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
SOUTHWINDS INC
Employer identification number
25-1460522
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.") ....
5,200,576
5,161,593
4,516,781
4,769,203
4,657,110
24,305,263
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
5,200,576
5,161,593
4,516,781
4,769,203
4,657,110
24,305,263
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.
24,305,263
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..
5,200,576
5,161,593
4,516,781
4,769,203
4,657,110
24,305,263
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
3,067
1,872
613
262
168
5,982
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.)..
94,564
89,848
101,376
97,837
84,327
467,952
11
Total support (Add lines 7 through 10).
24,779,197
12
Gross receipts from related activities, etc. (see instructions)
..................
12
1,878,959
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
98.090 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
98.050 %
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
SOUTHWINDS INC
Employer identification number
25-1460522
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 2
DEREK JANCISIN AND DALE KILLMEYER HAVE A BUSINESS RELATIONSHIP. DALE KILLMEYER AND ART MCAULEY HAVE A BUSINESS RELATIONSHIP.
FORM 990, PART VI, SECTION B, LINE 11
THE BUDGET/FINANCE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWED THIS FORM 990 IN DETAIL AND EACH MEMBER OF THE BOARD OF DIRECTORS WAS PROVIDED A COPY OF THIS FORM 990 PRIOR TO ITS FINAL APPROVAL BY THE ENTIRE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 12C
THE BOARD CHAIRPERSON ANNUALLY ASKS THE BOARD MEMBERS AND KEY EMPLOYEES TO SUBMIT A CONFLICT OF INTEREST STATEMENT TO THE EXECUTIVE DIRECTOR. UPON RECEIPT, CONFLICT OF INTEREST STATEMENTS ARE REVIEWED BY THE EXECUTIVE DIRECTOR, THE BOARD CHAIRPERSON, AND THE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS. IF ANY ACTION OR CLARIFICATION IS NECESSARY, THE BOARD CHAIRPERSON DISCUSSES WITH THE BOARD MEMBER(S) AND/OR KEY EMPLOYEE(S) INVOLVED.
FORM 990, PART VI, SECTION B, LINE 15
15 (A)- A PERFORMANCE REVIEW OF THE EXECUTIVE DIRECTOR IS CONDUCTED ANNUALLY AT THE END OF THE FISCAL YEAR BY AN EVALUATION COMMITTEE APPOINTED BY THE BOARD OF DIRECTORS AND BASED UPON THE EXECUTIVE DIRECTOR'S JOB DESCRIPTION. THE EXECUTIVE DIRECTOR ALSO COMPLETES A SELF-ASSESSMENT WHICH IS PART OF THE PERFORMANCE REVIEW. TOGETHER, THE EVALUATION COMMITTEE AND EXECUTIVE DIRECTOR DEVELOP GOALS FOR THE UPCOMING YEAR AND EVALUATE THE EXECUTIVE DIRECTOR'S ACHIEVEMENT OF THE PREVIOUS YEAR'S GOALS. IF THE PERFORMANCE EVALUATION IS DEEMED SATISFACTORY BY THE EVALUATION COMMITTEE, THE EXECUTIVE DIRECTOR RECEIVES A COST-OF-LIVING INCREASE (1-3%), BUDGET PERMITTING. ADDITIONALLY, THE EVALUATION COMMITTEE MAY RECOMMEND TO THE BOARD OF DIRECTORS THAT AN ADDITIONAL MERIT INCREASE (1 OR 2%), BUDGET PERMITTING, BE AWARDED PRIOR TO THE CLOSE OF THE FISCAL YEAR. THE EVALUATION COMMITTEE MUST INCLUDE DETAILED DOCUMENTATION OF EXAMPLES OF EXEMPLARY PERFORMANCE BY THE EXECUTIVE DIRECTOR TO SUPPORT THE RECOMMENDATION FOR MERIT INCREASE. THE BOARD OF DIRECTORS HAS FINAL APPROVAL OF THE MERIT INCREASE. THE AMOUNT OF FUNDS AVAILABLE FOR BOTH COST-OF-LIVING AND MERIT INCREASES IS APPROVED ANNUALLY BY THE BUDGET/FINANCE COMMITTEE AND THE BOARD OF DIRECTORS. 15(B) - A PERFORMANCE REVIEW OF KEY EMPLOYEES IS CONDUCTED ANNUALLY AT THE END OF EACH FISCAL YEAR BY THE EXECUTIVE DIRECTOR BASED ON THE KEY EMPLOYEE'S JOB DESCRIPTION. THE KEY EMPLOYEE ALSO COMPLETES A SELF-ASSESSMENT WHICH IS PART OF THE PERFORMANCE REVIEW. TOGETHER THE KEY EMPLOYEE AND EXECUTIVE DIRECTOR DEVELOP GOALS FOR THE UPCOMING YEAR AND EVALUATE THE KEY EMPLOYEE'S ACHIEVEMENT OF THE PREVIOUS YEAR'S GOALS. IF THE PERFORMANCE EVALUATION IS DEEMED SATISFACTORY BY THE EXECUTIVE DIRECTOR, THE KEY EMPLOYEE RECEIVES A COST OF LIVING INCREASE (1% TO 3%), BUDGET PERMITTING. ADDITIONALLY, THE EXECUTIVE DIRECTOR MAY RECOMMEND TO THE BOARD OF DIRECTORS THAT AN ADDITIONAL MERIT INCREASE (1% OR 2%), BUDGET PERMITTING, BE AWARDED PRIOR TO THE CLOSE OF THE FISCAL YEAR. THE EXECUTIVE DIRECTOR MUST INCLUDE DETAILED DOCUMENTATION OF EXAMPLES OF EXEMPLARY PERFORMANCE BY THE KEY EMPLOYEE TO SUPPORT THE RECOMMENDATION FOR THE ADDITIONAL MERIT INCREASE. THE BOARD OF DIRECTORS HAS FINAL APPROVAL OF THE MERIT INCREASE. THE AMOUNT OF FUNDS AVAILABLE FOR BOTH COST OF LIVING AND MERIT INCREASES IS APPROVED ANNUALLY BY THE BUDGET/FINANCE COMMITTEE AND THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19
SOUTHWINDS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XII, LINE 2C
SOUTHWINDS HAS NOT CHANGED ITS PROCESS FOR OVERSIGHT OF THE AUDIT OR SELECTION OF AN INDEPENDENT ACCOUNTANT.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.