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
AGING IN AMERICA COMMUNITY SERVICES INC
Employer identification number
13-4099045
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.") ....
2,502,894
2,877,715
2,418,973
1,946,435
1,862,303
11,608,320
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..
2,502,894
2,877,715
2,418,973
1,946,435
1,862,303
11,608,320
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)..
356,495
6
Public Support. Subtract line 5 from line 4.
11,251,825
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..
2,502,894
2,877,715
2,418,973
1,946,435
1,862,303
11,608,320
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
40,406
40,406
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..
292,200
234,325
526,525
11
Total support (Add lines 7 through 10).
12,175,251
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
3,325,466
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
92.420 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
97.380 %
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, PART II, LINE 10, EXPLANATION OF OTHER INCOME: MANAGEMENT FEE
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
AGING IN AMERICA COMMUNITY SERVICES INC
Employer identification number
13-4099045
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
AGING IN AMERICA, INC. IS THE SOLE MEMBER OF AGING IN AMERICA COMMUNITY SERVICES, INC.
FORM 990, PART VI, SECTION A, LINE 7A
AGING IN AMERICA, INC. IS RESPONSIBLE FOR ELECTING THE MEMBERS OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION A, LINE 7B
SOME DECISIONS AND ACTIVITIES OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF AGING IN AMERICA, INC. AND OTHER DECISIONS AND ACTIVITIES OF THE GOVERNING BODY ARE SUBJECT TO THE APPROVAL OF THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11
ORGANIZATION RECEIVED DRAFT FROM THE PREPARERS, TO REVIEW; COPIES WERE PREPARED FOR BOARD MEETING. THE BOARD AND FINANCE COMMITTEE MEMBERS REVIEWED AND COMMENTED ON DRAFT. THE ORGANIZATION RECEIVED COMMENTS FROM FINANCE COMMITTEE AND SENT THESE COMMENTS TO THE TAX PREPARERS FOR FINAL REVISIONS. THE ORGANIZATION RECEIVED THE FINAL FORM 990 FROM THE TAX PREPARERS AND FINAL REVIEW WAS PERFORMED BY CEO AND CFO.
FORM 990, PART VI, SECTION B, LINE 12C
ALL EMPLOYEES, OFFICERS, AND DIRECTORS OF AGING IN AMERICA COMMUNITY SERVICES, INC. SHALL SCRUPULOUSLY AVOID AT ALL TIMES ANY CONFLICTS BETWEEN THEIR OWN PERSONAL INTERESTS AND THE INTERESTS OF AGING IN AMERICA COMMUNITY SERVICES, INC. EVERY EMPLOYEE, OFFICER, AND DIRECTOR OF AGING IN AMERICA COMMUNITY SERVICES, INC. IS EXPECTED: - TO BE LOYAL TO THE ORGANIZATION, - TO ACT IN THE BEST INTEREST OF THE ORGANIZATION - TO AVOID USING HIS OR HER POSITION FOR PERSONAL GAIN, AND - TO COMPLY WITH THIS CONFLICT OF INTEREST POLICY. A CONFLICT EXISTS, OR COULD EXIST, WHEN AN INDIVIDUAL'S PERSONAL ACTIVITIES OR FINANCIAL INTERESTS CREATE AN OBLIGATION OR SITUATION THAT MAY NEGATIVELY INFLUENCE OR AFFECT HIS/HER JUDGMENT IN THE PERFORMANCE OF HIS/HER DUTY. AN APPARENT CONFLICT IS AS HARMFUL TO THE ORGANIZATION AS AN ACTUAL CONFLICT, THEREFORE ALL CONFLICTS INCLUDING POTENTIAL, THEORETICAL AND REAL ONES, MUST BE DISCLOSED AND RESOLVED PROMPTLY. NOT ALL CONFLICTS CAN BE ANTICIPATED OR EASILY DESCRIBED. WE HAVE THEREFORE CONSTRUCTED AN ANNUAL QUESTIONNAIRE THAT PROBES GENERAL AND COMMON SITUATIONS THAT LEAD, OR COULD LEAD, TO THE DEVELOPMENT OF A CONFLICT. IT IS OUR INTENTION TO PROMPT CAREFUL CONSIDERATION OF SUCH SITUATIONS AND ENCOURAGE INDIVIDUALS COVERED BY THIS POLICY TO DISCLOSE ALL RELATIONSHIPS AND TRANSACTIONS (INCLUDING THOSE PROPOSED OR CONTEMPLATED) WITH VENDORS, SUPPLIERS, CONSULTANTS AND COMPETITORS. THERE IS AN AFFIRMATIVE AND CONTINUING OBLIGATION TO DISCLOSE ALL CONFLICTS THROUGHOUT THE YEAR. ANY REAL, POTENTIAL, OR APPARENT CONFLICT THAT ARISES AT ANY TIME DURING THE YEAR REQUIRES A NEW AND TIMELY DISCLOSURE. A COPY OF THIS STATEMENT SHALL BE FURNISHED TO EACH MANAGEMENT-LEVEL EMPLOYEE (JOB TITLES OF SUPERVISORS AND ABOVE), OFFICER, OR DIRECTOR WHO MAY HEREAFTER BECOME ASSOCIATED WITH AGING IN AMERICA COMMUNITY SERVICES, INC.
FORM 990, PART VI, SECTION B, LINE 15A
A SALARY SEARCH IS CONDUCTED BY AN INDEPENDENT SOURCE. BOARD APPROVAL IS REQUIRED FOR CEO'S SALARY. THESE TWO PROCEDURES ARE PERFORMED ANNUALLY; THE SALARY SEARCH WAS PERFORMED IN 2007.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST.
FORM 990, PART XII, LINE 2C:
THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.
HOURS WORKED FOR RELATED ORGANIZATIONS
FORM 990, PART VII:
DR. WILLIAM T. SMITH - 35.9 LINDA MARTIN - 36.1 MITCHELL DEFRIN - 35.8
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.