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
DOWN SYNDROME ASSN OF NE INDIANA
Employer identification number
35-2096448
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.") ....
78,441
67,853
95,425
76,487
72,567
390,773
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..
78,441
67,853
95,425
76,487
72,567
390,773
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)..
11,296
6
Public Support. Subtract line 5 from line 4.
379,477
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..
78,441
67,853
95,425
76,487
72,567
390,773
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,309
159
143
116
87
1,814
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).
392,587
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
358
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
96.660 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
98.110 %
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
DOWN SYNDROME ASSN OF NE INDIANA
Employer identification number
35-2096448
Identifier
Return Reference
Explanation
PAYMENTS TO AFFILIATES
FORM 990-EZ, PART I, LINE 10
NATIONAL DOWN SYNDROME ASSOCIATION BUDDY WALK LICENSE 6,725
OTHER EXPENSES
FORM 990-EZ, PART I, LINE 16
EXPENSES BUDDY WALK ON DC 1,666 ANNUAL MEETING 4,882 STRATEGIC PLANNING MEETING 80 PROPERTY/LIABILITY INSURANCE 1,234 WORKERS COMPENSATION INSURANC 333 D&O LIABILITY INSURANCE 800 OFFICE SUPPLIES 497 INTERNET/WEBSITE 4,784 TELEPHONE 798 BUDDY WALK EXPENSES 15,218 NEW PARENT PACKETS/OUTREA 280 PROGRAM EXPENSES 11,625 FEES 300 OFFICE EQUIPMENT MTCE 537 OTHER OFFICE 702 NON-INVESTMENT DEPRECIATION 281 TOTAL 44,017
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
FORM 990-EZ, PART I, LINE 20
ROUNDING 0
OTHER ASSETS
FORM 990-EZ, PART II, LINE 24
22,776 22,776 LESS ACCUMULATED DEPRECIATION 21,675 21,956 TOTAL 1,101 820
PRIMARY EXEMPT PURPOSE
FORM 990-EZ, PART III
THE MISSION OF THE DOWN SYNDROME ASSOCIATION OF NORTHEAST INDIANA, INC. IS TO ENHANCE THE LIVES OF PEOPLE AFFECTED BY DOWN SYNDROME,TO ADVOCATE ON THEIR BEHALF, TO PROVIDE INFORMATION AND SUPPORT TO FAMILIES AND PROFESSIONALS, AND TO PROMOTE ACCEPTANCE AND INCLUSION OF PEOPLE WITH DOWN SYNDROME IN NORTHEAST INDIANA.
FIRST ACCOMPLISHMENT
FORM 990-EZ, PART III, LINE 28
THE DOWN SYNDROME ASSOCIATION OF NORTHEAST INDIANA, INC. SERVED 195 MEMBER FAMILIES AND PROFESSIONALS BY PROVIDING SUPPORT IN THE FOLLOWING AREAS: DSANI STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS 2011 INFANT-TODDLER PLAYGROUPS: THE PLAYGROUP CREATES OPPORTUNITIES FOR INFANTS AND YOUNGSTERS THROUGH KINDERGARTEN TO PLAY AND SOCIALIZE WHILE THEIR PARENTS AND SIBLINGS FIND SUPPORT IN A FUN ENVIRONMENT. 63 FAMILIES ON GROUP'S E-MAIL LIST ACTIVITIES INCLUDED: MONTHLY PLAYGROUPS IN A HOME,AVERAGE ATTENDANCE-8 FAMILIES WEEKLY SUMMER POOL PARTIES AT NORTH SIDE PARK, AVERAGE ATTENDANCE 8 FAMILIES GYMNASTICS CLASSES - 10 CHILDREN FALL OUTING WITH BUDDY CLUB-STEEL FARMS FAMILY PARTY AT ANDORFER COMMONS ALONG WITH BUDDY CLUB - 75 PEOPLE BUDDY CLUB: THIS GROUP OFFERS SOCIAL AND RECREATIONAL ACTIVITIES FOR CHILDREN 6 TO 12, AND TYPICALLY MEETING EVERY THREE MONTHS. CURRENT AVERAGE ATTENDANCE - 24, INCLUDING FAMILY MEMBERS. ACTIVITIES INCLUDED: ANDORFER COMMONS PARTY WITH INFANT PROGRAM. BUCKNER PARK PICNIC - 25 PEOPLE SWIM PARTY AT MIHUIC POOL - 6 FAMILIES STEEL FARM TOUR WITH INFANT GROUP, 80 PEOPLE FRIENDSHIP CLUB: AIMED AT TEENS AND YOUNG ADULTS, AGES 12 TO 21. THIS GROUP INCLUDES TEENS WITH DOWN SYNDROME AND OTHER LEARNING DISABILITIES, AS YOUTHS WITH DOWN SYNDROME DEVELOP FRIENDSHIPS IN SCHOOL AND THE COMMUNITY. AVERAGE ATTENDANCE FOR EVENTS 25-30 TEENS. ACTIVITIES INCLUDED: ST. PATRICK'S DAY DANCE 31 TEENS VALENTINE'S DAY DANCE - 38 TEENS FAMILY GYM NIGHT SEMI-FORMAL DINNER DANCE - 42 TEENS BACK TO SCHOOL PIZZA PARTY - 20 TEENS HALLOWEEN PARTY AND DANCE - 30 TEENS HOLIDAY PARTY - 67 PEOPLE SELF-ADVOCATES: INDIVIDUALS WITH DOWN SYNDROME WHO ARE 21 AND OLDER. AVERAGE ATTENDANCE FOR SOCIAL EVENTS - 15. ACTIVITIES INCLUDED: MAD ANTS BASKETBALL GAME- 28 SWIM PARTY - 10 HOLIDAY PARTY - 24 VOLUNTEERED AT NIDAC EVENT ATTENDED JESTERS PROGRAM PIZZA PARTY & BUDDY WALK CRAFTMAKING ATTENDED SEMI-FORMAL DANCE HOSTED BY FRIENDSHIP CLUB SENT REPRESENTATIVE TO BUDDY WALK ON WASHINGTON GRANDPARENTS GROUP: THIS GROUP OFFERS A WONDERFUL OPPORTUNITY FOR GRANDPARENTS TO SUPPORT FAMILY MEMBERS AND EACH OTHER IN A NURTURING CARING ENVIRONMENT. ACTIVITIES INCLUDED: 3 OFFICIAL MEETINGS - 7 TO 10 IN ATTENDANCE ASSISTED AT BUDDY WALK- 20 MEMBERS DADS GROUP: DADS APPRECIATING DOWN SYNDROME. THIS GROUP PROVIDES SPECIAL EVENTS TO BRING TOGETHER DADS IN SUPPORT OF EACH OTHER AND TO BUILD STRONG FAMILIES. AVERAGE ATTENDANCE - 10-13 DADS. EVENTS INCLUDED: MARCH MADNESS BASKETBALL EVENT SPONSORED 9TH ANNUAL STEWART GOLF OUTING WITH 10 TEAMS OUTREACH PROGRAM: OUTREACH EFFORTS INCLUDED UPDATING OUR EXPECTANT AND NEW PARENT PACKETS, CHANGING TO A REFERRAL PROGRAM AND DELIVERING THESE RESOURCES TO FAMILIES OF NEWLY DIAGNOSED BABIES WITH DOWN SYNDROME. OUTREACH VOLUNTEERS HELP PARENTS CONNECT WITH COMMUNITY SERVICES SUCH AS FIRST STEPS AND MEDICAID WAIVER. ALONG WITH PROVIDING INFORMATION, DSANI PARTICIPATED IN DOWN SYNDROME AWARENESS AND BUDDY WALK INFORMATION DAY AT FORT WAYNE TINCAPS GAME. PROGRAM EVENTS: IN ADDITION TO THE SPECIAL-INTEREST OR AGE-SPECIFIC ACTIVITIES THAT DSANI SPONSORED IN 2011 A NUMBER OF OTHER PROGRAMS MET WITH GREAT SUCCESS. EVENTS INCLUDED: DSANI ANNUAL MEETING WITH KEYNOTE SPEAKER MICHAEL REMUS - 80 ATTENDED DSANI FAMILY NIGHT, MAD ANTS BASKETBALL GAME WORKSHOP WITH MICHAEL REMUS "MORE THAN SHARED CLASSROOM:EDUCATING KIDS WITH AND WITHOUT DISABILITIES TOGETHER SUCCESSFULLY". SPONSORED WITH ST. FRANCIS UNIVERSITY; 50 ATTENDEES. SPONSORED NIDAC ABILITIES ABOUND RECEPTION WITH PARALYMPIAN MARK WELLMAN 120 ATTENDEES SPONSORED AND PARTICIPATED IN DISABILITIES EXPO. 105 EXHIBITORS AND APPROXIMATELY 1100 ATTENDESS PARENTS NIGHT OUT, 8 COUPLES ATTENDED DSANI FAMILY ZOO DAY- 95 TICKETS DISTRIBUTED SPONSORED CAMP RED CEDAR WITH PARTIAL SCHOLORSHIPS FOR 35 CHILDREN DSANI FAMILY OUTING- TIN CAPS BASEBALL GAME- 121 ATTENDEES 13TH ANNUAL BUDDY WALK--APPROXIMATELY 1200 PARTICIPANTS INCLUDING 110 VOLUNTEERS SPONSORED "ANITA IN ARGENTINA" MOVIE AT CINEMA CENTER WITH FORT WAYNE JEWISH FEDERATION- 50 ATTENDEES DSANI ANNUAL HOLIDAY PARTY - 150 FAMILY MEMBERS ALONG WITH OUR MANY GROUPS AND PROGRAMS, DSANI ALSO PROVIDES: A QUARTLY NEWSLETTER DISTRIBUTED TO 575 ADDRESSES ON MAILING LIST FAMILY DIRECTORY DISTRIBUTED TO FAMILIES AND PROFESSIONALS - 300 LIBRARY RESOURCES WEBSITE-UPDATED IN 2011 MONTHLY MEMBER ALERTS SENT THROUGH EMAIL FACEBOOK PAGE WITH CALENDAR OF EVENTS, UPDATES AND INFORMATION SUPPORTED FORD IRONMAN LOUISVILLE COMPETITION TO BRING AWARENESS OF DOWN SYNDROME PARTICIPATED IN KNIGHTS OF COLUMBUS ANNUAL TOOTSIE ROLL DRIVE SUPPORT SPECIAL OLYMPICS IN SEVERAL COUNTIES PARTICIPATED IN LEGISLATIVE FORUM SPONSORED SCOUTS DISABILITES AWARENESS DAY PARTICPATED IN MED TECH COLLEGE CAREER FAIR
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.