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.") .... | 7,001,944 | 7,157,587 | 12,791,035 | 9,271,983 | 7,744,490 | 43,967,039 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 7,001,944 | 7,157,587 | 12,791,035 | 9,271,983 | 7,744,490 | 43,967,039 |
| 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).. | 1,294,330 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 42,672,709 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 7,001,944 | 7,157,587 | 12,791,035 | 9,271,983 | 7,744,490 | 43,967,039 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 586,910 | 415,432 | 121,384 | 375,686 | 377,311 | 1,876,723 |
| 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.).. | 0 | |||||
| 11 | Total support Add lines 7 through 10. | 45,843,762 | |||||
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 |
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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 III, LINE 4A | PHARMACY SERVICES: DUE TO THE COMPLEX NATURE OF HIV TREATMENT, EVERY HIV PATIENT IS PROVIDED CARE THROUGH OUR INTENSIVE EDUCATION AND COMPREHENSIVE SUPPORT PROGRAM, MEDICATION SUPPORT TEAM (MST). THIS TEAM, WHICH HAS RECENTLY EXPANDED TO ALSO WORK WITH OTHER CHRONICALLY ILL PATIENTS, HELPS PATIENTS TO BETTER UNDERSTAND, MANAGE, AND COPE WITH THEIR MEDICATIONS AND DISEASES. CHASE BREXTON ALSO OFFERS HOME DELIVERY OF MEDICATIONS TO THOSE IN NEED. |
| FORM 990, PART III, LINE 4B | MEDICAL SERVICES: WE PROVIDE CARE TO PATIENTS OF ALL AGES, RACES, GENDERS, GENDER IDENTITIES, RELIGIONS, SEXUAL ORIENTATIONS, ETHNICITIES, AND SOCIOECONOMIC STATUSES. BECAUSE OF OUR SPECIAL EMPHASIS ON AFFIRMING, OPEN CARE, WE HAVE FOUND THAT MORE THAN 20% OF OUR PATIENTS IDENTIFY AS LESBIAN, GAY, BISEXUAL, OR TRANSGENDER. WE ALSO STAFF BOARD CERTIFIED INFECTIOUS DISEASE PHYSICIANS TO CARE FOR THOSE WITH HIV, HEPATITIS C, AND OTHER INFECTIOUS DISEASES THAT HAVE TAKEN HOLD IN OUR COMMUNITIES. ADDITIONALLY, OUR ABILITY TO PROVIDE CARE FOR ALL IS OF PARTICULAR IMPORTANCE AS THE NUMBER OF UNINSURED WE SERVE HAS STEADILY RISEN IN THE PAST YEARS. |
| FORM 990, PART III, LINE 4D | OTHER PROGRAM SERVICES: CASE MANAGEMENT - CASE MANAGERS HELP PEOPLE HELP THEMSELVES, INCLUDING PEOPLE OF EVERY AGE, GENDER, GENDER IDENTITY, RELIGION, CULTURE, RACE, SEXUAL ORIENTATION, SOCIOECONOMIC STATUS, OR COUNTY OF ORIGIN. CASE MANAGEMENT IS A SUPPORT SYSTEM FOR ANYONE IN NEED OF NEARLY ANY TYPE OF SUPPORT TO MAKE THEIR QUALITY OF LIFE BETTER. CHASE BREXTON'S CASE MANAGEMENT DEPARTMENT ADHERES TO AND BASES ITS PROVISION OF SERVICES UPON THE PRINCIPLES AND VALUES ESTABLISHED BY THE NATIONAL ASSOCIATION OF SOCIAL WORKERS CODE OF ETHICS. DENTAL SERVICES - CHASE BREXTON'S DENTISTS AND DENTAL HYGIENISTS CAN HELP IMPROVE A PATIENT'S SMILE AND GET CHILDREN STARTED FOR A LIFETIME OF HEALTHY TEETH. THE DENTAL PROGRAM PROVIDES PREVENTATIVE CARE FOR CHILDREN AND ADULTS, RESTORATIVE CARE, REPLACEMENT CARE, EMERGENCY CARE, ROUTINE ORAL SURGICAL AND ENDODONTIC TREATMENTS AND COSMETIC AND ELECTIVE CARE. OB/GYN - CHASE BREXTON'S OB/GYN TEAM PROVIDES MEDICAL CARE TO PATIENTS FROM PUBERTY THROUGH MENOPAUSE AND BEYOND. ADULT AND ADOLESCENT GYNECOLOGY SERVICES INCLUDE ROUTINE PREVENTIVE CARE, PRE-CONCEPTION COUNSELING, INFERTILITY COUNSELING, PREGNANCY TESTING, GYNECOLOGICAL CARE INCLUDING ADVANCED LAPAROSCOPY, ENDOCRINOLOGY, MENOPAUSE CARE, STD COUNSELING AND OBSTETRICS. |
| FORM 990, PART VI, SECTION A, LINE 4 | SIGNIFICANT CHANGES TO GOVERNING DOCUMENTS: THE ORGANIZATION AMENDED ITS BYLAWS EFFECTIVE DECEMBER 2014. SIGNIFICANT CHANGES TO THE BYLAWS INCLUDE: SECTION 2.1. Mission. The mission of the Corporation shall be: To provide compassionate, quality health care that honors diversity, inspires wellness, and improves our communities. Section 2.2. Purposes. The purposes for which the Corporation has been formed shall be set forth in the Articles of Incorporation. ADDITIONAL POWERS AND RESPONSIBILITIES OF THE BOARD OF DIRECTORS INCLUDING: -adopting the policies of the Corporation concerning: (i) hours of operation; (ii) health services provided; (iii) quality-of-care audit procedures; and (iv) the locations of the Corporation's sites; - conducting an annual strategic planning process and translating strategic planning goals into operation planning objectives, which would include regularly updating the Corporations mission, goals, and plans; -evaluating the Corporations progress in meeting its annual and long-term goals; - approving applications related to the Corporation's grant/designation under Section 330 of the Act and other Health Resources and ADMINISTRATION "HRSA" REQUESTS REGARDING SCOPE OF PROJECT; - evaluating the Corporations compliance activities and recommending, as necessary, the revision, restructuring, and updating go the compliance program; - evaluating all developed and recommended quality assurance activities. Removal of Officers. An officer may be removed at any time with or without cause, by the Board of Directors by at least a majority (51%) of the Board members present and voting at any regular meeting or special meeting called for such purpose. Removal as an Officer does not constitute automatic resignation from the Board. Article XI. Dissolution No Board member, Officer or employee shall be entitled to share in the distribution of any of the corporate assets upon the dissolution of the Corporation. All such persons shall be deemed to have expressly consented and agreed that upon such dissolution or winding up of the affairs of the Corporation, whether voluntary or involuntary, the assets of the Corporation, after all debts have been satisfied, then remaining in the hands of the Board, shall be distributed, transferred, conveyed, delivered and paid over, in such amounts as the Board may determine, or as may be determined by a court of competent jurisdiction upon the application of the Board, exclusively to charitable, religious, scientific, literary or educational organizations (i) which then qualify for exemption from Federal income taxation under the provisions of Code Section 501(c)(3) and the Treasury Regulations thereunder (as they now exist or as they may hereafter be amended) and (ii) contributions to which are deductible under Code Section 170(c)(2) and the Treasury Regulations thereunder (as they now exist or as they hereafter may be amended). Regulations thereunder (as they now exist or as they hereafter may be amended). |
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY THE FINANCE DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS REVIEWED BY TOP MANAGEMENT AND THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY COVERS THE ORGANIZATION'S DIRECTORS, OFFICERS AND ANY OTHER INDIVIDUALS ASSOCIATED WITH THE ORGANIZATION. PER THE POLICY, NO INTERESTED PERSON SHALL PARTICIPATE IN THE ORGANIZATION'S SELECTION, AWARD OR ADMINISTRATION OR ANY CONTRACT OR GRANT, PAID IN WHOLE OR IN PART WITH FEDERAL FUNDS, IF A REAL OF APPARENT CONFLICT OF INTEREST WOULD BE INVOLVED. REQUIREMENTS SURROUNDING FQHC'S STIPULATE THAT BOARD MEMBERS ARE INDEPENDENT AND HAVE NO CONFLICTS OF INTEREST. POTENTIAL BOARD MEMBERS ARE INTERVIEWED AS TO WHETHER ANY CONFLICTS EXIST AND ELECTED MEMBERS ARE REQUIRED TO CERTIFY. REVIEW IS PERFORMED BY MANAGEMENT ANNUALLY. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | COMPENSATION REVIEW OF CEO AND OTHER OFFICERS: THE COMPANY HAS AN EXECUTIVE COMPENSATION COMMITTEE WHICH REVIEWS THE SALARIES AND BENEFITS FOR ALL OFFICERS ON AN ANNUAL BASIS USING COMPARABILITY DATA. MINUTES AND MEMOS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE UPON WRITTEN REQUEST. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS: $ (90,174) TRANSFER TO AFFILIATE |
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