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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 574,274 | 623,092 | 609,519 | 543,543 | 742,330 | 3,092,758 |
| 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 | 574,274 | 623,092 | 609,519 | 543,543 | 742,330 | 3,092,758 |
| 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. | 3,092,758 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 574,274 | 623,092 | 609,519 | 543,543 | 742,330 | 3,092,758 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 11 | 11 | ||||
| 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.).. | 718 | 1,005 | 945 | 972 | 851 | 4,491 |
| 11 | Total support. Add lines 7 through 10 | 3,097,260 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2020 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2020 |
(iii) Distributable Amount for 2020 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2020 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 2020: | ||||
| a From 2015....... | ||||
| b From 2016....... | ||||
| c From 2017....... | ||||
| d From 2018....... | ||||
| e From 2019....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2020 distributable amount | ||||
|
i
Carryover from 2015 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2020 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2020 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2020, 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 2020. 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 2021. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2016..... | ||||
| b Excess from 2017..... | ||||
| c Excess from 2018..... | ||||
| d Excess from 2019..... | ||||
| e Excess from 2020..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART II, LINE 10, EXPLANATION OF OTHER INCOME: | SALES TAX REFUNDS - 2016 AMOUNT: $ 718. 2017 AMOUNT: $ 1,005. 2018 AMOUNT: $ 945. 2019 AMOUNT: $ 972. 2020 AMOUNT: $ 851. |
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Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 3 | RAISING A READER PROGRAM-IN SPRING OF 2020, CCPFC SOLICITED APPLICATIONS FROM EARLY EDUCATION AND LITERACY PROFESSIONALS TO PROVIDE THE RAISING A READER (RAR) PROGRAM IN FY 2020-21. FOUR SITES, INCLUDING CASWELL COUNTY SCHOOL'S THREE PRE-K CLASSROOMS AND GUNN MEMORIAL PUBLIC LIBRARY, SUBMITTED APPLICATIONS TO SERVE AS RAR SITES. ALL APPLICATIONS WERE APPROVED. AS OF LATE AUGUST 2020, GUNN MEMORIAL PUBLIC LIBRARY WAS NOT PROVIDING THE PRESCHOOL CHILDREN'S PROGRAM ONSITE AND CASWELL COUNTY SCHOOLS BEGAN THE SCHOOL YEAR WITH REMOTE LEARNING FOR ALL STUDENTS. BASED ON THIS INFORMATION, THE RAISING A READER PROGRAM WAS NOT IMPLEMENTED IN FY 2020-2021. REACH OUT AND READ PROGRAM-WELL CHILD VISITS DECREASED AT BOTH PARTICIPATING MEDICAL SITES (CASWELL FAMILY MEDICAL CENTER AND CASWELL COUNTY HEALTH DEPARTMENT) AS THE SITES RESPONDED TO AND TARGETED EFFORTS TO ADDRESS THE PANDEMIC. THE CASWELL COUNTY HEALTH DEPARTMENT MODIFIED THE PROGRAM INTERVENTION BY REMOVING THEIR READING CORNER, LOCATED IN THE WAITING AREA. THE SITE PROMOTED A LITERACY RICH ENVIRONMENT BY PLACING MATERIAL IN THE TRIAGE AREA, WHERE ALL PATIENTS DID MOST OF THEIR WAITING. THE CASWELL FAMILY MEDICAL CENTER (CFMC) SUSPENDED THE PROGRAM IN SEPTEMBER 2020 DUE TO THE LOSS OF BOTH THE SITE COORDINATOR AND PEDIATRICIAN (MEDICAL CONSULTANT). THE SITE RELAUNCHED THE PROGRAM IN MAY 2021. |
| FORM 990, PART VI, SECTION A, LINE 1 | THE BOARD DELEGATES AUTHORITY TO AN EXECUTIVE COMMITTEE TO ACT ON ITS BEHALF WITH BROAD AUTHORITY. ALL COMMITTEE MEMBERS ARE BOARD MEMBERS AND INCLUDE THE CHAIRPERSON, VICE-CHAIRPERSON, SECRETARY, TREASURER, PLANNING COMMITTEE CHAIRPERSON, AND ADVISORY COMMITTEE CHAIRPERSON. THE EXECUTIVE DIRECTOR SERVES AS EX OFFICIO AS REQUESTED. THE COMMITTEE EXERCISES ALL AUTHORITY OF THE BOARD WHEN IT IS NOT FEASIBLE TO CONVENE THE BOARD EXCEPT AS LIMITED BY NCGS 55A-8-25, HAS THE AUTHORITY TO HIRE AND DISMISS THE EXECUTIVE DIRECTOR, SERVES AS THE FINANCE COMMITTEE AND THE AUDIT COMMITTEE, AND MAY INVITE OTHER EX OFFICIO MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | PRIOR TO FILING, THE EXECUTIVE DIRECTOR REVIEWED THE FORM 990 AND ALL SCHEDULES. THE EXECUTIVE COMMITTEE REVIEWED THE FORM 990 AT ITS MEETING IN OCTOBER 2021, PRIOR TO FILING OF THE FORM. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MEMBER OF THE BOARD AND STAFF IS REQUIRED TO REVIEW A COPY OF THE CONFLICT OF INTEREST POLICY AND TO ACKNOWLEDGE HAVING DONE SO IN WRITING. EACH MEMBER OF THE BOARD SHALL ANNUALLY COMPLETE A DISCLOSURE FORM THAT SHALL BE SUBMITTED AND REVIEWED BY THE EXECUTIVE DIRECTOR. THE FORM IDENTIFIES THE BUSINESSES AND NONPROFIT ORGANIZATIONS OF WHICH THE BOARD MEMBER, THE BOARD MEMBER'S SPOUSE (IF ANY) THE BOARD MEMBER'S SIBLING(S)(OR SPOUSES) OR ANY CHILD OF THE BOARD MEMBER (OR SPOUSE) IS A DIRECTOR, OFFICER, EMPLOYEE OR PARTNER. A WRITTEN ACCOUNTING OF ALL POTENTIAL CONFLICTS OF INTEREST BY BOARD MEMBERS WITH RESPECT TO CCPFC CONTRACTS AND TRANSACTIONS IS AVAILABLE UPON REQUEST. IN ADDITION TO THE STEPS OUTLINED ABOVE, THE POLICY IS REVIEWED AT EACH BOARD AND COMMITTEE MEETING. A CONFLICT OF INTEREST REMINDER IS PRINTED ON EACH AGENDA, "IDENTIFICATION OF BOARD MEMBERS WITH CONFLICTS" IS INCLUDED AS AN AGENDA ITEM, AND THE BOARD/COMMITTEE CHAIRMAN ASKS MEMBERS TO IDENTIFY THEMSELVES PRIOR TO EACH VOTE. THE CCPFC CONFLICT OF INTEREST POLICY WAS REVISED AND ADOPTED BY THE BOARD OF DIRECTORS ON JANUARY 20, 2010. THE POLICY DESCRIBES THE REVIEW OF POLICY AND ANNUAL DISCLOSURE. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE COMMITTEE SERVES AS THE PERSONNEL COMMITTEE. THIS COMMITTEE MET IN SEPTEMBER 2021 TO EVALUATE THE EXECUTIVE DIRECTOR'S PERFORMANCE AND REVIEW COMPENSATION. THE COMMITTEE USED THE SMART START EXECUTIVE DIRECTOR SALARY SCHEDULE IMPLEMENTATION GUIDELINES ESTABLISHED BY THE NC PARTNERSHIP FOR CHILDREN TO DETERMINE THE ADJUSTMENTS TO THE EXECUTIVE DIRECTOR'S COMPENSATION. THE EXECUTIVE DIRECTOR REVIEWS THE PERFORMANCE OF ALL OTHER EMPLOYEES ON AN ANNUAL BASIS AND MAKES RECOMMENDATIONS TO THE EXECUTIVE COMMITTEE REGARDING ADJUSTMENTS TO COMPENSATION. THE EXECUTIVE DIRECTOR REVIEWS SIMILAR POSITIONS AND COMPENSATION FROM LOCAL PARTNERSHIPS IN SURROUNDING COUNTIES AND SIMILAR POSITIONS AT OTHER ORGANIZATIONS WITHIN CASWELL COUNTY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST AND ARE MAINTAINED IN A PUBLIC NOTEBOOK. |
| FORM 990, PART XII, LINE 1: | THE METHOD OF ACCOUNTING USED TO PREPARE FORM 990 IS MODIFIED-CASH BASIS OF ACCOUNTING. |
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