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
BOYS AND GIRLS CLUB OF THE PIKES PEAK REGION
Employer identification number
84-0416503
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.") ....
880,969
891,264
634,704
752,132
1,118,984
4,278,053
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..
880,969
891,264
634,704
752,132
1,118,984
4,278,053
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.
4,278,053
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..
880,969
891,264
634,704
752,132
1,118,984
4,278,053
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
24,198
16,105
5,156
1,497
3,895
50,851
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..
125,333
294,531
410,323
830,187
11
Total support (Add lines 7 through 10).
5,159,091
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
82.923 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
73.236 %
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
BOYS AND GIRLS CLUB OF THE PIKES PEAK REGION
Employer identification number
84-0416503
Identifier
Return Reference
Explanation
CONFLICT OF INTEREST POLICY MONITORING
FORM 990, PART VI, SECTION B, LINE 12
OFFICERS AND DIRECTORS OR TRUSTEE SIGN A WRITTEN CONFLICT OF INTEREST STATEMENT ANNUALLY.
EXECUTIVE DIRECTOR COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15
MEMBERS OF THE EXECUTIVE COMMITTEE MEET ON AN ANNUAL BASIS TO REVIEW THE EXECUTIVE DIRECTOR'S PERFORMANCE AND TO SET THE BONUS AND NEXT YEAR COMPENSATION TO BE PAID BY THE ORGANIZATION.
990 APPROVAL
FORM 990, PART VI, SECTION B, LINE 11A
A DRAFT OF THE TAX RETURN IS PRESENTED TO THE BOARD OF DIRECTORS FOR THERE REVIEW AND APPROVAL.
PUBLIC INSPECTION
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION'S GOVERNING DOCUMENT, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE FROM THE ORGANIZATION UPON WRITTEN REQUEST OF THE EXECUTIVE DIRECTOR.
OTHER CHANGES IN NET ASSETS
FORM 990, PART IX, LINE 5
THE OTHER CHANGES IN NET ASSETS IS UNREALIZED [LOSS] ON INVESTMENTS TOTALING [$33,166].
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:VIC ANDREWS TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DEBORAH HENDRIX TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:LANCE DICKSON TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JIM BENSBERG TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ERIC LIEBOLD TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JEFF COLERICK TITLE:SECRETARY HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:SUSAN L. MILLER TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:BRIAN GRADY TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ALLEN ROTH TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JIM DI BIASE TITLE:BOARD MEMBER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:BRUCE GILLOOLY TITLE:BOARD CHAIR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:MARY FLEMKE TITLE:VICE CHAIR HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:DEAN CHRISTENSEN TITLE:TREASURER HOURS:
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JAMES SULLIVAN TITLE:EXECUTIVE DIRECTOR HOURS:
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:DUES AND SUBSCRIPTIONS TOTAL EXPENSES:15269 PROGRAM SERVICES:9575 MANAGEMENT AND GENERAL:2206 FUNDRAISING:3488
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PRINTING AND PUBLICATIONS TOTAL EXPENSES:7530 PROGRAM SERVICES:5354 MANAGEMENT AND GENERAL:843 FUNDRAISING:1333
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TELEPHONE TOTAL EXPENSES:22398 PROGRAM SERVICES:15140 MANAGEMENT AND GENERAL:2813 FUNDRAISING:4445
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:BUILDING AND GROUND MAINTENANC TOTAL EXPENSES:54534 PROGRAM SERVICES:50716 MANAGEMENT AND GENERAL:2181 FUNDRAISING:1637
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EQUIPMENT LEASE TOTAL EXPENSES:13511 PROGRAM SERVICES:12725 MANAGEMENT AND GENERAL:449 FUNDRAISING:337
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:VEHICLE EXPENSE TOTAL EXPENSES:19732 PROGRAM SERVICES:18404 MANAGEMENT AND GENERAL:759 FUNDRAISING:569
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:POSTAGE TOTAL EXPENSES:1589 PROGRAM SERVICES:1025 MANAGEMENT AND GENERAL:218 FUNDRAISING:346
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:SECURITY TOTAL EXPENSES:2116 PROGRAM SERVICES:1968 MANAGEMENT AND GENERAL:85 FUNDRAISING:63
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:BUSINESS DEVELOPMENT TOTAL EXPENSES:6441 PROGRAM SERVICES:4516 MANAGEMENT AND GENERAL:774 FUNDRAISING:1151
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:MISCELLANEOUS TOTAL EXPENSES:13421 PROGRAM SERVICES:7341 MANAGEMENT AND GENERAL:2328 FUNDRAISING:3752
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PROPERTY TAXES TOTAL EXPENSES:690 PROGRAM SERVICES:412 MANAGEMENT AND GENERAL:107 FUNDRAISING:171
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.