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 (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants.) .... | 996,622 | 985,788 | 1,308,237 | 1,252,949 | 1,542,875 | 6,086,471 |
| 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 | 996,622 | 985,788 | 1,308,237 | 1,252,949 | 1,542,875 | 6,086,471 |
| 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).. | 57,849 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 6,028,622 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 996,622 | 985,788 | 1,308,237 | 1,252,949 | 1,542,875 | 6,086,471 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 9,120 | 8,847 | 9,657 | 12,236 | 13,948 | 53,808 |
| 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.).. | -4,075 | -7,933 | 6,964 | -5,044 | ||
| 11 | Total support. Add lines 7 through 10. | 6,135,235 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) |
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| 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) |
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| 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): |
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| 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 | ||||
| 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 2015 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-2015 |
(iii) Distributable Amount for 2015 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2015 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2015: | ||||
| a | ||||
| b | ||||
| c | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2015 distributable amount | ||||
|
i
Carryover from 2010 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2015 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2015 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2015, 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 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2016. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a | ||||
| b | ||||
| c Excess from 2013....... | ||||
| d From 2014....... | ||||
| e From 2015....... | ||||
| 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 I, LINE 1 | ORGANIZATIONS MISSION: THE ORGANIZATION IS ORGANIZED IS TO SERVE AS A PRIMARY RESOURCE FOR THE RENDERING OF HEALTHCARE SERVICES, WHICH SERVICES INCLUDE BUT ARE NOT LIMITED TO MEDICAL, DENTAL, AND MENTAL HEALTHCARE TO THOSE PERSONS IN HOWELL AND OREGON COUNTIES, AND SUCH OTHER COUNTIES IN THE STATE OF MISSOURI AS THE BOARD OF DIRECTORS MAY DESIGNATE; SUCH HEALTHCARE SERVICES SHALL BE RENDERED TO ALL INDIVIDUALS IN NEED OF SUCH SERVICES, BUT PARTICULARLY FOR MEDICALLY AND SOCIALLY INDIGENT INDIVIDUALS WHO CURRENTLY LACK ACCESS TO SUCH CARE; WITH A GOAL OF ENHANCING THE HEALTH OF MEMBERS OF THE COMMUNITY. THE BOARD OF DIRECTORS WILL ASSESS ON AN ONGOING BASIS THE HEALTH NEEDS OF THE TARGET AREAS TO ESTABLISH SHORT AND LONG TERM GOALS TO ACCOMPLISH ITS PURPOSES AND INSURE THAT SERVICES ARE AVAILABLE AND ACCESSIBLE. |
| FORM 990, PART III, LINE 3 | PROGRAM SERVICE CHANGES: SMCHC'S THAYER DENTAL CLINIC IS TEMPORARILY CLOSED DUE TO PROVIDER SHORTAGES. THE THAYER MEDICAL AND MENTAL HEALTH SERVICES ARE STILL BEING PROVIDED. |
| FORM 990, PART VI, SECTION A, LINE 4 | CHANGE IN BYLAWS: THE ORGANIZATION'S BYLAWS WERE UPDATED WITH THE FOLLOWING CHANGES: THE CONFLICT OF INTEREST POLICY WAS UPDATED TO INCLUDE: NO CURRENT BOARD MEMBER CAN SERVE ON THE BOARD IF SAID PERSON IS AN EMPLOYEE OF THE HEALTH CENTER OR AN IMMEDIATE FAMILY MEMBER OF AN EMPLOYEE. THE CEO OF THE CLINIC SHALL BE GIVEN NOTICE OF ALL BOARD MEETINGS AND SHALL HAVE THE RIGHT TO ATTEND. WHILE THE CEO SHALL HAVE THE RIGHT TO ATTEND AND PARTICIPATE IN MEETING BUSINESS, THE CEO SHALL NOT HAVE THE POWER TO VOTE ON ANY MATTER BEFORE THE BOARD. |
| 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 ACCOUNTING DEPARTMENT OF THE ORGANIZATION. THE FORM 990 IS INITIALLY REVIEWED BY BOTH THE CEO AND CFO. THE FINAL FORM 990 IS THEN PRESENTED TO THE FULL BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: THE CONFLICT OF INTEREST POLICY IS REVIEWED WITH ALL OFFICERS, DIRECTORS OR TRUSTEES, AND ALL EMPLOYEES UPON HIRE AND ANNUALLY. BEFORE UNDERTAKING ANY PROJECT OR DECIDING TO DO BUSINESS WITH ANY NEW VENDOR, ANY POTENTIAL OR PERCEIVED CONFLICTS ARE LOOKED FOR AND ADDRESSED IF FOUND. THE BOARD OF DIRECTORS AND EMPLOYEES ARE REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS THAT EXIST RELATING TO OUTSIDE INTERESTS, OUTSIDE ACTIVITIES, AND ANY GIFTS, GRATUITIES AND ENTERTAINMENT, OR INTERNAL INTEREST, THAT MAY GIVE RISE TO A CONFLICT OF INTEREST. IF A CONFLICT IS DETERMINED TO EXIST, APPROPRIATE ACTIONS ARE TAKEN TO ENSURE THE CONFLICT DOES NOT INTERFERE WITH THE INDIVIDUAL'S ABILITY TO BEST SERVE THE ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | REVIEW OF CEO, OTHER OFFICERS AND KEY EMPLOYEES COMPENSATION: THE CEO'S COMPENSATION REVIEW WAS COMPLETED BY THE ORGANIZATION'S BOARD PRESIDENT, USING DATA FROM THE MOST RECENT MISSOURI COMMUNITY HEALTH CENTERS' SALARY SURVEY AND FROM THE MOST RECENT NACHC HEALTH CENTER COMPENSATION AND BENEFITS REPORT. THE 50TH PERCENTILE, 75TH PERCENTILE AND AVERAGE WERE USED FROM THE NACHC BOOK FOR THE STATE OF MISSOURI. THE MPCA SALARY SURVEY LOOKS AT AVERAGE, MEDIAN, HIGH AND LOW FOR OVERALL CENTERS AND CENTERS THAT FALL WITHIN THE ORGANIZATION'S BUDGET CATEGORY. THE BOARD PRESIDENT THEN DISCUSSES THE CEO'S COMPENSATION WITH THE BOARD DURING A CLOSED SESSION MEETING. THE DISCUSSION AND ITS OUTCOME IS DOCUMENTED IN THE CLOSED SESSION MINUTES AND SIGNED BY THE BOARD PRESIDENT OR OTHER APPLICABLE OFFICER. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2015. COMPENSATION REVIEWS FOR ALL EMPLOYEES ARE COMPLETED BY THE BOARD FINANCE COMMITTEE AT LEAST ANNUALLY. DATA FROM THE MOST RECENT MISSOURI COMMUNITY HEALTH CENTERS' SALARY SURVEY, NACHC HEALTH CENTER COMPENSATION AND BENEFITS REPORT AND OTHER RECENT SOURCES AS APPLICABLE (MGMA, BUREAU OF LABOR STATISTICS) ARE USED. THE FINANCE COMMITTEE REVIEWS THE CURRENT SALARY AS WELL AS THE PROJECTED SALARY INCREASE FOR EACH EMPLOYEE FOR THE COMING FISCAL YEAR AS PART OF THE ANNUAL BUDGET PROCESS. THE FINANCE COMMITTEE THEN MAKES A RECOMMENDATION FOR APPROVAL TO THE FULL BOARD. BOTH THE FINANCE COMMITTEE'S REVIEW AND THE BOARD'S APPROVAL IS DOCUMENTED IN THE RESPECTIVE MINUTES. CLOSER TO THE EFFECTIVE DATE OF THE SALARY INCREASE FOR ANY OFFICERS AND KEY EMPLOYEES (NOT INCLUDING THE CEO), A FINAL REVIEW IS COMPLETED BY THE CEO AND BOARD PRESIDENT WHO DETERMINES THE ACTUAL FINAL AMOUNT OF THE INCREASE. THE SUBSTANTIATION AND DELIBERATION OF THIS FINAL DECISION IS DOCUMENTED IN A FILE KEPT IN THE CEO'S OFFICE. THE MOST RECENT COMPENSATION REVIEW WAS CONDUCTED IN 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC: UPON REQUEST, THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE FOR VIEWING AT THE ORGANIZATION OR BY MAIL. |
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