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.") .... | 948,900 | 1,014,787 | 985,482 | 1,100,234 | 782,400 | 4,831,803 |
| 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.. | 56,724 | 56,724 | 56,724 | 56,724 | 239,276 | 466,172 |
| 4 | Total. Add lines 1 through 3 | 1,005,624 | 1,071,511 | 1,042,206 | 1,156,958 | 1,021,676 | 5,297,975 |
| 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. | 5,297,975 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,005,624 | 1,071,511 | 1,042,206 | 1,156,958 | 1,021,676 | 5,297,975 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 13,983 | 13,814 | 14,180 | 11,133 | 10,758 | 63,868 |
| 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.).. | 12,741 | 5,895 | 36,429 | 16,671 | 22,570 | 94,306 |
| 11 | Total support Add lines 7 through 10. | 5,456,149 | |||||
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) |
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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) |
||||
| 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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| Software ID: | |
| Software Version: |
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, SECTION A, LINE 2 | BOARD MEMBERS JAN MOSS AND DAVID MOSS HAVE A FAMILY RELATIONSHIP |
| FORM 990, PART VI, SECTION B, LINE 11 | FORM 990 IS REVIEWED BY THE BOARD BEFORE BEING FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | STRAIGHT TALK CLINIC CONFLICT OF INTEREST POLICY GENERAL POLICY: THE BOARD OF DIRECTORS AND EMPLOYEES OF STRAIGHT TALK CLINIC, INC. ARE EXPECTED TO ADHERE TO HIGH ETHICAL STANDARDS OF CONDUCT IN THE PERFORMANCE OF THEIR DUTIES, OBSERVING ALL LAWS AND REGULATIONS GOVERNING BUSINESS TRANSACTIONS, COMPETING FAIRLY WITH OTHERS AND USING CLINIC FUNDS AND FACILITIES ONLY FOR LEGITIMATE AND ETHICAL PURPOSES. THE RIGHTS OF THE BOARD AND EMPLOYEES IN THEIR ACTIVITIES OUTSIDE THEIR DUTIES OR EMPLOYMENT THAT ARE PRIVATE IN NATURE AND WHICH IN NO WAY CONFLICT WITH OR REFLECT UPON THE CLINIC WILL BE RESPECTED. ALTHOUGH THE BOARD AND EMPLOYEES HAVE BEEN CAREFULLY SELECTED AND ARE ASSUMED TO POSSESS INTEGRITY AND JUDGMENT TO AVOID ANY MISUNDERSTANDING THE FOLLOWING STATEMENTS OF POLICY ARE MADE WITH RESPECT TO PROPER CONDUCT: POSSIBLE CONFLICTS OF INTEREST: 1. BOARD MEMBERS AND EMPLOYEES MUST AVOID INCURRING ANY KIND OF FINANCIAL INTEREST OR PERSONAL OBLIGATION THAT MIGHT AFFECT (OR APPEAR TO AFFECT) THEIR JUDGMENT IN DEALINGS ON BEHALF OF THE CLINIC WITH FIRMS OR INDIVIDUALS. EACH PERSON MUST EXAMINE HIS OR HER OWN ACTIVITIES AND THOSE OF HIS OR HER FAMILY TO BE SURE THAT NO CONDITION EXISTS WHICH COULD CREATE OR APPEAR TO CREATE A SELF-DEALING SITUATION IN RESPECT TO TRANSACTIONS WITH THE CLINIC. 2. THERE ARE CERTAIN AREAS WITH WHICH EACH INDIVIDUAL MUST BE ESPECIALLY CONCERNED. IN ORDER TO AVOID ANY QUESTION ABOUT A POSSIBLE CONFLICT OF INTEREST, EVEN THOUGH IT MAY NOT EXIST IN ACTUALITY, THE PARTICULAR SITUATION SHALL BE DISCLOSED IN WRITING AND SUBMITTED TO THE ADMINISTRATOR FOR EVALUATION. AREAS GIVING RISE TO CONFLICTS OF INTEREST INCLUDE, BUT ARE NOT LIMITED TO, THE FOLLOWING: A. HOLDING A MATERIAL FINANCIAL INTEREST, DIRECTLY OR INDIRECTLY (AS OWNER, SUBSTANTIAL STOCKHOLDER, PARTNER, JOINT VENTURE, CREDIT OR GUARANTOR), OR HAVING A MANAGEMENT OR POLICY-MAKING ROLE (SUCH AS BEING A DIRECTOR) IN A FIRM WHICH PROVIDES SERVICES AND SUPPLIES MATERIALS OR EQUIPMENT TO THE CLINIC, OR IN AN ORGANIZATION THAT IS IN COMPETITION WITH, OR APPEARS TO COMPETE WITH THE CLINIC, OR IN AN ORGANIZATION TO WHICH THE CLINIC PROVIDES SERVICES, OR DERIVES LEADS FOR SERVICES TO BE PROVIDED BY THE CLINIC. B. SPECULATING, INVESTING OR DEALING IN EQUIPMENT, SUPPLIES, MATERIALS OR BUSINESS THAT THE CLINIC PURCHASES, HAS PURCHASED OR CONTEMPLATES PURCHASING. C. OWING MONEY TO OR BORROWING MONEY FROM ANY SUPPLIER OR DEALER OR FROM AN INDIVIDUAL OR FIRM (EXCEPT A BANK OR BUSINESS ENTITY AS AN ORDINARY CONSUMER IN AMOUNTS THAT ARE REASONABLE UNDER SUCH CIRCUMSTANCES) WITH WHOM THE CLINIC DOES BUSINESS OF ANY KIND. D. ACCEPTING GIFTS OR FAVORS FOR HIMSELF OR HERSELF OR FAMILY MEMBERS, OR ENTERTAINMENT OR OTHER PERSONAL BENEFITS, WHICH ARE SUBSTANTIAL, FROM AN OUTSIDE ORGANIZATION OR INDIVIDUAL WITH WHOM THE CLINIC DOES OR MAY DO BUSINESS. THIS DOES NOT APPLY TO ACCEPTANCE OF A CASUAL GIFT OF NOMINAL VALUE, NOR REASONABLE PERSONAL ENTERTAINMENT (BUT NOT PAID TRAVEL EXPENSES), BUT CARE MUST BE EXERCISED TO BE SURE THAT CONTINUATION OF SUCH MATTERS DOES NOT GRADUALLY CREATE OR APPEAR TO CREATE OBLIGATION. GIFTS OF A SUBSTANTIAL NATURE SHOULD BE RETURNED TO THE DONOR WITH THE EXPLANATION THAT THE CLINIC'S POLICY WILL NOT PERMIT THE ACCEPTANCE OF THE GIFT. E. DISCLOSING TO OTHERS OUTSIDE THE CLINIC OR USING FOR HIS OR HER OWN BENEFIT INFORMATION NOT GENERALLY AVAILABLE TO THE PUBLIC WHICH THE BOARD MEMBER OR EMPLOYEE HAS ACCESS TO BY REASON OF HIS OR HER POSITION, SUCH AS CONFIDENTIAL INFORMATION OF TECHNICAL, FINANCIAL OR BUSINESS NATURE OR OTHER "INSIDE INFORMATION". F. SERVING ANOTHER ORGANIZATION IN ANY CAPACITY WHETHER SUCH SERVICE INCLUDES ACTIVITIES, COMPENSATED OR NOT, WHICH CAN AFFECT OR APPEAR TO AFFECT AN INDIVIDUAL'S ABILITY TO DISCHARGE HIS OR HER DUTIES TO THE CLINIC. G. MAINTENANCE OF A PERSONAL BUSINESS IS DISAPPROVED BY THE CLINIC, PROVIDED THAT NO BOARD MEMBER OR EMPLOYEE COMPETES WITH THE CLINIC IN ANY SUCH PERSONAL ACTIVITIES. THE CLINIC WILL FROM TIME TO TIME PROMULGATE GENERAL POLICIES CONCERNING FIELDS IN WHICH IT INTENDS TO PROVIDE SERVICES AND SUCH POLICIES WILL BE COMMUNICATED ON A CONFIDENTIAL BASIS TO THE BOARD OF DIRECTORS AND EMPLOYEES TO THE END THAT ANY COMPETITION BE AVOIDED. POSSIBLE IMPROPER OR ILLEGAL CONDUCT: BOARD MEMBERS AND EMPLOYEES ARE NOT EXPECTED TO BE FAMILIAR WITH EVERY LAW AND REGULATION RELATING TO THIS STATEMENT OR AFFECTING CLINIC OPERATIONS. WHEN IN DOUBT, HOWEVER, IT IS INCUMBENT UPON EACH BOARD MEMBER AND EMPLOYEE TO CONSULT WITH THE ADMINISTRATOR. 1. EACH PERSON MUST AVOID IMPROPER ACTS AND THE VIOLATION OF ANY GOVERNMENTAL LAW OR REGULATION IN THE COURSE OF PERFORMING HIS OR HER WORK. 2. TO PROVIDE GUIDANCE IN SPECIFIC AREAS, WE WILL CALL YOUR ATTENTION TO THE FOLLOWING MATTERS: A. NO CLINIC FUNDS OR ASSETS SHALL BE USED FOR ANY IMPROPER OR UNLAWFUL PURPOSES, INCLUDING; (I) PAYMENT, OR OFFER OF PAYMENT, OF ANYTHING OF VALUE TO ANY ENTITY OR INDIVIDUAL FOR THE PURPOSES OF EXERTING INFLUENCE IN OBTAINING OR RETAINING FAVORABLE TREATMENT. (II) OBTAINING PRIVILEGES, CONCESSIONS OR SPECIAL BENEFITS BY PAYING OR OFFERING TO PAY BRIBES, KICKBACKS TO ANY ENTITY OR INDIVIDUAL. THIS INCLUDES GIFTS OR ENTERTAINMENT TO A SUPPLIER OR SERVICE PROVIDER OF A KIND THAT THE BOARD MEMBERS AND EMPLOYEES COULD NOT ACCEPT UNDER THIS POLICY. (III) USING CLINIC FUNDS, PROPERTY OR RESOURCES FOR ANY PURPOSE OTHER THAN THOSE DIRECTLY BENEFITING THE CLINIC AND THE POPULATIONS WHICH IT SERVICES. B. NO BOARD MEMBER AND NO EMPLOYEE, IN THE COURSE OF HIS OR HER EMPLOYMENT, SHALL ACCEPT OR RECEIVE ANY PAYMENT OR OTHER THING OF VALUE (WHETHER CHARACTERIZED AS KICKBACK, BRIBE, REBATE, REFUND OR OTHERWISE, AND WHETHER INTENDED BY THE PAYOR TO BE FOR THE CLINIC OR FOR OTHER PERSONAL BENEFIT OF THE BOARD MEMBER OR EMPLOYEE) IF THE PAYMENT OR RECEIPT OR TENDER THEREOF IS ILLEGAL OR IS DESIGNED OR INTENDED TO CAUSE SUCH BOARD MEMBER OR EMPLOYEE TO GRANT A PRIVILEGE, CONCESSION OR BENEFIT TO THE PAYOR IN CONNECTION WITH CLINIC BUSINESS. IMPLEMENTATION - REPORTING: 1. IN ORDER TO IMPLEMENT THE FOREGOING POLICIES, THE BOARD OF DIRECTORS WILL DEVELOP DISCLOSURE STATEMENTS FOR COMPLETION BY BOARD MEMBERS AND EMPLOYEES ON AN ANNUAL BASIS. IT IS NEVERTHELESS EACH PERSON'S RESPONSIBILITY TO REPORT, IN WRITING, ON A CURRENT BASIS, ANY NEW DEVELOPMENTS AS TO MATTERS INCLUDED IN THIS POLICY STATEMENT OR IN THE DISCLOSURE STATEMENTS. 2. ALL DISCLOSURE STATEMENTS AND REPORTS SHALL BE MAINTAINED IN CONFIDENCE AND ACCESS TO SUCH MATERIALS SHALL BE LIMITED TO THE EXECUTIVE DIRECTOR, ADMINISTRATOR, BOARD OF DIRECTORS AND SUCH PERSONS WHO HAVE A REASONABLE NEED TO KNOW THE CONTENTS THEREOF OR WHOSE DUTIES INVOLVE CUSTODY OF SUCH MATERIALS. 3. THIS POLICY STATEMENT, OF NECESSITY, CONCERNS SOME MATTERS THAT REQUIRE EVALUATION, JUDGMENT, AND ANALYSIS OF THE LAW OR DISCRETIONARY ACTION. THEREFORE, THE BOARD OF DIRECTORS SHALL BE RESPONSIBLE FOR RESOLVING ANY DISPUTES, MAKING ANY INTERPRETATIONS AND PROMULGATING ANY ADVISORY OPINIONS IN RESPECT OF ALL MATTERS ARISING HEREUNDER. THE DECISIONS OF THE BOARD SHALL BE FINAL. THE BOARD OF DIRECTORS SHALL HAVE THE RIGHT TO AUTHORIZE DEVIATIONS FROM THIS POLICY IF, IN THEIR DISCRETION, SUCH DEVIATIONS SEEM ADVISABLE AND IN THE BEST INTEREST OF THE CLINIC. |
| FORM 990, PART VI, SECTION B, LINE 15 | EVALUATION INCLUDES REVIEW AND APPROVAL BY BOARD; REVIEW OF FORM 990 OF OTHER ORGANIZATIONS, WRITTEN EMPLOYMENT CONTRACT, COMPENSATION SURVEY OR STUDY. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE TAX RETURN IS AVAILABLE ON DUN & BRADSTREET WEBSITE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990 PART XII LINE 2C | THERE HAS BEEN NO CHANGE IN THE AUDIT OVERSIGHT PROCESS FROM THE PRIOR YEAR. |
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