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 | |||||
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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.") .. | 104,838 | 100,017 | 37,308 | 102,463 | 31,529 | 376,155 |
| 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 | 104,838 | 100,017 | 37,308 | 102,463 | 31,529 | 376,155 |
| 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. | 376,155 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 104,838 | 100,017 | 37,308 | 102,463 | 31,529 | 376,155 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 19 | 100 | 55 | 13 | 187 | |
| 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 | 376,342 | |||||
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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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 B, LINE 11B | FORM 990 IS PROVIDED TO EACH BOARD MEMBER BY E-MAIL FOR REVIEW PRIOR TO FILING. THE ORGANIZATION'S CERTIFIED PUBLIC ACCOUNTANT IS INVITED TO ATTEND THE NEXT BOARD MEETING TO DISCUSS THE 990 IF THERE ARE ANY UNCLEAR ISSUES. |
| FORM 990, PART VI, SECTION B, LINE 12C | EACH MEMBER OF THE BOARD OF DIRECTORS SIGNS A CONFLICT OF INTEREST POLICY ANNUALLY PURSUANT TO THE BYLAWS. BOARD MEMBERS ARE REQUIRED EACH YEAR TO DISCLOSE ANY CONFLICT OF INTEREST AND SIGN A DISCLOSURE AND CONFIDENTIALITY AGREEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE BOARD OF DIRECTORS REVIEWS ALL SALARIES OF UPPER MANAGEMENT. A PERFORMANCE EVALUATION IS COMPLETED FOR EACH INDIVIDUAL, AND THE BOARD FOLLOWS A COMPENSATION PLAN FOR IMPLEMENTING INCREASES. THE ORGANIZATION ALSO PARTICIPATES IN A NATIONAL SURVEY FOR REVIEW OF CHANGES IN THE SALARY MARKET TO REMAIN COMPETITIVE. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL DOCUMENTS ARE IN THE BOARD OF DIRECTOR'S HANDBOOK; COPIES ARE AVAILABLE UPON REQUEST. THE QUALITY IMPROVEMENT/QUALITY ASSURANCE COMMITTEE IS RESPONSIBLE FOR THE ANNUAL REVIEW. |
| FORM 990, EXPLANATION OF THE ORGANIZATION'S MISSION AND PROGRAM SERVICES: | SPRINGWELL NETWORK, INC. HAS BEEN SERVING INTELLECTUALLY/DEVELOPMENTALLY DISABLED ADULTS SINCE 1974. IT IS OUR BELIEF THAT INDIVIDUALS WHO HAVE DEVELOPMENTAL DISABILITIES HAVE THE INHERENT RIGHT TO STRIVE TO FULFILL THEIR POTENTIAL AS HUMAN BEINGS. WE BELIEVE THAT MANY FROM THIS POPULATION HAVE THE COGNITIVE ABILITY TO LEARN THE SKILLS NECESSARY TO OBTAIN SELF-SUFFICIENCY AND EVENTUALLY BE ABLE TO LIVE INDEPENDENTLY. SPRINGWELL NETWORK, INC.'S EXPERIENCE IN THIS FIELD WITH THIS TARGET POPULATION IS AN INTERNAL ACCELERATOR. OUR STAFF IS FAMILIAR WITH THE BARRIERS THIS POPULATION FACES AS THEY ARE EQUIPPED WITH THE KNOWLEDGE AND ABILITY TO TEACH AND ASSIST THESE INDIVIDUALS TO TRAVEL THE ROAD TO BECOMING SELF-SUFFICIENT. THE AGENCY HAS EXPERIENCE WITH WRITING PCP PLANS AND DEVELOPING TARGETED GOALS TO INCREASE SKILL BUILDING, CONFIDENCE, AND SATISFACTION. SPRINGWELL NETWORK, INC. IS A PRIVATE, NONPROFIT CORPORATION ESTABLISHED IN 1974 WHICH SERVES THE AREA OF FORSYTH, STOKES, AND DAVIE COUNTY. PRIMARY POPULATION CONSISTS OF DIAGNOSIS OF INTELLECTUAL DEVELOPMENTAL DISABILITIES OR DUAL DIAGNOSIS. SPRINGWELL NETWORK, INC. OPERATED SEVEN (7) GROUP HOMES, SIX IN FORSYTH COUNTY AND ONE IN STOKES COUNTY. RESIDENTS OF THE COMMUNITY HOMES RECEIVE ON-SITE, 24-HOUR DIRECT SUPERVISION AND SUPPORT. THE PRIMARY FOCUS IS TO INTEGRATE INDIVIDUALS INTO THE COMMUNITY. THE AGENCY OFFERS 4 ADULT BASIC EDUCATIONAL CLASSROOMS WITHIN A DAY PROGRAM. THE DAY PROGRAM INCLUDES TRAINING FOR CONTINUING EDUCATION, INDEPENDENT SKILL BUILDING, VOLUNTEER OPPORTUNITIES AND COMMUNITY INCLUSION. SPRINGWELL CURRENTLY HAS 33 BEDS FOR RESIDENTIAL PLACEMENT, 35 IN THE DAY PROGRAM, AND 107 IN THE COMMUNITY NAVIGATOR PROGRAM. CURRENTLY, THE AGENCY IS LICENSED FOR DAY ACTIVITY THROUGH THE DEPARTMENT OF MENTAL HEALTH LICENSURE AND MAINTAINS CARF ACCREDITATION AND CONTRACT WITH CARDINAL INNOVATIONS HEALTHCARE AND PARTNERS BEHAVIORAL HEALTH. ONSITE TRAINER FOR CPR, FIRST AID, NCI, CLIENTS RIGHTS, CONFIDENTIALITY, OSHA, FOOD SAFETY, DOCUMENTATION DATA AND COLLECTION, LICENSED RN AND PHARMACIST MONITORING. SPRINGWELL NETWORK, INC. HAS A PROUD HISTORY OF CULTURAL COMPETENCE AND DIVERSITY. OUR VISION OF DIVERSITY IS TO CREATE AN ALL-INCLUSIVE CULTURE THAT CELEBRATES AND ENCOURAGES DIVERSITY, NOT ONLY TO CONTRIBUTE TO THE SUCCESS OF OUR COMPANY BUT ALSO TO PROMOTE THE CONTINUED SERVICE FOR OUR COMMUNITY. THE PROGRAM WORKS WITH PEOPLE FROM A VARIETY OF RACIAL, CULTURAL, ETHNIC, AND RELIGIOUS BACKGROUNDS. ALL MEMBERS OF THE ORGANIZATION ARE ISSUED EXPECTATIONS TO REMAIN SENSITIVE TO NEEDS OF PERSONS SERVED REGARDLESS OF THE PHYSICAL, MENTAL, EMOTIONAL, OR ECONOMIC CONDITIONS. THE EFFORT IS PUT INTO PLACE TO PROTECT THE RIGHTS OF PERSON SERVED, AVOID THE ELIMINATION OF ANY POPULATIONS SEEKING SERVICES, REMAIN OPEN TO INPUT FROM PERSONS, TO REMAIN CULTURALLY SENSITIVE IN ALL AREAS OF HIRING AND PROMOTIONS, AND TO MEET THE NEEDS OF ALL PERSONS SERVED. AT SPRINGWELL NETWORK, INC. DIVERSITY MEANS RESPECTING, DRAWING OUT AND CHANNELING THE TALENTS OF OUR EMPLOYEES. WE ARE COMMITTED TO CREATING A WORK ENVIRONMENT WHERE OUR EMPLOYEES CAN REALIZE THEIR FULL POTENTIAL WHILE ALLOWING OUR COMPANY TO BENEFIT FROM THE COMPETITIVE ADVANTAGE OF OUR DIVERSE CULTURE. OUR GOAL IS TO ENSURE OUR COMPANY'S CULTURE IS WELCOMING, RESPECTFUL AND DEVELOPS AND LEVERAGES INDIVIDUAL DIFFERENCES AS A COMPETITIVE ADVANTAGE. ALL CONSUMERS ARE BELOW THE POVERTY LINE OF INCOME AND DO NOT HAVE RESOURCES TO MAKE IT ON THEIR OWN. CONSUMERS ARE PROVIDED PERIODIC PHYSICAL AND DENTAL EXAMINATIONS. OTHER MEDICAL NEEDS, SUCH AS SPEECH AND PHYSICAL THERAPY OR PSYCHOLOGICAL AND PSYCHIATRIC TREATMENT ARE ADDRESSED AS NEEDED THROUGH COMMUNITY SERVICES. THE PRIMARY RESPONSIBILITIES OF SPRINGWELL NETWORK, INC. ARE TO ENSURE THE BASIC NEEDS OF ALL ARE AVAILABLE AND PROTECTED TO ENCOURAGE INDIVIDUALIZED DEVELOPMENT. THE PROGRAM PLAN IS REINFORCED BY TRAINING IN THE HOME AND COMMUNITY. STAFF SHALL ENSURE THAT ACTIVITIES ARE SUITABLE FOR THE AGES, INTERESTS, AND TREATMENT/HABILITATION NEEDS OF THE CLIENTS AND CLIENTS SHALL PARTICIPATE IN THE PLANNING OR DETERMINING OF ACTIVITIES WHICH ARE OF INTEREST TO THE CONSUMER. THE AGENCY PRIDES ITSELF ON HELPING INDIVIDUALS TO BECOME SELF-RELIANT, CONTRIBUTING MEMBERS OF THEIR COMMUNITY BUILT ON RECOGNITION OF SELF-RESPECT, HOPE, AND THE ABILITY TO LOOK FOR THE NEED BEHIND THE PROBLEM. SPRINGWELL NETWORK, INC. IS ACTIVELY MEETING THE NEEDS OF THE COMMUNITY BY PROVIDING HOUSING, TRAINING, AND PROTECTION FOR THOSE WHO MAY OR MAY NOT HAVE SUPPORT TO LIVE A PRODUCTIVE LIFE. WE ARE MEETING THE NEEDS OF MANY IN THE FOLLOWING AREAS OF: HOUSING, MEDICAL CARE, INDEPENDENCE, PERSONAL AND PROFESSIONAL GROWTH, AND THE RIGHT TO LIVE AND FUNCTION IN A COMMUNITY WITH RESPECT AND DIGNITY. |
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