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
ALZHEIMERS ALLIANCE OF NORTHEAST TEXAS dba ALZHEIMERS ALLIANCE OF SMITH COUNTY
Employer identification number
75-2486061
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.") ....
423,813
210,242
240,943
282,379
305,497
1,462,874
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3..
423,813
210,242
240,943
282,379
305,497
1,462,874
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)..
299,094
6
Public Support. Subtract line 5 from line 4.
1,163,780
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..
423,813
210,242
240,943
282,379
305,497
1,462,874
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
16,487
15,318
13,398
11,655
9,699
66,557
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
155,762
198,975
123,544
478,281
11
Total support (Add lines 7 through 10).
2,007,712
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
57.970 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
63.610 %
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:
11000144
Software Version:
2011v1.2
-
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
ALZHEIMERS ALLIANCE OF NORTHEAST TEXAS dba ALZHEIMERS ALLIANCE OF SMITH COUNTY
Employer identification number
75-2486061
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
No documents available to the public.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
THE EXECUTIVE DIRECTOR MAKES RECOMMENDATIONS TO THE FINANCE COMMITTEE AND/OR BOARD WHEN SALARY INCREASES FOR OTHER EMPLOYEES ARE BEING CONSIDERED BASED ON PERFORMANCE. THE FINANCE COMMITTEE AND/OR BOARD HAS THE POWER TO APPROVE OR DISAPPROVE OF THESE PAY INCREASES.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
BOARD MEMBERS ARE WELL-KNOWN BY SEVERAL OTHER BOARD MEMBERS PERSONALLY AND/OR PROFESSIONALLY. POTENTIAL CONFLICTS OF INTEREST ARE READILY APPARENT AND ARE DISCLOSED. CONCERNS ARE ADDRESSED BY THE BOARD LEADERSHIP AND GOVERNANCE COMMITTEE WHEN NECESSARY.
Form 990, Part VI, Line 9
Form 990, Part VI, Line 9: Officer, Director, Trustee, Key Employee Mailing Address
Riter, Mrs. Cynthia 1717 S. College Ave - Hm Tyler, TX 75701Dyer, Mr. Bob Texas Bank & Trust of Longview P.O. Box 3188 Longview, TX 75606Eckert, Mrs. Mary Ann 1017 Wilmington - Hm Tyler, Texas 75701 Davis, Mrs. Debby 20779 Hickory Lane - Hm Whitehouse, Texas 75791 Adams, Margo 3510 Pat Lane - Hm Tyler, TX 75701Emerson, Mr. Wade Emerson Insurance 1905 Rickety Lane Tyler, Texas 75703 Evans, Mr. Mike Legacy Group 909 ESE Loop 323, Ste. 210 Tyler, Texas 75701 McCauley, Jan 323 W. Third St. Tyler, TX 75703Mabry, Dr. Rod UT Tyler 3900 University Blvd. Tyler, Texas 75799 Palmer, Sheryl Rogers P.O. Box 7189 Tyler, TX 75711Smith, Kari Kuenemann 2803 Pounds Avenue - Hm Tyler, TX 75701Swann, Elam Swann's Furniture Company 2401 SSE Loop 323 Tyler, Texas 75701Wick, Mrs. D'Anna 2002 Canberra Court - Hm Tyler, Texas 75703 McNally, Mrs. Fritter 4463 Couples Court Tyler, Texas 75709Murphy, Mrs. June 529 Woodside Hideaway, Texas 75771Shepard, Dr. Joe 520 E. Third Street Tyler, Texas 75701 Rowe, Dr. Marian 902 Harrison Avenue Abilene, Texas 79601
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
THE FINANCE COMMITTEE WILL REVIEW THE 990 AND PRESENT IT TO THE BOARD. THE ENTIRE BOARD WILL RECEIVE THE 990 BY EMAIL PRIOR TO THE MEETING.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: PHYSICIAN'S OUTREACH: THE ORGANIZATION PROVIDES ALZHEIMER'S DISEASE INFORMATION TO HEALTH CARE PROFESSIONALS AND EQUIPS PHYSICIANS TO "PRESCRIBE" A SOCIAL MODEL OF CARE. INFORMATION AND UNDERSTANDING ABOUT THE COMPLEXITY OF ALZHEIMER'S DISEASE, EVEN IN THE MEDICAL COMMUNITY, IS SORELY LACKING. MISCONCEPTIONS ABOUT THE DISEASE PROCESS ARE COMMON. NEW GUIDELINES FOR MEMORY SCREENING AND DIAGNOSIS HAVE COME OUT AND MANY HEALTH CARE PROFESSIONALS ARE UNAWARE OF THE FULL SPECTRUM OF TESTS AND EVALUATIONS NECESSARY TO MAKE A MORE ACCURATE ASSESSMENT OF ONE'S MEMORY. IN AN EFFORT TO BRIDGE THIS GAP, THE ORGANIZATION IS ACTIVELY BUILDING RELATIONSHIPS WITH PHYSICIANS, HOSPITALISTS, PHYSICIAN ASSISTANTS, NURSE PRACTITIONERS, NURSES, HOSPITAL ADMINISTRATORS, CASE MANAGERS, SOCIAL WORKERS, AND NURSING SCHOOLS. ALZHEIMER'S ALLIANCE IS PROVIDING INFORMATION, EDUCATIONAL SEMINARS (WITH CONTINUING EDUCATION CREDIT), AND PRACTICAL TOOLS FOR USE IN THE PRACTICE OF MEDICINE. IN ADDITION TO MEETING THE MEDICAL NEEDS OF PERSONS WITH DEMENTIA, PHYSICIANS NEED TO BE EQUIPPED TO "PRESCRIBE" A SOCIAL MODEL OF SUPPORT. CURRENTLY, THE MEDICAL COMMUNITY IS NOT POSITIONED TO ADDRESS THE SOCIAL ASPECT OF THIS DISEASE WHICH INCLUDES CHANGES IN BEHAVIOR AND LOSS OF DAILY FUNCTION - THERE SIMPLY IS NOT ENOUGH TIME TO DO SO. A BIG PART OF THE ORGANIZATION'S MESSAGE IS THAT THE ALZHEIMER'S ALLIANCE OF SMITH COUNTY IS ABLE TO ADDRESS THAT PIECE WITH THEIR PATIENTS. ALZHEIMER'S ALLIANCE HAS DEVELOPED A DEMENTIA RESOURCE KIT WHICH PHYSICIANS MAY HAND TO PERSONS DIAGNOSED WITH SOME FORM OF DEMENTIA. THE KIT INCLUDES REFERRAL TO THE ALZHEIMER'S ALLIANCE OF SMITH COUNTY.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.