Attach to Form 990 or Form 990-EZ.
See separate instructions.| (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? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| 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.") .... | 3,469,765 | 3,602,848 | 3,861,819 | 4,031,615 | 4,061,284 | 19,027,331 |
| 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.. | 3,469,765 | 3,602,848 | 3,861,819 | 4,031,615 | 4,061,284 | 19,027,331 |
| 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. | 19,027,331 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,469,765 | 3,602,848 | 3,861,819 | 4,031,615 | 4,061,284 | 19,027,331 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 11,708 | 9,245 | 7,543 | 10,564 | 5,842 | 44,902 |
| 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.. | 51 | 2,127 | 2,178 | |||
| 11 | Total support (Add lines 7 through 10). | 19,074,411 | |||||






| 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.) | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
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| Part II Line 10 Other income - 2009 - 51 and 2010 - 2,127 are miscellaneous revenue. |
| Explanation |
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| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 2 | Two board members are father and daughter and two members are mother and daughter. |
| Form 990 Part VI | 11b | The 990 is reviewed by the budget and finance committee, who will bring it to the board for review prior to signing and filing. |
| Form 990 Part VI | 12c | Conflict of Interest Policy - the president of the board diseminates annually the agency conflict of interest policy and disclosure forms to the board members. The president maintains completed forms. If a conflict is identified, the president will follow policy procedures related to the handling of potential conflicts, including identification of the actual or perceived conflict full disclosure of the conflict to the board an appropriate response to the conflict such as disqualification from voting, any possible necessary remedial action clarification of member participation in decision making process, etc. The president will ensure the full board agrees with the response and ensure that minutes of the meeting reflect the conflict and decision made for management. The president has available legal counsel if the conflict resolution cannot be agreed upon or need legal help. |
| Form 990 Part VI | 15b | Compensation of Executive Director ED - the Executive Committee EC of the board notifies all members of the evaluation of the ED, provides a blank evaluation form and seeks input. The EC seeks out information regarding compensation from other similar agencies or through verification review of ther agencys 990 online. The EC takes feedback from all board members and completes the ED evaluation. The EC requests the ED complete a self evaluation utilizing the same evaluation format. The EC meets in person with the ED to reveiw their self evaluation and the combined evaluation of the Baord. The EC reveiws board agreed upon progress on previously identified goals and mutually agrees upon future goals and compensation. A final draft which emcompasses the new objectives is developed and signed by both the ED and the President of the Board. |
| Form 990 Part VI | 19 | The Form 1023 and 990s are available upon request at the main office during normal business hours. |
| Form 990 Part XI | 5 | Other changes in net assets - 4,833 - adjustment of investments from cost basis for the previous year to market value for the current year. |
| Form 990 Part III Program Service Accomplishments | Line 4d Other Activities | Program Service Expenses 299,245, Grants and allocations 0, Revenue 309,142 Service Coordination - provided case management services, which included information regarding services and equipment provided by other agencies, education and training, respite care and advocacy. 128 individuals received services. |
| Form 990, Part III, Line 4d Program Service Expenses 299,245, Grants and allocations 0, Revenue 309,142 Service Coordination - provided case management services, which included information regarding services and equipment provided by other agencies, education and training, respite care and advocacy. 128 individuals received services. Form 990 Part VI Section A Line 2 Two board members are father and daughter and two members are mother and daughter. Form 990 Part VI Section B Line 11b The 990 is reviewed by the budget and finance committee, who will bring it to the board for review prior to signing and filing. Form 990 Part VI Section B Line 12c Conflict of Interest Policy - the president of the board diseminates annually the agency conflict of interest policy and disclosure forms to the board members. The president maintains completed forms. If a conflict is identified, the president will follow policy procedures related to the handling of potential conflicts, including identification of the actual or perceived conflict full disclosure of the conflict to the board an appropriate response to the conflict such as disqualification from voting, any possible necessary remedial action clarification of member participation in decision making process, etc. The president will ensure the full board agrees with the response and ensure that minutes of the meeting reflect the conflict and decision made for management. The president has available legal counsel if the conflict resolution cannot be agreed upon or need legal help. Form 990 Part VI Section B Line 15b Compensation of Executive Director ED - the Executive Committee EC of the board notifies all members of the evaluation of the ED, provides a blank evaluation form and seeks input. The EC seeks out information regarding compensation from other similar agencies or through verification review of ther agencys 990 online. The EC takes feedback from all board members and completes the ED evaluation. The EC requests the ED complete a self evaluation utilizing the same evaluation format. The EC meets in person with the ED to reveiw their self evaluation and the combined evaluation of the Baord. The EC reveiws board agreed upon progress on previously identified goals and mutually agrees upon future goals and compensation. A final draft which emcompasses the new objectives is developed and signed by both the ED and the President of the Board. Form 990 Part VI Section C Line 19 The Form 1023 and 990s are available upon request at the main office during normal business hours. Form 990 Part XI Line 5 Other changes in net assets - 4,833 - adjustment of investments from cost basis for the previous year to market value for the current year. |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |