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
CUMBERLAND GOODWILL FIRE RESCUE EMS INC
Employer identification number
23-2298422
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
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..
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.
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..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
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).
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
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
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.") .
543,709
685,783
457,632
265,785
282,043
2,234,952
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......
1,013,995
1,175,307
1,406,686
1,474,728
1,771,901
6,842,617
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.
1,557,704
1,861,090
1,864,318
1,740,513
2,053,944
9,077,569
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
0
8
Public Support (Subtract line 7c from line 6.)
9,077,569
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...
1,557,704
1,861,090
1,864,318
1,740,513
2,053,944
9,077,569
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
34,014
37,916
16,335
11,374
680
100,319
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
26,789
73,091
80,151
180,031
c
Add lines 10a and 10b.
34,014
37,916
43,124
84,465
80,831
280,350
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.)
184,612
19,994
24,970
20,902
10,077
260,555
13
Total support (Add lines 9, 10c, 11 and 12.).
1,776,330
1,919,000
1,932,412
1,845,880
2,144,852
9,618,474
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
94.380 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
94.620 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
2.910 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
2.360 %
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
CUMBERLAND GOODWILL FIRE RESCUE EMS INC
Employer identification number
23-2298422
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
A MEMBER OF THE GOVERNING BOARD AND OFFICER ARE RELATED.
FORM 990, PART VI, SECTION A, LINE 4
NEW BY-LAWS WERE ADOPTED BY THE ORGANIZATION AT ITS MARCH 2010 MEMBERSHIP MEETING. THESE BY-LAWS RECOGNIZED THE REORGANIZATION OF THE ORGANIZATION FROM A FIRE, RESUCE, EMS ORGANIZATION TO PRIMARILY AN EMS COMPANY PROVIDING BLS, ALS, AND RELATED SERVICES.
FORM 990, PART VI, SECTION A, LINE 6
CUMBERLAND GOODWILL FIRE RESCUE EMS IS STRUCTURED UNDER ITS BYLAWS AS A MEMBERSHIP ORGANIZATION WITH VARIOUS CLASSES OF MEMBERSHIP.
FORM 990, PART VI, SECTION A, LINE 7A
THE PRESIDENT, VICE PRESIDENT, AND TREASURER, ARE ELECTED BY THE MEMBERSHIP TO TWO YEAR TERMS. THE EMS CHIEF AND DEPUTY EMS CHIEF ARE EMPLOYEES AND ARE APPOINTED BY THE EXECUTIVE BOARD. ONE MEMBER AT LARGE IS ELECTED BY THE COMPANY FOR A ONE YEAR TERM AND THE OTHER MEMBER AT LARGE IS APPOINTED BY THE BOARD. THE CAPTAIN AND LIEUTENANTS ARE APPOINTED BY THE CHIEFS. THE OFFICERS OPERATE THE COMPANY ADMINISTRATIVELY AND OPERATIONALLY THROUGH THE BY-LAWS AND APPROVED BUDGET. IN ACCORDANCE WITH THE BY-LAWS THE QUARTERLY MEMBERSHIP MEETINGS ARE HELD ON THE 3RD TUESDAY OF MARCH, JUNE, SEPTEMBER, AND DECEMBER AT 7:30 P.M.
FORM 990, PART VI, SECTION A, LINE 8B
WITH THE EXCEPTION OF THE EXECUTIVE BOARD, COMMITTEE MINUTES ARE NOT MAINTAINED. RATHER THE COMMITTEE REPORTS ARE PRESENTED AT THE QUARTERLY MEMEBERSHIP MEETING AND MADE PART OF THE MEETING MINUTES.
FORM 990, PART VI, SECTION B, LINE 11
A COPY OF THE 990 IS PROVIDED TO THE EXECUTIVE BOARD AT THE REGULARLY SCHEDULED MEETING PRIOR TO FILING. THE PUBLIC DISCLOSURE COPY OF THE 990 IS MADE AVAILABLE TO THE MEMBERSHIP AT LARGE FOR REVIEW.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION POLICY - THE PAY RATE OF ALL EMPLOYEES IS DETERMINED BY THE EXECUTIVE BOARD. THIS IS TYPICALLY ACCOMPLISHED ANNUALLY AS PART OF THE BUDGET PROCESS. TYPICALLY THE EXISTING PAY RATES ARE REVIEWED FOR COMPETITIVENESS OF EACH POSITION IN THE REGION, AND PAY INCREASES ARE MADE ACROSS THE BOARD ON A PERCENTAGE BASIS, BASED ON THE COMPANY'S ABILITY TO SUPPORT THE INCREASE. APPROXIMATELY EVERY 3 YEARS WE DO A SALARY SURVEY TO VERIFY THE POSITIONING OF OUR WAGE RATE IN THE REGION. INTERIM CHANGES IN WAGE RATE ARE APPROVED BY THE EXECUTIVE BOARD.
FORM 990, PART VI, SECTION C, LINE 19
COPIES OF THE BY-LAWS AND COMPANY HANDBOOK ARE PROVIDED TO MEMBERS. STANDARD OPERATING GUIDELINES (SOG) ARE AVAILABLE TO MEMBERS. THE 990 AND FINANCIAL STATEMENTS ARE MADE AVAILABLE FOR REVIEW UPON REQUEST.
OVERSIGHT OF AUDIT
PART XI QUESTION 2C
THERE HAS BEEN NO CHANGE TO THE ORGANIZATIONS OVERSIGHT FOR THE AUDIT AND SELECTION OF THE ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.