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
Association of Regulatory Boards of Optometry Inc
Employer identification number
23-7091523
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.") .
171,571
110,450
79,750
138,450
114,050
614,271
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......
327,133
372,654
450,633
471,973
505,588
2,127,981
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
498,704
483,104
530,383
610,423
619,638
2,742,252
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
104,500
65,000
30,000
35,000
90,000
324,500
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.
0
c
Add lines 7a and 7b..
104,500
65,000
30,000
35,000
90,000
324,500
8
Public support (Subtract line 7c from line 6.)
2,417,752
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...
498,704
483,104
530,383
610,423
619,638
2,742,252
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
10,865
5,394
3,076
2,761
3,729
25,825
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
10,865
5,394
3,076
2,761
3,729
25,825
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
509,569
488,498
533,459
613,184
623,367
2,768,077
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
87.340 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
88.370 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0.930 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
1.390 %
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
Association of Regulatory Boards of Optometry Inc
Employer identification number
23-7091523
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
The bylaws and form 990 are available upon request
Form 990, Part VI, Line 15a
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management
The ARBO Board of Directors utilizes the Executive Director performance evaluation annually to review his/her work and accomplishments, and to set goals for the coming year. The performance appraisal process provides valuable job performance feedback and establishes goals, which focus on professional growth and enhanced capability as Executive Director of ARBO. The Board utilizes the ED performance evaluation process to determine compensation and also takes into account past compensation of former ED'sThe appraisal method utilizes a two-pronged approach in which the Executive Director performs a self-review, and the Board of Directors also rates his/her job performance. The same evaluation instrument is used for both appraisals, thus providing a side-by-side comparison of the Executive Directors work, as seen by himself, and as seen by the Board.The Executive Directors performance review is done annually by the ARBO President in conjunction with the spring board meeting (usually in March or April) immediately preceding the House of Delegates meeting. To provide continuity from year to year, the Executive Committee will also participate in Executive Director reviews. In the month prior to the review, the evaluation form is mailed to each Director and to the Executive Director. The Executive Director also receives a copy of the Executive Director Goals and Comments form.Directors complete and return their evaluations to the President, who will tabulate the results and formulate a Board of Directors consensus of the Executive Directors job performance over the last year.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
The Bookkeeper and Executive Director review a draft of the 990 before the return is filed.
Form 990, Part VI, Line 9
Form 990, Part VI, Line 9: Officer, Director, Trustee, Key Employee Mailing Address
Christina SorensonMidwestern University19555 N. 59th Ave.Glendale, AZ 85308Jerry Richt76 Mouse Creek Road Cleveland, TN 37312William RaffertyDuke Univ Eye & Laser Ctr.2025 Frontis Plaza Blvd.Suite 110Winston-Salem, NC 27103Michael Ohlson104 N. Walnut StWest Union, IA 52175Ernest Schlabach243 Neff Ave, Suite VHarrisonburg, VA 22801Roger D. Pabst500 East Bridge RoadRedwood Falls, MN 56283Susy Yu75 N. Fair Oaks Ave.Pasadena, CA 91103Gregory Moore 1800 Round Hill RoadCharleston, WV 25314Michael O'Hara6708 Pine Street Mammell Hall 228Omaha, NE 68182
Form 990, Part VI, Line 7b
Form 990, Part VI, Line 7b: Describe Decisions of Governing Body Approval by Members or Shareholders
The Board of Directors acts as governing body on behalf of the House of Delegates when not in session
Form 990, Part VI, Line 7a
Form 990, Part VI, Line 7a: How Members or Shareholders Elect Governing Body
Each Member of the House of Delegates in attendance has one vote in electing the members of the Board of Directors
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
The organization's members are 64 optometry licensing boards who make up the House of Delegates
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: CELMO - Council on Endorsed Licensure Mobility for Optometrists - assists state optometry boards in reviewing applications for licensure from established practitioners in other jurisdictions. Providing a license mobility vehicle by which state optometry boards can address the difficult task and burden of how to deal with the issue of licensure by endorsement in a uniform and consistent manner.Committees - meetings held during the year to carry out programs as decided during the annual meeting.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.