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
COMMUNITY AND SENIOR SERVICES OF JOHNSTON COUNTY INC
Employer identification number
56-1034246
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.") ....
2,362,767
2,188,551
1,054,285
2,146,608
3,084,374
10,836,585
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
2,362,767
2,188,551
1,054,285
2,146,608
3,084,374
10,836,585
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.
10,836,585
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..
2,362,767
2,188,551
1,054,285
2,146,608
3,084,374
10,836,585
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
6,100
6,853
4,574
3,926
4,457
25,910
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).
10,862,495
12
Gross receipts from related activities, etc. (see instructions)
..................
12
2,064,981
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
99.760 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
99.760 %
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
COMMUNITY AND SENIOR SERVICES OF JOHNSTON COUNTY INC
Employer identification number
56-1034246
Return Reference
Explanation
FORM 990, PAGE 6, PART VI, LINE 11B
THE RETURN IS REVIEWED BY THE EXECUTIVE DIRECTOR BEFORE IT IS FILED
FORM 990, PAGE 6, PART VI, LINE 19
UPON REQUEST
FORM 990, PART IX, LINE 24E
SINGLE FAMILY REHAB PROJE 112,962 0 0 TRANSPORTATION CONTRACT-M 64,981 0 0 CATERING EXPENSE-CONGREGA 55,130 0 0 VEHICLE TIRES & TUBES-OPE 51,290 0 0 MANAGEMENT FEES-OPERATION 51,140 0 0 NEW FREEDOM TRANS CONTRAC 37,564 0 0 EDTAP CONTRACT-MEDICAL TR 35,220 0 0 COMPUTER SUP/TECH ASSISTA 34,361 0 0 CATERING TRANSPORTATION-C 24,621 0 0 CATERING TRANSPORTATION-H 24,621 0 0 VEHICLE OIL-OPERATIONS 19,887 0 0 COMPUTER PROGRAMMING SERV 18,718 0 0 MONITORING EXPENSES LIFEL 0 15,347 0 CONTRACT SERVICES-CGVR RE 0 13,326 0 MAINT.&REPAIR-BLDGS/GROUN 5,062 7,406 0 CAPITAL:VEHICLE LICENSE T 10,969 0 0 TRANSPORTATION CONTRACT-G 10,700 0 0 TELEPHONE-ADMIN 9,768 0 0 BUISNESS/ACCT. SYSTEMS-AD 0 9,751 0 UTILITIES-ADMINISTRATIVE 0 9,261 0 UTILITIES-COMBINED 7,985 0 0 TELEPHONE-ADMINISTRATIVE 0 7,668 0 CAPITAL: VEHICLE LICENSE 7,562 0 0 CAPITAL-VEHICLE LETTERING 7,401 0 0 PROGRAM EXPENSES-HEALTH P 6,659 0 0 VEHICLE CLEANING-OPERATIO 6,318 0 0 CLEANING EXP-ADMINISTRATI 0 5,721 0 BUSINESS/ACCT. SYSTEMS-SE 5,597 0 0 TELEPHONE-SENIOR CENTERS 5,034 0 0 FEES EXPENSE-ADMINISTRATI 0 4,606 0 CAPITAL:TECHNOLOGY (OFFIC 3,798 0 0 PROGRAM SUPPLIES-CGVR TRA 3,614 0 0 SENIOR GAMES-GENERAL FUND 0 3,500 0 PROGRAM MANAGER-ELDERLY H 3,486 0 0 TAXES,PERMITS-OPERATIONS 3,486 0 0 MAINTENANCE-EQUIPMENT 0 3,363 0 TRAINING EMPLOYEE DEVELOP 3,305 0 0 SPC PROJECTS/FAN-SPECIAL 3,066 0 0 PROGRAM MANAGER - ELDERLY 3,042 0 0 CATERING EXPENSE-FEMA FUN 2,995 0 0 MTCE/REPAIR-BLDG./YARD/OT 2,974 0 0 UNIFORMS 2,895 0 0 CLEANING EXP-SENIOR CENTE 2,867 0 0 TELEPHONE-HOME DELIVERED 2,683 0 0 CAPITAL EQUIPMENT-MEDICAL 2,622 0 0 SITE SUPPLIES-SENIOR CENT 2,608 0 0 OTHER SUPPLIES-OPERATIONS 2,590 0 0 SITE SUPPLIES-CONGREGATE 2,550 0 0 TELEPHONE-CONGREGATE MEAL 2,448 0 0 MTCE/REPAIR-COMMUNICATION 2,388 0 0 SAFETY & WELLNESS PROGRAM 2,263 0 0 PROGRAM SUPPLIES-HOME DEL 2,212 0 0 MAINT.&REPAIR-BLDGS.GROUN 2,092 0 0 SMALL EQUIPMENT PURCHASES 2,045 0 0 EMPLOYEE TRAINING-ADMINIS 0 2,000 0 TELEPHONE-OPERATIONS 1,985 0 0 SPC.PROJECTS/ACTVITY EXP- 0 1,965 0 UTILITIES-CONGREGATE MEAL 1,952 0 0 UTILITIES-HOME DELIVERED 1,952 0 0 MAINTENANCE VEHICLES-ADMI 0 1,830 0 MTCE/REPAIR-BLDG/YARD/OTH 1,792 0 0 CAPITAL EQUIPMENT-SR CENT 1,778 0 0 PROGRAM SUPPLIES-CGVR-COU 1,778 0 0 PROGRAM EXPENSES-REGULAR 1,771 0 0 BUSINESS/ACCT. SYSTEMS-SR 1,721 0 0 CLEANING SERVICE 1,710 0 0 CATERING SUPPLIES-CONGREG 1,687 0 0 MISC. EMPLOYEE INCENTIVES 0 1,625 0 CABLE TV-SENIOR CENTERS 0 1,541 0 PROGRAM SUPPLIES-CGVR CON 1,520 0 0 UTILITIES - COMBINED - OP 1,513 0 0 CABLE TV-CONGREGATE MEALS 1,482 0 0 BUSINESS/ACCT. SYSTEMS-CO 1,468 0 0 SMALL TOOLS/DRIVER'S SUPP 1,406 0 0 JANITORIAL SUPPLIES 1,339 0 0 UTILITIES-SENIOR CENTERS 1,317 0 0 CATERING SUPPLIES-HOME DE 1,314 0 0 BUSINESS/ACCT. SYSTEMS-HO 1,243 0 0 EMPLOYEE TRAINING-SENIOR 1,216 0 0 LEASE EQUIPMENT-ADMINISTR 0 1,131 0 MEDICAL/PHYSICALS-OPERATI 1,085 0 0 MTCE. CONTRACT - COPIER 1,018 0 0 VEHICLE LETTERING-5316 JA 1,000 0 0 BACKGROUND CHECKS-OPERATI 972 0 0 SECURITY SERVICE - OPERAT 930 0 0 SITE SUPPLIES-ADMINISTRAT 0 883 0 DRUG & ALCOHOL TESTING - 846 0 0 EMPLOYEE TRAINING-CONGREG 828 0 0 CAPITAL-OFFICE FURNITURE 797 0 0 INTERNET-ADMIN 790 0 0 SITE SUPPLIES-HOME DELIVE 775 0 0 MTCE/REPAIR-OFFICE EQUIPM 762 0 0 MAINTENANCE-EQUIPMENT-SEN 708 0 0 RECORD DISPOSAL-ADMINISTR 0 695 0 BUSINESS/ACCT. SYSTEMS-EL 683 0 0 CLEANING EXP-HOME DELIVER 0 671 0 CLEANING EXP-CONGREGATE M 671 0 0 SPECIAL PROJECTS-CATERING 666 0 0 SUPPLIES 611 0 0 PROGRAM SUPPLIES-SR CENTE 609 0 0 CABLE TV-ADMINISTRATIVE O 0 604 0 TRAVEL-SUBSISTENCE: OPERA 556 0 0 JANITORIAL SUPPLIES - OPE 555 0 0 COMPUTER TRAINING-OPERATI 525 0 0 EMPLOYEE TRAINING-HOME DE 518 0 0 VEHICLE LETTERING-CAPITAL 500 0 0 CAPITAL EQUIPMENT-SENIOR 483 0 0 MAINTENANCE-EQUIPMENT: EL 470 0 0 PROGRAM SUPPLIES-CONGREGA 450 0 0 MAINTENANCE-EQUIPMENT-HOM 425 0 0 MAINTENANCE-EQUIPMENT-CON 425 0 0 FEES EXPENSE-MEDICAL ALER 408 0 0 TRASH REMOVAL 406 0 0 CLEANING SERVICE - OPERAT 405 0 0 MGT/INFORMATION SYSTEMS-H 0 399 0 PROGRAM EXPENSES - HOME D 393 0 0 PROGRAM EXPENSES 384 0 0 TELEPHONE - CAPITAL AND F 344 0 0 VEHICLE INSPECTIONS-OPERA 326 0 0 EMPLOYEE TRAINING-CGVR TR 320 0 0 CDL LICENSES-OPERATIONS 270 0 0 TRANSPORTATION CONTACT-SP 265 0 0 MGT/INFORMATION SYSTEMS-C 258 0 0 ENDOWMENT MANAGEMENT FEE 0 250 0 CAPITAL EQUIPMENT-ADMINIS 249 0 0 PERMITS, LICESNSES-ADMINI 0 244 0 INTERNET ACCESS EXPENSE-A 0 239 0 EMPLOYEE TRAINING-INFORMA 239 0 0 UNIFORMS-OPERATIONS 238 0 0 BUSINESS/ACCT. SYSTEMS-IN 234 0 0 EMPLOYEE TRAINING-IN HOME 220 0 0 SECURITY SERVICE 216 0 0 SITE SUPPLIES-SR CENTER C 213 0 0 CAPITAL-TECHNOLOGY (OFFIC 196 0 0 MTCE. CONTRACT - COPIER - 193 0 0 DRUG SCREENING-SENIOR CEN 191 0 0 PROGRAM EXPENSES-SPECIAL 184 0 0 PROGRAM SUPPLIES-SENIOR C 151 0 0 CLEANING EXP-SR CENTER CL 150 0 0 COMPUTER SUPPLIES-ADMIN 141 0 0 PROGRAM EXPENSES-SR CENTE 139 0 0 PROGRAM SUPPLIES-SILVER S 130 0 0 PROGRAM EXPENSES-CGVR CON 130 0 0 PROGRAM EXPENSES-CGVR TRA 111 0 0 INTERNET-OPERATIONS 110 0 0 DRUG SCREENING-HOME DELIV 105 0 0 PROGRAM EXPENSES-CONGREGA 101 0 0 WEB EXPENSE-ADMINISTRATIV 0 99 0 CAPITAL: TECHNOLOGY(OFFIC 93 0 0 MGT/INFORMATION SYSTEMS-I 90 0 0 DRUG SCREENING-CONGREGATE 87 0 0 CAPITAL EQUIPMENT-CONGREG 83 0 0 CAPITAL EQUIPMENT-HOME DE 83 0 0 CAPITAL EQUIPMENT-IN HOME 83 0 0 OTHER SUPPLIES-CONGREGATE 61 0 0 MGT/INFORMATION SYSTEMS-M 55 0 0 BENEVOLENCE EXPENSES-ADMI 0 50 0 MISC EMPLOYEE INCENTIVES- 43 0 0 MISC EMPLOYEE INCENTIVES- 43 0 0 VEHICLE GAS & OIL-ADMINIS 39 0 0 MGT/INFORMATION SYSTEMS-G 34 0 0 CATERING SUPPLIES-SENIOR 27 0 0 PROGRAM EXPENSES-MEDICAL 27 0 0 VEHICLE GAS & OIL - SENIO 22 0 0 MAINTENANCE-VEHICLES-ELDE 0 22 0 CAPITAL EQUIPMENT-GENERAL 17 0 0 BACKGROUND CHECKS-SENIOR 0 16 0 PROGRAM EXPENSES-RAMP PRO 10 0 0 BUSINESS/ACCT. SYSTEMS-ME 10 0 0 PURCHASED TRANSPORTATION- 10 0 0 LATE FEES & PENALTIES - O 8 0 0 BACKGROUND CHECKS-HOME DE 0 8 0 BACKGROUND CHECKS-CONGREG 0 8 0 DRUG SCREENING-INFORMATIO 4 0 0 VEHICLE GAS & OIL-RAMP PR 0 3 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.