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
Cleveland Chiropractic College of LA
Employer identification number
95-2988463
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
CCC KC
446000294
0
Yes
0
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:
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
Cleveland Chiropractic College of LA
Employer identification number
95-2988463
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990, PART III, LINE 1
THE EDUCATION MISSION OF THE INSTITUTION IS TO PREPARE COMPETENT, ENTRY-LEVEL DOCTORS OF CHIROPRACTIC AS PRIMARY HEALTH CARE PROVIDERS. THE FOUNDATION MISSION OF THE INSTITUTION SUPPORTS DEVELOPMENT AND INVESTMENT ACTIVITIES OF CHIROPRACTIC EDUCATION AND SERVICES IN SUPPORT OF CLEVELAND CHIROPRACTIC COLLEGE.
MEMBERS
FORM 990, PART VI, SECTION A, LINE 6
CLEVELAND CHIROPRACTIC COLLEGE, A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF CLEVELAND CHIRIOPRACTIC COLLEGE OF LOS ANGELES.
MEMBERS MAY ELECT GOVERNING BODY
FORM 990, PART VI, SECTION A, LINE 7A
CLEVELAND CHIROPRACTIC COLLEGE, BEING THE SOLE MEMBER OF CLEVELAND CHIROPRACTIC COLLEGE OF LOS ANGELES, HAS THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS.
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PART VI, SECTION A, LINE 7B
CLEVELAND CHIROPRACTIC COLELGE, THE SOLE MEMBER, HAS THE RIGHT TO APPROVE CLEVELAND CHIROPRACTIC COLLEGE OF LOS ANGELES' BYLAWS, ARTICLES OF INCORPORATION, AND ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION A, LINE 10
An independent accounting firm prepares and reviews the 990. The 990 is then reviewed by our officers and accounting personnel of Cleveland Chiropractic College. Any questions and concerns are addressed and any corrections or clarifications that need to be made are made. The 990 is then provided to the Finance Committee of the Board for their review prior to filing the 990. Any questions and concerns are addressed and any corrections or clarifications that need to be made are made. The final 990 with all required schedules is then provided to all voting members of the Board prior to filing.
CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
At the time of hire or election (in the case of Directors) and annually thereafter, the Officers, Directors and Key Employees shall provide the applicable conflict of interest disclosures which shall be completed to identify any relationships, positions, or circumstances in which it is believed a conflict may arise. If a conflict arises, the Officer, Director, or Key Employee abstains from the vote of the conflicted transaction. An appropriate report shall be submitted to the Executive Board concerning any interest disclosed for monitoring.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINES 15A
THE PRESIDENT WAS COMPENSATED BY CLEVELAND UNIVERSITY - KANSAS CITY (CUKC), A RELATED ORGANIZATION. CUKC CONSULTED AN INDEPENDENT FIRM TO PREPARE A COMPENSATION STUDY, WHICH THE INDEPENDENT MEMBERS OF CUKC'S BOARD USED TO REVIEW THE WRITTEN COMPENSATION CONTRACT OF THE PRESIDENT. THE REVIEW PROCESS AND DECISION MAKING REGARDING THE PRESIDENT'S COMPENSATION IS DOCUMENTED BY CUKC.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, SECTION C, LINE 19
The Organization's governinig documents, conflict of interest policy and financial statements are available upon request.
DR. CARL CLEVELAND'S COMPENSATION
FORM 990, PART VII, SECTION A, LINE 1A
DR. CARL CLEVELAND III PARTICIPATES IN A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN. NO ACCRUAL OR PAYMENTS WERE MADE FOR THE FISCAL YEAR ENDING 8/31/12, AND THE PREVIOUSLY ACCRUED PLAN WAS REDUCED BY $63,769.
OTHER CHANGES IN NET ASSETS OR FUND BALANCES
FORM 990, PART XI, LINE 5
UNREALIZED GAINS $ 21,060 TITLE IV EXPENSES (139,428) ---------- TOTAL (118,368) ==========
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Charles A Eddy DC TITLE:DIRECTOR/CHAIRMAN HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Ernst Anrig DC TITLE:DIRECTOR/VICE CHAIRMAN HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Timothy E Meng DC TITLE:DIRECTOR/SECRETARY/TREASURER HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Allen A Ashworth BS TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Daniel Fahnestock DC TITLE:DIRECTOR HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:The Honorable Anna Ho TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JAMES C ANDERSON TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Edward McKenzie DC TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Rosemarie Wilson DC TITLE:DIRECTOR HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:Carl Cleveland III DC TITLE:PRESIDENT HOURS:32
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:ASHLEY CLEVELAND TITLE:PROVOST HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION
FORM 990 PART VII
NAME:JEFFREY D KARP TITLE:COO HOURS:30
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.