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 - ORGANIZATION'S MISSION | FAMILY MEDICINE RESIDENCY OF IDAHO MAINTAINS A PROGRAM DESIGNED TO FURTHER THE EDUCATION OF GRADUATE PHYSICIANS IN THE MEDICAL SPECIALTY OF FAMILY MEDICINE AND FAMILY PRACTICE, PROVIDES CLINICAL TRAINING IN FAMILY PRACTICE THROUGH THE ESTABLISHMENT AND OPERATION OF A MODEL CLINIC, CONDUCTS A MEDICAL EDUCATION PROGRAM INCLUDING OPERATION OF THE MODEL CLINIC, PROMOTES A PROFESSIONALLY ATTRACTIVE ENVIRONMENT FOR THE RECRUITMENT AND RETENTION OF MEDICAL MANPOWER AND SUPPORTS HEALTH EDUCATION ACTIVITIES AND PROGRAMS FOR THE GENERAL PUBLIC WHILE SERVING THE UNDER-SERVED CITIZENS OF IDAHO. |
| FORM 990, PART III | AS OF JUNE 30, 2007, FAMILY PRACTICE RESIDENCY OF IDAHO, INC (THE PRACTICE) DEVELOPED AND MAINTAINED A PROGRAM DESIGNED TO FURTHER THE EDUCATION OF GRADUATE PHYSICIANS IN THE MEDICAL SPECIALTY OF FAMILY MEDICINE AND FAMILY PRACTICE, PROVIDED CLINICAL TRAINING IN FAMILY PRACTICE THROUGH THE ESTABLISHMENT AND OPERATION OF A MODEL CLINIC, CONDUCTED A MEDICAL EDUCATION PROGRAM INCLUDING OPERATION OF A MODEL CLINIC, PROMOTED A PROFESSIONALLY ATTRACTIVE ENVIRONMENT FOR THE RECRUITMENT AND RETENTION OF MEDICAL MANPOWER AND SUPPORTED HEALTH EDUCATION ACTIVITIES AND PROGRAMS FOR THE GENERAL PUBLIC WHILE SERVING THE UNDER-SERVED CITIZENS OF IDAHO. ON JULY 1, 2007, THE PRACTICE TRANSFERRED ITS ASSETS AND LIABILITIES TO FAMILY MEDICINE RESIDENCY OF IDAHO, INC. (FAMILY MEDICINE) IN ORDER TO FURTHER ITS EXEMPT PURPOSE. FAMILY MEDICINE WAS APPROVED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES AS A FEDERALLY-QUALIFIED HEALTH CENTER LOOK-A-LIKE FACILITY (FQHC-LA) IN JUNE 2007. FAMILY MEDICINE CURRENTLY OPERATES THE RESIDENCY PROGRAM PREVIOUSLY OPERATED UNDER THE PRACTICE. IN OCTOBER 2013, THE RESIDENCY WAS AWARDED A CONSOLIDATED HEALTH CENTERS GRANT FROM THE US DEPARTMENT OF HEALTH AND HUMAN SERVICES FOR ADDITIONAL SITES AND INCREASED CAPACITY. THE RESIDENCY OPERATES AS A DUAL STATUS ORGANIZATION, WITH ONE SITE BEING AN FQHC-LA CLINIC AND OTHER SITES BEING CONSOLIDATED HEALTH CENTER GRANT SITES FOR THE YEAR ENDED JUNE 30, 2015. THE FQHC-LA CLINIC BECAME A CONSOLIDATED HEALTH CENTER GRANT SITE EFFECTIVE AUGUST 23, 2015. SHOULD FAMILY MEDICINE CEASE TO QUALIFY FOR FQHC-LA OR SIMILAR STATUS, ALL ASSETS AND LIABILITIES OF FAMILY MEDICINE WILL THEN BE TRANSFERRED BACK TO THE PRACTICE IN ORDER TO CONTINUE ITS EXEMPT PURPOSE. |
| FORM 990, PAGE 6, PART VI, LINE 2 | TED EPPERLY JIM TROUNSON CEO BOARD MEMBER BUSINESS RELATIONSHIP |
| FORM 990, PAGE 6, PART VI, LINE 7A | ONE POSITION ON THE BOARD IS FILLED BY A PERSON WHO IS A SENIOR EXECUTIVE OF ST ALPHONSUS REGIONAL MEDICAL CENTER AND ONE FILLED BY A PERSON WHO IS A SENIOR EXECUTIVE OF ST LUKE'S REGIONAL MEDICAL CENTER. THESE SUPPORTING HOSPITALS NOMINATE INDIVIDUALS WHO ARE WILLING TO SERVE ON THE BOARD OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 7B | ONE SENIOR EXECUTIVE FROM EACH SUPPORTING HOSPITAL SERVE ON THE BOARD OF DIRECTORS AND HAS VOTING RIGHTS. THESE INDIVIDUALS ARE NOMINATED BY THE HOSPITALS, IMPACTING THE DECISIONS OF THE ORGANIZATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE CFO/COO WHO REVIEWS THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER. ONCE MANAGEMENT IS SATISFIED WITH THE 990, A COPY IS SUBMITTED TO THE FINANCE COMMITTEE FOR APPROVAL. WHEN THE BOARD AND MANAGEMENT AGREE THE RETURN IS COMPLETE AND ACCURATE, FINAL APPROVAL IS GIVEN TO THE PREPARER BEFORE FINALIZING THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE CONFLICT OF INTEREST POLICY IS CURRENTLY ENFORCED THROUGH SELF DISCLOSURE, SUBMITTED TO THE HUMAN RESOURCE DEPARTMENT IMMEDIATELY. IF CONFLICTS ARE REPORTED OR DISCOVERED, FMRI ADDRESSES THE SITUATION ACCORDINGLY. FMRI HAS A FORMAL CONFLICT OF INTEREST STATEMENT AND MANDATES THE BOARD, OFFICERS, AND KEY EMPLOYEES TO READ AND SIGN ON AN ANNUAL BASIS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS APPROVE MANAGEMENT COMPENSATION EACH YEAR BASED ON RECOMMENDATIONS FROM THE BOARD PRESIDENT FOR CEO COMPENSATION AND THE FINANCE COMMITTEE FOR OTHER TOP MANAGEMENT OFFICIALS. THE BOARD SETS THE CEO'S SALARY BASED ON MARKET CONDITIONS, LONGEVITY, KEY ACCOMPLISHMENTS, AND HOW THE RESIDENCY HAS BEEN ADVANCED OVER THE EVALUATION PERIOD BECAUSE OF INDIVIDUAL ACCOMPLISHMENTS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE FORM 990, PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | FMRI MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | FUNDRAISING EVENT EXPENSES INCLUDED IN EXPENSES ON FS 2,025 FUNDRAISING EVENT EXPENSES INCLUDED IN EXPENSES ON FS -2,025 |
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