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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 365,804 | 446,080 | 379,134 | 409,394 | 256,134 | 1,856,546 |
| 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 | 365,804 | 446,080 | 379,134 | 409,394 | 256,134 | 1,856,546 |
| 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. | 1,856,546 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 365,804 | 446,080 | 379,134 | 409,394 | 256,134 | 1,856,546 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 2,943 | 2,909 | 2,564 | 1,719 | 1,126 | 11,261 |
| 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.).. | 125 | 125 | ||||
| 11 | Total support. Add lines 7 through 10 | 1,876,969 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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) 2018 | (b) 2019 | (c) 2020 | (d) 2021 | (e) 2022 | (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 2022 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-2022 |
(iii) Distributable Amount for 2022 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2022 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2022 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2022: | ||||
| a From 2017....... | ||||
| b From 2018....... | ||||
| c From 2019....... | ||||
| d From 2020....... | ||||
| e From 2021....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2022 distributable amount | ||||
|
i
Carryover from 2017 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2022 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2022 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2022, 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 2022. 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 2023. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2018..... | ||||
| b Excess from 2019..... | ||||
| c Excess from 2020..... | ||||
| d Excess from 2021..... | ||||
| e Excess from 2022..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| PART II, LINE 10 | OTHER INCOME 125 |
| 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 1, PART I, LINE 6 | BOARD VOLUNTEERS ATTEND BOARD MEETINGS AND ATTEND VARIOUS EVENTS THROUGHOUT THE YEAR. STAFF VOLUNTEERS PROVIDE DIRECT CARE SERVICES. |
| FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION'S PARENT ORGANIZATION, PUTNAM FAMILY AND COMMUNITY SERVICES, INC., DOING BUSINESS AS "COVECARE CENTER", IS THE ORGANIZATION'S SOLE CORPORATE MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 7A | OF THE AVAILABLE NUMBER OF SEATS ON THE BOARD OF DIRECTORS, AT LEAST, TWO (2), SHALL BE RESERVED FOR EX OFFICIO, VOTING AND/OR NON-VOTING, REPRESENTATIVES ELECTED DIRECTLY BY THE SOLE CORPORATE MEMBER. NEWLY CREATED DIRECTORSHIPS RESULTING FROM AN INCREASE IN THE NUMBER OF DIRECTORS SHALL BE FILLED BY RESOLUTION OF THE SOLE CORPORATE MEMBER. |
| FORM 990, PAGE 6, PART VI, LINE 7B | OF THE AVAILABLE NUMBER OF SEATS ON THE BOARD OF DIRECTORS, AT LEAST, TWO (2), SHALL BE RESERVED FOR EX OFFICIO, VOTING AND/OR NON-VOTING, REPRESENTATIVES ELECTED DIRECTLY BY THE SOLE CORPORATE MEMBER. NEWLY CREATED DIRECTORSHIPS RESULTING FROM AN INCREASE IN THE NUMBER OF DIRECTORS SHALL BE FILLED BY RESOLUTION OF THE SOLE CORPORATE MEMBER. THE CORPORATION'S BY-LAWS MAY BE AMENDED, REPEALED OR ALTERED IN WHOLE, OR IN PART, BY RESOLUTION OF THE SOLE CORPORATE MEMBER'S BOARD OF DIRECTORS. THE CORPORATION CERTIFICATE OF INCORPORATION MAY BE CHANGED OR AMENDED, IN WHOLE OR IN PART, BY RESOLUTION OF THE MEMBER, PROVIDED ALL STATUTORY APPROVALS ARE SUBSEQUENTLY SECURED AND ANY CERTIFICATE OF AMENDMENT OR RESTATED CERTIFICATE OF INCORPORATION IS ACCEPTED FOR FILING BY THE NEW YORK STATE DEPARTMENT OF STATE. THIS CORPORATION MAY ENTER INTO AN AFFILIATE RELATIONSHIP, SUCH AS A PARENT/SUBSIDIARY WITH ANOTHER CORPORATION, OR FORM A NEW CORPORATION FOR PURPOSES OF ESTABLISHING AN AFFILIATE RELATIONSHIP, BY RESOLUTION OF THE MEMBER. THE CORPORATION MAY BE MERGED OR CONSOLIDATED BY RESOLUTION OF THE MEMBER, PROVIDED ALL STATUTORY APPROVALS ARE SUBSEQUENTLY SECURED AND ANY CERTIFICATE OF MERGER OR CONSOLIDATION IS ACCEPTED FOR FILING BY THE NEW YORK STATE DEPARTMENT OF STATE. THE CORPORATION MAY BE DISSOLVED BY RESOLUTION OF THE MEMBER, PROVIDED ALL STATUTORY APPROVALS ARE SUBSEQUENTLY SECURED AND A CERTIFICATE OF DISSOLUTION IS ACCEPTED FOR FILING BY THE NEW YORK STATE DEPARTMENT OF STATE. UPON DISSOLUTION OF THE CORPORATION, ANY RESIDUAL ASSETS SHALL BE DONATED TO PUTNAM FAMILY AND COMMUNITY SERVICES, INC., DOING BUSINESS AS "COVECARE CENTER", AS SOLE CORPORATE MEMBER, AND, IN THE EVENT THAT SUCH AN AWARD IS NOT PRACTICABLE, TO ANOTHER TAX-EXEMPT, NOT-FOR-PROFIT ORGANIZATION WITH PURPOSES SIMILAR TO THOSE OF THE CORPORATION. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE FEDERAL FORM 990 WAS PROVIDED TO ALL BOARD MEMBERS, WHICH WAS DISCUSSED AND REVIEWED DURING THE ORGANIZATION'S BOARD MEETING. ANY QUESTIONS REGARDING THE FEDERAL FORM 990 DURING THE BOARD MEETING WERE NOTED AND ANSWERS WERE PROVIDED BY THE ORGANIZATION'S ACCOUNTANT. THE FORM 990 WAS APPROVED BY ALL BOARD MEMBERS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. |
| FORM 990, PAGE 6, PART VI, LINE 12C | DIRECTORS OR OFFICERS OR KEY PERSONS OF THE CORPORATION, ON AN ANNUAL BASIS VIA A CONFLICT OF INTEREST STATEMENT, ARE REQUIRED TO TRUTHFULLY, COMPLETELY AND ACCURATELY DISCLOSE ALL POTENTIAL CONFLICTS. IF ANY CONFLICTS ARISE, SUCH CONFLICTS WILL BE DEALT WITH ACCORDING TO THE ORGANIZATION'S BYLAWS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | AT LEAST, ANNUALLY, THE BOARD OF DIRECTORS, AND/OR THE EXECUTIVE COMMITTEE, SHALL ENGAGE IN A COMPENSATION ANALYSIS OF THE EXECUTIVE DIRECTOR, AND, IF DEEMED NECESSARY AT THE DISCRETION THE BOARD, OF ANY OTHER "KEY PERSON(S)," TO RUN CONCURRENTLY WITH THE ANNUAL PERFORMANCE EVALUATION OF SUCH EMPLOYEE(S). IN ORDER TO DETERMINE THE REASONABLENESS OF COMPENSATION AS IT APPLIES TO THE CORPORATION, THIS COMPENSATION ANALYSIS SHALL CONFIRM THAT: I.THE COMPENSATION TO BE AUTHORIZED AND AWARDED IS REASONABLE FOR THE SERVICES TO BE PROVIDED TO THE CORPORATION; II.THERE IS NO RELATIONSHIP BETWEEN ANY OF THE CORPORATION'S DIRECTORS OR OFFICERS AND THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), OTHER THAN ONE OF EMPLOYMENT; III.THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), AS APPROPRIATE, HAS MET, OR EXCEEDED, PERFORMANCE EXPECTATIONS; BROUGHT VALUE TO THE CORPORATION; AND/OR PROVIDED SIGNIFICANT CONTRIBUTIONS TO ITS GROWTH AND DEVELOPMENT; IV.NO DIRECTOR OR OFFICER IS A RELATIVE OF, OR EMPLOYED BY THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), AS APPROPRIATE, OR ANY ENTITY IN WHICH THE EXECUTIVE DIRECTOR/KEY PERSON(S) (IF APPLICABLE) HAS/HAVE, AT LEAST, A THIRTY-FIVE PERCENT (35%) CONTROLLING INTEREST; AND, V.NO DIRECTOR OR OFFICER HAS A MATERIAL FINANCIAL INTEREST AFFECTED BY THE OUTCOME OF THE COMPENSATION REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 15B | AT LEAST, ANNUALLY, THE BOARD OF DIRECTORS, AND/OR THE EXECUTIVE COMMITTEE, SHALL ENGAGE IN A COMPENSATION ANALYSIS OF THE EXECUTIVE DIRECTOR, AND, IF DEEMED NECESSARY AT THE DISCRETION THE BOARD, OF ANY OTHER "KEY PERSON(S)," TO RUN CONCURRENTLY WITH THE ANNUAL PERFORMANCE EVALUATION OF SUCH EMPLOYEE(S). IN ORDER TO DETERMINE THE REASONABLENESS OF COMPENSATION AS IT APPLIES TO THE CORPORATION, THIS COMPENSATION ANALYSIS SHALL CONFIRM THAT: I.THE COMPENSATION TO BE AUTHORIZED AND AWARDED IS REASONABLE FOR THE SERVICES TO BE PROVIDED TO THE CORPORATION; II.THERE IS NO RELATIONSHIP BETWEEN ANY OF THE CORPORATION'S DIRECTORS OR OFFICERS AND THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), OTHER THAN ONE OF EMPLOYMENT; III.THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), AS APPROPRIATE, HAS MET, OR EXCEEDED, PERFORMANCE EXPECTATIONS; BROUGHT VALUE TO THE CORPORATION; AND/OR PROVIDED SIGNIFICANT CONTRIBUTIONS TO ITS GROWTH AND DEVELOPMENT; IV.NO DIRECTOR OR OFFICER IS A RELATIVE OF, OR EMPLOYED BY THE EXECUTIVE DIRECTOR, OR ANY OTHER KEY PERSON(S) (IF APPLICABLE), AS APPROPRIATE, OR ANY ENTITY IN WHICH THE EXECUTIVE DIRECTOR/KEY PERSON(S) (IF APPLICABLE) HAS/HAVE, AT LEAST, A THIRTY-FIVE PERCENT (35%) CONTROLLING INTEREST; AND, V.NO DIRECTOR OR OFFICER HAS A MATERIAL FINANCIAL INTEREST AFFECTED BY THE OUTCOME OF THE COMPENSATION REVIEW. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION'S FORM 990, FINANCIAL STATEMENTS, AND OTHER POLICIES OF THE ORGANIZATION ARE AVAILABLE UPON REQUEST AND ARE AVAILABLE FOR PUBLIC INSPECTION ON WWW.GUIDESTAR.ORG AND WWW.CHARITIESNYS.COM. |
| FORM 990, PART XI, LINE 9 | RETURN OF PRIOR YEAR GRANT INCOME -111,627 THE PUTMAN COUNTY VETERANS SERVICE AGENCY GRANT WAS NOT RENEWED AND WAS MOVED TO ANOTHER ORGANIZATION EFFECTIVE 5/1/2022. MENTAL HEALTH ASSOCIATION OF PUTNAM COUNTY II PAID 111,627 BACK TO PUTNAM COUNTY. |
| Software ID: | |
| Software Version: |