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
NATIVE AMERICAN CANCER RESEARCH
Employer identification number
31-1674625
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.") ....
131,120
20,672
61,794
1,865,186
810,406
2,889,178
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..
131,120
20,672
61,794
1,865,186
810,406
2,889,178
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.
2,889,178
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..
131,120
20,672
61,794
1,865,186
810,406
2,889,178
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
3,716
5,521
2,749
992
602
13,580
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..
5,695
5,520
4,510
14,971
1,850
32,546
11
Total support (Add lines 7 through 10).
2,935,304
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
3,308,135
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
98.430 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
97.940 %
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
NATIVE AMERICAN CANCER RESEARCH
Employer identification number
31-1674625
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
NACR IS DEDICATED TO HELPING IMPROVE THE LIVES OF NATIVE AMERICAN CANCER PATIENTS AND SURVIVORS. WE SEEK TO REDUCE NATIVE AMERICAN CANCER INCIDENCE AND MORTALITY, AND TO INCREASE SURVIVAL FROM CANCER AMONG NATIVE AMERICANS.
FIRST ACHIEVEMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
A FIVE YEAR NATIVE AMERICAN COMMUNITY BASED PARTICIPATORY RESEARCH (CBPR) STUDY FUNDED BY THE OFFICE OF MINORITY HEALTH, NATIONAL INSTITUTES OF HEALTH IMPLEMENTED BY NATIVE AMERICAN CANCER RESEARCH CORPORATION (NACR), INTERTRIBAL COUNCIL OF MICHIGAN, INC., RAPID CITY REGIONAL HOSPITAL AND THE ABERDEEN AREA TRIBAL CHAIRMEN'S HEALTH BOARD. NACR WAS AWARDED A SUPPLEMENT TO THE NATIVE NAVIGATORS AND THE CANCER CONTINUUM (NNACC) WAS FUNDED BY THE OFFICE OF MINORITY HEALTH AND HEALTH DISPARITIES, NATIONAL INSTITUTES OF HEALTH THAT ADDS A NEW SITE, MUSKOGEE CREEK, OK TO THE STUDY. ON MARCH 31, 2011, NACR COMPLETED WORK FOR THE DENVER METROPOLITAN, SUSAN G. KOMEN FOR THE CURE FOUNDATION, "WHERE WE ARE" EXPANDED CURRENT OUTREACH TO NATIVE WOMEN AGED 49 AND UNDER TO RECEIVE MAMMOGRAPHY'S AND TO SUPPORT CANCER EDUCATION TO THE NATIVE AMERICAN COMMUNITY FOCUSING ON BREAST CANCER. NACR WAS NEWLY FUNDED ON APRIL 1, 2011 FOR ANOTHER YEAR TITLED, "ENHANCING AIAN WOMEN'S COMFORT WITH AND ACCESS TO MAMMOGRAPHY." BEYOND THE USUAL RECRUITMENT AND SUPPORT FOR BREAST HEALTH SERVICES, NACR WAS FUNDED TO CONDUCT CULTURAL AWARENESS TRAININGS TO KOMEN AFFILIATE STAFF. "NATIVE AMERICAN WOMEN'S THOUGH AWARENESS" IS FUNDED BY THE STATE OF COLORADO, DEPARTMENT OF HEALTH AND THE ENVIRONMENT, WOMEN'S WELLNESS CONNECTION. THIS PROJECT PROVIDES LINKS TO UNDERSERVED WOMEN TO INCREASE KNOWLEDGE OF BREAST AND CERVICAL CANCER AND IMPROVE SCREENING SERVICES FOR WOMEN AGED 50 AND ABOVE AND ENDED ON JUNE 30, 2010. MAYO CLINIC: MAYO CLINIC'S SPIRIT OF EAGLES COMMUNITY NETWORK PROGRAMS (SOE-CNP) NCI U01 CA 114609 IS A FIVE-YEAR MULTI-SITE RESEARCH STUDY ENDING IN 2010. NACR IS A SUBCONTRACT TO MAYO CLINIC'S SOE-CNP TO EXPAND THE NACES WEBSITE AND COMPLETE EVALUATION SUMMARIES FOR THE CNP PARTNER NETWORK THROUGH NACR'S ONLINE WEBSITE. MAYO CLINIC SPIRIT OF EAGLES WAS REFUNDED FOR 5 YEARS AND NACR WAS AGAIN AWARDED A SMALL SUBCONTRACT TO COMPLETE NACES WORK AND TO PROVIDE CANCER SERVICES TO TWO SITES (NEBRASKA URBAN INDIAN CLINIC AND FLORIDA'S MISSION HARVEST).
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE EXECUTIVE DIRECTOR AND FINANCIAL OFFICER REVIEW THE DOCUMENT FOR ACCURACY; ONCE APPROVED, THE TREASURER REVIEWS, THEN APPROVES AND IS FINALIZED. THEN THE 990 IS PROVIDED TO THE FULL BOARD OF DIRECTORS.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
MOUNTAIN STATES EMPLOYMENT COUNCIL, AN INDEPENDENT AGENCY REVIEWED THE ORGANIZATION'S HUMAN RESOURCE POLICIES AND PROCEDURES. ALL STAFF AND THE BOARD OF DIRECTORS ARE REQUIRED TO ANNUALLY DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
A SUBCOMMITTEE OF THE BOARD OF DIRECTORS ANNUALLY REVIEWS SALARY/JOB DESCRIPTION/ANNUAL PERFORMANCE APPRAISALS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
OFFICER AND KEY EMPLOYEE COMPENSATION IS DETERMINED IN A MANNER SIMILAR TO THAT OF TOP MANAGEMENT.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE GOVERNING DOCUMENTS ARE AVAILABLE FOR INSPECTION AT THE MAIN OFFICE. THEY WILL ALSO BE SENT OUT UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.