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
JANE BOYD COMMUNITY HOUSE
Employer identification number
42-0680359
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.") ....
493,937
450,602
505,317
751,406
1,014,122
3,215,384
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
493,937
450,602
505,317
751,406
1,014,122
3,215,384
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)..
455,690
6
Public support. Subtract line 5 from line 4.
2,759,694
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..
493,937
450,602
505,317
751,406
1,014,122
3,215,384
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
52,935
54,722
67,301
58,014
57,022
289,994
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.)..
45,756
6,750
2,257
10,112
64,875
11
Total support (Add lines 7 through 10).
3,570,253
12
Gross receipts from related activities, etc. (see instructions)
..................
12
610,090
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
77.300 %
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
83.110 %
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
JANE BOYD COMMUNITY HOUSE
Employer identification number
42-0680359
Return Reference
Explanation
FORM 990, PART VI, SECTION A, LINE 6
FOUR OAKS FAMILY AND CHILDREN'S SERVICES IS THE SOLE MEMBER OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7A
JANE BOYD HAS AN AFFILIATE AGREEMENT WITH FOUR OAKS ENTITLING FOUR OAKS TO NOMINATE TWO (2) VOTING MEMBERS OF THE JANE BOYD BOARD OF DIRECTORS. THE APPOINTED REPRESENTATIVES ARE SELECTED BY FOUR OAKS FROM THE MEMBERSHIP OF FOUR OAKS' BOARD OF DIRECTORS AND ARE SUBJECT TO THE APPROVAL OF THE JANE BOYD BOARD OF DIRECTORS. THE JANE BOYD BOARD OF DIRECTORS ELECTS ALL OTHER DIRECTORS. HOWEVER, THE BYLAWS PROVIDE THAT TWO TO SIX (2-6) DIRECTORS MUST BE MEMBERS OF THE FOUR OAKS BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B
FOUR OAKS FAMILY AND CHILDREN'S SERVICES, THE SOLE MEMBER, HAS THE AUTHORITY TO REMOVE BOARD MEMBERS. THE SOLE MEMBER ALSO HAS AUTHORITY WITH REGARD TO APPROVAL OF CERTAIN BOARD ACTIONS SPECIFIED IN THE ORGANIZING DOCUMENTS.
FORM 990, PART VI, SECTION B, LINE 11
THE OUTSIDE TAX PREPARER REVIEWS THE FORM 990 WITH THE JANE BOYD EXECUTIVE DIRECTOR, TOP FINANCIAL OFFICIAL, AND EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS. ALL QUESTIONS AND CONCERNS ARE ADDRESSED TO FULL SATISFACTION BEFORE BECOMING FINAL. THE FINAL FORM 990 IS PROVIDED TO THE FULL BOARD PRIOR TO FILING WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C
THE ORGANIZATION REQUIRES ALL OFFICERS, DIRECTORS, AND EMPLOYEES TO SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY AS WELL AS REPORT ANY DUALITY OF INTEREST AS SOON AS THE INTEREST OCCURS. WHEN HIRING INDEPENDENT CONTRACTORS FOR MAJOR PROJECTS, THE ORGANIZATION SENDS REQUESTS FOR PROPOSAL ("RFPS.") FOR MAJOR RECURRING SERVICE CONTRACTS, RFPS ARE DONE EVERY 3-5 YEARS OR MARKET RATES ARE REVIEWED BY MANAGEMENT TO ENSURE THAT THE TERMS FOR RENEWING THE CONTRACT ARE STILL AT COMPETITIVE MARKET RATES. THROUGHOUT THE PROCESS, ANY INTERESTED BOARD MEMBERS AND/OR COMMITTEE MEMBERS MUST ABSTAIN FROM THE DISCUSSION AND THE SELECTION OF A CONTRACTOR. WHERE MAJOR CONFLICTS EXISTS, THE BOARD MEMBER WILL EITHER RESIGN AS A BOARD MEMBER OR WITHDRAW HIS/HER FIRM FROM CONSIDERATION FOR THE CONTRACT. AS AN ADDITIONAL SAFEGUARD, MANAGEMENT REVIEWS VENDOR LISTS AND BOARD MEMBER LISTS ANNUALLY.
FORM 990, PART VI, SECTION B, LINE 15
JAMES A. ERNST, INTERIM EXECUTIVE DIRECTOR/FOUR OAKS PRESIDENT/CEO, ANNE GRUENEWALD, FOUR OAKS PRESIDENT/CEO, TAMI GILLMORE, TOP FINANCIAL OFFICIAL, AND DORICE RAMSEY, JANE BOYD EXECUTIVE DIRECTOR, WERE COMPENSATED BY FOUR OAKS FAMILY & CHILDREN'S SERVICES, A RELATED TAX-EXEMPT ENTITY THAT IS THE SOLE MEMBER OF JANE BOYD. FOUR OAKS UTILIZES THE EXECUTIVE COMMITTEE FOR SETTING PRESIDENT/CEO COMPENSATION AS WELL AS OBTAINS A MARKET REVIEW AND COMPENSATION COMPARISON FROM AN INDEPENDENT ACCOUNTING FIRM EVERY THREE YEARS. THE EXECUTIVE COMMITTEE GIVES THE PRESIDENT/CEO DIRECTION ON SETTING COMPENSATION FOR THE REMAINING EXECUTIVE OFFICERS AND THE PRESIDENT/CEO AND COMMITTEE JOINTLY ARRIVE AT COMPENSATION FIGURES FOR SUCH OTHER OFFICERS. AN INDUSTRY SALARY SURVEY IS ALSO UTILIZED BY THE COMMITTEE IN SETTING COMPENSATION. FOUR OAKS RETAINS DOCUMENTATION WITH REGARD TO CRITERIA USED TO ARRIVE AT COMPENSATION FOR OFFICERS. MS. RAMSEY'S 2013 CALENDAR YEAR COMPENSATION REFLECTED IN FORM 990, PART VII WAS PAID BY FOUR OAKS FOR SERVICES SHE PROVIDED TO FOUR OAKS AS A PROGRAM MANAGER. MS. RAMSEY'S NEW POSITION AS JANE BOYD EXECUTIVE DIRECTOR BECAME EFFECTIVE APRIL OF 2014. MR. ERNST, MS. GRUENEWALD, AND MS. GILLMORE ARE COMPENSATED BY FOUR OAKS AS OFFICERS OF FOUR OAKS AND DO NOT RECEIVE ADDITIONAL COMPENSATION FOR THE SERVICES THEY PROVIDE TO JANE BOYD. FOUR OAKS ALLOCATED A PORTION OF MR. ERNST'S COMPENSATION TO JANE BOYD FOR BUDGETING PURPOSES FOR THE TIME PERIOD THAT HE SERVED AS JANE BOYD INTERIM EXECUTIVE DIRECTOR. ALL OTHER OFFICERS AND DIRECTORS SERVING ON THE JANE BOYD BOARD ARE UNCOMPENSATED VOLUNTEERS.
FORM 990, PART VI, SECTION C, LINE 19
THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC.
FORM 990, PART VIII, LINE 7(C)
THE $741 GAIN (LOSS) REPORTED REPRESENTS THE ORGANIZATION'S SHARE OF NET GAIN (LOSS) ON THE SALE OF POOLED INVESTMENTS HELD AT A COMMUNITY FOUNDATION. SINCE THE ORGANIZATION IS ALLOCATED A PERCENTAGE OF THE POOLED INVESTMENTS GAIN OR LOSS, GROSS PROCEEDS AND COST BASIS AMOUNTS ARE NOT AVAILABLE FOR REPORTING.
FORM 990, PART VI, LINE 10A AND 10B
JANE BOYD COMMUNITY HOUSE IS PRESENTLY UNDER AN AFFILIATE AGREEMENT WITH FOUR OAKS FAMILY AND CHILDREN'S SERVICES. ANY AFFILIATED ENTITIES IN WHICH JANE BOYD COMMUNITY HOUSE HAS THE PRESCRIBED AMOUNT OF DIRECT OR INDIRECT OWNERSHIP OR CONTROL ARE LISTED AS RELATED ORGANIZATIONS ON FORM 990, SCHEDULE R, AS APPROPRIATE.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.