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
HELP ME SEE INC
Employer identification number
27-3207754
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.") ....
3,038,049
8,989,514
13,896,500
25,924,063
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
3,038,049
8,989,514
13,896,500
25,924,063
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)..
18,654,523
6
Public support. Subtract line 5 from line 4.
7,269,540
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..
3,038,049
8,989,514
13,896,500
25,924,063
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
6
75
2,041
2,122
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.)..
5,541
40,664
46,205
11
Total support (Add lines 7 through 10).
25,972,390
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.") .
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) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
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
HELP ME SEE INC
Employer identification number
27-3207754
Return Reference
Explanation
FORM 990, PART III, LINE 1
AN ESTIMATED 20 MILLION PEOPLE ARE BILATERALLY BLIND DUE TO CATARACT, AND 167 MILLION SUFFER FROM VISUAL IMPAIRMENT CAUSED BY CATARACT. THEY COULD GET THEIR SIGHT RESTORED THANKS TO A SURGERY THAT TAKES AS LITTLE AS 5 MINUTES FOR AN ADULT AND 15 MINUTES FOR A CHILD. UNFORTUNATELY, 99% OF THEM WILL NEVER RECEIVE THIS SURGERY AND REMAIN BLIND BECAUSE THEY ARE TOO POOR TO AFFORD THE COST OF SURGERY AND/OR THEY LIVE IN REMOTE COMMUNITIES WITH NO ACCESS TO TREATMENT. THE HELPMESEE CAMPAIGN WAS CREATED TO ADDRESS THESE SPECIFIC DISPARITIES BY MAKING THIS ESSENTIAL SURGERY AVAILABLE TO EVERY BLIND CHILD AND ADULT IN THE WORLD WHO NEEDS IT REGARDLESS OF WHERE THEY LIVE OR HOW POOR THEY MAY BE. THE VAST MAJORITY OF THE BLIND LIVE IN DEVELOPING COUNTRIES, WHERE A LACK OF ACCESS TO HIGH-QUALITY SERVICE PREVENTS THEM FROM UNDERGOING A QUICK, YET SAFE SURGERY THAT COULD RESTORE THEIR VISION. ACCORDING TO A RECENTLY PUBLISHED RAND CORPORATION HEALTH STUDY, CATARACT BLINDNESS WILL INCREASE TO 32 MILLION BY 2020, COSTING THE WORLD GDP APPROXIMATELY $1 TRILLION EACH YEAR. THE HELPMESEE GOAL IS TO DELIVER VERY LOW-COST, HIGH-QUALITY MANUAL SMALL INCISION CATARACT SURGERY (MSICS) TO MILLIONS OF ADULTS AND CHILDREN IN THE DEVELOPING WORLD. AS OF APRIL 2014, WORKING WITH 149 PRACTICING PARTNER MSIC SURGEONS IN CHINA, INDIA, NEPAL, SIERRA LEONE AND TOGO, HELPMESEE HAS RESTORED SIGHT TO MORE THAN 150,000 BLIND PERSONS, WITH A PROJECTED INCREASE TO SURPASS 250,000 BY THE END OF 2014. BUILDING ON THIS MOMENTUM OF SUCCESS, THE HELPMESEE CAMPAIGN WILL EXPAND TO INCLUDE 35 COUNTRIES THROUGHOUT AFRICA, ASIA, AND LATIN AMERICA, OVER THE NEXT FIVE YEARS. ADDITIONALLY, BY CREATING AND IMPLEMENTING SIMULATION-BASED SURGICAL INSTRUCTION SYSTEMS, HELPMESEE EXPECTS TO TRAIN 1,680 MSICS SPECIALISTS BY 2017, ENABLING THEM TO SUCCESSFULLY PERFORM 1 MILLION SURGICAL PROCEDURES WITH HELPMESEE SUPPORT. IN 20 YEARS, HELPMESEE EXPECTS TO TRAIN 30,000 MSICS-DEDICATED SPECIALISTS TO DELIVER 60-70 MILLION SURGERIES REQUIRED TO PERMANENTLY ELIMINATE THE BACKLOG OF CATARACT BLINDNESS.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 WAS REVIEWED BY THE CHAIRMAN/TREASURER AND PRESIDENT AND CEO AND APPROVED BY THE SAME. FOR THIS YEAR, THE CEO (MOHAN JACOB THAZHATU) WILL SIGN THE FORM 990 AND MENGFANG MADGE BIAN WILL SIGN AS CUSTODIAN OF THE BOOKS. THE FORM 990 WAS DISCUSSED BY THE BOARD AND APPROVED THROUGH APPROPRIATE RESOLUTION BEFORE BEING FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD OF HELPMESEE REVIEWS THE CONFLICT OF INTEREST POLICY AND SIGNS THE FORM ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15
THE CHAIRMAN/TREASURER IN CONSULTATION WITH THE BOARD AND WITH INDEPENDENT EXTERNAL INPUT AND AUDITORS DETERMINES THE COMPENSATION OF THE PRESIDENT, CEO AND KEY EMPLOYEES.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX
DURING 2013, HELPMESEE GENERATED $14,311,968 IN REVENUE AND SUPPORT, SPENT $14,650,943 IN TOTAL EXPENSES, RESULTING IN A DECREASE IN NET ASSETS OF $338,975 AS OF DECEMBER 31, 2013. IN 2013, HELPMESEE LAUNCHED A JOINT FUNDRAISING CAMPAIGN WITH HELPAGE INDIA TO ELIMINATE CATARACT BLINDNESS IN INDIA. AS OF DECEMBER 31, 2013, THE CAMPAIGN RAISED $82,645 AND, TOGETHER, EXPECTS TO RAISE $887,160 BY THE END OF 2014. AL UELTSCHI FOUNDATION AND THE BILL & MELINDA GATES FOUNDATION CONTINUE TO SUPPORT HELPMESEE THROUGH UNRESTRICTED GRANTS. ADDITIONALLY, HELPMESEE RECEIVED $2,716,240 FROM INDIVIDUAL DONORS IN 2013. HELPMESEE'S PROGRAM EXPENSES RATIO IN 2013 IS 77%, AS COMPARED TO 69% IN 2012. FOR 2013, THE MANAGEMENT AND GENERAL EXPENSES ARE 7% AND FUNDRAISING COSTS 16% RESPECITIVELY. THE SURGICAL PROGRAM SUPPORT EXPENSES INCREASED SIGNIFICANTLY TO $3,513,101 IN 2013 AS COMPARED TO $1,350,708 IN 2012.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.