Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 51,662 | 0 | 0 | 0 | 35,400 | 87,062 |
| 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...... | 388,620,353 | 415,427,897 | 423,570,696 | 430,147,979 | 848,055,027 | 2,505,821,952 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 388,672,015 | 415,427,897 | 423,570,696 | 430,147,979 | 848,090,427 | 2,505,909,014 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 2,505,909,014 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 388,672,015 | 415,427,897 | 423,570,696 | 430,147,979 | 848,090,427 | 2,505,909,014 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 984,765 | 1,160,371 | 756,428 | 518,891 | 1,005,897 | 4,426,352 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 984,765 | 1,160,371 | 756,428 | 518,891 | 1,005,897 | 4,426,352 |
| 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 VI.) .. | 14,988 | 14,988 | ||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 389,671,768 | 416,588,268 | 424,327,124 | 430,666,870 | 849,096,324 | 2,510,350,354 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III, SECTION B, LINE 1, COLUMN (E) 2014 | FOR THE YEAR ENDED DECEMBER 31, 2014, CONTRIBUTIONS OF $35,400 RESULTED |
| SCHEDULE A, PART III, SECTION B, LINE 12, COLUMN (A) 2010 | FOR THE YEAR ENDED DECEMBER 31, 2010, MISCELLANEOUS INCOME OF $14,988 |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | AS A RESULT OF THE AFFORDABLE CARE ACT (ACA) THE ORGANIZATION HAS EXPANDED SERVICES IN TWO AREAS. THE ORGANIZATION ENTERED THE COMMERCIAL MARKET BY OFFERING PRODUCTS ON THE STATE'S HEALTH BENEFIT EXCHANGE. THE ORGANIZATION NOW OFFERS PRODUCTS ON THE INDIVIDUAL AND SHOP (PLANS FOR SMALL BUSINESS) EXCHANGES. THE ORGANIZATION ALSO EXPANDED ITS MEDICAID PROGRAMS. THE ORGANIZATION SERVES AS A MANAGED CARE ORGANIZATION FOR THE ADULT MEDICAID POPULATION WHO RECEIVE EITHER LONG TERM CARE AND/OR HOME AND COMMUNITY BASED SERVICES. THE PROGRAM IS BEING DEVELOPED IN TWO PHASES. THE FIRST IS TO MANAGE THE CARE AND COORDINATION OF THEIR MEDICAID SERVICES AND COVERAGE. THE SECOND PHASE, WHICH WILL FURTHER EXPAND BENEFITS COVERAGE, WILL BE IMPLEMENTED DURING 2015 AND 2016. |
| FORM 990, PART VI, LINE 1 | THE ORGANIZATION OPERATES WITH COMMUNITY HEALTH CENTERS (CHCS) TO SECURE ACCESS TO HEALTH CARE FOR RHODE ISLAND'S AT-RISK POPULATIONS; THE CEO AND/OR EXECUTIVE DIRECTOR OF EACH CHC IS A MEMBER OF THE ORGANIZATION'S GOVERNING BOARD. THE ORGANIZATION CHOSE TO REPORT THESE INDIVIDUALS AS INTERESTED PERSONS, HOWEVER PER THE SCH L INSTRUCTIONS, THEY ARE NOT INTERESTED PERSONS BY DEFINITION, SINCE THEY DO NOT OWN 35% OF THE ORGANIZATION AND THE CHCS ARE ALL 501C3 ORGANIZATIONS. THE RESULT OF OVER-REPORTING IS THAT THESE NINE INDIVIDUALS REPORTED ON SCH L APPEAR TO BE NON-INDEPENDENT, WHEN THEY ARE ACTUALLY INDEPENDENT. THEREFORE, ONLY ONE MEMBER OF THE GOVERNING BODY, OUT OF 16 MEMBERS, ARE NOT INDEPENDENT. DESCRIPTION OF RELATIONSHIPS FORM 990, PART VI, LINE 2 A MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS IS AN EXECUTIVE DIRECTOR OF A COMMUNITY HEALTH CENTER (CHC), BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. BLACKSTONE VALLEY HEALTH CARE, THROUGH A GRANT, INVESTED IN EQUIPMENT AND SOFTWARE FOR AN ELECTRONIC MEDICAL RECORD (EMR) SYSTEM. THREE OTHER CHC'S, EAST BAY, TRI-TOWN AND COMPREHENSIVE COMMUNITY ACTION PROGRAM, HAVE USE OF THE EMR AND BILLING SYSTEM AND WELLONE USES THE EMR PORTION OF THE SYSTEM. THE CHCS SHARE THE COST OF RUNNING THE SYSTEM. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 THE ORGANIZATION IS A 501(C)(3) CORPORATION AND HAS MEMBERS BUT DOES NOT HAVE ANY STOCKHOLDERS. THE ORGANIZATION HAS A BOARD OF DIRECTORS WHO ARE MEMBERS OF THE ORGANIZATION THAT MEET ON A REGULAR BASIS AND FUNCTION AS THE GOVERNING BODY OF THE ORGANIZATION. FORM 990, PART VI, LINE 7A THE MEMBERS OF THE ORGANIZATION ARE RHODE ISLAND COMMUNITY HEALTH CENTERS WHO HAVE THE AUTHORITY TO APPOINT A PORTION OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ALSO APPROVES THE HIRING OF THE CHIEF EXECUTIVE OFFICER WHO IS A VOTING MEMBER OF THE BOARD. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11B THE ORGANIZATION'S FISCAL OPERATIONS DEPARTMENT ACCUMULATES THE INFORMATION AND DATA NECESSARY TO COMPLETE THE FEDERAL FORM 990. AUDITED FINANCIAL STATEMENTS AND APPROVED POLICIES AND PROCEDURES ARE USED AS INPUT TO COMPLETE THE 990. A DRAFT RETURN IS PREPARED AND REVIEWED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS. AFTER THE REVIEW PROCESS IS COMPLETED BY THE INDEPENDENT ACCOUNTANTS, THE FINANCE STAFF REVIEWS THE RETURN PRIOR TO FILING WITH THE IRS. THE BOARD IS ALSO PROVIDED AN ELECTRONIC COPY OF THE RETURN PRIOR TO FILING WITH THE IRS. |
| POLICIES | FORM 990, PART VI, LINES 12A, 12B, 13 & 14 PURSUANT TO THE INSTRUCTIONS FOR FORM 990, THE ORGANIZATION MUST ANSWER NO TO THE QUESTIONS BECAUSE THE BOARD OF DIRECTORS DOES NOT APPROVE OR ADOPT THESE POLICIES ON AN ANNUAL BASIS. HOWEVER, THE ORGANIZATION HAS ISSUED THESE POLICIES AT THE DIRECTION OF MANAGEMENT AND THESE POLICIES AND PROCEDURES ARE STRICTLY ENFORCED BY THE ORGANIZATION'S MANAGEMENT TEAM. |
| CONFLICT OF INTEREST | FORM 990, PART VI, LINE 12C AS PROMULGATED BY THE ORGANIZATION'S COMPLIANCE PLAN, THE ORGANIZATION'S DIRECTOR OF COMPLIANCE IS ALSO THE ORGANIZATION'S CHIEF PRIVACY OFFICIAL. ALL BOARD MEMBERS, COMMITTEE MEMBERS AND EMPLOYEES MUST DISCLOSE ALL CONFLICTS ON A SIGNED DISCLOSURE FORM ON A YEARLY BASIS. IF A POTENTIAL CONFLICT OF INTEREST IS REPORTED, THE PRIVACY OFFICIAL REVIEWS THE CIRCUMSTANCES TO DETERMINE IF A POSSIBLE CONFLICT EXISTS. IF IT IS DETERMINED THAT A CONFLICT EXISTS, THE PRIVACY OFFICIAL WILL MONITOR THE CONFLICT OF INTEREST AS NECESSARY AND/OR REFERS THE APPROPRIATE ITEMS THROUGH THE CHIEF FINANCIAL OFFICER TO THE CHIEF EXECUTIVE OFFICER FOR A RESOLUTION/DECISION. BOARD AND COMMITTEE MEMBERS REFRAIN FROM VOTING ON ISSUES WHERE THERE IS AN APPEARANCE OF A CONFLICT. |
| OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | FORM 990, PART VI, LINES 15A & 15B THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE CONTRACT OF THE CEO AND ANY CHANGES TO THE CONTRACT. THE ORGANIZATIONAL DEVELOPMENT AND HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER BASED ON COMPENSATION SURVEYS. THE COMMITTEE SUBSCRIBES TO THREE OR FOUR SALARY SURVEYS THAT LIST SALARY AND SALARY INCREASES BY POSITION, GEOGRAPHY, PLAN SIZE AND PROFIT VS NON-PROFIT ORGANIZATIONS. THESE SURVEYS ARE USED TO SET COMPENSATION ANNUALLY. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S LOCATION AT 299 PROMENADE STREET, PROVIDENCE, RI 02908. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 YEAR-END CHANGES IN ENDING BALANCES OF NONADMITTED ASSETS: $1,031,015. |
| ACCOUNTING METHOD | FORM 990, PART XII, LINE 1 THE ORGANIZATION USES THE STATUTORY METHOD OF ACCOUNTING. |
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