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
BRATTLEBORO MUTUAL AID ASSOC INC
Employer identification number
03-0179415
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.") .
113,669
43,125
39,814
78,574
13,510
288,692
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......
4,147,406
4,181,357
4,437,026
4,677,529
4,671,259
22,114,577
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.
4,261,075
4,224,482
4,476,840
4,756,103
4,684,769
22,403,269
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
60,000
60,000
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..
60,000
60,000
8
Public support (Subtract line 7c from line 6.)
22,343,269
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...
4,261,075
4,224,482
4,476,840
4,756,103
4,684,769
22,403,269
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
19,933
46,578
22,302
34,165
23,751
146,729
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
19,933
46,578
22,302
34,165
23,751
146,729
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
5,965
5,965
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
25,409
24,497
26,556
23,759
100,221
13
Total support. (Add lines 9, 10c, 11, and 12.)..
4,281,008
4,296,469
4,523,639
4,816,824
4,738,244
22,656,184
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
98.620 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.650 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
1.000 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
1.000 %
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
BRATTLEBORO MUTUAL AID ASSOC INC
Employer identification number
03-0179415
Return Reference
Explanation
FORM 990, PAGE 6, PART VI, LINE 11B
A COPY OF THE FORM 990 IS PROVIDED TO THE FULL BOARD OF DIRECTORS UPON FILING.
FORM 990, PAGE 6, PART VI, LINE 12C
EACH DIRECTOR HAS A DUTY OF LOYALTY TO, AND A FIDUCIARY RELATIONSHIP WITH BRATTLEBORO MUTUAL AID ASSOCIATION WHICH REQUIRES EACH BOARD MEMBER: A) TO ACT IN A MANNER REASONABLY BELIEVED BY THE BOARD MEMBER TO BE IN THE BEST INTEREST OF BRATTLEBORO MUTUAL AID ASSOCIATION, AND B) TO FULLY DISCLOSE IN ADVANCE TO THE BOARD SITUATIONS IN WHICH THE INTEREST OF THE BRATTLEBORO MUTUAL AID ASSOCIATION MAY CONFLICT WITH THE INTEREST OF THE BOARD MEMBER OR ANY PERSON RELATED TO THE BOARD MEMBER. THESE SITUATIONS INCLUDE BUT ARE NOT LIMITED TO, 1) FINANCIAL CONFLICT OF INTEREST, 2) THE USE OF BRATTLEBORO MUTUAL AID ASSOCIATION PROPERTY OF CONFIDENTIAL INFORMATION, 3) A MATERIAL BENEFIT ARISING OUT OF A POSITION WITH THE BRATTLEBORO MUTUAL AID ASSOCIATION, 4) ACTION BY OR ON BEHALF OF A PERSON HAVING AN ADVERSE INTEREST TO THE BRATTLEBORO MUTUAL AID ASSOCIATION, 5) COMPETITION WITH THE BRATTLEBORO MUTUAL AID ASSOCIATION, OR 6) TAKING A BUSINESS OR GRANT OPPORTUNITY AWAY FROM THE BRATTLEBORO MUTUAL AID ASSOCIATION. WHEN A CONFLICT OF INTEREST IS PRESENTED, THE BOARD MAY APPROVE THE TRANSACTION BETWEEN BRATTLEBORO MUTUAL AID ASSOCIATION AND THE CONFLICTED BOARD MEMBER, OR MAY WAIVE THE CONFLICT WITH THE BRATTLEBORO MUTUAL AID ASSOCIATION'S INTEREST IN THE TRANSACTION IF THE BOARD REASONABLY BELIEVES THE TRANSACTION MEMBERS OF THE BOARD, WHO HAVE NO INTEREST IN THE TRANSACTION BEING APPROVED OR THE CONFLICT BEING WAIVED. IF THE TRANSACTION INVOLVING A CONFLICT OF INTEREST WITH A BOARD MEMBER IS DEEMED NOT IN THE INTEREST OF, OR UNFAIR TO, THE BRATTLEBORO MUTUAL AID ASSOCIATION, THE BOARD WILL TAKE STEPS TO CANCEL OR DECLINE TO ENTER INTO THE TRANSACTION.
FORM 990, PAGE 6, PART VI, LINE 15A
THE COMPENSATION COMMITTEE OF BRATTLEBORO MUTUAL AID ASSOCIATION AND THE BOARD OF DIRECTORS CONSIDERS THE FINANCIAL PERFORMANCE, GRANTS AND CLINICAL EXCELLENCE IN DETERMING THE COMPENSATION PAID TO THE KEY EMPLOYEES AND MANAGEMENT.
FORM 990, PAGE 6, PART VI, LINE 15B
BOARD REIMBURSEMENT COMMITTEE YEARLY REVIEW WITH MEASUREMENT TOOL
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE DURING THE NORMAL BUSINESS HOURS WITH A REQUEST TO THE ADMINISTRATOR
FORM 990, PART IX, LINE 24E
REPAIRS AND MAINT 128,904 0 0 OCCUPATIONAL THERAPY 115,771 0 0 FUEL AND GAS 93,915 0 0 ELECTRICITY 74,048 0 0 PHARMACY 50,253 0 0 DIETARY SUPPLIES 33,886 0 0 OTHER PATIENT SERVICES 30,021 0 0 HOUSEKEEPING SUPPLIES 23,072 0 0 ACTIVITIES EXPENSE 20,106 0 0 SPEECH THERAPY 18,292 0 0 LAUNDRY SUPPLIES 16,553 0 0 BAD DEBT EXPENSE 15,757 0 0 MISCELLANEOUS EXPENSES 14,966 0 0 PRIOR YEAR SETTLEMENTS 9,324 0 0 WATER AND SEWAGE 8,182 0 0 COMMUNICATIONS 7,987 0 0 LICENSING AND DUES 5,655 0 0 EDUCATION 5,504 0 0 LINENS 2,706 0 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.