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
DICKINSON IRON COMMUNITY SERVICES AGENCY
Employer identification number
38-2889846
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.") ....
2,828,686
3,405,191
4,712,091
4,229,390
3,197,103
18,372,461
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
274,736
301,452
328,382
287,554
1,192,124
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
3,103,422
3,706,643
5,040,473
4,516,944
3,197,103
19,564,585
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.
19,564,585
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..
3,103,422
3,706,643
5,040,473
4,516,944
3,197,103
19,564,585
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,780
1,432
1,283
988
5,483
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
4,691
4,691
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
636,716
731,191
214,342
708,236
2,290,485
11
Total support (Add lines 7 through 10).
21,865,244
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
920,481
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
89.480 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
87.170 %
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
DICKINSON IRON COMMUNITY SERVICES AGENCY
Employer identification number
38-2889846
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
TO DEVELOP & PROVIDE RESOURCES FOR THE PURPOSE OF ASSISTING LOW-INCOME, ELDERLY, HANDICAPPED AND DISADVANTAGED YOUTH THROUGH A VARIETY OF PROGRAMS. AS A COMMUNITY ACTION AGENCY, IT IS THE MISSION OF THE DICKINSON IRON COMMUNITY SERVICES AGENCY TO FOCUS AND COORDINATE ALL AVAILABLE RESOURCES UPON THE GOAL OF ENABLING INDIVIDUALS TO ATTAIN THE OPPORTUNITIES TO BECOME SELF-SUFFICIENT, THEREBY IMPROVING THEIR QUALITY OF LIFE. TO THIS END, DICKINSON IRON COMMUNITY SERVICES AGENCY WILL SPONSOR A VARIETY OF PROGRAMS AND SERVICES INTENDED TO PROMOTE SELF-DETERMINATION AND INDEPENDENCE FOR EVERYONE IN OUR COMMUNITY.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
PROVIDES HOMEMAKING, HOMECARE ASSISTANCE (PERSONAL CARE), RESPITE CARE AND HOME INJURY EQUIPMENT TO PARTICIPANTS IN DICKINSON AND IRON COUNTIES. DICSA'S SERVICE AREA INCLUDES THE CITIES AND VILLAGES OF IRON MOUNTAIN, KINGSFORD, NORWAY, QUINNESEC, FELCH, HARWOOD, RALPH, SAGOLA, CRYSTAL FALLS, IRON RIVER, STAMBAUGH, AND GAASTRA. 97 PARTICIPANTS WERE SERVED THROUGH THE IN-HOME PROGRAM. HOME DELIVERED MEAL PROGRAM SERVES DICKINSON, IRON AND BARAGA COUNTIES AND DELIVERED 60,388 MEALS. PERSONS QUALIFY FOR THE MEAL IF THEY ARE 60 YEARS OF AGE OR OLDER, UNABLE TO LEAVE THEIR HOME, UNABLE TO PREPARE THEIR OWN MEALS OR HAVE NO OTHER ACCESS TO A NUTRITIONALLY BALANCED MEAL. CONGREGATE MEAL PROGRAM PROVIDED 62,211 MEALS TO INDIVIDUALS 60 YEARS OF AGE OR OLDER IN DICKINSON, IRON AND BARAGA COUNTIES. THE PROGRAM ALSO PROVIDES AN OPPORTUNITY FOR SOCIALIZATION AND OBTAINING INFORMATION ABOUT OTHER SERVICES AVAILABLE IN THE AREA.
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
HOUSING SERVICES COMMUNITY DEVELOPMENT BLOCK GRANT THE CDBG PROGRAM PROVIDED HOUSING REHABILITATION SERVICES TO 2 INCOME ELIGIBLE HOMEOWNERS IN DICKINSON AND IRON COUNTIES. UPGRADES TO THE HOME MAY INCLUDE FURNACE, ROOF, PLUMBING AND ELECTRICAL REPAIRS. THE HOME IS BROUGHT UP TO MSHDA HOUSING QUALITY STANDARDS. EMERGENCY REPAIRS TO FURNACES, ROOFS AND WATER HEATERS ARE ALSO PROVIDED. EXPENSES 79,235 INCLUDING GRANTS OF 27,907. REVENUE 13,526. HOME PURCHASE REHABILITATION AND DOWN PAYMENT ASSISTANCE HELPS INCOME ELIGIBLE HOUSEHOLDS WITH DOWN PAYMENT AND COLSING COSTS RELATED TO THE PURCHASE OF A HOME, AND ALSO MAKES SOME FUNDS AVAILABLE FOR MODERATE REHABILITATION TO THE HOME. EXPENSES 231,452 INCLUDING GRANTS OF 228,942. REVENUE 6,631. COMMUNITY SERVICES THE EMERGENCY FOOD ASSISTANCE PROGRAM TEFAP IS DESIGNED TO PROVIDE FOOD AT NO COST TO LOW-INCOME RESIDENTS OF DICKINSON AND IRON COUNTIES. THE FOOD IS PROVIDED BY THE UNITED STATES DEPARTMENT OF AGICULTURE AND IS DISTRIBUTED UP TO FOUR TIMES A YEAR. 1,130 FAMILIES RECEIVED THIS FOOD. EXPENSES 107,117. INCLUDING GRANTS OF 107,117. REVENUE 0. ALL OTHER PROGRAM SERVICES EXPENSES 406,868. INCLUDING GRANTS OF 191,114. REVENUE 336,711.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF FORM 990 IS PROVIDED TO THE FULL BOARD AND TIME IS ALLOTED AT A FULL BOARD MEETING FOR QUESTIONS TO BE ANSWERED BY THE FINANCIAL DIRECTOR AND EXECUTIVE DIRECTOR BEFORE FILING.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE BOARD OF DIRECTORS APPROVES COMPENSATION FOR EXECUTIVE DIRECTOR AND TOP MANAGEMENT POSITIONS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
THE BOARD OF DIRECTORS APPROVES COMPENSATION FOR EXECUTIVE DIRECTOR AND TOP MANAGEMENT POSITIONS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION MAKES ALL GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.