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.") .. | ||||||
| 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 | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 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 | ||||||
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: |
| Return Reference | Explanation |
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| SCHEDULE E, PART I, LINE 3 | A NOTICE OF THE NON-DISCRIMINATION POLICY IS PUBLISHED ON THE ORGANIZATION'S WEBSITE AND IS ALSO AVAIABLE IN CATALOGUES AND BROCHURES DISTRIBUTED TO THE PUBLIC. |
| 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, PART VI, SECTION A, LINE 6 | SERVIAM IS A NON-STOCK CORPORATION WITH FIVE MEMBERS. THE MEMBERS ARE NOT TRUSTEES OF THE GOVERNING BODY. RATHER, THEY HAVE RESERVED RIGHTS AND POWERS EXCLUSIVE TO THE MEMBERS, INCLUDING THE ELECTION OF GOVERNING BODY AND REMOVAL OF ANY DIRECTOR; THE APPOINTMENT OF THE ORGANIZATION'S FINANCIAL AUDITOR AND ITS ATTORNEY, AND APPROVAL OF THE FINANCIALS; HIRING THE PRESIDENT AND NAMING THE CHAIR; AMENDING THE BY-LAWS; AUTHORIZING CAPITAL IMPROVEMENTS OR THE SALES OF ASSETS; AND THE MERGER, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | FROM OUR BYLAWS, AND ADHERED TO ON ALL ACCOUNTS: SECTION 6. POWERS RESERVED TO MEMBERS. NOTWITHSTANDING ANY PROVISION OF THESE BYLAWS TO THE CONTRARY, THE FOLLOWING POWERS ARE RESERVED EXCLUSIVELY TO THE MEMBERS OF THE CORPORATION: (A) TO ARTICULATE AND MEDIATE THE PHILOSOPHY OF THE CORPORATION, INCLUDING THE APPROVAL OF THE MISSION STATEMENT, MAJOR POLICY CHANGES, AND LONG-RANGE PLANNING OBJECTIVES OF THE CORPORATION; (B) TO APPOINT, BY A MAJORITY VOTE OF ALL THE MEMBERS, THE DIRECTORS AND THE CHAIRPERSON OF THE BOARD OF DIRECTORS (THE "CHAIR") AFTER HAVING CONSIDERED RECOMMENDATIONS FROM THE BOARD OF DIRECTORS; (C) ALL DECISIONS AND APPROVALS REGARDING THE APPOINTMENT AND EMPLOYMENT OF THE PRESIDENT OF THE CORPORATION (THE "PRESIDENT"), WHICH SHALL BE BY MAJORITY VOTE OF ALL THE MEMBERS OF THE CORPORATION AFTER HAVING CONSIDERED RECOMMENDATIONS FROM THE BOARD OF DIRECTORS, PROVIDED THAT THE MEMBERS SHALL NOT HAVE THE POWER TO TERMINATE THE PRESIDENT PRIOR TO THE EXPIRATION OF HIS OR HER THEN CURRENT TERM OF EMPLOYMENT (WHETHER BY CONTRACT OR OTHERWISE) UNLESS SUCH TERMINATION HAS BEEN APPROVED BY AT LEAST 66 2/3% OF THE VOTING POWER OF THE MEMBERS OF THE CORPORATION; (D) TO AMEND, ALTER, OR REPEAL ANY PROVISIONS CONTAINED IN THE CERTIFICATE OF INCORPORATION OF THE CORPORATION (THE "CERTIFICATE OF INCORPORATION"), AND ALL RIGHTS CONFERRED HEREIN ARE GRANTED SUBJECT TO THIS RESERVATION; PROVIDED, HOWEVER, THAT NO AMENDMENT SHALL AUTHORIZE THE BOARD OF DIRECTORS TO CONDUCT THE AFFAIRS OF THE CORPORATION IN ANY MANNER OR FOR ANY PURPOSE CONTRARY TO THE PROVISIONS OF SECTION 501(C)(3) OF THE CODE, OR THE CORRESPONDING PROVISION OF ANY SUBSEQUENT FEDERAL TAX LAW; (E) TO AUTHORIZE, AFTER APPROVAL BY THE BOARD OF DIRECTORS, ALL CAPITAL IMPROVEMENTS AND ANY SALE, MORTGAGE OR SUBORDINATION OF INTEREST IN THE ASSETS OF THE CORPORATION; (G) TO MERGE, CONSOLIDATE OR DISSOLVE THE CORPORATION, PROVIDED THAT SUCH ACTIONS MAY BE TAKEN ONLY IF THEY DO NOT CHANGE THE TAX-EXEMPT STATUS OF THE CORPORATION AS AN EDUCATIONAL OR CHARITABLE ORGANIZATION; (H) TO APPOINT THE FINANCIAL AUDITOR OF THE CORPORATION AND TO APPROVE THE ANNUAL AUDIT OF THE CORPORATION; AND (I) TO APPOINT THE ATTORNEY FOR THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7B | SERVIAM IS A NON-STOCK CORPORATION WITH MEMEBERS. THE MEMBERS ARE NOT TRUSTEES OF THE GOVERNING BODY. RATHER, THEY HAVE THE RIGHT TO ELECT THE GOVERNING BODY OR TO REMOVE ANY DIRECTOR. THEY ALSO HAVE CERTAIN POWERS RESERVED UNTO THEMSELVES INCLUDING APPROVING THE FINANCIALS, HIRING THE PRESIDENT, AND NAMING THE CHAIR. THE MEMEBERS APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY INCLUDING, FOR EXAMPLE, THE HIRING OF THE PRESIDENT; THE APPOINTMENT OF THE CHAIR; THE AMENDMENT OF THE BY-LAWS; THE AUTHORIZATION OF CAPITAL IMPROVEMENTS OR SALES OF ASSETS; THE MERGER, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION; THE APPOINTMENT OF THE ORGANIZATION'S FINANCIAL AUDITOR AND IT'S ATTORNEY. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE DRAFT 990 IS REVIEWED IN DETAIL BY THE FINANCE COMMITTEE, WHO AFTER ANY NEEDED REVISIONS ARE MADE, SENDS THE "APPROVED" 990 TO THE BOARD OF DIRECTORS AND THE BOARD OF MEMBERS FOR FINAL APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTOR REQUIRES ALL BOARD MEMBERS TO REVIEW THE POLICY AND SIGN OFF ON THE CONFLICT OF INTEREST FORM EVERY SEPTEMBER. |
| FORM 990, PART VI, SECTION B, LINE 15 | MEMBERS OF THE EXECUTIVE COMMITTEE MEET WITH THE PRESIDENT FOR AN ANNUAL REVIEW AND MAKE RECOMMENDATIONS FOR HER COMPENSATION TO THE FULL COMMITTEE. FINAL APPROVAL IS OBTAINED BY THE BOARD OF DIRECTORS. SALARY ACTUALS REVIEWED MONTHLY BY BREAKWATER VIA PAYROLL POSTINGS. THE BOARD REVIEWS TOTAL MONTHLY COMPENSATION VIA FINANCIAL STATEMENTS AND ANALYTICS. BUDGET IS REVIEWED AGAINST ACTUALS MONTHLY BY BOARD & BREAKWATER |
| FORM 990, PART VI, SECTION C, LINE 19 | UPON REQUEST |
| Software ID: | |
| Software Version: |