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
FAMILY YMCA OF EMPORIA GREENSVILLE FAMILY YMCA OF EMPORIA GREENSVILLE
Employer identification number
54-2005981
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.
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...
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
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.") .
224,397
631,118
596,538
676,983
842,377
2,971,413
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......
56,287
269,759
274,910
271,833
237,444
1,110,233
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.
280,684
900,877
871,448
948,816
1,079,821
4,081,646
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.)
4,081,646
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...
280,684
900,877
871,448
948,816
1,079,821
4,081,646
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.)..
280,684
900,877
871,448
948,816
1,079,821
4,081,646
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
100.000 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
100.000 %
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 %
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
FAMILY YMCA OF EMPORIA GREENSVILLE FAMILY YMCA OF EMPORIA GREENSVILLE
Employer identification number
54-2005981
Return Reference
Explanation
FORM 990 - ORGANIZATION'S MISSION
THE FAMILY YMCA OF EMPORIA-GREENSVILLE IS A CHARITABLE COMMUNITY SERVICE ORGANIZATION THAT PROVIDES SERVICES TO MEN, WOMEN AND CHILDREN OF ALL AGES, ABILITIES, INCOMES, RACES AND RELIGIONS. THE ORGANIZATION IS DEDICATED TO BUILDING STRONG KIDS, STRONG FAMILIES, AND STRONG COMMUNITIES BY PUTTING CHRISTIAN PRINCIPLES INTO PRACTICE THROUGH PROGRAMS THAT PROMOTE HEALTHY LIFESTYLES, STRONG VALUES, LEADERSHIP DEVELOPMENT, COMMUNITY INTERACTION, AND INTERNATIONAL UNDERSTANDING AS WELL AS PROMOTING THE CORE VALUES OF CARING, HONESTY, RESPECT AND RESPONSIBILITY. PROGRAMS OFFERED INCLUDE BEFORE/AFTER SCHOOL CHILDCARE, SCHOOL VACATION CHILDCARE AND PRE-SCHOOL LICENSED BY THE VIRGINIA DEPARTMENT OF SOCIAL SERVICES; SENIOR WELLNESS AND SOCIAL INTERACTION; TEEN PROGRAMS; AQUATICS AND WELLNESS THROUGH INDIVIDUAL AND GROUP FITNESS ACTIVITIES. THE CORE VALUES ARE INCORPORATED INTO ALL OUR PROGRAMS. ALL PERSONS ARE WELCOME AT OUR YMCA REGARDLESS OF THEIR ABILITY TO PAY. THE YMCA IS FOUNDED AND LED BY VOLUNTEERS FROM THE COMMUNITY; VOLUNTEERS ALSO SERVE AS MENTORS, PROGRAM LEADERS, AND INSTRUCTORS.
FORM 990, PAGE 2, PART III, LINE 4A
GRADE THROUGH 10TH GRADE HAD 17 KIDS ENROLLED FOR THE 2013 SCHOOL YEAR. THE LEADER'S CLUB PROVIDES TEENS WITH KNOWLEDGE, TRAINING, STRONG COMMUNICATION SKILLS,AND VALUABLE TEAM BUILDING EXPERIENCES THROUGH YMCA SERVICE AND LEADERSHIP DEVELOPMENT PROGRAMS AND ACTIVITIES. THE GROUP- ORIENTED SERVICE PROGRAM TEACHES THEM TO BETTER SERVE OTHERS WHILE ENCOURAGING EACH OTHER; BUILDING A HEALTHY SPIRIT, MIND AND BODY FOR ALL. IN ADDITION, THE Y OFFERS CHILDWATCH FOR CHILDREN UP TO 12 YEARS WHILE THEIR PARENTS WORK OUT. CHILDWATCH CURRENTLY SERVES APPROXIMATELY 75 CHILDREN PER WEEK.
FORM 990, PAGE 2, PART III, LINE 4C
FOR MEMBERS WITH LIMITED MOBILITY CAUSED BY OBESITY, ARTHRITIS, OR OTHER CHRONIC MEDICAL CONDITIONS THAT WANT TO EXERCISE BUT CANNOT PARTICPATE IN FULL WEIGHT-BEARING ACTIVITIES. THE AQUATICS PROGRAM ALSO OFFERS SWIM LESSONS TO KIDS AGES TWO AND UP AS WELL AS ADULTS OF ANY AGE. ALTERNATE FORMS OF RECREATION ARE EASILY ACCESSIBLE WITH THE CLIMBING WALL, GYM, AND WALKING TRACK. IN ADDITION, THE YMCA HOSTS TWO 5K/10K RUN/WALKS PER YEAR. IN TOTAL, OVER 115 PEOPLE AGES FOUR TO 79 YEARS OLD PARTICIPATE IN THE RACES. THROUGH COLLABORATION WITH SOUTHSIDE VIRGINIA COMMUNITY COLLEGE (SVCC), THE YMCA OFFERS FOUR PHYSICAL EDUCATION CLASSES (AEROBICS I, AEROBICS II, WEIGHT LIFTING I, WEIGHT LIFTING II) FOR STUDENTS COMPLETING THEIR ASSOCIATE'S DEGREE LOCALLY. WITH MOST OF SVCC'S STUDENTS BEING ADULTS WITH FULL-TIME JOBS, OFFERING THE CLASSES LOCALLY SAVES THEM FROM HAVING TO TAKE TIME OFF OF WORK TO TRAVEL APPROXIMATELY 40 MINUTES TO ANOTHER CAMPUS FOR THIS REQUIREMENT. IN APRIL 2013, THE YMCA PARTICIAPTED IN HEALTHY KIDS DAY - A NATIONALLY CELEBREATED YMCA EVENT HIGHLIGHTING OUR DELIVERY OF MISSION-BASED PROGRAMS SUPPORTING THE HEALTHY GROWTH AND DEVELOPMENT OF KIDS. BASED ON THE PREMISE THAT CHILDREN WHO ARE TAUGHT TO PRACTICE HEALTHY HABITS WILL GROW INTO STRONG ADULTS, THE YMCA HEALTHY KIDS DAY AIMS TO RAISE PUBLIC AWARENESS OF THE IMPORTANCE OF HEALTHY LIFESTYLES AND TO SUPPORT COMMUNITY STRATEGIES TO IMPROVE THE HEALTH OF YOUTH AND THEIR FAMILIES. OVER 100 CHILDREN AGES ONE YEAR TO 15 YEARS OLD ATTEND THE EVENT.
FORM 990, PAGE 6, PART VI, LINE 2
JEFF ROBINSON BRENDA ROBINSON CHAIRMAN PT EMPLOYEE HUSBAND/WIFE
FORM 990, PAGE 6, PART VI, LINE 11B
THE BOARD REVIEWS THE COMPLETED 990 IN DRAFT FORM BEFORE SUBMISSION. ANY CHANGES ARE NOTED AND SUBMITTED FOR CORRECTION. THE FINAL DRAFT IS APPROVED BY THE BOARD BEFORE SUBMISSION AT A MONTHLY MEETING PRIOR TO THE DUE DATE.
FORM 990, PAGE 6, PART VI, LINE 12C
ACCORDING TO THE CONFLICT OF INTEREST POLICY FOR THE FAMILY YMCA OF EMPORIA-GREENSVILLE, THE ORGANIZATION WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST WITHOUT ESTABLISHING APPROPRIATE SAFEGUARDS TO PROTECT THE INTEREST OF THE ORGANIZATION. TO THAT END: A.) EACH SIGNIFICANT PERSON MUST PROMPTLY, FULLY AND TIMELY COMPLY WITH THE DISCLOSURE REQUIREMENTS SET FORTH IN THIS POLICY, OR AS OTHERWISE ADOPTED BY THE BOARD IN ACCORDANCE WITH THIS POLICY. B.) ALL TRANSACTIONS, CONTRACTS OR ARRANGEMENTS INVOLVING A CONFLICT OF INTEREST MUST BE REVIEWED BY THE BOARD OR BY A DESIGNATED BODY OF DISINTERESTED PERSONS. C.) THE BOARD, OR DESIGNATED BODY, MUST DETERMINE BY A MAJORITY VOTE OF DISINTERESTED PERSONS THAT APPROPRIATE SAFEGUARDS ARE IN PLACE TO PROTECT THE INTEREST OF THE ORGANIZATION AND ARE CONSISTENT WITH THE PURPOSES OF THIS POLICY. D.)WHERE APPROPRIATE, THE BOARD OR DESIGNATED BODY SHALL SEEK ADVICE OF LEGAL COUNSEL. THIS POLICY APPLIES TO (A) SIGNIFICANT PERSONS, AND (B) ANY CONTRACT, TRANSACTION OR ARRANGEMENT INVOLVING THE ORGANIZATION. TO MONITOR AND BE SURE THE POLICY IS ENFORCED, THE EXECUTIVE COMMITTEE WILL DISTRIBUTE THE ANNUAL CONFLICT OF INTEREST QUESTIONNAIRE (THE ANNUAL QUESTIONNAIRE) TO EACH SIGNIFICANT PERSON AND CALL FOR THEM TO ACCURATELY AND TIMELY SUBMIT THE COMPLETED QUESTIONNAIRE TO THE COMMITTEE FOR REVIEW. UPON SUBMISSION OF THE COMPLETED QUESTIONNAIRES, THE COMMITTEE WILL REVIEW EACH FOR POSSIBLE CONFLICTS OF INTEREST. THE COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF DISINTERESTED DIRECTORS WHETHER THE DISCLOSED INTEREST MAY RESULT IN A CONFLICT OF INTEREST AFTER MEETING, DISCUSSING AND VOTING ON THE MATTER. THE COMMITTEE MAY REQUEST ADDITIONAL INFORMATION CONCERNING THE RELEVANT INTEREST FROM ALL REASONABLE SOURCES BEFORE REACHING A DETERMINATION. A SIGNIFICANT PERSON MAY MAKE A PRESENTATION AT THE COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF AND THE VOTE ON THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. IF THE COMMITTEE HAS REASONABLE CAUSE TO BELIEVE A SIGNIFICANT PERSON HAS FAILED TO COMPLY WITH THE DISCLOSURE REQUIREMENTS IN THIS POLICY, IT SHALL INFORM THE PERSON OF THE BASIS FOR SUCH BELIEF AND AFFORD THE PERSON AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF AFTER HEARING THE SIGNIFICANT PERSON'S RESPONSE AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, THE BOARD OR COMMITTEE DETERMINES THE SIGNIFICANT PERSON HAS FAILED TO DISCLOSE AN ACTUAL OR POSSIBLE CONFLICT OF INTEREST, IT SHALL TAKE APPROPRIATE DISCIPLINARY CORRECTIVE ACTION. TO ENSURE THAT THE ORGANIZATION OPERATES IN A MANNER CONSISTENT WITH CHARITABLE PURPOSES AND DOES NOT ENGAGE IN ACTIVITIES THAT COULD JEOPARDIZE ITS TAX-EXEMPT STATUS, PERIODIC REVIEWS SHALL BE CONDUCTED. THE PERIODIC REVIEWS SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING: 1.) WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE, ARE BASED ON COMPETENT SURVEY INFORMATION AND ARE THE RESULT OF ARM'S LENGTH BARGAINING. 2.) WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENT FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION.
FORM 990, PAGE 6, PART VI, LINE 15A
THE EXECUTIVE DIRECTOR IS EVALUATED BY THE PERSONNEL COMMITTEE ON A YEARLY BASIS EVERY DECEMBER. THE RESULTS OF THE EVALUATION ARE SHARED WITH THE EXECUTIVE DIRECTOR AT A SEPARATE MEETING ONCE THE EVALUATION IS COMPLETE. THE EVALUATION TOOL USED HAS BEEN DEVELOPED BY THE PERSONNEL COMMITTEE AND BASED OFF OF SAMPLES PROVIDED BY THE YMCA OF THE USA AND OTHER HUMAN RESOURCE MATERIALS. THE EXECUTIVE DIRECTOR'S COMPENSATION PACKAGE IS REVIEWED ANNUALLY BY THE PERSONNEL COMMITTEE AS PART OF THE BUDGET PROCESS. TO ENSURE THAT THE COMPENSATION IS APPROPRIATE, THE COMMITTEE COMPARES THE PACKAGE TO THAT OF OTHER COMMUNITY LEADERS IN SIMILAR OCCUPATIONAL POSITIONS. IN ADDITION, THE COMMITTEE REVIEWS THE ANNUAL SALARY ADMINISTRATION GUIDELINE RECOMMENDATIONS COMPILED BY THE YMCA OF THE USA'S HUMAN RESOURCES TASK FORCE. THE DOCUMENT PROVIDES RELEVANT TRENDS ACROSS THE MOVEMENT IN REFERENCE TO SALARY GUIDELINES AS WELL AS ACTUAL SALARY RECOMMENDATIONS FOR EXECUTIVE DIRECTORS AND CEO'S BASED ON THE ORGANIZATION'S BUDGET SIZE.
FORM 990, PAGE 6, PART VI, LINE 15B
THE EVALUATION PROCESS FOR KEY EMPLOYEES IS SIMILAR TO THAT FOR THE EXECUTIVE DIRECTOR, USING TOOLS PROVIDED BY THE YMCA OF THE USA AND OTHER HUMAN RESOURCE MATERIALS. POSITIONS AND SALARY LEVELS ARE EVALUATED EVERY YEAR DURING THE BUDGET PROCESS. MEMBERS OF THE BOARD OF DIRECTORS ARE NOT COMPENSATED AND ARE PURELY VOLUNTARY.
FORM 990, PAGE 6, PART VI, LINE 19
THE 990 IS AVAILABLE FOR REVIEW AT THE ORGANIZATION UPON REQUEST AND IS ALSO AVAILABLE ON WWW.GUIDESTAR.COM.
FORM 990, PART XI, LINE 9
LOSS ON DISPOSAL OF ASSETS 0 LOSS ON DISPOSAL OF ASSETS 0
FORM 990, PART XI, LINE 9
PRIOR PERIOD ADJUSTMENT 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.