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 & GIRLS CLUBS IN TENNESSEE
Employer identification number
26-4568046
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.") ....
2,501
345,305
1,518,530
1,866,336
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..
2,501
345,305
1,518,530
1,866,336
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.
1,866,336
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..
2,501
345,305
1,518,530
1,866,336
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
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..
4,537
4,537
11
Total support (Add lines 7 through 10).
1,870,873
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
0 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
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 & GIRLS CLUBS IN TENNESSEE
Employer identification number
26-4568046
Identifier
Return Reference
Explanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS
FORM 990, PAGE 1, PART I, LINE 6
BOARD MEMBERS PROVIDE ADMIN SERVICES FOR GRANTS OVERSIGHT OF THE BUSINESS, STRATEGY, DISTRIBUTION AND OTHER MATTERS
ANY SIGNIFICANT NEW PROGRAM SERVICES NOT LISTED ON A PRIOR RETURN
FORM 990, PAGE 2, PART III, LINE 2
IN FY11 OUR GOVERNMENT GRANTS REVENUE INCREASED 1,159,577 FROM FY10. THE REASON BEING THAT THE THE GRANTS HAD BEEN ADMINISTERED BY THE BOYS & GIRLS CLUBS OF THE TENNESSEE VALLEY IN FY10. BUT NOW ARE BEING ADMINISTERED BY OUR ORGANIZATION. THIS WAS ONE OF THE MAJOR PURPOSES FOR CREATING THIS ORGANIZATIOON. THE RECIPIENTS OF THE GRANTS DID NOT CHANGE. THE ONLY DIFFERENCE IS THAT THE FUNDS WERE RECEIVED AND DISBURSED BY OUR ORGANIZATION INSTEAD OF THE BOYS & GIRLS CLUBS OF THE TENNESSEE VALLEY.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
UNIVERSITY IS TO PROVIDE STUDENTS WITH ACADEMIC ENHANCEMENT OPPORTUNITIES AND SUPPORT SERVICES TO IMPROVE STUDENT ACADEMIC PERFORMANCE IN CORE CONTENT AREAS AND TO BUILD A FOUNDATION FOR POST-SECONDARY EDUCATION AND CAREER OPPORTUNITIES. THE SEVEN MAJOR PROGRAM COMPONENTS OF CLUB UNIVERSITY ARE (1) KIDZLIT 101 (2) KIDZMATH 102 (3) SCIENCE EXPLORER 103 (4) COLLEGE AND CAREER BEGINNINGS 104 AND (5) ENRICHMENT 105 (6) FAMILY STUDIES 106 AND (7) ELECTIVES. ELECTIVES WILL INCLUDE MUSIC, ARTS, DRAMA, SOCIAL STUDIES, AND SAFETY PROGRAMS, AMONG OTHER YOUTH DEVELOPMENT PROGRAMS. CLUB UNIVERSITY WILL OFFER INTENSIVE AFTER SCHOOL AND SUMMER SERVICES SO THAT AT-RISK STUDENTS MAY IMPROVE THEIR ACADEMIC PERFORMANCE AND BE EMPOWERED TO REACH THEIR FULL POTENTIAL. LEAP (LOTTERY THROUGH EDUCATION IN AFTER SCHOOL PROGRAMS) GRANT: FUNDED THROUGH STATE REVENUES OF UNCLAIMED LOTTERY PRIZES (SET ASIDE FOR AFTER SCHOOL PROGRAMS), THE TENNESSEE DEPARTMENT OF EDUCATION: SAFE AND SUPPORTIVE SCHOOLS' CENTER FOR EXTENDED LEARNING GRANTED BOYS & GIRLS CLUBS IN TENNESSEE GRANT FUNDS TO SERVE HUNDREDS OF YOUTH THROUGH ITS' "GREAT FUTURES START HERE" PROGRAM. THE GREAT FUTURES PROGRAM INCLUDES THE FOLLOWING PROGRAM COMPONENTS: KIDS COLLEGE (FOR READING, MATH, AND SCIENCE LEARNING ENHANCEMENT-TO ENABLE YOUTH TO ACHIEVE PROFICIENCY IN THESE CORE SUBJECT AREAS); ROBOTICS (LEGO MINDSTORMS ROBOTICS); STUDY HALL (TUTORING AND HOMEWORK HELP); COLLEGE PREPARATORY ACTIVITIES, EDUCATIONAL ENRICHMENT ACTIVITIES, AND THE TRIPLE PLAY: A GAME PLAN FOR THE MIND, BODY, AND SOUL PROGRAM (HEALTHY LIFESTYLES PROGRAM). THROUGH THE LEAP GRANT, HUNDREDS OF YOUTH AT MULTIPLE CLUB SITES IN TENNESSEE HAVE ACCESS TO EDUCATIONAL ENHANCEMENT AND ENRICHMENT PROGRAMS AFTER SCHOOL TO ENABLE THEM TO ACHIEVE ACADEMIC SUCCESS. YEI (YOUTH EMPOWERMENT INITIATIVE) GRANT: FUNDED THROUGH A JOINT PARTNERSHIP BETWEEN THE TENNESSEE DEPARTMENT OF EDUCATION AND THE TENNESSEE DEPARTMENT OF HUMAN SERVICES, THIS GRANT PROVIDED TENNESSEE CLUBS WITH THE FUNDS TO IMPLEMENT THE "TEEN LEADERSHIP PROGRAM". THE TEEN LEADERSHIP PROGRAM INCLUDED THE FOLLOWING COMPONENTS (1) SMART MOVES (PREVENTION AND LIFE SKILL PROGRAM); (2) LEADERSHIP, LIFE SKILL, AND SUPPORT PROGRAMMING-SUCH AS THE CAREER LAUNCH, TORCH CLUB, AND KEYSTONE PROGRAMS; (3) PROJECT LEARN EDUCATIONAL ENHANCEMENT PROGRAM (HOMEWORK HELP, TUTORING, ENRICHMENT, ACTIVE LEARNING ACTIVITIES) AND THE (4) DELINQUENCY PREVENTION THROUGH TARGETED OUTREACH PROGRAM. THE PROGRAM ENABLED SOME OF THE STATE'S MOST AT-RISK YOUTH TO BE TARGETED FOR SERVICES AND PROVIDED WITH PREVENTION, LIFE SKILL, LEADERSHIP, ACADEMIC, AND CAREER DEVELOPMENT PROGRAMS TO ENABLE THEM TO BUILD KEY PROTECTIVE FACTORS AND HAVE OPPORTUNITIES TO REACH ACADEMIC SUCCESS-AS WELL AS TO DETERMINE CAREER GOALS AND PATHS TO FOLLOW. TRIPLE PLAY: FUNDED THROUGH THE WALMART FOUNDATION'S STATE GIVING PROGRAM, THIS ONE YEAR GRANT PROVIDED FUNDS TO EACH CLUB ORGANIZATION IN TENNESSEE TO IMPLEMENT BOYS & GIRLS CLUBS OF AMERICA'S "TRIPLE PLAY: A GAME PLAN FOR THE MIND, BODY, AND SOUL" PROGRAM. TRIPLE PLAY: A GAME PLAN FOR THE MIND, BODY, AND SOUL" IS A PROGRAM DESIGNED TO PROMOTE HEALTH AND WELLNESS FOR BOYS & GIRLS CLUB MEMBERS AGES 6-18. IT IS A MULTI-FACETED PROGRAM DESIGNED TO HELP YOUNG PEOPLE TO BECOME HEALTHY, ACTIVE AND LEARN NEW WAYS TO HANDLE STRESS, MAINTAIN A HEALTHY BODY AND FORM POSITIVE RELATIONSHIPS. THIS COMPREHENSIVE APPROACH INCLUDES: "MIND - THE HEALTHY HABIT PROGRAM PROVIDES A WIDE-RANGING APPROACH TO ADDRESSING NUTRITION EDUCATION AND FITNESS. "BODY - TRIPLE PLAY GAMES (SPORTS, FITNESS, AND PHYSICAL EDUCATION PROGRAMS) GET MEMBERS UP, ACTIVE AND STRONG THROUGH DAILY FITNESS CHALLENGES AND PHYSICAL EDUCATION ACTIVITIES, GAMES, AND SPORTS TOURNAMENTS. "SOUL - TRIPLE PLAY SOCIAL RECREATION UTILIZES THE GAME ROOM TO TEACH AND REINFORCE SOCIAL AND ETHICAL SKILLS YOUNG PEOPLE NEED TO BE SUCCESSFUL, WHILE ALSO ENGAGING YOUTH IN PHYSICAL FITNESS ACTIVITIES.
ADDITIONAL INFORMATION
FORM 990, PART VI
SECTION A - LINE 2 N 2011 THE FOLLOWING MEMBERS OF THE BOARD OF DIRECTORS HAD RELATIONSHIPS WITH ANOTHER MEMBER RELATED PARTIES GLENN PERMUY KEVIN MCCARTNEY CYNDI COURT DEBBIE DAVIS LORRAINE ORR LORENE JACKSON M V PRASAD CHET NICHOLS KRISTINE MORAIN RELATIONSHIP BUSINESS (KRISTINE MORAIN IS AN OFFICER OF BOYS & GIRLS CLUBS OF AMERICA WHICH EMPLOYS THE OTHER LISTED BOARD MEMBERS
AUTHORITY DELEGATED TO COMMITTEE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 1A
THE EXECUTIVE COMMITTEE SHALL HAVE ALL THE POWERS OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE BOARD. AT MEETINGS OF THE EXECUTIVE COMMITTEE, A QUOROM SHALL CONSIST OF THREE MEMBERS. THE EXECUTIVE COMMITTEE SHALL ASSUME SUCH DUTIES AND POWERS AS ARE DELEGATEDTO IT BY THE BOARD OF DIRECTORS.
OFFICERS WHO CANNOT BE REACHED
FORM 990, PAGE 6, PART VI, LINE 9
KELLY ROLLINS 820 JONES BLVD. MURFREESBORO, TN 37133 MICHAEL SAULS 215 SUSONG LANE GREENVILLE, TN 37743 KELLY THOMAS 1712 MONTVALE ROAD MARYVILLE, TN 37803 ELIZABETH DONNOVIN 428 MCCALLIE AVENUE CHATTANOOGA, TN 37402 JAMIE MCGEHEE 1530 CARR AVENUE MEMPHIS, TN 38104 MICHAEL CRANFORD P O BOX 11567 CHATTANOOGA, TN 37401 LAMAR ARP 2650 PEERLESS RD. NW CLEVELAND, TN 37312 GLENN PERMUY 1275 PEACHTREE ST NW ATLANTA, GA 30309 KEVIN MCCARTNEY 1825 G ST. NW SUITE 770 WASHINGTON, DC 20005 DEBRA DAVIS 100 E WHITESTONE BLVD SUITE 148 CEDAR PARK, TX 78613 M V PRASAD 1275 PEACHTREE ST NW ATLANTA, GA 30309 CYNDI COURT 1275 PEACHTREE ST NW ATLANTA, GA 30309 LORRAINE ORR 1275 PEACHTREE ST NW ATLANTA, GA 30309 CHET NICHOLS 1275 PEACHTREE ST NW ATLANTA, GA 30309 LORENE JACKSON 2911 TAZEWELL PIKE 318 KNOXVILLE, TN 37918 KRISTINE MORAIN 1275 PEACHTREE ST NW ATLANTA, GA 30309
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE FORM IS PROVIDED TO EACH BOARD MEMBER FOR REVIEW. THEY ARE GIVEN A WEEK TO REVIEW AND SUPPLY COMMENTS. QUESIONS, CONCERNS OR CHANGES ARE GIVEN TO THE TREASURER TO DETERMINE THE MERIT OF THE REQUEST AND WHETHER A CHANGE NEEDS TO BE MADE TO THE 990.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
CONFLICT OF INTEREST AND WHISTLE BLOWER POLICIES ARE BEING DEVELOPED AND WILL BE ADDRESSED AT NEXT BOARD MEETING.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
WEBSITE (WHEN OPERATIONAL) AND OUR OFFICE AT 220 CARRICK ST. SUITE 318, KNOXVILLE TN 37921
ADDITIONAL INFORMATION
FORM 990, PART VII
AVERAGE HOURS WORKED BY BOARD MEMBERS FOR RELATED ORGANIZATIONS SOME EMPLOYEES OF BOYS & GIRLS CLUBS OF AMERICA (BGCA) ARE NOMINATED TO TO THE BOARD OF BOYS & GIRLS CLUBS IN TENNESSEE (BGCTN). THEY ARE COMPENSATED FOR THEIR SERVICES TO BGCA FOR 40 HOURS PER WEEK. AS VOLUNTEERS AND MEMBERS OF THE BOARD OF DIRECTORS OF BGCTN THEY ARE ENGAGED IN THE OVERSIGHT OF THE BUSINESS, STRATEGY, DISTRIBUTION AND OTHER MATTERS RELATING TO THE GOVERNANCE OF BGCTN AND THEIR RANGES FROM 1 TO 40 HOURS PER WEEK
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.