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
NATIONAL ATAXIA FOUNDATION INCORPORATED
Employer identification number
41-0832903
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.") ....
1,567,584
961,326
879,107
783,972
699,967
4,891,956
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..
1,567,584
961,326
879,107
783,972
699,967
4,891,956
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)..
1,461,828
6
Public Support. Subtract line 5 from line 4.
3,430,128
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..
1,567,584
961,326
879,107
783,972
699,967
4,891,956
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
140,413
-209,314
-143,409
169,178
89,440
46,308
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..
11
Total support (Add lines 7 through 10).
4,938,264
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
28,446
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
69.460 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
68.850 %
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
NATIONAL ATAXIA FOUNDATION INCORPORATED
Employer identification number
41-0832903
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
THE ORGANIZATION HAS MEMBERSHIPS. AN ACTIVE MEMBERSHIP DOES ALLOW THE MEMBER TO VOTE FOR THE BOARD OF DIRECTORS AT THE ANNUAL MEETING.
FORM 990, PART VI, SECTION A, LINE 7A
THE ORGANIZATION HAS MEMBERSHIPS. AN ACTIVE MEMBERSHIP DOES ALLOW THE MEMBER TO VOTE FOR THE BOARD OF DIRECTORS AT THE ANNUAL MEETING.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PREPARED BY THE CERTIFIED PUBLIC ACCOUNTANT WITH THE HELP OF THE EXECUTIVE DIRECTOR. THE PRELIMINARY FORM IS REVIEWED AS NEEDED. THE FORM 990 IS THEN PREPARED AND IS PRESENTED AT AN EXECUTIVE COMMITTEE OR BOARD MEETING PRIOR TO THE RETURN BEING SIGNED AND SUBMITTED TO THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C
1. EACH RESPONSIBLE PERSON (OFFICER, EMPLOYEE OR BOARD MEMBER) SHALL ANNUALLY COMPLETE A DISCLOSURE FORM IDENTIFYING ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WHICH COULD CONTRIBUTE TO A POTENTIAL CONFLICT OF INTEREST. 2. PRIOR TO BOARD OR COMMITTEE ACTION, ALL FACTS SHALL BE DISCLOSED RELATING TO THE POTENTIAL CONFLICT OF INTEREST AND SUCH DISCLOSURE WILL BE REFLECTED IN THE MINUTES OF THE MEETING. 3. THE PERSON CANNOT BE COUNTED TOWARDS HAVING A QUORUM TO VOTE AND IS NOT ALLOWED TO VOTE ON THE ISSUE. THEY ARE ALSO NOT ALLOWED TO EXERT ANY PERSONAL INFLUENCE IN THE MATTER. 4. THE POLICY SHALL BE REVIEWED ANNUALLY BY EACH MEMBER OF THE EXECUTIVE COMMITTEE.
FORM 990, PART VI, SECTION B, LINE 15
EXECUTIVE DIRECTOR'S POSITION: AN ANNUAL REVIEW IS CONDUCTED BY THE FOUNDATION'S PRESIDENT. THE PERFORMANCE REVIEW IS BASED IN PART ON ACHIEVING THE ANNUAL GOALS OF THE FOUNDATION. THE PRESIDENT ANNUALLY EVALUATES THE PERFORMANCE IN A WRITTEN REPORT AND THEN PRESENTS THE REVIEW AND RECOMMENDATIONS TO THE BOARD/EXECUTIVE COMMITTEE WHO DETERMINE ANY ACTIONS, INCLUDING PAY RAISES. OTHER EMPLOYEES: THE EXECUTIVE ANNUALLY EVALUATES THE PERFORMANCE OF EMPLOYEES IN A WRITTEN REPORT AND THEN PRESENTS THE REVIEW AND RECOMMENDATIONS TO THE BOARD/EXECUTIVE COMMITTEE WHO DETERMINE ANY ACTIONS, INCLUDING PAY RAISES.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION WILL FURNISH ALL REQUESTS FOR ORGANIZING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS UPON REQUEST. THERE ARE EXCERPTS FROM THE FINANCIAL STATEMENTS POSTED ON THE WEBSITE.
EXPLANATION OF THE NUMBER OF EMPLOYEES
FORM 990, PAGE 1, LINE 5: NUMBER OF EMPLOYEES
THE NATIONAL ATAXIA FOUNDATION HAD A LAWFUL GAMBLING FUND WHICH CEASED OPERATIONS IN MARCH OF 2010. THE GAMBLING FUND EMPLOYED A GAMBLING MANAGER AND TWO OTHER PART-TIME EMPLOYEES. THE NATIONAL ATAXIA FOUNDATION EMPLOYS SIX EMPLOYEES IN THE CONDUCT OF ITS NORMAL DAY TO DAY OPERATIONS. THE DIFFERENCE IN THE NUMBER OF EMPLOYEES LISTED ON LINE 5 IS DUE TO EMPLOYEE TURNOVER.
ADDITIONAL INFORMATION ON INVESTMENT ACTIVITY
FORM 990, PAGE 9, LINE 11A: MARKET ADJUSTMENT
ON DECEMBER 13, 2006, THE BOARD OF DIRECTORS CREATED AN ENDOWMENT FUND FOR SCA 3 RESEARCH. THE DONOR WISHED TO ESTABLISH AN ENDOWMENT. THE COMMITTEE GOVERNING THE ENDOWMENT HAS THE AUTHORITY TO DISTRIBUTE ANY AND ALL EARNINGS OR INCREASE IN VALUE. DISTRIBUTIONS FROM THE FUND WILL ONLY BE USED FOR SCA 3 RESEARCH AND IN SUPPORTING PROMISING THERAPIES THAT MAY LEAD TO AN EFFECTIVE TREATMENT OR CURE FOR THE SCA'S, INCLUDING SCA 3. ONLY DIRECT COSTS WILL BE ALLOWED FROM THIS FUND, NO INDIRECT COSTS WILL BE ALLOWED. ONCE A CURE IS FOUND, THEN THE BOARD MAY DETERMINE A NEW USE AND PURPOSE FOR THE FUND, BUT THE ORIGINAL AMOUNT SHALL REMAIN AS AN ENDOWMENT. AS OF DECEMBER 31, 2010, THE PERMANENTLY RESTRICTED NET ASSETS WERE $600,000.00 AND TEMPORARILY RESTRICTED NET ASSETS WERE $32,565.17.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.