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.") .... | 9,868,849 | 16,915,436 | 9,748,240 | 9,491,738 | 10,138,521 | 56,162,784 |
| 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 | 9,868,849 | 16,915,436 | 9,748,240 | 9,491,738 | 10,138,521 | 56,162,784 |
| 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. | 56,162,784 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 9,868,849 | 16,915,436 | 9,748,240 | 9,491,738 | 10,138,521 | 56,162,784 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 97,921 | 66,949 | 22,824 | 5,441 | 1,635 | 194,770 |
| 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.).. | 279,362 | 128,957 | 477,982 | 497,621 | 1,383,922 | |
| 11 | Total support Add lines 7 through 10. | 57,741,476 | |||||
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 |
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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 II, LINE 10, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS - 2010 AMOUNT: $ 279,362. 2011 AMOUNT: $ 128,957. 2013 AMOUNT: $ 307,982. 2014 AMOUNT: $ 217,121. MEANINGFUL USE INCENTIVE - 2013 AMOUNT: $ 170,000. 2014 AMOUNT: $ 280,500. |
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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 4A: | SU CLINICA'S COMMITMENT TO A HEALTHY SOCIETY INCLUDES PARTICIPATION IN A VARIETY OF DIFFERENT PROGRAMS, AS LISTED HERE. -DIABETES COLLABORATIVE - A NATIONAL PROGRAM TO PROVIDE PERSONALIZED CASE MANAGEMENT SERVICES TO DIABETES PATIENTS. -HEALTHY START - PROVIDES PERSONALIZED COUNSELING TO HIGH RISK MOTHERS-TO-BE. -CHILD HEALTH INSURANCE PROGRAM (CHIP) OUTREACH PROGRAM - INFORMS LOW INCOME FAMILIES ON THE BENEFITS OF ENROLLING CHILDREN IN THE STATE CHIP PROGRAM. -REACH OUT AND READ - MAKES EARLY LITERACY PART OF PEDIATRIC PRACTICE BY PROVIDING BOOKS TO CHILDREN WHOSE FAMILIES HAVE LIMITED RESOURCES AND BY PROVIDING READING MENTORS IN OUR PEDIATRIC WAITING ROOM. -PATIENT CENTERED MEDICAL HOME (PCMH) - SU CLINICA FAMILIAR HAS TWO LEVEL 2 PCMH AT ITS BROWNSVILLE, TEXAS AND RAYMONDVILLE, TEXAS LOCATIONS. THE ORGANIZATION IS IN PROGRESS IN OBTAINING ACCREDITATION FOR TWO OTHER LOCATIONS. -ACCOUNTABLE CARE ORGANIZATION (ACO) - SU CLINICA FAMILIAR IS ENGAGED IN AN ACO WHICH IS CHARACTERIZED BY A PAYMENT AND CARE DELIVERY MODEL THAT SEEKS TO TIE PROVIDER REIMBURSEMENTS TO QUALITY METRICS AND REDUCTIONS IN THE TOTAL COST OF CARE FOR ITS MEDICARE PATIENT POPULATION. THE ACO IS ACCOUNTABLE TO THE PATIENTS AND THE THIRD-PARTY PAYER FOR THE QUALITY, PPROPRIATENESS AND EFFICIENCY OF THE HEALTH CARE PROVIDED. -DELIVERY SYSTEM REFORM INCENTIVE PAYMENT (DSRIP) 1115 WAIVER - THE CLINIC EXPECTS THAT THE USE OF ELECTRONIC MEDICAL RECORDS, HEALTH INFORMATION EXCHANGE, PATIENT CENTERED MEDICAL HOME AND COORDINATION WITH THE HOSPITAL WILL LEAD TO A PERCENTAGE REDUCTION IN THE NUMBER OF ADULT PATIENTS WITH TYPE 1 OR 2 DIABETES WHOSE HBA1C IS ABOVE 9.0%, OTHERWISE KNOWN AS POOR CONTROL. -RETINOPATHY SCREENING -SU CLINICA FAMILIAR PARTICIPATES IN A DIABETIC RETINOPATHY SCREENING PROGRAM WHICH INVOLVES A UNIQUE PARTNERSHIP AMONG SU CLINICA FAMILIAR, METHODIST HEALTHCARE MINISTRIES AND LOCAL SPECIALISTS. THE INITIATIVE IS DESIGNED TO EXPAND THE MEDICAL HOME MODEL TO INCLUDE IN-HOUSE RETINOPATHY SCREENING IN COMBINATION WITH VOUCHERS FOR FOLLOW-UP SERVICES WHICH WOULD RESULT IN GREATER ACCESS TO CARE FOR UNINSURED DIABETIC PATIENTS IDENTIFYING POTENTIAL SHORT TERM OR LONG TERM VISION COMPLICATION DECREASING HEALTH CARE COSTS AND INCREASING PATIENTS' QUALITY OF LIFE. -EXPANDED PRIMARY HEALTH CARE-THE DSHS EXPANDED PRIMARY HEALTH CARE(EPHC) PROGRAM PROVIDES PRIMARY, PREVENTIVE AND SCREENING SERVICES TO WOMEN AGE 18 AND ABOVE WHOSE INCOME IS AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY LEVEL (FPL). OUTREACH AND DIRECT SERVICES ARE PROVIDED THROUGH COMMUNITY-BASED CLINICS UNDER CONTRACT WITH DSHS. COMMUNITY HEALTH WORKERS (CHWS) WILL HELP ENSURE WOMEN ACCESS THE PREVENTIVE AND SCREENING SERVICES APPROPRIATE TO THEM. -HRSA OUTREACH AND ENROLLMENT PROGRAM - EXPAND CURRENT OUTREACH AND ENROLLMENT ASSISTANCE ACTIVITIES AND FACILITATE ENROLLMENT OF ELIGIBLE HEALTH CENTER PATIENTS AND SERVICE AREA RESIDENTS INTO AFFORDABLE HEALTH INSURANCE COVERAGE THROUGH THE HEALTH INSURANCE MARKETPLACES, MEDICAID, OR THE CHILDREN'S HEALTH INSURANCE PROGRAM. -INNOVATIONS IN CARE GRANT PROGRAM - THIS PROJECT REPRESENTS A COMMUNITY BASED INTERVENTION DESIGNED TO TEST THE EFFECTIVENESS OF IN-HOUSE MEDICATION THERAPY MANAGEMENT SERVICES PROVIDED BY A CLINICAL PHARMACIST IN A COMMUNITY HEALTH CENTER SETTING WITH A LARGE HISPANIC POPULATION. THE CLINICAL GOAL OF THE PROJECT IS TO DECREASE THE PERCENTAGE OF DIABETIC PATIENTS WITH HBA1C IN POOR CONTROL (HBA1C >9%). THE FINANCIAL GOAL IS TO ACHIEVE COST SAVINGS THROUGH A EMONSTRATED DECREASE IN RELATED EMERGENCY ROOM VISITS. |
| FORM 990, PART VI, SECTION B, LINE 11 | 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 CHIEF FINANCIAL OFFICER REVIEWS THE 990 AND PRESENTS IT TO THE CHIEF EXECUTIVE OFFICER FOR SECONDARY REVIEW. A BOARD OF DIRECTORS MEETING IS THEN HELD FOR PRESENTATION AND APPROVAL OF THE RETURN PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DIRECTORS AND EMPLOYEES ARE REQUIRED TO SIGN A CONFLICT OF INTEREST REVIEW ANNUALLY. THE FORM CLEARLY STATES THAT THEY COMPLY WITH THE POLICY. THE CENTER REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. |
| FORM 990, PART VI, SECTION B, LINE 15 | A SALARY RANGE IS PREPARED AND APPROVED BY THE BOARD OF DIRECTORS. THIS SALARY RANGE IS COMPRISED OF INFORMATION OBTAINED FROM OTHER COMMUNITY HEALTH CENTERS AND THE LOCAL MARKET FOR THE CHIEF EXECUTIVE OFFICER. A SURVEY OF THE MAJOR COMMUNITY HEALTH CENTERS IS COMPILED USING THE BUDGET OF THE CENTER AS A KEY INDICATOR. THIS INFORMATION IS PRESENTED TO THE CHAIRMAN OF THE BOARD. THE BOARD, VIA EXECUTIVE SESSION, USES THIS INFORMATION TO DETERMINE THE CEO'S SALARY. IN ADDITION, THE BOARD REVIEWS THE SALARIES OF ALL INDIVIDUALS OVER $100K. PHYSICIANS' SALARIES ARE DETERMINED BY USING THE MGMA COMPENSATION AND PRODUCTIVITY INFORMATION. KEY PERSONNEL SALARIES ARE DETERMINED BY SURVEYING THE LOCAL MARKET AND HEALTH CENTER COMPENSATION GUIDE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES THE CONFLICT OF INTEREST POLICY, ALL GOVERNING DOCUMENTS, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT -196,685. |
| FORM 990 PART XII LINE 2C: | THE ORGANIZATION HAS A COMMITTEE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT AND THE SELECTION OF THE INDEPENDET ACCOUNTANT. |
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