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
GEORGIA OVARIAN CANCER ALLIANCEINC
Employer identification number
58-2424106
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.") ....
151,855
170,502
192,116
234,093
248,438
997,004
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
151,855
170,502
192,116
234,093
248,438
997,004
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)..
112,270
6
Public support. Subtract line 5 from line 4.
884,734
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..
151,855
170,502
192,116
234,093
248,438
997,004
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
1,509
16
6
25
349
1,905
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.)..
430
430
11
Total support (Add lines 7 through 10).
999,339
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
88.530 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
91.070 %
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:
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
2012
Open to Public Inspection
Name of the organization
GEORGIA OVARIAN CANCER ALLIANCEINC
Employer identification number
58-2424106
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
THE MISSION OF THE GEORGIA OVARIAN CANCER ALLIANCE IS TO INCREASE AWARENESS AND EDUCATE GEORGIA'S WOMEN OF ALL AGES AND THEIR FAMILIES AS WELL AS THE HEALTHCARE COMMUNITY ABOUT THE RISKS AND SYMPTOMS LEADING TO EARLIER DETECTION.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
WE ARE IN A UNIQUE POSITION TO HELP STUDENTS TO BECOME MORE SENSITIVE TO THE SYMPTOMS OF AND RISK FACTORS FOR OVARIAN CANCER SO THAT WHEN THEY BECOME DIAGNOSTICIANS THEY CAN DIAGNOSE WOMEN EARLY AND SAVE LIVES. WE HAVE BEEN PARTNERING WITH EMORY MEDICAL SCHOOL FOR THE PAST 7 YEARS AND THE PROGRAM HAS BEEN INCORPORATED IN TO THE MEDICAL SCHOOL CURRICULUM. TO DATE, OVER 1,100 FUTURE DOCTORS HAVE TAKEN PART IN THIS PROGRAM. WE ARE WORKING ON EXPANDING THE PROGRAM TO ADDITIONAL MEDICAL SCHOOLS, AS WELL AS NURSING AND PHYSICIAN ASSISTANT PROGRAMS. EDUCATION AND AWARENESS - "AWARENESS.KNOWLEDGE.ACTION" A KEY COMPONENT OF THE AWARENESS.KNOWLEDGE.ACTION CAMPAIGN CONSISTS OF SPEAKING ENGAGEMENTS AND DISSEMINATION OF GOCA COLLATERAL TO THE FEMALE POPULATION, OF ALL AGES, AND THEIR FAMILIES ACROSS GEORGIA. THIS IS ACCOMPLISHED VIA HEALTH FAIRS, SPEAKING ENGAGEMENTS, LUNCH & LEARN SESSIONS, AND COMMUNITY EVENTS. THE UTILIZATION OF OVARIAN CANCER PATIENTS AND SURVIVORS DURING THESE PRESENTATIONS "PUTS A FACE ON" THE DISEASE AND VALIDATES THE MESSAGE ALONG WITH THE IMPORTANCE OF KNOWING THE FACTS, SIGNS AND SYMPTOMS OF OVARIAN CANCER, AND INFORMING WOMEN OF THE IMPORTANCE OF KNOWING THEIR BODY AND TAKING ACTION THAT LEADS TO EARLY DIAGNOSIS. WE HAVE RESOURCES ACROSS THE STATE AND CAN TAILOR A PRESENTATION, LARGE OR SMALL, TO ANY DEMOGRAPHIC. THROUGH THE USE OF SOCIAL MEDIA WE ARE ABLE TO REACH NEW PARTNERS THAT CAN HELP SPREAD OUR MISSION AS WELL AS PROMOTE OTHER OVARIAN CANCER ORGANIZATIONS. THE GOCA ONLINE MEDIA LIBRARY IS A VITAL PART TO THE EDUCATION AND AWARENESS OF OVARIAN CANCER AS WELL AS THE MANY TOPICS THAT CROSS OVER TO ALL CANCERS. THIS PROGRAM PROVIDES AN EXTENSIVE RESOURCE AND EDUCATIONAL ONLINE LIBRARY VIA VIDEO; A COMPLETE VIDEO LIBRARY AVAILABLE TO THE ENTIRE CANCER COMMUNITY- WOMEN AND THEIR FAMILIES AND CAREGIVERS, WHICH INCLUDES VIDEOS ON BASIC OVARIAN CANCER FACTS AND SYMPTOMS, PUBLIC SERVICE ANNOUNCEMENTS, TUTORIALS ON CURRENT CHEMOTHERAPIES, INTEGRATIVE MEDICINES, TRENDS AND TREATMENTS, AND THE NEEDED RESOURCES AVAILABLE TO WOMEN, THEIR FAMILIES AND CAREGIVERS, AND STORIES OF COURAGE AND SUPPORT AS WELL AS DISCUSSIONS ON OC RESEARCH IN A VERY FRIENDLY FORMAT, INCLUDING INTERVIEWS WITH SURVIVORS, FAMILY MEMBERS AND CAREGIVERS BAG OF HOPE THE GEORGIA OVARIAN CANCER ALLIANCE PROVIDES THE BAG OF HOPE, FREE OF CHARGE, TO NEWLY DIAGNOSED OVARIAN CANCER PATIENTS LETTING THEM KNOW THEY ARE NOT ALONE ON THIS JOURNEY. THE BAG OF HOPE HAS BEEN CREATED IN RESPONSE TO THE EXPRESSED NEED, BY WOMEN DIAGNOSED WITH OVARIAN CANCER, TO HAVE BOTH READILY AVAILABLE AND RELIABLE INFORMATION ON OVARIAN CANCER RESOURCES, TREATMENT AND SUPPORT. THE CONTENTS OF THE BAG OF HOPE FULFILL THE INITIAL NEED TO BECOME EDUCATED ABOUT THE DIAGNOSIS AND WHERE TO TURN FOR HELP. THE BAG CONTAINS A BLANKET, HAT, WATER BOTTLE, BOOTIES, LIGHTWEIGHT TURBAN, JOURNAL, PEN, HOT/COLD PACK, INFORMATIONAL CD, SURVIVOR STORIES DVD, AND GOCA BRACELET. THE CONTENTS ARE PERIODICALLY REVIEWED BY OVARIAN CANCER PATIENTS AND CAREGIVERS TO ENSURE WE ARE PROVIDING WHAT IS NEEDED. SINCE THE INCEPTION OF THE PROGRAM, IN 2008, OVER 1,100 BAGS OF HOPE HAVE BEEN DISTRIBUTED TO WOMEN BATTLING OVARIAN CANCER. SPONSORSHIP OF A BAG OF HOPE IS POSSIBLE WITH A 100 DONATION. THE DONOR GETS TO SEND A PERSONALIZED MESSAGE OF SUPPORT AND HOPE TO THE RECIPIENT.
RELATED PARTY INFORMATION AMONG OFFICERS
FORM 990, PAGE 6, PART VI, LINE 2
CHUCK POWELL ALI BARDEN BOARD MEMBER SECRETARY FATHER/DAUGHTER LARRY ABER DONNA ABER BOARD MEMBER BOARD MEMBER SPOUSE
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
THE DRAFT 990 WILL BE PROVIDED TO THE BOARD MEMBERS WITH SPECIFIC INSTRUCTIONS REGARDING TIME PERIOD FOR COMPLETING REVIEW. QUESTIONS/CONCERNS WILL BE COMMUNICATED THROUGH THE EXECUTIVE DIRECTOR FOR ANSWERS OR CORRECTIONS.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
BOARD MEMBERS AND STAFF ARE ASKED EACH YEAR TO DISCLOSE ANY CONFLICT OF INTERESTS THEY MAY HAVE. THE REQUEST IS MADE ANNUALLY TO THE BOARD MEMBERS AND STAFF.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE BOARD OF DIRECTORS DISCUSS, REVIEW, AND EVALUATE THE EXECUTIVE DIRECTOR'S PERFORMANCE ON AN ANNUAL BASIS. COMPENSATION OF EXECUTIVE DIRECTORS OF SIMILAR SIZED ORGANIZATIONS ARE ALSO REVIEWED DURING THESE DISCUSSIONS AND REVIEW. THE EXECUTIVE DIRECTOR PROVIDES AN ANNUAL EMPLOYEE REVIEW AND EVALUATION ALONG WITH ANY SUGGESTED COMPENSATION CHANGES TO THE BOARD OF DIRECTORS FOR THEIR REVIEW. THE BOARD OF DIRECTORS HAS THE FINAL DECISION ON ANY AND ALL EMPLOYEE COMPENSATION CHANGES.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
BY WRITTEN REQUEST TO THE GOCA OFFICE
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.