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
TOTAL HEALTH CARE INC
Employer identification number
23-7267007
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.") ....
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.
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..
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).
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
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
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
TOTAL HEALTH CARE INC
Employer identification number
23-7267007
Return Reference
Explanation
FORM 990, PART I, LINE 1
SINCE 1968, TOTAL HEALTH CARE (THC) HAS BEEN WORKING TO CLOSE HEALTHCARE DISPARITIES BY PROVIDING COMPREHENSIVE, QUALITY CARE TO PEOPLE LIVING IN SOME OF BALTIMORE'S LOWEST INCOME AND MOST CHALLENGING NEIGHBORHOODS. AGENCY-WIDE, THOUGH EIGHT SEPARATE CLINICS, WE PROVIDE PRIMARY MEDICAL, PEDIATRIC, INFECTIOUS DISEASE, DENTAL AND EYE CARE ALONG WITH INTEGRATED BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE ABUSE RECOVERY) SERVICES. WE ALSO OFFER SIX PHARMACIES; AN ARRAY OF SKILLS TRAINING AND HEALTH COURSES LIKE DISEASE MANAGEMENT, SMOKING CESSATION AND NUTRITION; AND SUPPORTIVE PERSONNEL LIKE CASE MANAGERS AND COMMUNITY HEALTH WORKERS. THC IS AT THE VANGUARD OF COMMUNITY HEALTH CLINICS IN ADOPTING BEST-PRACTICES SUCH AS THE PATIENT CENTERED MEDICAL HOME MODEL. OVER THE PAST YEAR, THC SERVED 38,358 PATIENTS FOR A TOTAL OF 160,548 VISITS WHICH CONSISTED OF 61% MEDICAL, 10% DENTAL AND ABOUT 14.5% EACH OF MENTAL HEALTH AND SUBSTANCE ABUSE RECOVERY. OUR MISSION HAS BEEN AND REMAINS FOCUSED ON IMPROVING THE QUALITY OF LIFE THE INDIVIDUALS WE SERVE EXPERIENCE. THC'S PATIENTS LIVE MOSTLY IN THE COMMUNITIES OF WEST BALTIMORE AND ARE AMONG THE MOST MEDICALLY UNDERSERVED RESIDENTS OF OUR CITY. 284,286 PEOPLE LIVE WITHIN THESE AREAS, NEARLY 73% OF WHOM ARE AFRICAN AMERICAN AND OVER 44% OF WHOM HAVE INCOMES LESS THAN 200% OF THE FEDERAL POVERTY LEVEL. ALMOST 86% OF THC'S PATIENTS ARE AFRICAN AMERICAN AND OVER 93% ARE CONSIDERED LOW INCOME (EARNING LESS THAN 80% OF BALTIMORE CITY'S MEDIAN INCOME OF $23,802). OUR PATIENTS FACE A HOST OF HEALTH CHALLENGES, INCLUDING LOW BIRTH WEIGHT, DIABETES, HYPERTENSION, OBESITY, INFECTIOUS DISEASES, SUBSTANCE ABUSE, UNDIAGNOSED OR UNTREATED MENTAL ILLNESSES, AND PREMATURE MORTALITY. THC'S ENTIRE SERVICE GEOGRAPHY HAS BEEN DESIGNATED A "MEDICALLY UNDERSERVED" AREA BY THE FEDERAL GOVERNMENT. NEARLY ONE-QUARTER OF OUR ADULTS AND 9% OF OUR CHILDREN REMAIN UNINSURED. ALMOST 70% OF OUR PATIENTS ARE COVERED BY MEDICAID - PATIENTS WHO, ALTHOUGH THEIR MEDICAL CARE MAY BE COVERED, FACE DAUNTING BARRIERS LIKE UNHEALTHY HOUSING, EXPOSURE TO AND EXPERIENCE OF VIOLENCE, POOR FOOD OPTIONS AND A LACK OF TRANSPORTATION OR CHILDCARE THAT CAN PREVENT THEIR ACCESSING AND/OR FOLLOWING THROUGH WITH MEDICAL CARE. PATIENTS WHO ARE INSURED CAN FACE THE SOMETIMES INSURMOUNTABLE AND ALWAYS CHALLENGING BURDENS OF DEDUCTIBLES AND CO-PAYS. INDEED, THE NATIONAL CENTER FOR HEALTH STATISTICS REPORTED IN 2013 THAT 14% OF MEDICAID AND 9% OF PRIVATE INSURANCE PATIENTS SKIP PRESCRIBED MEDICATIONS BECAUSE THEY CANNOT AFFORD OUT-OF-POCKET CO-PAYS AND DEDUCTIBLES. ALL OF THESE ARE THE INDIVIDUALS FOR WHOM THC EXISTS.
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE FINAL DRAFT OF THE 990 WILL BE REVIEWED BY THE CEO AND CFO, THEN SUBSEQUENTLY PRESENTED TO THE FULL BOARD.
FORM 990, PART VI, SECTION B, LINE 12C
TOTAL HEALTH CARE, INC. HAS A WRITTEN CONFLICT OF INTEREST POLICY. KEY EMPLOYEES, OFFICERS AND DIRECTORS UPDATE ANNUALLY THEIR DISCLOSURE STATEMENT. ANY CONFLICTS ARE REVIEWED BY THE BOARD. IF THE POTENTIAL CONFLICT INVOLVES A BOARD MEMBER, THE POTENTIALLY-CONFLICTED BOARD MEMBER SHALL ABSTAIN FROM PARTICIPATING IN THE DETERMINATION OF WHETHER A CONFLICT OF INTEREST EXISTS. THE DECISION OF THE BOARD IS FINAL. IF THE BOARD DETERMINES A CONFLICT DOES NOT EXIST, THE INTERESTED PERSON MAY PROCEED WITH THE TRANSACTION; HOWEVER, HE OR SHE WILL NOT BE ELIGIBLE TO VOTE ON RELATED ISSUES SHOULD THEY ARISE.
FORM 990, PART VI, SECTION B, LINE 15
THE COMPENSATION OF THE CEO IS ESTABLISHED BY THE BOARD OF DIRECTORS AND IS DETERMINED ANNUALLY. CHANGES TO THE CEOS BASE COMPENSATION AS WELL AS ANY APPLICABLE BONUS PAYOUTS ARE MADE BASED UPON THE CEOS PERFORMANCE FOR THE YEAR BEING EVALUATED. PERIODICALLY THE BOARD OF DIRECTORS CONDUCTS A MARKET SURVEY OF COMPARABLE COMPENSATION DATA TO ENSURE THAT THE CEO IS BEING FAIRLY COMPENSATED RELATIVE TO MARKET TRENDS. THE BOARD OF DIRECTORS RECORDS AND APPROVES THE TOTAL COMPENSATION PACKAGE FOR THE CEO ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION C, LINE 19
ALL ORGANIZATIONAL DOCUMENTS, FINANCIAL STATEMENTS, AND ITS CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST FOR THE SAME PERIOD OF DISCLOSURE AS SET FORTH IN SECTION 6104(D).
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.