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.") .. | ||||||
| 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) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (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) 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.") . | 35,400 | 0 | 11,987 | 2,500 | 0 | 49,887 |
| 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 | 848,055,027 | 980,546,905 | 1,165,729,604 | 1,365,884,063 | 1,377,747,020 | 5,737,962,619 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | 0 | |||||
| 6 | Total. Add lines 1 through 5 | 848,090,427 | 980,546,905 | 1,165,741,591 | 1,365,886,563 | 1,377,747,020 | 5,738,012,506 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | 0 | ||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | ||||
| 8 | Public support. (Subtract line 7c from line 6.) | 5,738,012,506 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2014 | (b) 2015 | (c) 2016 | (d) 2017 | (e) 2018 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 848,090,427 | 980,546,905 | 1,165,741,591 | 1,365,886,563 | 1,377,747,020 | 5,738,012,506 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,005,897 | 1,477,997 | 1,721,501 | 2,138,981 | 3,765,561 | 10,109,937 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 1,005,897 | 1,477,997 | 1,721,501 | 2,138,981 | 3,765,561 | 10,109,937 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | 0 | |||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 849,096,324 | 982,024,902 | 1,167,463,092 | 1,368,025,544 | 1,381,512,581 | 5,748,122,443 |
| 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 |
|---|---|
| Cessation of Services | 990, PART III, LINE 3 Neighborhood Health Plan ceased services to the Rhody Health Options - Unity line of business. |
| DESCRIPTION OF RELATIONSHIPS | 990, PART VI, LINE 2 A MEMBER OF THE ORGANIZATION'S BOARD OF DIRECTORS IS AN EXECUTIVE DIRECTOR OF A COMMUNITY HEALTH CENTER (CHC), BLACKSTONE VALLEY COMMUNITY HEALTH CARE, INC. BLACKSTONE VALLEY HEALTH CARE, THROUGH A GRANT,INVESTED IN EQUIPMENT AND SOFTWARE FOR AN ELECTRONIC MEDICAL RECORD(EMR)SYSTEM. ONE OTHER CHC, TRI-TOWN, HAS USE OF THE EMR AND BILLING SYSTEM. THE CHCS SHARE THE COST OF RUNNING the system. |
| DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, LINE 6 THE ORGANIZATION IS A 501(C)(3) CORPORATION AND HAS MEMBERS, BUT DOES NOT HAVE ANY STOCKHOLDERS. THE ORGANIZATION HAS A BOARD OF DIRECTORS WHO ARE MEMBERS OF THE ORGANIZATION THAT MEET ON A REGULAR BASIS AND FUNCTION AS THE GOVERNING BODY OF THE ORGANIZATION. |
| DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS | FORM 990, PART VI, LINE 7A THE MEMBERS OF THE ORGANIZATION ARE RHODE ISLAND COMMUNITY HEALTH CENTERS WHO HAVE THE AUTHORITY TO APPOINT A PORTION OF THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS ALSO APPROVES THE HIRING OF THE CHIEF EXECUTIVE OFFICER WHO IS A VOTING MEMBER OF THE BOARD. |
| DESCRIBE THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 | FORM 990, PART VI, LINE 11B THE ORGANIZATION'S FISCAL OPERATIONS DEPARTMENT ACCUMULATES THE INFORMATION AND DATA NECESSARY TO COMPLETE THE FEDERAL FORM 990. AUDITED FINANCIAL STATEMENTS AND APPROVED POLICIES AND PROCEDURES ARE USED AS INPUT TO COMPLETE THE 990. A DRAFT RETURN IS PREPARED AND REVIEWED BY THE ORGANIZATION'S INDEPENDENT CERTIFIED PUBLIC ACCOUNTANTS. AFTER THE REVIEW PROCESS IS COMPLETED BY THE INDEPENDENT ACCOUNTANTS, THE FINANCE STAFF REVIEW THE RETURN PRIOR TO FILING WITH THE IRS. THE FINANCE AND AUDIT COMMITTEE AND BOARD OF DIRECTORS ARE PROVIDED A DRAFT COPY OF THE RETURN FOR APPROVAL PRIOR TO FILING WITH THE IRS. |
| DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS | OF INTEREST FORM 990, PART VI, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY APPLIES TO, AND SERVES TO DESCRIBE EXPECTED BEHAVIORS AND ACTIONS OF, ITS OFFICERS AND MEMBERS OF ITS BOARD OF DIRECTORS (DIRECTORS). THE BOARD OF DIRECTORS (BOARD) IS RESPONSIBLE FOR ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY. AN OFFICER OR DIRECTOR OF THE ORGANIZATION HAS AN "INTEREST" IN A GIVEN MATTER IF HE OR SHE HAS, DIRECTLY OR INDIRECTLY, THROUGH AN IMMEDIATE FAMILY MEMBER, A BUSINESS, FINANCIAL, FIDUCIARY OR PERSONAL RELATIONSHIP WITH A PARTY OR PARTIES AS DESCRIBED WITHIN THE ORGANIZATION'S BYLAWS. THE ORGANIZATION REQUIRES CURRENT AND PROSPECTIVE OFFICERS AND DIRECTORS TO DISCLOSE IN WRITING, AND UPDATE ANNUALLY, ALL INTERESTS WHICH MAY CREATE A CONFLICT OF INTEREST AND, WHERE APPLICABLE, PROVIDE A STATEMENT SUGGESTING HOW SUCH CONFLICT COULD BE AVOIDED OR MITIGATED. OFFICERS AND DIRECTORS ARE REQUIRED TO DISCLOSE IN WRITING ANY INTERESTS THAT ARISE AFTER FILING THE ANNUAL DISCLOSURE. THE BOARD, OR A DULY DESIGNATED COMMITTEE, REVIEWS INSTANCES WHERE A DISCLOSURE INDICATES A POTENTIAL CONFLICT OF INTEREST. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT IS REQUIRED TO PROVIDE INFORMATION REQUESTED BY, AND RESPOND TO QUESTIONS FROM, THE BOARD OR ITS DESIGNATED COMMITTEE. IF THE BOARD HAS REASONABLE CAUSE TO BELIEVE THAT AN INDIVIDUAL FAILED TO DISCLOSE AN INTEREST, THE INDIVIDUAL MUST BE INFORMED OF THIS AND GIVEN THE OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE INDIVIDUAL'S RESPONSE, AND CONDUCTING FURTHER INVESTIGATION AS NEEDED, IF THE BOARD DETERMINES THE INDIVIDUAL HAS FAILED TO DISCLOSE AN INTEREST AS DEFINED IN ACCORDANCE WITH THE ORGANIZATION'S BYLAWS, THE BOARD WILL TAKE APPROPRIATE CORRECTIVE AND/OR DISCIPLINARY ACTION. |
| POLICIES | FORM 990, PART VI, LINES 13 & 14 PURSUANT TO THE INSTRUCTIONS FOR FORM 990, THE ORGANIZATION MUST ANSWER NO TO QUESTIONS 13 & 14 BECAUSE THE BOARD OF DIRECTORS HAS NOT YET FORMALLY ADOPTED THESE POLICIES. HOWEVER, THE ORGANIZATION HAS ISSUED THESE POLICIES AT THE DIRECTION OF MANAGEMENT AND THESE POLICIES AND PROCEDURES ARE STRICTLY ENFORCED BY THE ORGANIZATION'S MANAGEMENT TEAM. THE ORGANIZATION HAS WRITTEN WHISTLEBLOWER AND DOCUMENT RETENTION AND DESTRUCTION POLICIES. |
| OFFICERS & POSITIONS FOR WHICH PROCESS WAS USED, & YEAR PROCESS WAS BEGUN | FORM 990, PART VI, LINES 15A & 15B THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS AND APPROVES THE CONTRACT OF THE CEO AND ANY CHANGES TO THE CONTRACT. THE HUMAN RESOURCES COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE COMPENSATION OF THE CHIEF FINANCIAL OFFICER, CHIEF MEDICAL OFFICER AND THE CHIEF OPERATING OFFICER BASED ON COMPENSATION SURVEYS. THE EXECUTIVE COMMITTEE SUBSCRIBES TO THREE OR FOUR SALARY SURVEYS THAT LIST SALARY AND SALARY INCREASES BY POSITION, GEOGRAPHY, PLAN SIZE AND PROFIT VS. NON-PROFIT ORGANIZATIONS. THESE SURVEYS ARE USED TO SET COMPENSATION ANNUALLY. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST AT THE ORGANIZATION'S LOCATION AT 910 DOUGLAS PIKE, SMITHFIELD, RI 02917. |
| OTHER CHANGES IN NET ASSETS | FORM 990, PART XI, LINE 9 CHANGE IN NON-ADMITTED ASSETS ($5,262,829) ROUNDING ($956) ------------ TOTAL ($5,263,785) |
| ACCOUNTING METHOD USED TO PREPARE THE FORM 990 | FORM 990, PART XII, LINE 1a THE ORGANIZATION'S STATUTORY FINANCIAL STATEMENTS ARE PRESENTED ON THE BASIS OF ACCOUNTING PRATICES PRESCRIBED OR PERMITTED BY THE DBR. THE DBR HAS ADPOTED THE NATIONAL ASSOCIATION OF INSURANCE COMMISSIONERS' STATUTORY ACCOUNTING PRATICES (NAIC SAP) AS THE BASIS OF ITS STATUTORY ACCOUNTING PRATICES (SAP) |
| Software ID: | |
| Software Version: |