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
Spring Branch Community Health Center
Employer identification number
30-0198705
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.") ....
1,120,352
1,171,939
1,292,273
1,325,052
2,151,416
7,061,032
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
1,120,352
1,171,939
1,292,273
1,325,052
2,151,416
7,061,032
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.
7,061,032
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..
1,120,352
1,171,939
1,292,273
1,325,052
2,151,416
7,061,032
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,491
3,948
2,630
1,676
9,745
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).
7,070,777
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
99.860 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
99.860 %
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.)
0
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
0 %
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
0 %
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:
13000178
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
Spring Branch Community Health Center
Employer identification number
30-0198705
Return Reference
Explanation
Pt VI, Line 12c
The conflict of interest policy is included in the by laws article
Pt VI, Line 15a
CEO compensation is determined by the Board of Directors. Annual
Pt VI, Line 15a
performance reviews are done by the Board of Directors.
Pt III, Line 2
Prenatal Ultrasound services was started in February 2011, Dental
Pt III, Line 2
services started in April 2011.
Pt VI, Line 19
The conflict of Interest policy and the Financial statement
Pt VI, Line 19
are given to the public upon request. Policies regarding the
Pt VI, Line 19
company's operation are available to all employees.
Pt VI, Line 11b
Both CEO and CFO review all the information on the Federal Form 990.
Pt VI, Line 11b
Then it is presented to the Finance Committee for review. Any
Pt VI, Line 11b
changes or adjustments will be communicated to preparer, the auditor and
Pt VI, Line 11b
final Form 990 will be distributed to the Finance Committee to approve before filing.
Pt VI, Line 15b
Employees and other officers compensations are conducted by the CEO.
Pt VI, Line 15b
All have annual reviews which affects compensations.
Pt III, Line 2
SBCHC opened a third site in Oct of 2013 located in West Houston
Pt III, Line 2
providing family and pediatric health care services.
About SBCHC
The Spring Branch Community Health Center, (SBCHC), is a
About SBCHC
nonprofit corporation registered with the Texas Secretary
About SBCHC
of State, formed in June 2003 for the purposes of providing
About SBCHC
comprehensive health care services to indigent patients
About SBCHC
in the Spring Branch area, and specifically, the Medically
About SBCHC
Underserved Population (MUP). SBCHC was granted a 501(c)(3)
About SBCHC
exemption by the Internal Revenue Service on September 11, 2003.
About SBCHC
The SBCHC mission is: "to provide comprehensive health
About SBCHC
care services to all patients." SBCHC was developed to reduce
About SBCHC
area health disparities by creating a neighborhood-based
Form 990, Part IX, Line 24f
DUES
About SBCHC
health center and by providing comprehensive primary health
About SBCHC
care and enabling services which are culturally competent,
About SBCHC
linguistically appropriate and client-driven in a
About SBCHC
location easily accessible to public transportation.
About SBCHC
In this way, individuals and families are able to access a
About SBCHC
health care home outside of the hospital emergency room, with
About SBCHC
a goal of eliminating episodic and inappropriate access
About SBCHC
to primary care services. SBCHC is located on the
About SBCHC
west side of Houston, Texas, in Harris County. SBCHC began
About SBCHC
providing health care services in May 2004 and received
About SBCHC
initial Section 330 funding in September 2005. The population
About SBCHC
we serve is uninsured and needs access to primary
About SBCHC
health care.There are a growing number of families visiting
About SBCHC
the health center for all their health care needs
About SBCHC
including an increasing number of pregnant women needing
About SBCHC
prenatal care. Due to the increase in demand for affordable
About SBCHC
health care in the service area, SBCHC has reached
About SBCHC
maximum capacity in 2013 with its two locations. In
About SBCHC
Octomber 2013, SBCHC expanded to West Houston with a third
About SBCHC
location and this additional facility was needed to expand
About SBCHC
services and fulfill the growing needs of patients.
About SBCHC
In 2013, the community health center served
About SBCHC
10, 275 individual patients that generated
About SBCHC
32,584 total patient visits. The community health
About SBCHC
center continues to grow every year and it will
About SBCHC
continue providing quality and affordable primary
About SBCHC
care services to the population of West Houston.
Part I, Line 1
testing services. SBCHC serves both insured and uninsured patients;
Part I, Line 1
with a large percentage of patients being medically indigent,
Part I, Line 1
under-insured, and uninsured.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.