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
CHAUTAUQUA CO CHAPTER OF NYSARC INC
Employer identification number
16-0968914
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.") ....
102,884
101,046
38,511,304
38,565,593
41,422,382
118,703,209
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..
102,884
101,046
38,511,304
38,565,593
41,422,382
118,703,209
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.
118,703,209
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..
102,884
101,046
38,511,304
38,565,593
41,422,382
118,703,209
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
25,674
49,235
50,830
60,251
78,148
264,138
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..
240,022
242,024
348,275
325,570
331,326
1,487,217
11
Total support (Add lines 7 through 10).
120,454,564
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
339,957,952
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
98.550 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
97.870 %
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
SERVICE REIMBURSEMENT - REIMBURSEMENT FOR SERVICES PROVIDED TO TAX EXEMPT ENTITIES PROVIDING SERVICES AND SUPPORT FOR THE RESOURCE CENTER'S MISSION. INTERNAL DURABLE MEDICAL DEVICE SALES - SALES OF DURABLE MEDICAL DEVICES TO CONSUMERS PARTICIPATING IN THE RESOURCE CENTER'S TREATMENT PROGRAMS. SCHEDULE A, SECTION A, LINE 1 - BEGINNING IN 2008, TO COMPLY WITH TREASURY REGULATION SECTION 1.170A-9(F)(8)(II), THE ORGANIZATION CORRECTED PRIOR PRACTICE AND REPORTS AS "CONTRIBUTIONS AND GRANTS" THE GOVERNMENT REVENUES IT RECEIVED FOR THE DIRECT BENEFIT OF THE PUBLIC WITHIN THE MEANING OF THAT REGULATION.
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
CHAUTAUQUA CO CHAPTER OF NYSARC INC
Employer identification number
16-0968914
Identifier
Return Reference
Explanation
ALL OTHER ACHIEVEMENTS DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
MENTAL HEALTH SERVICES - TO PROVIDE DIAGNOSTIC, TREATMENT AND SUPPORT SERVICES TO INDIVIDUALS WITH MENTAL HEALTH SUPPORT NEEDS THAT PROMOTE AND FACILITATE PERSONAL RECOVERY AND ADJUSTMENT. EXP 2,912,804 REV 2,605,726 DIAGNOSTIC & TREATMENT CENTER - TO PROVIDE DIAGNOSTIC AND TREATMENT PRIMARY CARE, DENTAL AND ANCILLARY SERVICES FOR INDIVIDUALS WITH DISABILING CONDITIONS AND TO THE GENERAL PUBLIC. EXP 5,523,435 REV 5,298,459 PHARMACY - TO PROVIDE LOW COST PHARMACEUTICALS, IN A QUICK AND EFFICIENT MANNER, FOR THE BENEFIT OF THE ORGANIZATION'S STAFF AND RESIDENTIAL PARTICIPANTS. EXP 2,575,229 REV 2,710,923 OTHER PROGRAMS AND SUPPORT SERVICES - INCLUDE CHILDREN'S SERVICES, ADAPTIVE EQUIPMENT,SOCIAL SERVICES, AND SED SERVICES, AMONG OTHERS. EXP 1,585,381 REV 238,575
CLASSES OF MEMBERS OR STOCKHOLDERS
FORM 990, PAGE 6, PART VI, LINE 6
THE ORGANIZATION IS A NON-STOCK, NOT-FOR-PROFIT ASSOCIATION WITH MEMBERS. THE CLASSES OF MEMBERS CONSIST OF ACTIVE, LIFE AND ASSOCIATE MEMBERS. MEMBERS PAY AN ANNUAL FEE DEPENDING ON THEIR LEVEL OF MEMBERSHIP.
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
ALL ACTIVE MEMBERS ELECT THE BOARD OF DIRECTORS AT THE ANNUAL MEMBERSHIP MEETING.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7B
ANY REVISIONS OF THE BY-LAWS OR THE CERTIFICATE OF ORGANIZATION ARE SUBJECT TO THE APPROVAL OF MEMBERSHIP.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE 990 REVIEW COMMITTEE (A SUB-COMMITTEE OF THE BOARD OF DIRECTORS), COMPOSED OF THE BOARD PRESIDENT, BOARD TREASURER, EXECUTIVE DIRECTOR (C.E.O.), ASSOCIATE EXECUTIVE DIRECTOR (C.O.O.) AND THE DIRECTOR OF FISCAL SERVICES, MEETS TO REVIEW, APPROVE AND SIGN THE FEDERAL FORM 990 AND REQUIRED SUPPLEMENTARY SCHEDULES PRIOR TO ITS FILING WITH THE IRS. THE SUB-COMMITTEE ALSO PROVIDES A FULL REPORT OF THIS ACTIVITY TO THE FULL BOARD OF DIRECTORS AND A COPY IS AVAILABLE FOR REVIEW UPON REQUEST.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
DESIGNATED STAFF (DESIGNATED STAFF SHALL MEAN ALL MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM AS WELL AS ANY EMPLOYEE WHO IS IN THE POSITION TO MAKE DECISIONS THAT INVOLVE PURCHASING GOODS OR SERVICES, OR THAT OTHERWISE MAY ENCUMBER THE ORGANIZATION), BOARD ADVISORY COMMITTEES AND BOARD OF DIRECTORS COMPLETE A CONFLICT OF INTEREST FORM ANNUALLY. THE ORGANIZATION'S CORPORATE COMPLIANCE OFFICER REVIEWS ALL FORMS AND REPORTS RESULTS TO THE BOARD OF DIRECTORS AND CORPORATE COMPLIANCE COMMITTEE.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
CEO EMPLOYMENT CONTRACT IS REVIEWED BY THE EXECUTIVE COMMITTEE. COMPARATIVE SALARY STUDIES ARE PROVIDED FROM BUSINESS FIRST PUBLICATIONS AND OTHER LOCAL COMPETITORS FOR THE EXECUTIVE COMMITTEE TO CONSIDER. THE EXECUTIVE COMMITTEE MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
COO EMPLOYMENT CONTRACT AND OTHER EXECUTIVE MANAGEMENT TEAM SALARIES ARE REVIEWED BY THE EXECUTIVE COMMITTEE. COMPARATIVE SALARY STUDIES ARE PROVIDED FROM BUSINESS FIRST PUBLICATIONS AND OTHER LOCAL COMPETITORS FOR THE EXECUTIVE COMMITTEE TO CONSIDER. THE EXECUTIVE COMMITTEE MAKES A RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL. ALL OTHER SALARIES ARE REVIEWED BY SALARY ADVISORY COMMITTEE, THE PERSONNEL DEPARTMENT AND ULTIMATELY THE BOARD OF DIRECTORS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE ON FILE WITH STATE REGULATORY AGENCIES REGULATING THE RESOURCE CENTER'S ACTIVITIES.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 5
THE ORGANIZATION'S BEGINNING NET ASSETS AT JANUARY 1, 2009 AND THE 2009 CHANGE IN NET ASSETS HAVE BEEN RESTATED TO REFLECT A RETROACTIVE ADJUSTMENT RELATED TO THE RECORDING OF INCOME AND EXPENSE FOR A GRANT RECEIVED BY THE ORGANIZATION. THE ADJUSTMENT RESULTED IN AN INCREASE OF 169,332 IN NET ASSETS AT JANUARY 1, 2009 AND A DECREASE OF 49,256 IN THE 2009 CHANGE IN NET ASSETS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.