Form 990 - Return Of Organization Exempt From Income Tax - 2012 Page 6
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126
Form 990 (2012)
Page
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No”
response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . . . . . .
Section A. Governing Body and Management
Yes
No
1a Enter the number of voting members of the governing body at the end of the tax year .
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1a
If there are material differences in voting rights among members of the governing body, or
if the governing body delegated broad authority to an executive committee or similar
committee, explain in Schedule O.
b Enter the number of voting members included in line 1a, above, who are independent
1b
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2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
any other officer, director, trustee, or key employee?
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2
3
Did the organization delegate control over management duties customarily performed by or under the direct
supervision of officers, directors, or trustees, or key employees to a management company or other person?
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3
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4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
6
Did the organization have members or stockholders?
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7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body?
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7a
b Are any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body? .
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7b
8
Did the organization contemporaneously document the meetings held or written actions undertaken during
the year by the following:
a The governing body? .
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8a
b Each committee with authority to act on behalf of the governing body?
8b
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9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .
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9
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a Did the organization have local chapters, branches, or affiliates?
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10a
b If “Yes,” did the organization have written policies and procedures governing the activities of such chapters,
affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
12a Did the organization have a written conflict of interest policy? If “No,” go to line 13
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12a
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
12b
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,”
describe in Schedule O how this was done .
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12c
13
Did the organization have a written whistleblower policy? .
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13
14
Did the organization have a written document retention and destruction policy?
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14
15
Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a The organization’s CEO, Executive Director, or top management official .
15a
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b Other officers or key employees of the organization .
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15b
If “Yes” to line 15a or 15b, describe the process in Schedule O (see instructions).
16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year? .
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16a
b If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its
participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the
organization’s exempt status with respect to such arrangements? .
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16b
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
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18
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only)
available for public inspection. Indicate how you made these available. Check all that apply.
Own website
Another’s website
Upon request
Other (explain in Schedule O)
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy,
and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the
organization:
▶
990
Form
(2012)
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