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
2012
Open to Public Inspection
Name of the organization
Delphi Schools Inc
Employer identification number
93-0630376
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 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 monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
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—2011.
If the organization did not check a 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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
Additional Data
Software ID:
12000229
Software Version:
2012v2.0
-
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
2012
Open to Public Inspection
Name of the organization
Delphi Schools Inc
Employer identification number
93-0630376
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
Yes
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
No
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) 2012
Schedule E (Form 990 or 990EZ) 2012
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
THE ORGANIZATION HAS PUBLISHED NOTICE STATING ITS RACIALLY NONDISCRIMINATORY POLICY IN THE REQUIRED FORM, IN NEWSPAPERS OF GENERAL CIRCULATION, AND AT LEAST ONCE ANNUALLY (BUT IN ALL EVENTS, DURING ITS REGISTRATION PERIODS).
Schedule E (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000229
Software Version:
2012v2.0
-
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
2012
Open to Public Inspection
Name of the organization
Delphi Schools Inc
Employer identification number
93-0630376
Identifier
Return Reference
Explanation
Delphi-Phocis Merger
PHOCIS, INC., AND DELPHI SCHOOLS, INC., BOTH OREGON NONPROFIT PUBLIC BENEFIT CORPORATIONS QUALIFIED AS TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE OF 1986, BY ACTION OF THE RESPECTIVE BOARD OF DIRECTORS ON MAY 24, 2012, MERGED EFFECTIVE JUNE 30, 2012 ("DSI-PHOCIS MERGER"). THE DSI-PHOCIS MERGER WAS STRUCTURED AS A SO-CALLED "A REORGANIZATION" UNDER SECTION 368(A)(1)(A) OF THE INTERNAL REVENUE CODE OF 1986, AND WAS PURSUANT TO OREGON REVISED STATUTES 65.481 AND OREGON REVISED STATUTES 65.487. AS REFLECTED BY THE ATTACHED CERTIFIED ARTICLES OF MERGER, DELPHI SCHOOLS, INC., WAS THE SURVIVING CORPORATION OF THE DSI-PHOCIS MERGER, AND:(A) DELPHI SCHOOLS, INC.'S ARTICLES OF INCORPORATION AND BYLAWS AT THE TIME OF THE DSI-PHOCIS MERGER ON JUNE 30, 2012, SUBSEQUENTLY CONTINUED TO BE THE ARTICLES OF INCORPORATION AND BYLAWS FOR DELPHI SCHOOLS, INC., AS THE SURVIVING CORPORATION.(B) DELPHI SCHOOLS, INC.'S BOARD OF DIRECTORS AT THE TIME OF THE DSI-PHOCIS MERGER ON JUNE 30, 2012, SUBSEQUENTLY CONTINUED TO BE THE BOARD OF DIRECTORS FOR DELPHI SCHOOLS, INC., AS THE SURVIVING CORPORATION.(C) ALL PROPERTY, BOTH REAL AND PERSONAL, BELONGING TO PHOCIS, INC., ON JUNE 30, 2012, WAS, PURSUANT TO THE DSI-PHOCIS MERGER, AUTOMATICALLY TRANSFERRED TO, AND VESTED IN, DELPHI SCHOOLS, INC., EFFECTIVE JUNE 30, 2012, WITHOUT FURTHER ACT OR DEED.(D) DELPHI SCHOOLS, INC., RECEIVED, TOOK POSSESSION OF, AND IN ALL RESPECTS POSSESSED, PURSUANT TO THE DSI-PHOCIS MERGER, ALL OF THE PROPERTY INTERESTS, ASSETS, RIGHTS, PRIVILEGES, IMMUNITIES, AND FRANCHISES, WHETHER PUBLIC OR PRIVATE IN NATURE, BELONGING TO PHOCIS, INC., EFFECTIVE JUNE 30, 2012.(E) DELPHI SCHOOLS, INC., BECAME RESPONSIBLE FOR, PURSUANT TO THE DSI-PHOCIS MERGER, ALL LIABILITIES OF PHOCIS, INC., EFFECTIVE JUNE 30, 2012.IMMEDIATELY PRIOR TO THE DSI-PHOCIS MERGER, THE BALANCE SHEET OF PHOCIS, INC., AS MIGHT HAVE OTHERWISE BEEN REFLECTED BY PHOCIS, INC.'S 2012 FORM 990, PART X, COLUMN (B), WAS AS FOLLOWS (FOR THE PURPOSES OF PHOCIS, INC.'S 2012, FORM 990, ALL ASSETS AND LIABILITIES OF PHOCIS, INC., AT JUNE 30, 2012, ARE TREATED FOR FINANCIAL AND TAX PURPOSES AS HAVING BEEN CONTRIBUTED BY PHOCIS, INC., TO DELPHI SCHOOLS, INC. (SEE SCHEDULE N)(SEE BALANCE SHEET ATTACHMENT).
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Delphi Schools, Inc., makes its governing documents, conflicts-of-interest policy, and/or financial statements available to the public only as required by Federal and State law.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
DELPHI SCHOOLS, INC., HAS A COMPENSATION POLICY THAT ENSURES AGAINST PAYMENTS IN EXCESS OF REASONABLE COMPENSATION TO ITS OFFICERS, DIRECTORS, AND KEY EMPLOYEES -- THAT IS, AGAINST PAYMENTS IN EXCESS OF COMPENSATION AMOUNTS THAT WOULD ORDINARILY BE PAID FOR LIKE SERVICES BY A LIKE ORGANIZATION UNDER LIKE CIRCUMSTANCES. IN ADDITION, THE CORPORATION'S CONFLICTS-OF-INTEREST POLICY REQUIRES PERIODIC REVIEW BY THE BOARD OF DIRECTORS TO ENSURE THAT COMPENSATION ARRANGEMENTS AND BENEFITS FOR THE CORPORATION'S OFFICERS, DIRECTORS, AND KEY EMPLOYEES DO NOT EXCEED LEVELS THAT ARE REASONABLE, BASED ON INDEPENDENT COMPENSATION CONSULTANT'S WRITTEN ANALYSIS, INDEPENDENT LEGAL COUNSEL REVIEW, AND ARM'S-LENGTH BARGAINING.THE COMPENSATION REVIEW PROCESS DESCRIBED ABOVE WAS COMPLETED FOR THE FOLLOWING INDIVIDUALS: GREGORY OTT 2006 ROSEMARY DIDEAR 2006 JOHN NOSKO 2006 ALAN ROTHE 2006 SUSAN OTT 2006
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
DELPHI SCHOOLS, INC., HAS A CONFLICTS-OF-INTEREST POLICY AND A WHISTLE BLOWER POLICY, WHICH TOGETHER ENSURE THAT ANY MEMBER OF THE CORPORATION'S BOARD OF DIRECTORS (OR ANY COMMITTEE OF THE BOARD OF DIRECTORS), AND/OR ANY OFFICER, EMPLOYEE, FIDUCIARY, OR AGENT OF THE CORPORATION (COLLECTIVELY "INTERESTED PERSON"), WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST (A DEFINED TERM, WHICH INCLUDES ALL CIRCUMSTANCES IN WHICH AN INTERESTED PERSON MAY PROFIT FROM AN ACTION OR DECISION BY THE CORPORATION IN WHICH THE INTERESTED PERSONNEL PARTICIPATES, AND OF WHICH HE OR SHE HAS KNOWLEDGE) IN A TRANSACTION OR ACTIVITY, DISCLOSES THE EXISTENCE OF THE FINANCIAL INTEREST. SUCH DISCLOSURE MUST BE MADE TO THE BOARD OF DIRECTORS (OR IT'S APPROPRIATE COMMITTEE) WHICH, IN TURN, MUST MAKE A DECISION ON WHETHER A CONFLICT EXISTS, AND IF IT DOES, WHETHER THE SUBJECT TRANSACTION OR ACTIVITY IS IN THE CORPORATION'S BEST INTEREST, IS FOR THE CORPORATION'S BENEFIT, AND IS FAIR AND REASONABLE. VIOLATIONS RESULT IN APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION. ALL INTERESTED PERSONS SIGN ANNUAL STATEMENTS ATTESTING TO THEIR COMPLIANCE WITH THE CORPORATION'S CONFLICTS-OF-INTEREST POLICY. ALL MEMBERS OF THE BOARD OF DIRECTORS, AND ALL OFFICERS, EMPLOYEES, FIDUCIARIES, AND AGENTS OF THE CORPORATION, ARE ALSO PROVIDED WITH A COPY OF THE CORPORATION'S CONFLICTS-OF-INTEREST POLICY AND WHISTLE BLOWER POLICY.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
The Form 990 is reviewed by the corporation's management, legal counsel, and board of directors.
Form 990, Part VI, Line 2
Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et
See Schedule L Part IV
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.