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
EAST TEXAS BORDER HEALTH CLINIC GENESIS PRIMECARE
Employer identification number
03-0538912
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.") ....
1,040,104
844,946
875,212
1,482,771
1,952,689
6,195,722
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
1,040,104
844,946
875,212
1,482,771
1,952,689
6,195,722
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.
6,195,722
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..
1,040,104
844,946
875,212
1,482,771
1,952,689
6,195,722
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).
6,195,722
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,504,387
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
100.000 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
100.000 %
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
EAST TEXAS BORDER HEALTH CLINIC GENESIS PRIMECARE
Employer identification number
03-0538912
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
ETBHC CHANGED ITS BYLAWS ON MAY 29, 2014. THE CHANGES INCLUDE: 1. ARTICLE II, SECTION B(2) WAS CHANGED TO INCLUDE MARION AND BOWIE COUNTIES TO THE SERVICE AREA. 2. ARICLE IV, SECTION B WAS ADDED TO DEFINE WHAT EACH BOARD MEMBER MUST DO TO AVIOD A CONFLICT OF INTEREST. 3. ARTICLE IV, SECTION C WAS ADDED TO REQUIRE THE BOARD TO CONDUCT A SELF-EVALUATION ANNUALLY. 4. ARTICLE V, SECTION E WAS MODIFIED TO CHANGE THE TERM OF OFFICE FOR BOARD MEMBERS FROM TWO YEARS TO THREE YEARS; TO CHANGE THE NUMBER OF MAXIMUM TERMS FROM THREE TERMS ONLY TWO OF WHICH MAY BE CONSECUTIVE TO FOUR TERMS ONLY THREE OF WHICH MAY BE CONSECUTIVE; AND, TO CHANGE THE NUMBER OF TERMS A BOARD MEMBER CAN RETURN TO THREE TERMS FROM TWO TERMS. 5. ARTICLE VI, SECTION C(2) WAS MODIFIED TO STATE THAT A DIRECTOR MAY BE REMOVED EITHER WITH OR WITHOUT CAUSE AND TO CHANGE THE TIME PERIOD FOR ATTENDING FIFTY PERCENT OF REGULAR BOARD MEETINGS FROM JANUARY TO DECEMBER TO ANY SIX MONTH PERIOD. 6. ARTICLE VI, SECTION D WAS DELETED SINCE THIS SECTION WAS DUPLICATE OF SECTION VI, SECTION C(1). 7. ARTICLE VI, SECTION E BECAME THE NEW SECTION D. 8. ARTICLE VI, SECTION E WAS ADDED TO ADDRESS PROCEDURES FOR FILLING A VACANCY ON THE BOARD. NEW DIRECTORS WILL HOLD THE OFFICE FOR THE UNEXPIRED TERM OF THE PREDECESSOR DIRECTOR. IF THE VACANCY IS DUE TO CREATING A NEW POSITION ON THE BOARD, NEW BOARD MEMBERS MUST BE DULY ELECTED AND QUALIFIED. 9. ARTICLE VI, SECTION F WAS ADDED TO ALLOW ACTION REQUIRED OR PERMITTED TO BE TAKEN AT ANY MEETING OF THE BOARD OR BOARD COMMITTEE MAY BE TAKEN WITHOUT A MEETING IF PRIOR WRITTEN CONSENT IS SIGNED BY ALL BOARD OR COMMITTEE MEMBERS AND THE WRITTEN CONSENT IS FILED WITH BOARD OR COMMITTE MINUTES. 10. ARTICLE VI, SECTION G WAS ADDED TO REQUIRE NEW DIRECTORS TO BE ELECTED BY EXISTING DIRECTORS QUALIFIED TO VOTE AT AN ANNUAL MEETING OF THE DIRECTORS. 11. ARTCILE VII, SECTION D WAS MODIFIED TO EXPAND THE DUTIES OF THE SECRETARY TO INCLUDE SAFEKEEPING THE SEAL OF THE CORPORATION, AFFIXING THE SEAL WHEN AUTHORIZED AND ATTESTING THE SEAL BY ADDING HIS/HER SIGNATURE OR THE SIGNATURE OF THE TREASURER OR ASSISTANT SECRETARY AS WELL AS PERFORMING OTHER DUTIES ASSIGNED BY THE BOARD. 12. ARTICLE VII, SECTION E REQUIRES THE CHIEF FINANCIAL OFFICER TO BE THE TREASURER AND DESCRIBES THE DUTIES OF HAVING CUSTODY OF AND RESPONSIBLE FOR ALL FUNDS AND SECURITIES OWNED BY THE CORPORATION.
FORM 990, PART VI, SECTION A, LINE 4
13. ARTICLE IX WAS MODIFIED. SECTION A BECAME SECTION D. SECTION D STATES THAT THERE SHALL BE THREE TYPES OF COMMITTEES - EXECUTIVE, STANDING AND SPECIAL COMMITTEES. THE PLANNING AND MARKETING COMMITTEE AND PERSONNEL COMMITTEE WERE REMOVED AS STANDING COMMITTEES AND THE NOMINATING COMMITTEE WAS RENAMED THE MEMBERSHIP COMMITTEE. 14. ARTICLE IX, SECTION A WAS ADDED TO AUTHORIZE THE BOARD TO DESIGNATE ONE OR MORE COMMITTEES, REQUIRES THE CHAIRPERSON TO BE A MEMBER OF THE COMMITTEE AND FOR EACH COMMITTEE TO KEEP MINUTES OF ITS PROCEEDINGS TO PRESENT TO THE BOARD. 15. ARTICLE IX, SECTION B WAS ADDED AND STATES THAT THE BOARD MAY DESIGNATE AN EXECUTIVE COMMITTEE THAT CONSISTS OF THE CORPORATION'S OFFICERS. THE EC SHALL HAVE AND MAY EXERCISE ALL OF THE AUTHORITY OF THE BOARD BUT IT SHALL NOT OPERATE TO RELIEVE THE BOARD OR ANY DIRECTOR OF ANY REPONSIBILTY IMPOSED UPON THE BOARD OR DIRECTED BY LAW. 16. ARTICLE IX, SECTION C WAS ADDED TO DEFINE A QUORUM AS A MAJORITY OF THE MEMBERS OF THE COMMITTEE. 17. ARTICLE X, SECTION A EXPANDED THE LOCATIONS FOR BOARD MEETINGS TO INCLUDE LOCATIONS IN MARION AND BOWIE COUNTIES. 18. ARTICLE X, SECTION B WAS MODIFIED TO ALLOW BOARD MEMBERS TO PARTICIPATE IN REGULARLY SCHEDULED BOARD MEETINGS VIA TELECOMMUNICATIONS. 19. ARTICLE X, SECTION E WAS CHANGED TO REQUIRE THE SECRETARY TO KEEP MINUTES OF THE BOARD MEETINGS AND TO PRESENT MINUTES AT THE SUBSEQUENT BOARD MEETING FOR APPROVAL. 20. ARTICLE X, SECTION I BECAME PART OF SECTION H. 21. ARTICLE X, SECTION I WAS ADDED TO PROHIBIT BOARD MEMBERS FROM RECEIVING ANY FEE FOR THEIR SERVICES. BOARD MEMBERS MAY RECEIVE REIMBURSEMENT FOR REASONABLE EXPENSES REALTED TO ATTENDING BOARD MEETINGS. 22. ARTICLE X, SECTION J WAS ADDED TO STATE THAT BOARD MEETINGS ARE GENERALLY OPEN TO THE PUBLIC. EXECUTIVE SESSIONS CLOSED TO THE PUBLIC CAN BE CALLED TO DISCUSS SENSITIVE OR CONFIDENTIAL MATTERS. BOARD MEMBERS WITH A CONFLICT OF INTEREST ARE EXCLUDED FROM THE EXECUTIVE SESSIONS. 23. ARTICLE X, SECTION K WAS ADDED TO STATE THAT ROBER'S RULE OF ORDER SHALL GOVERN MEETINGS AND PROCEDURES NOT ADDRESSED BY LAW, THE ARTICLES OF INCORPORATION OR THE BYLAWS. 24. ARTICLE XII WAS ADDED TO STATE THAT THE BYLAWS CAN BE AMDENDED BY A MAJORITY VOTE OF THE BOARD DURING A MEETING IN WHICH A QUORUM OF VOTING BOARD MEMBERS ARE PRESENT. THE CHANGES TO THE BYLAWS MUST BE CONSISTENT WITH THE ARTICLES OF INCORPORATION. 25. ARTICLE XIII WAS ADDED TO ESTABLISH A COMPLIANCE AND PERFORMANCE IMPROVEMENT COMMITTEE FOR THE PURPOSE OF ENSURING COMPLIANCE WITH STATE AND FEDERAL LAWS AND FOR MONITORING AND IMPROVING THE PERFORMANCE AND QUALTIY OF SERVICES PROVIDED. 26. ARTICLE XIV WAS ADDED TO INDEMNIFY A DIRECTOR, OFFICER OR COMMITTEE MEMBER WHO IS NAMED AS A DEFENDANT IN ANY LEGAL PROCEDURES AS A RESULT OF HIS/HER ACTIONS OR OMMISSIONS WITHIN THE SCOPE OF HIS/HER OFFICIAL CAPACITY AS LONG AS HE/SHE NOTIFIES THE CORPORATION ON A TIMELY BASIS. THE CORPORATION WILL IDEMNIFY THE PERSON ONLY IF HE/SHE ACTED IN GOOD FAITH AND REASONABLY BELIEVED THE CONDUCT WAS IN THE CORPORATIONS BEST INTEREST. 27. ARTICLE XV WAS ADDED TO STATE THAT UPON DISSOLUTION, THE CORPORATION'S REMAINING ASSETS MUST BE TRANSFERRED TO ONE OR MORE IRC SECTION 501(C)(3) EXEMPT ORGANIZATIONS AS DESIGNATED BY THE BOARD.
FORM 990, PART VI, SECTION B, LINE 11
ETBHC'S EXECUTIVES AND ACCOUNTANTS REVIEW THE FORM 990 BEFORE PRESENTING THE RETURN TO THE BOARD OF DIRECTORS. UPON PRESENTATION TO THE BOD, THE BOARD APPROVES THE RETURN. ONCE THE BOARD APPROVES THE RETURN, THE RETURN IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
BOARD MEMBERS ARE REQUIRED TO REVIEW AND SIGN CONFLICT OF INTEREST POLICIES AT LEAST ANNUALLY OR AS NECESSARY.
FORM 990, PART VI, SECTION B, LINE 15A
THE PROCESS FOR DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO INCLUDES A REVIEW OF COMPARABILITY DATA FOR SIMILAR ORGANIZATIONS AND APPROVAL BY THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 18
THE ORGANIZATION'S FORM 1023 AND FORM 990 ARE AVAILABLE TO THE PUBLIC UPON REQUEST WHEN DEEMED REASONABLY NECESSARY.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST WHEN DEEMED REASONABLY NECESSARY.
FORM 990, PART IX, LINE 11G
PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 650,976. MANAGEMENT AND GENERAL EXPENSES 22,470. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 673,446.
FORM 990, PART XII, LINE 2C:
THE ORGANIZATION'S BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, REVIEW, AND COMPILATION OF ITS FINANCIAL STATEMENTS. THE BOARD OF DIRECTORS IS ALSO RESPONSIBLE FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.