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
Cumberland Crisis Pregnancy Center
Employer identification number
58-1705496
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.") ....
1,053,329
519,344
624,995
635,608
656,631
3,489,907
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
1,053,329
519,344
624,995
635,608
656,631
3,489,907
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.
3,489,907
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..
1,053,329
519,344
624,995
635,608
656,631
3,489,907
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
7,604
12,280
1,201
1,168
720
22,973
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.)..
476
642
4
10,066
11,188
11
Total support (Add lines 7 through 10).
3,524,068
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
99.030 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
99.030 %
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
Cumberland Crisis Pregnancy Center
Employer identification number
58-1705496
Identifier
Return Reference
Explanation
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
If the governing documents (articles of incorporation, bylaws, and constitution) andconflict of interest policy of our organization are subject to the Federal public disclosure rules (or state public disclosure rules), these documents will be made publicly available as applicable law may require. Otherwise, the governing documents and conflict of interest policy will be provided to the public at the discretion of management.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
e. Our compensation system will include periodic adjustments to pay ranges based on changes in the marketplace, subject to organizational financial constraints. All adjustments to pay will be consistent with practice in thenonprofit marketplace.f. The marketplace adequacy of the compensation structure will be judged in terms of total compensation, including benefits; the total packages will be competitive with the marketplace, subject to organizational financial constraints.g. The compensation structure will be linked to an effective performance management system with individual growth and development as well as professional achievement goals.Approving Compensationa. The compensation of all disqualified persons (defined below) for each year, or the terms of compensation for a multi-year contract will be established by the Board in advance" If any board members are employees of the organization or related to disqualified persons receiving compensation, they may provide input to the board, but will leave the room and not participate in the discussion or decision making by the Board. The minutes will reflect that they were not in the room during the discussion and vote .b. "Disqualified persons" - The primary definition includes board members, the CEO, president, COO, executive director, CFO, Controller, any vice-president responsible for a substantial portion of the organization, any person (if not listed previously) able to exercise substantial influence over the affairs of the organization- Any person who has held any of the position in (i) with in the past five (5) years.- Any family member of a person listed above including spouse,ancestors,descendents, siblings, spouses of siblings and spouses ofdescendents.c. In considering compensation, all elements will be provided to the Board, including (but not limited to): the value of all employee benefits whether taxable or not, housing allowance or value of provided housing, the value of vehicles to the employee or the family of the employee and retirement plan contributions.d. The chairman of the board or a board compensation committee will meet with the CEO/President/Executive Director in advance of Board compensation discussion to consider with the CEO/President/Executive Director his or her projected needs for the coming year, perspective on his or her compensation, and the types of benefits or "perquisites that might help the CEO/President/Executive Director personally, in their family, and in their job." The CEO/President/Executive Director input on how the organization's compensation philosophy may apply to him or her will be requested.e. Prior to a final vote on the compensation, the Board will collect informationregarding amounts paid by comparable organizations for comparable services and consider how the proposed compensation compares to such to the comparison information. If the amount proposed as compensation seems high based on the comparison information, the Board will consider collecting additional information or obtaining a professional compensation opinion.f. The vote by the Board will be recorded in the meeting minutes within sixty daysafter the meeting, including the amount authorized and references to the comparison information" Full collected compensation information and any compensation opinions provided to the board will be kept with the Board records.
Form 990, Part VI, Line 15a
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management
Compensation Philosophy:a. The compensation plan will support our organization's mission, strategy, and values.b. We will pay for performance, skills and competencies, development and growth, and effective visible commitment to the organization.c. The compensation structure will encourage recruitment, retention, and motivation of outstanding executives so that the organization can achieve its missionand objectives.d. Our compensation structure may include base salary, retirement and other benefits.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
Annually, the Board of Directors will fill out and sign a questionnaire disclosing any conflicts of interest. The Board is asked to disclose any conflicts as they arise throughout the year, as well, at regularly scheduled meetings of the board.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
It is Cumberland Crisis Pregnancy Center's policy that the Cumber Crisis Pregnancy Center's Board of Directors reviews the IRS Form 990 that is filed on the organization's behalf before it is filed with the IRS.A board resolution is required in order for the Form 990 to be filed.The means delivery shall be in hard copy, given at the board meeting at the time of the audit review by the auditors.
Form 990, Part VI, Line 8
Form 990, Part VI, Line 8: Explanation of No Contemporaneously Documentation of Meetings
The organization does not have committees with authority to act on behalf of the governing body.
Form 990, Part VI, Line 4
Form 990, Part VI, Line 4: Description of Significant Changes to Organizational Documents
Our bylaws were amended this year with the following major changes. The number of directors was changed to a minimum of 5 and a maximum of 15. The annual meeting was changed from the 2nd Monday of November to a regular board meeting at such a time and place as the board may determine. There is no longer an executive committee of the board. Officers will now consist of the Chair, Vice Chair, Treasurer, Secretary, and Executive Director. Specific committees were removed, but committees may be designated by the board and shall consist of at least two or more directors. The executive director is now the CEO. The bylaws may now be amended at any regular meeting of the board provided that ten days notice of the proposed amendment is given to all Directors and approved by a two-thirds vote of all board members.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.