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.") . | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 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) |
||||
|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
||||
|
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 |
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| Return Reference | Explanation |
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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 VI, LINE 1A | ORGANIZATION'S MISSION: WE HAVE BEEN PROVIDING PREMIUM MEDICAL HEALTH CARE TO THE COMMUNITY SINCE 1921. AS A FEDERALLY QUALIFIED HEALTH CENTER WE SERVE FULLY INSURED, MEDICARE AND MEDICAID PATIENTS, ALONG WITH THE UNINSURED, HIGH-RISK, AND SUSCEPTIBLE POPULATION OF NORTHEASTERN OKLAHOMA. OUR MISSION IS TO SAVE LIVES THROUGH QUALITY HEALTH CARE. |
| FORM 990, PART III, LINE 4D | PROGRAM SERVICES: THE ORGANIZATION PROVIDES NUMEROUS OTHER SERVICES TO ITS PATIENTS INCLUDING: -WOMEN'S HEALTH CARE INCLUDING OBSTETRICS AND GYNECOLOGY -LABORATORY AND RADIOLOGY SERVICES -PHARMACY -OPTOMETRY -NUTRITION COUNSELING -COMPLETE PHYSICAL EXAMINATIONS AND IMMUNIZATIONS -TREATMENT OF FLU AS WELL AS BROKEN BONES, SPRAINS, AND OTHER INJURIES -COMMUNITY, HEALTH EDUCATION, AND OUTREACH -TRANSPORTATION |
| FORM 990, PART VI, SECTION B, LINE 11B | REVIEW PROCESS OF THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE ORGANIZATION'S CEO, CFO, AND CONTROLLER REVIEW THE FORM 990 IN DETAIL. THEN, A COPY WILL BE PROVIDED TO THE FULL BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: EACH DIRECTOR OF THE ORGANIZATION MUST PLEDGE HIS OR HER LOYALTY TO THE CORPORATION AND ACKNOWLEDGE THAT HIS OR HER PERSONAL INTERESTS CANNOT BE FURTHERED AT THE EXPENSE OF THE CORPORATION. AT THE BEGINNING OF EACH TERM OF OFFICE, DIRECTORS WILL PROVIDE THE PRESIDENT AND THE CEO WITH WRITTEN NOTIFICATION OF EVERY DIRECT OR INDIRECT FINANCIAL INTEREST HE OR SHE MAY HAVE WITH ANY ENTITY IN THE HEALTH CARE SYSTEM OR ANY ENTITY WITH WHICH THE CORPORATION PRESENTLY HAS A BUSINESS RELATIONSHIP. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE AND NATURE OF HIS OR HER PERSONAL OR FINANCIAL INTEREST TO THE BOARD AND MEMBERS OF COMMITTEES WITH BOARD DELEGATED POWERS CONSIDERING A PROPOSED TRANSACTION OR ARRANGEMENT. NO PERSON SHALL PROVIDE ANY GOODS, EQUIPMENT, OR SUPPLIES TO THE CORPORATION WHO HAS AN IMMEDIATE FAMILY MEMBER EMPLOYED BY THE CORPORATION. NO DIRECTOR, OFFICER OR MEMBER OF A COMMITTEE WITH BOARD DELEGATED POWERS SHALL ATTEMPT TO INFLUENCE OR PROMOTE A TRANSACTION OR OTHER BUSINESS ARRANGEMENT BETWEEN THE CORPORATION AND AN ENTITY WITH WHICH THE DIRECTOR, OFFICER OR COMMITTEE MEMBER IS AN INTERESTED PERSON. NO OFFICER OR BOARD MEMBER WILL INFLUENCE MANAGEMENT OR PROMOTE EMPLOYMENT FOR ANYONE WITH WHOM HE OR SHE IS HAVING AN EMPLOYMENT RELATIONSHIP WHETHER AS EMPLOYEE, CONSULTANT, PARTNER, OR A CANDIDATE FOR EMPLOYMENT SEEKING ACTIVE EMPLOYMENT OR BUSINESS ENGAGEMENT WITH THE CORPORATION. KNOWLEDGE OF THIS TYPE OF EMPLOYMENT INTEREST THAT COULD CREATE DIVIDED LOYALTY, OR THE APPEARANCE THEREOF, MUST BE DISCLOSED TO THE ENTIRE BOARD. IMMEDIATELY UPON EXPIRATION OF TERM OR RESIGNATION FROM THE BOARD, A FORMER BOARD MEMBER CONSIDERING EMPLOYMENT WITH THE CORPORATION MUST WAIT AT LEAST ONE (1) YEAR TO APPLY FOR EMPLOYMENT WITH THE CORPORATION, AND CONVERSELY, ANY EMPLOYEE OF THE CORPORATION INTERESTED IN SERVING AS A DIRECTOR OF THE CORPORATION MUST BE OFF OF THE CORPORATION'S PAYROLL FOR AT LEAST ONE (1) YEAR. COMPLETION OF SUCH WAITING PERIODS SHALL BE A REQUIRED QUALIFICATION FOR SUCH PERSON(S) SUBSEQUENT APPROVAL/HIRING AS A DIRECTOR OR EMPLOYEE OF THE CORPORATION, AS APPLICABLE. NO EMPLOYEE, AGENT, OR DIRECTOR SHALL PARTICIPATE DIRECTLY OR INDIRECTLY IN THE SELECTION, AWARD OR ADMINISTRATION OF ANY CONTRACT SHOULD A CONFLICT, REAL OR APPARENT BECOME EVIDENT. A CONFLICT WILL ARISE WHEN A FINANCIAL OR OTHER INTEREST IN A VENDOR OR FIRM SELECTED, INVOLVES AN EMPLOYEE, OFFICER OR AGENT OF THE CORPORATION IN SECURING THE AWARD, OR ANY ONE RELATED BY THIRD DEGREE CONSANGUINITY OR MARRIAGE, OR ANY BUSINESS PARTNER AND/OR ORGANIZATION WHICH EMPLOYS ANY OF THE ABOVE DESCRIBED INDIVIDUALS OR INSTITUTIONS. WHENEVER A CONFLICT OF INTEREST IS FOUND TO EXIST WITH RESPECT TO ANY DIRECTOR, SUCH DIRECTOR SHALL ABSTAIN FROM VOTING ON SUCH MATTER. FOR THE PURPOSES OF OBTAINING A QUORUM FOR THE CONDUCT OF BUSINESS REGARDING SUCH ISSUES BEFORE THE BOARD, NO DIRECTOR WITH THE AFOREMENTIONED TYPE OF INTEREST SHALL BE COUNTED AMONG BOARD MEMBERS PRESENT AND ELIGIBLE TO VOTE ON THE PARTICULAR ISSUE. AFTER DISCOVERY OR DISCLOSURE OF ANY INTERESTED PERSON SERVING ON THE BOARD OR A COMMITTEE, THE INTERESTED PERSON SHALL LEAVE ANY BOARD OR COMMITTEE MEETING IN WHICH THE RELEVANT ARRANGEMENT OR TRANSACTION IS DISCUSSED, INVESTIGATED AND VOTED UPON. THE DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS. IF THE DISINTERESTED MEMBERS DETERMINE A CONFLICT OF INTEREST EXISTS, THEY MUST PROCEED IN A MANNER CONSISTENT WITH THE BEST INTERESTS OF THE CORPORATION. POTENTIAL PROCEDURES TO ADDRESS THE CONFLICT OF INTEREST MAY INCLUDE, BUT NOT NECESSARILY BE LIMITED TO, THE FOLLOWING: THE PRESIDENT OR A COMMITTEE SHALL, IF APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE CORPORATION CAN OBTAIN A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS OR COMMITTEE MEMBERS PRESENT AT ANY REGULAR OR SPECIAL MEETING CALLED FOR THAT PURPOSE, AS APPLICABLE, WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE BEST INTERESTS OF THE CORPORATION AND FOR ITS SOLE BENEFIT, WHETHER THE TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, AND SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT IN CONFORMITY WITH SUCH DETERMINATION. IF THE BOARD OR COMMITTEE HAS REASONABLE CAUSE TO BELIEVE THAT A MEMBER HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, OR BELIEVES THAT AN INTERESTED PERSON HAS IMPROPERLY ATTEMPTED TO INFLUENCE A TRANSACTION OR ARRANGEMENT, IT SHALL INFORM THE MEMBER OF THE BASIS FOR SUCH BELIEF AND ALLOW THE MEMBER AN OPPORTUNITY TO EXPLAIN SUCH ACTS OR OMISSIONS. IF, AFTER HEARING THE RESPONSE OF THE MEMBER AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THAT THE MEMBER HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, OR DETERMINES THAT AN INTERESTED PERSON HAS IMPROPERLY ATTEMPTED TO INFLUENCE A TRANSACTION OR ARRANGEMENT, IT SHALL TAKE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, INCLUDING, BUT NOT LIMITED TO, TERMINATION OF MEMBERSHIP. THE MINUTES OF THE BOARD AND ALL COMMITTEES WITH BOARD DELEGATED POWERS SHALL CONTAIN THE FOLLOWING: THE NAMES OF THE PERSONS WHO DISCLOSED OR OTHERWISE WERE FOUND TO BE INTERESTED PERSONS IN CONNECTION WITH ANY POTENTIAL TRANSACTION OR ARRANGEMENT, THE NATURE OF THE PERSONAL OR FINANCIAL INTEREST, AND ANY ACTION TAKEN TO DETERMINE WHETHER A CONFLICT OF INTEREST IN FACT EXISTED. THE NAMES OF THE PERSONS WHO WERE PRESENT FOR DISCUSSIONS AND VOTES RELATING TO THE TRANSACTION OR ARRANGEMENT, THE CONTENT OF THE DISCUSSION, INCLUDING ANY ALTERNATIVES TO THE PROPOSED TRANSACTION OR ARRANGEMENT, AND A RECORD OF ANY VOTES TAKEN IN CONNECTION THEREWITH. |
| FORM 990, PART VI, SECTION C, LINE 15A | EXECUTIVE COMPENSATION: THE EXECUTIVE BOARD OF MORTON COMPREHENSIVE HEALTH SERVICES REVIEWS THE CEO SALARY ANNUALLY BASED ON THE HEALTH CENTER COMPENSATION & BENEFITS REPORT SET, THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND HOSPITAL & HEALTHCARE COMPENSATION SERVICES, ALONG WITH PERFORMANCE MEASURES SET BY THE FULL BOARD. THIS REVIEW WAS COMPLETED DECEMBER OF 2014. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE: BOARD BYLAWS, ARTICLES OF INCORPORATION, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. THE FINANCIAL STATEMENTS ARE DISCUSSED IN AN OPEN BOARD OF DIRECTORS MEETING THE FOURTH TUESDAY OF EVERY MONTH. THIS NOTICE IS POSTED BY CITY AND COUNTY COURT CLERKS FOR PUBLIC NOTICE PER THE OPENING MEETINGS ACT MONTHLY. |
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