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
TESSA
Employer identification number
84-0746803
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.") ....
1,973,228
1,475,548
941,010
1,420,228
1,620,524
7,430,538
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..
1,973,228
1,475,548
941,010
1,420,228
1,620,524
7,430,538
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)..
148,777
6
Public Support. Subtract line 5 from line 4.
7,281,761
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..
1,973,228
1,475,548
941,010
1,420,228
1,620,524
7,430,538
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
12,901
14,860
5,468
9,632
9,241
52,102
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..
11,652
9,950
29,718
18,702
8,509
78,531
11
Total support (Add lines 7 through 10).
7,561,171
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
689,610
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
96.305 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
96.065 %
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
TESSA
Employer identification number
84-0746803
Identifier
Return Reference
Explanation
FORM 990, PART III, LINE 1
Mission Continued: WE PURSUE THREE PRIMARY OBJECTIVES TOWARD OUR MISSION: TO PROVIDE IMMEDIATE SAFETY FOR WOMEN AND CHILDREN IN CRISIS. TO EMPOWER SURVIVORS THROUGH SUPPORTIVE SERVICES SUCH AS OUR ADVOCACY, COUNSELING AND CHILDREN'S PROGRAMS. TO CREATE A SAFER COMMUNITY FOR ALL FAMILIES THROUGH EDUCATION AND AWARENESS OUTREACH.
FORM 990, PART III, LINE 4A
SAFEHOUSE CONTINUED: The Safehouse Program provides safe shelter vouchers to adult male victims and their children through collaborations with local hotels. In 2012, TESSA provided 9,401 nights of shelter to 230 adults and 184 children. Staff and trained volunteers provide crisis intervention, information, safety planning, and community referral services to domestic violence and/or sexual assault victims. Approximately 1,000 calls come through the crisis line each month.
FORM 990, PART III, LINE 4B
VICTIM ADVOCACY CONTINUED: Services are provided in a secure and safe environment. Advocacy allows victims to identify options; develop safety plans; receive assistance with temporary protection orders; and acquire information and referrals. Confidential Victim Advocates also provide 24/7 hospital response to victims seeking medical attention due to an incidence of abuse and/or sexual assault. In 2012, TESSA provided advocacy services to 1,781, including hospital call outs to 454 victims. TESSA provides training and education to schools, businesses, community associations, and faith-based organizations. In addition, TESSA staff work closely with many schools in our community to provide education and outreach to teachers, staff and students around interpersonal violence prevention and teen dating violence. In 2012, TESSA reached 4,870 individuals through direct education and over 3,450 at local health fairs and community awareness events.
FORM 990, PART III, LINE 4D
COUNSELING PROGRAM: The Counseling Program staff provide clinical services to victims of domestic violence and/or sexual assault. TESSA's counselors, specifically trained to treat the psychological issues that result from these types of violence, provide individual psychotherapy; psycho-educational support groups for adult victims of domestic violence; and therapeutic support groups for sexual assault and domestic violence survivors. These services encourage participants to work on self-esteem, provide education about healthy vs. unhealthy relationships, and assist in goal setting and problem solving. In 2012, TESSA provided group counseling services to 87 victims and individual counseling services to 115 victims, including those residing in the safehouse. CHILDREN'S PROGRAM: The Children's Program offers therapeutic and non-therapeutic services for children who have witnessed and/or been victims of domestic violence. Available to both children residing in TESSA's safehouse (Residential) and children from the community-at-large (Community), services include: therapy; psycho-educational/age-appropriate support groups; case management; child-specific advocacy; and recreational opportunities. In 2012, TESSA's childrens program provided services to 184 residential children and 96 children from the community.
FORM 990, PART VI, SECTION B, LINE 11
THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS MEETS MONTHLY AND REVIEWS ALL FINANCIAL DOCUMENTS, INCLUDING THE ANNUAL AUDIT AND THE FORM 990.
FORM 990, PART VI, SECTION B, LINE 12C
POTENTIAL NEW BOARD MEMBERS RECEIVE ALL POLICIES BEFORE JOINING THE BOARD. THE BOARD IS ASKED ANNUALLY TO REAFFIRM THAT THEY DO NOT HAVE INTERESTS THAT COULD GIVE RISE TO CONFLICTS OF INTEREST.
FORM 990, PART VI, SECTION B, LINE 15
TESSA USES DATA FROM CANPO (COLORADO ASSOCIATION OF NON PROFIT ORGANIZATIONS) SURVEYS FOR COMPARABILITY OF JOB RESPONSIBILITIES AND COMPENSATION. TESSA STRIVES TO BE IN THE 25TH PERCENTILE OF OUR PEERS (SIZE & SERVICES) FOR ANNUAL SALARY RATES FOR ALL POSITIONS.
FORM 990, PART VI, SECTION C, LINE 19
TESSA'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. CERTAIN DOCUMENTS ARE ALSO AVAILABLE ON THE ORGANIZATION'S WEBSITE.
FORM 990, PART XI, LINE 5
CHANGES IN NET ASSETS: NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS: $64,954
FORM 990, PART XII, LINE 2C
THE EXECUTIVE COMMITTEE ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, REVIEW, AND COMPILATION OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.