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.") .. | 15,546,038 | 16,514,373 | 17,443,712 | 18,111,470 | 17,912,754 | 85,528,347 |
| 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.. | 20,232 | 20,232 | 20,232 | 20,232 | 20,232 | 101,160 |
| 4 | Total. Add lines 1 through 3 | 15,566,270 | 16,534,605 | 17,463,944 | 18,131,702 | 17,932,986 | 85,629,507 |
| 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. | 85,629,507 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 15,566,270 | 16,534,605 | 17,463,944 | 18,131,702 | 17,932,986 | 85,629,507 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 167,878 | 186,059 | 218,389 | 236,516 | 224,435 | 1,033,277 |
| 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.).. | 141,889 | 145,205 | 155,954 | 167,130 | 610,178 | |
| 11 | Total support. Add lines 7 through 10 | 87,272,962 | |||||
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) |
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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 |
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| 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, EXPLANATION FOR OTHER INCOME: | OTHER INCOME INCLUDES VENDING REVENUE, COPY REVENUE, MAINTENANCE CHARGES, AND BOOKEEPING SERVICES TO A RELATED ENTITY. 2014 AMOUNT: $ 141,889. 2015 AMOUNT: $ 145,205. 2016 AMOUNT: $ 155,954. 2017 AMOUNT: $ 167,130. |
| 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 1 | THE BOARD MAY, BY RESOLUTION, DESIGNATE THREE (3) OR MORE OF THEIR NUMBER TO CONSTITUTE AN EXECUTIVE COMMITTEE WHICH, TO THE EXTENT PROVIDED IN SUCH RESOLUTION, SHALL HAVE THE POWERS OF THE BOARD BETWEEN MEETINGS OF THE BOARD. COPIES OF MINUTES OF ITS MEETINGS SHALL BE SENT TO EACH DIRECTOR PROMPTLY AFTER EACH MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE INDEPENDENT ACCOUNTING FIRM THAT PERFORMS THE ANNUAL AUDIT ALSO ASSISTS IN PREPARING THE FORM 990. MANAGEMENT PROVIDES THE ACCOUNTING FIRM WITH THE ADDITIONAL INFORMATION NECESSARY TO COMPLETE THE FORM 990, AND REVIEWS FOR ACCURACY. THE COMPLETED FORM 990 IS THEN PRESENTED TO THE FINANCE COMMITTEE WHICH REVIEWS AND ACCEPTS AFTER ALL QUESTIONS ARE ANSWERED. THE FINANCE COMMITTEE MAKES A COPY OF THE FORM 990 AVAILABLE TO THE FULL BOARD FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS. BOARD MEMBERS, OFFICERS AND MEMBERS OF SENIOR MANAGEMENT MUST REVIEW AND SIGN A STATEMENT ANNUALLY DISCLOSING OR UPDATING THEIR INTEREST, AND THOSE OF THEIR FAMILY MEMBERS, THAT COULD GIVE RISE TO A CONFLICT OF INTEREST IN THE OPERATIONS OF PEACE RIVER CENTER. AS MATTERS COME FORWARD FOR BOARD DECISION, EACH INTERESTED PARTY IS RESPONSIBLE FOR DISCLOSING ANY CONFLICT OF INTEREST AND ALL FACTS MATERIAL TO THE CONFLICT OF INTEREST TO THE BOARD, WHETHER OR NOT THE INTERESTED PARTY WILL ATTEND THE MEETING AT WHICH SUCH DECISIONS OR ACTIONS WILL TAKE PLACE. THE DISCLOSURE SHALL BE REFLECTED IN THE MINUTES. UPON DISCLOSURE OF CONFLICT OF INTEREST BY AN INTERESTED PARTY, THE BOARD WILL FOLLOW THE FOLLOWING PROCEDURES. THE MATTER UNDER DISCUSSION SHOULD BE INVESTIGATED AND PRESENTED BY A NON-INTERESTED PARTY. THE INTERESTED PARTY MAY BE REQUESTED TO LEAVE THE MEETING AFTER THE INTERESTED PARTY HAS HAD AN OPPORTUNITY TO DISCUSS THE MATTER. THE TRANSACTION CAN ONLY BE PASSED BY A MAJORITY OF BOARD MEMBERS PRESENT, NOT INCLUDING THE INTERESTED PARTY IF THAT PERSON IS A BOARD MEMBER. THE BOARD MINUTES SHOULD REFLECT THE FACT THAT THE INTERESTED PARTY WAS NOT PRESENT, AND SHOULD RECORD A ROLL CALL OF THE VOTE. THE ROLL CALL SHOULD REFLECT WHO WAS PRESENT FOR THE VOTE, BUT NOT NECESSARILY HOW THEY VOTED. |
| FORM 990, PART VI, SECTION B, LINE 15A | AN EXECUTIVE COMPENSATION COMMITTEE WAS FORMED AND A CHAIR OF THE COMMITTEE WAS APPOINTED. AN EVALUATION OF THE CEO'S PERFORMANCE WAS OBTAINED AND REVIEWED, THIS WAS ACCOMPLISHED BY SURVEYING THE BOARD MEMBERS. TO UPDATE AND VALIDATE THE RANGE OF RECOMMENDED COMPENSATION FOR THE CEO POSITION, THE CHAIR OBTAINED NATIONAL SURVEY DATA FOR COMPARABLE MENTAL HEALTH AND HEALTH CARE ENTITIES. IN ADDITION TO THIS SURVEY DATA, THE COMMITTEE OBTAINED CEO COMPENSATION INFORMATION THROUGH GUIDESTAR FROM FORMS 990 FOR SELECTED FLORIDA COMMUNITY MENTAL HEALTH ENTITIES THAT THE COMMITTEE FELT WERE COMPARABLE BOTH IN BUDGET AND SCOPE OF SERVICES MANAGED. USING A COMBINATION OF THE NATIONAL SURVEY DATA AND THE FLORIDA CEO COMPENSATION FIGURES OBTAINED THORUGH GUIDESTAR, THE COMMITTEE DEVELOPED AND RECOMMENDED AN UPDATED CEO COMPENSATION RANGE FOR THE CURRENT FISCAL YEAR. THE RANGE WAS RECOMMENDED TO THE EXECUTIVE COMMITTEE WHO COMPARED TO THE CURRENT COMPENSATION FOR THE CEO AND A RECOMMENDATION WAS THEN MADE TO THE BOARD FOR ACTION TO ADJUST ACCORDINGLY. THE CEO REVIEWS THE PERFORMANCE OF THE OTHER CORPORATE OFFICERS AND PERIODICALLY REVIEWS SALARY RANGES. THE HUMAN RESOURCES DEPERTMENT COORDINATES AND CONDUCTS THE SALARY SURVEYS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| PART VII, SECTION A: COMPENSATION OF DIRECTORS | PETER GOLOTKO IS A PRINCIPAL IN A FIRM THAT MANAGES RETIREMENT PLANS. THIS FIRM HAS BEEN RETAINED BY PEACE RIVER CENTER TO MANAGE THE 401K PLAN AND IS A CO-FIDUCIARY IN THE ADMINISTRATION OF THE PLAN. THE FIRM RECEIVES COMPENSATION FROM THE PLAN PARTICIPANTS. THE FIRM WAS SELECTED THROUGH A COMPETITIVE BID PROCESS. SOZON VATIKIOTIS IS THE CEO OF AN INSURANCE BROKERAGE FIRM THAT PROVIDES SERVICES RELATED TO THE PEACE RIVER CENTER HEALTH AND WELFARE BENEFIT PLANS. THE FIRM RECEIVES COMPENSATION FROM THE INSURANCE COMPANIES HIRED TO PROCESS CLAIMS AND PROVIDE STOP-LOSS COVERAGE. THE FIRM WAS SELECTED THROUGH A COMPETITIVE BID PROCESS. |
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