Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 3,333,170 | 3,876,047 | 5,385,584 | 5,963,175 | 6,732,857 | 25,290,833 |
| 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 | 3,333,170 | 3,876,047 | 5,385,584 | 5,963,175 | 6,732,857 | 25,290,833 |
| 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. | 25,290,833 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,333,170 | 3,876,047 | 5,385,584 | 5,963,175 | 6,732,857 | 25,290,833 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 213 | 2,147 | 8,735 | 6,995 | 4,634 | 22,724 |
| 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.).. | 273,270 | 89,430 | 142,922 | 505,622 | ||
| 11 | Total support. Add lines 7 through 10 | 25,819,179 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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 2018 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-2018 |
(iii) Distributable Amount for 2018 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2018 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2018 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2018: | ||||
| a From 2013....... | ||||
| b From 2014....... | ||||
| c From 2015....... | ||||
| d From 2016....... | ||||
| e From 2017....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2018 distributable amount | ||||
|
i
Carryover from 2013 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2018 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2018 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2019. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2014...... | ||||
| b Excess from 2015..... | ||||
| c Excess from 2016..... | ||||
| d Excess from 2017..... | ||||
| e Excess from 2018..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 4 | DURING 2018, THE ORGANIZATION'S BYLAWS WERE AMENDED AS FOLLOWS: -ARTICLE I, SECTION 1.1 THE PURPOSE OF THE ORGANIZATION WAS CLARIFIED AND READS "THE PURPOSE OF THE CORPORATION IS TO PROVIDE ACCESSIBILITY TO QUALITY PRIMARY HEALTH CARE PATIENT MEDICAL / DENTAL HOME TO ALL, INCLUDING THE HUMAN RESOURCE SERVICES ADMINSTRATION (HRSA) PRIMARY SERVICE AREA OF INDIAN RIVER COUNTY." -ARTICLE II, SECTION 2.1.2 - THE NUMBER OF MEMBER DIRECTORS WAS CHANGED FROM 16 MEMBERS TO BETWEEN 11 AND 19 MEMBERS. -ARTICLE II, SECTION 2.2.1 - CONSUMER MEMBERS WERE RENAMED TO PATIENT MEMBERS AND NON-CONSUMER MEMBERS WERE RENAMED TO NON-PATIENT MEMBERS UNDER THE COMPOSITION OF THE GOVERNING BOARD. A NEW CLASSIFICATION WAS ADDED TO THE COMPOSITION OF THE GOVERNING BOARD, "REPRESENTATIVE(S) FROM OR FOR EACH OF THE SPECIAL POPULATIONS THAT RECEIVE ANY AWARD/DESIGNATION UNDER ONE OR MORE OF THE SPECIAL POPULATIONS SECTION 330 SUBPARTS 330 (G), (H), AND/OR (I)." -ARTICLE II, SECTION 2.2.1(I)(A) - THE REQUIREMENT FOR A PATIENT MEMBER OF THE GOVERNING BOARD TO HAVE UTILIZED THE CORPORATION'S SERVICES WITHIN THE PAST TWO YEARS WAS MOVED TO ARTICLE II, SECTION 2.2.1(I)(C). -ARTICLE II, SECTION 2.2.1(I)(B) - THE DEFINITION OF LEGAL GUARDIAN OF A PATIENT MEMBER WAS CLARIFIED. THE ARTICLE NOW ALLOWS STUDENTS WHO ARE HEALTH CARE CENTER PATIENTS TO PARTICIPATE AS BOARD MEMBERS SUBJECT TO STATE LAWS. -ARTICLE II, SECTION 2.2.1(I)(D) - THIS SECTION WAS ADDED. IT STATES, "THE HEALTH CENTER PATIENT BOARD MEMBERS MUST, AS A GROUP, REPRESENT THE INDIVIDUALS WHO ARE SERVED BY THE HEALTH CENTER IN TERMS OF DEMOGRAPHIC FACTORS, SUCH AS RACE, ETHNICITY, AND GENDER." -ARTICLE II, SECTION 2.2.1(II) - THE REQUIREMENT FOR NON-PATIENT MEMBERS WAS SIMPLIFIED TO "LIVE AND/OR WORK IN THE COMMUNITY, OR HAVE A DEMONSTRABLE CONNECTION TO THE COMMUNITY." -ARTICLE II, SECTION 2.2.1(III) - THIS SECTION WAS ADDED TO DEFINE THE REQUIREMENTS FOR THE NEW SPECIAL POPULATIONS CLASSIFICATION OF BOARD MEMBERS. -ARTICLE II, SECTION 2.5 ELECTION OF MEMBERS - THE ELECTION PROCESS FOR BOARD MEMBERS WAS REVISED. -ARTICLE II, SECTION 2.6.3 - THE NUMBER OF MEETINGS MISSED BY A BOARD MEMBER BEFORE AUTOMATIC TERMINATION WAS CHANGED FROM THREE TO SIX AND NOW INCLUDES ANY MISSED COMMITTEE MEETINGS. -ARTICLE II, SECTION 2.7.2(I) REIMBURSEMENT OF LOST WAGES WAS EDITED TO ADD THAT "WAGES LOST BY REASON OF PARTICIPATION IN THE ACTIVITIES IS POSSIBLE FOR SUCH BOARD MEMBERS IF THE MEMBER IS FROM A FAMILY WITH AN ANNUAL FAMILY INCOME OF LESS THAN $10,000 OR IF THE MEMBER IS A SINGLE PERSON WITH AN ANNUAL INCOME OF LESS THAN $7,000." -ARTICLE II, SECTION 2.7.2(III) USE OF 330 GRANT FUNDS - IT WAS EXPLAINED THAT THE ANNUAL FAMILY INCOME FOR REIMBURSEMENT MUST BE BELOW THE LIMITS SET BY THE HRSA. ARTICE III, SECTION 3.3.1 - THE GENERAL DUTIES AND RESPONSIBILITIES OF THE GOVERNING BOARD WERE EXPANDED. -ARTICLE III, SECTION 3.4.7.1 THE TIMEFRAME FOR THE CHAIRPERSON TO NOMINATE A COMMITTEE TO NOMINATE OFFICERS FOR ELECTION WAS CLARIFIED AS AT LEAST 30 DAYS PRIOR TO ANY SPECIAL OR ANNUAL MEETING AT WHICH OFFICERS ARE ELECTED. -ARTICLE IV, SECTION 4.3 AD-HOC COMMITTEES WAS ADDED. FOLLOWING SECTIONS WERE RENUMBERED APPROPRIATELY. -ARTICLE IV, SECTION 4.3.26 - REMOVED. -ARTICLE IV, SECTION 4.38 - THE STANDING COMMITTEE MUST NOW MEET AT LEAST ONCE EVERY TWO MONTHS, INSTEAD OF BIMONTHLY. ARTICLE V, SECTION 5.3 - THE ANNUAL MEETING OF THE CORPORATION WILL NOW BE DETERMINED AT THE JANUARY BOARD MEETING UNLESS OTHERWISE MOVED TO ANOTHER DATE BY UNANIMOUS CONSENT BY MARCH 31 OF THAT YEAR. OTHER WORDING AND GRAMMER CHANGES WERE ALSO MADE TO THE BYLAWS FOR CLARIFICATION AND UNDERSTANDING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 TAX RETURN IS SCHEDULED FOR REVIEW PRIOR TO FILING BY SHARING THE COMPLETED FORM WITH THE FINANCE COMMITTEE FOR A DETAILED REVIEW. THE 990 TAX RETURN IS THEN PART OF THE GOVERNING BOARD'S MONTHLY PACKET OF INFORMATION. THE RETURN IS BROUGHT BEFORE THE GOVERNING BOARD FOR REVIEW AND APPROVAL FOR SUBMISSION. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL DIRECTORS, OFFICERS, AND MEMBERS OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, ARE REQUIRED TO SIGN THE CONFLICT OF INTEREST POLICY ANNUALLY. THE POLICY REQUIRES THAT ALL ACTUAL AND POSSIBLE CONFLICTS OF INTEREST BE DISCLOSED AND ALL MATERIAL FACTS BE PRESENTED TO THE FINANCE COMMITTEE FOR EVALUATION. THE POLICY IS MONITORED AND REVIEWED BY THE FINANCE COMMITTEE AND DIRECTION GIVEN TO MANAGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION FOLLOWS A SALARY PRACTICES POLICY TO DETERMINE COMPENSATION. THE PROCESS USES THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTER'S SURVEY TO ESTABLISH AN APPROPRIATE SALARY GRADE/PAY RANGE FOR POSITIONS DUE TO THE SMALL COMPARATIVE BODY LOCALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON INDIVIDUAL REQUEST. |
| FORM 990, PART XII, LINE 2C: | THE FINANCE COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT OF THE ANNUAL FINANCIAL STATEMENT AUDIT AND THE SELECTION OF THE INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT RETAINED TO CONDUCT THE AUDIT. THE FINANCE COMMITTEE INCLUDES THE TREASURER OF THE GOVERNING BOARD AS CHAIRPERSON. THE COMMITTEE'S DUTIES ARE TO REVIEW THE FINANCES OF THE ORGANIZATION AND MAKE APPROPRIATE FINANCIAL REPORTS TO THE GOVERNING BOARD, TO DEVELOP POLICIES RELATED TO MONIES, TO MONITOR THE ORGANIZATION'S ASSET PERFORMANCE, TO DEVELOP THE ANNUAL BUDGET AND ITS FINANCIAL PRIORITIES, TO REVIEW THE ORGANIZATION'S ANNUAL AUDIT AND TO MAKE PERTINENT RECOMMENDATIONS TO THE GOVERNING BOARD. THESE INCLUDE INVESTMENTS, CASH FLOW ANALYSIS, MONTHLY REVIEW OF PROFITS AND LOSSES, AND CAPITAL PLANNING. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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| Software Version: |