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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 2,682,947 | 2,484,560 | 2,353,692 | 2,362,792 | 3,975,690 | 13,859,681 |
| 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 | 2,682,947 | 2,484,560 | 2,353,692 | 2,362,792 | 3,975,690 | 13,859,681 |
| 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).. | 11,737,735 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 2,121,946 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,682,947 | 2,484,560 | 2,353,692 | 2,362,792 | 3,975,690 | 13,859,681 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 69 | 69 | ||||
| 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.).. | 246 | 437 | 5,024 | 6,856 | 325 | 12,888 |
| 11 | Total support. Add lines 7 through 10 | 13,872,638 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 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 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| FEMHEALTH USA, INC. QUALIFIES AS A PUBLIC CHARITY UNDER THE "FACTS AND CIRCUMSTANCES" TEST OF 1.170A-9(F)(3) OF THE TREASURY REGULATIONS, BASED UPON THE FOLLOWING: ITS SUPPORT, AS REPORTED FOR 2020, IS 15.30%, THEREBY MEETING THE REQUIREMENT OF 1.170A-9(F)(3)(I). FEMHEALTH USA, INC. IS ORGANIZED AND OPERATED SO AS TO ATTRACT NEW AND ADDITIONAL FUNDING ON A CONTINUOUS BASIS, THEREBY MEETING THE REQUIREMENT OF 1.170A-9(F)(3)(II). FEMHEALTH USA, INC. HAS RECENTLY UNDERTAKEN SIGNIFICANT EFFORTS TO ATTRACT NEW AND ADDITIONAL PUBLIC SUPPORT. RECOGNIZING THE VALUE OF FEMHEALTH USA, INC.'S WORK TO THE COMMUNITY, A SMALL NUMBER OF PRIVATE FOUNDATIONS HAVE PROVIDED FEMHEALTH USA, INC. WITH SUPPORT IN RECENT MONTHS NOT ONLY TO HELP THE ORGANIZATION CONTINUE ITS WORK BUT ALSO TO BEGIN A NEW DEVELOPMENT EFFORT TO BROADEN FEMHEALTH USA, INC.'S BASE OF SUPPORT. FEMHEALTH USA, INC.'S PUBLIC SUPPORT, AT 15.30%, IS ABOVE THE 10% MINIMUM REQUIRED FOR THE "FACTS AND CIRCUMSTANCES" TEST, THEREBY MEETING THE REQUIREMENT OF 1.170A-9(F)(3)(III). IN MEETING THE REQUIREMENT OF 1.170A-9(F)(3)(I), FEMHEALTH USA, INC. HAS RECEIVED SUPPORT FROM A REPRESENTATIVE NUMBER OF PERSONS, RATHER THAN RECEIVING ALL OR MOST OF ITS SUPPORT FROM THE MEMBERS OF A SINGLE FAMILY, OR FROM A SINGLE DONOR. IN FACT, FEMHEALTH USA, INC. HAS RECEIVED FINANCIAL SUPPORT FROM HUNDREDS OF INDIVIDUAL DONORS, IN ADDITION TO GRANTS RECEIVED FROM A NUMBER OF DIFFERENT FOUNDATIONS. FEMHEALTH USA, INC.'S CURRENT FUNDRAISING PLANS ARE TARGETED AT A BROAD BASE OF DONORS. IN THIS RESPECT, FEMHEALTH USA, INC. MEETS THE REQUIREMENT OF 1.170A-9(F)(3)(III)(B). FEMHEALTH USA, INC. REMAINS AN ORGANIZATION COMMITTED TO SERVING THE PUBLIC THROUGH ITS WORK. FEMHEALTH USA, INC. WAS FORMED TO PROVIDE CONVENIENT AND PROFESSIONAL ABORTION CARE AND FAMILY PLANNING SO PEOPLE CAN CONTROL THE NUMBER AND SPACING OF THEIR CHILDREN. FEMHEALTH USA, INC. WORKS EXCLUSIVELY TO TO OFFER CARING, COMPASSIONATE AND CONFIDENTIAL SUPPORT THAT IS DESIGNED SPECIFICALLY FOR THE COMFORT AND PEACE OF MIND OF THOSE WITH UNINTENDED OR UNWANTED PREGNANCIES. IN THIS MANNER, FEMHEALTH USA, INC. MEETS THE REQUIREMENT OF 1.170A-9(F)(3)(III)(D). |
| Return Reference | Explanation |
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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 2 | THE ORGANIZATION HAS IMPLEMENTED THE OPTION TO OBTAIN MEDICAL CARE THROUGH TELEMEDICINE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO AND PRESIDENT, CHIEF OPERATIONS OFFICER (COO), AND OUTSOURCED CFO WORKS IN CONJUNCTION WITH THE OUTSIDE ACCOUNTING FIRM ENGAGED TO PREPARE THE FORM 990 TO REVIEW ITS ACCURACY PRIOR TO BOARD REVIEW AND SUBMISSION. THE FINANCE COMMITTEE AND THE TREASURER REVIEWS THE FORM 990 AND THE EXECUTIVE DIRECTOR SIGNS IT. UPON RESOLUTION BY THE AUDIT COMMITTEE AND PRESENTATION TO THE BOARD, THE CEO AND PRESIDENT, CFO AND COO ENSURES THE FILING OF THE FORM 990 BY THE DEADLINE EACH YEAR. |
| FORM 990, PART VI, SECTION B, LINE 12C | FEMHEALTH LEADERSHIP CONSISTENTLY AND REGULARLY MONITORS COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY THROUGH PERIODIC REVIEWS, CONVERSATIONS ACROSS STAFF MEMBERS, CHECKS BY THE FINANCE TEAM, AND QUERIES FROM THE BOARD. IF A CONFLICT ARISES, IT IS REFERRED TO THE CEO FOR INVESTIGATION AND POSSIBLE CORRECTIVE ACTION. IF THE CONFLICT INVOLVES THE CEO, IT IS ESCALATED TO THE BOARD FOR SIMILAR REVIEW AND/OR ACTION. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE COMPENSATION PROCESS CONSISTS OF A COMPARISON OF SIMILAR POSITIONS, JOB RESPONSIBILITIES, AND SALARIES IN THE MARKETPLACE. PROPOSED SALARY INCREASES ARE PRESENTED TO THE BOARD FOR APPROVAL. THE CEO DETERMINES KEY EMPLOYEE WAGES BASED ON ORGANIZATIONS SIMILAR IN SIZE AND PRACTICE. THE CEO RECEIVES COMPENSATION AS APPROVED BY THE FINANCE COMMITTEE OF THE BOARD. DOCUMENTATION OF THIS COMPENSATION IS KEPT IN THE CEO'S PERSONNEL FILE. THIS WAS LAST DONE IN DECEMBER 2019. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 10,370. MANAGEMENT AND GENERAL EXPENSES 1,630. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,000. HEALTH NETWORK SERVICE: PROGRAM SERVICE EXPENSES 216,359. MANAGEMENT AND GENERAL EXPENSES 34,006. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250,365. DKT ADMIN. FEE: PROGRAM SERVICE EXPENSES 95,059. MANAGEMENT AND GENERAL EXPENSES 14,941. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,000. NAS/PEOPLEWISE: PROGRAM SERVICE EXPENSES 216. MANAGEMENT AND GENERAL EXPENSES 34. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250. MERCHANT SERVICES: PROGRAM SERVICE EXPENSES 50,800. MANAGEMENT AND GENERAL EXPENSES 7,984. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 58,784. CONSULTING PHYSICIAN FEE: PROGRAM SERVICE EXPENSES 407,121. MANAGEMENT AND GENERAL EXPENSES 63,989. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 471,110. EDITOR FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 79,000. TOTAL EXPENSES 79,000. |
| FORM 990, PART X, LINE 24: | ON MAY 15, 2020, FEMHEALTH RECEIVED LOAN PROCEEDS IN THE AMOUNT OF $315,300 UNDER THE PAYCHECK PROTECTION PROGRAM. THE PROMISSORY NOTE CALLED FOR MONTHLY PRINCIPAL AND INTEREST PAYMENTS AMORTIZED OVER THE TERM OF THE PROMISSORY NOTE WITH A DEFERRAL OF PAYMENTS FOR THE FIRST SIX MONTHS. UNDER THE CORONAVIRUS AID, RELIEF, AND ECONOMIC SECURITY ACT (CARES ACT), THE PROMISSORY NOTE COULD HAVE BEEN FORGIVEN BY THE SMALL BUSINESS ADMINISTRATION IN WHOLE OR IN PART. DURING THE YEAR ENDED DECEMBER 31, 2020, FEMHEALTH USED THE LOAN PROCEEDS FOR PURPOSES CONSISTENT WITH THE PAYCHECK PROTECTION PROGRAM AND APPLIED FOR FORGIVENESS SUBSEQUENT TO THE 24-WEEK PERIOD STIPULATED BY THE TERMS. SUBSEQUENT TO YEAR-END ON APRIL 12, 2021, FEMHEALTH RECEIVED NOTICE OF FULL FORGIVENESS OF THE LOAN BY THE SBA AND WILL RECORD REVENUE FROM EXTINGUISHMENT OF DEBT IN 2021. |
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