Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| 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.") .... | 177,048 | 332,719 | 261,052 | 891,529 | 453,576 | 2,115,924 |
| 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.. | 177,048 | 332,719 | 261,052 | 891,529 | 453,576 | 2,115,924 |
| 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. | 2,115,924 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 177,048 | 332,719 | 261,052 | 891,529 | 453,576 | 2,115,924 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 229 | 3,350 | 938 | 4,517 | ||
| 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). | 2,120,441 | |||||






| 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.) | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURN | FORM 990, PAGE 2, PART III, LINE 2 | THE JANUARY 12, 2010 EARTHQUAKE COMPELLED US INTO AN EMERGENCY RESPONSE ON BEHALF OF OUR PARTNERS IN 2010. BECAUSE OF THE DIRE URGENCY OF THE SITUATION AND OUR LONGSTANDING GRASSROOTS RELATIONSHIPS IN THE JACMEL AREA, WE WERE ABLE TO EFFICIENTLY AND SWIFTLY FACILITATE EMERGENCY MEDICAL RELIEF, BASIC HUMANITARIAN RELIEF, AND PROVIDE TEMPORARY SHELTER FOR THOUSANDS. IN THE LATTER PART OF 2010 AND AT THE REQUEST OF THE AUTHORITIES IN THE JACMEL AREA, WE OVERSAW A CHOLERA AWARENESS, PREVENTION, AND TREATMENT INITIATIVE FOR THE SOUTHEAST DEPARTMENT OF HAITI. THE PRIMARY TARGET OF OUR INITIATIVE WAS CHILDREN, AND THE EDUCATION PIECE OF THE INITIATIVE INCLUDED HYGIENE AND OTHER PRECAUTIONARY AND PROTECTIVE SKILLS. THIS CHOLERA AWARENESS INITIATIVE CONTINUED INTO 2011 AND WAS MADE POSSIBLE, IN PART, FROM A GENEROUS GRANT FROM THE UNIVERSITY OF COLORADO. |
| FIRST ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | THEY ATTEND ONE OF THE THREE ACCREDITED UNIVERSITIES IN HAITI - THE UNIVERSITY OF HAITI, THE UNIVERSITY OF NOTRE DAME AND QUISQUIYA UNIVERSITY. THESE STUDENTS COME FROM SUCH POOR BACKGROUNDS THAT A COLLEGE EDUCATION WOULD OTHERWISE BE OUT OF THE QUESTION. IN ORDER TO APPLY FOR A SCHOLARSHIP THEY NEED TO NOT ONLY COME FROM THE MOST IMPOVERISHED SITUATIONS BUT ALSO HAVE AN A OR A+ AVERAGE IN HIGH SCHOOL. THE FUNDING PROVIDES TUITION, ENGLISH CLASSES, BOARD, ROOM, A SMALL STIPEND, A COMPUTER LAB AND EMPOWERMENT. OVER THE NINE YEARS THAT WE HAVE BEEN IN THIS PROGRAM, 100% OF THOSE COMPLETING THEIR COLLEGE EDUCATION ARE EMPLOYED AT SALARIES AVERAGING 13,000 PER YEAR (OVER 30 TIMES THE NATIONAL PER CAPITA INCOME). OUR ORGANIZATION PROVIDED 100,000 IN GRANT FUNDS TO HELP IN 2011, WHICH PROVIDED FULL FUNDING FOR MORE THAN THIRTEEN STUDENTS. THE THIRD LARGEST PROGRAM SERVICE FOR OUTLAYS IN 2011 IS THE CHEMEN LAVI MIYO (PATH TO A BETTER LIFE) PROJECT THROUGH FONKOZE, HAITI'S BANK FOR THE POOR. THIS IS THE INITIATIVE THAT WORKS TO LIFT ULTRA-POOR FAMILIES (USUALLY A MOTHER WITH THREE TO SEVEN CHILDREN) IN THE CENTRAL PLATEAU OF HAITI OUT OF ULTRA-POVERTY. BASIC HUMAN NEEDS ARE MET, INCLUDING HEALTH CARE. CLEAN WATER IS PROVIDED, EMPOWERMENT IS GIVEN, AN ECONOMIC ENTERPRISE IS MADE POSSIBLE, AND THE CHILDREN ARE ENROLLED IN SCHOOL. OVER AN 18 MONTH PROCESS USING A CASE WORKER MODEL, FAMILIES ARE RAISED UP FROM DESPERATE POVERTY TO A POSITION WHERE THEY NOW QUALIFY FOR MICRO-FINANCING. IN TOTAL, 2,184 FAMILIES TOOK PART IN THE CLM PROGRAM IN 2011. OF THOSE, 1,100 WERE RECRUITED IN 2010 AND WILL HAVE THE OPPORTUNITY TO GRADUATE IN 2012. OF THE REMAINDER, 950 WERE NEWLY RECRUITED IN 2011. FINALLY, WE ARE THRILLED THAT 132 MEMBERS WERE ABLE TO GRADUATE OUT OF A TOTAL OF 134 THAT ACTUALLY FINISHED THE PROGRAM IN 2011. THE 98% GRADUATION RATE IS A TESTAMENT TO THE FACT THAT CLM'S TEAM OF CASE MANAGERS IS CONTUING TO DO WORK THAT IS TRULY CHANGING MEMBERS' LIVES AND HELPING THEM ON THE PATH TO A BETTER LIFE. THOUGH NOT AN ONGOING PROGRAM SERVICE, THE ORGANIZATION NECESSARILY HAD TO RAISE FUNDS IN 2010 FOR EMERGENCY RELIEF AND THE RECONSTRUCTION OF ONE OF OUR PARTNER HOMES IN HAITI, THE ST. JOSEPH'S HOME FOR BOYS IN PORT-AU-PRINCE THAT WAS DESTROYED IN THE EARTHQUAKE IN JANUARY 2010. THROUGH THIS MINISTRY, STREET CHILDREN ARE GIVEN A FAMILY, EDUCATION, HOUSING AND NUTRITION, AND ARE TAUGHT LEADERSHIP. ADDITIONALLY, AS A DIRECT RESULT OF CONTINUED POOR LIVING CONDITIONS IN THE WAKE OF THE EARTHQUAKE, AS WELL AS SEVERAL HURRICANES AND TROPICAL STORMS, THERE WERE A NUMBER OF CHOLERA OUTBREAKS IN HAITI. APPROXIMATELY 106,000 WAS DEPLOYED FOR EMERGENCY RELIEF, INCLUDING WATER FILTRATION PROJECTS, IN 2011. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | A DRAFT OF THE FORM 990 WILL BE DISTRIBUTED TO THE BOARD MEMBERS VIA EMAIL FOR DISCUSSION AND APPROVAL. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | WE HAVE SEMI-ANNUAL LEADERSHIP TEAM MEETINGS AND REMIND EACH BOARD MEMBER OF HIS/HER COMPLIANCE AT THAT TIME. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | AVAILABLE UPON REQUEST. |
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