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
LEBANON VALLEY FAMILY YMCA
Employer identification number
23-1243980
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.") ....
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.
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..
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).
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 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
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.") .
730,068
642,696
1,071,782
1,304,385
808,979
4,557,910
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......
2,864,313
2,692,628
2,905,596
2,891,326
3,062,108
14,415,971
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
18,291
12,164
15,630
17,133
63,218
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.
3,594,381
3,353,615
3,989,542
4,211,341
3,888,220
19,037,099
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.)
19,037,099
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...
3,594,381
3,353,615
3,989,542
4,211,341
3,888,220
19,037,099
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
27,687
54,003
60,493
78,496
70,942
291,621
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
27,687
54,003
60,493
78,496
70,942
291,621
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
26,608
39,540
66,148
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.)..
3,622,068
3,407,618
4,050,035
4,316,445
3,998,702
19,394,868
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
98.160 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
98.340 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
2.000 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
2.000 %
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
LEBANON VALLEY FAMILY YMCA
Employer identification number
23-1243980
Identifier
Return Reference
Explanation
ORGANIZATION'S MISSION
FORM 990 - ORGANIZATION'S MISSION
TO PUT CHRISTIAN PRINCIPLES INTO PRACTICE THROUGH PROGRAMS THAT BUILD HEALTHY SPIRIT, MIND, AND BODY FOR ALL. BUILDING HEALTHY SPIRIT, MIND, AND BODY FOR ALL WHILE IMPROVING THE QUALITY OF LIFE AND NURTURING LIFELONG DEVELOPMENT OF HEALTHIER INDIVIDUALS, FAMILIES AND COMMUNITY BY PREPARING YOUTH FOR THE ROLE THEY WILL PLAY IN CREATING STRONG COMMUNITIES FOR TOMORROW, IMPROVING THE HEALTH AND WELLNESS OF OUR COMMUNITY, STRENGTHENING FAMILIES THROUGH HOLISTIC PROGRAMS AND ACTIVITIES, DEVELOPING RELATIONSHIPS WITH MEMBERS THAT STRENGTHEN THEIR COMMITMENT TO OUR MISSION, ADVANCING OUR MISSION BY PROVIDING NECESSARY RESOURCES THROUGH THE LEADERSHIP OF VOLUNTEERS AND STAFF CREATING STRATEGIC PARTNERSHIPS THAT ADDRESS CRITICAL COMMUNITY NEEDS.
FIRST ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4A
ASSISTANCE TO THOSE WHO NEED IT. IN 2013 WE SERVED OVER 10,000 INDIVIDUALS IN OUR COMMUNITY. WE PROVIDED OVER 140,000 IN FINANCIAL SUPPORT AND UNDERWRITTEN PROGRAMS TO OVER 900 DIFFERENT PERSONS IN THE AREA OF HEALTH AND WELL-BEING. THE LEBANON VALLEY FAMILY YMCA, FREER FAMILY COMMUNITY YOUTH CENTER OFFERS CHILDREN BETWEEN GRADES 6TH - 11TH THE OPPORTUNITY TO PARTICIPATE IN FREE ACTIVITIES WHICH INCLUDE BASKETBALL, COMPUTER LAB, HOMEWORK HELP, FIELD TRIPS AND RECREATION ROOM ACTIVITIES, SUCH AS POOL, PING PONG, VIDEO ARCADES AND GAMES. ALL YOUTH ARE ALSO PROVIDED WITH DAILY SNACKS. THE CENTER OPENS AT SCHOOL DISMISSAL UNTIL 6 PM. YMCA STAFF WORK WITH THE YOUTH IN PLANNING MONTHLY ACTIVITIES. AN AVERAGE OF 65 YOUTH PARTICIPATE DAILY IN THE CENTERS ACTIVITIES. THE CENTER IS OPEN FOR FREE TO ALL YOUTH IN LEBANON COUNTY.
SECOND ACCOMPLISHMENT DESCRIPTION
FORM 990, PAGE 2, PART III, LINE 4B
CHRISTIAN MINISTRIES, AND THE PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE, WE SERVE OVER 420 CHILDREN DAILY IN LICENSED YMCA CHILDCARE. WE PROVIDED OVER 78,000 IN DIRECT FINANCIAL ASSISTANCE TO CHILDREN IN THESE AREAS. OUR LICENSED CHILDCARE OFFERS AGE APPROPRIATE PROGRAMMING FOR AGES 6 TO 13 IN THE FIELDS OF OUTDOOR ENVIRONMENTAL EDUCATION, EXPERIENTIAL LEARNING, LEADERSHIP DEVELOPMENT AND HANDS ON TEACHING THAT ENCOMPASSES THE FOUR CORE VALUES OF THE YMCA, CARING, HONESTY, RESPECT AND RESPONSIBILITY. WE FOCUS ON PERSONAL DEVELOPMENT AND THE BUILDING OF RELATIONSHIPS THROUGH THE PROGRAMMING WE OFFER. WE SERVE CHILDREN AND FAMILIES FROM A DIVERSE BACKGROUND AND OFFER PROGRAMMING FOR ALL REGARDLESS OF THEIR ABILITY TO PAY. WE PARTNER WITH SCHOOL DISTRICTS, SERVICE CLUBS AND OTHER COMMUNITY AGENCIES TO PROVIDE QUALITY PROGRAMMING. IN 2013 THE LEBANON VALLEY FAMILY YMCA SERVED OVER 3,900 YOUTH AND TEENS IN YMCA MISSION DRIVEN PROGRAMS AND SERVICES.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
FORM 990 IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING.
ENFORCEMENT OF CONFLICTS POLICY
FORM 990, PAGE 6, PART VI, LINE 12C
ALL ASSOCIATION BOARD OF DIRECTORS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY. THE QUESTIONNAIRES ARE REVIEWE ANNUALLY BY THE EXECUTIVE COMMITTEE OF THE ASSOCIATION BOARD OF DIRECTORS WHEN AND IF A CONFLICT EXISTS, THE AFFECTED BOARD MEMBER IS REMOVED FROM THE DECISION MAKING PROCESS OF ANY ISSUE THAT MAY RESULT IN A POTENTIAL OR PRECEIVED CONFLICT.
COMPENSATION PROCESS FOR TOP OFFICIAL
FORM 990, PAGE 6, PART VI, LINE 15A
BOARD REVIEWS AND APPROVES ON AN ANNUAL BASIS.
COMPENSATION PROCESS FOR OFFICERS
FORM 990, PAGE 6, PART VI, LINE 15B
BOARD REVIEWS AND APPROVES ON AN ANNUAL BASIS.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE ORGANIZATION MAKES ITS' GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICYAND OTHER FINANCIAL STATEMENTS AVAIALBLE UPON REQUEST.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 9
UNREALIZED GAIN ON INVESTMENTS 0 UNREALIZED LOSS ON INVESTMENTS 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.