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
DEVELOPMENTAL DISABILITIES INFORMATION SERVICE INC
Employer identification number
39-1156302
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.") ....
864,158
1,578,046
2,306,087
2,504,161
1,470,338
8,722,790
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
864,158
1,578,046
2,306,087
2,504,161
1,470,338
8,722,790
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)..
0
6
Public Support. Subtract line 5 from line 4.
8,722,790
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..
864,158
1,578,046
2,306,087
2,504,161
1,470,338
8,722,790
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
287
253
781
13,564
9,876
24,761
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
17,446
4,290
3,219
8,056
33,011
11
Total support (Add lines 7 through 10).
8,780,562
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
99.340 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.500 %
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:
10000105
Software Version:
2010v3.2
-
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
DEVELOPMENTAL DISABILITIES INFORMATION SERVICE INC
Employer identification number
39-1156302
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The documents are available to the public upon request.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
A copy of the 990 will be sent electronically to each director for review prior to filing the return.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: COMMUNITY ASSISTANCE PROGRAM The Community Assistance Program has been designed as a supplement to the long-term care system for individuals who are developmentally disabled but able to maintain themselves in the community with minimal supports. The consumers of this program will be ineligible for other funding through Racine County or on the waiting list for funding. The available services will include: advocacy, education or training ,housing assistance, medical support, referral to other community services, protective payee services, informal case management and transportion. The staff will consist of a primary case coordinator and/or a skills trainer. Number of clients served: OTHER PROGRAM SERVICES 5: CLT CASE MANAGEMENT/AUTISM-The case manager providing service coordination will receive referrals for children under the age of eight(8) with a diagnosis of autism for inclusion in the intensive autism treatment program. Basic care management services will be provided to the family while the child is receiving in-home services and assist the child and family in transitioning to post-intensive CLTS services. The child can continue to receive post-intensive services until age twenty-two(22) if appropriate.Number of units provided: 4286 clients served: OTHER PROGRAM SERVICES 6: PROTECTIVE PAYEE-This program is designed to assist persons with their financial affairs when they are unable to do so independently. This program is jointly run with the Social Security Administration, whose regulations must also be followed as it pertains to the program. The contracted payee program should be used only as a last resort when there is no interested and appropriate family member, guardian, residential provider willing to handle the payee duties. Participants'accounts will reflect a positive balance at the end of each month. Number of units provided : 1111, Clients served: OTHER PROGRAM SERVICES 7: FEE FOR SERVICE-is exactly the same as the Protective Payee program except the particiapnt pays for the monthly fee . Number of units provided: OTHER PROGRAM SERVICES 8: KATIE BECKETT-This program is operated through a contract with Sally Mather Associates to help certain medically, physically, or emotionally needy children living at home obtain a Wisconsin Medical Assistance card. A consultant talks and visits with families in Racine and Kenosha about what the program offers and whether or not the family should apply on behalf of the child. If requested, the consultant will send out an application packet,set up a home visit, go over the application and answer necessary questions. A required recertification is done annually or when significant changes occur. OTHER PROGRAM SERVICES 9: LTS CASE MANAGEMENT-(Support and Service Coordination)- This program provides case management for Human Services Department BWI, CIP1A, CIP1B and CIPII waiver clients. Support and Service Coordination includes assistance with establishing Medicaid financial and functional eligibility, assisting participants gain access to Waiver supports and services, Medicaid State Plan services, medical, social and educational assessments and services, and any other resources regardless of funding source and to identify the supports necessary to ensure the participant's health and safety. The minimum requirements regarding the provision of supoport and service coordination are: monthly collateral contact, face to face participant contact every three months at least one of the face to face contacts shall be at the participant's place of residence and to assure health and safety, more frequent contact may be required in response to individual needs identified in assessments or prior criticalincidents. OTHER PROGRAM SERVICES 10: COMPASS WISCONSIN:THRESHOLD - Compass WIsconsin:Threshold is supported by the Department of Health Services-Bureau of Long-Term Support to provide a unified point of intake. Threshold is availabale to families in Racine or Walworth County that have children with long-term support needs and wish to apply for Children's Long-Term Support services for their child. This point of intake offers families the opportunity to apply for four state CLTS programs: Children's Long-Term Support Medicaid Waiver, Katie Beckett, Family Support and Community Option Program.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.