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.") .. | 1,643,352 | 2,153,570 | 2,986,278 | 2,939,713 | 2,792,828 | 12,515,741 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 1,643,352 | 2,153,570 | 2,986,278 | 2,939,713 | 2,792,828 | 12,515,741 |
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 12,515,741 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,643,352 | 2,153,570 | 2,986,278 | 2,939,713 | 2,792,828 | 12,515,741 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,403 | 750 | 710 | 713 | 681 | 4,257 |
| 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.).. | 122,847 | 120,111 | 150,742 | 255,304 | 106,503 | 755,507 |
| 11 | Total support. Add lines 7 through 10 | 13,275,505 | |||||
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 IV, LINE 11F | The organization is currently in the process of having their fiscal year ended January 31, 2019 financial statements audited. The auditor is expected to have the final financial statements completed near the end of January 2020. Therefore, there is no footnote available from final financials that addresses the organization's liability for uncertain tax positions under FIN 48(ASC 740). |
| FORM 990, PART IV LINE 12A | THE ORGANIZATION IS CURRENTLY IN THE PROCESS OF HAVING THEIR FISCAL YEAR ENDED JANUARY 31, 2019 FINANCIAL STATEMENTS AUDITED. THE AUDITOR IS EXPECTED TO HAVE THE FINAL FINANCIAL STATEMENTS COMPLETED NEAR THE END OF JANUARY 2020. THEREFORE, THE RECONCILIATION OF THIS RETURN TO THE FINANCIAL STATEMENTS WAS NOT ABLE TO BE COMPLETED ON SCHEDULE D. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE HAS THE AUTHORITY TO ACT ON URGENT MATTERS WHEN THE FULL BOARD IS NOT IN SEASON. IT SHALL REVIEW OPERATING POLICY MATTERS AND BRING RECOMMENDATIONS TO THE BOARD WHERE BOARD APPROVAL IS REQUIRED, COORDINATE THE WORK OF THE COMMITTEE, EVALUATE PERFORMANCE OF THE CHIEF EXECTUIVE OFFICER, NEGOTIATE THE CHIEF EXECUTIVE OFFICER'S CONTRACT, REVIEW AND RECOMMEND BY-LAW CHANGES, IN CONJUNCTION WITH CHIEF EXECUTIVE OFFICER'S CONTRACT, DESIGNATE A REPRESENTATIVE OF THE BOARD TO PARTICIPATE WITH APPROPRIATE BOARD MEMBERS OF THE BOARD TO RESOLVE PATIENT GRIEVANCES. THE EXECUTIVE COMMITTEE WILL ALSO DEVELOP MECHANISMS FOR EVALUATING BOARD MEMBERS' PERFORMANCE ON AN ANNUAL BASIS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CFO. A COPY OF THE FORM 990 IS MADE AVAILABLE TO ALL BOARD MEMBERS PRIOR TO THE BOARD MEETING TO APPROVE THE RETURN BEFORE THE FINAL COPY IS FILED WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PART VI, SECTION B, LINE 12C | IT IS THE ORGANIZATION'S POLICY TO AVOID THE PARTICIPATION OF ANY DIRECTOR IN THE BOARD OF DIRECTORS' CONSIDERATION OF A MATTER WHICH POSES A CONFLICT OF INTEREST FOR THAT DIRECTOR. WHENEVER ANY MATTER COMES BEFORE A MEETING OF THE BOARD OF DIRECTORS WHICH GIVES RISE TO A POTENTIAL CONFLICT OF INTEREST, THEN THE FOLLOWING PROCEDURE SHALL APPLY. THE MINUTES OF A MEETING AT WHICH A CONFLICT OF INTEREST ARISES SHALL REFLECT THAT THE DISCLOSURE WAS MADE, THE AFFECTED DIRECTOR'S WITHDRAWAL FROM THE MEETING AND ABSTAIN FROM VOTING, AND IF ACTION IS TAKEN ON THAT MATTER, THE CONTINUED PRESENCE OF QUORUM. THE BOARD OF DIRECTORS AND MANAGEMENT MEET QUARTERLY TO DISCUSS ANY ISSUES PERTAINING TO THE ORGANIZATION'S CONFLICT OF INTEREST POLICIES AND PROCEDURES AND THEY ARE ASKED TO DISCLOSE ANY CONFLICTS OF INTEREST THAT MIGHT ARISE DURING THE YEAR. FOR THE CONFLICTS THAT ARE NOTED, THE BOARD EVALUATES HOW THE CONFLICT CAN BE MITIGATED AND ESTABLISH APPROPRIATE CONTROLS AND OVERSIGHT TO MONITOR AND ENSURE THE POLICY IS IN PLACE. . |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS REVIEWED BY THE PERSONNEL COMMITTEE. THE CHAIRPERSON AND MEMBERS OF THE PERSONNEL COMMITTEE ARE APPOINTED BY THE BOARD CHAIRPERSON. THE PERSONNEL COMMITTEE COMPARES THE CEO COMPENSATION TO THE COMMUNITY HEALTH CENTER ORGANIZATION'S BENCHMARK DATA TO DETERMINE A REASONABLE AND COMPETITIVE CONTRACT. THE CEO'S COMPENSATION IS REVIEWED ANNUALLY AND LAST OCCURRED IN 2014. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART X - SECURED MORTGAGES AND NOTES PAYABLE | LENDER: WSFS INTEREST RATE: 4.75% MATURITY DATE: 09/01/2022 REPAYMENT TERMS: $3,105 PRINCIPAL & INTEREST MONTHLY INSTALLMENTS SECURITY PROVIDED: ALL ASSETS OF THE ORGANIZATION ENDING BALANCE DUE.................................. $186,563 LENDER: WSFS INTEREST RATE: 5.50% MATURITY DATE: 09/01/2022 REPAYMENT TERMS: $3,242 PRINCIPAL & INTEREST MONTHLY INSTALLMENTS SECURITY PROVIDED: ALL ASSETS OF THE ORGANIZATION ENDING BALANCE DUE.................................. $260,547 LENDER: M&T BANK INTEREST RATE: 7.50% MATURITY DATE: N/A REPAYMENT TERMS: INTEREST ONLY SECURITY PROVIDED: $200,000 SECURED SAVINGS ACCOUNT ENDING BALANCE DUE.................................. $147,750 TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE...... $594,860 |
| FORM 990, PART XI, LINE 8 PRIOR PERIOD ADJUSTMENTS | ADDITIONS TO PRIOR PERIOD ADJUSTMENTS RELATED TO THE FOLLOWING: - $204,652 - REDUCTION OF PRIOR PERIOD ACCRUED PAYROLL EXPENSES NOT STILL OWED TO EMPLOYEES TOTAL ADDITIONS OF $204,652 SUBTRACTION RELATED TO PRIOR PERIOD ADJUSTMENTS DUE TO THE FOLLOWING: - $56,809 - AUDIT ADJUSTMENTS MADE AFTER FILING OF PRIOR YEAR RETURN - $502 - PRIOR PERIOD DEPRECIATION NOT REPORTED - $14,561 - WRITE-OFF OF PRIOR PERIOD UNCOLLECTIBLE ACCOUNTS RECEIVABLE - $1,171 - WRITE-OFF OF PRIOR PERIOD UNCOLLECTIBLE GRANTS RECEIVABLE TOTAL SUBTRACTIONS OF $73,043 TOTAL NET ADJUSTMENT OF $131,609 |
| FORM 990, PART XII, LINE 2B | The organization is currently in the process of having their fiscal year ended January 31, 2019 financial statements audited. The auditor is expected to have the final financial statements completed near the end of January 2020. FORM 990, PART XII, LINE 2C THE FINANCE COMMITTEE, LED BY THE TREASURER SHALL REVIEW ALL MATTERS PERTAINING TO THE ANNUAL AUDIT. |
| Software ID: | |
| Software Version: |