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.) .... | 8,648,021 | 9,148,356 | 12,761,581 | 12,554,847 | 11,783,524 | 54,896,329 |
| 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 | 8,648,021 | 9,148,356 | 12,761,581 | 12,554,847 | 11,783,524 | 54,896,329 |
| 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. | 54,896,329 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 8,648,021 | 9,148,356 | 12,761,581 | 12,554,847 | 11,783,524 | 54,896,329 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,527 | 4,373 | 8,006 | 83,072 | 62,627 | 159,605 |
| 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.).. | 207,101 | 460,575 | 324,035 | 47,108 | 108,507 | 1,147,326 |
| 11 | Total support. Add lines 7 through 10. | 56,203,260 | |||||
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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| SECTION B, LINE 10E | THE AMOUNT IN OTHER INCOME REPRESENTS PERFORMANCE AND MANAGEMENT FEES WHICH ARE INCENTIVE FEES FOR MEETING CERTAIN BENCHMARKS AS DEFINED BY THE GIVER. |
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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 1 | FHCW'S TEAM IS COMPRISED OF MORE THAN 345 MEDICAL, DENTAL, SOCIAL SERVICE AND OTHER CLINICAL PROVIDERS, PHARMACISTS, NUTRITIONISTS, INTERPRETERS, HEALTH BENEFITS ADVISORS AND VOLUNTEERS WHO SERVE OUR PATIENTS WITH RESPECT AND COMPASSION. WE PROVIDE SERVICES IN 37 LANGUAGES, INCLUDING: ALBANIAN, ARABIC, BURMESE, FARSI, FRENCH, GERMAN, CAMBODIAN, CHINESE, CREOLE, HINDI, KABA, KHMER, NEPALI, POLISH, PORTUGUESE, RUSSIAN, SANGO, SPANISH, SWEDISH, SOMALI, SWAHILI, TWI, URDU, VIETNAMESE AND MORE. FHCW SERVED 38,500 INDIVIDUALS WITH MEDICAL, DENTAL, VISION, MENTAL HEALTH AND SOCIAL SERVICES, NUTRITION COUNSELING, HEALTH BENEFITS ADVISING AND SCHOOL-BASED HEALTH SERVICES THROUGH 126,000+ CLINICAL VISITS AND ALMOST 35,000 NUTRITION VISITS FOR LOW-INCOME CLIENTS. 97% OF OUR PATIENTS HAVE INCOMES BELOW 200% OF POVERTY AND 87% LIVE BELOW 100% OF POVERTY. 45% OF OUR PATIENTS ARE BEST SERVED IN A LANGUAGE OTHER THAN ENGLISH. FHCW ATTAINED THE NATIONAL CENTER OF QUALITY ASSURANCE (NCQA) PATIENT CENTERED MEDICAL HOME LEVEL 2 RECOGNITION ON OCTOBER 18, 2013 AND ARE NOW WORKING TO ACHIEVE LEVEL 3, NCQA'S HIGHEST LEVEL OF RECOGNITION, WHICH WE ANTICIPATE ACCOMPLISHING IN THE FALL OF 2016. NCQA IS A NOT-FOR-PROFIT ORGANIZATION DEDICATED TO IMPROVING THE QUALITY AND COORDINATION OF CARE IN THE NATION'S HEALTH SYSTEM. PCMH STANDARDS EMPHASIZE THE USE OF SYSTEMATIC, PATIENT-CENTERED AND COORDINATED CARE THAT SUPPORTS ACCESS, COMMUNICATION AND PATIENT INVOLVEMENT. FHCW PROVIDES HIGH QUALITY, COMPREHENSIVE, CULTURALLY COMPETENT, PATIENT-CENTERED PRIMARY MEDICAL CARE (FAMILY MEDICINE), DENTAL CARE, BEHAVIORAL/MENTAL HEALTH SERVICES, URGENT/SAME-DAY/WALK-IN CARE, REFUGEE/IMMIGRANT HEALTH SERVICES, HOMELESS FAMILIES PROGRAM, HIV/AIDS INTEGRATED CARE PROGRAM, O/B PRENATAL CARE AND DELIVERY PROGRAM, VISION SERVICES, PHARMACY, LAB, RADIOLOGY (X-RAY, ULTRASOUND, DIGITAL MAMMOGRAPHY), OUTPATIENT SUBOXONE TREATMENT, CENTERING PREGNANCY GROUP PRENATAL CARE, BABY CAFE TO SUPPORT NEW MOTHERS, WOMEN INFANTS AND CHILDREN (WIC) NUTRITION PROGRAM FOR THE REGION, TEEN HEALTH CLINIC, HEALTH EDUCATION OUTREACH, AND SCHOOL-BASED HEALTH SERVICES AT 7 PUBLIC SCHOOL LOCATIONS IN WORCESTER AND WEBSTER. FHCW PROVIDES SERVICES IN A FAMILY PRACTICE MODEL WHERE EVERY PATIENT IS SEEN IN THE CONTEXT OF HIS/HER FAMILY, CULTURE AND COMMUNITY. TO ASSURE PATIENT ACCESS TO CARE, FHCW OFFERS AN ARRAY OF WRAPAROUND ENABLING SERVICES INCLUDING HEALTH BENEFITS ADVISING (MULTILINGUAL CERTIFIED APPLICATIONS COUNSELORS), HEALTH EDUCATION OUTREACH, MEDICAL INTERPRETATION AND CULTURAL CASE MANAGEMENT, NURSING CARE MANAGEMENT, CHRONIC DISEASE CARE COORDINATION, TRANSPORTATION ASSISTANCE, EMERGENCY FOOD VOUCHERS, PATIENT NAVIGATION, AND CONNECTION TO COMMUNITY-BASED SUPPORT SERVICES. FHCW PROVIDES SERVICES AT 15 LOCATIONS IN WORCESTER, MILLBURY, SOUTHBRIDGE, AND WEBSTER. FHCW'S MAIN CLINICAL AND ADMINISTRATIVE SITE IS LOCATED AT 26 QUEEN STREET IN DOWNTOWN WORCESTER, FORMERLY THE HOME OF WORCESTER CITY HOSPITAL. OUR NEWEST SITE IN SOUTHBRIDGE AT 32 ORCHARD STREET OPENED ON MARCH 31, 2014 TO MEET THE PRIMARY CARE NEEDS OF MEDICALLY UNDERSERVED LOW-INCOME RESIDENTS IN THE SOUTHBRIDGE AREA. IT HAS BECOME EVIDENT THAT WE NEED TO ADDRESS THE ORAL HEALTH NEEDS OF CURRENT PATIENTS AND OTHER LOW-INCOME SOUTHBRIDGE AREA RESIDENTS AND OFFERED DENTAL SERVICES IN SOUTHBRIDGE IN JUNE 2015. FHCW IS AN ACADEMIC HEALTH CENTER COMMITTED TO WORKFORCE DEVELOPMENT TO HELP MEET THE NEED FOR PROVIDERS TO WORK IN UNDERSERVED COMMUNITIES THROUGH OUR FAMILY MEDICINE RESIDENCY (SINCE 1974), FAMILY NURSE PRACTITIONER RESIDENCY (SINCE 2009), ADVANCED EDUCATION IN GENERAL DENTISTRY RESIDENCY (SINCE 2005), POST-DOCTORAL PSYCHOLOGY FELLOWSHIP, SOCIAL WORK (MSW) INTERNSHIP PROGRAM, DOCTOR OF PHARMACY INTERNSHIP PROGRAM, AND TRAINING PROGRAMS FOR MEDICAL STUDENTS, NURSES, PHLEBOTOMISTS, AND OPTOMETRISTS (2014). OUR MOST RECENT ACADEMIC TRAINING PROGRAM, IMPLEMENTED IN COLLABORATION WITH THE MA COLLEGE OF PHARMACY & HEALTH SCIENCES (MCPHS), TRAINS GRADUATE OPTOMETRY STUDENTS. OUR VISION CLINIC TRAINED 62 GRADUATE STUDENTS PER SEMESTER, WHO ARE ACCOMPANIED BY FACULTY PRECEPTORS ON ROTATION, CONDUCTING EYE EXAMS FOR UP TO 64 PATIENTS IN ONE AND A HALF HOUR VISITS PER WEEK. EACH EXAM IS CONDUCTED BY 2 STUDENTS AND A PRECEPTOR AND OFFERS OPTOMETRISTS THE OPPORTUNITY TO VIEW A WIDE RANGE OF HEALTH CONDITIONS IMPACTING VISION. A MAJOR ACCOMPLISHMENT WAS THE OPENING OF OUR NEW OPTICAL RETAIL SHOP, WHICH CONNECTS LOW-INCOME PATIENTS TO AFFORDABLE EYEWEAR WITHOUT REGARD FOR ABILITY TO PAY. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CFO, TREASURER AND BOARD OF DIRECTORS ARE PROVIDED A COPY OF THE 990 TO REVIEW BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | FAMILY HEALTH CENTER OF WORCESTER, INC. HAS IMPLEMENTED A CONFLICT OF INTEREST AND CONFIDENTIAL DISCLOSURE STATEMENT WHICH STATES THAT BOARD MEMBERS AND STAFF MEMBERS MUST DISCLOSE ANY CONFLICTS OF INTEREST AS SOON AS THEY ARE AWARE OF IT. THERE IS AN ANNUAL QUESTIONAIRE THAT IS GIVEN TO THESE OFFICERS AND DIRECTORS TO DISCLOSE ANNUAL INTERESTS THAT COULD GIVE RISE TO CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE COMPENSATION OF THE HEALTH CENTER OFFICERS AND KEY EMPLOYEES IS APPROVED BY THE BOARD OF DIRECTORS UTILIZING A SALARY SURVEY. THE CHIEF FINANCIAL OFFICER AND FINANCE COMMITTEE SET THE OTHER EMPLOYEES' SALARIES BASED ON A SALARY SURVEY IN ACCORDANCE WITH THE HEALTH CENTER'S BUDGET PARAMETERS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE HEALTH CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE BOARD OF DIRECTORS AND FINANCE COMMITTEE ARE RESPONSIBLE FOR THE OVERSIGHT OF THE AUDIT. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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