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
Gibault Inc
Employer identification number
35-0868093
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
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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—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:
11000144
Software Version:
2011v1.2
-
TIN:
SCHEDULE E(Form 990 or 990-EZ) Department of the TreasuryInternal Revenue Service
SchoolsComplete if the organization answered "Yes" to Form 990, Part IV, line 13,or Form 990-EZ, Part VI, line 48. Attach to Form 990 or Form 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Gibault Inc
Employer identification number
35-0868093
Part I
YES
NO
1
Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body?
......................
1
Yes
2
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its
brochures, catalogues, and other written communications with the public dealing with student admissions,
programs, and scholarships?
......................................
2
Yes
3
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way
that makes the policy known to all parts of the general community it serves? If "Yes," please describe. If "No,"
please explain. If you need more space use Part II.
.............................
3
No
4
Does the organization maintain the following?
a
Records indicating the racial composition of the student body, faculty, and administrative staff?
..........
4a
Yes
b
Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory
Other extracurricular activities?
.....................................
5h
No
If you answered "Yes" to any of the above, please explain. If you need more space, use Part II.
6a
Does the organization receive any financial aid or assistance from a governmental agency?
...........
6a
Yes
b
Has the organization's right to such aid ever been revoked or suspended?
...................
6b
No
If you answered "Yes" to either line 6a or line 6b, explain on Part II.
7
Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscrimination? If "No," explain on Part II.
7
Yes
Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50085D
Schedule E (Form 990 or 990-EZ) 2011
Schedule E (Form 990 or 990EZ) 2011
Page 2
Part II
Supplemental Information
Complete this part to provide the explanations required by Part I, lines 3, 4d, 5h, 6b, and 7, as applicable. Also complete this part to provide any other additional information (see instructions).
Identifier
Return Reference
Explanation
Schedule E, Line 3 - Racially Nondiscriminatory Policy Publicized
Revenue Procedure 75-50 Sec. 4.03 part 2(b) states that if a school customarily draws a substantial percentage of its students from a large geographic section of the United States and follows a racially nondiscriminatory policy as to students, such school may demonstrate that it follows a racially nondiscriminatory policy by showing that it currently enrolls students of racial minority groups in meaningful numbers. Gibault, Inc. services the entire state of Indiana, and occasionally has boys and girls from other midwestern states admitted into their program. The racial and gender composition of students in 2010 was as follows: Caucasian 86% African American 9% Multi-racial 3% Hispanic 1% Native American 1% Gender: Male 76% Female 24%
Schedule E, Line 6 - Explanation of Aid or Assistance from Governmental Agency
Gibault, Inc. receives funds from the following government programs/grants: Department of Agriculture School Breakfast Program and National School Lunch Program Department of Education, Chapter I Department of Education, Division of School Finance and Educational Information - Textbook Reimbursement Grant Department of Agriculture Food Distribution Program (Commodities) Indiana Department of Education - Choice Scholarship Program Jasper County, Indiana - CASA Program Grant Newton County, Indiana - CASA Program Grant
Schedule E (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000144
Software Version:
2011v1.2
-
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
2011
Open to Public Inspection
Name of the organization
Gibault Inc
Employer identification number
35-0868093
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The governing documents, conflict of interest policy and financial statements are maintained at the corporate offices of Gibault, Inc. located at 6401 South U.S. Highway 41, Terre Haute, Indiana 47802. These documents may be viewed upon request by contacting Amy Atchley, Director of Finance at Gibault, Inc.
Form 990, Part VI, Line 11
Form 990, Part VI, Line 11: Form 990 Review Process
Form 990 not provided to board of directors; however, Chief Financial Officer reviews the 990 prior to its submission.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d : Other Program Services Description
OTHER PROGRAM SERVICES 4: Autism Spectrum Behaviorial Learning Environment (ABLE) program offers a broad continuum of services to children and families of children diagnosed with high functioning Autism, Pervasive Developmental Disorder, and Asperger's Syndrome. The ABLE Program provides one-on-one supervision in a semi-secure residential environment for males ages 8-18. The goal of the program is to successfully reintegrate each student back into his community, home and school by improving his quality of life making him as independent as possible. The ABLE program teaches life skills that children need to become active members of society. The program is equipped to provide special education and residential programming, as well as psychological and therapeutic services, as needed.Gibault, Inc. also provides aftercare for a defined period after the students are released from the campus. This may include face-to-face visits, telephone calls, and inquiries of the those people who interact with the students on a day to day basis (ie employer, teacher, friend, etc). Aftercare is to provide additional assistance to the students to make sure they continue to make good decisions and to provide positive enforcement to the students once they leave Gibault's campus. OTHER PROGRAM SERVICES 5: Intensive Sexual Intervention System (ISIS) program is a specialized treatment unit for male sex abusers. The primary goal of the ISIS program is to have the juvenile offender demonstrate appropriate sexual behavior. This goal is met through the main objective of the sexual abuser learning to demonstrate empathy for victims, generating improved self-esteem, and learning healthy human sexuality. Counseling and therapy is provided in a staff-secure environment in both individual and group settings. Development of appropriate relationships, responsibility, empathy, communication, and social skills training is emphasized. OTHER PROGRAM SERVICES 6: Group Home - Gibault, Inc. operates one male and one female group homes in Shelbyville, Indiana. The group homes provide a 24-hour staff secure envrionment for males and females ages 6-18. The group homes are designed for clients who have shown significant advancement in their treatment and are in need of a less restrictive environment. Group home clients are given more privileges and personal freedom to pursue their social and educational interests. The clients may also seek employment positions in the community. Clincial services are provided by licensed mental health practitioners and include weekly individual, group therapy, and family therapy. Community service projects and community councils are also offered to enhance each client's placement. The goal of the group homes are to help clients reintegrate back into their home, school, and community. OTHER PROGRAM SERVICES 7: Henry County Youth Center - Gibault, Inc. operates a youth detention center in New Castle, Indiana. It is a 50 bed facility providing 30 secure, ten non-secure/shelter and ten residential treatment beds. The facility serves multiple counties in Indiana. The mission of the center is to provide leadership, structured care, and supervision to youth through a balanced approach of creative programs and services that teach responsibility, accountability, and sensitivity to oneself, one's family and the community.The residential treatment part of the facility is used to provide therapeutic intervention for individuals who can not or do not function satisfactorily in their own environments. This program is for youth ages 8 and above who are subject to the jurisdiction of the court and who require staff-secure treatment setting for a period of three to eight months.The facility also provides emergency shelter care which is the temporary and safe custody of youth ages eight and older who are subject to the jurisdiction of the court and require the least restrictive out of home placement. These beds are licensed through the Indiana Department of Children Services.The facility closed in late 2011. OTHER PROGRAM SERVICES 8: Jasper County Youth Center - Gibault, Inc. operates a youth center in Rensselaer, Indiana providing child care, preschool and youth programs that focus on cognitive, social, emotional, and physical experiences in a safe and positive learning environment. The child care/preschool center is state licensed.The facility also provides a CASA program (Court Appointed Special Advocates). The program focuses on recruiting, training, supervising and supporting quality volunteers whose mission is to advocate for the timely and safe placement of abused and neglected children. CASA volunteers speak for the best interest of children in the courts and advocate for each child to have a safe, permanent home. OTHER PROGRAM SERVICES 9: Foster care - Gibault, Inc. is developing a foster care program. Gibault, Inc. would oversee the families. Gibault is seeking a married couple who would move into a home owned by Gibault, Inc. to provide foster care to area children in need. The home is designed to be able to comfortably house a large family and is ideal for keeping siblings together while in care.During 2011, Gibault had no placements, but incurred training expenses. OTHER PROGRAM SERVICES 10: Odyssey House - Gibault, Inc. operates the Odyssey House which is a sober living environment for adult males that uses the proven effective methods of the 12 step program. The primary goal of Odyssey House is to successfully transition individuals back into the community with a focus on sober living, employment, education, and family.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.