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.") .. | 8,757,480 | 10,636,803 | 10,391,742 | 12,428,910 | 13,878,706 | 56,093,641 |
| 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 | 8,757,480 | 10,636,803 | 10,391,742 | 12,428,910 | 13,878,706 | 56,093,641 |
| 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. | 56,093,641 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 8,757,480 | 10,636,803 | 10,391,742 | 12,428,910 | 13,878,706 | 56,093,641 |
| 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 | 56,093,641 | |||||
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) |
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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 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 |
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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 | THE BYLAWS WERE AMENDED AS FOLLOWS: - REPLACED THE TERM "FQHC" WITH "CORPORATION" THROUGHOUT TO CLARIFY TYPE OF ORGANIZATION THAT IS COMMUNITYCARE AND ADDED REFERENCE TO "HEALTH CENTER PROGRAM" WHEREVER GOVERNANCE WAS UNIQUE TO HRSA REQUIRED AUTHORITIES. - ARTICLE II. UPDATED MISSION AND INCLUDED A PURPOSE STATEMENT. - SECTION 4.01. CLARIFIED DESCRIPTION OF THE BOARD AS A CO-APPLICANT, RATHER THAN AS THE FQHC. - SECTION 4.01. ADDED KEY AUTHORITIES SUCH AS SELECTING AN INDEPENDENT AUDITOR TO PERFORM THE ANNUAL AUDIT AND SELECTING, EVALUATING AND DISMISSING THE CEO. - SECTION 4.02. ADDED LANGUAGE PROHIBITING THIRD PARTIES FROM APPROVAL AUTHORITY OR VETO POWER WITH REGARD TO THE REQUIRED AUTHORITIES. - SECTION 4.03. STRUCK MOST OF THE BUDGET PROCESS AND REPLACED WITH A HIGH-LEVEL SUMMARY OF ACTUAL, CURRENT PROCESS WITH CENTRAL HEALTH. DETAILED PROCEDURES WILL BE OUTLINED IN THE CO-APPLICANT AGREEMENT. - SECTION 5.02(2). ADDED LANGUAGE THAT ALLOWS A LEGAL GUARDIAN OF A PATIENT OR A LEGAL SPONSOR OF AN IMMIGRANT PATIENT TO BE CONSIDERED A CONSUMER FOR PURPOSES OF BOARD REPRESENTATION. - SECTION 5.02(3). ADDED HEALTHCARE AS AN INDUSTRY THAT NON-CONSUMERS CAN REPRESENT. - SECTION 5.02(5). ADDED REFERENCE TO THE NORTH AMERICAN CLASSIFICATION SYSTEM THAT WE USE TO DEFINE THE HEALTH CARE INDUSTRY FOR PURPOSES OF THE 10% INCOME REQUIREMENT. - SECTION 5.04. ADDED PROHIBITION AGAINST THIRD PARTY REQUIRING REMOVAL OF ANY DIRECTOR. ADDED NOTIFICATION REQUIREMENTS TO CENTRAL HEALTH IN THE EVENT A CENTRAL HEALTH APPOINTED BOARD DIRECTOR IS REMOVED OR SUSPENDED. - SECTION 5.05. ADDED PROCEDURES FOR DIRECTOR RESIGNATIONS. - SECTION 5.07. ADDED A PROCESS FOR TAKING ACTION OUTSIDE OF A MEETING. - SECTION 6.01-6.02. CLARIFIED INTENT OF BOARD RECRUITMENT EFFORTS, MOVED UP THE ELECTION DATE FOR REAPPOINTMENTS, TERMS TO BEGIN UPON REAPPOINTMENT AND ADDED PROHIBITIONS AROUND THIRD PARTY SELECTION/APPOINTMENT OF BOARD DIRECTORS. - SECTION 7.02. ALIGNED OFFICER APPOINTMENTS WITH DIRECTOR APPOINTMENTS. - ARTICLE VII. CLARIFIED AND STRENGTHENED RESPONSIBILITIES OF CHAIRMAN, SECRETARY AND TREASURER. - ARTICLE VIII. STRUCK QUALITY AND PERFORMANCE IMPROVEMENT COMMITTEE, MEDICAL PEER REVIEW COMMITTEE AND NURSING PEER REVIEW COMMITTEE AS THESE ARE NOT COMMITTEES OF THE BOARD, BUT RATHER STAFF COMMITTEES, BUT KEPT REFERENCE REGARDING AUTHORITY TO ESTABLISH AND OVERSEE PEER REVIEW FUNCTIONS (AT SECTION 4.01(7). - SECTION 8.02. CLARIFIED FUNCTION OF EXECUTIVE COMMITTEE. - SECTION 8.04. CHANGED FREQUENCY OF STRATEGIC PLANNING COMMITTEE FROM ANNUALLY TO QUARTERLY. - SECTION 8.06. STRUCK REQUIREMENT TO HOLD AT LEAST TWO PATIENT EXPERIENCE COMMITTEE MEETINGS AS PUBLIC FORUMS AS OBJECTIVE WILL BE ACHIEVED THROUGH PATIENT ADVISORY COUNCIL. - SECTION 9.01. CLARIFIED FUNCTION OF EXECUTIVE SESSION. - SECTION 9.10. CLARIFIED AND EXPANDED CIRCUMSTANCES FOR BOARD COMPENSATION. - SECTION 10.02-10.04. STRUCK MOST OF SELECTION PROCESS OF CEO AS THIS IS ENCOMPASSED IN CO-APPLICANT AGREEMENT. CLARIFIED THAT BOARD IS RESPONSIBLE FOR SELECTING AND DISMISSING THE CEO. - SECTION 12.02. ADDED A CONFIDENTIALITY REQUIREMENT. - SECTION 12.03. ADDED PROHIBITIONS AGAINST ACTING INDIVIDUALLY ON BEHALF OF THE BOARD, DIRECTING STAFF, AND TAKING ACTIONS THAT RUN AFOUL CHARITABLE, TAX-EXEMPT PURPOSES. - SECTION 13.02. STRUCK ACCESS AND AUDIT PROCEDURES FROM ARTICLE XIII AS THOSE ARE ENCOMPASSED IN CO-APPLICANT AGREEMENT AND STRUCK CENTRAL HEALTH FROM APPROVAL PROCESS OF INDEPENDENT AUDIT. |
| FORM 990, PART VI, SECTION A, LINE 7A | TRAVIS COUNTY HEALTH DISTRICT, DBA CENTRAL HEALTH CAN APPOINT 2 MEMBERS TO THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE CO-APPLICANT AGREEMENT WITH TRAVIS COUNTY HEALTHCARE DISTRICT GIVES THE DISTRICT AUTHORITY CONCERNING CERTAIN DECISIONS ABOUT BUDGET, BOARD MEMBERSHIP, CEO EMPLOYMENT AND POLICIES. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE AND AT THE MONTHLY BOARD MEETING. |
| FORM 990, PART VI, SECTION B, LINE 12C | REPORTS ARE RUN TO MONITOR THE PROGRESS OF SUBMITTED DISCLOSURE FORMS AND DISCREPANCIES ARE REPORTED TO EXECUTIVE MANAGEMENT FOR ENFORCEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD SET POLICY THAT COMPENSATION WOULD REFLECT MARKET RATES. IMPLEMENTATION OF THE SALARY STRUCTURE, SETTING PAY GRADES AND RELATED COMPENSATION IS DELEGATED TO THE CEO BY THE BOARD. INDEPENDENT MARKET SURVEYS ARE PURCHASED TO EVALUATE ALL POSITIONS AND ESTABLISH PAY GRADES AND USED TO DETERMINE THE SCALE FOR MERIT INCREASES EACH YEAR. THIS IS THE PROCESS FOR ALL EMPLOYEES INCLUDING KEY EMPLOYEES. THE BOARD REVIEWS PERFORMANCE AND APPROVES COMPENSATION FOR THE CEO USING MARKET SURVEY INFORMATION. |
| 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 REQUEST. |
| FORM 990, PART IX, LINE 11G | BILLING STATEMENT AND COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 766,188. MANAGEMENT AND GENERAL EXPENSES 957,698. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,723,886. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 7,584,181. MANAGEMENT AND GENERAL EXPENSES 129,498. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,713,679. RECRUITMENT SERVICES: PROGRAM SERVICE EXPENSES 50,268. MANAGEMENT AND GENERAL EXPENSES 62,832. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 113,100. OTHER SERVICES: PROGRAM SERVICE EXPENSES 948,710. MANAGEMENT AND GENERAL EXPENSES 789,413. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,738,123. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 5,378,020. MANAGEMENT AND GENERAL EXPENSES 437,128. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,815,148. |
| FORM 990, PART XII, LINE 2C | THE PROCESS OF SELECTING AN INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |