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
ALASKA TRAUMATIC BRAIN INJURY ADVISORY BOARD
Employer identification number
77-0621661
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.") ....
223,652
326,006
374,986
432,364
431,561
1,788,569
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..
223,652
326,006
374,986
432,364
431,561
1,788,569
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.
1,788,569
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..
223,652
326,006
374,986
432,364
431,561
1,788,569
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
91
174
111
33
82
491
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).
1,789,060
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
146,940
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
99.970 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.970 %
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.") .
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
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
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:
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
2010
Open to Public Inspection
Name of the organization
ALASKA TRAUMATIC BRAIN INJURY ADVISORY BOARD
Employer identification number
77-0621661
Identifier
Return Reference
Explanation
NEW PROGRAM SERVICES
FORM 990, PART III, LINE 2
THE ORGANIZATION EXPANDED ITS EDUCATION AND OUTREACH PROGRAM TO INCLUDE A CONFERENCE IN PARTNERSHIP WITH THE NORTH AMERICAN BRAIN INJURY SOCIETY.
PROGRAM SERVICE STATEMENT
FORM 990, PART III, LINE 4A
TBI ADVISORY BOARD: SITE VISITS AND PUBLIC TESTIMONY: THE TBI ADVISORY BOARD MEMBERS VISIT ALASKA COMMUNITIES TO LEARN FROM THE LOCAL RESIDENTS: - WHAT SERVICES ARE AVAILABLE IN YOUR COMMUNITY AND REGION? - WHAT SERVICES ARE NEEDED IN YOUR COMMUNITY AND REGION? - DO YOU SERVE PEOPLE WITH TRAUMATIC BRAIN INJURY? - DO YOU SCREEN FOR TRAUMATIC BRAIN INJURY? - WHAT SERVICES ARE NEEDED TO BETTER SERVE PEOPLE WITH TRAUMATIC BRAIN INJURY IN YOUR AGENCY, COMMUNITY, AND/OR REGION? - DO YOU HAVE A HEAD INJURY SUPPORT GROUP IN YOUR COMMUNITY? - ARE THERE PREVENTION EFFORTS SUCH AS HELMET ORDINANCES, BICYCLE RODEOS, HELMET PROGRAMS, ETC.? THE ALASKA BRAIN INJURY NETWORK ORGANIZES SITE VISITS FOR THE TBI ADVISORY BOARD MEMBERS. WE ALSO ORGANIZE PUBLIC TESTIMONY. THIS IS AN OPPORTUNITY FOR INDIVIDUALS TO SHARE THEIR PERSONAL STORY. IT IS ALSO AN OPPORTUNITY FOR FAMILY MEMBERS OR PROVIDERS TO SHARE WHAT RESOURCES WERE HELPFUL OR RESOURCES THAT ARE NEEDED? IF THE COMMUNITY IS INTERESTED IN TRAINING, ABIN BOARD MEMBERS VOLUNTEER THEIR TIME TO PRESENT THE LATEST INFORMATION ON BRAIN INJURY SCREENING, ASSESSMENT, TREATMENT, REHABILITATION, AND LONG-TERM SUPPORTS. SYSTEM'S PLANNING: THE ALASKA BRAIN INJURY NETWORK BOARD MEMBERS AND STAFF PARTICIPATE IN MANY DEPARTMENT OF HEALTH AND SOCIAL SERVICES AND ALASKA MENTAL HEALTH TRUST AUTHORITY PLANNING COMMITTEES. THE TBI ADVISORY BOARD MEMBERS AND STAFF ARE ADVOCATING ON BEHALF OF ALL ALASKANS WITH TRAUMATIC BRAIN INJURY. WORKING TO IMPROVE EXISTING SERVICES AND CREATE NEW SERVICES THAT MEET THE UNIQUE NEEDS OF PEOPLE WITH TRAUMATIC BRAIN INJURY. COMMITTEE TOPICS INCLUDE: WORKFORCE DEVELOPMENT, BRING THE KIDS HOME, DISABILITY JUSTICE, HOUSING, LONG-TERM CARE, COMPLEX BEHAVIORS COLLABORATIVE, COMPREHENSIVE INTEGRATED MENTAL HEALTH PLAN, PREVENTION, AND MORE. LEGISLATIVE ADVOCACY: THE TBI ADVISORY BOARD MEMBERS PARTICIPATE IN LEGISLATIVE ADVOCACY ACTIVITIES INCLUDING PRESENTATIONS TO LEGISLATIVE COMMITTEES, MEETING WITH INDIVIDUAL SENATORS AND REPRESENTATIVES, AND TESTIFYING ON BILLS RELATED TO BRAIN INJURY FUNDING AND SERVICES. THE TBI ADVISORY BOARD HAS BEEN SUCCESSFUL IN ADVOCATING FOR OVER $4 MILLION IN FUNDING SPECIFICALLY FOR ALASKANS WITH TRAUMATIC/ACQUIRED BRAIN INJURY. EXAMPLES OF FUNDING INCLUDE: DURING FY11, THE TRAUMATIC BRAIN INJURY ADVISORY BOARD VISITED THE COMMUNITIES HOMER, GIRDWOOD, AND KETCHIKAN, AND HELD PUBLIC TESTIMONY IN ALL THREE LOCATIONS. THE BOARD HEARD TESTIMONY FROM APPROXIMATELY 30 ALASKANS AT THESE MEETINGS. IN ADDITION, THE BOARD HELD TBI TRAINING SESSIONS FOR HEALTH CARE PROVIDERS AND COMMUNITY MEMBERS IN HOMER AND KETCHIKAN.
PROGRAM SERVICE STATEMENT
FORM 990 PART III, LINE 4B
RESOURCE NAVIGATION: OUR RESOURCE NAVIGATORS PROVIDE INFORMATION AND REFERRAL AND MORE. - RESPOND TO REQUESTS FOR ASSISTANCE, INFORMATION, RESOURCES, AND REFERRAL. - MAINTAINS A BRAIN INJURY RESOURCE DIRECTORY WITH STATEWIDE AND LOCAL RESOURCES AND SUPPORTS AVAILABLE TO INDIVIDUALS, FAMILIES, FRIENDS, PROFESSIONALS, CAREGIVERS AND THE GENERAL PUBLIC. - PROVIDES TECHNICAL ASSISTANCE TO COMMUNITIES INTERESTED IN DEVELOPING BRAIN INJURY SUPPORT GROUPS. - DISTRIBUTE EDUCATIONAL AND INFORMATIONAL RESOURCES TO THE PUBLIC. MOST OF ALL, OUR RESOURCE NAVIGATORS LISTEN. THEY WILL LISTEN TO YOUR UNIQUE STORY AND HELP IDENTIFY SERVICES AND SUPPORTS. THEY WILL HELP YOU MAKE THE NECESSARY PHONE CALLS IF NEEDED. THEY WILL ALSO HELP BRAINSTORM COMPENSATORY STRATEGIES OR STRATEGIES YOU CAN USE AT HOME IF SERVICES ARE NOT AVAILABLE IN YOUR AREA. DURING FY11, THE RESOURCE NAVIGATION PROGRAM RECEIVED APPROXIMATELY 486 UNIQUE CONTACTS FROM INDIVIDUALS WITH BRAIN INJURY, A LOVED ONE WITH A BRAIN INJURY, OR A PROVIDER IN ALASKA. A TOTAL OF 1191 TOTAL CONTACTS OCCURRED. 243 INDIVIDUALS WITH BRAIN INJURY RECEIVED RESOURCE NAVIGATION SUPPORT.
PROGRAM SERVICE STATEMENT
FORM 990, PART III, LINE 4C
EDUCATION AND OUTREACH: WE ARE COMMITTED TO INCREASING THE PUBLIC'S AWARENESS ABOUT TRAUMATIC BRAIN INJURY. YOU CAN FIND OUR BOOTH AT MANY CONFERENCES AND EVENTS. IF YOU ARE INTERESTED IN ORGANIZING A BOOTH AT AN EVENT IN YOUR COMMUNITY, SUCH AS A HEALTH FAIR, WE CAN MAIL YOU BRAIN INJURY EDUCATIONAL MATERIALS, PAMPHLETS, AND DISPLAY BOARDS. JUST GIVE US A CALL. EDUCATION: THE ALASKA BRAIN INJURY NETWORK WANTS TO HELP YOU GET THE EDUCATION AND TRAINING YOU ARE LOOKING FOR. - CONTACT US TO LEARN ABOUT ONGOING TRAINING OPPORTUNITIES. - IF YOU ARE LOOKING TO ORGANIZE A TRAINING, WE CAN HELP YOU FIND THE RIGHT PROFESSIONAL OR PERSON TO DELIVER THE INFORMATION REQUESTED. - ABIN'S KNOWLEDGEABLE STAFF IS AVAILABLE TO COME SPEAK TO YOUR STAFF ABOUT TRAUMATIC BRAIN INJURY, SIGNS AND SYMPTOMS, RESOURCES, AND MORE. - ABIN ALSO HAS A NETWORK OF TBI SURVIVORS AND FAMILY MEMBERS THAT OFFER THE BEST INFORMATION ON TRAUMATIC BRAIN INJURY. WE ENCOURAGE TRAININGS TO INCLUDE TBI SURVIVORS AND/OR FAMILY MEMBERS. THE NORTH AMERICAN BRAIN INJURY SOCIETY (NABIS) WORKED WITH ABIN TO HOST THE ALASKA BRAIN INJURY CONFERENCE IN JULY 2010. THIS EVENT HAD OVER 300 PARTICIPANTS AND FOCUSED ON MULTIDISCIPLINARY INFORMATION ABOUT BRAIN INJURY, FOR PROVIDERS AND THOSE WHO EXPERIENCE BRAIN INJURY.
FORM 990, PART VI, SECTION B, LINE 11
THE EXECUTIVE DIRECTOR OF ALASKA BRAIN INJURY NETWORK RECEIVES THE PREPARED FORM 990, REVIEWS IT WITH ACCOUNTANTS FOR ACCURACY BEFORE SIGNING AND FILING.
FORM 990, PART VI, SECTION B, LINE 12C
ALASKA BRAIN INJURY NETWORK'S BYLAWS, ARTICLE XX, SECTION 20.2, CONFLICTS OF INTEREST STATES "ANY DIRECTOR WITH A POTENTIAL CONFLICT OF INTEREST CONCERNING AN ISSUE TO BE CONSIDERED BY THE BOARD SHALL ANNOUNCE THAT CONFLICT AT THE BEGINNING OF THE BOARD MEETING AT WHICH THE ISSUE WILL BE CONSIDERED, OR AT SUCH TIME AS THE POTENTIAL CONFLICT BECOMES APPARENT."
FORM 990, PART VI, SECTION B, LINE 15B
TO DETERMINE COMPENSATION OF THE ORGANIZATION'S EXECUTIVE DIRECTOR AND EMPLOYEES, THE ALASKA BRAIN INJURY NETWORK PURCHASED THE FORAKER GROUP 2008 SALARY AND BENEFITS SURVEY, WHICH PROVIDES RELIABLE INFORMATION TO USE AS ORGANIZATIONS DEVELOP NEW POSITIONS, AND PROVIDES INSIGHT INTO BUILDING A SALARY STRUCTURE FOR THE ORGANIZATION
FORM 990, PART VI, SECTION C, LINE 19
THE ALASKA BRAIN INJURY NETWORK MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE GENERAL PUBLIC, UPON REQUEST. THE DOCUMENTS CAN BE INSPECTED AT ABIN'S OFFICE.
CHANGE TO OVERSIGHT PROCESS
FORM 990, PART XII LINE 2C
THE ORGANIZATION'S FINANCE COMMITTEE HAS BECOME MORE ACTIVELY INVOLVED IN THE OVERSIGHT PROCESS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.