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
DISABILITY NETWORKLAKESHORE
Employer identification number
38-3038466
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.") ....
594,807
569,210
632,316
559,251
670,172
3,025,756
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
594,807
569,210
632,316
559,251
670,172
3,025,756
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.
3,025,756
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..
594,807
569,210
632,316
559,251
670,172
3,025,756
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
2,219
878
766
586
456
4,905
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).
3,030,661
12
Gross receipts from related activities, etc. (see instructions)
..................
12
178,382
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
99.840 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
99.790 %
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
DISABILITY NETWORKLAKESHORE
Employer identification number
38-3038466
Return Reference
Explanation
FORM 990, PAGE 1, PART I, LINE 6
VOLUNTEERS WERE EXTENSIVELY USED IN A VARIETY OF ROLES SUCH AS: PROVIDING GENERAL OFFICE AND ADMINISTRATIVE SUPPORT, CLERICAL AND RECEPTION SERVICES; BOARD OF DIRECTORS; EMPLOYMENT SERVICES SUCH AS MOCK INTERVIEWING AND RESUME REVIEW. PROVIDED LIFE SKILLS AND EMPLOYMENT-RELATED MENTORING SPECIFIC TO YOUTH IN SIGNIFICANT LONG-TERM RELATIONSHIPS WITH ADULTS WHO HAVE DISABILITY EXPERIENCE.
FORM 990, PAGE 2, PART III, LINE 4A
HEALTH/MENTAL HEALTH CARE: OF THE 91 TOTAL PEOPLE WITH SIGNIFICANT DISABILITIES WHO REQUIRED ACCESS TO PREVIOUSLY UNAVAILABLE HEALTH/MENTAL HEALTH CARE, 76 INCREASED THEIR KNOWLEDGE OF HEALTH/MENTAL HEALTH CARE OPTIONS, ACQUIRED APPROPRIATE HEALTH AND/OR MENTAL HEALTH CARE INSURANCE AND/OR SERVICES,AND/OR INCREASED THEIR KNOWLEDGE OF HEALTH LIFESTYLES AND PREVENTION OF SECONDARY DISABILITIES. TRANSPORTATION: OF THE 42 TOTAL PERSONS WITH SIGNIFICANT DISABILITIES WHO REQUIRED ACCESS TO PREVIOUSLY UNAVAILABLE TRANSPORTATION, 31 INCREASED THEIR KNOWLEDGE OF THE TRANSPORTATION OPTIONS AVAILABLE TO THEM, ACQUIRED THE SILLS OR RESOURCES NECESSARY TO EITHER UTILIZE PUBLIC TRANSPORTATION, OBTAINED RELIABLE DEPENDABLE PRIVATE TRANSPORTATION, AND/OR OBTAINED NECESSARY ADAPTIVE VEHICLE MODIFICATIONS. EMPLOYMENT: 116 PERSONS RECEIVED EMPLOYEMENT RELATED SERVICES. OF THESE: 33 PERSONS UNDERWENT COMPREHENSIVE INDEPENDENT LIVING ASSESSMENTS, WHICH IDENTIFIED BARRIERS TO BE ADDRESSED IN ORDER TO HELP THEM TO SUCCESSFULLY OBTAIN AND/OR MAINTAIN EMPLOYMENT; 44 PERSONS RECEIVED INTENSIVE INDIVIDUALIZED PEER SUPPORT FOR BARRIER RESOLUTION; 40 PERSONS SUCCESSFULLY COPLETED ALL FOUR WORK HABIT ASSESSMENT/JOB CLUB SESSIONS AND INCREASED THEIR KNOWLEDGE OF EMPLOYMENT OPTIONS; 19 PARTICIPATED IN THE FELONY AND CONVICTIONS EMPLOYMENT SUPPORTS PROGRAM. 60 PERSONS OBTAINED AND/OR MAINTAINED EITHER PART OR FULL-TIME COMPETITIVE EMPLOYMENT IN INTEGRATED SETTINGS. YOUTH TRANSITION: COMPLETED 6 YOUTH EMPLOYMENT SUMMIT PROGRAMS AT VARIOUS HIGH SCHOOLS. NURSING FACILITY TRANSITION: 81 NURSING FACILITY RESIDENTS WERE VISTED. TRANSITIONED 19 NURSING FACILITY RESIDENTS TO COMMUNITY-BASED LIVING OPTIONS OF THEIR CHOICE, WITH A MINIMUM CALCULATED SAVINGS TO MEDICAID OF 948,000. 21 NURSING FACILITY RESIDENTS WHO WERE PREVIOUSLY TRANSITIONED RECEIVED FOLLOW-ALONG SUPPORT SERVICES. GUIDE PROGRAM: 36 PERSONS WERE ENROLLED IN THE IL GUIDE PROGRAM, ESTABLISHED INDEPENDENT LIVING GOALS AND OBJECTS, AND DEVELOPED AND IMPLEMENTED PERSONAL PATHWAYS TO SELF-SUFFICIENCY. GUIDE PARTICIPANTS WERE ASSISTED WITH A VARIETY OF SERVICES INCLUDING: APPLYING FOR DHS SERVICES; RESUME DEVELOPMENT, ONLINE JOB APPLICATION AND INTERVIEWING SKILL DEVELOPMENT; NAVIGATING THE SOCIAL SECURITY SYSTEM; SSDI AND SSI APPLICATION UTILIZING THE SOAR PROCESS, APPLICATION FOR EXPANDED MEDICAID, AND ASSISTANCE WITH OBTAINING EMPLOYMENT. COMMUNITY OUTCOMES: EMPLOYMENT: 40 NEW AREA EMPLOYERS WERE EDUCATED ABOUT THE VALUE AND ABILITY OF PERSONS WITH DISABILITIES IN THE WORKPLACE. ACCESSIBILITY: EDUCATED 141 NEW BUSINESSES, COMMUNITY ORGANIZATIONS, HOSPITALS, GOVERNMENTAL UNITS AND CHURCHES ABOUT ACCESS AND DISABILITY ISSUES. 22 PRIVATE, PUBLIC, GOVERNMENT AND NON-PROFIT ENTITIES INCREASED THEIR PHYSICAL OR PROGRAMMATIC ACCESSIBILITY, OR DEVELOPED PLANS TO DO SO AS THEIR BUDGETS ALLOWED.
FORM 990, PAGE 6, PART VI, LINE 11B
A DRAFT COPY OF FORM 990 AND SUPPORTING SCHEDULES WAS SUBMITTED VIA EMAIL, TO THE EXECUTIVE DIRECTOR AND THE TREASURER. CONFIRMATION OF RECEIPT AND APPROVAL WAS SENT VIA RETURN EMAIL RESPONSE. AFTER SAID APPROVAL, A COPY OF THE 990 WAS PROVIDED TO ALL BOARD MEMBERS.
FORM 990, PAGE 6, PART VI, LINE 12C
THE ORGANIZATION STRIVES TO MAINTAIN THE HIGHEST ETHICAL STANDARDS IN ALL POLICIES, PROCEDURES AND PROGRAMS TO AVOID ANY CONFLICT OF INTEREST. EACH DIRECTOR AND EMPLOYEE SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON: 1) HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; 2) HAS READ AND UNDERSTANDS THE POLICY; 3) HAS AGREED TO COMPLY WITH THE POLICY. IN CONNECTION WITH ANY DIRECT OR INDIRECT FINANCIAL INTEREST OR CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF HIS/HER FINANCIAL INTEREST OR AFFILIATION AND ALL MATERIAL FACTS TO THE BOARD. AFTER SUCH DISCLOSURE AND DISCUSSION WITH THE INTERESTED PERSON, HE OR SHE SHALL LEAVE THE BOARD MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD MEMBERS SHALL DETERMINE IF A CONFLICT OF INTEREST EXISTS.
FORM 990, PAGE 6, PART VI, LINE 15A
AN EXECUTIVE DIRECTOR'S SALARY AND PERFORMANCE REVIEW SHALL TAKE PLACE ANNUALLY. THE REVIEW CONSISTS OF A REVIEW BY INDEPENDENT PERSONS, COMPARABILITY DATA AND DISCUSSION OF THE RESULTS AT THE BOARD MEETING. THE ANNUAL SALARY AND PERFORMANCE REVIEW OF THE EXECUTIVE DORECTOR SHALL BE COMPLETED BY THE EXECUTIVE COMMITTEE AND SHALL INCLUDE REVIEW AND CONSIDERATION OF: 1) FEEDBACK GATHERED FROM THE BOARD, STAFF, AND/OR COMMUNITY PARTNERS 2) THE DIRECTOR'S GOALS FOR THE CURRENT YEAR AND ACHIEVEMENT OF THOSE GOALS 3) THE DIRECTOR'S GOALS FOR THE COMING YEAR. 4) RECENT SALARY DATA COMPARED BY ORGANIZATIONAL SIZE AND POSITION FOR WEST MICHIGAN AND MICHIGAN AS A WHOLE USING THE MICHIGAN NONPROFIT ASSOCIATION SALARY AND BENEFIT SURVEY. 5) BUDGET DATA FOR THE COMING YEAR
FORM 990, PAGE 6, PART VI, LINE 15B
ANNUAL EVALUATIONS ARE PERFORMED FOR EACH EMPLOYEE. COMPENSATION OF STAFF IS DETERMINED BY ANNUAL PERFORMANCE EVALUATIONS. GENERALLY SPEAKING, SALARY RANGES HAVE BEEN ESTABLISHED FOR EACH STAFF POSITION. THE PRIMARY TOOLS USED TO SET THE SALARY RANGES INCLUDE LOOKING AT POSITION DESCRIPTIONS AND COMPARABLE SALARY RANGES AS IDENTIFIED IN THE MICHIGAN NON-PROFIT ASSOCIATION SALARY AND BENEFIT SURVEY.
FORM 990, PAGE 6, PART VI, LINE 19
GOVERNING DOCUMENTS SUCH AS THE 1023 APPLICATION, ARTICLES OF INCORPORATION AND BY-LAWS ARE READILY AVAILABLE UPON REQUEST. THE ORGANIZATION'S ANNUAL REPORT IS AVAILABLE ON THEIR WEBSITE.
FORM 990, PART XI, LINE 9
SPECIAL EVENT EXPENSES 8,283 SPECIAL EVENT EXPENSES -8,283
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.