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. Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CZECH CULTURAL & COMMUNITY CENTER
Employer identification number
76-0496649
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
405,917
134,387
178,336
73,368
189,477
981,485
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......
104,861
168,891
132,507
84,647
80,019
570,925
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.
510,778
303,278
310,843
158,015
269,496
1,552,410
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
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..
0
8
Public support (Subtract line 7c from line 6.)
1,552,410
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
510,778
303,278
310,843
158,015
269,496
1,552,410
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
7,585
3,588
7,051
14,094
17,759
50,077
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
7,585
3,588
7,051
14,094
17,759
50,077
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.)
..
3,026
1,657
12,052
59,320
76,055
13
Total support. (Add lines 9, 10c, 11, and 12.)..
518,363
309,892
319,551
184,161
346,575
1,678,542
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
92.490 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
96.360 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
2.980 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
2.570 %
19a
33 1/3% support tests—2013.
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—2012.
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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information.
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) 2013
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.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
CZECH CULTURAL & COMMUNITY CENTER
Employer identification number
76-0496649
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
FAMILY RELATIONSHIP THE VICE PRESIDENT OF ADMINISTRATION IS THE SPOUSE OF THE ORGANIZATION'S CHAIRMAN OF THE BOARD.
FORM 990, PART VI, SECTION A, LINE 8B
CONTEMPORANEOUS DOCUMENT OF COMMITTEE MINUTES THE ORGANIZATION CURRENTLY HAS NO FUNCTIONING COMMITTEES, THEREFORE, THERE ARE NO COMMITTEE MEETINGS TO DOCUMENT.
FORM 990, PART VI, SECTION B, LINE 11
FORM 990 REVIEW PROCESS A SIGNED AND COMPLETE FORM 990 IS DISTRIBUTED TO ALL BOARD MEMBERS DURING THE ORGANIZATION'S NORMAL BOARD MEETING. AT THAT MEETING, THE BOARD MEMBERS REVIEW THE RETURN AND QUESTION ANY ITEM ON THE RETURN. ANSWERS ARE SUPPLIED TO THE BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 12C
CONFLICT OF INTEREST POLICY THE CONFLICT OF INTEREST POLICY CALLS FOR FULL DISCLOSURE, IN WRITING, OF ALL CONFLICTS OF INTEREST. ANY INTERESTED BOARD MEMBER, OFFICER OR STAFF MEMBER OF THE ORGANIZATION IS EXCLUDED FROM ANY DISCUSSION OR DEBATE OF THE BOARD OF DIRECTORS IN WHICH THE SUBJECT IS A CONTRACT, TRANSACTION, OR SITUATION IN WHICH THERE MAY BE A PERCIEVED OR ACTUAL CONFLICT OF INTEREST. THAT INDIVIDUAL MAY, HOWEVER, BE PRESENT TO PROVIDE ANY CLARIFYING INFORMATION IN SUCH A DISCUSSION UNLESS THEIR PRESENCE IS OBJECTED TO BY ANY PRESENT BOARD MEMBER. THE POLICY AND DISCLOSURE FORM MUST BE FILED ANNUALLY BY ALL SPECIFIED PARTIES.
FORM 990, PART VI, SECTION B, LINE 15
COMPENSATION OF KEY PERSONNEL THE ORGANIZATION DOES NOT COMPENSATE ANY OF THEIR KEY EMPLOYEES OR BOARD MEMBERS.
FORM 990, PART VI, SECTION C, LINE 19
DISCLOSURE AVAILABILITY THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON THE INTERNET (PROVIDED BY GUIDESTAR) OR AN APPOINTMENT WITH THE OFFICE TO VIEW PUBLIC RECORDS.
PART VI, SECTION B, LINE 13
WHISTLEBLOWER POLICY EMPLOYEES OF THE ORGANIZATION ARE ENCOURAGED TO EXPOSE ANY ILLEGAL PRACTICES OR ANY VIOLATIONS OF THE ADOPTED POLICIES OF THE ORGANIZATION. ANY SUCH VIOLATION OR PRACTICE MAY BE REPORTED TO A MEMBER OF THE STAFF, BOARD OF DIRECTORS, OR RELIABLE OUTSIDE SOURCES. THESE INDIVIDUALS ARE PROTECTED BY THE ORGANIZATION OR ANY OF ITS MEMBERS.
PART VI, SECTION B, LINE 14
DOCUMENT RETENTION & DESTRUCTION POLICY THE FOLLOWING IS THE DOCUMENT DESTRUCTION POLICY: THERE IS A 2 YEAR MINIMUM REQUIREMENT FOR THE FOLLOWING DOCUMENTS: BANK RECONCILIATIONS, GENERAL CORRESPONDENCE, AND DUPLICATE DEPOSIT SLIPS. THERE IS A 3 YEAR MINIMUM REQUIREMENT FOR THE FOLLOWING DOCUMENTS: BANK STATEMENTS, EMPLOYMENT APPLICATIONS, AND INSURANCE POLICIES (EXPIRED). THERE IS A 7 YEAR MINIMUM REQUIREMENT FOR THE FOLLOWING DOCUMENTS: CONTRACT, MORTGAGES, NOTES AND LEASES, EXPENSE ANALYSES/EXPENSES DISTRIBUTIONS SCHEDULES, INVENTORIES, PAYROLL RECORDS AND SUMMARIES, PERSONNEL FILES, TIME SHEETS, AND WITHHOLDING TAX STATEMENTS. THE FOLLOWING DOCUMENTS ARE PERMANENTLY RETAINED: DEEDS, MORTGAGES, DEPRECIATION SCHEDULES, YEAR END FINANCIAL STATEMENTS, MINUTE BOOKS, BYLAWS AND CHARTER, TAX RETURNS AND WORK SHEETS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.