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
Seniors Inc
Employer identification number
23-7090107
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.") ....
1,598,710
1,888,443
1,965,554
1,906,684
1,794,271
9,153,662
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..
1,598,710
1,888,443
1,965,554
1,906,684
1,794,271
9,153,662
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)..
356,616
6
Public Support. Subtract line 5 from line 4.
8,797,046
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..
1,598,710
1,888,443
1,965,554
1,906,684
1,794,271
9,153,662
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
59,171
62,298
45,457
37,478
26,545
230,949
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).
9,384,611
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
18,930,856
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
93.739 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
94.654 %
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
Seniors Inc
Employer identification number
23-7090107
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4D
OTHER PROGRAM SERVICES
Seniors! Inc. provides other services to our community, such as the foster grandparent program, energy outreach, prescription drug maintenance, medicare & medicaid counseling, helpline, money management, experience at work, and transportation. Foster Grandparents: Foster Grandparents is a national program through which volunteers receive a modest tax-free stipend to tutor and offer emotional support to disadvantaged children with low literacy skills. Foster Grandparents specialize in working one-on-one with children who need extra attention-perhaps the child is in Special Ed or has been out sick for two weeks and needs someone to help him catch up. Help Line: Volunteers provide information to callers about valuable community resources. People call us when they need yard work, or the snow shoveled off their sidewalk so they can get to the bus. Or they call us when a parent is being discharged from a hospital and will need continuing care in the home. Others call when they need a hearing aid or a will. And, of course, we get many requests for help with heating and hospital bills. Energy Assistance: This service helps people in emergency situations to pay the balance on their utility bills. Prescription Drug Assistance Service: This service helps individuals obtain prescription medications from pharmaceutical companies at little or no cost (many but not all drugs are available.) Individuals are also screened for eligibility for all types of assistance. If they qualify, we help them fill out and submit the required application(s.) Medicare/Medicaid Outreach: Seniors Inc. screens callers for eligibility for all types of assistance. For those qualified, we help to fill out and submit the required applications. Many of the people who call us are eligible for public benefits through Medicare or Medicaid. Home Care: Seniors Inc. Home Care programs provides compassionate, unskilled assistance to people of any age who need temporary help or long-term assistance to maximize their personal independence regardless of where they live. Homemaker Program: This program provides free temporary respite care services by assisting with cooking and light housekeeping needs. Money Management Program - Bill Payer Service: Trained, insured, and supervised volunteers assist clients with organizing their paperwork and mail; organizing, review, and payment of monthly bills; checkbook management and checkbook balancing; personal budgeting; and related personal financial matters. Senior Health Insurance Assistance Program (SHIP): Trained counselors provide accurate and objective counseling, assistance, and education about Medicare and health insurance plans. Senior Community Service Employment Program (SCSEP): SCSEP is a national program providing subsidized, part-time, work-based training. Program participants are placed in a wide variety of community service activities at non-profit and government agencies, work an average of 20 hours a week, and are paid minimum wage It is intended that these community service experiences serve as a bridge to other employment positions that are not supported with federal funds. Care Calls: Volunteers provide free daily or weekly check-in telephone calls for just a friendly chat and to find out if everything is going well to homebound seniors. Transportation Program: Transportation services are available under this program - one for which there is a fee, and one for which there is no charge (although riders are asked to make a donation to support the program.) Transportation is available to all Denver Home Care clients either as fee-for-service for Medicaid clients or included in the cost of care for those who pay privately. Other seniors who call for transportation are accommodated as scheduling permits. We try to limit no-cost rides to individuals with low incomes for grocery shopping or medical appointments.
FORM 990, PART VI, LINE 6
MEMBERS OR STOCKHOLDERS
For 990 purposes, Total Community Options, Inc. (TCO) a related entity, is a member of Seniors!, Inc. TCO appoints Board members for the organization.
FORM 990, PART VI, LINE 7A
ELECTION OF GOVERNING BODY
Total Community Options, Inc. approves and can remove Board members.
FORM 990, PART VI, LINE 7B
DECISIONS SUBJECT TO APPROVAL
TOTAL COMMUNITY OPTIONS, INC. APPROVES STRATEGIC BUSINESS PLANS AND BUDGETS.
FORM 990, PART VI, LINE 11B
DESCRIBE PROCESS TO REVIEW 990
The 990 is prepared by a third party preparer and an initial review is conducted by the Director of Accounting, V.P. of Accounting and CFO of the Organization. A secondary review is conducted by the Audit Committee and the final version of the 990 is made available to the entire board prior to filing the return with the IRS.
FORM 990, PART VI, LINE 12C
DESCRIBE HOW CONFLICT OF INTEREST POLICY IS MONITORED & ENFORCED
Each Seniors! Inc. staff member signs a conflict of interest statement. This statement is maintained in the personnel file. If a potential conflict of interest is disclosed or uncovered, it is reviewed by the Executive Director. If, after review, the potential conflict is found to be an actual conflict of interest, the employee is either: a) prohibited from engaging in the activity, transaction or arrangement that would cause the conflict or b) restricted from taking part in any decisions that pertain to the activity, arrangement or transaction. If the conflict or perception of conflict involves the Executive Director of Seniors! Inc., the determination is made by the President of TCO. Each board member signs a conflict of interest statement and, in addition, board members are asked to disclose any conflicts of interest at the beginning of each board meeting. If a conflict of interest is disclosed, the board of directors either: a) prohibit the board member from engaging in the activity, transaction or arrangement that would cause the conflict or b) restrict the board member from taking part in any decisions that pertain to the activity, arrangement or transaction.
FORM 990, PART VI, LINE 15A
DESCRIBE PROCESS FOR DETERMINING COMPENSATION
Compensation of all employees is based on a performance evaluation and review of comparable organizations' compensation. CEO compensation is determined and approved by the board of directors of Seniors! Inc. The last review of other officer compensation was performed by John Backe in 2010.
FORM 990, PART VI, LINE 15B
DESCRIBE PROCESS FOR DETERMINING COMPENSATION
Compensation of all employees is based on a performance evaluation and review of comparable organizations' compensation. COO compensation is approved by the Executive Director of Seniors! Inc. CFO compensation is determined and approved by the CFO of Total Community Options, Inc. The last review of other officer compensation was performed by Dan Blyth in 2010.
FORM 990, PART VI, LINE 19
DESCRIBE HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC
Seniors!, Inc. makes its governing documents and conlfict of interest policy available upon request, or sent to entities that require this information per their contract.
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:BEN BRAHINSKY TITLE:CO-CHAIR 1/06 - Current HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JERRI BRAINARD TITLE:CHAIR 10/06 - Current HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:KARIN GILLIES TITLE:TREASURER & CFO 4/11 - Current HOURS:14
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.