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
NATIONAL MULTIPLE SCLEROSIS SOCIETY MID-AMERICA CHAPTER
Employer identification number
44-0613436
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.") ....
3,258,342
2,970,312
2,756,778
3,316,977
4,171,690
16,474,099
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..
3,258,342
2,970,312
2,756,778
3,316,977
4,171,690
16,474,099
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)..
91,741
6
Public Support. Subtract line 5 from line 4.
16,382,358
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..
3,258,342
2,970,312
2,756,778
3,316,977
4,171,690
16,474,099
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
17,848
4,653
3,659
1,683
461
28,304
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..
526
0
96
49,238
309,300
359,160
11
Total support (Add lines 7 through 10).
16,861,563
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
552,291
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
97.158 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
99.370 %
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
NATIONAL MULTIPLE SCLEROSIS SOCIETY MID-AMERICA CHAPTER
Employer identification number
44-0613436
Identifier
Return Reference
Explanation
SIGNIFICANT NEW PROGRAM SERVICES
FORM 990, PART III, LINE 2
The Chapter was formed on October 1, 2011, as the result of a merger between two existing National Multiple Sclerosis Chapters: Nebraska Chapter and Mid America Chapter. Both of these entities shared the common mission of providing services to people with multiple sclerosis, support multiple sclerosis research through its national organization and educate the public about the impact of multiple sclerosis.
PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4D
Community Programs includes networking and collaborating with other community organizations that can and do have an impact on those affected by multiple sclerosis, including programs designed to detect disease or health problems, planning and improving community health practices, supporting clinics or other public health facilities, conducting rehabilitative and similar-type programs, plus all other expenses incurred in performing functions which, directly or indirectly, benefit the multiple sclerosis community. Total expenses: $605,813. Public Education - represents programs conducted for the purpose of informing and educating the general public about multiple sclerosis and its effects, the distribution of literature and other materials designed to increase the publics awareness and knowledge about this disease, including complexity and variety of symptoms or physical conditions, plus all other costs or expenses which directly relate to the performance of health educational service. Total expenses: $334,970. Professional education and training represents activities or programs designed to improve the knowledge, skills and critical judgment of physicians and other healthcare professionals engaged (directly or indirectly) in providing client services by keeping them abreast of new diagnostic techniques, therapies, etc. Total expenses: $109,433.
SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS
FORM 990, PART VI, SECTION A, LINE 4
On October 1, 2011, the former Nebraska Chapter realigned and merged with the Mid-America Chapter. Organizational documents and by-laws were revised accordingly to reflect the realignment.
FORM 990 REVIEW PROCESS
FORM 990, PART VI, SECTION B, LINE 11B
AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE CHAPTER'S OFFICERS WITH ANY CORRECTIONS OR CLARIFICATIONS BEING ADDRESSED PRIOR TO THE AUDIT COMMITTEE REVIEW. THE CHAPTER'S AUDIT COMMITTEE REVIEWS AND APPROVES THE FORM 990 PRIOR TO DISTRIBUTION TO THE ENTIRE BOARD. A COPY OF THE 990 FORM AND ACCOMPANYING SCHEDULES IS PROVIDED TO THE ENTIRE BOARD WITH A PERIOD FOR PROVIDING COMMENTS, EDITS OR CORRECTIONS PRIOR TO SUBMISSION TO THE IRS.
CONFLICT OF INTEREST POLICY
FORM 990, PART VI, SECTION B, LINE 12C
ON AN ANNUAL BASIS, THE AUDIT COMITTEE REVIEWS THE CODE OF CONDUCT FORMS FILED BY DIRECTORS, OFFICERS AND EMPLOYEES FOR POTENTIAL CONFLICTS. WHERE POTENTIAL CONFLICTS EXIST, THE DIRECTOR, OFFICER OR EMPLOYEE IS NOT ALLOWED TO PARTICIPATE IN ANY VOTE AND TRANSACTIONS ARE SUBJECT TO COMPETITIVE BIDDING. AT THE CURRENT TIME, NO POTENTIAL CONFLICTS OF INTEREST HAVE BEEN IDENTIFIED.
COMPENSATION REVIEW
FORM 990, PART VI, SECTION B, LINES 15A & B
THE COMPENSATION COMMITTEE WHICH IS COMPRISED OF AT LEAST THREE BUT NO MORE THAN FIVE INDEPENDENT DIRECTORS DETERMINES THE COMPENSATION OF THE PRESIDENT AND OTHER KEY EMPLOYEES. THE NATIONAL ORGANIZATION PROVIDES EACH CHAPTER WITH COMPARABLE SALARY DATA FOR PRESIDENTS AT NATIONAL MULTIPLE SCLEROSIS SOCIETY CHAPTERS AND OTHER VOLUNTARY HEALTH AGENCIES OF SIMILAR BUDGET SIZE(S) AND GEOGRAPHICAL LOCATION(S). IN ADDITION, THE PRESIDENT'S PERFORMANCE IS EVALUATED ANNUALLY IN A JOINT REVIEW PROCESS BY THE NATIONAL ORGANIZATION'S CEO OR HER DESIGNEE AND THE LOCAL COMMITTEE OF INDEPENDENT DIRECTORS. THE PRESIDENT CONDUCTS PERFORMANCE EVALUATIONS FOR THE OTHER KEY EMPLOYEES AND DETERMINES THEIR COMPENSATION, WHICH IS SUBMITTED TO THE COMPENSATION COMMITTEE FOR REVIEW.
AVAILABILITY OF DOCUMENTS
FORM 990, PART VI, SECTION C, LINE 19
THE CHAPTER'S GOVERNING DOCUMENTS AND CODE OF CONDUCT FORMS ARE AVAILABLE UPON REQUEST. THE CHAPTER'S FORM 990, AND FINANCIAL STATEMENTS ARE AVAILABLE ON THE CHAPTER'S WEBSITE AND WILL ALSO BE PROVIDED IN A HARD COPY FORMAT UPON REQUEST. THE BOOKS AND RECORDS OF THE ORGANIZATION ARE LOCATED AT THE NATIONAL MULTIPLE SCLEROSIS SOCIETY, MID-AMERICA CHAPTER, 7611 STATE LINE ROAD SUITE 100, KANSAS CITY, MO 64114. 913-432-3926
OTHER CHANGES IN NET ASSETS
FORM 990, PART XI, LINE 5
NEBRASKA CHAPTER MERGER $108,106
CHANGE IN OVERSIGHT PROCESS
FORM 990, PART XII, LINE 2C
The Mid-America Chapter selected new auditors for fiscal year 2012.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.