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
CARDINAL SERVICES INC OF INDIANA
Employer identification number
35-6005615
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.") .
3,576,517
3,015,906
3,060,974
2,935,167
3,001,453
15,590,017
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......
17,177,486
15,789,603
15,727,783
15,773,028
16,271,593
80,739,493
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
72,463
122,195
82,660
0
100,140
377,458
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
20,826,466
18,927,704
18,871,417
18,708,195
19,373,186
96,706,968
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
29,715
21,680
61,228
33,582
146,205
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.
0
0
0
0
0
0
c
Add lines 7a and 7b..
0
29,715
21,680
61,228
33,582
146,205
8
Public support (Subtract line 7c from line 6.)
96,560,763
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...
20,826,466
18,927,704
18,871,417
18,708,195
19,373,186
96,706,968
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
144,739
164,469
171,716
164,671
175,023
820,618
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
144,739
164,469
171,716
164,671
175,023
820,618
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
10,802
14,637
33,969
30,448
15,632
105,488
13
Total support. (Add lines 9, 10c, 11, and 12.)..
20,982,007
19,106,810
19,077,102
18,903,314
19,563,841
97,633,074
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
98.900 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
98.880 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.840 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
0.840 %
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:
13000248
Software Version:
2013v3.1
-
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
CARDINAL SERVICES INC OF INDIANA
Employer identification number
35-6005615
Return Reference
Explanation
FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION
(CONTINUED FROM PART III) THE ORGANIZATION ACHIEVES ITS MISSION BY ADHERING TO THE FOLLOWING GUIDING VALUES: -TREAT EACH PERSON WITH RESPECT AND DIGNITY. -LISTEN WITH YOUR HEART AS WELL AS YOUR EARS. -SERVICE TO OTHERS BUILDS COMMUNITY. -BE OPEN TO NEW OPPORTUNITIES FOR GROWTH. -EMPOWER EACH PERSON TO REACH AND ACHIEVE THEIR UTMOST. -EVERYONE HAS A PLACE OF VALUE IN OUR COMMUNITY.
FORM 990, PART III, LINE 4C, CHILDREN AND FAMILY SERVICES (CONTINUED)
(CONTINUED FROM PART III, LINE 4C) CARDINAL SERVICES OFFERS THREE DIFFERENT PROGRAMS FOR CHILDREN AND THEIR FAMILIES: 1.) WIC (WOMEN, INFANTS, AND CHILDREN) IS A FEDERAL NUTRITION PROGRAM SERVING TO SAFEGUARD THE HEALTH OF INCOME ELIGIBLE WOMEN, INFANTS, AND CHILDREN UP TO AGE 5 WHO ARE AT NUTRITIONAL RISK. CARDINAL SERVES OVER 1,700 PARTICIPANTS EACH MONTH, PROVIDING SUPPLEMENTAL FOODS, NUTRITION EDUCATION AND NUTRITIONAL HEALTH SCREENINGS. 2.) HEAD START/EARLY HEAD START PROGRAMS PROMOTE SCHOOL READINESS BY ENHANCING THE SOCIAL AND COGNITIVE DEVELOPMENT OF CHILDREN THROUGH THE PROVISION OF EDUCATIONAL, HEALTH, NUTRITIONAL, DISABILITY, SOCIAL, MENTAL HEALTH AND OTHER SERVICES TO ENROLLED CHILDREN AND FAMILIES. 3.) HEALTHY FAMILIES IS A PROGRAM FOR FIRST-TIME PARENTS, UP TO AGE 3 OF THE CHILD, DESIGNED TO STRENGTHEN FAMILIES AND PROMOTE HEALTHY CHILDHOOD GROWTH AND DEVELOPMENT. HEALTHY FAMILIES HELPS SUPPORT PARENTS, TEACHES PROBLEM-SOLVING SKILLS, ENCOURAGES FAMILY SUPPORT SYSTEMS, AND PROVIDES CURRENT COMMUNITY RESOURCE INFORMATION FOR FAMILIES.
Form 990, Part VI, Sec A, Line 1a, Delegate broad authority to a committee
THE GOVERNANCE COMMITTEE SHALL EXERCISE ALL THE POWERS OF THE BOARD OF DIRECTORS BETWEEN MEETINGS OF THE BOARD, SERVES AS THE NOMINATING COMMITTEE, ESTABLISHES PRIORITIES FOR BOARD DEVELOPMENT, AND REVIEWS AND MAY APPROVE THE SUCCESSION PLAN FOR THE PRESIDENT/CEO. THE GOVERNANCE COMMITTEE APPROVES THE INCENTIVE PROGRAM FOR THE ADMINISTRATIVE STAFF AND REVIEWS PLANNED VERSUS ACTUAL PRESIDENT/CEO COMPENSATION ACTIVITY. THE GOVERNANCE COMMITTEE TAKES THE LEAD ON ASSESSING THE PERFORMANCE OF THE PRESIDENT/CEO BEFORE SEEKING THE APPROVAL OF THE BOARD OF DIRECTORS. IT MEETS AT THE DISCRETION OF THE CHAIRPERSON. A MAJORITY OF THE COMMITTEE MEMBERS PRESENT IN PERSON PROVIDES A QUORUM.
Form 990, Part VI, Sec A, Line 4, Significant changes to organizational documents
THE ORGANIZATION'S BYLAWS WERE AMENDED IN SECTION VI ITEM I TO STATE THAT A SIMPLE MAJORITY MUST BE PRESENT IN PERSON TO CONSTITUTE A QUORUM.
Form 990, Part VI, Sec B, Line 11b, Review of form 990 by governing body
THE ORGANIZATION'S CFO REVIEWS A DRAFT OF THE FORM 990 IN DETAIL. THEN THE ORGANIZATION'S FINANCE COMMITTEE REVIEWS A FINAL DRAFT OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, WITH THE ORGANIZATION'S MANAGEMENT AT A REGULARLY SCHEDULED MEETING IN JANUARY 2015. A COPY OF THE FULL FORM 990, INCLUDING ALL APPLICABLE SCHEDULES, IS THEN PROVIDED TO EACH REMAINING MEMBER OF THE GOVERNING BODY PRIOR TO FILING WITH THE IRS.
Form 990, Part VI, Sec B, Line 12c, Conflict of interest policy
THE BOARD COMPLETES A CONFLICT OF INTEREST QUESTIONNAIRE ANNUALLY IN JANUARY. IN ADDITION, ALL BOARD MEMBERS AND OFFICERS COMPLETE AN AUTOMATED CONFLICT OF INTEREST QUESTIONNAIRE. THE QUESTIONNAIRES ARE REVIEWED BY THE ORGANIZATION'S CFO TO DETERMINE IF ANY CONFLICTS EXIST. IF A CONFLICT DOES EXIST, THE ENTIRE BOARD OF DIRECTORS IS NOTIFIED AND THAT BOARD MEMBER DOES NOT VOTE ON ANY TRANSACTIONS THAT ARE AFFECTED BY THE CONFLICT. ADDITIONALLY, IF NEW VENDORS OR NEW RELATIONSHIPS ARE STARTED DURING THE YEAR THAT CAUSE A CONFLICT, THAT BOARD MEMBER WOULD BE ASKED TO COMPLETE A NEW CONFLICT OF INTEREST STATEMENT.
FORM 990, PART VI, LINE 15A, PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL
THE ORGANIZATION RECEIVES WAGE SURVEYS FROM A NUMBER OF ORGANIZATIONS, INCLUDING THE INDIANA ASSOCIATION OF REHABILITATION FACILITIES (INARF), ELKHART AND KOSCIUSKO COUNTIES, AND DUNGARVIN. THE BOARD OF DIRECTORS USES THESE COMPARATIVE WAGE ANALYSES IN DETERMINING THE COMPENSATION FOR THE ORGANIZATION'S PRESIDENT/CEO. THE BOARD'S REVIEW AND APPROVAL OF THE COMPENSATION AMOUNT IS DOCUMENTED IN THE BOARD MEETING MINUTES. THE PRESIDENT/CEO'S COMPENSATION WAS LAST REVIEWED AND APPROVED IN APRIL 2013 USING THE MOST RECENT WAGE SURVEYS.
FORM 990, PART VI, LINE 15B, PROCESS USED TO ESTABLISH COMPENSATION OF OTHER OFFICERS
THE ORGANIZATION'S PRESIDENT/CEO CONDUCTS AN ANNUAL PERFORMANCE REVIEW ON ALL OTHER EMPLOYEES, INCLUDING OTHER OFFICERS. SHE USES THE MOST RECENT WAGE SURVEY COMPLETED BY THE INDIANA ASSOCIATION OF REHABILITATION FACILITIES (INARF) TO REVIEW AND APPROVE THE BASE COMPENSATION FOR ALL EMPLOYEES. BASED ON THE PERFORMANCE REVIEWS, THE PRESIDENT/CEO MAKES SUGGESTIONS TO THE BOARD OF DIRECTORS REGARDING ANY POTENTIAL BONUSES TO BE GIVEN; THE BOARD OF DIRECTORS REVIEWS THESE SUGGESTIONS AND MAKES THE FINAL DECISION REGARDING BONUS PAYOUTS. THIS REVIEW PROCESS WAS LAST COMPLETED IN APRIL 2014.
Form 990, Part VI, Sec C, Line 19, Required documents available to the public
COPIES OF THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.