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
2010
Open to Public Inspection
Name of the organization
COMMUNITY ACTION OF SOUTHERN KENTUCKY INC
Employer identification number
61-0660969
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
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..
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.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
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..
11
Total support (Add lines 7 through 10).
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
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
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—2009.
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—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
10,650,950
10,878,474
15,482,677
21,622,256
21,629,939
80,264,296
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......
745,526
2,000,097
1,853,789
578,430
460,467
5,638,309
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
11,396,476
12,878,571
17,336,466
22,200,686
22,090,406
85,902,605
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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.
0
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
85,902,605
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
11,396,476
12,878,571
17,336,466
22,200,686
22,090,406
85,902,605
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
63,761
67,439
24,865
14,620
10,052
180,737
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
63,761
67,439
24,865
14,620
10,052
180,737
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
0
13
Total support (Add lines 9, 10c, 11 and 12.).
11,460,237
12,946,010
17,361,331
22,215,306
22,100,458
86,083,342
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 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
99.790 %
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
0.210 %
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
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—2009.
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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2010
Additional Data
Software ID:
10000105
Software Version:
2010v3.2
-
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
2010
Open to Public Inspection
Name of the organization
COMMUNITY ACTION OF SOUTHERN KENTUCKY INC
Employer identification number
61-0660969
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
COMMUNITY ACTION OF SOUTHERN KENTUCKY, INC MAITAINS A PUBLIC DISCLOSURE FILE OF THE APPLICATION FOR RECOGNITION OF EXEMPTION AND THREE YEARS OF FORM 990.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
SEE ABOVE EXPLANATION.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
THE EXECUTIVE DIRECTOR IS AWARE OF THE BUSINESS INTEREST OF EACH MEMBER OF THE BOARD OF DIRECTORS AND OVERSEES ALL TRANSACTIONS TO BE SURE THERE IS NOT VOILATION OF THE CONFLICT OF INTEREST POLICY.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
A COPY OF FORM 990 IS AVAILABLE FOR MEMBERS OF THE BOARD OF DIRECTORS TO INSPECT UPON REQUEST. THEY ARE ADVISED BY EMAIL BEFORE THE FORM 990 IS FILED, IT IS AVAILABLE. FORM 990 IS USED TO INFORM MEMBERS OF THE BOARD OF DIRECTORS OF THE PROGRAMS AND RELATED FINANCES. FORM 990 IS USED IN THE ORIENTATION OF NEW MEMBERS OF THE BOARD OF DIRECTORS.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: CHILD CARE CENTERS- THIS PROGRAM IS OPERATED TO INCREASE PARTICIPATION AND SELF SUFFICIENCY OF PARENTS AND CHILDREN IN THE HEAD START PROGRAM. 397 CHILDREN IN EDMONSON,METCALF AND WARREN COUNTIES ACCESSED REASONABLY PRICED, AGE APPROPRIATE CHILD CARE SERVICES, WHILE THEIR PARENTS WORKED, ATTENDED COLLEGE OT TRAINING ACTIVITIES. OTHER PROGRAM SERVICES 5: COMMUNITY SERVICES BLOCK GRANT (CSBG)- PROVIDES A VARIETY OF SERVICES TO ALLEVIATE THE CAUSES AND CONDITIONS OF POVERTY, INCLUDING FOOD, SHELTER OR DEVELOPMENT ASSISTANCE (EDUCATION AND JOB TRAINING). EMERGENCY FOOD AND SHELTER PROGRAM- 464 HOUSEHOLDS RECEIVED ASSISTANCE, GARDEN PROGRAM- 904 HOUSEHOLDS GREW VEGETABLES GARDENS FOR SELF-SUPPORT; SCHOLARSHIPS-15 HIGH SCHOOL SENIORS AND 10 NON-TRADITIONAL STUDENTS WERE EACH AWARDED $1,500 POST-SECONDARY SCHOLARSHIPS; SUPPORTIVE HOUSING 163 HOUSEHOLDS RECEIVED $46,799 IN HOUSING AND CASE MANAGEMENT. OTHER PROGRAM SERVICES 6: Weatherization- provides assistance and improvements to eligible homeowners and renters in order to achieve safer homes more energy efficient. 301 homes received weatherization services- material cost totaled $442,702 and labor cost totaled $649,178; 406 applications for services were received. OTHER PROGRAM SERVICES 7: FAMILY PRESERVATION AND REUNIFICATION SERVICES- PROVIDES INTENSIVE IN-HOME,CRISIS INTERVENTION SERVICES AND EDUCATIONAL PROGRAMS TO REDUCE THE NEED FOR OUT-OF-HOME PLACEMENT OF CHILDREN AND PROVIDES ASSISTANCE WITH REUNIFICATION AND TRANSITION OF CHILDREN BACK INTO THE HOME FORM OUT-OF-HOME PLACEMENT. 129 REFERRALS RECEIVE; 260 CHILDREN AT RISK OF REMOVAL; 92% MAINTAINED OR RETURNED HOME. OTHER PROGRAM SERVICES 8: ACCESS VISITATION PROVIDES SUPPORT AND FACILITATES NON-CUSTODIAL PARENTS' ACCESS TO VISITATION OF THEIR CHILDREN. 97 FAMILIES ASSISTED; 54 SUPERVISED VISITATION; 16 THERAPEUTIC MONITORING, 15 MEDIATIONS; AND 12 NEUTRAL EXCHANGES. OTHER PROGRAM SERVICES 9: ADULT EDUCATION AND JOB DEVELOPMENT PROVIDES BASIC TUTORING, COMPUTER CLASSES AND JOB DEVELOPMENT CLASSES FOR ADULTS. 172 INDIVIDUALS RECEIVED SERVICES; 160 INDIVIDUALS IMPROVED BASIC SKILLS AND 113 INDIVIDUALS IMPROVED JOB DEVELOPMENT SKILLS. OTHER PROGRAM SERVICES 10: COMMUNITY COLLABORATIONS FOR CHILDREN PROVIDES ENHANCEMENT AND PREVENTATIVE SERVICES TO FAMILIES IN CRISIS OR CHILDREN AT RISK OF ABUSE OR NEGLECT.- 43 IN-HOME BASED SERVICES; 41 SUPERVISED VISITS AND 84 FAMILIES ASSISTED. OTHER PROGRAM SERVICES 11: FOOD SERVICES PROVIDES A UNIFIED FOOD SERVICE FOR ALL AGENCY OPERATIONS- 176,666 HEAD START MEALS SERVED AND 64,597 CHILD CARE MEALS SERVED IN ADDITION TO SUMMER FOOD SERVICE PROGRAM MEALS. OTHER PROGRAM SERVICES 12: FOSTER GRANDPARENT PROGRAM PROVIDES SENIOR CITIZENS 55 YEARS OR OLDER THE OPPORTUNITY TO GIVE GUIDANCE AND ONE-ON-ONE ASSISTANCE WITH CHILDREN AND YOUTH WHO HAVE SPECIAL AND EXCEPTIONAL NEEDS.-112 FOSTER GRANDPARENTS ASSISTED 309 CHILDREN IN 42 SITES AND PROVIDED 84,972 VOLUNTEER HOURS. OTHER PROGRAM SERVICES 13: RETIRED AND SENIOR VOLUNTEER PROGRAM- VOLUNTEERS AGE 55 AND OLDER INVOLVED IN THIS PROGRAM SERVE IN AREAS OF HEALTH, SAFETY, CHILDREN'S SERVICES, SENIOR SERVICES, DISASTER PREPAREDNESS AND OTHER COMMUNITY NEEDS. 160 VOLUNTEERS AT 21 VOLUNTEER STATIONS SERVED 18,734 HOURS. OTHER PROGRAM SERVICES 14: SENIOR CENTERS- PROVIDE ACTIVITIES AND SERVICES DESIGNED TO AID IN THE SOCIAL AND NUTRITIONAL WELL BEING OF OUR SENIOR CITIZENS AGE 60 AND OLDER.- 21,536 TRANSPORTATION TRIPS PROVIDED; 35,149 CONGREGATE MEALS SERVED; 62,221 HOME DELIVERED MEALS PROVIDED. OTHER PROGRAM SERVICES 15: ALL OTHER PROGRAMS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.