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 | 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) 2011 | (b) 2012 | (c) 2013 | (d) 2014 | (e) 2015 | (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) 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 |
||||
|
2
Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions) |
||||
| 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 |
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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 B, LINE 11 | THE FORM 990 IS EMAILED OR HANDED OUT AT THE BOARD MEETING DEPENDING ON TIMING AND REVIEWED PRIOR TO FILING THE RETURN. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION DOES REGULARLY AND CONSISTENTLY MONITOR AND ENFORCE COMPLIANCE WITH THE CONFLICTS OF INTEREST POLICY |
| FORM 990, PART VI, SECTION B, LINE 15 | SALARIES ARE APPROVED UPON REVIEW BY THE CEO AND COO. THE CHAIRMAN OF THE BOARD IS CONSULTED ON THE CEO AND COO'S COMPENSATION. BENCHMARKS SUCH AS MGMA'S SALARY REPORT ARE USED. |
| FORM 990, PART VI, SECTION C, LINE 19 | RECORDS MAY BE REQUESTED TO BE REVIEWED ON SITE OR COPIED FOR A NOMINAL CHARGE |
| FORM 990, PART IX, LINE 24E | MEDICAL LAB AND OPERATING SUPPLIES: PROGRAM SERVICE EXPENSES 712,054. MANAGEMENT AND GENERAL EXPENSES 71,348. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 783,402. UTILITIES EXPENSE: PROGRAM SERVICE EXPENSES 25,773. MANAGEMENT AND GENERAL EXPENSES 632,117. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 657,890. EMPLOYEE DONOR PATIENT RELATIONS: PROGRAM SERVICE EXPENSES 111,882. MANAGEMENT AND GENERAL EXPENSES 343,160. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 455,042. LICENSES AND FEES: PROGRAM SERVICE EXPENSES 142,659. MANAGEMENT AND GENERAL EXPENSES 161,333. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 303,992. TELEPHONE EXPENSES: PROGRAM SERVICE EXPENSES 216,786. MANAGEMENT AND GENERAL EXPENSES 72,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 288,979. OFFICE SUPPLIES: PROGRAM SERVICE EXPENSES 170,673. MANAGEMENT AND GENERAL EXPENSES 111,197. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 281,870. POSTAGE AND FREIGHT: PROGRAM SERVICE EXPENSES 31,672. MANAGEMENT AND GENERAL EXPENSES 170,955. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 202,627. BANK AND CREDIT CARD CHARGES: PROGRAM SERVICE EXPENSES 2,238. MANAGEMENT AND GENERAL EXPENSES 158,561. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 160,799. ELECTRONIC CLAIMS FILING EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 140,774. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 140,774. OTHER EXPENSES: PROGRAM SERVICE EXPENSES -105,579. MANAGEMENT AND GENERAL EXPENSES 225,626. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 120,047. PROFESSIONAL LIABILITY INSURANCE: PROGRAM SERVICE EXPENSES 88,916. MANAGEMENT AND GENERAL EXPENSES 25,461. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 114,377. INSURANCE ON PHYSICAL PLANT: PROGRAM SERVICE EXPENSES 30,946. MANAGEMENT AND GENERAL EXPENSES 79,932. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,878. OFFICE EQUIPMENT LEASES: PROGRAM SERVICE EXPENSES 59,605. MANAGEMENT AND GENERAL EXPENSES 33,763. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 93,368. OUTSIDE PAYROLL AND DATA PROCESSING SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 74,254. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,254. GENERAL LIABILITY INSURANCE EXPENSE: PROGRAM SERVICE EXPENSES 19,724. MANAGEMENT AND GENERAL EXPENSES 50,465. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,189. ELECTRONIC ELIGIBILITY: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 49,005. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,005. PRINTING AND PUBLICATIONS: PROGRAM SERVICE EXPENSES 7,807. MANAGEMENT AND GENERAL EXPENSES 40,289. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 48,096. TEMPORARY SERVICES: PROGRAM SERVICE EXPENSES 723. MANAGEMENT AND GENERAL EXPENSES 28,196. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,919. NEW HIRE COSTS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 22,400. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,400. ELECTRONIC PYMT POSTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,307. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,307. BOOKS AND SUBSCRIPTIONS: PROGRAM SERVICE EXPENSES 9,052. MANAGEMENT AND GENERAL EXPENSES 7,306. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,358. UNIFORM AND LAUNDRY EXPENSE: PROGRAM SERVICE EXPENSES 12,199. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,199. DISBURSEMENT TO CORRESPONDENT ORGANIZATION: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 12,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,000. EQUIPMENT LEASES: PROGRAM SERVICE EXPENSES 1,100. MANAGEMENT AND GENERAL EXPENSES 9,600. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,700. GREENERY LEASES: PROGRAM SERVICE EXPENSES 1,938. MANAGEMENT AND GENERAL EXPENSES 1,530. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,468. EDUCATION RELATED COSTS: PROGRAM SERVICE EXPENSES 3,047. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,047. CAPITAL LEASE PAYMENT INTEREST: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 182. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 182. COLLECTION AGENCY EXPENSE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 74. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74. MISCELLANEOUS A/P DISCOUNTS: PROGRAM SERVICE EXPENSES -1,782. MANAGEMENT AND GENERAL EXPENSES -24. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -1,806. |
| FORM 990, PART XI, LINE 9: | FUNDRAISING EXP. ALLOCATED TO MCGEE EYE INST. ENDOW. FUND -368,588. |
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| Software Version: |