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
THE INDIANA CHAPTER OF THE ALS ASSOCIATION INC
Employer identification number
35-2029321
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.") ....
384,622
311,419
474,300
454,761
429,301
2,054,403
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..
384,622
311,419
474,300
454,761
429,301
2,054,403
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.
2,054,403
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..
384,622
311,419
474,300
454,761
429,301
2,054,403
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
15,935
18,283
20,447
476
280
55,421
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..
575
269
844
11
Total support (Add lines 7 through 10).
2,110,668
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
97.330 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
96.840 %
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
THE INDIANA CHAPTER OF THE ALS ASSOCIATION INC
Employer identification number
35-2029321
Identifier
Return Reference
Explanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS
FORM 990, PAGE 1, PART I, LINE 6
ELEVEN (11) MEMBERS OF THE BOARD OF TRUSTEES ARE UNPAID VOLUNTEERS WHO MEET EVERY OTHER MONTH, SERVE ON AT LEAST ONE BOARD COMMITTEE, ATTEND CHAPTER EVENTS, SUPPORT THE ORGANIZATION BY MAKING DONATIONS AND CULTIVATING DONORS AND RECRUIT/LEAD THEIR OWN WALK TO DEFEAT ALS (TM) TEAMS. TWENTY (20) WALK COMMITTEE VOLUNTEERS HANDLE ALL PLANNING AND LOGISTICS FOR THE CHAPTER'S THREE MAJOR FUNDRAISING EVENTS, THE NORTHERN, CENTRAL, AND SOUTHERN INDIANA WALKS TO DEFEAT ALS. WALK SUBCOMMITTEES INCLUDE FOOD AND BEVERAGE, ACCOUNTING, WALK DAY VOLUNTEERS, TEAM MENTORS, AND MEDIA/PR. VOLUNTEERS ALSO ASSIST IN OBTAINING INDIVIDUAL AND CORPORATE IN-KIND DONATIONS OF FOOD, BEVERAGES, SERVICES, PRODUCTS AND EQUIPMENT FOR USE ON WALK DAY. ONE-HUNDRED-SIXTEEN (116) WALK DAY VOLUNTEERS SET UP AND TEAR DOWN ALL THE TENTS, SIGNAGE, TABLES, CHAIRS STAGE AND OTHER EQUIPMENT AND ACTIVITY AREAS AS WELL AS ASSIST WALKERS IN THE REGISTRATION, ENTERTAINMENT, FOOD & BEVERAGE, CHILDREN'S AREA, ADVOCACY, TEAM PHOTOS, TEAM TENTS AND VOLUNTEER TENT. POST WALK DAY VOLUNTEERS ENSURE THANK YOU LETTERS ARE SENT OUT, ENTER DATA ABOUT WALKERS AND DONATIONS IN THE CHAPTER DATABASE AND ASSIST WITH THE WALK AWARDS AND YEAR-END RECOGNITION EVENT. TWENTY-SEVEN (27) PATIENT SERVICES VOLUNTEERS ARE AN INTEGRAL PART OF PROGRAMMING AND PROVIDE CRITICAL ASSISTANCE WITH THE CHAPTER'S NINE (9) SUPPORT GROUPS FOR PATIENTS AND CAREGIVERS, QUARTERLY CAREGIVER RETREATS IN EACH OF THE THREE REGIONS AND WITH THE CHAPTER'S TWO EQUIPMENT LOAN CLOSETS. A HALF DOZEN (6) ADMINISTRATIVE/OTHER SUPPORT VOLUNTEERS HANDLE A WIDE VARIETY OF CLERICAL, ADMINISTRATIVE, DATABASE MANAGEMENT, MAILING ASSEMBLY AND OTHER TASKS EITHER IN THE OFFICE OR AT HOME.
FIRST ACHIEVEMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
SCHEDULED IN 2010. WHILE SOME OF THOSE VISITS MAY BE A REPEAT VISIT BY THE SAME PATIENT WITHIN THE SAME CALENDAR YEAR, USUALLY 200 OR MORE INDIVIDUAL PATIENTS ARE SEEN IN THE CLINIC OVER THE COURSE OF THE YEAR. THE CHAPTER PROVIDES FINANCIAL SUPPORT TO THE CLINIC WHICH IS USED FOR MULTI-DISCIPLINARY AND RESEARCH CLINICAL TRIAL STAFF AND GENERAL SUPPORT AND MAINTENANCE OF THE CLINIC. THE CHAPTER'S DIRECTOR OF PATIENT SERVICES IS A MEMBER OF THE CLINIC'S MULTI-DISCIPLINARY TEAM.
SECOND ACHIEVEMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
MODELS OF ALS.
THIRD ACHIEVEMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
THOUGHTS, FEELINGS, ISSUES, CONCERNS AND QUESTIONS. WHILE ATTENDANCE AT INDIVIDUAL SUPPORT GROUPS VARIES FROM MONTH TO MONTH, STATEWIDE AN AVERAGE OF 80 PATIENTS AND CAREGIVERS ATTEND A SUPPORT GROUP MEETING EACH MONTH. AVERAGE ATTENDANCE PER SUPPORT GROUP: INDIANAPOLIS 14 INDIANAPOLIS YOUNG CAREGIVERS 4 EVANSVILLE 11 EVANSVILLE SURVIVORS 8 WARSAW 12 MUNCIE 6 RICHMOND 6 BLOOMINGTON 12 W. LAFAYETTE 7
ALL OTHER ACHIEVEMENTS DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
OTHER PROGRAMS INCLUDE: CAREGIVER DAY, WHICH IS AN ANNUAL EVENT WHERE APPROXIMATELY 110 CAREGIVERS AND CAREGIVER/VOLUNTEERS COME TOGETHER FOR SUPPORT, ENCOURAGEMENT, EDUCATION AND FUN. LOAN CLOSETS, WHICH ARE TWO EQUIPMENT AND SUPPLY RESOURCES FOR PATIENTS AND CAREGIVERS. AND A VARIETY MISCELLANEOUS PROGRAMS AS NEEDED FROM TIME TO TIME.
ADDITIONAL INFORMATION
FORM 990, PART VI
SECTION B, 15A THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES DETERMINES THE COMPENSATION FOR THE EXECUTIVE DIRECTOR. THE EXECUTIVE DIRECTOR'S PAY WAS LAST DETERMINED IN 2009. NO MEMBER OF THE EXECUTIVE COMMITTEE HAD A CONFLICT OF INTEREST WITH RESPECT TO THE COMPENSATION ARRANGEMENT. THE EXECUTIVE COMMITTEE USED DATA AS TO COMPARABLE COMPENSATION FOR SIMILARLY QUALIFIED PERSONS IN FUNCTIONALLY COMPARABLE POSITIONS AT SIMILARLY SITUATED ORGANIZATIONS IN ORDER TO DETERMINE COMPENSATION. HOWEVER, THERE WAS NO CONTEMPORANEOUS DOCUMENTATION AND RECORDKEEPING OF THE DELIBERATIONS AND DECISIONS REGARDING THE COMPENSATION ARRANGEMENT. THE EXECUTIVE DIRECTOR'S PAY WAS NOT ADJUSTED DURING 2010.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS
FORM 990, PAGE 6, PART VI, LINE 4
THE BOARD VOTED TO UPDATE THE BYLAWS IN NOVEMBER 2010. THE NEW BYLAWS DIFFER FROM THE OLD BYLAWS AS FOLLOWS: ARTICLE 1 - CHANGES NAME AND PRINCIPAL OFFICE: THE ALS ASSOCIATION INDIANA CHAPTER, 6525 E 82ND STREET, STE 115, INDIANAPOLIS, IN 46220 ARTICLE 2 - ORGANIZATION-INCORPORATES THE CHAPTER CHARTER WHICH CONTROLS IF THERE IS A CONFLICT WITH THE BYLAWS. THE CHAPTER SHALL HAVE NO MEMBERS ARTICLE 3 - TERRITORY-REQUIRES PRIOR CONSENT OF THE ASSOCIATION TO SOLICIT CONTRIBUTIONS FROM NEIGHBORING AREAS NOT CURRENTLY SERVICED BY ANOTHER CHAPTER ARTICLE 4 - PURPOSE-ADDS LANGUAGE THAT FORBIDS ENGAGEMENT IN "ANY ACTIVITY NOT PERMISSIBLE FOR AN ENTITY RECOGNIZED AS TAX EXEMPT BY THE IRS UNDER SECTION 501(C)(3)" OF THE IRS CODE. DELETES THE PART WHICH FORBIDS THE CHAPTER TO "CARRY ON PROPAGANDA OR OTHERWISE ATTEMPT TO INFLUENCE LEGISLATION" ARTICLE 5 - BOARD OF DIRECTORS-DELETES ENTIRE MEMBERSHIP SECTION. PROSCRIBES NUMBER OF BOARD MEMBERS (NO LESS THAN 7) AND REDEFINES HONORARY DIRECTORS. INCLUDES SECTIONS ON ELECTIONS, TERMS OF SERVICE BY CLASS A, B AND C DIRECTORS, REMOVAL OF BOARD MEMBER BY 75% VOTE OF THOSE PRESENT. QUORUM EQUALS THE MAJORITY OF MEMBERS PRESENT AT THE MEETING. QUORUM HOLDS THROUGHOUT MEETING. IN THE ABSENCE OF QUORUM MEETING SHALL BE ADJOURNED AND RESCHEDULED. TELECONFERENCE COUNTS TOWARD QUORUM. LACK OF ADEQUATE EXCUSE FOR MISSING 3 CONSECUTIVE MEETINGS EQUALS AUTOMATIC DISMISSAL. ARTICLE 6 - ADVISORY BOARD-MEMBERS ARE ELECTED BY BOARD OF DIRECTORS AND SERVE AT THEIR PLEASURE. NO VOTING RIGHTS AND NOT COUNTED AS "DIRECTORS" ARTICLE 7 - OFFICERS-LISTS AS: PRESIDENT, PRESIDENT-ELECT, VICE PRESIDENT, EXECUTIVE DIRECTOR, SECRETARY, TREASURER. SECRETARY/TREASURER MAY BE COMBINED. VICE PRESIDENT OR ANY OTHER OFFICER EXCEPT EXECUTIVE DIRECTOR MAY BE PRESIDENT-ELECT. TWO YEAR TERMS EXCEPT FOR PRESIDENT-ELECT'S ONE YEAR TERM. IMMEDIATE PAST PRESIDENT REMAINS EX-OFFICIO ON EXECUTIVE COMMITTEE FOR ONE YEAR. TERM EXTENSION FOR THOSE WHOSE TERM EXPIRES BEFORE TERM AS OFFICER DOES. OFFICERS SERVE WITHOUT COMPENSATION EXCEPT FOR THE EXECUTIVE DIRECTOR. WHEN VACANCIES OCCUR, BOARD OR EXECUTIVE COMMITTEE SHALL FILL THEM FOR THE REMAINDER OF THE TERM. OFFICERS MAY BE REMOVED BY MAJORITY VOTE OF THE BOARD WHENEVER IT SERVES THE BEST INTERESTS OF THE CHAPTER. ARTICLE 8 - STANDING COMMITTEES-REQUIRED: EXECUTIVE, BOARD DEVELOPMENT & NOMINATING (GOVERNANCE), BUDGET/FINANCE. RECOMMENDED: PUBLIC AWARENESS, PATIENT & FAMILY SERVICES, ADVOCACY AND DEVELOPMENT (FUNDRAISING) ARTICLE 9 - REPRESENTATIVES TO THE ASSOCIATION-BOARD SHALL ELECT VOTING AND NON-VOTING REPRESENTATIVES FOR ASSOCIATION BOARD OF REPRESENTATIVES. THE CHAPTER, THROUGH IT'S BOARD, SHALL COMPLY WITH BYLAWS OF THE ASSOCIATION AS A "MEMBER" ARTICLE 10 - FISCAL MANAGEMENT-MUST RECEIVE WRITTEN AUTHORIZATION FROM THE ASSOCIATION TO ACQUIRE REAL PROPERTY WHETHER BY PURCHASE, GRANT, GIFT, BEQUEST OR OTHERWISE ARTICLE 11 - POLICY OF NON-DISCRIMINATION (NEW) ARTICLE 12 - INDEMNIFICATION-REQUIRES CHAPTER TO INDEMNIFY DIRECTORS, OFFICERS, EMPLOYEES, ETC. ARTICLE 13 - CONFLICT OF INTEREST-DEFINES CONFLICT AND CONDUCT REQUIRED (NEW) ARTICLE 14 - AMENDMENTS-TWO THIRDS VOTE REQUIRED TO ALTER, AMEND OR REPEAL CHAPTER BYLAWS
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
A DRAFT COPY OF FORM 990 WILL BE PROVIDED TO ALL BOARD MEMBERS FOR REVIEW PRIOR TO FILING IT WITH THE INTERNAL REVENUE SERVICE.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY IS MONITORED REGULARLY. ALL EXEMPT AND NON-EXEMPT EMPLOYEES ARE COVERED AS ARE MEMBERS OF THE BOARD OF TRUSTEES. ALL NEW EMPLOYEES AND BOARD MEMBERS MUST SIGN A CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE REQUIRED TO SIGN A NEW CONFLICT OF INTEREST POLICY EVERY YEAR. THE EXECUTIVE DIRECTOR DETERMINES AND REVIEWS ANY CONFLICTS WITH STAFF THAT HAVE THE POTENTIAL TO NEGATIVELY AFFECT PERFORMANCE OR DECISION MAKING. THE BOARD PRESIDENT DETERMINES AND REVIEWS ANY CONFLICTS WITH BOARD MEMBERS. BOARD MEMBERS MUST RECUSE THEMSELVES FROM ANY DISCUSSION OR VOTE THAT INVOLVES A CONFLICT OF INTEREST.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC IN THE CHAPTER OFFICE UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.