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
Hamilton Centers Youth Service Bureau DBA Promising Futures of Central Indiana
Employer identification number
35-1305755
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.") ....
644,312
606,906
555,376
737,231
722,160
3,265,985
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
644,312
606,906
555,376
737,231
722,160
3,265,985
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.
3,265,985
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..
644,312
606,906
555,376
737,231
722,160
3,265,985
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
919
-1,053
1,021
887
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.)..
109,937
87,985
197,922
11
Total support (Add lines 7 through 10).
3,464,794
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
94.260 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
96.100 %
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
Hamilton Centers Youth Service Bureau DBA Promising Futures of Central Indiana
Employer identification number
35-1305755
Identifier
Return Reference
Explanation
Form 990, Part XI, Line 9
Other Changes In Net Assets Or Fund Balances - Other Decreases
Rounding = -$1
Form 990, Part XI, Line 9
Other Changes In Net Assets Or Fund Balances - Other Decreases
Donated Services = -$10436
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 15a
Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management
An annual performance review of the Executive Director is completed by the Executive Committee of the Board of Directors, led by the Board Chairperson. The annual performance review is presented to the full Board of Directors for their review and approval. During the full board review, a review of comparable compensation and related industry standards are used to determine appropriate salary adjustments. The Executive Director is then provided the performance review once it is approved by the full board.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The conflict of interest policy is addressed in the Board of Directors Handbook. All board members receive the handbook upon becoming members. If a potential conflict of interest in any proceedings exists, the member shall refrain from discussion and from voting on such proceedings. The minutes of such meeting shall clearly indicate such disclosure. Additionally, all members sign a conflict of interest statement on an annual basis. Also, all management and staff are required to disclose any conflict of interest as noted in the employee manual.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
The Form 990 is initially prepared by an independent certified public accounting firm. A draft copy of the 990 is provided to the Executive Director. The draft copy is reviewed by the Executive Director and finance committee. After the review, the 990 is finalized and presented to the Board of Directors for final approval. The Executive Director is authorized to sign the return on behalf of the Organization.
Form 990, Part VI, Line 6
Form 990, Part VI, Line 6: Explanation of Classes of Members or Shareholder
Members represent the membership in the agency's Auxillary. These members elect their representative to the board.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: Family Access Center - Supervised visitations and exchanges occur at the Family Access Center, a comfortable location stocked with many of the comforts of homes, including toys, full kitchens, outdoor grill, books and puzzles.Supervised VisitationsUnder certain circumstances, it may be appropriate for a parent to be supervised when interacting with his or her children. supervised visitation allows a parent and child to spend time together in a neutral, safe and home-like environment while being assisted or observed by the Visitation Facilitator.During the visit, non-custodial parents are offered an opprotunity to spend time with and parent their child in a comfortable, safe environment. Guidance, assistance and feedback are provided as needed by the Visitation Facilitator.The child's welfare is assured during visits offering custodial parents or guardians peace of mind.Supervised ExchangesThe comfort and safety of the children is top priority. During a supervised exchange, children are transferred between a custodial parent or guardian and the non-custodial parent. The adult involved in the exchange do not have to come in contact with one another, and children are supervised until the arrival of the other parent. The children are safe, engaged and occupied while they wait for their parent.Supervised Exchanges reduce conflict witnessed by the children and are scheduled and confirmed with both parents by the Exchange Facilitator. OTHER PROGRAM SERVICES 5: Safe Place - Safe Place is designed to provide safe and immediate help for runaway, homeless and in-crisis youth. Safe Place provides the opportunity for teens to take the initiative in getting help. The majority of cases, teens receive crisis intervention counseling abd referral for the family, and in some instances, emergency shelter care is provided with parental permission. Project Safe Place is a resource available to any youth experiencing abuse, neglect, social or family problems with which he or she is unable to cope. OTHER PROGRAM SERVICES 6: Parenting Coalition - Guides parents through sharing and learning. OTHER PROGRAM SERVICES 7: Choose to Live - Helping teens make positive choices when it comes to the use of drugs and alocohol and impaired driving.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.