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Form 990 (2012) Page 6
<br />Govemance, ManageroeM, and Dischmre For each "Yes" response to lines 2 through 7b below, and for a "No"
<br />response to line Be, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
<br />Check if Schedule O contains a response to any question in this Part VI . ❑
<br />Section A. Governing Body and ManagemeM
<br />Yes
<br />No
<br />1a Enter the number of voting members of the governing body at the end of the tax year. 1a
<br />If there are material differences in voting rights among members of the governing body, or
<br />if the governing body delegated broad authority to an executive committee or similar
<br />committee, explain in Schedule O.
<br />b Enter the number of voting members included in line 1 a, above, who are independent 1b
<br />2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
<br />any other officer, director, trustee, or key employee? . . . . . . . . . . . . . . . . . .
<br />2
<br />3 Did the organization delegate control over management duties customarily performed by or under the direct
<br />supervision of officers, directors, or trustees, or key employees to a management company or other person?
<br />3
<br />4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
<br />4
<br />5 Did the organization become aware during the year of a significant diversion of the organization's assets? .
<br />5
<br />6 Did the organization have members or stockholders? . . . . . . . . . . . . . . . . . .
<br />6
<br />7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint
<br />one or more members of the governing body? . . . . . . . . . . . . . . . . . . . .
<br />7a
<br />b Are any governance decisions of the organization reserved to (or subject to approval by) members,
<br />stockholders, or persons other than the governing body? . . . . . . . . . . . . . . . . .
<br />7b
<br />8 Did the organization contemporaneously document the meetings held or written actions undertaken during
<br />the year by the following:
<br />a The governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
<br />8a
<br />b Each committee with authority to act on behalf of the governing body?
<br />8b
<br />9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
<br />the organization's mailing address? If "Yes," provide the names and addresses in Schedule O . . . . .
<br />g
<br />Section B. Policies his Section B requests information about policies not iced by the lnterrfal Revenue Code.)
<br />Yes
<br />No
<br />10a Did the organization have local chapters, branches, or affiliates? . . . . . . . . . . . . . .
<br />103
<br />b If "Yes," did the organization have written policies and procedures governing the activities of such chapters,
<br />affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
<br />10b
<br />11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
<br />11 a
<br />b Describe in Schedule O the process, if any, used by the organization to review this Form 990.
<br />12a Did the organization have a written conflict of interest policy? if "No," go to line 13 . . . . . . . .
<br />12a
<br />b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
<br />12b
<br />c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes,"
<br />describe in Schedule O how this was done . . . . . . . . . . . . . . . . . . . . . .
<br />12c
<br />13
<br />13 Did the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . .
<br />14 Did the organization have a written document retention and destruction policy? . . . . . . . . .
<br />14
<br />15 Did the process for determining compensation of the following persons Include a review and approval by
<br />independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
<br />a The organization's CEO, Executive Director, or top management official . . . . . . . . . . . .
<br />15a
<br />b Other officers or key employees of the organization . . . . . . . . . . . . . . . . . . .
<br />15b
<br />If "Yes" to line 15a or 15b, describe the process in Schedule O (see Instructions).
<br />16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
<br />with a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . •
<br />16a
<br />b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate Its
<br />participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the
<br />organization's exempt status with respect to such arrangements? . . . . . . . . . . . . . .
<br />16b
<br />Section C. Disclosure
<br />17 List the states with which a copy of this Form 990 is required to be filed ►
<br />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)
<br />available for public inspection. Indicate how you made these available. Check all that apply.
<br />❑ Own website ❑ Another's website ❑ Upon request ❑ Other (explain in Schedule O)
<br />19 Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of Interest policy,
<br />and financial statements available to the public during the tax year.
<br />20 State the name, physical address, and telephone number of the person who possesses the books and records of the
<br />organization: ►
<br />Form 990 (2012)
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