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
ABC FOR HEALTH INCORPORATED
Employer identification number
39-1783748
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.") ....
356,001
463,112
188,678
147,601
163,779
1,319,171
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
356,001
463,112
188,678
147,601
163,779
1,319,171
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.
1,319,171
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..
356,001
463,112
188,678
147,601
163,779
1,319,171
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
436
386
428
323
213
1,786
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).
1,320,957
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,437,237
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
99.880 %
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
ABC FOR HEALTH INCORPORATED
Employer identification number
39-1783748
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
THE PREPARED FORM 990 IS REVIEWED BY THE MEMBERS OF THE GOVERNING BODY BEFORE THE RETURN IS FILED WITH THE IRS. THE DISTRIBUTION OF THE RETURN AND THE REVIEW OF THE RETURN BY THE GOVERNING BODY PRIOR TO FILING IS GENERALLY CONDUCTED ELECTRONICALLY.
FORM 990, PART VI, SECTION B, LINE 12C
ANNUALLY ALL DIRECTORS AND OFFICERS COMPLETE AND SIGN A STATEMENT DISCLOSING INTERESTS THAT COULD GIVE RISE TO CONFLICTS. THE SIGNED STATEMENTS ARE KEPT AT THE ORGANIZATION'S ADMINISTRATIVE OFFICE. THE MEMBERS OF THE GOVERNING BODY MAKE DETERMINATIONS OF WHETHER A CONFLICT EXISTS AND REVIEW ACTUAL CONFLICTS. ANY PERSON WITH A CONFLICT IS GENERALLY PROHIBITED FROM PARTICIPATING IN THE GOVERNING BODY'S DELIBERATIONS AND DECISIONS IN THE TRANSACTION.
FORM 990, PART VI, SECTION B, LINE 15A
THE DIRECTORS TYPICALLY CONDUCT AN ANNUAL PERFORMANCE REVIEW OF THE EXECUTIVE DIRECTOR AND DETERMINE THE EXECUTIVE DIRECTOR'S COMPENSATION USING DATA ON COMPENSATION PAID BY COMPARABLE ORGANIZATIONS FOR SIMILAR SERVICES.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
STATEMENT OF CASES IN LITIGATION DURING THE YEAR:
CASE 1: IN THE MATTER OF A.F. WISCONSIN DIVISION OF HEARINGS & APPEALS CASE NO. MPA-13/160767 THIS CASE CHALLENGED A WISCONSIN MEDICAID DENIAL OF PRIOR AUTHORIZATION FOR A SPECIALIZED CAR SEAT REQUESTED ON BEHALF OF A DEVELOPMENTALLY DISABLED FOUR YEAR OLD GIRL IN A LOW INCOME HOUSEHOLD. THIS LITIGATION SERVED THE PUBLIC INTEREST BY ADVANCING THE CAUSE OF A DISADVANTAGED FAMILY. FEES RECEIVED: NONE CASE 2: HAVENS V. WISCONSIN DEPARTMENT OF HEALTH SERVICES ROCK COUNTY CIRCUIT COURT CASE NO. 14-CV-1104 THIS CASE SEEKS TO DEFINE THE STATE'S AUTHORITY TO RECOUP MEDICAID PRESUMPTIVE DISABILITY BENEFITS PAID PENDING AN ADVERSE FAIR HEARING DECISION WHEN THE BENEFITS WERE NOT INCORRECTLY PAID AS A RESULT OF THE RECIPIENT MISREPRESENTING OR OMITTING INFORMATION RELEVANT TO BENEFITS ELIGIBILITY. THIS CASE SERVES THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN AND BY ADVANCING THE CAUSE OF A DISADVANTAGED INDIVIDUAL. FEES RECEIVED: NONE CASE 3: KESSLER V. WISCONSIN DEPARTMENT OF HEALTH SERVICES WISCONSIN COURT OF APPEALS CASE NO. 14-AP-1544 IN FOLLOW UP TO A FAVORABLE ADMINISTRATIVE HEARING DECISION, THIS CASE SOUGHT TO CLARIFY CASE LAW CONCERNING APPLICATION OF THE SUBSTANTIAL JUSTIFICATION STANDARD TO FEE AWARDS UNDER WISCONSIN'S EQUAL ACCESS TO JUSTICE ACT. THIS CASE SERVED THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN. FEES RECEIVED: NONE CASE 4: IN THE MATTER OF B.S. COMMERCIAL INSURANCE ADMINISTRATIVE APPEAL THIS CASE INVOLVES AN ADMINISTRATIVE GRIEVANCE APPEAL AND FOLLOW UP COMPLAINT FILING WITH WISCONSIN'S OFFICE OF THE COMMISSIONER OF INSURANCE REGARDING THE APPLICATION OF THE "NEWBORN MANDATE" UNDER WISCONSIN INSURANCE LAW TO AN INSURANCE POLICY'S GENERAL EXCLUSION OF COVERAGE FOR "HABILITATIVE SERVICES." THIS CASE SERVES THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN AND BY ADVANCING THE CAUSE OF A DISADVANTAGED INDIVIDUAL. FEES RECEIVED: $1,050.00 CASE 5: MONDRY V. AMERICAN FAMILY MUTUAL INSURANCE COMPANY U.S. COURT OF APPEALS, 7TH CIRCUIT, CASE NOS. 07-1109, 10-3409, 11-1750 U.S. DISTRICT COURT, WESTERN DISTRICT OF WI, CASE NO. 06-CV-320-BBC THIS ERISA LITIGATION, INITIATED IN 2003, CONCLUDED IN 2014 WITH THE DISTRIBUTION OF COURT AWARDED ATTORNEY FEES AND DAMAGES. THIS CASE SET PRECEDENT IN THE SEVENTH CIRCUIT BY ESTABLISHING A REQUIREMENT THAT BENEFITS PLAN ADMINISTRATORS PRODUCE ALL INTERNAL CLAIMS DETERMINATION DOCUMENT RELIED UPON AS THE BASIS FOR AN ADVERSE DECISION UPON WRITTEN REQUEST OF THE SUBJECT PLAN PARTICIPANT. THIS CASE SERVED THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN AND BY ADVANCING THE CAUSE OF A DISADVANTAGED INDIVIDUAL. FEES AND COSTS RECEIVED: $42,695.81 CASE 6: IN THE MATTER OF R.B. WISCONSIN DIVISION OF HEARINGS & APPEALS CASE NO. MOP/150777 THIS CASE CHALLENGED THE STATE'S AUTHORITY TO RECOUP FROM A NON-MARITAL COHABITANT PARTNER MEDICAID BENEFITS PAID ON BEHALF OF THE OTHER PARTNER. THIS CASE SERVED THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN. FEES RECEIVED: $3,891.32 CASE 7: IN THE MATTER OF A.M. WISCONSIN DIVISION OF HEARINGS & APPEALS CASE NO. CBCC/146185 THIS CASE CHALLENGED THE TERMINATION OF MEDICAID BENEFITS FOR A RECIPIENT WHO RECEIVED INADEQUATE NOTICE OF TERMINATION AND INCURRED SUBSTANTIAL MEDICAL EXPENSES UNDER THE ERRONEOUS BELIEF THE MEDICAID COVERAGE WAS ACTIVE. THIS CASE SERVED THE PUBLIC INTEREST BY ADDRESSING AN ISSUE OF BROAD PUBLIC CONCERN AND BY ADVANCING THE CAUSE OF A DISADVANTAGED INDIVIDUAL. FEES RECEIVED: $6,073.97
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.