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 | 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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 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.") . | 8,920,690 | 7,790,925 | 13,280,269 | 9,557,766 | 13,895,211 | 53,444,861 |
| 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 | 16,487,879 | 23,075,360 | 23,702,965 | 23,922,242 | 21,290,655 | 108,479,101 |
| 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 | 25,408,569 | 30,866,285 | 36,983,234 | 33,480,008 | 35,185,866 | 161,923,962 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 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 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 161,923,962 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 25,408,569 | 30,866,285 | 36,983,234 | 33,480,008 | 35,185,866 | 161,923,962 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 83 | 36 | 87 | 66 | 2,684 | 2,956 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 83 | 36 | 87 | 66 | 2,684 | 2,956 |
| 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.) .. | 2,972,700 | 95,761 | 243,726 | 3,312,187 | ||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 28,381,352 | 30,962,082 | 36,983,321 | 33,480,074 | 35,432,276 | 165,239,105 |
| 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): |
|||||
| 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 |
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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 B, LINE 11B | A COPY OF THE FINAL FORM 990 IS PROVIDED TO THE FINANCE/AUDIT COMMITTEE OF THE BOARD FOR REVIEW AND TO MAKE RECOMMENDATIONS TO THE FULL BOARD. A COPY OF THE FINAL FORM 990 IS PROVIDED TO EACH VOTING MEMBER OF THE BOARD PRIOR TO FILING WITH THE IRS, |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTORS, OFFICERS, AND KEY PERSONS MUST, AT ALL TIMES, ACT FAIRLY, REASONABLY AND IN THE HEALTH CENTER'S BEST INTERESTS, AND MUST REFRAIN FROM PERSONAL CONSIDERATIONS OF ANY KIND THAT CONFLICT WITH, OR THAT APPEAR TO CONFLICT WITH, THE BEST INTERESTS OF THE HEALTH CENTER AND ITS PATIENTS. ALL DIRECTORS, OFFICERS AND KEY PERSONS WILL, AT LEAST ANNUALLY, FILE A WRITTEN CONFLICT OF INTEREST DISCLOSURE STATEMENT WITH THE COMPLIANCE OFFICER . THE COMPLIANCE OFFICER WILL COLLECT SUCH STATEMENTS AND MAY ALSO COLLECT OTHER RELEVANT DOCUMENTS OR INFORMATION RELATING TO THE STATEMENTS. FOR DIRECTORS, THE CONFLICT OF INTEREST DISCLOSURE STATEMENT WILL SPECIFICALLY INCLUDE, AMONG OTHER DISCLOSABLE CONFLICTS OF INTEREST, A STATEMENT IDENTIFYING, TO THE BEST OF THE DIRECTOR'S KNOWLEDGE, ANY ENTITY OF WHICH HE OR SHE IS AN OFFICER, DIRECTOR, TRUSTEE, MEMBER, OWNER (EITHER AS A SOLE PROPRIETOR OR A PARTNER), OR EMPLOYEE AND WITH WHICH THE HEALTH CENTER HAS A RELATIONSHIP, AND ANY TRANSACTION IN WHICH THE HEALTH CENTER IS A PARTICIPANT AND IN WHICH THE DIRECTOR MIGHT HAVE A DISCLOSABLE CONFLICT OF INTEREST. ALL COMPLETED CONFLICT OF INTEREST DISCLOSURE STATEMENTS AND ALL OTHER DISCLOSURES OF DISCLOSABLE CONFLICTS OF INTEREST (E.G., CREDENTIALING APPLICATIONS OR EMPLOYEE OR OTHER DISCLOSURES) THAT RAISE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR THAT CREATE THE APPEARANCE OF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, WILL BE REVIEWED BY THE COMPLIANCE OFFICER , FOR ITS CONSIDERATION, ALONG WITH OTHER RELEVANT DOCUMENTS AND INFORMATION (IF ANY). THE COMPLIANCE OFFICER WILL CONDUCT A FULL REVIEW OF ALL MATTERS THAT RAISE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR THAT CREATE THE APPEARANCE OF AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IN SO DOING, THE COMPLIANCE OFFICER: A. WILL CONSIDER ALL RELEVANT FACTS AND CIRCUMSTANCES INVOLVED IN THE MATTER, AND IN PARTICULAR, WHAT IS FAIR, REASONABLE AND IN THE BEST INTERESTS OF THE HEALTH CENTER AND ITS PATIENTS; B. WILL RECOMMEND TO THE AUDIT COMMITTEE TO EXCLUDE THE AFFECTED INDIVIDUAL(S) FROM BEING PRESENT AT OR PARTICIPATING IN THE DELIBERATIONS OR VOTING ON THE MATTER; C. WILL RECOMMEND TO THE AUDIT COMMITTEE TO PROHIBIT THE AFFECTED INDIVIDUAL(S) FROM ANY ATTEMPT TO IMPROPERLY INFLUENCE THE DELIBERATIONS OR VOTING ON THE MATTER; AND D. WILL RECOMMEND TO THE AUDIT COMMITTEE THAT THE AFFECTED INDIVIDUAL(S) BE PERMITTED, TO PRESENT INFORMATION AS BACKGROUND OR ANSWER QUESTIONS CONCERNING THE MATTER AT A BOARD MEETING PRIOR TO COMMENCEMENT OF DELIBERATIONS OR VOTING ON THE MATTER; AND E. WILL RECOMMEND TO THE AUDIT COMMITTEE THE RECUSAL OF ANY DIRECTOR BE REQUIRED TO VOTE OR BE COUNTED IN DETERMINING THE QUORUM FOR ANY VOTE, ON ANY TRANSACTION BETWEEN THE HEALTH CENTER AND ANOTHER CORPORATION, FIRM, ASSOCIATION OR OTHER ENTITY IN WHICH THE RECUSED DIRECTOR IS AN OFFICER OR DIRECTOR OR HAS A DIRECT OR INDIRECT SUBSTANTIAL FINANCIAL INTEREST. THE COMPLIANCE OFFICER WILL MAKE A FINAL DETERMINATION AND PROVIDE A RECOMMENDATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS OR MAY EXIST, AND WHAT COURSE THE HEALTH CENTER SHOULD TAKE IN CONNECTION WITH THE MATTER. THE COMPLIANCE OFFICER SHALL REPORT HIS/HER ACTIONS TO THE CEO FOR REVIEW AND PRESENTATION TO THE BOARD. IF THE COMPLIANCE OFFICER OR CEO AS APPLICABLE, HAS REASONABLE CAUSE TO BELIEVE THAT A PERSON HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE PERSON SHALL BE INFORMED OF THE BASIS FOR SUCH BELIEF AND AFFORDED AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING THE RESPONSE OF THE INDIVIDUAL WHO FAILED TO DISCLOSE A CONFLICT OF INTEREST, AND MAKING SUCH FURTHER INVESTIGATION AS MAY BE WARRANTED IN THE CIRCUMSTANCES, THE COMPLIANCE OFFICER OR CEO DETERMINES THAT THE INDIVIDUAL HAS IN FACT FAILED TO DISCLOSE A CONFLICT OF INTEREST IN ACCORDANCE WITH THIS POLICY, APPROPRIATE CORRECTIVE AND/OR DISCIPLINARY ACTION SHALL BE TAKEN, INCLUDING REMOVAL OF THE INDIVIDUAL FROM THE SELECTION, NEGOTIATION, OR ADMINISTRATION OF ANY CONTRACTS OR GRANTS. |
| FORM 990, PART VI, SECTION B, LINE 15 | EVERY 2-3 YEARS, THE ORGANIZATION SEEKS TO EVALUATE THE KEY EMPLOYEES AND C-SUITE EMPLOYEES TO ENSURE THAT SALARY IS COMPARABLE TO THAT OF THE MARKET (UTILIZING SIMILAR SIZE, REVENUE, DIRECT REPORTS, ETC.). HR DIRECTOR REACHES OUT TO THE THIRD-PARTY CONSULTANT (COMPENSATION RESOURCES) TO INITIATE THE PROCESS VIA THE ORDER OF THE CEO. COMPENSATION RESOURCES PROVIDES THE SERVICE AND FINAL RECOMMENDATION. HR DIRECTOR SHARES THE INFORMATION WITH CEO BUT REVIEWS WITH CFO. CEO AND CFO RECOMMENDS DATE ADJUSTMENTS ARE TO BE MADE. THE PROCESS WAS DONE IN 2019 AND ADJUSTMENTS WERE DONE ON 1/6/2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FORM 990, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST AT 592 ROCKAWAY AVENUE, BROOKLYN, NY 11212. |
| FORM 990, PART XII, LINE 2C | THE ORGANIZATION HAS A COMMITTEE THAT IS CHARGED WITH OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT. THIS PROCESS IS UNCHANGED FROM LAST YEAR. |
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| Software Version: |