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 LEADERSHIP INSTITUTE FOR SCHOOL IMPROVEMENT INC
Employer identification number
45-5209297
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)
No
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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.") .
0
0
0
100,000
1,084,617
1,184,617
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......
2,102,256
2,102,256
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.
0
0
0
100,000
3,186,873
3,286,873
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
1,081,617
1,081,617
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.
1,280,799
1,280,799
c
Add lines 7a and 7b..
2,362,416
2,362,416
8
Public support (Subtract line 7c from line 6.)
924,457
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...
0
0
0
100,000
3,186,873
3,286,873
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
1,746
1,746
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
1,746
1,746
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.)..
0
0
0
100,000
3,188,619
3,288,619
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
0 %
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
THE 2011 RETURN WAS A SHORT PERIOD COVERING 04/01/2012-06/30/2012
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 LEADERSHIP INSTITUTE FOR SCHOOL IMPROVEMENT INC
Employer identification number
45-5209297
Identifier
Return Reference
Explanation
FORM 990, PART III, QUESTION 2
Due to having just incorporated at the time of filing our FY12 990, there were zero program services described in that 990. All significant programs undertaken by the organization are described in Part III of this filing.
FORM 990, PART III, QUESTION 4D
The Race to the Top Innovation Fund grant is a two-year partnership between GLISI, the Paulding County School District, the Georgia Partnership for Excellence in Education and Thinkgate. The purpose of the grant is "to prepare a pipeline of effective high school leaders to yield sustained high quality teaching and student outcomes in all high schools so that students graduate prepared for the demands of college and careers." The focus of GLISI's work on the project is three-fold: 1) training for a selected group of current and aspiring high school leaders; 2) consulting to build talent management infrastructure and capacity in central office leaders; and 3) project management and coordination of all grant partners. During FY13, GLISI served 37 education leaders in Paulding County including the superintendent, other central office leaders, high school principals, assistant principals and teacher leaders throuh over 920 person-hours of training and consulting (# education leaders x # in-district training and consulting hours). In addition, GLISI facilitated over 22 hours of cross-partner project planning meetings to coordinate and monitor project progress toward goals. Ultimate project success will be measured by rate of principal turnover; number of quality leaders identified in the district ready for leadership responsibility; as well as student outcomes including End-of-Course-Test results and post-secondary enrollments. Interim results at the end of year one include evidence that the pool of 16 aspiring leaders participating in GLISI training are ready for leadership positions: 2 of the 16 leaders (12.5%) were promoted to district or other school leadership positions during the first year of the project.
FORM 990, PART VI, QUESTION 11
Prior to filing, the board chair and secretary/treasurer will conduct a close review of the draft 990. An electronic copy of the draft 990 will be provided to the full board prior to filing.
FORM 990, PART VI, QUESTION 12
By-laws require directors to disclose conflicts of interest as they arise. Interested directors are not permitted to participate in discussion or vote on the matter. The annual meeting agenda includes a conflicts of interest item during which the board reviews and monitors all existing disclosed conflicts.
FORM 990, PART VI, QUESTION 15
the compensation committee comprised in the first year of GLISI's operations of the Board Chair and Board Secretary/Treasurer gathered data from a variety of sources on comparable CEO/Executive Director salaries from similar organizations for review. Compensation committee makes a recommendation for salary adjustments to the Board of Directors for approval. Salary adjustments are included in the organization's budget and approved by the Board of Directors.
FORM 990, PART VI, QUESTION 19
All governing documents, conflict of interest policy, and financial statements are available by written request.
FORM 990, PART VII
ALL BOARD MEMBERS ARE INDEPENDENT, AS THERE ARE NO RELATIONSHIPS OR TRANSACTIONS WHICH WOULD CAUSE AN INDIVIDUAL TO BE CONSIDERED NOT INDEPENDENT. ONE BOARD MEMBER SERVES AS THE EXECUTIVE DIRECTOR OF A NONPROFIT ORGANIZATION THAT HELPED GLISI CONDUCT BUSINESS BEFORE ITS TAX EXEMPT STATUS DETERMINATION LETTER WAS RECEIVED. THE ORGANIZATIONS DO NOT SHARE COMMON CONTROL; THEREFORE, WE HAVE DETERMINED THAT THE DETAILS OF THESE TRANSACTIONS DO NOT MEET THE THRESHOLDS THAT WOULD REQUIRE ADDITIONAL REPORTING.
FORM 990, PART XI, LINE 9
Prior to July 1, 2012, GLISI operated under the corporate structure of Georgia Parternship for Excellence in Education, Inc. ("GPEE"). In 2012, the Georgia Leadership Institute for School Improvement, Inc. (the "organization") was incorporated and, commencing on July 1, 2012, began operating the programs of GLISI as an independent entity. On July 1, 2012, The Organization received from GPEE the rights and obligations to the followings assets (liabilities): Cash and cash equivalents $ 99,746 Pledges receivable 100,000 Consulting fees receivable 23,500 Due from related party 643,715 Donated equipment 4,072 Accounts payable (17,124) Net Assets at July 1, 2012 853,909 Less previously reported net assets (99,746) Adjustment to net assets $ 754,163
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES
FORM 990 PART IX LINE 11G
DESCRIPTION:CONSULTANTS TOTAL FEES:726297
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.