PUBLIC. THE ORGANIZATION HAS A CONTINUOUS FUND-RAISING PROGRAM FROM ITS COMMUNITY AND THE GENERAL PUBLIC AND HAS A GOVERNING BODY WHICH REPRESENTS THE BROAD INTERESTS OF THE GENERAL PUBLIC. THROUGH ITS PROGRAMS AND GRANTS, IT PROVIDES SERVICES FOR THE BENEFIT OF THE GENERAL PUBLIC ON A CONTINUING BASIS. ORIGINALLY FORMED AS A SUPPORTING ORGANIZATION FOR MOUNTAINSIDE HOSPITAL, THE ORGANIZATION BECAME A SEPARATE, SELF-GOVERNING PUBLIC CHARITY WITH THE APPROVAL OF THE NEW JERSEY SUPERIOR COURT WHEN THE HOSPITAL WAS SOLD TO A FOR-PROFIT ENTITY. THE MISSION OF PARTNERS FOR HEALTH IS TO STRENGTHEN HEALTH AND WELLNESS IN MONTCLAIR, NEW JERSEY, AND 14 SURROUNDING COMMUNITIES. ITS VISION IS TO CREATE HEALTHIER COMMUNITIES BY SUPPORTING AND ADVANCING GOOD HEALTH, WELLNESS EDUCATION, AND DISEASE PREVENTION AND TREATMENT. THROUGH ITS UNIQUE APPROACH TO GRANTMAKING, PARTNERS FOR HEALTH DEVELOPS COLLABORATIONS AMONG KEY STAKEHOLDERS TO ENCOURAGE AREA RESIDENTS TO LIVE HEALTHIER LIFESTYLES AND TO ENHANCE THEIR ABILITY TO DO SO. 1.PART II, SECTION C OF SCHEDULE A SHOWS THAT THE PUBLIC SUPPORT PERCENTAGE FOR 2013 IS 20.96%, WHICH IS WELL ABOVE THE 10% REQUIREMENT. 2.THE ORGANIZATION'S DEVELOPMENT COMMITTEE OVERSEES ITS FUNDRAISING PROGRAM. THIS INCLUDES AN ANNUAL GOLF TOURNAMENT, A TRUSTEE GIVING PROGRAM, AND AN ANNUAL APPEAL SOLICITATION TO MEMBERS OF THE COMMUNITY. BETWEEN 2009 AND 2013, THE ORGANIZATION RECEIVED CONTRIBUTIONS TOTALING 1,036,462 FROM 575 DONORS. 3.PARTNERS FOR HEALTH IS SELF-GOVERNED BY A BOARD OF TRUSTEES WHO SERVE IN A VOLUNTARY CAPACITY, AND WHO LIVE OR WORK IN COMMUNITIES SERVED BY THE ORGANIZATION, AND ALSO VOLUNTEER IN NUMEROUS OTHER CAPACITIES IN THEIR COMMUNITIES. TRUSTEES ARE ELECTED TO SERVE FOR A THREE-YEAR TERM, AND CAN BE RE-ELECTED FOR A SECOND THREE-YEAR TERM. THE BOARD HAS SIX STANDING COMMITTEES, INCLUDING: AUDIT, DEVELOPMENT, FINANCE, GRANTS, NOMINATING AND TRUSTEESHIP. AT YEAR-END 2013, PARTNERS FOR HEALTH HAD 18 TRUSTEES. SINCE 2007, 43 INDIVIDUALS HAVE SERVED AS TRUSTEES PROVIDING THE EXPERIENCE AND EXPERTISE OF A BROAD CROSS-SECTION OF THE COMMUNITY TO PARTNERS FOR HEALTH. 4.PARTNERS FOR HEALTH HAS CONDUCTED PROGRAMS AND MADE GRANTS WHICH HAVE SERVED AS A CATALYST FOR IMPROVING THE HEALTH AND WELLNESS OF THE PEOPLE LIVING IN THE 15 COMMUNITIES WHICH IT SERVES. THESE INCLUDE: "ACCESS TO HEALTH" GRANTS THAT PROVIDE HEALTH SCREENINGS, EDUCATION, AND DIAGNOSTIC AND PREVENTIVE CARE WITH AN EMPHASIS ON MEETING THE NEEDS OF UNDERSERVED CHILDREN AND ADULTS, INCLUDING THE ELDERLY AND DISABLED. "AGING IN PLACE" PROGRAMS DESIGNED TO ENHANCE THE QUALITY OF LIFE FOR SENIORS WHO WANT TO BE VIBRANT MEMBERS OF THE COMMUNITY WHILE REMAINING IN THEIR OWN HOMES. "HEALTH PROMOTION/CHRONIC DISEASE PREVENTION" EFFORTS THAT STRIVE TO MAKE HEALTHY CHOICES EASIER BY SUPPORTING POLICY, SYSTEM AND ENVIRONMENTAL CHANGES. THE "FIGHT HUNGER THE HEALTHY WAY" CAMPAIGN ENGAGES SCHOOLS, YOUTH GROUPS, ORGANIZATIONS, BUSINESSES AND FAMILIES IN RAISING AWARENESS ABOUT HUNGER IN SUBURBIA, AND INSPIRES ACTION TO DONATE HEALTHY FOODS TO LOCAL EMERGENCY FOOD PROGRAMS. "MENTAL HEALTH" PROJECTS THAT IDENTIFY AND TARGET EARLY INTERVENTIONS OF MENTAL ILLNESS, INCREASE ACCESS TO SERVICES, AND REMOVE THE STIGMA SURROUNDING MENTAL ILLNESS. THE "SAFE RETURN TO PLAY - SPORTS CONCUSSION" CAMPAIGN THAT PROVIDES CONCUSSION PREVENTION EDUCATION AND AWARENESS FOR STUDENT ATHLETES.
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PARTNERS FOR HEALTH INC
Employer identification number
22-3122804
Return Reference
Explanation
FORM 990, PAGE 6, PART VI, LINE 11B
THE BOARD HAS DESIGNATED A MEMBER OF THE AUDIT COMMITTEE TO REVIEW THE 990 PRIOR TO FILING. THE FORM IS ALSO REVIEWED BY THE EXECUTIVE DIRECTOR AND BOARD REPRESENTATIVES WHO ARE KNOWLEDGEABLE IN NOT-FOR-PROFIT ACCOUNTING AND REPORTING PRIOR TO FILING. AN ELECTRONIC VERSION OF THE FORM 990 IS PROVIDED TO ALL BOARD MEMBERS SUBSEQUENT TO FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
A CONFLICT OF INTEREST QUESTIONNAIRE IS COMPLETED AND SIGNED ANNUALLY BY EACH MEMBER OF THE BOARD. THE AUDIT COMMITTEE REVIEWS THE QUESTIONNAIRES AND REPORTS ITS FINDINGS TO THE BOARD OF TRUSTEES.
FORM 990, PAGE 6, PART VI, LINE 15A
COMPENSATION IS REVIEWED ANNUALLY BY THE CHAIRMAN OF THE BOARD AND THE EXECUTIVE COMMITTEE. BUSINESS & LEGAL REPORTS, INC. WAS CONSULTED TO DETERMINE AVERAGE PLANNED MERIT INCREASES FOR COMPARABLE POSITIONS.
FORM 990, PAGE 6, PART VI, LINE 15B
THE ORGANIZATION USES INDEPENDENT GUIDELINES TO ESTABLISH SALARY INCREASES WHICH ARE THEN PRESENTED TO THE BOARD FOR APPROVAL.
FORM 990, PAGE 6, PART VI, LINE 18
THE FOUNDATION'S FINANCIAL STATEMENTS AND TAX RETURN ARE AVAILABLE AT THE NEW JERSEY DIVISION OF CONSUMER AFFAIRS.
FORM 990, PAGE 6, PART VI, LINE 19
THE FOUNDATION'S GOVERNING DOCUMENTS, ITS REGISTRATION STATEMENT AND ITS ANNUAL VERIFICATION STATEMENT ARE AVAILABLE AT THE CHARITIES REGISTRATION SECTION OF THE NEW JERSEY DIVISION OF CONSUMER AFFAIRS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.