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
2011
Open to Public Inspection
Name of the organization
HEAD INJURY ASSOCIATION INC
Employer identification number
11-2946185
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
3,884,624
4,042,187
3,299,417
3,670,517
365,966
15,262,711
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..
3,884,624
4,042,187
3,299,417
3,670,517
365,966
15,262,711
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.
15,262,711
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
3,884,624
4,042,187
3,299,417
3,670,517
365,966
15,262,711
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
112,005
62,597
21,753
11,614
2,234
210,203
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..
0
49,362
4,455
2,621
18,733
75,171
11
Total support (Add lines 7 through 10).
15,548,085
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
49,055,211
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
98.165 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
98.460 %
16a
33 1/3% support test—2011.
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—2010.
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—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
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—2010.
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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
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
2011
Open to Public Inspection
Name of the organization
HEAD INJURY ASSOCIATION INC
Employer identification number
11-2946185
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 4D:
1) STRUCTURED DAY PROGRAM- DEPARTMENT OF HEALTH - HEAD INJURY ASSOCIATION PROVIDES SERVICES TO MEMBERS UNDER THE NEW YORK STATE DEPARTMENT OF HEALTH WAIVER IN A STRUCTURED DAY PROGRAM SETTING. TASK COMPLETION CAN BE WORKED ON IN A WIDE VARIETY OF SETTINGS. THE CONSUMERS ARE CONSTANTLY WORKING HARD TO COMPLETE DAILY TASKS AT THE PROGRAM. COMMUNICATION SKILLS ARE EMPHASIZED THROUGH THE USE OF COMPUTERS. MEMBERS HAVE THE OPTION OF USING THE COMPUTERS TO ACCESS THE INTERNET AND E-MAIL. THEY CAN ALSO UTILIZE A WIDE RANGE OF COGNITIVE REHABILITATIVE SOFTWARE TO IMPROVE THEIR COMMUNICATION SKILLS. USING THE COMPUTERS ALSO HELPS WITH SENSORY-MOTOR SKILLS. INTERPERSONAL SKILLS AND APPROPRIATE SOCIAL BEHAVIORS ARE TARGETED AS ONE OF THE MAIN GOALS OF THE PROGRAM. MEMBERS ATTEND ACTIVITIES AND STRUCTURED GROUPS AND HAVE THE OPPORTUNITY TO PARTICIPATE IN DISCUSSIONS ABOUT A VARIETY OF TOPICS. SOCIALIZATION IS ENCOURAGED BETWEEN MEMBERS AND ALSO WITH STAFF. ABILITY TO MAINTAIN A HOUSEHOLD IS WORKED ON BY MANY OF OUR CONSUMERS. THEY HELP TO MAINTAIN A CLEAN ENVIRONMENT AND ASSIST IN THE KITCHEN BY SETTING UP TABLES, SERVING LUNCH AND STOCKING ITEMS. THIS PROGRAM ALSO PROVIDES COMMUNITY INTEGRATION, AND EDUCATIONAL PROGRAM, RECREATION AND VOCATIONAL GUIDANCE. EXPENSES: $562,827. REVENUE: $876,905. 2) RESIDENTIAL PROPERTY MANAGEMENT - HEAD INJURY ASSOCIATION CURRENTLY OWNS NUMEROUS PROPERTIES/CONDOMINIUM UNITS IN THE BRETTON WOODS AND BLUE RIDGE CONDOMINIUM COMMUNITIES LOCATED IN SUFFOLK COUNTY, NY. HEAD INJURY ASSOCIATION RENTS MANY OF THESE UNITS TO CONSUMERS WITH TRAUMATIC BRAIN INJURY WHO RECEIVE RENTAL AND UTILITY ASSISTANCE FROM THE TRAUMATIC BRAIN INJURY (TBI) WAIVER PROGRAM. AS THE LANDLORD, HEAD INJURY ASSOCIATION IS RESPONSIBLE FOR PROVIDING ONGOING MAINTENANCE/UPKEEP OF EACH UNIT AND WORKING WITH THE INDIVIDUALS AND TBI WAIVER PROGRAM TO MANAGE THE MONTHLY RENTAL PAYMENTS MADE BY THE WAIVER PROGRAM AND TBI SURVIVOR. IT IS ANTICIPATED THAT IN THE NEAR FUTURE ANY VACANT UNITS OWNED BY HEAD INJURY ASSOCIATION WILL UNDERGO RENOVATIONS AND BE UTILIZED AS RESIDENTIAL OPPORTUNITIES FOR INDIVIDUALS FUNDED THROUGH THE OFFICE FOR PEOPLE WITH DEVELOPMENTAL DISABILITIES (OPWDD). EXPENSES: $336,956. REVENUE: $135,227. 3) OTHER PROGRAMS - EXPENSES: $1,437,949. REVENUE: $1,649,332.
FORM 990, PART VI, SECTION A, LINE 2:
STUART GLEIBER AND JILL GLEIBER ARE HUSBAND AND WIFE RESPECTIVELY.
FORM 990, PART VI, SECTION B, LINE 11B:
FORM 990 WAS PREPARED BY A NATIONALLY RENOWNED ACCOUNTING FIRM IN CONJUNCTION WITH THE ORGANIZATION'S FINANCIAL DEPARTMENT. DRAFT FORM 990 WAS REVIEWED BY THE ORGANIZATION'S CEO AND CFO AND THEN PROVIDED TO ALL MEMBERS OF THE BOARD OF DIRECTORS IN DRAFT VIA ELECTRONIC MAIL, WITH AN OPPORTUNITY FOR THEM TO COMMENT OR MAKE INQUIRY BEFORE IT WAS FILED WITH THE INTERNAL REVENUE SERVICE.
FORM 990, PART VI, SECTION B, LINE 12C:
THE CEO REVIEWS IT THE CONFLICT OF INTEREST POLICY ANNUALLY WITH BOARD OF DIRECTORS WHO SIGN ANNUALLY.
FORM 990, PART VI, SECTION B, LINES 15A AND 15B:
THE ORGANIZATION USES AN OUTSIDE INDEPENDENT ACCOUNTING CONSULTING FIRM WITH EXPERTISE IN THE NOT-FOR-PROFIT INDUSTRY TO PERFORM A COMPENSATION ANALYSIS FOR THE CEO AND OTHER CORPORATE OFFICERS. THE COMPENSATION ANALYSES INCLUDE THE FOLLOWING: COMPENSATION SURVEYS BASED UPON THE COMPENSATION AND FRINGE BENEFITS REPORTED ON THE 990 TAX RETURNS FOR COMPARABLE AGENCIES IN THE INDUSTRY AND/OR ACTUAL WRITTEN OFFERS FROM SIMILAR ORGANIZATIONS COMPETING FOR SERVICES OF THE EMPLOYEE. THE RESULTS OF THIS COMPENSATION ANALYSIS ARE PRESENTED TO THE BOARD OF DIRECTORS, WHO REVIEW THE ANALYSIS TO DETERMINE APPROPRIATE COMPENSATION LEVELS AND ENSURE COMPLIANCE WITH THE DUE DILIGENCE GUIDELINES AS OUTLINED IN IRC 4958. THE BASIS FOR ITS DETERMINATION AND ALL DECISIONS MADE ARE CONTEMPORANEOUSLY DOCUMENTED IN MEETING MINUTES AND BOARD RESOLUTIONS.
FORM 990, PART VI, SECTION C, LINE 19:
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 5:
CHANGE IN VALUATION OF INTEREST RATE SWAP....$(113,388.)
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:STUART A. GLEIBER TITLE:PRESIDENT HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LEONARD FEINSTEIN TITLE:VICE PRESIDENT HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DAVID NEWMAN TITLE:SECRETARY HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ROBERT YAFFE TITLE:TREASURER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JILL GLEIBER TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:GEORGE ZIEGLER TITLE:BOARD MEMBER HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LIZ GIORDANO TITLE:CEO HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DANUTA PONIATOWSKI TITLE:CFO HOURS:2
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.