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
JEFFREY GOTTFURCHT CHILDREN'S ARTHRITIS FOUNDATION
Employer identification number
80-0478327
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.") ....
47,200
59,400
132,679
109,898
105,901
455,078
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
47,200
59,400
132,679
109,898
105,901
455,078
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)..
248,446
6
Public support. Subtract line 5 from line 4.
206,632
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..
47,200
59,400
132,679
109,898
105,901
455,078
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).
455,078
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.") .
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
JEFFREY GOTTFURCHT CHILDREN'S ARTHRITIS FOUNDATION
Employer identification number
80-0478327
Return Reference
Explanation
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID
ACTIVITY CLASSIFICATION: DIRECT "DREAM" EXPENSES FOR CHILDREN. GRANTEE NAME: VARIOUS. GRANTEE ADDRESS: 9440 SANTA MONICA BLVD., 8TH FL. BEVERLY HILLS, CA 90210. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 12/31/13. AMOUNT GIVEN: 39,620.
FORM 990-EZ, PART I, LINE 14
DESCRIPTION: DEPRECIATION. AMOUNT: 233.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES
DESCRIPTION: TELEPHONE EXPENSE. AMOUNT: 5,816. DESCRIPTION: BANK CHARGES. AMOUNT: 2,235. DESCRIPTION: INSURANCE. AMOUNT: 3,343. DESCRIPTION: MEALS & ENTERTAINMENT. AMOUNT: 869. DESCRIPTION: OFFICE EXPENSE. AMOUNT: 698. DESCRIPTION: MOUNTAIN CLIMBING. AMOUNT: 3,709. DESCRIPTION: PROMOTION. AMOUNT: 1,363. DESCRIPTION: TRAVEL. AMOUNT: 11,112. DESCRIPTION: TAXES. AMOUNT: 33. DESCRIPTION: PAYPAL FEES. AMOUNT: 342. DESCRIPTION: DUES AND SUBSCRIPTION. AMOUNT: 180. TOTAL TO FORM 990-EZ, LINE 16: 29,700.
PART I, LINE 10 AND SCH O
DUE TO TAX SOFTWARE LIMITATIONS, DECEMBER 31, 2013 WAS SHOWN AS THE DATE THAT GRANTS WERE MADE AS OPPOSED TO VARIOUS.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS
DESCRIPTION: TRADEMARKS. BEG. OF YEAR AMOUNT: 550. END OF YEAR AMOUNT: 550. DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 974. END OF YEAR AMOUNT: 742.
FORM 990-EZ, PART III, PROGRAM SERVICE ACCOMPLISHMENTS
DREAMS . IN 2013, WE, JEFFREY GOTTFURCHT CHILDREN'S ARTHRITIS FOUNDATION (JGCAF), GRANTED 15 DREAMS ACROSS THE UNITED STATES. WE GRANTED DREAMS TO CHILDREN ACROSS THE NATION AND OUR ESPECIALLY PROUD THAT WE SENT FAMILIES FROM NEBRASKA, COLORADO AND NEW YORK TO HAWAII FOR VACATIONS THAT BROUGHT JOY, HAPPINESS AND HOPE TO THESE WELL DESERVING FAMILIES. . BESIDES TRIPS TO HAWAII - DREAM GRANTS ALSO CONSISTED OF - COMPUTER EQUIPMENT- CELL PHONES- SHOPPING SPREES- GIFT CERTIFICATES - MEDICAL EQUIPMENT - JACUZZI'S FOR TREATMENT -MEETING CELEBRITIES AND WE'RE VERY PROUD THAT WE'VE BEEN ABLE TO GRANT FINANCIAL AID FOR COLLEGE AND ELEMENTARY SCHOOL CHILDREN. JGCAF ALSO MADE A NUMBER OF DREAMS COME WITH THE HELP OF THE NATIONAL FOOTBALL LEAGUE (NFL) - FOR CHILDREN WHO WANTED TO MEET THEIR FAVORITE PLAYERS AND TEAMS. HAVING THIS RELATIONSHIP WITH THE NFL GREATLY BRINGS EXPOSURE TO THE KIDS WE HELP. . . EDUCATION, SUPPORT, RESOURCES: . IN OUR QUEST TO BRING DREAMS TO CHILDREN WITH JUVENILE ARTHRITIS, JGCAF DISCOVERED CERTAIN NEEDS WE FELT WEREN'T BEING MET SUCH AS: A) FAMILIES THAT HAS A CHILD WITH JUVENILE ARTHRITIS FEELING EMOTIONALLY ALONE AND NOT SURE IN SOME INSTANCES WHAT TO DO; B) LACK OF KNOWLEDGE ABOUT JUVENILE ARTHRITIS. JGCAF HAS ATTEMPTED TO MEET THESE NEEDS IN THE FOLLOWING WAYS: 1) OUR FACEBOOK PAGE PROVIDES A FORUM WHERE PEOPLE CAN ASK QUESTIONS, GET ANSWERS, EXPRESS THOUGHTS, AND CONNECT WITH ONE ANOTHER. THIS CONNECTION HELPS PARENTS AND KIDS SUPPORT ONE ANOTHER AND TO KNOW THAT EVEN THOUGH ONLY 300,000 HAVE JUVENILE ARTHRITIS ACROSS THE USA, THEY CAN COUNT ON ONE ANOTHER. IN ADDITION, IT PROVIDES ADDITIONAL RESOURCES SUCH AS TO HELP FAMILIES BE ALERTED AS TO WHAT CHILDREN'S ARTHRITIS EVENTS ARE HAPPENING ACROSS THE UNITED STATES. 2) WE HAVE RELATIONSHIPS WITH CERTAIN HOSPITALS THAT HAVE A STRONG REPUTATION IN TREATING JUVENILE ARTHRITIS THAT INCLUDES CHILDREN'S HOSPITAL OF LOS ANGELES, NYU MEDICAL CENTER, CHILDREN'S HOSPITAL OF MICHIGAN, AND KAPOLANI MEDICAL CENTER OF HAWAII. . ALTOGETHER THERE WERE THOUSANDS OF PEOPLE- KIDS AND ADULTS- REACHING OUT TO JGCAF THROUGH VARIOUS CHANNELS SUCH AS WEBSITE, FACEBOOK, TWITTER, EMAILS, PHONE CALLS, AS WELL AS THROUGH THE HOSPITALS. . . OUTREACH: . OUR FOUNDER WAS ALSO FORTUNATE ENOUGH TO HAVE TO OPPORTUNITY TO SPEAK AT SIX DIFFERENT VENUES ACROSS THE UNITED STATES TO SHARE HIS STORY OF ARTHRITIS AND GREATLY BRINGING THE STORY OF JGCAF WHICH WAS ATTENDED BY APPROXIMATELY 5,500 PEOPLE IN TOTAL. HIS OWN STORY INCLUDES HIS DREAM WHICH IS TO BE THE FIRST PERSON WITH RHEUMATOID ARTHRITIS TO CLIMB THE HIGHEST MOUNTAINS IN EACH OF THE SEVEN CONTINENTS WITH THE HOPE THIS WILL INSPIRE CHILDREN AND OTHERS WITH ARTHRITIS NOT TO GIVE UP ON THEIR OWN DREAMS (AS OF DECEMBER 31, 2013, HE HAD CLIMBED FIVE SUCH MOUNTAINS). THE ABILITY FOR OUR FOUNDER TO REACH SO MANY PEOPLE- IN REAL LIFE PRESENTATIONS- ALLOWS THE STORY OF JUVENILE ARTHRITIS TO TOUCH PEOPLE WHO MIGHT HAVE NEVER HEARD OR HAD AN INTEREST IN THE CONDITION. . IN ADDITION TO SPEAKING - JGCAF PARTNERED WITH THE DETROIT LIONS TO BRING MASSIVE AWARENESS TO OUR CAUSE. IN DOING SO-- PRO BOWL WIDE RECEIVER CALVIN JOHNSON WHO BROKE THE NFL'S LEAGUE RECORD FOR YARDS CAUGHT BY A WIDE RECEIVER- GAVE HIS RECORD BREAKING HALL OF FAME BOUND JERSEY TO OUR FOUNDER TO CARRY TO THE TOP OF KILIMANJARO WHICH WAS BLOGGED LIVE ON THE DETROIT LIONS WEBSITE-TWITTER AND FACEBOOK. THAT EVENT WAS WATCHED BY THE OVER 1.6 MILLION VIEWERS JUST ON THE LIONS FACEBOOK PAGE PROVIDING JGCAF WITH HUGE EXPOSURE. . WHILE JGCAF GETS PLENTY OF PRESS ON BLOGS- NEWSPAPERS-TELEVISION- MARKETING LITERATURE- ETC. - IT'S OUR ABILITY TO REACH PEOPLE WITH OUR MISSION AND INCREDIBLE STORY THAT WILL ALLOW US TO CONTINUE TO MAKE DREAMS COME TRUE FOR KIDS FIGHTING JUVENILE ARTHRITIS- AND MOST IMPORTANTLY HOPEFULLY - ONE DAY WE WILL NOT HAVE TO GRANT ANYMORE DREAMS - AS WE KEEP OUR FINGERS CROSSED THAT A CURE WILL BE FOUND.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.