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 |
||||||
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.") .. | 149,722 | 182,783 | 248,568 | 277,773 | 214,688 | 1,073,534 |
| 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 | 149,722 | 182,783 | 248,568 | 277,773 | 214,688 | 1,073,534 |
| 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).. | 12,492 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 1,061,042 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 149,722 | 182,783 | 248,568 | 277,773 | 214,688 | 1,073,534 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 1,125 | 1,199 | 740 | 140 | 3,204 | |
| 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.).. | 39,415 | 7,005 | 10,332 | 13,935 | 15,281 | 85,968 |
| 11 | Total support. Add lines 7 through 10 | 1,162,706 | |||||
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) |
||||
| 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) |
||||
| 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): |
|||||
| 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. |
||||
| 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) |
||||
| 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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2021. Add lines 3j and 4c. |
||||
| 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 |
|---|---|
| PART II, LINE 10 | 85,968 |
| 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 4D | COMMUNITY SERVICES INCLUDE THE INTERNET CAFE, FACILITY USE FOR ACTIVITIES, AND THE ANNUAL THANKSGIVING DINNER. SENIOR DIVISION NOT ONLY PROVIDES A SAFE PLACE WHERE SENIORS CAN GATHER FOR COMMUNITY AND SOCIALIZATION, BUT THEY ARE ABLE TO TAKE PART IN OUR WELLNESS PROGRAMS AND USE THE WELLNESS CENTER. THE WELLNESS PROGRAMS INCLUDE, BUT ARE NOT LIMITED TO, NUTRITION CLASSES, HEART HEALTH, BALANCE CLASSES, BLOOD PRESSURE SCREENING, DIABETES AWARENESS, AND HEALTH FAIRS. THE WELLNESS CENTER IS A MONITORED EXERCISE ROOM WHERE THE SENIORS CAN WORK OUT AND EAR INCENTIVES. THE SENIORS ALSO PARTICIPATE IN FUN SOCIAL ACTIVITIES: OUTING, EUCHRE, BINGO, AND HAVE OCCASIONAL GUEST SPEAKERS. EMERGENCY SERVICES: FOOD PANTRY PROVIDES NUTRITIONAL FOOD TO LOW TO MIDDLE INCOME FAMILIES, INDIVIDUALS, AND THE ELDERLY. THE PANTRY ALLOWS THEM TO STRETCH THEIR FOOD BUDGET, WHICH ALLOWS THEM MORE MONEY TO MEET THEIR FINANCIAL OBLIGATIONS. IN ADDITION, IT PROVIDES ONE OF THEIR MOST IMPORTANT BASIC NEEDS. OVER 200 HOUSEHOLDS WERE SERVED. |
| FORM 990, PAGE 6, PART VI, LINE 4 | ARTICLE I, SECTION 5: PLACE OF MEETING ALL MEETINGS SHALL BE HELD AT THE ORGANIZATION'S PRINCIPAL PLACE OF BUSINESS UNLESS OTHERWISE STATED IN THE NOTICE. SPECIAL EXCEPTION FOR A VIRTUAL (ZOOM) MEETING DUE TO COVID-19 OR OTHER FUTURE EMERGENCIES WHEN IN-PERSON MEETINGS ARE OFF-SITE. NOTICE OF SUCH VIRTUAL/HYBRID MEETINGS MAY BE GIVEN THROUGH ELECTRONIC COMMUNICATION. DUE NOTICE AND A QUORUM OF A MAJORITY OF DIRECTORS ON THE ACTIVE ROLL SHALL BE REQUIRED. ARTICLE II, SECTION 2: DIRECTORS - ELECTION AND TERM OF OFFICE THE DIRECTORS SHALL BE ELECTED AT THE ANNUAL MEETING. EACH DIRECTOR SHALL SERVE A TERM OF TWO (2) YEARS, BUT EVALUATED EACH YEAR BY THE EXECUTIVE COMMITTEE OR UNTIL A SUCCESSOR HAS BEEN ELECTED AND QUALIFIED. MEMBERS CAN SERVE UP TO THREE (3) CONSECUTIVE TERMS BEFORE NEEDING TO TAKE A ONE (1) YEAR BREAK. FOR EXECUTIVE COMMITTEE MEMBERS, THEY ARE ABLE TO SERVE UNTIL A QUALIFIED SUCCESSOR HAS BEEN IDENTIFIED AND ELECTED. NOMINATIONS FOR DIRECTOR SHALL BE MADE BY A COMMITTEE APPOINTED FOR SUCH PURPOSE BY THE PRESIDENT, AND THE NOMINATIONS SHALL BE AVAILABLE FOR INSPECTION TEN (10) DAYS PRIOR TO THE ANNUAL MEETING. THE TOTAL NUMBER OF DIRECTORS, INCLUDING OFFICERS, SHALL NOT BE FEWER THAN 7 AND MORE THAN 11. NOMINATIONS MAY NOT BE MADE FROM THE FLOOR WITHOUT TWO-THIRDS (2/3) CONSENT OF THE INCUMBENT DIRECTORS. NOMINATIONS MAY BE VOTED ON AS A SLATE OR INDIVIDUALLY SUBJECT TO A YES OR NO VOTE. IF THE NUMBER OF NOMINEES EXCEED THE SEATS AVAILABLE, A MAJORITY OF VOTES CAST SHALL BE REQUIRED FOR ELECTION, WITH EACH SEAT VOTED ON IN SERIES. TERM IS FROM JULY 1ST AND ENDING JUNE 30TH OF THE FOLLOWING YEAR. ARTICLE III, SECTION 2: OFFICERS - ELECTION AND TERM OF OFFICE THE OFFICERS SHALL BE ELECTED ANNUALLY BY THE BOARD OF DIRECTORS AT THE FIRST MEETING OF THE BOARD OF DIRECTORS, IMMEDIATELY FOLLOWING THE ANNUAL MEETING. EACH OFFICER SHALL SERVE A TERM OF TWO (2) YEARS, BUT EVALUATED EACH YEAR BY THE EXECUTIVE COMMITTEE OR UNTIL A SUCCESSOR HAS BEEN ELECTED AND QUALIFIED. MEMBERS CAN SERVE UP TO THREE (3) CONSECUTIVE TERMS BEFORE NEEDING TO TAKE A ONE (1) YEAR BREAK. FOR EXECUTIVE COMMITTEE MEMBERS, THEY ARE ABLE TO SERVE A TERM OF TWO (2) YEARS, BUT EVALUATED EACH YEAR BY THE EXECUTIVE COMMITTEE OR UNTIL A SUCCESSOR HAS BEEN ELECTED AND QUALIFIED. MEMBERS CAN SERVE UP TO THREE (2) CONSECUTIVE TERMS BEFORE NEEDING TO TAKE A ONE (1) YEAR BREAK. FOR EXECUTIVE COMMITTEE MEMBERS, THEY ARE ABLE TO SERVE UNTIL A QUALIFIED SUCCESSOR HAS BEEN IDENTIFIED AND ELECTED. NOMINATIONS FOR DIRECTOR SHALL BE MADE BY A COMMITTEE APPOINTED FOR SUCH PURPOSE BY THE PRESIDENT, AND THE NOMINATIONS SHALL BE AVAILABLE FOR INSPECTION TEN (10) DAYS PRIOR TO THE ANNUAL MEETING. NOMINATIONS MAY NOT BE MADE FROM THE FLOOR WITHOUT TWO-THIRDS (2/3) CONSENT OF THE INCUMBENT DIRECTORS. NOMINATIONS MAY BE VOTED ON AS A SLATE OR INDIVIDUALLY SUBJECT TO A YES OR NO VOTE. IF THE NUMBER OF NOMINEES EXCEED THE SEATS AVAILABLE, A MAJORITY OF VOTES CAST SHALL BE REQUIRED FOR ELECTION, WITH EACH SEAT VOTED ON IN SERIES. TERM IS FROM JULY 1ST AND ENDING JUNE 30TH OF THE FOLLOWING YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS REVIEWED BY THE EXECUTIVE COMMITTEE PRIOR TO FILING |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICT OF INTEREST FORMS ARE GIVEN TO BOARD MEMBERS AT THE ANNUAL MEETING. THE FORM IS REVIEWED DURING THE MEETING. BOARD MEMBERS SIGN AT THE MEETING AND THE FORMS ARE COLLECTED BY THE BOARD PRESIDENT AND EXECUTIVE DIRECTOR. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS ARE AVAILABLE UPON REQUEST |
| FORM 990, PART XI, LINE 9 | BOOK / TAX DEPRECIATION DIFFERENCE 31,323 |
| Software ID: | |
| Software Version: |