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
DANE COUNTY HUMANE SOCIETY INC
Employer identification number
39-0806335
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.") ....
1,892,769
1,661,870
2,133,050
2,089,206
2,062,564
9,839,459
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
1,892,769
1,661,870
2,133,050
2,089,206
2,062,564
9,839,459
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)..
1,126,511
6
Public support. Subtract line 5 from line 4.
8,712,948
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..
1,892,769
1,661,870
2,133,050
2,089,206
2,062,564
9,839,459
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
12,795
19,317
30,824
49,137
56,367
168,440
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).
10,007,899
12
Gross receipts from related activities, etc. (see instructions)
..................
12
5,298,405
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
87.060 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
88.070 %
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
DANE COUNTY HUMANE SOCIETY INC
Employer identification number
39-0806335
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 4
BYLAWS WERE AMENDED TO REFLECT CHANGES IN MEMBER VOTING RIGHTS.
FORM 990, PART VI, SECTION A, LINE 6
DCHS HAS A SINGLE CATEGORY OF MEMBERSHIP FOR WHICH A MINIMUM AMOUNT OF DUES IS REQUIRED TO BE ENTITLED TO VOTING RIGHTS. DCHS HAS FIVE ADDITIONAL GIVING LEVELS FOR THOSE PERSONS WHO CONTRIBUTE AMOUNTS ABOVE THE MINIMUM REQUIRED DUES.
FORM 990, PART VI, SECTION A, LINE 7A
THE MEMBERS ELECT THE DIRECTORS OF DCHS AT THE ANNUAL MEMBERSHIP MEETING.
FORM 990, PART VI, SECTION A, LINE 7B
ALL CURRENT MEMBERS, EXCEPT FOR YOUTH MEMBERS UNDER AGE 18, SHALL BE ENTITLED TO VOTE ON ALL MATTERS SUBMITTED TO A VOTE OF THE MEMBERS AND SUCH OTHER ADDITIONAL RIGHTS AND POWERS AS SET FORTH IN THESE BYLAWS OR CONFERRED UPON VOTING MEMBERS OF NON-STOCK CORPORATIONS UNDER APPLICABLE LAW; PROVIDED, HOWEVER, THAT NO MEMBER SHALL HAVE VOTING RIGHTS UNTIL HE OR SHE HAS BEEN A MEMBER OF DCHS FOR THREE (3) CONTINUOUS MONTHS IMMEDIATELY PRIOR TO THE DATE OF SUCH VOTE. A MAJORITY OF THE VOTES ENTITLED TO BE CAST BY THE MEMBERS AT A MEETING AT WHICH A QUORUM IS PRESENT SHALL BE NECESSARY FOR THE ADOPTION OF ANY MATTER VOTED UPON BY MEMBERS, UNLESS A GREATER PROPORTION IS REQUIRED BY LAW, THESE BYLAWS, OR THE ARTICLES OF INCORPORATION. AT ANY MEMBERSHIP MEETING, THOSE VOTING MEMBERS PRESENT, BUT NOT FEWER THAN TWENTY-FIVE (25), SHALL HAVE THE AUTHORITY TO TRANSACT ALL BUSINESS THAT MAY COME BEFORE THE MEMBERSHIP MEETING. AT ALL MEETINGS OF THE MEMBERS, A MEMBER MAY ONLY VOTE WHEN PRESENT AT THE MEETING.
FORM 990, PART VI, SECTION B, LINE 11
THE FORM 990 IS PREPARED BY AN INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT AS PART OF THE ANNUAL FINANCIAL STATEMENT AUDIT ENGAGEMENT. WHEN COMPLETED, THE FORM 990 IS REVIEWED BY DCHS'S EXECUTIVE DIRECTOR AND THE GOVERNING BODY. UPON APPROVAL OF THE COMPLETED FORM 990 BY BOTH THE EXECUTIVE DIRECTOR AND THE GOVERNING BODY, THE FORM 990 WILL BE FILED WITH THE IRS. EACH MEMBER OF THE GOVERNING BODY IS GIVEN ACCESS TO A SECURE SECTION OF DCHS'S WEBSITE WHERE A DRAFT FORM 990 RESIDES. NOTICE OF THE POSTING OF THE UPDATED DRAFT FORM 990 IS GIVEN TO EACH DIRECTOR AT THE MEETING FOLLOWING THE POSTING OF THE UPDATED DRAFT AND BY EMAIL FROM THE PRESIDENT. THE CONTENT OF THE UPDATED DRAFT FORM 990 IS APPROVED BY THE EXECUTIVE DIRECTOR AND THE FINANCE COMMITTEE PRIOR TO POSTING. EACH DIRECTOR IS RESPONSIBLE FOR REVIEWING THE POSTED DRAFT PRIOR TO THE NEXT MEETING. AT THE MEETING OF THE GOVERNING BODY FOLLOWING THE POSTING AND REVIEW OF THE UPDATED DRAFT FORM 990, AN AGENDA ITEM IS ADDED TO DISCUSS QUESTIONS OR CONCERNS REGARDING THE INFORMATION CONTAINED IN THE FORM 990. ONCE ALL ISSUES REGARDING THE FORM 990 HAVE BEEN RESOLVED, THE GOVERNING BODY FORMALLY APPROVES THE COMPLETED FORM 990. UPON APPROVAL BY THE GOVERNING BODY, THE FORM 990 IS FILED WITH THE IRS. THE SECTIONS OF THE APPROVED FORM 990 OPEN TO PUBLIC INSPECTION ARE POSTED ON DCHS'S WEBSITE ONCE FILED. THE PRESIDENT IS RESPONSIBLE FOR ENSURING THAT THIS PROCEDURE IS FOLLOWED ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 12C
ANY DIRECTOR, PRINCIPAL OFFICER, OR MEMBER OF A COMMITTEE WITH GOVERNING BODY DELEGATED POWERS AGREES TO BE BOUND BY DCHS'S CONFLICT OF INTEREST POLICY. THIS CONFLICT OF INTEREST POLICY REQUIRES SELF-REPORTING. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE REPORTED CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BODY DELEGATED POWERS. AFTER DISCLOSURE OF THE INTEREST AND ALL MATERIAL FACTS, THE INTERESTED PERSON SHALL LEAVE THE GOVERNING BODY OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON BY THE REMAINING DIRECTORS OR COMMITTEE MEMBERS. THE GOVERNING BODY OR A DESIGNATED COMMITTEE CONDUCTS PERIODIC REVIEWS TO ENSURE THAT DCHS DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS.
FORM 990, PART VI, SECTION B, LINE 15A
THE PERFORMANCE OF THE DCHS EXECUTIVE DIRECTOR IS REVIEWED BY THE GOVERNING BODY ON AN ANNUAL BASIS. THIS REVIEW OCCURS WITHIN FOUR WEEKS OF THE ANNIVERSARY OF THE EXECUTIVE DIRECTOR'S HIRE DATE. WHEN THE REVIEW HAS BEEN COMPLETED AND FORMALLY APPROVED BY THE GOVERNING BODY, THE DIRECTORS DETERMINE AND APPROVE ANY SALARY ADJUSTMENT AND SUBMIT THE CHANGE TO DCHS'S ACCOUNTANT. APPROXIMATELY 60 DAYS PRIOR TO THE EXECUTIVE DIRECTOR'S ANNIVERSARY DATE, THE GOVERNING BODY APPOINTS A DIRECTOR TO LEAD THE REVIEW EFFORT. THE LEAD COMPILES ALL COMMENTS SUBMITTED BY THE DIRECTORS AND CREATES A SINGLE COHESIVE REVIEW THAT IS SHARED WITH THE EXECUTIVE DIRECTOR AFTER BEING APPROVED BY THE GOVERNING BODY. ONCE THE GOVERNING BODY APPROVES THE COMPILED REVIEW, THE DIRECTORS ARE RESPONSIBLE FOR DISCUSSING AND APPROVING ANY SALARY ADJUSTMENTS. THE PRESIDENT IS RESPONSIBLE FOR ENSURING THAT THIS PROCEDURE IS FOLLOWED ANNUALLY.
FORM 990, PART VI, SECTION C, LINE 19
DCHS MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.