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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 591,253 | 746,440 | 553,405 | 794,899 | 1,263,972 | 3,949,969 |
| 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 | 591,253 | 746,440 | 553,405 | 794,899 | 1,263,972 | 3,949,969 |
| 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. | 3,949,969 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 591,253 | 746,440 | 553,405 | 794,899 | 1,263,972 | 3,949,969 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 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 | 4,380,164 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 on 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 2021 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-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| 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 | ROMP GUATEMALA PROGRAMS SUPPORT FOR THE ROMP GUATEMALA OPERATIONS WAS DISTRIBUTED IN THE FORM OF A 95603 FINANCIAL PACKAGE TO THE ASOCIACION CIVIL PROYECTO DE RANGOS EN MOVIMIENTO. 52000 WAS SPENT ON COMMUNITY BASED REHABILITATION (CBR) SERVICES FOR PATIENTS IN GUATEMALA. THIS ENTITY IS AN INDEPENDENTLY OPERATED BRANCH OF RANGE OF MOTION PROJECT RESPONSIBLE FOR CARRYING OUT THE MISSION OF ROMP IN GUATEMALA. THE AFOREMENTIONED 95603 GRANT COVERED OPERATIONAL EXPENSES OF THE ROMP GUATEMALA CLINIC INCLUDING: STAFFING EXPENSES, THE PURCHASE OF MATERIALS AND SUPPLIES, IMPORTATION OF PROSTHETIC COMPONENTS, AND OTHER OPERATIONAL EXPENSES. THE ROMP GUATEMALA CLINIC WAS RESPONSIBLE FOR DELIVERING 163 CUSTOM PROSTHETIC DEVICES WHILE PROCESSING 713 INDIVIDUAL PATIENT VISITS IN ITS FIXED CLINIC SITE IN ZACAPA, GUATEMALA. THE CBR PROGRAM GRADUATED 30 INDIVIDUALS FROM ITS MOBILITY AND EMPOWERMENT COURSE. 305 TOTAL HOME VISITS WERE PERFORMED IN CBR. SUPPORT FOR THE ROMP ECUADOR OPERATIONS WAS DISTRIBUTED IN THE FORM OF A 158435 FINANCIAL PACKAGE TO THE ECUADORIAN FUNDACION PROYECTO DE RANGOS EN MOVIMIENTO. 34972 OF RESTRICTED FUNDS FROM THE US STATE DEPARTMENT WERE SPENT ON THE CREATION OF A DIGITAL SPANISH LANGUAGE RESOURCE HUB CALLED ROMPTEMUEVE.ORG. WHEREAS THE REMAINING 123463 GRANT COVERED OPERATIONAL EXPENSES OF THE ROMP ECUADOR CLINIC INCLUDING: STAFFING EXPENSES, THE PURCHASE OF MATERIALS AND SUPPLIES, IMPORTATION OF PROSTHETIC COMPONENTS, AND OTHER OPERATIONAL EXPENSES. THE ROMP ECUADOR CLINIC WAS RESPONSIBLE FOR DELIVERING 116 CUSTOM PROSTHETIC DEVICES WHILE PROCESSING 446 INDIVIDUAL PATIENT VISITS IN ITS FIXED CLINIC SITE IN QUITO, ECUADOR AND VIA MOBILE CLINIC OPERATIONS THROUGHOUT THE COUNTRY. |
| FORM 990, PAGE 2, PART III, LINE 4B | COMPONENTS FOR A CAUSE PROGRAM PURCHASE, PROCESSING, STORAGE, AND DISTRIBUTION OF RECYCLED AND NEW PROSTHETIC COMPONENTS AND SUPPLIES FOR ROMP CLINIC SITES IN THE WESTERN HEMISPHERE. PURCHASE OF NEW COMPONENTS AND MATERIALS: 17,813 SHIPPING OF COMPONENTS TO STORAGE AND PROGRAM SITES: 37,421 THESE COMPONENTS WERE USED TO FABRICATE A TOTAL OF 306 CUSTOM PROSTHETIC DEVICES FOR AMPUTEES IN NEED OF CARE. ADDITIONALLY, THESE COMPONENTS AND MATERIALS SUPPORTED FOLLOW-UP AND REPAIR SERVICES FOR 1296 TOTAL PATIENT VISITS ACROSS THE ORGANIZATION. 18,471 IN REVENUE WAS RECEIVED FROM USAP PROGRAM PAYING PATIENT RECIPIENTS. |
| FORM 990, PAGE 2, PART III, LINE 4C | THE ROMP CHIEF PROGRAM OFFICER RECEIVED 45,623 BY WAY OF WAGES AND BENEFITS THE ROMP EXECUTIVE DIRECTOR RECEIVED 30798 BY WAY OF WAGES THE ROMP USAP PROGRAM COORDINATOR RECEIVED 3683 PROGRAM TAXES AND WITHHOLDING TOTALED 24713 FOR THE PERIOD THE CHIEF PROGRAM OFFICER WAS RESPONSIBLE FOR COORDINATING AND MANAGING ALL OF ROMP'S PROGRAMS RESULTING IN THE DELIVERY OF 306 CUSTOM PROSTHETIC DEVICES ACROSS ALL OF ROMP'S OPERATIONS AND THE GRADUATION OF 30 CBR PARTICIPANTS IN 2021. THE EXECUTIVE DIRECTOR WAS RESPONSIBLE FOR OVERSEEING THE PATIENT CARE OPERATION IN ROMP ECUADOR WHICH DELIVERED 116 OF THE TOTAL 306 CUSTOM PROSTHETIC DEVICES DELIVERED BY THE ORGANIZATION AS A WHOLE. THE ROMP USAP PROGRAM COORDINATOR WAS RESPONSIBLE FOR CASE MANAGEMENT OF THE 27 CUSTOM PROSTHETIC DEVICES DELIVERED THROUGH ROMP'S US-BASED PATIENT CARE PROGRAM (USAP) |
| FORM 990, PAGE 2, PART III, LINE 4D | ADDITIONAL RELATED EXPENSES 67,630 - CLIMBING FOR ROMP AMPUTEE CLIMBING PROGRAM EXPENSE IN ECUADOR 5,838 - PROGRAM TRAVEL EXPENSES 2,099 - PROGRAM TECHNOLOGIES EXPENSE INCLUDING DIGITAL STORAGE, DIGITAL MEDICAL RECORD SYSTEM AND PROGRAM WEBSITE EXPENSES 74 - AMBASSADOR PROGRAM 29,904 - USA PATIENT CARE PROGRAM (USAP) EXPENSES 43,962 - VOLUNTEER PROGRAM EXPENSES |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE COMPLETED FORM 990 AND ALL REQUIRED SCHEDULES WERE SENT TO THE ORGANIZATION'S BOARD OF DIRECTORS VIA E-MAIL FOR REVIEW PRIOR TO SUBMITTING TO THE IRS. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL OF THE ORGANIZATIONS KEY EMPLOYEES, AND BOARD OF DIRECTOR MEMBERS ARE REQUIRED TO DISCLOSE CONFLICTS OF INTEREST IN WRITING AT THE YEAR-END BOARD OF DIRECTOR MEETING IN ACCORDANCE WITH THE CONFLICT OF INTEREST POLICY AS ESTABLISHED IN THE ORGANIZATIONS BYLAWS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR THE ORGANIZATION'S EXECUTIVE DIRECTOR AND OFFICERS WAS DETERMINED AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 15B | COMPENSATION FOR THE ORGANIZATION'S EXECUTIVE DIRECTOR AND OFFICERS WAS DETERMINED AND APPROVED BY THE ORGANIZATION'S BOARD OF DIRECTORS. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| Software ID: | |
| Software Version: |