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.") .. | 31,692 | 30,739 | 34,419 | 28,029 | 75,536 | 200,415 |
| 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 | 31,692 | 30,739 | 34,419 | 28,029 | 75,536 | 200,415 |
| 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. | 200,415 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2016 | (b) 2017 | (c) 2018 | (d) 2019 | (e) 2020 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 31,692 | 30,739 | 34,419 | 28,029 | 75,536 | 200,415 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 3,810 | 6,722 | 6,055 | 5,045 | 10,125 | 31,757 |
| 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 | 232,172 | |||||
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 |
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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 | DUE TO THE PANDEMIC, WE DID NOT PROVIDE ON-SITE ADULT DAY SERVICE THIS PAST FISCAL YEAR AND WE CURTAILED OUR EDUCATION SERVICES. DURING THIS TIME, WE CONDUCTED WELLNESS CHECKS VIA TELEPHONE AND DELIVERED ACTIVITY KITS TO ADULT DAY SERVICE PARTICIPANTS, CONTINUED TO PROVIDE FAMILY CARE PLANNING TO CAREGIVERS VIA TELEPHONE AND OFFERED 7 ON-LINE OR IN-PERSON CAREGIVER EDUCATION CLASSES. COMMUNITY EDUCATION PRESENTATIONS WERE NOT PROVIDED. |
| FORM 990, PAGE 2, PART III, LINE 4A | DUE TO THE PANDEMIC, WE DID NOT PROVIDE ADULT DAY SERVICE THIS PAST FISCAL YEAR. DURING THIS TIME, 1-4 MONTHLY TELEPHONE WELLNESS CHECKS, PENDING INDIVIDUAL PREFERENCES FOR TELEPHONE CONTACTS, WERE MADE TO PROGRAM PARTICIPANTS, ALL OF WHOM HAVE A DEMENTIA OR RELATED MEMORY LOSS DISORDER, AND/OR TO THEIR FAMILY CAREGIVERS BY A STAFF NURSE. BASED ON INDIVIDUAL NEEDS EXPRESSED DURING THE WELLNESS CHECKS, REFERRALS, CAREGIVING TIPS AND INFORMATION WAS PROVIDED AND SERVED TO HELP REDUCE THE SOCIAL ISOLATION EXPERIENCED BY MANY OF OUR PARTICIPANTS AND THEIR FAMILY CAREGIVERS. TWO ACTIVITY KITS COMPRISING SEVERAL CRAFTS, WORD PUZZLES, CARDS, BALLONS FOR BALLOON TOSS EXERCISE, COLORING BOOKS, PAINTS, MARKERS, ETC. ALONG WITH SUGGESTIONS FOR ACTIVITIES WERE PERSONALLY DELIVERED OR MAILED TO PARTICIPANTS TO HELP KEEP THEM ENGAGED IN ENJOYABLE ACTIVITIES THAT WOULD PROMOTE THE USE OF THEIR FUNCTIONAL ABILITIES. ACTIVITIES PROVIDED INCLUDED THOSE THAT COULD BE DONE WITH OTHERS TO PROMOTE SOCIAL INTERACTION WITH THEIR FAMILY MEMBERS AS WELL AS INDIVIDUAL ACTIVITIES THAT WOOULD KEEP PARTICIPANTS OCCUPIED WHILE THEIR CAREGIVERS WORKED FROM HOME, TENDED TO IN-HOME TASKS OR TOOK TIME TO RELAX. WHILE CLOSED, SEVERAL MODIFICATIONS TO OUR DAY CENTER WERE TAKEN TO PROMOTE A SAFE RE-OPENING SOME OF WHICH INCLUDED THE INSTALLATION OF TOUCHLESS FAUCETS AND SOAP DISPENSERS IN RESTROOMS AND THE PURCHASE OF AIR PURIFIERS, EASY TO CLEAN SEATING FURNITURE AND TO ALLOW FOR PHYSICAL DISTANCING SMALLER DINING TABLES AND MOBILE ACRYLIC ROOM DIVIDERS. UPON RE-OPENING SAFELY, OUR ADULT DAY SERVICE WILL RESUME OUR CORE SERVICES: ASSESSMENT 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. |
| FORM 990, PAGE 2, PART III, LINE 4B | DUE TO THE PANDEMIC, PUBLIC EDUCATION PROGRAMS WERE NOT OFFERED THIS PAST FISCAL YEAR. OUR EDUCATION SERVICE PROVIDED FAMILY CARE PLANNING DELIVERED VIA TELEPHONE THROUGHOUT THE FISCAL YEAR AND OFFERED 7 ON-LINE OR IN-PERSON CAREGIVER EDUCATION CLASSES. 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, ADDRESS CONCERNS RELEVANT TO PROVIDING CARE TO SOMEONE WITH A DEMENTIA AND HELP IN IDENTIFYING AVAILABLE COMMUNITY SERVICES IN A CLASS SETTING. PERSONALIZED CARE PLANNING IS OFFERED TO CAREGIVERS WHO REQUIRE OR WISH ADDITIONAL HELP IN UNDERSTANDING THE DISEASE. BY IDENTIFYING THE NEEDS OF THE INDIVIDUAL WITH DEMENTIA AND THOSE OF THE CAREGIVER A PLAN IS DEVELOPED TO HELP THE CAREGIVER MANAGE THE CARE OF THE PERSON WITH DEMENTIA AMD/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. |
| 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 NON-ASSIGNABLE. MEMBERSHIP REGULATIONS ARE DOCUMENTED IN ARTICLE III OF OUR CODE OF REGULATIONS. MEMBERS DO NOT SHARE IN ORGANIZATION REVENUES. IN THE FISCAL YEAR 2021, THERE WERE 14 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 | NO ANNUAL PERFORMANCE EVALUATION OF THE PRESIDENT WAS CONDUCTED NOR WAS THERE A CHANGE IN THE PRESIDENT'S SALARY DURING THIS TAX YEAR DUE TO THE DISRUPTION OF SERVICES, THE REASSIGNEMENT OF WORK OBJETIVES AND BUDGET CONTRAINTS DUE TO THE PANDEMIC. 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: |