Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and 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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 527,047 | 534,034 | 91,437 | 219,273 | 176,444 | 1,548,235 |
| 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 | 527,047 | 534,034 | 91,437 | 219,273 | 176,444 | 1,548,235 |
| 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).. | 66,887 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,481,348 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 527,047 | 534,034 | 91,437 | 219,273 | 176,444 | 1,548,235 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 0 | |||||
| 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.).. | 28,577 | 1,728 | 87,570 | 8,554 | 3,157 | 129,586 |
| 11 | Total support. Add lines 7 through 10 | 1,677,821 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, 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 2019. 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 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Schedule A, Part II, Line 10 Other Income | DESCRIPTION - OTHER INCOME, COLUMN A - 28577.0, COLUMN B - 1728.0, COLUMN C - 87570.0, COLUMN D - 8554.0, COLUMN E - 3157.0, COLUMN F - 129586.0; |
| Software ID: | 17005876 |
| Software Version: | 2017v2.2 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990, Part III, Line 1 Organization's Mission | (Continued from part III) During the fiscal year ended September 30, 2018, ASAP served 26,860 clients through its many programs. |
| Form 990, Part III, Line 4d Description of other program services | (Expenses $ 5,536,603 including grants of $ 162,153)(Revenue $ 7,019,768) Other program highlights for 2018 include: EPIC's Brighter Seasons for Children Program: The program is a grassroots campaign started over 15 years ago by community members who wanted to make a difference in the lives of children infected and affected by HIV/AIDS living in Pinellas County. EPIC currently serves 40 families which include 120 children. Each year, Brighter Seasons provides families with holiday food packages at Thanksgiving and Christmas, a holiday party with Santa, a holiday gift distribution, and a spring picnic and egg hunt. The program also provides back-packs at the beginning of each school year fully loaded with needed school supplies. Our medical co-pay assistance program helps clients with limited financial aid for doctor visits, lab work and medications. To qualify, a client must be HIV positive, employed, insured and reside in Pinellas County. In addition, clients are unable to receive this service if they are on disability, Medicaid or Medicare assistance programs. The collaborative fellowship dinner is free to the community. Clients are encouraged to invite their friends and families to attend. Our goal is to promote kinship, awareness and education in a safe, enjoyable environment. On a quarterly basis, educational speakers are brought in to present the latest updates on medications, services and developments in the HIV/AIDs community. EPIC provides free HIV testing for anyone age 13 and up, as well as education and prevention programs for the entire community. Individual support services are available for those who are at high risk for acquiring HIV. EPIC provides services that cover HIV positive new born babies or babies with an HIV positive parent. Programs and services are for all people of all ages. Many EPIC clients are senior adults. EPIC offers HIV education, prevention services, testing, case management, food and personal needs pantry, a children's program, some financial assistance and many other options. Case managers help their EPIC clients find avenues of care and other resources to help them deal with their individual situations. Testing is provided by certified testers and staff educators provide vital information on prevention and other topics. EPIC provides support groups and counseling for those living with HIV/AIDS and collaborates with other AIDS organizations to provide additional options. EPIC's Home 3050 and 340(b) programs meet all of a HIV client's health care needs in one place, a true one stop shop, serving over 900 clients annually. Treatments include medical care, medical case management, counseling services, care coordination, and pharmaceutical consults. Through its 340(b) program, 100% of all proceeds realized through EPIC's partnered pharmacy, are allocated back to maintain and expand EPIC's services to the HIV community. |
| Form 990, Part VI, Line 15b PROCESS OF DETERMINING COMPENSATION OF OTHER OFFICERS | The compensation of the organization's other officers is determined by Empath Health, Inc. (EHI), a related organization. Therefore, this question is answered "no" in accordance with Form 990 instructions. The compensation of other officers is reviewed on an annual basis by the CEO of EHI, and was most recently evaluated during the year ended September 30, 2018. After reviewing officer compensation, the CEO's recommendations are then approved by EHI's Board of Directors. These reviews are documented in each employee's file. The review of other officers' compensation includes information provided in the most recent external compensation review. External compensation reviews are performed according to the process below. Every 3-5 years HUMAN RESOURCES will employ a well-recognized, independent compensation consultant to review the market ranges for the CEO of EHI and the other officers. The review will include a national comparison of similar jobs at similarly situated companies in order to make certain that these key employees are paid within a reasonable and appropriate range. The resulting recommendations will be reviewed as is appropriate to recommend any market-based changes or possibly just assure ourselves of the current correct positioning of compensation for these individuals. |
| Form 990, Part VI, Line 15a compensation of top management official | The organization's top management official is the president and CEO of Empath Health, Inc. (EHI), a related organization. The CEO's compensation is determined and paid by EHI. Therefore, this question is answered "no" in accordance with Form 990 instructions. The executive committee of the EHI board meets annually to review and approve the compensation of the president and CEO. The Executive Committee last reviewed CEO compensation during the year ended September 30, 2018, and the process and decisions were contemporaneously documented in the executive committee minutes. The Executive Committee's review of CEO compensation includes information provided in the most recent external compensation review. External compensation reviews are performed according to the process below. Every 3-5 years HUMAN RESOURCES will employ a well-recognized, independent compensation consultant to review the market ranges for the CEO of EHI. The review will include a national comparison of similar jobs at similarly situated companies in order to make certain that these key employees are paid within a reasonable and appropriate range. The resulting recommendations will be reviewed by the executive committee to recommend any market-based changes or possibly just assure ourselves of the current correct positioning of compensation for these individuals. During this review, HUMAN RESOURCES will also give the executive committee a broad overview of the structure of the full organization's compensation system including the philosophy and systems set in place to manage it. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | The Board of Directors has an Executive Committee, which consists of the Chairman of the Board, the Vice Chairman of the Board, the President/Chief Executive Officer, the Secretary and the Treasurer. The Board of Directors may designate from its members up to two additional Directors to serve as members of the Executive Committee. When the Board of Directors is not in session, the Executive Committee has and may exercise all of the powers of the Board of Directors, except to the extent, if any, that such authority shall be limited by a resolution adopted by a majority of Directors in office. |
| Form 990, Part VI, Line 2 Family/business relationships amongst interested persons | RAFAEL SCIULLO, SCOTT KISTLER, AND MITCHEL MOREL - ALL ARE EITHER BOARD MEMBERS AND/OR ARE OFFICERS OF HOSPICE SYSTEMS, INC. A RELATED, FOR-PROFIT COMPANY - Business relationship |
| Form 990, Part VI, Line 6 Classes of members or stockholders | Pursuant to the organization's governing documents, the sole voting member of AIDS Service Association of Pinellas, Inc (ASAP) shall be EMPATH HEALTH, Inc. (EHI), a related tax-exempt organization. As the organization's sole corporate member, EHI has the right to participate in the organization's governance. |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | Pursuant to the organization's governing documents, the sole corporate member, EHI, has the right to elect, appoint, or remove any director of ASAP without cause at any time. |
| Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders | The sole corporate member, EHI, has the right to approve or ratify significant decisions of the organization's governing body. The board of directors of ASAP shall not have the authority to make significant decisions without the approval of the EHI board. Significant decisions include but are not limited to: the right to amend, repeal or alter their governing documents; sell, lease or otherwise dispose of substantially all of the organization's assets; and merge or consolidate the organization with another organization. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The organization retains the expertise of an independent tax advisor to assist in the preparation and review of its IRS Form 990. Prior to filing the IRS Form 990, management and the independent tax advisor review the tax return and all required disclosures. The Form 990 is then reviewed by the audit committee, consisting of independent directors of the organization. The audit committee makes a recommendation to the board of directors TO ACCEPT OR REJECT THE FORM 990. The Form 990 is then provided to the full board of directors for their review prior to filing with the IRS. |
| Form 990, Part VI, Line 12c Conflict of interest policy | All officers, directors, trustees, key employees and highest paid employees (interested persons) of the organization have a duty to avoid conflicts of interest, both real and perceived, which may negatively impact the organization or those it serves. The organization's interested persons are to be guided by the organization's mission, vision and values and to serve patients, families and the general public without need for any personal favor or gain. The organization's ethics and compliance plan emphasizes the duty interested persons have to disclose any actual or potential conflicts of interest that may benefit their private interests or result in a possible excess benefit transaction. Conflicts are disclosed annually on a conflict of interest questionnaire that is distributed to the officers, directors, key employees, and highest compensated employees. In the event of any actual or potential conflicts of interest, interested persons must disclose the existence of their financial interest and disclose all material facts to the board chair, CEO or other designated persons. If it is determined an actual conflict of interest exists between the organization and an interested person, the party with a conflict of interest must abstain from any discussion or voting on the transaction or arrangement involving the conflict of interest. At each board meeting, board members are reminded that they have signed a conflict of interest disclosure and are asked to review the agenda and, for the record, disclose any items with which they may have a conflict of interest. |
| Form 990, Part VI, Line 19 Required documents available to the public | Financial Statements, governing documents, and conflict of interest policies are not required disclosures pursuant to Internal Revenue Code (IRC) Section 6104. These documents are not available to the public at this time. |
| Form 990, Part IX, Line 11g Other Fees | MISCELLANEOUS CLIENT EXPENSES - Total Expense: 453147, Program Service Expense: 453147, Management and General Expenses: , Fundraising Expenses: ; CLIENT EDUCATION - Total Expense: 11407, Program Service Expense: 11407, Management and General Expenses: , Fundraising Expenses: ; CLIENT TRANSPORTATION - Total Expense: 19937, Program Service Expense: 19937, Management and General Expenses: , Fundraising Expenses: ; PHARMACY DISPENSE FEES - Total Expense: 913105, Program Service Expense: 913105, Management and General Expenses: , Fundraising Expenses: ; OVERHEAD - Total Expense: 516992, Program Service Expense: , Management and General Expenses: 516992, Fundraising Expenses: ; OTHER FEES FOR SERVICES - Total Expense: 121512, Program Service Expense: 102969, Management and General Expenses: 11164, Fundraising Expenses: 7379; |
| Software ID: | 17005876 |
| Software Version: | 2017v2.2 |