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 |
||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 3,045,582 | 3,136,742 | 4,256,925 | 4,617,694 | 5,303,090 | 20,360,033 |
| 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 | 3,045,582 | 3,136,742 | 4,256,925 | 4,617,694 | 5,303,090 | 20,360,033 |
| 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. | 20,360,033 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,045,582 | 3,136,742 | 4,256,925 | 4,617,694 | 5,303,090 | 20,360,033 |
| 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.).. | 838 | 838 | ||||
| 11 | Total support. Add lines 7 through 10 | 20,360,871 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 on 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) |
||||
| 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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
||||
| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
6
Remaining underdistributions for 2022. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
||||
|
7 Excess distributions carryover to 2023. Add lines 3j and 4c. |
||||
| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | MISCELLANEOUS - 2018 AMOUNT: $ 838. |
| 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 1A | THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE, WHICH CONSISTS OF THE CHAIRMAN OF THE BOARD, THE VICE CHAIRMAN OF THE BOARD, THE PRESIDENT/CHIEF EXECUTIVE OFFICER, THE SECRETARY, AND THE TREASURER. THE BOARD OF DIRECTORS MAY DESIGNATE, FROM ITS MEMBERS, UP TO TWO ADDITIONAL DIRECTORS TO SERVE AS MEMBERS OF THE EXECUTIVE COMMITTEE. WHEN THE BOARD OF DIRECTORS IS NOT IN SESSION, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE ALL OF THE POWERS OF THE BOARD OF DIRECTORS, EXCEPT TO THE EXTENT, IF ANY, THAT SUCH AUTHORITY SHALL BE LIMITED BY A RESOLUTION ADOPTED BY A MAJORITY OF DIRECTORS IN OFFICE. |
| FORM 990, PART VI, SECTION A, LINE 6 | PURUSANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE VOTING MEMBER OF AIDS SERVICE ASSOCIATION OF PINELLAS, INC. (ASAP) SHALL BE EMPATH HEALTH, INC. (EHI), A RELATED TAX-EXEMPT ORGANIZATION. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER, EHI HAS THE RIGHT TO PARTICIPATE IN THE ORGANIZATION'S GOVERNANCE. |
| FORM 990, PART VI, SECTION A, LINE 7A | PURSUANT TO THE ORGANIZATION'S GOVERNING DOCUMENTS, THE SOLE CORPORATE MEMBER, EHI, HAS THE RIGHT TO ELECT, APPOINT, OR REMOVE ANY DIRECTOR OF ASAP WITHOUT CAUSE AT ANY TIME. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE CORPORATE MEMBER, EHI, HAS THE RIGHT TO APPROVE OR RATIFY SIGNIFICANT DECISIONS OF THE ORGANIZATION'S GOVERNING BODY. THE BOARD OF DIRECTORS OF ASAP SHALL NOT HAVE THE AUTHORITY TO MAKE SIGNIFICANT DECISIONS WITHOUT THE APPROVAL OF THE EHI BOARD. SIGNIFICANT DECISIONS INCLUDE, BUT ARE NOT LIMITED TO: THE RIGHT TO AMEND, REPEAL OR ALTER THEIR GOVERNING DOCUMENTS; SELL, LEASE OR OTHERWISE DISPOSE OF SUBSTANTIALLY ALL OF THE ORGANIZATION'S ASSETS; AND MERGE OR CONSOLIDATE THE ORGANIZATION WITH ANOTHER ORGANIZATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | UPON COMPLETION AND BEFORE SUBMISSION, THE FORM 990 IS PROVIDED TO EACH BOARD MEMBER ALONG WITH A SUMMARY OF IMPORTANT HIGHLIGHTS, NOTING THE PAGE NUMBERS AND LINES FOR ITEMS OF PARTICULAR IMPORTANCE TO REVIEW. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS, DIRECTORS, TRUSTEES, KEY EMPLOYEES, AND HIGHEST PAID EMPLOYEES (INTERESTED PERSONS) OF THE ORGANIZATION HAVE A DUTY TO AVOID CONFLICTS OF INTEREST, BOTH REAL AND PERCEIVED, WHICH MAY NEGATIVELY IMPACT THE ORGANIZATION OR THOSE IT SERVES. THE ORGANIZATION'S INTERESTED PERSONS ARE TO BE GUIDED BY THE ORGANIZATION'S MISSION, VISION AND VALUES, AND TO SERVE PATIENTS, FAMILIES, AND THE GENERAL PUBLIC WITHOUT NEED FOR ANY PERSONAL FAVOR OR GAIN. THE ORGANIZATION'S ETHICS AND COMPLIANCE PLAN EMPHASIZES THE DUTY INTERESTED PERSONS HAVE TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT MAY BENEFIT THEIR PRIVATE INTERESTS OR RESULT IN A POSSIBLE EXCESS BENEFIT TRANSACTION. CONFLICTS ARE DISCLOSED ANNUALLY ON A CONFLICT OF INTEREST QUESTIONNAIRE THAT IS DISTRIBUTED TO THE OFFICERS, DIRECTORS, KEY EMPLOYEES, AND HIGHEST COMPENSATED EMPLOYEES. IN THE EVENT OF ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST, INTERESTED PERSONS MUST DISCLOSE THE EXISTENCE OF THEIR FINANCIAL INTEREST AND DISCLOSE ALL MATERIAL FACTS TO THE BOARD CHAIR, CEO, OR OTHER DESIGNATED PERSONS. IF IT IS DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS BETWEEN THE ORGANIZATION AND AN INTERESTED PERSON, THE PARTY WITH A CONFLICT OF INTEREST BUT ABSTAIN FROM ANY DISCUSSION OR VOTING ON THE TRANSACTION OR ARRANGEMENT INVOLVING THE CONFLICT OF INTEREST. AT EACH BOARD MEETING, BOARD MEMBERS ARE REMINDED THAT THEY HAVE SIGNED A CONFLICT OF INTEREST DISCLOSURE AND ARE ASKED TO REVIEW THE AGENDA. AT THAT TIME, FOR THE RECORD, THEY ARE TO DISCLOSE ANY ITEMS WITH WHICH THEY MAY HAVE A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL IS THE PRESIDENT AND CEO OF EMPATH HEALTH, INC. (EHI), A RELATED ORGANIZATION. THE CEO'S COMPENSATION IS DETERMINED BY AND PAID FOR BY EHI. THE EXECUTIVE COMMITTEE OF THE EHI BOARD MEETS ANNUALLY TO REVIEW AND APPROVE THE COMPENSATION OF THE PRESIDENT AND CEO. THE EXECUTIVE COMMITTEE'S REVIEW OF CEO COMPENSATION INCLUDES INFORMATION PROVIDED IN THE MOST RECENT EXTERNAL COMPENSATION REVIEW. THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS IS ALSO DETERMINED BY EHI. THE COMPENSATION OF OTHER OFFICERS IS REVIEWED ON AN ANNUAL BASIS BY THE CEO OF EHI. AFTER REVIEWING OFFICER COMPENSATION, THE CEO'S RECOMMENDATIONS ARE THEN APPROVED BY EHI'S BOARD OF DIRECTORS. THESE REVIEWS ARE DOCUMENTED IN EACH EMPLOYEE'S FILE. THE REVIEW OF OTHER OFFICERS' COMPENSATION INCLUDES INFORMATION PROVIDED IN THE MOST RECENT EXTERNAL COMPENSATION REVIEW. EXTERNAL COMPENSATION REVIEWS ARE PERFORMED ACCORDING TO THE FOLLOWING PROCESS: EVERY 3-5 YEARS HUMAN RESOURCES WILL EMPLOY A WELL-RECOGNIZED, INDEPENDENT COMPENSATION CONSULTANT TO REVIEW THE MARKET RANGES FOR THE CEO OF EHI. THE REVIEW WILL INCLUDE A NATIONAL COMPARISON OF SIMILAR JOBS AT SIMILARLY SITUATED COMPANIES IN ORDER TO MAKE CERTAIN THAT THESE KEY EMPLOYEES ARE PAID WITHIN A REASONABLE AND APPROPRIATE RANGE. THE RESULTING RECOMMENDATIONS WILL BE REVIEWED BY THE EXECUTIVE COMMITTEE TO RECOMMEND ANY MARKET-BASED CHANGES OR TO ENSURE THAT THE CURRENT COMPENSATION OF THESE INDIVIDUALS ARE CORRECT. DURING THIS REVIEW, HUMAN RESOURCES WILL ALSO GIVE THE EXECUTIVE COMMITTEE A BROAD OVERVIEW OF THE STRUCTURE OF THE FULL ORGANIZATION'S COMPENSATION SYSTEM, INCLUDING THE PHILOSOPHY AND SYSTEMS SET IN PLACE TO MANAGE IT. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICIES ARE NOT REQUIRED DISCLOSURES PURSUANT TO IRC SECTION 6104. THESE DOCUMENTS ARE NOT AVAILABLE TO THE PUBLIC AT THIS TIME. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 294,971. MANAGEMENT AND GENERAL EXPENSES 2,948. FUNDRAISING EXPENSES 15,000. TOTAL EXPENSES 312,919. MEDICAL TRANSPORTATION: PROGRAM SERVICE EXPENSES 54,506. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,506. PATIENT CARE: PROGRAM SERVICE EXPENSES 182,793. MANAGEMENT AND GENERAL EXPENSES 7,232. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 190,025. SALARIES AND BENEFITS ALLOCATION: PROGRAM SERVICE EXPENSES 3,245,219. MANAGEMENT AND GENERAL EXPENSES 359,629. FUNDRAISING EXPENSES 16,362. TOTAL EXPENSES 3,621,210. |
| FORM 990, PART XII, LINE 2C | THE SOLE CORPORATE MEMBER, EMPATH HEALTH, INC., IS RESPONSIBLE FOR THE OVERSIGHT OF THE ORGANIZATION'S FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE WAS NO CHANGE IN THIS PROCESS FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |