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 | |||||
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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.") .. | 40,194 | 31,692 | 30,739 | 34,419 | 28,029 | 165,073 |
| 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 | 40,194 | 31,692 | 30,739 | 34,419 | 28,029 | 165,073 |
| 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. | 165,073 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 40,194 | 31,692 | 30,739 | 34,419 | 28,029 | 165,073 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 5,415 | 3,810 | 6,722 | 6,055 | 5,045 | 27,047 |
| 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 | 192,120 | |||||
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 - ORGANIZATION'S MISSION | TO OPERATE AN ADULT DAY CARE CENTER THAT PROVIDES CARE TO PEOPLE WITH ALZHEIMER'S DISEASE AND RELATED DEMENTIAS, RESPITE FOR THEIR CAREGIVERS AND EDUCATIONAL SERVICES TO CAREGIVERS OF THOSE WITH A DEMENTIA AND INTERESTED OTHERS. THE CAROL STRAWN CENTER IS COMMITTED TO AFFORDABLE, QUALITY CARE. OUR ADULT DAY SERVICE IS OFFERED ON A SLIDING FEE SCALE AND OUR EDUCATION SERVICE IS OFFERED ON A DONATION BASIS. |
| FORM 990, PAGE 2, PART III, LINE 3 | MARCH 20 THROUGH JUNE 30, 2020, WE CEASED PROVIDING OUR ADULT DAY SERVICE AND CURTAILED OUR EDUCATION SERVICES DUE TO AN OHIO DEPARTMENT OF PUBLIC HEALTH ORDER CLOSING ALL OLDER ADULT DAY CARE CENTERS DUE TO THE CORONAVIRUS PANDEMIC. DURING THIS TIME, WE CONDUCTED WELLNESS CHECKS VIA TELEPHONE AND DELIVERED ACTIVITY KITS TO ADULT DAY SERVICE PARTICIPANTS, AND CONTINUED TO PROVIDE FAMILY CARE PLANNING TO CAREGIVERS VIA TELEPHONE. |
| FORM 990, PAGE 2, PART III, LINE 4A | ADULT DAY SERVICE OUR ADULT DAY SERVICE PROVIDES COMPETENT AND COMPASSIONATE CARE FOR ADULTS WITH ALZHEIMER'S DISEASE/RELATED MEMORY LOSS DISORDERS IN A SUPERVISED SETTING TO MAXIMIZE THE COGNITIVE AND PHYSICAL ABILITIES OF OUR PROGRAM PARTICIPANTS FOR AS LONG AS THE PROGRESSION OF THEIR DISEASE/DISORDER PERMITS. OUR FOCUS ON RESPECT FOR INDIVIDUALITY ALLOWS PARTICIPANTS TO RECEIVE THERAPEUTIC SOCIAL/RECREATIONAL ACTIVITIES, HEALTH-RELATED AND PERSONAL CARE MATCHED TO EACH INDIVIDUAL BASED ON HIS/HER PREFERENCES AND SPECIFIC NEEDS. OUR ADULT DAY SERVICE ALSO PROVIDES CRITICAL RESPITE TIME FOR OUR PARTICIPANTS' CAREGIVERS FROM THEIR CONSTANT CARE RESPONSIBILITIES TO RE-ENERGIZE, MAINTAIN EMPLOYMENT OR TEND TO OTHER ADULT DAY SERVICES OBLIGATIONS. IN FISCAL YEAR 2020, 76 INDIVIDUALS BENEFITED FROM OUR SERVICE. 93% OF CAREGIVERS RESPONDING TO OUR FAMILY SATISFACTION SURVEY QUESTIONS REPORTED THAT OUR PROGRAM HELPED THEIR FAMILY MEMBER, WHO WAS ENROLLED IN OUR ADULT DAY SERVICE, TO MAINTAIN HIS/HER HIGHEST LEVEL OF FUNCTIONING AND THAT OUR SERVICE IMPROVED THE QUALITY OF LIFE OF THEIR FAMILY MEMBER. ALL CAREGIVERS ALSO REPORTED THEIR PERSONAL (CAREGIVER)STRESS LEVEL WAS REDUCED AS A RESULT OF THEIR FAMILY MEMBER ATTENDING OUR PROGRAM (79% RESPONSE RATE). OUR ADULT DAY SERVICE PROVIDES REDUCED SERVICE FEES, BOTH FULL AND HALF DAY CARE OPTIONS WITH FLEXIBLE SCHEDULING, AND THE FOLLOWING CORE SERVICES: ASSESSMENT AND CARE PLANNING, ASSISTANCE WITH ACTIVITIES OF DAILY LIVING, HEALTH-RELATED SERVICES, THERAPEUTIC SOCIAL/RECREATIONAL ACTIVITIES, EXERCISE ACTIVITIES, NUTRITIOUS MEALS AND SNACKS. TRANSPORTATION IS PROVIDED FOR QUALIFYING GOVERNMENT FUNDED PARTICIPANTS AND IT IS COORDINATED WITH LOCAL SERVICE PROVIDERS FOR OTHERS. PARTICIPANTS REQUIRE VARIOUS LEVELS OF CARE AND SUPPORT RESULTING FROM INDIVIDUAL PHYSICAL OR COGNITIVE LIMITATIONS ASSOCIATED WITH DEPRESSION, DIABETES, HIGH BLOOD PRESSURE, ARTHRITIS, VISUAL OR HEARING IMPAIRMENTS, STROKE AND DEMENTIA. IN ADDITION TO THE CASH SUPPORT REPORTED ABOVE, THE SERVICE RECEIVED NON- CASH SUPPORT IN THE FORM OF DONATED FACILITY SPACE, VALUED AT 24,880. |
| FORM 990, PAGE 2, PART III, LINE 4B | EDUCATION SERVICE OUR EDUCATION SERVICE PROVIDES FAMILY CAREGIVER AND PUBLIC EDUCATION PROGRAMS TO SUPPORT CARE PROVIDED TO THOSE WITH A DEMENTIA BY FAMILY CAREGIVERS; TO PROVIDE INFORMATION TO THOSE INTERESTED IN LEARNING ABOUT, OR WHO ARE CONCERNED, WITH DEMENTIA RELATED MEMORY LOSS; AND TO INCREASE PUBLIC AWARENESS OF ALZHEIMER'S DISEASE/RELATED DEMENTIAS AND AVAILABLE COMMUNITY RESOURCES. PROVIDING CARE FOR SOMEONE WITH A DEMENTIA CAN BE OVERWHELMING FOR FAMILY CAREGIVERS. OUR EDUCATION SERVICE PROVIDES CAREGIVERS INFORMATION AND SUPPORT TO INCREASE THEIR KNOWLEDGE ABOUT ALZHEIMER'S DISEASE AND RELATED DEMENTIAS, CONCERNS RELEVANT TO PROVIDING CARE TO SOMEONE WITH A DEMENTIA AND HELP IN IDENTIFYING AVAILABLE COMMUNITY EDUCATION SERVICES SERVICES IN A CLASS SETTING. PERSONALIZED EDUCATIONAL SUPPORT IS OFFERED TO CAREGIVERS NEEDING ADDITIONAL HELP IN UNDERSTANDING THE DISEASE, IDENTIFYING THE NEEDS OF THE INDIVIDUAL WITH DEMENTIA AND THOSE OF THE CAREGIVER AND IN DEVELOPING A PLAN TO MANAGE THE CARE OF THE PERSON WITH DEMENTIA AND/OR CAREGIVER. FOLLOW-UP AND ON-GOING ASSISTANCE ARE PROVIDED. THROUGH EDUCATION, CAREGIVERS GAIN UNDERSTANDING AND CONFIDENCE AND LEARN POSITIVE CAREGIVING APPROACHES AND COPING TECHNIQUES FOR DEMENTIA CARE. BASIC INFORMATION ON ALZHEIMER'S DISEASE/RELATED DEMENTIAS AND MEMORY SCREENING ARE OFFERED TO THE GENERAL PUBLIC THROUGH COMMUNITY PRESENTATIONS AND/OR WELLNESS FAIRS. IN FISCAL YEAR 2020, 268 INDIVIDUALS WERE SERVED WITH ONE OR MORE EDUCATION SERVICE. OVER THE COURSE OF A YEAR, 97% OF THOSE COMPLETING OUR CAREGIVER CLASS EVALUATIONS REPORTED THAT THEY WERE LIKELY TO IMPROVE THE CARE THEY PROVIDED BECAUSE OF ATTENDING OUR CLASSES (75% RESPONSE RATE TO THIS EVALUATION QUESTION). THIS SERVICE RECEIVED NON-CASH SUPPORT IN THE FORM OF DONATED FACILITY SPACE, VALUED AT 6,755. |
| FORM 990, PAGE 6, PART VI, LINE 6 | CURRENT AND FORMER TRUSTEES COMPRISE THE MEMBERSHIP. MEMBERS PAY ANNUAL MEMBERSHIP DUES, WHICH ARE DETERMINED BY THE BOARD OF TRUSTEES. MEMBERSHIP IS NONTRANSFERABLE AND NONASSIGNABLE. MEMBERSHIP REGULATIONS ARE DOCUMENTED IN ARTICLE III OF OUR CODE OF REGULATIONS. MEMBERS DO NOT SHARE IN ORGANIZATION REVENUES. IN THE FISCAL YEAR 2020, THERE WERE 15 MEMBERS. |
| FORM 990, PAGE 6, PART VI, LINE 7A | MEMBERS ELECT BOARD TRUSTEES FOR THREE-YEAR TERMS. ANY VACANCY OCCURRING ON THE BOARD OF TRUSTEES, AND ANY DIRECTORSHIP TO BE FILLED BY REASON OF AN INCREASE IN THE NUMBER OF TRUSTEES, WILL BE FILLED BY APPOINTMENT BY A MAJORITY OF THE REMAINING BOARD OF TRUSTEES. THE NEW TRUSTEE APPOINTED TO FILL THE VACANCY WILL SERVE FOR THE UNEXPIRED TERM OF THE PREDECESSOR IN OFFICE. |
| FORM 990, PAGE 6, PART VI, LINE 7B | PROPOSED CHANGES TO CSC'S CODE OF REGULATIONS MUST BE VOTED UPON AND APPROVED BY A MAJORITY OF THE MEMBERSHIP. MEMBERS ALSO HAVE A VOTE ON OTHER MATTERS BROUGHT TO THE MEMBERSHIP BY THE BOARD OF TRUSTEES BUT IN GENERAL, THE DECISIONS OF THE GOVERNING BODY ARE NOT SUBJECT TO THE APPROVAL BY MEMBERS OR OTHERS. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS COMPLETED BY DIXON, DAVIS, BAGENT & COMPANY BASED ON INPUT OBTAINED FROM THE AUDITED FINANCIAL STATEMENTS, VARIOUS INTERNAL DOCUMENTS AND CSC MANAGEMENT. THE TREASURER AND MANAGEMENT REVIEWED THE FORM 990 PRIOR TO PROVIDING EACH BOARD TRUSTEE WITH A COPY. THE INDEPENDENT AUDITOR, WHO COMPLETED THE FORM 990, REVIEWED IT WITH THE BOARD OF TRUSTEES DURING A BOARD MEETING. THE BOARD APPROVED THE FORM 990 BY A VOTE RESOLUTION PRIOR TO FILING. BOARD ACTION TAKEN AND RESOLUTION VOTED UPON WERE DOCUMENTED IN THE MEETING MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 12C | OFFICERS AND TRUSTEES ANNUALLY REVIEW THE POLICY AND SUBMIT A COMPLETED CONFLICT OF INTEREST FORM, WHICH IS REVIEWED BY MANAGEMENT. IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY ANY ACTUAL OR POTENTIAL CONFLICTS OF INTEREST THAT MAY DEVELOP THROUGHOUT THE YEAR ARE REPORTED TO THE BOARD CHAIR AND/OR PRESIDENT. ANY MEMBER OF THE BOARD OF TRUSTEES WHO HAS A CONFLICT OF INTEREST REGARDING ANY MATTER REQUIRING ACTION BY THE BOARD IS REQUIRED TO BE ABSENT FROM THE MEETING DURING THE BOARD'S DISCUSSION OF THE MATTER AND DURING ANY ACTION TAKEN ON THE MATTER BY VOTE. THE MEMBER'S ABSENCE DURING DISCUSSION AND VOTING ARE RECORDED IN THE MEETING MINUTES. ALL STAFF ALSO SIGN A COPY OF THE POLICY, WHICH IS PLACED IN THEIR PERSONNEL FILE. |
| FORM 990, PAGE 6, PART VI, LINE 15A | AN ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT WAS CONDUCTED BY THE BOARD CHAIR BUT NO INCREASE IN SALARY WAS GIVEN TO THE PRESIDENT DURING THIS TAX YEAR DUE TO BUDGET CONSTRAINTS. THE USUAL PROCESS FOR DETERMINING COMPENSATION FOR THE PRESIDENT IS AN ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT BY THE BOARD CHAIR, FOLLOWED BY MEMBERS OF THE EXECUTIVE COMMITTEE BEING APPOINTED BY THE BOARD CHAIR TO REVIEW COMPENSATION FOR THE PRESIDENT. WITH CONSIDERATION OF BUDGET FIGURES AND SALARIES PAID TO THE TOP OFFICIAL IN OTHER LOCAL ORGANIZATIONS, A SALARY RECOMMENDATION IS MADE TO THE BOARD OF TRUSTEES FOR THEIR CONSIDERATION DURING A BOARD MEETING, WHICH IS NOT ATTENDED BY THE PRESIDENT. |
| FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| Software ID: | |
| Software Version: |