Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ANDOVER VILLAGE IMPROVEMENT SOCIETY
Employer identification number
04-6060602
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
123,246
76,948
98,342
131,437
98,421
528,394
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..
123,246
76,948
98,342
131,437
98,421
528,394
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)..
85,988
6
Public Support. Subtract line 5 from line 4.
442,406
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
123,246
76,948
98,342
131,437
98,421
528,394
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
16,676
17,397
15,075
2,422
3,541
55,111
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
2,549
18,052
3,002
3,363
2,595
29,561
11
Total support (Add lines 7 through 10).
613,066
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
72.160 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
60.430 %
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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 IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
ANDOVER VILLAGE IMPROVEMENT SOCIETY
Employer identification number
04-6060602
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS A SINGLE CLASS OF MEMBERS WHO HAVE THE RIGHT TO VOTE FOR THE ELECTION OF THE ORGANIZATION'S TRUSTEES (GOVERNING BODY) ANNUALLY.
FORM 990, PART VI, SECTION A, LINE 7A
THE ORGANIZATION HAS A SINGLE CLASS OF MEMBERS WHO HAVE THE RIGHT TO VOTE FOR THE ELECTION OF THE ORGANIZATION'S TRUSTEES (GOVERNING BODY) ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 11
THE TREASURER DISTRIBUTED THE FORM 990 TO THE TRUSTEES AND DISCUSSED ANY QUESTIONS OR COMMENTS THEY HAD.
FORM 990, PART VI, SECTION B, LINE 12C
IN CONNECTION WITH EACH MATERIAL TRANSACTION, THE ORGANIZATION ASCERTAINS WHETHER ANY TRUSTEE OR KEY EMPLOYEE HAS A CONFLICT OF INTEREST AND, IF SO, THE ORGANIZATION WOULD COMPLY WITH THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15A
THE ORGANIZATION HAS A RENTAL ARRANGEMENT WITH RESPECT TO A SMALL HOUSE IT OWNS AT 491 SOUTH MAIN STREET, ANDOVER, MASS. THE HOUSE IS ADJACENT TO ONE OF THE ORGANIZATION'S LARGEST RESERVATIONS (CONSERVATION LAND). THE RENT WAS $650 PER MONTH, OR $7,800 PER YEAR, UNDER A TWO-YEAR RENTAL AGREEMENT COVERING 2010 AND 2011. THE TENANT IS DAVID DARGIE, WHO WAS AN EMPLOYEE OF THE ORGANIZATION DURING THIS PERIOD. UNDER THE RENTAL ARRANGEMENT, MR. DARGIE PROVIDES IN-KIND SERVICES IN PAYMENT OF THE RENTAL OBLIGATION, FOR WHICH PURPOSE HIS LABOR WAS CREDITED DURING 2010 AT $50/HR. THE LABOR MR. DARGIE PERFORMS IS SKILLED LAND CONSERVATION WORK, THE PARTICULARS OF WHICH ARE DETERMINED AND OVERSEEN BY THE ORGANIZATION'S LAND MANAGEMENT COMMITTEE. IN ADDITION, AS A CONDITION OF THE RENTAL ARRANGEMENT, MR. DARGIE IS REQUIRED TO BE AVAILABLE, INCLUDING AT NIGHT, TO PERFORM WITHOUT ADDITIONAL COMPENSATION A NUMBER OF IMPORTANT MANAGEMENT, SUPERVISORY, AND MEMBERSHIP DUTIES WITH RESPECT TO THE ADJACENT RESERVATION THAT CAN ONLY BE PERFORMED BY SOMEONE LIVING ON-SITE. THE ORGANIZATION HAD PREVIOUSLY DETERMINED THAT THE TOTAL AMOUNT OF THE RENT CHARGED WAS NOT LESS THAN THE FAIR MARKET VALUE OF THE PROPERTY BY OBTAINING AN OPINION FROM EACH OF THREE LOCAL, RENTAL REAL ESTATE BROKERS, AND IT UPDATED THAT OPINION WITH TWO LOCAL, RENTAL REAL ESTATE BROKERS AT THE END OF 2009. FACTORS THAT AFFECTED THE FAIR MARKET VALUE DETERMINATION, AMONG OTHERS, INCLUDED (A) LOCAL RENTAL RATES, (B) THE VERY SMALL SIZE OF THE HOUSE, (C) THE ADDITIONAL, UNCOMPENSATED DUTIES REQUIRED OF THE TENANT, AND (D) THE FACT THAT THE ORGANIZATION RESERVES THE RIGHTS TO AND DOES (I) USE A PORTION OF THE HOUSE FOR STORAGE, (II) USE THE GROUNDS OF THE PROPERTY FOR PARKING AND OTHER ORGANIZATIONAL USES, AND (III) HAVE ACCESS TO THE PREMISES AT ALL TIMES, THUS LIMITING THE TENANT'S FULL USAGE. THE ORGANIZATION DETERMINED THE FAIR MARKET VALUE OF MR. DARGIE'S SERVICES BY REVIEWING THE RATES CHARGED TO THE ORGANIZATION, TO THE TOWN OF ANDOVER, TO SIMILAR LAND CONSERVATION ORGANIZATIONS, AND TO OTHER ENTITIES FOR SIMILAR WORK BY OTHER SKILLED CONTRACTORS, AS WELL AS THE RATES MR. DARGIE CHARGES OTHER, UNAFFILIATED PERSONS FOR HIS SERVICES. IN FINDING THAT THE RATE TO BE CREDITED TO MR. DARGIE FOR HIS IN-KIND CONTRIBUTION IS NOT GREATER THAN FAIR MARKET VALUE FOR HIS SERVICES, THE TRUSTEES ALSO CONSIDERED A NUMBER OF ADDITIONAL BENEFITS RECEIVED BY THE ORGANIZATION FROM HAVING THESE SERVICES PERFORMED BY MR. DARGIE RATHER THAN OTHERS. IN ADDITION, THE ORGANIZATION COMPARED THE ARRANGEMENT WITH SIMILAR ARRANGEMENTS UNDERTAKEN BY ONE OF MASSACHUSETTS' LARGEST LAND CONSERVATION ENTITIES AND THE MASSACHUSETTS AFFILIATE OF A NATIONAL ENVIRONMENTAL ORGANIZATION AND DETERMINED THAT THE INSTANT ARRANGEMENT WAS AT LEAST AS FAVORABLE TO THE ORGANIZATION AS THOSE OTHER ONES. THE TRUSTEES OF THE ORGANIZATION, ALL OF WHOM ARE DISINTERESTED, UNANIMOUSLY APPROVED THE RENTAL ARRANGEMENT AT A MEETING AFTER FULL DISCLOSURE AND DISCUSSION OF ALL THE PERTINENT DETAILS OF THE ARRANGEMENT AND OF THE FAIR MARKET VALUE DETERMINATIONS MADE BY THE ORGANIZATION WITH RESPECT TO BOTH THE RENTAL VALUE OF THE HOUSE AND THE VALUE OF THE SERVICES MR. DARGIE PROVIDES IN KIND. THE TRUSTEES' APPROVAL, AND THE BASIS THEREFOR, WAS RECORDED IN THE ORGANIZATION'S MINUTES.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 13,774.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.