Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 779,678 | 770,102 | 578,662 | 876,630 | 659,906 | 3,664,978 |
| 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 | 779,678 | 770,102 | 578,662 | 876,630 | 659,906 | 3,664,978 |
| 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).. | 78,608 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 3,586,370 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 779,678 | 770,102 | 578,662 | 876,630 | 659,906 | 3,664,978 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 25,322 | 23,930 | 21,641 | 22,927 | 25,981 | 119,801 |
| 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 VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | 3,784,779 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2019 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PAGE 2, PART III, LINE 4A | ALS CLINICS AND CERTIFIED CENTER SUPPORT: TO SUPPORT THE HIGHEST QUALITY HEALTHCARE FOR PEOPLE WITH ALS, THE ORGANIZATION PARTNERS WITH AND FINANCIALLY SUPPORTS COMMUNITY HEALTHCARE PROVIDERS IN OFFERING ALS MULTIDISCIPLINARY CLINICS. THESE CLINICS ARE EVIDENCE BASED MODELS THAT PROMOTE COORDINATED CARE FOR PEOPLE WITH ALS. THESE CLINICS ARE HELD AT ONE OF THE ALS ASSOCIATION CERTIFIED CENTERS OF EXCELLENCE AT IU NEUROSCIENCE CENTER, RECOGNIZED ALS CENTER AT RICHARD L. ROUDEBUSH VA MEDICAL CENTER, AS WELL AS THE NEWLY ESTABLISHED ALS CLINIC, OPENED NOVMEBER 2019, IN PARTNERSHIP WITH PARKVIEW NEUORSCIENCE. THE CHAPTER HAS ASSISTED WITH LICENSED SOCIAL WORK STAFFING, NUTRITION CART, SUPPLIES, AND FINANCIAL COMMITTMENT. DURING THE YEAR ENDED JANUARY 31, 2020, THE CHAPTER SUPPORTED 831 CLINIC APPOINTMENTS FOR FAMILIES WITH ALS. |
| FORM 990, PAGE 2, PART III, LINE 4B | EDUCATION & SUPPORT PROGRAMS: STRATEGICALLY BASED IN AND NEAR PATIENT'S HOME COMMUNITIES, CARE SERVICE COORDINATORS WORK DIRECTLY WITH PEOPLE WITH ALS AND THEIR FAMILIES TO HELP THEM NAVIGATE MANAGEMENT OF ALS AS WELL AS ACCESS COMMUNITY RESOURCES. IN FISCAL YEAR END JANUARY 31, 2020 CARE SERVICE COORDINATORS SERVED 515 PATIENTS PROVIDING 3,308 HOURS OF SOCIAL WORK. COORDINATORS ARE OFTEN THE CRUCIAL SUPPORT PEOPLE NEED WITH GUIDANCE ON FINANCE, EMPLOYMENT ISSUES, INSURANCE QUESTIONS, SOCIAL SECURITY DISABILITY, MEDICARE, MEDICAID AND LONG-TERM CARE PLANNING. COORDINATORS ASSISTED 7 MONTHLY SUPPORT GROUPS ACROSS THE REGION WITH 418 ENGAGEMENTS. CARE SERVICES STAFF ALSO PROVIDED PROFESSIONAL EDUCATION FOR COMMUNITY PARTNERS SUCH AS HOSPICE, HOME HEALTH AND HOME CARE AGENCIES TO INCREASE THEIR KNOWLEDGE OF ALS. THE CHAPTER HAS A VERY EXTENSIVE LENDING PROGRAM. WE RECOGNIZE THE IMPORTANCE OF PROPER EQUIPMENT AND ASSISTIVE DEVICES IN MAINTAINING SAFETY, INDEPENDENCE AND IN MAXIMIZING PATIENTS FUNCTIONALITY AND MINIMIZING FINANCIAL COST ASSOCIATED WITH ALS. THE EQUIPMENT LOAN CLOSET PROGRAM PROVIDES ACCESS TO THE NEEDED MEDICAL EQUIPMENT EITHER AS A BRIDGE WHILE AWAITING INSURANCE APPROVAL OR TO THOSE PATIENTS WITH NO INSURANCE COVERAGE FOR THE EQUIPMENT BEING REQUESTED. THE SUCCESS OF THIS PROGRAM IS DUE TO THE GENEROSITY OF OUR SUPPORTERS AND VENDORS WHO DONATE EQUIPMENT AND TO THE FUNDS RAISED THROUGH OUR WALK TO DEFEAT ALS PROGRAMS WHICH ALLOW US TO PURCHASE NEW ITEMS, REPAIR/REPLACE EXISTING ITEMS, AND ENSURES PROPER MAINTENANCE TO THE VARIOUS DME ITEMS IN THE LOAN CLOSET. DURING THE YEAR ENDED JANUARY 31, 2020, THE CHAPTER LOANED 567 PIECES OF EQUIPMENT TO 189 PATIENTS. PATIENT FINANCIAL GRANT PROGRAMS SUPPORTED 55 PATIENTS FOR CAREGIVER RELIEF, NUTRITION, DME ITEMS NOT AVAILABLE IN CHAPTER LOAN CLOSET, MEDICAL TRANSPORTATION TO/FROM MEDICAL APPOINTMENTS, AND MEDICAL COPAYS. |
| FORM 990, PAGE 2, PART III, LINE 4D | OUTREACH & ADVOCACY: AS ONE OF 39 CHAPTERS AFFILIATED WITH THE NATIONAL ALS ASSOCIATION, THE INDIANA CHAPTER PROVIDES ONGOING FINANCIAL SUPPORT FOR THE NATIONAL ALS ASSOCIATION TO SUPPORT FEDERAL PUBLIC POLICY INITIATIVES TO IMPROVE THE LIVES OF FAMILIES LIVING WITH ALS, OUTREACH EFFORTS TO RAISE PUBLIC AWARENESS ABOUT ALS, AS WELL AS GLOBAL RESEARCH WORKING TOWARDS TREATMENTS AND A CURE FOR ALS. PUBLIC POLICY ACCOMPLISHMENTS DURING THE YEAR ENDED JANUARY 31, 2020 INCLUDE SENDING A SUCCESSFUL DELEGATION OF PEOPLE WITH ALS TO WASHINGTON D.C. TO ADVOCATE FOR THE NATIONAL ALS REGISTRY, THE ALS RESEARCH PROGRAM AT THE DEPARTMENT OF DEFENSE, AND PROMOTING FEDERAL SUPPORT FOR ALS RESEARCH. |
| FORM 990, PAGE 6, PART VI, LINE 11B | AN ELECTRONIC COPY OF THE 990 WAS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE EXECUTIVE DIRECTOR SENDS TO ALL EMPLOYEES THE CONFLICT OF INTEREST POLICY WHICH MUST BE SIGNED BY THE EMPLOYEE. THE EXECUTIVE DIRECTOR MONITORS THE RETURNS AND, WHEN RECEIVED, PLACES THEM IN THE EMPLOYEE'S PERSONNEL FILE HELD IN THE BOOKKEEPER'S OFFICE. A NEW FORM IS COMPLETED AT THE BEGINNING OF EACH FISCAL YEAR. THE BOARD OF DIRECTORS CHAIR SENDS THE FORM TO ALL DIRECTORS AT THE BEGINNING OF THE YEAR AND RETAINS THE SIGNED FORMS IN THE BOOKKEEPER'S OFFICE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF DIRECTORS APPROVE ALL SALARIES, RAISES, AND DISCRETIONARY BONUSES, IF APPLICABLE, BASED ON PERFORMANCE/OPERATIONS DURING THE FISCAL YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC IN THE CHAPTER OFFICE UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | DIRECT FUNDRAISING EXPENSES 70,092 DIRECT FUNDRAISING EXPENSES -70,092 DEPRECIATION -232 TOTAL -232 |
| Software ID: | |
| Software Version: |