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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
OLYMPIA UNION GOSPEL MISSION
Employer identification number
91-1680748
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
1,411,346
1,138,479
1,172,077
1,208,093
1,424,083
6,354,078
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
1,411,346
1,138,479
1,172,077
1,208,093
1,424,083
6,354,078
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)..
28,286
6
Public support. Subtract line 5 from line 4.
6,325,792
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
1,411,346
1,138,479
1,172,077
1,208,093
1,424,083
6,354,078
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
30,551
19,146
20,280
16,402
4,896
91,275
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.)..
35,119
38,787
37,154
29,293
140,353
11
Total support (Add lines 7 through 10).
6,585,706
12
Gross receipts from related activities, etc. (see instructions)
..................
12
409,079
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
96.050 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
96.040 %
16a
33 1/3% support test—2012.
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—2011.
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—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
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—2011.
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) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to 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) 2012
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.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
OLYMPIA UNION GOSPEL MISSION
Employer identification number
91-1680748
Identifier
Return Reference
Explanation
EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS
FORM 990, PAGE 1, PART I, LINE 6
VOLUNTEERS PROVIDE MEDICAL, DENTAL, AND VISION EXAMINATIONS AND SERVICES TO OUR CLIENTS. IN ADDITION WE HAVE AN UNPAID, VOLUNTEER BOARD OF DIRECTORS PROVIDING MANAGEMENT OVERSIGHT AND OPERATIONAL GUIDANCE.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
2.ESTABLISH RELATIONSHIPS WITH OTHER PARTNERS (DENTISTS, GOVERNMENTAL AGENCIES AND SPECIALISTS.) 3.ESTABLISH RELATIONSHIPS WITH CLIENTS AND SHARE THE GOSPEL. PATIENT VISITS = 2,134 IN-KIND DONATED SERVICES RECEIVED = 475,526 VISION CLINIC THIS IS A SERVICE AVAILABLE TO INDIVIDUALS WITH HOUSE HOLD INCOMES THAT PLACE THEM AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, WHO HAVE NO INSURANCE FOR VISION SERVICES OR OTHER MEANS TO PAY FOR CARE. AT NO FEE, PATIENTS ARE PROVIDED A COMPLETE VISION EXAMINATION BY A LICENSED EYE PHYSICIAN AND, AS NEEDED, PRESCRIPTION GLASSES. ON A CASE BY CASE BASIS, REFERRAL TO EYE SURGEONS IS AVAILABLE FOR PATIENTS WITH CATARACTS. PATIENT VISITS = 747 IN-KIND DONATED SERVICES RECEIVED = 178,141 MEDICAL CLINIC THE MEDICAL CLINIC PROVIDES, AT NO-FEE TO UNINSURED INDIVIDUALS WITH HOUSEHOLD INCOMES THAT PLACE THEM AT, OR BELOW, 200% OF THE FEDERAL POVERTY LEVEL, PRIMARY CARE MEDICAL SERVICES FOR THE DIAGNOSIS AND MANAGEMENT OF DIABETES, HYPERTENSION, HEART FAILURE, ASTHMA AND COPD. IN ADDITION TO CLINICAL SERVICES PROVIDED BY A VOLUNTEER LICENSED MEDICAL PROVIDER, PATIENT SERVICES INCLUDE CLINICAL LABORATORY TESTING, THE OPPORTUNITY TO MEET WITH DIETITIANS AND SOCIAL WORKERS, AND FINANCIAL ASSISTANCE PURCHASING PRESCRIBED MEDICATIONS UNTIL THE PATIENT CAN BE ACCEPTED INTO THE PRESCRIPTION ASSISTANCE PROGRAMS OFFERED BY DRUG MANUFACTURES. PATIENT VISITS = 1,703 TOTAL CLIENT SERVICES = 130,205 IN-KIND DONATED SERVICES RECEIVED = 355,630
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
D.HELP INDIVIDUALS TO CONNECT WITH A LOCAL CHRISTIAN BODY OF BELIEVERS. NUMBER IN ATTENDANCE = 3,481 2. CHRISTIAN COUNSELING TO PROVIDE BIBLICAL BASED COUNSELING TO INDIVIDUALS FACING DIFFICULT ISSUES / DECISIONS IN THEIR LIVES. COUNSELING SESSIONS = 462 3. LRC FOOD SERVICE PROGRAMS BREAKFAST THERE ARE MANY IN OUR COMMUNITY WHO ARE HOMELESS AND POOR WHO OBTAIN WORK THROUGH TEMPORARY JOB SERVICES BUT GET NO BREAKFAST TO BEGIN THEIR DAY. THIS PROGRAM IS DESIGNED TO PROVIDE DAY LABORERS AND OTHER EARLY RISERS WITH A GOOD MEAL SO THEY CAN BE MORE HEALTHY AND PRODUCTIVE. A.PROVIDE A NUTRITIOUS BREAKFAST TO DAY LABORERS OBTAINING WORK THROUGH TEMPORARY DAY JOBS. B.PROVIDE AND OPPORTUNITY TO SHARE THE GOSPEL THOUGH A DEVOTIONAL SETTING. C.PROVIDE AN OPPORTUNITY FOR MISSION STAFF AND VOLUNTEERS TO BUILD RELATIONSHIPS, WHICH WITH GOD'S HELP WILL LEAD TO BRINGING THEM INTO THE KINGDOM. D.PROVIDE AN OPPORTUNITY FOR VOLUNTEER TEAMS TO WORK IN THE MISSION. LRC LUNCH PROGRAM THE LUNCH PROGRAM PROVIDES A NUTRITIOUS HOT MEAL TO INDIVIDUALS WHO COME TO THE MISSION FOR A NOON BIBLE STUDY. A.PROVIDE A NUTRITIOUS HOT LUNCH TO POOR AND HOMELESS INDIVIDUALS AS WELL AS CLIENTS OF MISSION PROGRAMS. B.PROVIDE AN OPPORTUNITY TO SHARE THE GOSPEL THOUGH A DEVOTIONAL SETTING. C.PROVIDE AN OPPORTUNITY FOR MISSION STAFF AND VOLUNTEERS TO BUILD RELATIONSHIPS, WHICH WITH GOD'S HELP WILL LEAD TO BRINGING THEM INTO THE KINGDOM. LRC DINNER PROGRAM THE EVENING DINNER PROGRAM PROVIDES A HOT NUTRITIOUS MEAL. THE DINNER IS ACCOMPANIED BY A MESSAGE. A. PROVIDE A NUTRITIOUS HOT MEAL TO POOR AND HOMELESS INDIVIDUALS AS WELL AS CLIENTS OF MISSION PROGRAMS. B.PROVIDE AND OPPORTUNITY TO SHARE THE GOSPEL THOUGH A DEVOTIONAL SETTING. C.PROVIDE AN OPPORTUNITY FOR MISSION STAFF AND VOLUNTEERS TO BUILD RELATIONSHIPS, WHICH WITH GOD'S HELP WILL LEAD TO BRINGING THEM INTO THE KINGDOM. TOTAL FOOD SERVICE MEALS = 84,275 4. LIFE RECOVERY CENTER (LRC) DAY CENTER THE LRC IS DESIGNED TO PROVIDE FOR A SAFE AND WHOLESOME ENVIRONMENT FOR THE HOMELESS AND THE POOR TO COME DURING THE DAY. 1.MINSTER TO MEN, WOMEN AND CHILDREN 2.PROVIDE SPIRITUAL COUNSELING AND SUPPORT FOR THOSE SEEKING HELP. 3.PROVIDE VARIOUS WORKSHOPS AND STUDY SESSIONS THROUGH OUT THE DAY. 4.PROVIDE HOT SHOWERS AND LAUNDRY. 5.PROVIDE FOR EMERGENCY CLOTHING NEEDS. 6.PROVIDE DONATED PERSONAL CARE PRODUCTS TO THOSE IN NEED 7.PROVIDE LIFE SKILLS TRAINING 8.PROVIDE ARTS AND CRAFTS CLASSES 9.CREATE AN ENVIRONMENT THAT FOSTERS THE DEVELOPMENT OF HEALTHY RELATIONSHIPS BETWEEN CLIENTS, VOLUNTEERS AND STAFF 10.PROVIDE AN OPPORTUNITY FOR VOLUNTEER TEAMS TO WORK IN THE MISSION. NUMBER OF VISITS = 36,939 5. BENEVOLENCE MINISTRY THIS MINISTRY SEEKS TO MEET EMERGENCY NEEDS FOR MONEY TO PAY FOR UTILITIES AND RENT FOR THOSE WHO HAVE RECEIVED NOTICE OF UTILITY SHUT-OFF OR EVICTION. MONEY IS ALSO MADE AVAILABLE TO PAY FOR PRESCRIPTION DRUGS SUCH AS ANTIBIOTICS (NO NARCOTICS). 1.TELEPHONE INTERVIEW WITH EACH REQUESTOR AS TO THEIR NEED. DETERMINE IF A FURTHER INTERVIEW IS JUSTIFIED TO PROVIDE FINANCIAL HELP. 2.MEET WITH THE PERSON FACE TO FACE. VIEW THEIR NOTICE OR PRESCRIPTION DETERMINE AS BEST AS POSSIBLE WHERE GOD IS IN THEIR CIRCUMSTANCES. PROVIDE EMERGENCY FUNDS AS JUSTIFIED ON A CASE-BY-CASE BASIS. 3.PROVIDE BUS PASSES TO MISSION CLIENTS AND THOSE NEEDING TRANSPORTATION TO AND FORM WORK OR MEDICAL APPOINTMENTS, ETC. 4.SHARE THE GOSPEL AND PRAY WITH THE PERSON. CLIENTS SERVED = 438
THIRD ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4C
HOMELESSNESS. 6.PROVIDE FOR RESOLVING/PAYING OFF DEBT AND/OR FINES. 7.PROVIDE OPPORTUNITIES FOR ADDITIONAL EDUCATION, JOB TRAINING 8.PROVIDE OPPORTUNITIES TO OBTAIN BETTER EMPLOYMENT CLIENTS SERVED = 12
ALL OTHER ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4D
MEN'S DRUG AND ALCOHOL RECOVERY PROGRAM TRANSITIONAL HOUSING FOR MEN THIS PROGRAM PROVIDES TRANSITIONAL LIVING DRUG AND ALCOHOL RECOVERY FOR UP TO 12 MEN. 1.PROVIDE DRUG AND ALCOHOL RECOVERY SERVICES USING THE "GENESIS" PROCESS. 2.PROVIDE HOUSING FOR THE HOMELESS IN RECOVERY. 3.PROVIDE LIFE SKILLS AND DISCIPLESHIP TRAINING. 4.PROVIDE SUPPORT FOR BETTER EDUCATION, ECONOMIC RECOVERY AND EMPLOYMENT. 5.CONNECT CLIENTS WITH A LOCAL CHRISTIAN EVANGELICAL CHURCH. CLIENTS SERVED = 14
RELATED PARTY INFORMATION AMONG OFFICERS
FORM 990, PAGE 6, PART VI, LINE 2
CINDY MCREYNOLDS CHARLES MCREYNOLDS BOARD MEMBER BOARD MEMBER SPOUSE
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
BOARD MEMBERS ARE PROVIDED A COPY OF THE 990 FOR REVIEW WITH TIME AND OPPORTUNITY TO ASK QUESTIONS THEY HAVE ABOUT THE FORM.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
THE EXECUTIVE DIRECTOR BEING FAMILIAR WITH OPERATIONS AND HOW OPERATIONS IMPACT THE BOARD MEMBERS AND VISA VERSE MONITORS FOR ANY POTENTIAL CONFLICTS. ONCE A YEAR AS PART OF THE BOARD MEETING AGENDA, EACH BOARD MEMBER'S RESPONSIBILITIES, INCLUDING THE EXECUTIVE DIRECTOR'S, ARE DISCUSSED, BOTH INSIDE AND OUTSIDE THE MISSION ARE TO IDENTIFY ANY POTENTIAL CONFLICTS.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
THE EXECUTIVE DIRECTOR'S COMPENSATION IS DETERMINED USING A SALARY SURVEY FROM THE ASSOCIATION OF GOSPEL RESCUE MISSIONS AND IS REVIEWED AND APPROVED ANNUALLY BY THE BOARD OF DIRECTORS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
THE EXECUTIVE DIRECTOR OBTAINS A SALARY SURVEY FROM THE ASSOCIATION OF GOSPEL RESCUE MISSIONS AND USES THE SURVEY TO ASSIST IN DETERMINING COMPENSATION OF ALL KEY STAFF. ALL KEY STAFF COMPENSATION IS DISCUSSED AND APPROVED ANNUALLY IN A BOARD MEETING.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS AND POLICIES ARE AVAILABLE UPON REQUEST WITH THE FORM 990 AVAILABLE BY REQUEST AND ON GUIDESTAR'S WEBSITE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.