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
DOOR COUNTY YMCA INC
Employer identification number
39-1738982
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.") ....
570,896
757,463
569,143
644,324
562,313
3,104,139
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..
570,896
757,463
569,143
644,324
562,313
3,104,139
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)..
140,253
6
Public Support. Subtract line 5 from line 4.
2,963,886
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..
570,896
757,463
569,143
644,324
562,313
3,104,139
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
95,790
130,051
101,987
84,853
88,870
501,551
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
19,854
22,966
6,244
10,240
32,151
91,455
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
3,697,145
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
9,357,139
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
80.170 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
60.880 %
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
DOOR COUNTY YMCA INC
Employer identification number
39-1738982
Identifier
Return Reference
Explanation
ORGANIZATION MISSION STATEMENT
FORM 990, PART I, LINE 1
FOUNDED IN 1987 IN DOOR COUNTY, THE DOOR COUNTY YMCA QUICKLY BECAME THE COMMUNITY LEADER IN FAMILY AND YOUTH-BASED PROGRAMMING, EMPHASIZING FAIR PLAY, INCLUSION OF ALL AND A FOCUS ON CHARACTER DEVELOPMENT WITH THE CORE VALUES OF CARING, HONESTY, RESPECT AND RESPONSIBILITY MODELED AND TAUGHT IN ALL ACTIVITIES. THE YMCA HAS ALSO BECOME THE CENTER OF RECREATION AND EXERCISE FOR YOUTH, ADULTS, FAMILIES AND SENIORS THROUGHOUT THE COMMUNITY. IN A RELATIVELY SMALL AND RURAL COUNTY, THE YMCA - WITH TWO BRANCH LOCATIONS - IS THE CENTER OF RECREATION AND WELLNESS PROGRAMMING FOR THE ENTIRE COUNTY. PARTNERING WITH LOCAL SCHOOL DISTRICTS, BUSINESSES, NON-PROFIT AGENCIES AND GOVERNMENT AGENCIES, THE YMCA SEEKS TO PROVIDE FOR OPTIMAL HEALTH AND WELL-BEING OF ALL WHO CALL DOOR COUNTY HOME. THE DOOR COUNTY YMCA IS THE LARGEST NON-PROFIT COMMUNITY SERVICE ORGANIZATION IN THE SERVICE AREA. THE YMCA IS AT THE HEART OF COMMUNITY LIFE WHILE WORKING TO MEET THE HEALTH AND SOCIAL SERVICE NEEDS OF ALL MEN, WOMEN AND CHILDREN THROUGHOUT THE COUNTY. THE DOOR COUNTY YMCA'S MISSION OF PUTTING CHRISTIAN PRINCIPLES INTO PRACTICE THROUGH PROGRAMS THAT DEVELOP SPIRIT, MIND AND BODY FOR ALL HELPS THE ORGANIZATION TO SERVE PEOPLE OF ALL FAITHS, RACES, ABILITIES, AGES AND INCOMES. NO ONE IS TURNED AWAY FOR INABILITY TO PAY AND FINANCIAL ASSISTANCE IS PROVIDED TO ALL WITH A DEMONSTRATED NEED. MEMBERSHIPS TO THE YMCA ALLOW MEMBERS TO USE THE FACILITIES OF THE DOOR COUNTY YMCA AND PARTICIPATE IN HUNDREDS OF PROGRAM OPPORTUNITIES THROUGHOUT THE YEAR. THE DOOR COUNTY YMCA HAD APPROXIMATELY 7,300 MEMBERS AS OF MAY 2011, OF WHICH MORE THAN 1,900 RECEIVED SOME FORM OF FINANCIAL ASSISTANCE. MEMBERSHIPS ARE PURCHASED ON A MONTHLY OR ANNUAL BASIS AND FINANCIAL ASSISTANCE UP TO 90% OF COST IS OFFERED TO THOSE WITH DEMONSTRATED INCOME NEED. MEMBERSHIP IS NOT REQUIRED TO PARTICIPATE IN YMCA PROGRAMS. ALL YMCA PROGRAMMING IS OPEN TO ANYONE IN THE COMMUNITY. THE YMCA STRIVES TO BE A GOOD NEIGHBOR AND COMMUNITY ADVOCATE BY OFFERING NUMEROUS OUTREACH AND COLLABORATIVE PROGRAMS IN RESPONSE TO COMMUNITY AND PARTNER NON-PROFIT NEEDS. OTHER PROGRAMMING PROVIDED BY THE DOOR COUNTY YMCA INCLUDES, BUT IS NOT LIMITED TO CAMPING, CHILD CARE, TEEN CLUBS, ENVIRONMENTAL PROGRAMS, SUBSTANCE ABUSE PREVENTION, YOUTH SPORTS, FAMILY NIGHTS, LEADERSHIP AND JOB TRAINING, GYMNASTICS, DANCE, AQUATICS SAFETY, TEAM SPORTS, SENIOR AEROBICS, EXERCISE FOR SPECIAL POPULATIONS AND SPECIAL NEEDS GROUPS AND MANY MORE.
FORM 990, PART VI, SECTION A, LINE 2
BOARD MEMBERS INCLUDE MARRIED COUPLES CARLA AND ELLSWORTH PETERSON AND JILL AND TOM HERLACHE.
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD OF DIRECTORS REVIEWS AND APPROVES A DRAFT OF FORM 990 BEFORE IT IS SUBMITTED.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION ANNUALLY REQUIRES DISCLOSURE OF ANY CONFLICTS OF INTEREST. THE BOARD MEMBER MUST DISCLOSE ANY CONFLICT AND ABSTAIN FROM VOTING ON THE ISSUE. IF ANOTHER BOARD MEMBER FEELS THERE IS A CONFLICT OF INTEREST AND ANOTHER MEMBER SHOULD BE ABSTAINING, THAT BOARD MEMBER MAY BRING UP THE POTENTIAL CONFLICT AND THE BOARD WILL VOTE ON IT.
FORM 990, PART VI, SECTION B, LINE 15
THE EXECUTIVE COMMITTEE PERFORMS AN ANNUAL EVALUATION OF THE CEO, WITH ASSISTANCE FROM A CONSULTANT, WHO IS ABREAST ON NORMS FOR YMCAS ACROSS THE REGION, AND A RECOMMENDATION IS MADE AND APPROVED REGARDING COMPENSATION. KEY EMPLOYEES ARE REVIEWED BY SUPERVISORS ANNUALLY BEFORE ANY CHANGES IN COMPENSATION OCCUR.
FORM 990, PART VI, SECTION C, LINE 18
A COPY OF THE DOOR COUNTY YMCA'S FORM 1023 AND FORM 990 ARE AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
A HARD COPY OF THE DOOR COUNTY YMCA'S DOCUMENTS ARE AVAILABLE UPON REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 117,770.
THERE HAS BEEN NO CHANGE IN THE DOOR COUNTY YMCA'S OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.