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
PREFERRED FAMILY HEALTHCARE INC
Employer identification number
43-1236557
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.") ....
1,487,785
1,222,089
2,336,502
3,792,515
6,033,887
14,872,778
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
1,487,785
1,222,089
2,336,502
3,792,515
6,033,887
14,872,778
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)..
0
6
Public support. Subtract line 5 from line 4.
14,872,778
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..
1,487,785
1,222,089
2,336,502
3,792,515
6,033,887
14,872,778
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
56,106
62,878
79,762
100,976
29,711
329,433
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
15,202,211
12
Gross receipts from related activities, etc. (see instructions)
..................
12
166,400,287
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
97.833 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
96.760 %
16a
33 1/3% support test—2013.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2012.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2013.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
13
Total support. (Add lines 9, 10c, 11, and 12.)..
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2012.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2013
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PREFERRED FAMILY HEALTHCARE INC
Employer identification number
43-1236557
Return Reference
Explanation
FORM 990, PART III, LINE 2
NEW PROGRAM SERVICE: DURING 2014, PFH, INC. OPENED A FEDERALLY QUALIFIED HEALTH CENTER WHICH PROVIDES HEALTH CARE AND EDUCATION SERVICES TO PATIENTS THROUGH A CLINIC LOCATED IN HANNIBAL, MISSOURI.
FORM 990, PART III, LINE 4D
OTHER PROGRAM SERVICES: THE FEDERALLY QUALIFIED HEALTH CENTER PROVIDES HEALTH CARE AND EDUCATION SERVICES TO PATIENTS THROUGH A CLINIC LOCATED IN HANNIBAL, MISSOURI.
FORM 990, PART VI, SECTION A, LINE 4
SIGNIFICANT CHANGES TO THE GOVERNING DOCUMENTS: THE ORGANIZATION HAD THE FOLLOWING SIGNIFICANT CHANGES TO ITS BYLAWS DURING THE YEAR: MANAGEMENT: THE NUMBER OF DIRECTORS OF THE CORPORATION SHALL HAVE A MINIMUM OF NINE (9) AND A MAXIMUM OF FIFTEEN (15) PERSON(S). THE NUMBER OF DIRECTORS CONSTITUTING THE BOARD SHALL BE AS FIXED FROM TIME TO TIME BY THE BOARD OF DIRECTORS. QUALIFICATIONS: THE BOARD OF DIRECTORS WILL BE COMPRISED OF AT LEAST FIFTY-ONE (51%) OF PERSON(S) WHO ARE CONSUMERS OF THE CORPORATION; CONSUMERS AS DEFINED AS INDIVIDUALS WHO ARE SERVED BY THE CORPORATION AND WHO UTILIZE THE CORPORATION AS THEIR PRINCIPAL SOURCE OF PRIMARY CARE OR AS INDIVIDUALS WHO SERVE AS THE LEGAL GUARDIAN OF A DEPENDENT CHILD OR ADULT WHO IS A CONSUMER OF THE CORPORATION. DIRECTORS CONSIDERED NON-USER MEMBERS OF THE BOARD WILL BE REPRESENTATIVE OF THE COMMUNITY IN WHICH THE CORPORATION IS LOCATED AND SHOULD BE SELECTED FOR THEIR EXPERTISE IN COMMUNITY AFFAIRS, LOCAL GOVERNMENT, FINANCE AND BANKING, LEGAL AFFAIRS, TRADE UNIONS, AND OTHER COMMERCIAL AND INDUSTRIAL CONCERNS, OR SOCIAL SERVICE AGENCIES WITHIN IN THE COMMUNITY. DIRECTORS SHALL REASONABLY REPRESENT INDIVIDUALS SERVED BY THE CORPORATION IN TERMS OF RACE, ETHINICITY AND GENDER. NO MEMBER OF THE BOARD MAY BE AN EMPLOYEE OF THE CORPORATION, OR A SPOUSE, CHILD, PARENT, OR SIBLING, BY BLOOD OR BY MARRIAGE, OF AN EMPLOYEE OF THE CORPORATION. IN ADDITION, MORE THAN ONE-HALF OF THE NON-CONSUMER DIRECTORS MAY BE PERSONS WHO DERIVE MORE THAN TEN PERCENT (10%) OF THEIR ANNUAL INCOME FROM THE HEALTH CARE INDUSTRY. RESPONSIBILITY OF THE BOARD: THE BOARD OF DIRECTORS SHALL HAVE SUPERVISION, CONTROL AND DIRECTION OF THE MANAGEMENT, AFFAIRS AND PROPERTY OF THE CORPORATION; SHALL DETERMINE IT'S POLICIES OR CHANGES THEREIN; AND SHALL ACTIVELY IMPLEMENT AND PURSUE ITS PURPOSES AND OBJECTIVES AND SUPERVISE THE DISBURSEMENT OF ITS FUNDS. INDIVIDUAL BOARD MEMBERS DO NOT HAVE THE AUTHORITY TO ACT OR SPEAK ON BEHALF OF THE ENTIRE BOARD WITHOUT THE EXPRESS WRITTEN BOARD APPROVAL OR CONSENT. DUTIES OF THE BOARD: SPECIFIC DUTIES OF THE BOARD OF DIRECTORS INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING: -THE SELECTION AND DISMISSAL OF THE PRESIDENT/CEO OF THE CORPORATION, AND HIS OR HER EVALUATION. THE PRESIDENT/CEO IS AN AGENT OF THE BOARD AND IS ACCOUNTABLE TO THE BOARD. -ADOPTION OF POLICIES FOR FINANCIAL MANAGEMENT PRACTICES, INCLUDING A SYSTEM TO ASSURE ACCOUNTABILITY FOR CORPORATION RESOURCES, AND APPROVAL OF THE ANNUAL BUDGET, GRANT APPLICATIONS, THE ANNUAL AUDIT, BUDGET PRIORITIES, ELIGIBILITY FOR SERVICES, CRITERIA FOR PARTIAL PAYMENT SCHEDULES AND LONG-RANGE FINANCIAL PLANNING. -EVALUATION OF CORPORATION ACTIVITIES INCLUDING SERVICE UTILIZATION PATTERNS, PATIENT CARE POLICIES, PRODUCTIVITY, PATIENT SATISFACTION, ACHIEVEMENT OF PROJECT OBJECTIVES, AND DEVELOPMENT OF A PROCESS OF HEARING AND RESOLVING PATIENT GRIEVANCES. -ASSURE COMPLIANCE WITH APPLICABLE FEDERAL, STATE, AND LOCAL LAWS AND REGULATIONS. -ADOPTION OF HEALTHCARE POLICIES, INCLUDING ACCESSIBILITY, SCOPE AND AVAILABILITY OF SERVICES POLICIES, LOCATION OF SERVICES, HOURS OF OPERATION, AND QUALITY OF CARE AUDIT PROCEDURES. -DEVELOPING, ADOPTING, AND PERIODICALLY UPDATING PERSONNEL POLICIES INCLUDING SELECTION AND DISMISSAL PROCEDURES, SALARY AND BENEFIT SCALES, HEALTH CARE, EMPLOYEE GRIEVANCE PROCEDURES, AND EQUAL OPPORTUNITY PRACTICES. CHIEF FINANCIAL OFFICER: THE CHEIF FINANCIAL OFFICER ("CFO") SHALL BE AN EMPLOYEE OF THE CORPORATION AND SHALL REPORT DIRECTLY TO THE PRESIDENT/CEO. THE CFO SHALL OVERSEE, MONITOR AND CONTROL THE CORPORATE FUNDS AND SHALL KEEP FULL AND ACCURATE RECORDS AND ACCOUNTS OF ALL RECEIPTS AND DISBURSEMENTS AND SHALL DEPOSIT, INVEST OR REINVEST ALL MONIES AND LIQUID ASSETS IN THE NAME AND TO THE CREDIT OF THE CORPORATION IN SUCH DEPOSITORIES AS MAY BE DESIGNATED BY THE BOARD OF DIRECTORS. THE CFO SHALL OVERSEE, MONITOR AND CONTROL ALL DISBURSEMENTS OF ALL FUNDS OF THE CORPORATION DEMANDING AND REQUIRING PROPER VOUCHERS FOR SUCH DISBURSEMENTS, AND SHALL RENDER TO THE BOARD AT SUCH TIME OR TIMES AS THE BOARD OF DIRECTORS MAY REQUIRE, AN ACCOUNT OF ALL CORPORATE TRANSACTIONS AND THE FINANCIAL CONDITION OF THE CORPORATION. FINANCE/AUDIT COMMITTEE: THE CHAIR OF THE FINANCE COMMITTEE SHALL BE THE CHIEF FINANCIAL OFFICER OF THE CORPORATION. THE FINANCE COMMITTEE SHALL REVIEW AND MAKE RECOMMENDATIONS TO THE BOARD REGARDING THE FINANCIAL FEASIBILITY OF ALL CORPORATE ACTIVITIES AND UNDERTAKINGS, CORPORATE INVESTMENT POLICIES, COMPENSATION OF OFFICERS, THE ANNUAL INDEPENDENT AUDIT OF THE CORPORATION, EVALUATING EFFICIENCY, EFFECTIVENESS, AND COMPLIANCE WITH ALL SECTION 330 REQUIREMENTS, AND THE FISCAL AND FINANCIAL AFFAIRS OF THE CORPORATION.
FORM 990, PART VI, SECTION B, LINE 11B
PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DELIVERED TO ALL BOARD MEMBERS FOR REVIEW AND APPROVAL PRIOR TO SIGNING AND FILING.
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST POLICY: PREFERRED FAMILY HEALTHCARE, INC HAS A CONFLICT OF INTEREST POLICY TO PROTECT ITS INTEREST WHEN CONTEMPLATING ENTERING INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A DIRECTOR OR AN OFFICER OF THE ORGANIZATION OR THAT MIGHT RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. ANNUALLY ALL BOARD MEMBERS COMPLETE A CONFLICT OF INTEREST STATEMENT DISCLOSING ANY POSSIBLE SOURCES OF CONFLICT. THESE POTENTIAL CONFLICTS ARE PRESENTED AT A BOARD MEETING WITH THE INTERESTED PARTY BEING EXCUSED FROM THE ROOM. THE REMAINING BOARD MEMBERS DELIBERATE THE ISSUES AND CONDUCT A VOTE REGARDING THE SIGNIFICANCE OF THE CONFLICT AND WHETHER THE TRANSACTION IS ACCEPTABLE TO THE ORGANIZATION.
FORM 990, PART VI, SECTION B, LINES 15A & 15B
CEO, CFO AND SENIOR EXECUTIVE COMPENSATION REVIEW: AN INDEPENDENT COMPENSATION COMMITTEE PERFORMED A REVIEW OF COMPENSATION FOR THE CEO, CFO, AND ALL SENIOR EXECUTIVES IN THE 2009 YEAR. THIS REVIEW INCLUDED COMPARABLE DATA FROM SEVERAL SOURCES AND WAS APPROVED BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
GOVERNING DOCUMENT AVAILABILITY: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C
OVERSIGHT AND SELECTION PROCESS THE BYLAWS WERE AMENDED DURING THE YEAR AND FORMALLY ESTABLISHED THE FINANCE/AUDIT COMMITTEE. THIS COMMITTEE'S RESPONSIBILITIES INCLUDE THE ANNUAL INDEPENDENT AUDIT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.