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
ALZHEIMER'S DISEASE AND RELATED DISORDERS ASSOC INC MINNESOTA-NORTH DAKOTA CHAPTER
Employer identification number
41-1361624
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.") ....
3,006,299
1,503,273
865,513
949,958
4,950,533
11,275,576
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
0
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
4
Total. Add lines 1 through 3
3,006,299
1,503,273
865,513
949,958
4,950,533
11,275,576
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)..
543,643
6
Public support. Subtract line 5 from line 4.
10,731,933
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..
3,006,299
1,503,273
865,513
949,958
4,950,533
11,275,576
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
50,621
45,331
47,955
47,555
41,823
233,285
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
1,344,993
1,758,604
1,914,964
140,324
5,158,885
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
0
11
Total support (Add lines 7 through 10).
16,667,746
12
Gross receipts from related activities, etc. (see instructions)
..................
12
3,564,410
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
64.387 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
59.716 %
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
ALZHEIMER'S DISEASE AND RELATED DISORDERS ASSOC INC MINNESOTA-NORTH DAKOTA CHAPTER
Employer identification number
41-1361624
Return Reference
Explanation
PART I, LINE I
OUR MISSION IS TO ELIMINATE ALZHEIMER'S DISEASE THROUGH THE ADVANCEMENT OF RESEARCH; TO PROVIDE AND ENHANCE CARE AND SUPPORT FOR ALL AFFECTED; AND TO REDUCE THE RISK OF DEMENTIA THROUGH THE PROMOTION OF BRAIN HEALTH. Our vision is a world without Alzheimer's.
FORM 990, PART VI, SECTION B, LINE 11(b)
A draft of form 990 is internally reviewed by the VP of Finance & Operations. It is then reviewed by the Finance Committee before it is presented to the Board of Directors for approval.
FORM 990, PART VI, SECTION B, LINE 12C
ANNUALLY DIRECTORS, STAFF, AND VOLUNTEERS COMPLETE A DISCLOSURE CHECKLIST.
FORM 990, PART VI, SECTION B, LINE 15A
AT THE END OF THE PRIOR YEAR, WE HAD THE EXECUTIVE DIRECTOR (CHIEF EXECUTIVE OFFICER AS OF JUNE 30, 2014) PREPARE THE GOALS FOR THE COMING YEAR. THESE WERE REVIEWED BY THE COMPENSATION COMMITTEE. AT THE END OF THE YEAR WE HAD THE CEO COMPLETE A SELF ASSESSMENT OF RESULTS RELATIVE TO THE GOALS. A SUBGROUP (REVIEW COMMITTEE) OF THE COMPENSATION COMMITTEE PREPARED THE PERFORMANCE CRITERIA TO BE USED IN THE REVIEW. THE PERFORMANCE EVALUATION FORMS WERE PROVIDED TO ALL CHAPTER BOARD MEMBERS AND DIRECT REPORTS, WERE COMPLETED AND RETURNED DIRECTLY TO THE COMPENSATION COMMITTEE. THE COMPENSATION COMMITTEE COMPILED THE QUANTITATIVE RESULTS AND SUMMARIZED THE QUALITATIVE COMMENTS. THE BOARD PERFORMANCE REVIEW RESULTS AND CEO'S GOALS AND SELF ASSESSMENT WERE REVIEWED BY THE COMPENSATION COMMITTEE. RECOMMENDATIONS FOR KEY COMMUNICATION POINTS AND INPUT INTO FUTURE GOALS WERE AGREED UPON. THE COMPENSATION COMMITTEE DISCUSSED COMPENSATION SCENARIOS AND CAME TO A RECOMMENDATION. THE COMPENSATION COMMITTEE DISCUSSED THE PERFORMANCE REVIEW RESULTS AND THE COMPENSATION COMMITTEE INPUT WITH CEO. CEO WAS PROVIDED THE OPPORTUNITY TO COMMENT ON THE RESULTS AND WAS ASKED TO DRAFT THE NEXT YEAR'S GOALS/OBJECTIVES. THE SUMMARIZED RESULTS AND A PROPOSED COMPENSATION ACTION WERE THEN DISCUSSED WITH THE FULL BOARD. THE COMPENSATION ACTION WAS APPROVED. COMPENSATION ACTION WAS COMMUNICATED TO CEO. CEO PREPARED GOALS FOR THE COMING YEAR.
FORM 990, PART VI, SECTION C, LINE 19
AVAILABLE UPON REQUEST
PART XI, LINE 5
NET UNREALIZED GAIN- $102,194
PROGRAMS AND SERVICES
During the year ended June 30, 2014, the Association provided more than 38,600 individuals with dementia, their care partners, community members and health care professionals with programs and services. Early-Stage Engagement Programs - In FY14, attendance at programs serving people in the early stage of the disease, such as Memory Club, Meetup and Mentor and the Living Well program, was 1,707. Information Referral - More than 8,460 calls were made to the 24/7 Helpline for information, support and resources. The Association website, which contains information about Alzheimer's and other dementias, received more than 65,600 web visits during the year ended June 30, 2014. Safety Services - In FY14, 105 people enrolled in MedicAlert+ Alzheimer's Association Safe Return, a national, 24-hour, emergency response service for individuals with dementia who wander or have a medical emergency. In total, 3,040 people are enrolled across Minnesota and North Dakota. Support groups - 9,890 individuals attended support groups led by trained volunteer facilitators which provided assistance and encouragement to individuals and their care partners affected by dementia during the year ended June 30, 2014. Advocacy - During the year ended June 30, 2014, Alzheimer's Association staff successfully advocated for the passage of the Minnesota Dementia Staff Training Law, mandating increased staff training in assisted living facilities and ensuring that people with dementia living in these facilities receive a higher level of care. In addition, in 2014, 47 advocates from Minnesota and North Dakota traveled to Washington, D.C., for the annual Alzheimer's Association Advocacy Forum, where they advocated with nearly 900 others for increased Alzheimer's research funding. Research - Nationally, the Alzheimer's Association is committed to accelerating the global effort to eliminate Alzheimer's disease through a variety of initiatives, such as the Alzheimer's Association International Conference (AAIC), the Alzheimer's Association Research Roundtable, Alzheimer's & Dementia: The Journal of the Alzheimer's Association, TrialMatch and the International Research Grants Program. Volunteers - The Alzheimer's Association's programs, services and events would not be possible without the commitment and generous support of its volunteers. During the year ended June 30, 2014, more than 600 people provided more than 10,000 hours of service towards the Association's mission.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.