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) 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)
![]() |
(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) |
||||
| 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 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. |
||||
| 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) |
||||
| 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. |
||||
|
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. |
||||
|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
||||
| 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 |
|---|
| Return Reference | Explanation |
|---|
| 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 1A | THERE SHALL BE AN EXECUTIVE COMMITTEE CONSISTING OF SEVEN MEMBERS OF THE BOARD OF DIRECTORS. MEMBERSHIP OF THE EXECUTIVE COMMITTEE SHALL INCLUDE THE ELECTED OFFICERS OF THE BOARD (TO WIT, THE PRESIDENT, VICE PRESIDENT, TREASURER, AND SECRETARY) AND THREE (3) OTHER DIRECTORS AMONG WHOM SHALL INCLUDE THE CHAIRMAN OF THE NOMINATING AND PUBLIC RELATIONS COMMITTEE AND THE CHAIRMAN OF THE LONG RANGE PLANNING AND PROPERTY COMMITTEE. AN "AT LARGE" DIRECTOR MEMBER OF THIS COMMITTEE SHALL BE ELECTED BY THE BOARD AT THE ANNUAL MEETING. THE EXECUTIVE COMMITTEE MAY MEET AT A STATED TIME OR ON NOTICE TO ALL BY ANY OF THEIR NUMBER. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 TAX RETURN WAS PROVIDED TO EACH BOARD MEMBER PRESENT AT THE BOARD MEETING WHILE A REPRESENTATIVE FROM THE TAX PREPARER'S OFFICE WAS AVAILABLE TO DISCUSS AND ANSWER QUESTIONS. THOSE NOT PRESENT AT THE BOARD MEETING WERE MAILED A COPY OF THE 990 TAX RETURN BY CERTIFIED MAIL OR A COPY WAS EMAILED TO THEM BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH DIRECTOR, PRINCIPAL OFFICER, AND COMMITTEE MEMBER WITH GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY SIGN A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAD READ AND UNDERSTANDS THE POLICY, AND HAS AGREED TO COMPLY WITH THE POLICY. PERIODIC REVIEWS SHALL BE CONDUCTED TO DETERMINE WHETHER COMPENSATION ARRANGEMENTS AND BENEFITS ARE REASONABLE BASED ON COMPETENT SURVEY INFORMATION AND THE RESULT OF ARM'S LENGTH. THESE REVIEWS WILL ALSO DETERMINE WHETHER PARTNERSHIPS, JOINT VENTURES, AND ARRANGEMENTS WITH MANAGEMENT ORGANIZATIONS CONFORM TO THE ORGANIZATION'S WRITTEN POLICIES, ARE PROPERLY RECORDED, REFLECT REASONABLE INVESTMENT OR PAYMENTS FOR GOODS AND SERVICES, FURTHER CHARITABLE PURPOSES AND DO NOT RESULT IN INUREMENT, IMPERMISSIBLE PRIVATE BENEFIT OR IN AN EXCESS BENEFIT TRANSACTION. THE ORGANIZATION MAY USE OUTSIDE ADVISORS BUT ARE NOT REQUIRED TO DO SO. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE EXECUTIVE DIRECTOR PRESENTS ALL DEPARTMENT MANAGERS' SALARIES AND PROPOSED INCREASES TO THE BOARD OF DIRECTORS PRIOR TO AN INDIVIDUAL'S ANNUAL REVIEW. THE EXECUTIVE DIRECTOR PERFORMS A SEARCH FOR PAY RATES FOR COMPARISON TO THE PAY RATES OF DEPARTMENT MANAGERS AND SOMETIMES POLLS OTHER ADMINISTRATORS TO FIND OUT WHAT IS COMMON PAY FOR CERTAIN POSITIONS. THE BOARD APPROVES PROPOSED INCREASES OR ADJUSTS IT ACCORDINGLY. WHEN IT IS TIME FOR THE EXECUTIVE DIRECTOR'S ANNUAL REVIEW AND PAY CONSIDERATION, THE PRESIDENT OF THE BOARD DISCUSSES THE ANNUAL REVIEW WITH THE BOARD OF DIRECTORS. THE BOARD APPROVES PROPOSED INCREASES OR ADJUSTS IT ACCORDINGLY. THE PRESIDENT OF THE BOARD THEN DISCUSSES THE OUTCOME WITH THE EXECUTIVE DIRECTOR. |
| FORM 990, PART VI, SECTION C, LINE 18 | THE ORGANIZATION MAKES ITS FORM AVAILABLE TO THE PUBLIC UPON REQUEST AND ON WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND CONFLICT OF INTEREST POLICY ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES : PROGRAM SERVICE EXPENSES 223,968. MANAGEMENT AND GENERAL EXPENSES 57,080. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 281,048. CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 6,069,042. MANAGEMENT AND GENERAL EXPENSES 7,988. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 6,077,030. PHYSICAL THERAPY : PROGRAM SERVICE EXPENSES 275,643. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 275,643. OCCUPATIONAL THERAPY : PROGRAM SERVICE EXPENSES 49,919. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 49,919. SPEECH THERAPY : PROGRAM SERVICE EXPENSES 97,033. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 97,033. |
| FORM 990, PART IX, LINE 24E | OPERATING AND MAINTENANCE : PROGRAM SERVICE EXPENSES 63,647. MANAGEMENT AND GENERAL EXPENSES 78. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 63,725. EMPLOYEE APPRECIATION / RELATIONS : PROGRAM SERVICE EXPENSES 16,444. MANAGEMENT AND GENERAL EXPENSES 23,680. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,124. FOOD AND DIETARY SUPPLIES : PROGRAM SERVICE EXPENSES 37,650. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,650. OTHER TAXES AND LICENSES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 20,346. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,346. CONTINUING EDUCATION : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 575. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 575. |
| FORM 990, PART XII, LINE 2C,AUDIT OVERSIGHT/SELECTION OF INDEPENDENT ACCT | THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
| Software ID: | |
| Software Version: |