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
SOUTHEAST OHIO SIGHT CENTER INC
Employer identification number
31-0855360
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.") ....
129,722
126,373
130,974
148,076
154,069
689,214
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
129,722
126,373
130,974
148,076
154,069
689,214
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.
689,214
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..
129,722
126,373
130,974
148,076
154,069
689,214
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.)..
4,260
4,260
11
Total support (Add lines 7 through 10).
693,474
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
99.390 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
100.000 %
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:
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
2012
Open to Public Inspection
Name of the organization
SOUTHEAST OHIO SIGHT CENTER INC
Employer identification number
31-0855360
Identifier
Return Reference
Explanation
OTHER EXPENSES
FORM 990-EZ, PART I, LINE 16
EXPENSES SUPPLIES 4,145 COMMUNICATIONS 4,006 TRAVEL 5,845 DEPRECIATION 2,890 COST OF VISUAL AIDS 25,354 TOTAL 42,240
OTHER ASSETS
FORM 990-EZ, PART II, LINE 24
ACCOUNTS RECEIVABLE 2,357 5,578 LEASEHOLD IMPROVEMENTS 12,564 12,564 LESS ACCUMULATED DEPRECIATION 12,564 12,564 COMPUTERS 1,460 1,460 LESS ACCUMULATED DEPRECIATION 1,338 1,460 FURNITURE, FIXTURES AND EQUIPMENT 17,228 17,228 LESS ACCUMULATED DEPRECIATION 8,228 10,228 CCTV 3,840 3,840 LESS ACCUMULATED DEPRECIATION 384 1,152 TOTAL 14,935 15,266
THE PURPOSE OF THE CENTER IS TO PROMOTE INDEPENDENT LIVING SKILLS FOR CLIENTS WHO ARE LEGALLY BLIND OR SEVERELY VISUALLY IMPAIRED AND ALSO TO PREVENT VISION LOSS THROUGH VISION SCREENINGS AND PUBLIC EDUCATION.
FIRST ACCOMPLISHMENT
FORM 990-EZ, PART III, LINE 28
INDEPENDENT LIVING ACCOMPLISHMENTS SOUTHEAST OHIO SIGHT CENTER INDEPENDENT LIVING PROGRAM GOAL IS: TO PROMOTE INDEPENDENT LIVING SKILLS FOR CONSUMERS WHO ARE BLIND OR SEVERELY VISUALLY IMPAIRED. THIS IS ACCOMPLISHED THROUGH PROVIDING EVALUATIONS, LOW VISION AND ADAPTIVE AIDS, AND TRAINING SO OUR CONSUMERS CAN REMAIN IN THEIR HOMES AND FUNCTION SAFELY AND INDEPENDENTLY. SIMPLE THINGS LIKE COOKING, READING RECIPES, IDENTIFYING A CAN OF SOUP, OR MANAGING MEDICATIONS CAN BECOME A STRUGGLE. SOMETIMES THESE ISSUES BECOME MORE CRITICAL TO OUR CONSUMERS' HEALTH, FOR EXAMPLE: ACCURATELY DRAWING INSULIN SYRINGES TO MANAGE BLOOD SUGAR LEVELS. OUR CONSUMERS DESIRE TO MAINTAIN THESE LIFE SKILLS AND WE WANT TO BE THE SOLUTION TO THEIR EVERYDAY PROBLEMS. THE AGENCY PROVIDED THE FOLLOWING OUTCOMES/IMPACTS TO ITS CONSUMERS: 1) MAINTAINED INDEPENDENCE, 2) REGAINED INDEPENDENCE, AND 3) INCREASED SOCIALIZATION. THE AGENCY CONTINUED TO SECURE FUNDING FROM THE OHIO REHABILITATION SERVICES COMMISSION, UNITED WAY OF FAIRFIELD AND HOCKING COUNTIES, FAIRFIELD COUNTY FOUNDATION, ATHENS COUNTY FOUNDATION AND LOCAL INTEREST GROUPS. THE FUNDING FROM THE TWO FOUNDATIONS ALLOWED THE AGENCY TO INCREASE THE NUMBER OF VIDEO MAGNIFICATION LOANED TO CONSUMERS OF THE ENRICHMENT PROGRAM. THE SOUTHEAST OHIO SIGHT CENTER SERVED 284 CONSUMERS IN 2012. 96 WHO HAD INDEPENDENT LIVING CASES WERE SERVED THROUGH THE OHIO REHABILITATION SERVICES COMMISSION. THE CONSUMERS RECEIVED EVALUATIONS, REHABILITATION TEACHING, LOW VISION AIDS AND ADAPTIVE AIDS, WITH GOALS AND OBJECTIVES ACCOMPLISHED SUCCESSFULLY. THE REMAINDER OF THE CONSUMERS WERE SERVED IN VARIOUS WAYS THROUGH OTHER SOURCES OF FUNDING: 48 WERE TRANSFERRED TO OTHER AGENCIES TO BE SERVED, 44 CLOSED FROM REFERRAL FROM SOSC, BUT GIVEN INFORMATION ON POSSIBLE SERVICES FROM OTHER AGENCIES, 38 CONSUMERS PURCHASED AIDS FROM SOSC WITHOUT TRAINING, 78 RECEIVED INFORMATION PERTINENT TO THEIR NEEDS, 8 RECEIVED INFORMATION CONCERNING THE TALKING BOOKS PROGRAM. THESE CONSUMERS HAD VARIOUS DIAGNOSES: MACULAR DEGENERATION: 67.2%STROKE: 3.8% GLAUCOMA: 2.3% RETINITIS PIGMENTOSA: 2.3% CATARACTS: 4.2%HISTOPLASMOSIS: 6.8% DIABETIC RETINOPATHY: 6.4% 39% OF OUR CONSUMERS WERE FROM FAIRFIELD COUNTY, WITH 61% OF ALL THE REFERRALS WERE FROM OTHER SOUTHEASTERN COUNTIES THE AGENCY SERVES. WITH REGARDS TO OUTCOMES, 96 CONSUMERS WERE SERVED AND CLOSED WITH COMPLETE INDEPENDENT LIVING PLANS. AFTER AGENCY SERVICES, 82% OF THE CONSUMERS HAD IMPROVED THEIR INDEPENDENCE AND 52% FELT SAFER IN THEIR ENVIRONMENT. PREVENTION PROGRAM ACCOMPLISHMENTS THE GOAL OF THE PREVENTION PROGRAM IS TO SCREEN FOR UNDETECTED EYE CONDITIONS POSSIBLY AFFECTING CHILDREN AND ADULTS. WITHOUT EARLY DETECTION WE ARE SETTING CHILDREN UP FOR FAILURE IN SCHOOL AND AT HOME. 80% OF LEARNING IN A CHILD'S FIRST 12 YEARS COMES THROUGH THE EYES AMBLYOPIA WHICH AFFECTS 3 PERCENT OF ALL CHILDREN IS RESPONSIBLE FOR MORE LOSS OF VISION IN PEOPLE AGE 45 AND YOUNGER THAN ALL OTHER EYE DISEASES AND TRAUMA COMBINED. ALL CHILDREN REFERRED ARE CONTACTED BY THE PREVENTION COORDINATOR. IF A CHILD'S PARENTS CANNOT AFFORD EYEGLASSES OR AN EYE EXAM THE PREVENTION COORDINATOR CAN REFER THESE FAMILIES TO "SIGHT FOR STUDENTS" A PREVENT BLINDNESS OHIO PROGRAM. CURRENTLY THE SOUTHEAST OHIO SIGHT CENTER IS THE ONLY ENTITY PROVIDING VISION SCREENINGS AT THE PRE-SCHOOL LEVEL AND FOR ADULTS THROUGHOUT FAIRFIELD COUNTY. THE AGENCY IS NOT ONLY PROVIDING SCREENINGS BUT IMPLEMENTING EDUCATION AND OUTREACH TO THE COMMUNITY. THE AGENCY CONTINUED ITS COLLABORATION WITH PREVENT BLINDNESS OHIO'S VISION CARE OUTREACH PROGRAM. THIS PROGRAM ENABLES THE AGENCY TO BE A LIAISON FOR ADULT INDIVIDUALS THAT NEED EYE CARE AND EYEGLASSES IN FAIRFIELD COUNTY. WE WERE ABLE TO SERVE 5 CLIENTS IN THIS PROGRAM. THE AGENCY WITH A GRANT FROM THE GORDON FLESCH FOUNDATION ESTABLISHED A NEW PROGRAM, VISION CARE SOLUTIONS, WHICH COVERS THE COST OF EYE EXAMS AND EYE GLASSES FOR ALL CHILDREN UNDER 18 YEARS OLD WHO CANNOT AFFORD SUCH PREVENTION. THE PREVENTION PROGRAM CONTINUES TO SECURE FUNDING THROUGH FAIRFIELD COUNTY UNITED WAY, LIONS CLUBS AND OTHER LOCAL INTEREST GROUPS. THE FOLLOWING UNITS OF SERVICES WERE COLLECTED FOR 2012 WITH 74% PRESCHOOL CHILDREN RECEIVING CARE AND 25% OF ADULTS RECEIVED CARE. PREVENTION PROGRAM PRESCHOOL CHILDREN SCREENED 366 CHILDREN REFERRED 23 - 17 RECEIVED CARE ADULTS SCREENED 122 ADULTS REFERRED 32 - 8 RECEIVED CARE VISION CARE OUTREACH VISION CARE SOLUTIONS 51 TOTALS 492 SCREENED 55 REFERRED 6 PARTICIPATES IN OTHER PROGRAMS
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.