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
ROTARY CLUB OF DES MOINES FOUNDATION
Employer identification number
42-1194017
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.") ....
59,154
75,745
86,437
91,279
62,841
375,456
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..
59,154
75,745
86,437
91,279
62,841
375,456
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.
375,456
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..
59,154
75,745
86,437
91,279
62,841
375,456
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
30,798
21,481
4,076
22,862
26,089
105,306
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).
480,762
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
78.100 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
78.610 %
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
0 %
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
0 %
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:
11000218
Software Version:
2011.0.0
-
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
ROTARY CLUB OF DES MOINES FOUNDATION
Employer identification number
42-1194017
Identifier
Return Reference
Explanation
Form 990 Part III
2
In honor of the 100th anniversary of the Rotary Club of Des Moines, the Foundation took on the special project of raising funds for the World Food Prize Foundation. This project will not be an on-going project.
Form 990 Part VI
6 7
The organization is made up of members of the Rotary Club of Des Moines. These members appoint members to the governing body of the Foundation.
Form 990 Part VI
11b
Form 990 is prepared from the Foundations Financial statements subject to agreed upon procedures by a qualified tax preparer or firm. The RCDM Audit Committee and Executive Director review Form 990 with the tax preparer prior to the review by the Foundation Board of Directors. A representative of the Audit Committee or other qualified member presents Form 990 to the Foundation Board of Directors prior to submission to the IRS.
Form 990 Part VI
12c
All board members of the RCDM Foundation and the executive director are required to complete a written disclosure of any known conflicts of interest including business and family relationship conflicts. The annual disclosure forms are monitored by the club officers and executive director. The Foundation monitors potential conflicts of interest for ongoing transactions by calling for any potential conflicts at the beginning of each agenda. The full Foundation board determines whether a conflict exists and reviews any actual conflicts that do arise. Any persons with a potential or actual conflict are requested to recuse themselves from the discussion of and vote on the matter.
Form 990 Part VI
15 a b
The RCDM Audit committee includes analysis of the management services provided by the club to the Foundation in its annual compensation review. RCDM provides the Foundation with its procedures for determining the compensation of the executive director and a management charge is made by the RCDM for the services of the executive director to the Foundation.
Form 990 Part VI
19
The following Foundation documents are made available on the Foundation pages of the RCDM website Form 990, organizations mission statement, organizations board of directors, bylaws, constitution, code of ethics policy, conflict of interest policy and whistleblower policy.
Form 990 Part XI
5
Unrealized gain or loss at year end has been added to the net assets of the Foundation and included in the year end fund balances.
Form 990 Part XII
2c
The RCDM audit committee is comprised of members with expertise in accounting and finance. The RCDM Audit Committee assumes responsibility for oversight of the Foundations financial statements, annual agreed upon procedures, selection of the individual or form and preliminary review of Form 990. The RCDM audit committee has performed a thorough review of the Foundations policies and procedures and the recommendations it provides to the Foundation Board of Directors.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 12,467, Grants and allocations 8,500, Revenue 0 Police, Firefighter teacher awards to annually recongize community leaders.
Form 990 Part III Program Service Accomplishments
Line 4d Other Activities
Program Service Expenses 4,175, Grants and allocations 4,175, Revenue 0 Funds are raised to provide food baskets or grocery gift cards at Thanksgiving time to underprivileged families in the Des Moines community.
Form 990, Part III, Line 4d Program Service Expenses 12,467, Grants and allocations 8,500, Revenue 0 Police, Firefighter teacher awards to annually recongize community leaders. Form 990, Part III, Line 4d Program Service Expenses 4,175, Grants and allocations 4,175, Revenue 0 Funds are raised to provide food baskets or grocery gift cards at Thanksgiving time to underprivileged families in the Des Moines community. Form 990 Part III Line 2 In honor of the 100th anniversary of the Rotary Club of Des Moines, the Foundation took on the special project of raising funds for the World Food Prize Foundation. This project will not be an on-going project. Form 990 Part VI Section A Line 6 7 The organization is made up of members of the Rotary Club of Des Moines. These members appoint members to the governing body of the Foundation. Form 990 Part VI Section B Line 11b Form 990 is prepared from the Foundations Financial statements subject to agreed upon procedures by a qualified tax preparer or firm. The RCDM Audit Committee and Executive Director review Form 990 with the tax preparer prior to the review by the Foundation Board of Directors. A representative of the Audit Committee or other qualified member presents Form 990 to the Foundation Board of Directors prior to submission to the IRS. Form 990 Part VI Section B Line 12c All board members of the RCDM Foundation and the executive director are required to complete a written disclosure of any known conflicts of interest including business and family relationship conflicts. The annual disclosure forms are monitored by the club officers and executive director. The Foundation monitors potential conflicts of interest for ongoing transactions by calling for any potential conflicts at the beginning of each agenda. The full Foundation board determines whether a conflict exists and reviews any actual conflicts that do arise. Any persons with a potential or actual conflict are requested to recuse themselves from the discussion of and vote on the matter. Form 990 Part VI Section B Line 15 a b The RCDM Audit committee includes analysis of the management services provided by the club to the Foundation in its annual compensation review. RCDM provides the Foundation with its procedures for determining the compensation of the executive director and a management charge is made by the RCDM for the services of the executive director to the Foundation. Form 990 Part VI Section C Line 19 The following Foundation documents are made available on the Foundation pages of the RCDM website Form 990, organizations mission statement, organizations board of directors, bylaws, constitution, code of ethics policy, conflict of interest policy and whistleblower policy. Form 990 Part XI Line 5 Unrealized gain or loss at year end has been added to the net assets of the Foundation and included in the year end fund balances. Form 990 Part XII Line 2c The RCDM audit committee is comprised of members with expertise in accounting and finance. The RCDM Audit Committee assumes responsibility for oversight of the Foundations financial statements, annual agreed upon procedures, selection of the individual or form and preliminary review of Form 990. The RCDM audit committee has performed a thorough review of the Foundations policies and procedures and the recommendations it provides to the Foundation Board of Directors.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.