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
MT ZION CHILD DEVELOPMENT CENTER INC
Employer identification number
39-1713521
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.
0
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...
0
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
0 %
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.") .
23,747
17,562
17,024
15,260
14,462
88,055
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......
153,246
163,702
156,074
220,910
205,383
899,315
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
9,948
12,987
12,418
10,888
10,832
57,073
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.
186,941
194,251
185,516
247,058
230,677
1,044,443
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.)
1,044,443
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...
186,941
194,251
185,516
247,058
230,677
1,044,443
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
47
167
109
129
188
640
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
47
167
109
129
188
640
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.)..
1,045,083
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
99.940 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
99.950 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.060 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.050 %
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:
13000178
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
MT ZION CHILD DEVELOPMENT CENTER INC
Employer identification number
39-1713521
Return Reference
Explanation
Pt VI, Line 11b
The licensed certified public accountant (CPA) that completes
Pt VI, Line 11b
Form 990 for the organization reviews the form with the
Pt VI, Line 11b
Assistant Treasurer. In turn, the Assistant Treasurer presents
Pt VI, Line 11b
copies of the form to each director and officer prior to a
Pt VI, Line 11b
properly scheduled Board meeting to discuss the filing. At
Pt VI, Line 11b
the meeting, all directors and officers have an opportunity to
Pt VI, Line 11b
ask questions about the form or to otherwise make comments
Pt VI, Line 11b
about the form and its contents. If the Assistant Treasurer
Pt VI, Line 11b
cannot adequately answer a question about the form, the
Pt VI, Line 11b
question is passed on to and is answered by the CPA via a
Pt VI, Line 11b
telephone call. Once all questions are adequately answered,
Pt VI, Line 11b
the Board passes a motion to have the Assistant Treasurer
Pt VI, Line 11b
sign the paper return and authorize the CPA to e-file the return.
Pt VI, Line 11b
END.
Pt VI, Line 12c
A copy of the organization's written conflict of interest policy
Pt VI, Line 12c
is timely distributed to all new directors, officers and
Pt VI, Line 12c
employees as well as to all existing directors, officers and
Pt VI, Line 12c
employees every time the policy is modified. The policy requires
Pt VI, Line 12c
that any director, officer or employee must disclose to the
Pt VI, Line 12c
President (or to at least two Directors if the discloser is the
Pt VI, Line 12c
President or a Director) any pending or contemplated transaction
Pt VI, Line 12c
that might give rise to a potential conflict of interest.
Pt VI, Line 12c
The President (or the two Directors) then determines whether
Pt VI, Line 12c
the transaction constitutes a conflict, and so informs the
Pt VI, Line 12c
discloser. Both the disclosure and decision are recorded in the
Pt VI, Line 12c
discloser's personnel record and is reported at the next
SHARLIE F. MCCAIN W135N7273 LUND CIR MENOMONEE FALLS WI XXX-XX-XXXX BURMA L. HUDSON 9437 W ROCHELLE AVE MILWAUKEE WI XXX-XX-XXXX JAMES C. HAMBERLIN 6920 N LINCOLNSHIRE CIR MILWAUKEE WI XXX-XX-XXXX ALFRED DAVIS 9405 N 67TH ST MILWAUKEE WI XXX-XX-XXXX DESSIE E. HARRIS 5869 N 74TH ST MILWAUKEE WI XXX-XX-XXXX PASTOR LOUIS E. SIBLEY, III 1849 N 1ST ST MILWAUKEE WI XXX-XX-XXXX JUANITA WILLIAMS 2541 N 14TH ST MILWAUKEE WI XXX-XX-XXXX JENNELL CALVERT 5244 N 67TH ST MILWAUKEE WI XXX-XX-XXXX MARTHA E. CARTER 3867 N 68TH
Pt VI, Line 12c
Board meeting. The policy also encourages any employee
Pt VI, Line 12c
to anonymously report any possible conflict of interest they
Pt VI, Line 12c
observe. Also, the outside bookkeeper and CPA remain
Pt VI, Line 12c
diligent in looking for possible conflicts of interest.
Pt VI, Line 12c
END.
Pt VI, Line 15a
The organization's independent Directors within the
Pt VI, Line 15a
Personnel Committee review and approve all compensation and
Pt VI, Line 15a
benefits for all officers, other top management staff and key
Pt VI, Line 15b
employees. The Directors use in their deliberations compara-
Pt VI, Line 15b
bility data consisting of salary and benefit survey results of
Pt VI, Line 15b
similar organizations. The Committee's decisions are
Pt VI, Line 15b
a part of its contemporaneous meeting minutes, which are
Pt VI, Line 15b
then forwarded to the full Board for discussion and approval.
Pt VI, Line 15b
END.
Pt VI, Line 19
The organization's governing documents, conflict of interest
Pt VI, Line 19
policy, financial statements and Form 990 are made available
Pt VI, Line 19
to the public upon demand. Any person who requests any
Pt VI, Line 19
of these documents from any director, officer or employee
Pt VI, Line 19
in person, by mail or by telephone are promptly provided
Pt VI, Line 19
with a free copy of each of the requested document(s).
Pt VI, Line 19
END.
Pt XI, Line 9
Rounding difference.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.