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
JEFFERSON REHABILITATION CENTER CHAPTER OF NYSARC INC
Employer identification number
16-1134631
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.") ....
3,711,106
4,507,701
4,320,020
4,056,483
4,380,368
20,975,678
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..
3,711,106
4,507,701
4,320,020
4,056,483
4,380,368
20,975,678
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.
20,975,678
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..
3,711,106
4,507,701
4,320,020
4,056,483
4,380,368
20,975,678
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
609,339
708,330
560,505
316,932
438,237
2,633,343
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).
23,609,021
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
112,669,292
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
88.850 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
88.480 %
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
JEFFERSON REHABILITATION CENTER CHAPTER OF NYSARC INC
Employer identification number
16-1134631
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
BETTY BRESLER, BOARD VICE PRESIDENT, IS MARRIED TO FRED BRESLER, BOARD SECRETARY/TREASURER
FORM 990, PART VI, SECTION A, LINE 6
NYSARC, INC. IS A UNITARY CORPORATION CONSISTING OF ITS 55 CHAPTERS. JEFFERSON REHABILITATION CENTER, CHAPTER OF NYSARC, INC. IS ONE DIVISION OF THE CORPORATION. THE CORPORATION AND CHAPTERS GOVERNING BODY IS THE BOARD OF GOVERNORS REPRESENTING THE INDIVIDUAL MEMBERSHIP IN EACH CHAPTERS JURISDICTION. EACH CHAPTER HAD FROM 1-6 GOVERNORS BASED ON MEMBERSHIP. THE CORPORATION THROUGH ARTICLE VI SECTION 3 OF ITS BYLAWS DELEGATES DAY-TO-DAY OPERATING AUTHORITY TO THE CHAPTERS BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE OF THE BOARD OF GOVERNORS (SEE PART VI, LINE 7A BELOW) COMPRISES THE CORPORATIONS ELECTED OFFICERS AND EXERCISES ALL POWERS OF THE BOARD OF GOVERNORS BETWEEN PLENARY MEETINGS OF THE GOVERNORS. ALSO, JEFFERSON REHABILITATION CENTER HAS MEMBERS WHO PAY ANNUAL DUES (OR HAVE PREVIOUSLY PAID FOR A LIFETIME MEMBERSHIP).
FORM 990, PART VI, SECTION A, LINE 7A
THE DELEGATE ASSEMBLY, WHICH REPRESENTS NYSARC'S 70,000 MEMBERS, ELECTS THE CORPORATION PRESIDENT, SECRETARY, TREASURER, AND ASSISTANT TREASURER TO 1-YEAR TERMS. DELEGATES ELECT REGIONAL VICE PRESIDENTS TO 1-YEAR TERMS FROM THEIR RESPECTIVE REGIONS. THE BOARD OF GOVERNORS ELECTS ONE VICE PRESIDENT AS A SENIOR VICE PRESIDENT. ALSO, MEMBERS IN ATTENDANCE AT JEFFERSON REHABILITATION CENTER'S ANNUAL MEETING CAN ACCEPT AND VOTE ON THE SLATE OF OFFICERS AND DIRECTORS PROPOSED TO THE GENERAL MEMBERSHIP OF JEFFERSON REHABILITATION CENTER BY THE NOMINATING COMMITTEE.
FORM 990, PART VI, SECTION A, LINE 7B
CHAPTER BYLAW AMENDMENTS ARE SUBJECT TO BOARD OF GOVERNOR APPROVAL. ANY ACTION OF THE BOARD OF GOVERNORS MAY BE REVIEWED AT THE SUCCEEDING DELEGATE ASSEMBLY. NO ACTION OF THE GOVERNORS THAT AFFECTS THE IRREVOCABLE RIGHT OF THIRD PARTIES MAY BE RESCINDED. CORPORATE BYLAW AMENDMENTS ARE SUBJECT TO APPROVAL BY A MAJORITY OF CHAPTERS.
FORM 990, PART VI, SECTION B, LINE 11
THE BOARD OF GOVERNORS DOES NOT REVIEW THE CHAPTERS FORM 990'S BEFORE THEY ARE FILED. EACH INDIVIDUAL CHAPTER SUBMITS A COPY OF ITS FORM 990 TO THE CORPORATIONS BOARD OF GOVERNORS WHEN THE FORM 990 IS FILED BY THE CHAPTER. THE CHAPTER MUST HAVE A POLICY AND PROCEDURE PROCESS FOR ITS BOARD OF DIRECTORS TO REVIEW THE CHAPTERS FORM 990. JEFFERSON REHABILITATION CENTER HAS A DESIGNATED BOARD COMMITTEE OR INDIVIDUAL BOARD MEMBER ASSIGNED RESPONSIBILTY FOR THE REVIEW, APPROVAL AND SIGNATURE OF ITS 990 BEFORE IT IS FILED.
FORM 990, PART VI, SECTION B, LINE 12C
KEY EMPLOYEES, AND BOARD OF DIRECTOR MEMBERS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS.
FORM 990, PART VI, SECTION B, LINE 15
FOR THE BOARD OF DIRECTORS, EXEMPT WAGE SCALE INFORMATION IS DEVELOPED BY AN OUTSIDE FIRM.
FORM 990, PART VI, SECTION C, LINE 18
UPON REQUEST, COPIES OF THE FORM 990 WILL BE PROVIDED TO THE PERSON MAKING THE REQUEST.
FORM 990, PART VI, SECTION C, LINE 19
UPON REQUESET, THE GOVERNING BOARD DOCUMENTS, AND CONFLICT OF INTEREST POLICY IS PROVIDED TO THE PERSON MAKING THE REQUEST.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED GAINS ON INVESTMENTS: 843,081. CHANGE IN FUNDED STATUS OF PENSION PLAN -677,635. TOTAL TO FORM 990, PART XI, LINE 5: 165,446.
FORM 990, PART XII, LINE 2C
THE FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE SELECTION OF THE AUDITORS AND OVERSEES THE AUDIT PROCESS.
FORM 990, PART VI, SECTION A, LINE 9:
THE OFFICERS AND BOARD OF GOVERNORS OF NYSARC MAY BE REACHED AT NYSARC, INC., 393 DELAWARE AVE., DELMAR, NY 12054 AS FOLLOWS: ALBANY CHAPTER - MILTON KAPLAN JEFFERY PLATT ALLEGANY CHAPTER - LINDA CLAYSON THOMAS J. TALBETT, JR BENEVOLENT SOCIETY (STATEN ISLAND DC) - JERRY ISAACS AL TURK BRONX DC CHAPTER - IDA RIOS BROOME-TIOGA CHAPTER - VINCENT FIACCO DENIS WICKHAM CATTARAUGUS CHAPTER - RAPHAEL SMITH CHAUTAUQUA CHAPTER - VACANCY CHEMUNG CHAPTER - MARYANN BRYANT BETTY BUTZ SUE CUNNINGHAM CHENANGO CHAPTER - VACANCY CLINTON CHAPTER - JILL ABDALLAH DR. JAMES ASHE GILBERT DUKEN MERRILEE HAMLIN CYNTHIA LACKI MARY SKILLAN COLUMBIA CHAPTER - JENIFER HARVEY DOROTHY WHEELER COMMUNITY LEAGUE (WASSAIC DC) - ROSE MARY CELLA DONALD GEER DELAWARE CHAPTER - LUELLA ROGERS RUTH VITALE DUTCHESS CHAPTER - DAWN DESMOND MARK METZGER, ESQ. ERIE CHAPTER - DONNA L. BURDEN, ESQ. SCOTT GORSKI ESSEX CHAPTER - GERALD EDWARDS MARLA RODRIGUEZ FRANKLIN-HAMILTON CHAPTER- ROBERT KLEPPANG GAIL CORBIN FULTON CHAPTER - JUDY SCHELLE GENESEE CHAPTER - THELMA MONTREAL CANDIE POCOCK HERKIMER CHAPTER - RONALD GEORGE GARY RUFF LIVINGSTON-WYOMING CHAPTER - CHERYL ENGLERT MARCY VANZANDT MADISON-CORTLAND CHAPTER - RANDY SCHAAL, ESQ. ERIC STICKELS MONROE CHAPTER - MAYTHORNE WINTERKORN MARY BETH WUNSCH MONTGOMERY CHAPTER - JOEL KAPLAN SALLY ROMANO NASSAU CHAPTER - RANDY BRUELL JACK GAROFALO SAUNDRA M. GUMEROVE HOWARD JURIST DOROTHY LENOWICZ HARRIET TRAVERSA NEW YORK CITY CHAPTER - DR. MELVIN GERTNER LAURA KENNEDY CHARLES KING EDITH NIEDERT GENEVIEVE O'NEIL MARILYN JAFFE-RUIZ NIAGARA CHAPTER - MARIE-THERESE FRIERI DONALD SMITH ONEIDA-LEWIS CHAPTER - DR. JOHN KOWALCZYK RUTH RIDGWAY ONONDAGA CHAPTER - JAMES CANNON JOYCE CARMEN GORDON EYER ONTARIO CHAPTER - JOSEPH M. BOGNANNO ELIZABETH PALMATIER. ORANGE CHAPTER - JOANNE GRANT ORLEANS CHAPTER - REV. KEN DEGNAN MARLENE HILL OSWEGO CHAPTER - MARY ANN BARBARINO RICHARD RIMA OTSEGO CHAPTER - WALTER HOGAN PUTNAM CHAPTER - LAURA DODGE HEATHER STRICKLAND SUSAN LUCAS RENSSELAER CHAPTER - EDIE HALL HENRIETTA MESSIER ROCKLAND CHAPTER - DR. IRVING CAMINSKY SONIA CRANNAGE, ESQ. KAREN FEINSTEIN LYNDA MELTZER GISELA SCHMIDT AUDREY TARANTINO ROME TRI-COUNTY - VACANCY ST. LAWRENCE CHAPTER - PATRICIA CAMPANELLA BARB ROESER CAROLYN SMITH SARATOGA CHAPTER - ROBERT DESIO DR. LAWRENCE FEIN PATRICIA POKLEMBA SCHENECTADY CHAPTER - PATRICIA ROSS BELLA STUART SCHOHARIE CHAPTER - ROBERTA BROOKS JOHN DESANTO SCHUYLER CHAPTER - HAROLD HOFFMEIER, JR. MARCIA KASPRZYK SENECA-CAYUGA CHAPTER - JOHN BECKER, II ROSE PALMIERI STEUBEN CHAPTHER - PAUL GREENFIELD ARTHUR STILWELL MISCHELLE K. SHATTUCK SUFFOLK CHAPTER - JOSEPH DEL BROCCOLO JAMES MCENEANEY FRED K. SALZBERG KENNETH WALKER SULLIVAN CHAPTER - IRENE KIRTACK STEVEN DROBYSH ULSTER-GREENE CHAPTER - ROBERT BOENING THOMAS HITCHCOCK WARREN-WASHINGTON ANNE MARIE LOCKHART DAN MARTINDALE WAYNE CHAPTER - CAROL KENYON JOSEPH VANHAELST WELFARE LEAGUE (LETCHWORTH VILLAGE DC) - DIAN CIFUNI NELVA TUREK WESTCHESTER CHAPTER - ANTHONY ASSALONE SHERYL R. FRISHMAN MOHAN MEHRA JERRY SHENKMAN WEST SENECA, DC - MARY ELLEN MURPHY ELLEN OWENS YATES CHAPTER - GREG BOOTH PRESIDENT - JOHN A. SCHUPPENHAUER, ESQ. IMMEDIATE PAST PRESIDENT - KATHARINE WILSON CONROY
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.