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.) .... | 2,419,193 | 2,781,327 | 2,008,270 | 7,474,829 | 7,567,305 | 22,250,924 |
| 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 | 2,419,193 | 2,781,327 | 2,008,270 | 7,474,829 | 7,567,305 | 22,250,924 |
| 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. | 22,250,924 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,419,193 | 2,781,327 | 2,008,270 | 7,474,829 | 7,567,305 | 22,250,924 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 182 | 740 | 967 | 1,262 | 3,269 | 6,420 |
| 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.).. | 70,425 | 25,860 | 4,013 | 26,617 | 4,439 | 131,354 |
| 11 | Total support. Add lines 7 through 10. | 22,388,698 | |||||
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) |
||||
| 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 | ||||
| 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) |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|---|
| PART II, LINE 10 | OTHER INCOME 131,354 |
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| 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, PAGE 6, PART VI, LINE 11B | THE TREASURER AND THE EXECUTIVE COMMITTEE INITIALLY REVIEW AND APPROVE THE ENTITY'S FORM 990. IF NO ISSUES ARE RAISED, THE FORM 990 IS THEN FILED WITH THE APPROPRIATE AGENCY. A COPY OF THE FORM 990 IS AVAILABLE TO ALL BOARD MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST POLICY COMPLIANCE PROCEDURES: THE ORGANIZATION'S CONFLICT OF INTEREST POLICY MANDATES AS FOLLOWS: THE BOARD OF DIRECTORS SHALL COMPLETE A FINANCIAL DISCLOSURE - CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST. THESE DISCLOSED POTENTIAL CONFLICTS OF INTEREST SHALL BE EVALUATED BY THE CHAIR OF THE BOARD OF DIRECTORS AND THE EXECUTIVE DIRECTOR TO DEFINE A STRATEGY FOR MANAGING THEM IN ACCORDANCE WITH THE PRINCIPLES OUTLINED IN THIS POLICY. HHH DIRECTORS WHO PROPOSE TO CONDUCT AN ACTIVITY OR ENTER INTO A RELATIONSHIP WHICH COULD BE A CONFLICT SHALL FULLY DISCLOSE IN WRITING THE NATURE AND EXTENT OF THE POTENTIAL CONFLICT TO THE CHAIR OF THE BOARD OF DIRECTORS WHO SHALL MAKE A PRELIMINARY DETERMINATION OF THE NECESSARY PROPOSED ACTION TO RESOLVE THE CONFLICT. A COPY OF SUCH DETERMINATION SHALL BE SENT TO THE EXECUTIVE DIRECTOR FOR A FINAL DETERMINATION AS TO WHETHER THE PROPOSED ACTION IS CONSISTENT WITH THIS POLICY AND ANY APPLICABLE LAWS OR REGULATIONS. ALL COMMUNICATIONS REGARDING DISCLOSURES AND DETERMINATIONS OF CONFLICT OF INTEREST SHALL BE RETAINED IN CONFIDENCE. BECAUSE THIS POLICY DOES NOT TREAT ALL POTENTIAL CONFLICTS OF INTEREST BY WAY OF SPECIFIC PROVISIONS, HHH STRONGLY ENCOURAGES ALL DIRECTORS TO SEEK ADVICE ON TRANSACTIONS WHICH PRESENT POTENTIAL CONFLICTS OF INTEREST BEFORE COMMITTING TO SUCH TRANSACTIONS. QUESTIONS CONCERNING THE CONFLICT OF INTEREST POLICY SHOULD BE ADDRESSED TO THE EXECUTIVE DIRECTOR OR THE CHAIR OF THE BOARD OF DIRECTORS. ADMINISTRATION OF POLICY - CONFLICT OF INTEREST SELECT PERSONNEL, AS DETERMINED BY THE BOARD OF DIRECTORS, SHALL COMPLETE A FINANCIAL DISCLOSURE - CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS TO IDENTIFY POTENTIAL CONFLICTS OF INTEREST. THESE DISCLOSED POTENTIAL CONFLICTS OF INTEREST SHALL BE EVALUATED BY THE CHAIR OF THE BOARD OF DIRECTORS AND THE EXECUTIVE DIRECTOR, TO DEFINE A STRATEGY FOR MANAGING THEM IN ACCORDANCE WITH THE PRINCIPLES OUTLINED IN THIS POLICY. HHH PERSONS WHO PROPOSE TO CONDUCT AN ACTIVITY OR ENTER INTO A RELATIONSHIP WHICH COULD VIOLATE, OR APPEAR TO VIOLATE, THIS POLICY SHALL FULLY DISCLOSE IN WRITING THE NATURE AND EXTENT OF THE PROPOSED ACTION (INCLUDING COMPENSATION AND OTHER BENEFITS RECEIVED) TO HIS OR HER DEPARTMENTAL CHAIR OR HEAD OF HIS OR HER OPERATING DIVISION WHO SHALL MAKE A PRELIMINARY DETERMINATION IN WRITING OF THE PROPRIETY OR IMPROPRIETY OF THE PROPOSED ACTION AND OF HOW ANY POTENTIAL CONFLICTS OF INTEREST MIGHT BE MANAGED. A COPY OF SUCH DETERMINATION SHALL BE SENT TO THE EXECUTIVE DIRECTOR FOR A FINAL DETERMINATION AS TO WHETHER THE PROPOSED ACTION IS CONSISTENT WITH THIS POLICY AND ANY APPLICABLE LAWS OR REGULATIONS. FOR PURPOSES OF THIS POLICY, A GIFT WITH FAIR MARKET VALUE OF LESS THAN 100 WILL BE CONSIDERED TO BE OF NOMINAL VALUE. ALL COMMUNICATIONS REGARDING DISCLOSURES AND DETERMINATIONS OF CONFLICT OF INTEREST SHALL BE RETAINED IN CONFIDENCE. BECAUSE THIS POLICY DOES NOT TREAT ALL POTENTIAL CONFLICTS OF INTEREST BY WAY OF SPECIFIC PROVISIONS, HHH STRONGLY ENCOURAGES ALL CONTRACTED PERSONS TO SEEK ADVICE ON TRANSACTIONS WHICH PRESENT POTENTIAL CONFLICTS OF INTEREST BEFORE COMMITTING TO SUCH TRANSACTIONS. QUESTIONS CONCERNING THE CONFLICT OF INTEREST POLICY SHOULD BE ADDRESSED TO THE EXECUTIVE DIRECTOR OR THE CHAIR OF THE BOARD OF DIRECTORS. IN THE EVENT OF A CONFLICT OF INTEREST, HHH WILL TAKE WHATEVER CORRECTIVE ACTION IS NECESSARY TO PROTECT THE INTEGRITY OF THE INSTITUTION ITSELF AND ITS PROJECTS. IN THE CASE OF AN INTENTIONAL VIOLATION OF THIS POLICY, THE PENALTY FOR SUCH VIOLATION MAY RANGE FROM REPRIMAND TO TERMINATIONS DEPENDING UPON THE SEVERITY OF THE VIOLATION. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE EXECUTIVE COMMITTEE HAS RESPONSIBILITY FOR MATTERS CONCERNING SELECTION, EVALUATION, RETENTION, REMUNERATION, AND DISMISSAL OF KEY PERSONNEL INCLUDING THE EXECUTIVE DIRECTOR. THE EXECUTIVE COMMITTEE HAS RELIED ON THE LOCAL UNITED WAY WAGE AND BENEFITS SURVEY, LOCAL WAGE COMPARISONS FROM SALARY.COM, AND AN INFORMAL SURVEY OF AREA NONPROFIT CLINICS AS COMPENSATION GUIDELINES. THE INFORMATION IS REVIEWED BY THE EXECUTIVE COMMITTEE TO BE USED, IN CONJUNCTION WITH AN ANNUAL PERFORMANCE REVIEW, TO DETERMINE THE SALARY OF THE EXECUTIVE DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE EXECUTIVE COMMITTEE HAS RESPONSIBILITY FOR MATTERS CONCERNING SELECTION, EVALUATION, RETENTION, REMUNERATION, AND DISMISSAL OF KEY PERSONNEL INCLUDING THE EXECUTIVE DIRECTOR. THE EXECUTIVE COMMITTEE HAS RELIED ON THE LOCAL UNITED WAY WAGE AND BENEFITS SURVEY, LOCAL WAGE COMPARISONS FROM SALARY.COM, AND AN INFORMAL SURVEY OF AREA NONPROFIT CLINICS AS COMPENSATION GUIDELINES. THE INFORMATION IS REVIEWED BY THE EXECUTIVE COMMITTEE TO BE USED, IN CONJUNCTION WITH AN ANNUAL PERFORMANCE REVIEW, TO DETERMINE THE SALARY OF THE EXECUTIVE DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL INFORMATION IS AVAILABLE UPON REQUEST. |
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