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
CENTER FOR HEALTH & LEARNING LTD
Employer identification number
03-0351024
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.") ....
644,948
666,731
623,161
623,317
370,478
2,928,635
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
644,948
666,731
623,161
623,317
370,478
2,928,635
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)..
0
6
Public support. Subtract line 5 from line 4.
2,928,635
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..
644,948
666,731
623,161
623,317
370,478
2,928,635
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
24
136
256
183
608
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
0
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
650
932
150
300
30
2,062
11
Total support (Add lines 7 through 10).
2,931,305
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
99.910 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
99.900 %
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 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
CENTER FOR HEALTH & LEARNING LTD
Employer identification number
03-0351024
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
No documents available to the public.
Form 990, Part VI, Line 18
Form 990, Part VI, Line 18: Explanation of Other Means Forms Available For Public Inspection
GOVERNING DOCUMENTS, POLICIES AND PROCEDURES AND FINANCIAL STATEMENTS WILL BE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
Form 990, Part VI, Line 15a
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management
THE BOARD OF DIRECTORS PERFORMS AN ANNUAL REVIEW OF THE EXECUTIVE DIRECTOR AND UTILIZES THIRD-PARTY LEADERSHIP CONSULTANTS FOR ASSISTANCE IN LEADERSHIP DEVELOPMENT.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
No review was or will be conducted.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: OTHER PROGRAM SERVICES 5: ADAP - CONDUCTED SIX STATEWIDE TRAININGS AS A PREVENTION SERIERS FOR COMMUNITY-LEVEL WORK AIMED AT SUBSTANCE ABUSE PREVENTION, COMMUNITY DEVELOPMENT AND COALITION SUSTAINABILITY. ALSO COORDINATED THE STATEWIDE COLLEGE SYMPOSIUM ON HIGH-RISK DRINKING ON COLLEGE CAMPUSES AND ADMINISTERED THE PREVENTION WORKS! COALITION PARTNERSHIP PROGRAM FOR VERMONT DEPARTMENT OF HEALTH, ALCOHOL AND DRUG ABUSE PROGRAMS. OTHER PROGRAM SERVICES 6: SPE - COMPLETED A STATEWIDE ASSESSMENT ON PREVENTION ACTIVITIES FOR THE STATE OF VERMONT INCLUDING NEEDS ASSESSMENT, PRIORITY STRATEGY DEVELOPMENT, DATA AND GAP ANALYSIS, STAKEHOLDER ENGAGEMENT, PARTICIPATION MANAGEMENT, COMMUNICATION AND INFORMAITON DEPLOYMENT FOR VERMONT DEPT. OF HEALTH, ALCOHOL AND DRUG ABUSE PROGRAMS. OTHER PROGRAM SERVICES 7: PREP - COORDINATED AND CONDUCTED TRAININGS IN PERSONAL RESPONSIBILITY EDUCATION FOR VERMONT DEPT. OF HEALTH. OTHER PROGRAM SERVICES 8: CDC - DEVELOPED AND COORDINATED TRI-STATE NORTHERN NEW ENGLAND CONFERENCE ON HIV, STDS AND VIRAL HEPATITIS FOR THE CENTER FOR DISEASE CONTROL. OTHER PROGRAM SERVICES 9: MINORITY HEALTH - CREATED AN ADVISORY GROUP AND CONDUCTED FOCUS GROUPS TO IMPROVE THE CULTURAL COMPETANCY OF SUICIDE PREVENTION MATERIALS AND ACTIVITIES IN VERMONT. PRODUCED REVISED MATERIALS. OTHER PROGRAM SERVICES 10: SRTS - TRAINED TEACHERS, VOLUNTEERS AND OTHERS IN SAFE WALKING AND BIKING ACTIVITIES FOR SCHOOL CHILDREN IN GRADES 3-8 FOR THE VERMONT DEPT. OF TRANSPORTATION AND THEIR SUBCONTRACTOR, TOOLE DESIGN. OTHER PROGRAM SERVICES 11: UNITED WAY OF WINDHAM COUNTY - CONDUCTED COMMUNITY NEEDS ASSESSMENT IN SUICIDE PREVENTION AND RESILIENCY TRAINING IN VERMONT'S WINDHAM COUNTY AND COORDINATED, RECRUITED AND CONDUCTED TRAINING. OTHER PROGRAM SERVICES 12: CAG - ADMINISTERED AND COORDINATED THE COMMUNITY ADVISORY GROUP FOR HIV EDUCATION PROGRAMS, INCLUDING COORDINATION OF FIFTEEN MEETINGS ON HIV/AIDS/STD STATEWIDE PLANNING FOR VERMONT DEPT. OF HEALTH. OTHER PROGRAM SERVICES 13: ALA - PROVIDED TRAINING AND TECHINAL ASSISTANCE OF THE NOT-ON-TOBACCO TEEN SMOKING CESSATION PROGRAM IN SCHOOLS FOR THE AMERICAN LUNG ASSOCIATION. OTHER PROGRAM SERVICES 14: DOE - CONDUCTED CURRICULUM TRAININGS ON MICHIGAN MODEL, SAFER CHOICES, KNOW YOUR BODY, PUBERTY THE WONDER YEARS, COMPREHENSIVE HEALTH EDUCATION AND ASSESSMENT AND LIFE SKILLS TRAININGS FOR HEALTH EDUCATORS IN VERMONT AND NEW HAMPSHIRE FOR THE DEPTS. OF HEALTH. OTHER PROGRAM SERVICES 15: TUITION BASED - DEVELOPED, ADMINISTERED AND FACILITATED AN ONLINE FOR-CREDIT COURSE FOR EDUCATORS. THE OTHER WAS INJURY AND VIOLENCE PREVENTION. BOTH WERE THROUGH THE UNIVERSITY OF VERMONT'S CONTINUING EDUCATION PROGRAM FOR PROFESSIONAL DEVELOPMENT AND HEALTH EDUCATION GRUADUTE STUDENTS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.