Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PARTNERS IN RECOVERY LLC
Employer identification number
26-4681471
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
0 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
211,109
187,092
20,776
300
600
419,877
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......
257,550
18,425,526
18,951,441
19,080,087
22,309,873
79,024,477
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.
468,659
18,612,618
18,972,217
19,080,387
22,310,473
79,444,354
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.)
79,444,354
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
468,659
18,612,618
18,972,217
19,080,387
22,310,473
79,444,354
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
374
7,258
7,266
14,362
29,260
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
374
7,258
7,266
14,362
29,260
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
69
83
11,072
11,549
22,773
13
Total support. (Add lines 9, 10c, 11, and 12.)..
468,659
18,613,061
18,979,558
19,098,725
22,336,384
79,496,387
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
0 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Part III Line 12 Other income 2009 Workers Compensation refunds 2010 Workers Compensation refunds and FSA forfeitures 2011 Insurance and legal fee refunds and medical record copying fees 2012 Rebates refunds, medical record copying, Training stipend and Lease buy-out reimbursement.
Explanation
Part III Line 12 Other income 2009 Workers Compensation refunds 2010 Workers Compensation refunds and FSA forfeitures 2011 Insurance and legal fee refunds and medical record copying fees 2012 Rebates refunds, medical record copying, Training stipend and Lease buy-out reimbursement.
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000057
Software Version:
12.19.1011.1
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
PARTNERS IN RECOVERY LLC
Employer identification number
26-4681471
Identifier
Return Reference
Explanation
Form 990 Part VI Section A Line 6 Under an Operating Agreement between the Members of the Organization, the Organization has Class A Members and Class B Members. Class B Members do not have an economic interest in the Organization and are therefore not obligated to make capital contributions and do not have the right to participate in or receive distributions from the Organization or the obligation to contribute to the losses of the Organization. Class B Members do not have the right to vote on any matter submitted to the vote of the Members unless expressly provided for in the Operating Agreement. Each Member, both Class A and Class B may appoint three individual board directors.
Form 990 Part VI Section A Line 7a Class A Members may each appoint three board members.
Form 990 Part VI Section A Line 7b The following acts require approval from the Membership Body 1 Amendments to the Organizations Operating Agreement, 2 Sale or Disposition of substantially all of the assets, 3 Assignment for the benefit of creditors, file a voluntary petition in bankruptcy or consent to appointment of a receiver for the Organization, 4 Approval of a plan of merger or consolidation, 5 Contract or agreement with any Member, Interest Holder or Affiliate Member, 6 Acquisition or sale of real property, 7 Borrowing money from any lender or Member in excess of 50,000, 8 Issuance of further Membership Interests, 9 Decisions that affect the tax liability of the Organization or Members as well as any elections that would affect the Organization or Members, 10 Institution of fringe benefits for Organization employees, 11 Distributions to Members except as otherwise provided, 12 Expanding into new business area such as providing different products or services that exceed 5 of the amount set forth in the budget or any line thereof, and 13 Adoption or Modification of the annual budget.
Form 990 Part VI Section B Line 11 Copies of the 990 and all related schedules are sent out to the entire Board of Directors for review. Any questions the Board might have are directed back to the Chief Financial Officer. The 990 is then discussed at a full board meeting and approved by the Board of Directors.
Form 990 Part VI Section B Line 12c Enforcing agency policy on conflicts of interest is the responsibility of Partners in Recoverys Governance committee. This committee dedicates one meeting per year to 1 Ensure all conflict of interest statements have been received, 2 Ensure conflicts are fully understood and implications discussed and disposition agreed upon, 3 Ensure the board members with conflicts, if any, follow policy with respect to voting on matters that they may have a conflict with, and 4 Recommend enhancements to existing forms, policies and training related to conflicts of interest.
Form 990 Part VI Section B Line 15 a b Partners in Recovery used market data from 990s and market data from the Regional Behavioral Health Authority Magellan that reflected what comparable positions were being paid.
Form 990 Part VI Section C Line 19 The Organization will provide in a timely manner, copies of all policies, procedures, annual financial audits and 990s when requested.
Form 990 Part IX Section 24 Line E Other Expense Detail 193,000 Medicaid revenue repayment, 4,103 of Miscellaneous expenses.
Form 990 Part XII Line 2c The Governance Committee is responsible for all business, finances, property, policy and affairs of the Corporation.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.