nmcaa 990 fy 14

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nmcaa 990 fy 14
Form
990
Do not enter Social Security numbers on this form as it may be made public.
lnformaon about Form 990 and its instructions is at wwwir ov/formqj
A For the 2013 calendar year, or tax year beginning
and ending SEP 3 0,
OCT 1, 2013
Check 1
applicable.
LiAdOresS
C Name of organization
NORTHWEST MICHIGAN CONMUNITY ACTION
AGENCY, INC.
38—2027389
Room/suite
E Telephone number
3963 THREE MILE ROAD N.
pending
231-947-3780
17
G Gross receipts s
H(a)lsthisagroupreturn
City or town, state or province, country, and ZIP or foreign postal code
TRAVERSE CITY,
MI
49686
F Name and address of principal officer:JOHN
SAME AS C ABOVE
Lxi 501(c)(3) L.i 501(c) (
I Tax-exempt status:
J Website h. WWW.
K Form of organization:
)
STEPHENSON
(insert no.)
1
,
9 58 , 1 3 3
1 No
for subordinates?
ElYes
H(b) Areaiisubordinatesinciuoed7LlYes
No
If ‘No, attach a list. (see instructions)
H(c) Group exemptlon number
1. Year of formation: 1 9 7 3 M State of legal domicile: MI
L_i 4947(a)(1) or L_J 527
NNCAA. NET
LX] Corporation Li Trust L_J Association L_J
I
Other
Part II Summary
,
20 14
D Employer identification number
Number and street (or P.O. box if mail is not delivered to street address)
jgiica
Open to Public
-
Doing Business As
Liie
20 13
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Department of the Treasury
internal Pevenue Service
B
DM8 No.
Return of Organization Exempt From Income Tax
TO HELP PEOPLE BY LINKING
SERVICES, RESOURCES AND OPPORTUNITIES.
Briefly describe the organization’s mission or most significant activities:
Li
Check this box
if the organization discontinued its operations or disposed of more than 25% of its net assets.
Number of voting members of the governing body (Part VI, line la)
3
Number of independent voting members of the governing body (Part VI, line 1 b)
4
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a)
5
6 Total number of volunteers (estimate if necessary)
6
7a Total unrelated business revenue from Part VIII, column (C), line 12
7a
b Net unrelated business taxable income from Form 990-T, line 34
7b
2
3
4
28
28
468
2500
0
0
....
Prior Year
8
9
10
11
12
13
17,228,790.
417,388.
17,477,554.
411,129.
Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Otherrevenue(PartVIIl, column (A), lines 5, 6d, Bc, 9c, lOc, and lie)
Totalrevenue-add lines 8through 11 (mustegual Part VIII, column (A), line 12)
Grantsandsimilaramountspaid(PartlX,column(A),linesi.3)
9 940.
39 579
17 695 697
5,648,592.
0
9 0 61 28 7
0
10 9 88.
29 831
17 929 502
5,807,880.
0
9 119 804
0
,
.
.
14
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
16a Professional fundraising fees (Part IX, column (A), line lie)
7 5 , 413
b Total fundraising expenses (Part IX, column (D), line 25)
17 Otherexpenses(Part lX,column(A), lines ha-lid, lif-24e)
.
18
19
,
.
,
,
.
,
,
.
,
,
.
15
LU
Current Year
Contributionsandgrants(PartVlll. Iinelh)
Programservicerevenue(PartVlll,line2g)
.
Totalexpenses.Add linesi3.i7(mustequalPartlX,column(A),line25)
Revenue less expenses. Subtract line 18 from line 12
.
20
21
22
art II
Totalassets(PartX,linel6)
Totalliabilities(PartX,line26)
Netassetsorfundbalances.Subtractline2i fromline20
,
,
,
2,921,464.
2,968,508.
17,631,343.
17,896,192.
64 354.
33 310
,
,
Beginning of CurrentYear
‘
,
.
End of Year
3,836,206.
3,768,556.
1,552,451.
1,444,221.
2,283,755.
2,324,335.
I Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign
Signature of officer
Here
JOHN STEPHENSON,
Date
EXECUTIVE DIRECTOR
Type or print name and title
Print/Type preparer s name
Paid
Preparer
Use Only
Preparer s signature
TEAN CHRISTENSEN
3EAN CHRISTENSEN
Firmsname .WIPFLI LLP
Firmsaddress. P0 BOX 8700
MADISON, WI 53708 8700
May the IRS discuss this return with the prenarer shown above? (see instructions)
-2
C
h
PaperN rk Reduction A N t
e
e separate instru tt n
Uate
02/10/15
irm’sEIN
Li I
PuN
P00368719
39—0758449
Phoneno.6O8 274—1980
LXj yes L_iNo
990(201 a
________
___________
____________
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC
Form990(2013)
382027389
2
Page
Part Ill Statement of Program Service Accomplishments
Check if ScheduleD contains a response or note to any line in this Part Ill
Briefly describe the organizations mission:
THE ORGANIZATION’S MISSION IS TO HELP PEOPLE BY LINKING SERVICES,
RESOURCES AND OPPORTUNITIES. NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY FULFILLS THIS MISSION BY DEVELOPING AND PROVIDING RESOURCES FOR
THE PURPOSE OF ASSISTING LOW-INCOME INDIVIDUALS THROUGH A VARIETY OF
2
Did the organization undertake any significant program services during the year which were not listed on
3
the prior Form 990 or 990-EZ?
If ‘Yes, describe these new services on Schedule 0.
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
4
ElYes
L1 No
EZYes
No
If ‘Yes, describe these changes on Schedule 0.
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses.
Section 501 (c)(3) and 501 (c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and
revenue, if any, for each program service reported.
4a
1.932.
9,261,607. nciudinggrantsofS
)(ExpensesS
744:437 ) (eve’ueS
PROVIDES COMPREHENSIVE DEVELOPMENT SERVICES FOR LOW
CHILD EDUCATION
INCOME PRESCHOOL CHILDREN AND THEIR FAMILIES THROUGH EDUCATION, HEALTH,
TOTAL CHILDREN RECEIVING SERVICES
NUTRITION, AND PARENT INVOLVEMENT.
IS 1,054.
(Code:
-
4b
(Code:
2 , 481 , 635
) (Expenses
.
including grants ot $
1 577 404
,
,
.
98 , 602
(Revenue $
PROGRAMS INCLUDE COUNSELING AND ONE TIME CASH
HOUSING PROGRAM
ASSISTANCE TO HOMEOWNERS TO PREVENT MORTGAGE FORECLOSURE, HOME REPAIR
AND REPLACEMENT FOR LOW TO MODERATE INCOME HOMEOWNERS, GUIDANCE AND ONE
TIME CASH ASSISTANCE TO RENTERS FACING EVICTION, GUIDANCE FOR LANDLORD
AND TENANT DISPUTES, GUIDANCE AND ONE TIME CASH ASSISTANCE TO HELP
ESTABLISH PERMANENT HOUSING FOR THOSE WITHOUT A HOME, INFORMATION ON
LOW-INCOME RENTAL HOUSING, LANDLORDS, AND BUDGET ANALYSIS FOR
INDIVIDUALS SEEKING A PLACE TO RENT, ASSISTANCE TO IMPROVE THE HOUSING
STABILITY OF VETERAN FAMILIES INCLUDING RENTAL, UTILITY,
TRANSPORTATION, CHILD CARE, MOVING COSTS, AND EMERGENCY SUPPLIES
ASSISTANCE AND HOUSING DEVELOPMENT WITH PARTNER COMMUNITIES TO DEVELOP
TOTAL HOUSEHOLDS
NEW HOUSING OPPORTUNITIES FOR RENTERS AND HOMEBUYERS.
-
4c
(Code:
) (Expenses $
2 , 408 , 078
.
including grants of
$
1 , 525 , 621
.
(Revenue
3 , 407
$
OPERATES ENERGY ASSISTANCE VOUCHER PROGRAMS,
COMMUNITY SERVICES
BUDGET COUNSELING, AND TAX PREPARATION FOR LOW INCOME CLIENTS AND
INDIVIDUAL DEVELOPMENT ACCOUNTS ARE ESTABLISHED AND
SENIORS.
MAINTAINED FOR QUALIFIED CLIENTS, COUNSELING FOR MEDICAID ENROLLMENTS,
BANKRUPTCY COUNSELING, AND ASSISTANCE WITH NEEDS TO PROMOTE
TOTAL HOUSEHOLDS RECEIVING PROGRAM SERVICES IS
SELF-SUFFICIENCY.
6,028.
-
4d
Other program services (Describe in Schedule 0.)
(Expenses S
3 , 068 , 402
40Totairg.senJiCeexpenses
.
1 , 960 , 418
17,219,722.
including grants of s
.
(Revenue S
307 , 188
.
—
Form
SEE SCHEDULE 0 FOR CONTINUATION(S)
990 (2013)
NORTHWEST MICHIGAN CONMUNITY ACTION
AGENCY, INC
Part IV Checklist of Required Schedules
382O27389
Form99O(2013)
Paqe3
—
Yes
1
Is the organization described in section 501 (c)(3) or 4947(a)(1) (other than a private foundation)?
If ‘Yes, complete Schedule A
2
3
Is the organization required to complete Schedule B, Schedule of Contributors?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office? If ‘Yes,’ complete Schedule C, Part I
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year? If “Yes,” complete Schedule C, Part II
5
Is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues, assessments, or
similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part Ill
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to
provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes, ‘complete Schedule D, Part I
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If ‘Yes, ‘complete Schedule D, Part II
fc9 If ‘Y.c ‘rnmnitp
Hntirnc nf wnrkc of rt hitorir-i tr.irc or nthr miir
flid th nrgni7tinn mintir
.j_
............
.
7
R
.
10
11
.
—
.
X
_•
_i_
_•
_..
Schedule D, Part III
9
No
X
6
_L
—
_L.
X
8
Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodian for
amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services?
If “Yes,” complete Schedule D, Part IV
.•.
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent
endowments, or quasi-endowments? If” Yes,” complete Schedule D, Part V
If the organization’s answer to any of the following questions is “Yes,” then complete Schedule D, Parts VI, VII, VIII, IX, or X
as applicable.
a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If “Yes,” complete Schedule D,
Part VI
ha
b Did the organization report an amount for investments other securities in Part X, line 12 that is 5% or more of its total
assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII
c Did the organization report an amount for investments program related in Part X, line 13 that is 5% or more of its total
assets reported in Part X, line 16? If “Yes,” complete Schedule 0, Part VIII
X
-
X
lib
-
.ii
__
d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in
Part X, line 16? If “Yes,” complete Schedule D, Part IX
_.
e Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X
f Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses
the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X
j
12a Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete
Schedule D, Parts XI and XII
12b
Is the organization a school described in section 1 70(b)(1 )(A)(ii)? If “Yes, ‘complete Schedule E
14a Did the organization maintain an office, employees, or agents outside of the United States?
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business,
investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000
or more? If “Yes, ‘complete Schedule F Parts I and IV
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any
15
13
_ii
1_
17
foreign organization? If ‘Yes,” complete Schedule F, Parts II and IV
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to
or for foreign individuals? If ‘Yes,” complete Schedule F, Parts III and IV
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,
column (A). lines 6 and lie? If ‘Yes,” complete Schedule G, Part I
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1 c and 8a? If “Yes, ‘complete Schedule G, Part II
X
—
—
—
__
X
.
16
X
12a
b Was the organization included in consolidated, independent audited financial statements for the tax year?
If “Yes, ‘and if the organization answered “No’to line 12a, then completing Schedule D, Parts XI and XII is optional
_
._i_
..
.
18
19
Did the organization report more than $15,000 of gross income from gaming activtes on Part VIII. line 9a? If “Yes,”
complete Scheduie G. Part III
20a Did the organzation operate one or more hospital facilities? If “Yes,” compiete Schedule H
b If ‘Yes to line 20a, did the organization attach a copy of its audited financial statements to this return?
.
X
18
j.
20b
Form 990(201 3(
—
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Part IV j Checklist of Required Schedules (continued)
382O27389
Form9SO(2013)
4
Page
—
Yes
—
No
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
government on Part IX, column (A), line 1? If ‘Yes.’ complete Schedule I, Parts land!!
21
X
22
Did the organization report more than $5,000 of grants or other assistance to individuals in the United States on Part IX,
column (A), line 2? If “Yes,” complete Schedule I, Parts land Ill
22
X
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organizations current
and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete
ScheduleJ
23
X
24a
X
24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the
last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete
ScheduleKlf”No”,gotoline25a
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
d Did the nrgani7ation act as an “nn behalf nf” issuer fnr honds outstanding at any time during th yar7
25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a
disqualified person during the year? If “Yes,” complete Schedule L, Part I
b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and
that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete
Schedule L, Part!
26
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or
former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so,
complete Schedule L, Part II
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial
contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member
of any of these persons? If “Yes,” complete Schedule L, Part III
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV
instructions for applicable filing thresholds, conditions, and exceptions):
a A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV
b A family member of a current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV
_•
X
25b
_•
2L.
c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer,
director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV
—
29
30
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions? If “Yes,” complete Schedule M
31
Did the organization liquidate, terminate, or dissolve and cease operations?
If “Yes,” complete Schedule N, Part I
31
X
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?If “Yes,” complete
Schedule N, Part II
32
X
32
33
34
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule A, Part II, III, or l and
Part 11 line 1
35a Did the organization have a controlled entity within the meaning of section 51 2(b)(1 3)?
b If “Yes” to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity
within the meaning of section 51 2(b)(1 3)? If “Yes,” complete Schedule R, Part t4 line 2
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization?
If ‘Yes,’ complete Schedule A, Part V, line 2
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
38
Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 b and 19?
Note. All Form 990 filers are required to complete Schedule 0
—
.
35a
X
.
.L
2L.
38
Form
X
990 (2013)
—
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Statements Regarding Other IRS Filings and Tax Compliance
382027389
Form 990 (2013)
Part V I
Check if Schedule 0 contains a response or note to any line in this Part V
.
5
Page
.
Yes
la
1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable
lb
b Enter the number of Forms W-2G included in hne 1 a. Enter -0- if not applicable
C Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?
lc
.
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
2a
filed for the calendar year ending with or within the year covered by this return
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1 a and 2a is greater than 250, you may be required toe-fi/e (see instructions)
46 8
2b
3a Did the organization have unrelated business gross income of $1000 or more during the year?
b If Yes, has it filed a Form 990-T for this year? If No, to line 3b, provide an explanation in Schedule 0
4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a
financial account in a foreign country (such as a bank account, securities account, or other financial account)?
h if Vpc
th nmc nf th fnriign co Intry
See instructions for filing requirements for Form TD F 90-221, Report of Foreign Bank and Financial Accounts.
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
C If Yes, to line 5a or Sb, did the organization file Form 8886-T?
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit
any contributions that were not tax deductible as charitable contributions?
b If Yes, did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible?
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?
b If Yes, did the organization notify the donor of the value of the goods or services provided?
C Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
7d
d If Yes, indicate the number of Forms 8282 filed during the year
e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?.
h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1 098-C?
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting
organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?
I
9
a
b
10
a
b
11
a
b
12a
b
13
a
b
c
14a
b
3a
3b
4a
5a
5b
5c
6a
X
x
x
x
x
x
6b
7a
7b
x
7c
x
7e
7f
x
x
I
Sponsoring organizations maintaining donor advised funds.
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
Section 501(c)(7) organizations. Enter:
Initiation fees and capital contributions included on Part VIII, line 12
lOa
lOb
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
Section 501(c)(12) organizations. Enter:
Gross income from members or shareholders
1 la
Gross income from other sources (Do not net amounts due or paid to other sources against
amounts due or received from them.)
llb
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
If Yes, enter the amount of tax-exempt interest received or accrued during the year
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Is the organization licensed to issue qualified health plans in more than one state?
Note. See the instructions for additional information the organization must report on Schedule 0
Enter the amount of reserves the organization is required to maintain by the states in which the
organization is licensed to issue qualified health plans
Enter the amount of reserves on hand
Did the organization receive any payments for indoor tanning services during the tax year?
If Yes. has it filed a Form 720 to reoort these oavments? If ‘No, provide an explanation in Schedule 0
...
No
253
0
7h
8
9a
9b
12a
I
l3a
x
14a
14b
Form 990(2013
____
____
________
___
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
38—2027389
6
Page
[Part VI] Governance, Management, and Disclosure For each Yes response to lines 2 through 7b below, and for a No response
Form9gO(2013)
to line 8a, 8b, or lOb below, describe the circumstances, processes, or changes in Schedule 0. See instructions.
Check if Schedule 0 contains a response or note to any line in this Part VI
Section A. Governing Body and Management
—
Yes
la Enter the number of voting members of the governing body at the end of the tax year
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 0.
2
3
la
b Enter the number of voting members included in line 1 a, above, who are independent
lb
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?
28
_.
_._.
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?
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization’s assets?
Did the organization have members or stockholders?
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?
4
4
5
6
5
6
b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a The governing body?
b Each committee with authority to act on behalf of the governing body?
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the
9
organization’s mailing address? If ‘Yes,” provide the names and addresses in Schedule 0
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
X
X
X
7a
—
-
—
8a
•
9
c Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe
in Schedule 0 how this was done
13
Did the organization have a written whistleblower policy?
14 Did the organization have a written document retention and destruction policy?
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
b Other officers or key employees of the organization
If “Yes” to line 15a or 15b, describe the process in Schedule 0 (see instructions).
a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
6
l
taxable entity during the year’?
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?
X
—
_!2
lOb
ha
j
20
—
—
X
14
X
X
X
15a
X
12c
13
.!
16b
‘
-
49686
—
—
-—
_-.
—
List the states with which a copy of this Form 990 is required to be filed MI
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 0)
Describe in Schedule 0 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.
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
DANIEL DEWEY
231-947-3780
3963 THREE MILE ROAD N., TRAVERSE CITY, MI
No
—-..
El
19
X
—
Section C. Disclosure
18
X
_.
Yes
lOa Did the organization have local chapters, branches, or affiliates?
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?
1 la Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
b Describe in Schedule 0 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
b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
17
No
28
—
NORTHWEST MICHIGAN CONiIUNITY ACTION
AGENCY, INC.
382027389
VIIj Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors
Form 990 (2013)
ft
Paoe7
Check if Schedule 0 contains a response or note to any line in this Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
la Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
• List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.
Enter -0- in columns (D), (E), and (F) if no compensation was paid.
• List all of the organization’s current key employees, if any. See instructions for definition of key employee
• List the organization’s five current highest compensated employees (other than an officer, director, trustee, or key employee) who received report
able compensation (Box 5 of Form W-2 and/or Box 7 of Form 1 099-MISC) of more than $100,000 from the organization and any related organizations.
• List all of the organizations former officers, key employees, and highest compensated employees who received more than $100,000 of
reportable compensation from the organization and any related organizations.
• List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the organization,
more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees;
and former such persons.
Check this box if neither the oraanization nor any related oraanization comDensated any current officer. director. or trustee.
(A)
(B)
(C)
(D)
(E)
Name and Title
Average
Reportable
Reportable
(do not c
than one
hours per box, unless person is both an
Compensation
compensation
week
from
from related
(list any
the
organizations
hours for
organization
(W-2/1 099-MISC)
related
(W-2/1 099-MISC)
organizations
below
a
a
line)
(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
.
(1>
BRUCE ANDERSEN
1.00
MEMBER (THRU NOVEMBER)
(2>
ANTHONY ANSORGE
DEBBIE BISHOP
YVONNE DONOHOE
LOUIS FANTINI
NANCY KIDA
MARY KLEIN
GEORGE LASATER
DAN LATHROP
1.00
LARRY LEVENGOOD
1.00
DR.
KAREN MCCLINTOCK
1.00
MEMBER (THRU JUNE)
(12)
TOM MCCORRY
SALLY JO MESSERSMITH
MAUREEN MICKELSON
MARC MILBURN
JEFF MILLER
TOM OLMSTED
MEMBER
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
0.
0.
0.
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
—
—
—
—
—
—
—
—
—
—
—
—
1.00
MEMBER
(17)
0.
1.00
MEMBER
(16)
X
1,00
MEMBER
(15)
0.
1.00
MEMBER
(14)
0.
1.00
MEMBER
(13)
0.
X
MEMBER
(11)
X
X
MEMBER
(10)
0.
1. 00
MEMBER
(9)
0.
1.00
MEMBER
(8)
0.
1.00
MEMBER
(7)
X
1.00
MEMBER
(6)
0.
1. 00
MEMBER
(5)
0.
1.00
MEMBER
(4)
0.
1. 00
MEMBER
(3)
—
X
1,00
Form 990(2013)
NORTHWEST MICHIGAN COMMUNITY ACTION
INC.
38—2027389
AGENCY,
FormggO(2013)
8
Page
I Part VIII Section A. Officers. Directors. Trustees. Key Emolovees. and Hicihest ComDensated Employees (continued)
(A)
Name and title
(18)
CAROLYN RENTENBAC}4
(B)
Average
hours per
week
(list any
hours for
related
organizations
below
line)
1.00
SUSAN ROGERS
1.00
SHIRLEY ROLOFF
1.00
MEMBER (THRU MARCH)
(21)
CAROL SMITH
—
—
—
—
—
—
—
—
—
—
—
—
—
—
0.
0.
0.
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
0.
—
—
1. 00
MEMBER
(23> LINDSEY WALKER
(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
1.00
MEMBER
(22) DAWN TAYLOR
(E)
Reportable
compensation
from related
organizations
(W.2/1 099-MISC)
X
MEMBER
(20>
chk more than one
Id
box, ,nless person is both an
otfid
rector/trustee)
—
(D)
Reportable
compensation
from
the
organization
(W-2/1 099-MISC)
—
X
MEMBER
(19>
(C)
—
1.00
X
0.
0.
0.
(24> BRENDA WILLSON
1.00
MEMBER
X
1.00
1. 00 X
1.00
X
0.
0.
0.
X
0.
0.
0.
X
0.
0.
15 8, 725.
158,725.
0.
0.
0
0
0.
0.
1, 212.
1,212.
MEMBER
(25)
LES ATCHISON
CHAIRPERSON
(26) ROSS RICHARDSON
VICE CHAIRPERSON
lb Sub-total
c Total from continuation sheets to Part VII, Section A
d Total (add lines lb and lc)
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization
2
—
3
Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on
line 1 a? If “Yes,’ complete Schedule J for such individual
.
.
0
—
Yes
—
—.....
No
—
--...
4
For any individual listed on line 1 a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual
5
Did any person listed on line 1 a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? If “Yes.” complete Schedule J for such person
Section B. Independent Contractors
5
—
X
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from
the organization. Report compensation for the calendar year ending with or within the organizations tax year.
(A)
(B)
(C)
Name and business address
Compensation
Description of services
NONE
I
2
—
Total number of independent contractors (including but not limited to those listed above) who received more than
0Oofcomensationfromtheoranization0
SEE PART VII,
008
SECTION A CONTINUATION SHEETS
O(2013)
99
Forrn
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Form 990
Part VIII
38-2027389
Officers. Directors. Trustees. Key Emølovees. and Hiahest Comoensated Emolovees (con tinued)
(A)
(B)
(C)
(D)
(E)
Name and title
Average
Position
Reportable
Reportable
hours
(check all that apply)
compensation
compensation
per
from
from related
week
the
organizations
(list any
organization
(W-2/1 099-MISC)
hours for
(W-2/1099-MISC)
related
organizations
below
.5
5
line)
Section A.
(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
.
(27)
1.00
BRENDA DEKtJIPER
(28)
1.00
JOHN FUSCONE
CENTRAL SECTOR REPRESENTATIVE
—
—
0.
0.
0.
0.
0.
0.
—
X
—
X
X
0.
0.
0.
X
X
0.
0.
0.
0.
0.
0.
87,023.
0.
531.
71,702.
0.
681.
1.00
REV GERALD COOK
X
NORTHERN SECTOR REPRESENTATIVE
40.00
1.00
40.00
JOHN STEPHENSON
EXECUTIVE DIRECTOR
(33) DANIEL DEWEY
CONTROLLER
Total to Part VII. Section A, line ic
—
1.00
PAM STEPHAN
SOUTHERN SECTOR REPRESENTATIVE
(32)
—
1.00
(29) TOM KELLEY
(31)
X
X
SECRETARY
(30)
—
X
TREASURER
.
.
—
—
X
—
—
X
—
—
—
158 725.
,
1, 212.
_________________
____________
_____________
____________
___________
NORTHWEST MICHIGAN CON1UNITY ACTION
AGENCY, INC.
Statement of Revenue
38—2027389
Form99O(2013)
Part VIII
I
Check if Schedule 0 contains a response or note to any line in this Part VIII
(A)
Total revenue
z
o
1 a Federated campaigns
b Membership dues
c Fundraising events
d Related organizations
e Government grants (contributions)
f All other contributions, gifts, grants, and
ç<
h.
a5’ E
°
similar amounts not included above
o
g Noncash contnbutons ncluded
h TotaiAddlinesla-lf
c’
o
Qca
la
11,000.
le
16,883,810.
if
582,744.
927,089,
—
...
n hnes ia-if, $
(B)
(C)
Related or
Unrelated
exempt function
business
revenue
revenue
9
Page
(D)
El
Revenue excluded
from tax under
sections
512-514
17,477,554.
business Cock.
V
I
624210
305,138.
305.138.
531390
98,602.
98,602.
624200
3,407.
3,407.
d CHILD EDUCATION
624410
1,932.
1,932.
FOOD PROGRAMS
624200
1,200,
1,200,
624100
f Allotherprogramservicerevenue
g Total.Addlines2a-2f
3
Investment income (including dividends, interest, and
850.
850.
OLDER AMERICANS
a)
—-
‘
Q
E
e
)c1:
b HOUSING PROGRAM
c COMMUNITY SERVICES
e
o
other
similar
amounts).....
...........................
4
Income from investment of tax-exempt bond proceeds
5
Royalties
(i) Real
Less:
rental
(i) Securities
8, 765.
7a Gross amount from sales of
assets other than inventory
b Less: cost or other basis
1,452.
1,452.
11,422,
11,422.
(ii) Other
1,452.
Gain or (loss)
d Net gain or (loss)
C
8a Gross income from fundraising events (not
of
including$
>
a)
0
18,409.
7,313.
and sales expenses
a)
‘C
18,409.
(ii) Personal
18,409.
Rental income or (loss)
d Net rental income or (loss)
a)
9,536.
0.
expenses
C
C
9,536.
18,409.
6a Gross rents
b
411,129.
contributions reported on line lc). See
Part IV, line 18
a
b Less: direct expenses
b
c Net income or (loss) from fundraising events
9 a Gross income from gaming activities. See
Part IV, line 19
a
b Less: direct expenses
b
c Net income or (loss) from gaming activities
10 a Gross sales of inventory, less returns
and allowances
a
21,318.
21,318.
b Less: cost of goods sold
b
c Net income or (loss) from sales of inventory
Miscellaneous Revenue
usiness CodE
.
ii
a
b
c
900099
d All other revenue
e Total,Add lines ha-lid
12
3320
Total revenue. See
instructions,
11,422,
17,929,502,
411,129.
40,819,
990 20
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Part IX j Statement of Functional Expenses
Form 990 (2O1
Page
Section 501 (c)(3) and 501 (c)(4) orqanizations must complete all columns All other orqanizafions must complete column (A).
Check if Schedule 0 contains a response or note to any line in this Part IX
(A)
(B)
(C)
Do not include amounts reported on lines 6b,
Total expenses
Program service
Management and
7b, 8b, 9b, and lOb of Part VIII.
general expenses
expenses
Grants and other assistance to governments and
1
311,755.
311,755.
organizations in the United States. See Part IV, line 21
2 Grants and other assistance to individuals in
5,496,125.
5,496,125.
the United States. See Part IV, line 22
Grants and other assistance to governments,
3
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16
Benefits paid to or for members
4
Compensation of current officers, directors,
5
179,975.
179,975.
trustees, and key employees
6 Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
7,452,034.
7,100,036,
292,612.
7 Other salaries and wages
8 Pension plan accruals and contributions (include
section 40 1(k) and 403(b) employer contributions>
7,822.
927,495.
913,210.
9 Other employee benefits
520,920.
34,980.
560,300.
10 Payroll taxes
Fees for services (non.employees):
11
a Management
636.
636.
b Legal
55 000.
55,000.
c Accounting
d Lobbying
e Professional fundraising services. See Part IV, line 17
f Investment management fees
g Other. (If line hg amount exceeds 10% of line 25,
1,158,508.
column (A) amount, list line hg expenses on Sch 0.)
1,158,057.
52 ,123.
52,123.
12 Advertising and promotion
235, 442.
231, 519.
13 Office expenses
16, 536.
16,266.
270.
Information technology
14
15 Royalties
588,731.
580,223.
8,508.
16 Occupancy
608,352.
603,361.
4,541.
17 Travel
18 Payments of travel or entertainment expenses
for any federal, state, or local public officials
35,268.
27,798.
7,470.
19 Conferences, conventions, and meetings
20 Interest
Payments to affiliates
21
85,515.
82,134.
3,381.
22 Depreciation, depletion, and amortization
63,336.
56,
838.
6,498.
Insurance
23
24 Other expenses. Itemize expenses not covered
above. (List miscellaneous expenses in line 24e. If line
24e amount exceeds 10°!. of line 25, column (A)
amount, list line 24e expenses on Schedule 0.)
41,863.
41 863
a PROFESSIONAL DEVELOPMEN
10
LZ[
(D)
Fundraising
expenses
59,386.
6,463.
4,400.
451.
3 t23.
450.
b
C
d
e All other expenses
25 Total functional expenses. Add lines 1 through 24e
26 Joint costs. Complete this line only if the organization
reported in column (8) joint costs from a combined
educational campaign and fundrasinq solicitation.
eck here
27,198.
17,896,192.
26,758.
17,219,722.
601,057.
440.
75,413.
o owng hOP 98-2 (ASC 958-720)
99
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Form9gO (2013)
38—2027389
Page ii
TPaII X I Balance Sheet
Check
if
U
Schedule 0 contains a response or note to any line n this Part X
(A)
Beginning of year
(B>
End of year
Cash non-interest-bearing
Savings and temporary cash investments
1, 5 04, 167.
2
3
4
Pledges and grants receivable, net
Accounts receivable, net
1
5
Loans and other receivables from current and former officers, directors,
trustees, key employees, and highest compensated employees. Complete
6
Loans and other receivables from other disqualified persons (as defined under
section 4958(fl(1 )), persons described in section 4958(c)(3)(B), and contributing
1
-
,
272
35
,
,
18 0
884
T’
1 523, 624.
,
1 244 35 6
,
.
,
14
.
,
10 3
PartllofScheduleL
7
employers and sponsoring organizations of section 501 (c)(9) voluntary
employees’ beneficiary organizations (see instr). Complete Part II of Sch L
Notes and loans reneivahle, net
8
Inventories for sale or use
,
<
.
-
7
230 , 170.
8, 50 3.
Prepaid expenses and deferred charges
9
lOa Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
3 , 187 , 79 3.
2,865,108
lOa
-
b Less:accumulateddepreciation
Investments.publiclytradedsecurities
11
lOb
14
Investments other securities. See Part IV, line 11
Investments- program-related. See Part IV, line 11
Intangible assets
15
16
Other assets. See Part IV, line 11
Totalassets.Addlinesl throughls(mustequalline34)
17
18
Accountspayableand accrued expenses
Grants payable
19
20
Deferred revenue
Tax-exempt bond liabilities
21
22
Escrow or custodial account liability. Complete Part IV of Schedule D
Loans and other payables to current and former officers, directors, trustees,
key employees, highest compensated employees, and disqualified persons.
23
24
Secured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third parties
25
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 1 7-24). Complete Part X of
Schedule D
Total liabilities.Add lines l7throuqh 25
12
13
-.
-
-
402,134. lOc
222,646. ii
2 , 250 . 12
158 , 272.
14
15
3,836,206.
691,946.
27
28
‘
‘
,
,
505.
Organizations that follow SFAS 117 (ASC 958), check here
complete lines 27 through 29, and lines 33 and 34.
Unrestricted net assets
Temporarilyrestrictednetassets
793.
24
Lxi
Capital stock or trust principal, or current funds
31
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
25
-
1,552,451
1,444,221.
1, 291 , 76 0 27
941,995.
50 , 000
29
1
and
,
3 36, 96 9.
897,366.
9 0 , 0 00
30
.
-
31
32
Totalnetassetsorfund balances
Totalliabilitiesandnetassets/fund balances
,
23
30
34
733
19
20
21
-
Permanently restricted net assets
Organizations that do not follow SFAS 117 (ASC 958), check here
and complete lines 30 through 34.
Z
3,768,556.
710,428.
22
-
29
32
16
17
18
860
-
26
322,685.
233,545.
765
180 , 369
‘‘
Complete Part II of Schedule L
‘
231, 239.
17, 870.
8
-
-
.
.
2,283,755
3,836,206
34
2,324,335.
3,768,556.
Form 990(2013)
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Part XIJ Reconciliation of Net Assets
Form 990 (201 3’l
I
Check if Schedule 0 contains a response or note to any hne n this Part Xl
1
2
3
4
5
6
7
8
9
10
38 2027389
.
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A))
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
Other changes in net assets or fund balances (explain in Schedule 0)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,
column(B))
EZJ
.
1
2
3
Totalrevenue(mustequalPartVlll,column(A),linel2)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
Pagel2
17,929,502.
17, 89 6 19 2.
3 3, 310.
2, 283 75 5.
7 270
,
,
5
6
,
0
9
10
2,324,335.
j Part Xlii Financial Statements and Reporting
Check if Schedule 0 contains a response or note to any line in this Part XII
.
Yes
L1
No
L1
Accounting method used to prepare the Form 990:
Cash
Accrual
Other
If the organization changed its method of accounting from a prior year or checked Other, explain in Schedule 0.
2a Were the organization’s financial statements compiled or reviewed by an independent accountant?
If Yes, check a box below to indicate whether the financial statements for the year were compiled or reviewed on a
separate basis, consolidated basis, or both:
1
El
0
—
X
El
Separate basis
Consolidated basis
Both consolidated and separate basis
b Were the organization’s financial statements audited by an independent accountant?
If “Yes, check a box below to indicate whether the financial statements for the year were audited on a separate basis,
consolidated basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
c If Yes to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit,
review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule 0.
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit
Act and 0MB Circular A-i 33?
b If Yes, did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits
El
2a
—
El
—
3a
X
—
3b X
Form 990(2013)
—
__________
SCHEDULE A
(Form 990 or 990-EZ)
Department of the Treasury
internal Revenue Serv C
Name of the organization
[Pad I j
0MB No, 1545-0047
Public Charity Status and Public Support
Ø
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Opefl to Public
Attach to Form 990 or Form 990-EZ.
lnspect,Ofl
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form99O.
Employer identification number
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Reason for Public Charity Status (AB organizations must complete this part.) See instructions.
38—2027389
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
1
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)
2
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital’s name,
city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II.)
R [1 A fpcl.rai etat nr inrai grefPrnmPnt nr gnicrnmønfai I nit
er-rihlad in s,-tinn 17A(h)(t)(A)(u)
EEl
EEl
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8
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10
ii
e
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An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
section 170(b)(1)(A)(vi). (Complete Part II.)
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions -subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See section 509(a)(2). (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or
more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3) Check the box that
describes the type of supporting organization and complete lines lie through 11 h.
a
Type
b
Type II
Type Ill Non-functionally integrated
c
Type Ill Functionally integrated
d
By checking this box, certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III
supporting organization, check this box
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below,
Yes No
the governing body of the supported organization?
1 lg(i)
(ii) A family member of a person described in (i) above?
119(u)
(iii) A 35% controlled entity of a person described in (i) or (ii) above?
1 lg(iii)
Provide the following information about the supported organization(s).
El
El
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-
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-
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g
h
(I) Name of supported
organization
(ii) EIN
(vi) Is the
(iii) Type of organization iv) Is the organization (v) Did you notify the o•rganization
(vii) Amount of monetary
iii col.
n
col.
(I)
listed
in
your
organization
in
coi.
(described on lines 1-9
support
(i) organized in the
above or IRC section governing document? (i) of your support?
U.S.?
(see instructions))
Yes
No
Yes
No
Yes
No
—
Total
LHA For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990EZ
—
Schedule A (Form 990 or 990EZ) 2013
__________
_____________
__________
__________
_____________
__________
______________
__________
_____________
__________
_____________
__________
______________
__________
_____________
___________
_______________
___________
______________
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
38—2027389
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Schedule A (Form 990 or 990-EZ) 2013
EPart IFI
Page 2
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part Ill. If the organization
fails to qualify under the tests listed below, please complete Part Ill.)
èction A. Public Support
Calendar year (or fiscal year beginning in)
1
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
Gifts, grants, contributions, and
membership fees received. (Do not
includeanyunusualgrants.)
22153694.22027943.17641632.17228790.17477554.96529613.
2 Tax revenues levied for the organ
ization’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
without
organization
charge
4 TotaLAddlineslthrough3
c Thm pnrtion nf tmti r-rrnfrihi tinri
22153694.22027943.17641632.17228790.17477554.96529613.
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.
9 6529613.
Subtract ne 5 from line 4.
Section B. Total Support
Calendar year (or fiscal year beginning in)
7 Amountsfromline4
8 Gross income from interest,
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(f) Total
(e) 2013
22153694.22027943.17641632.17228790.17477554.96529613.
dividends, payments received on
securities loans, rents, royalties
12,319.
andincomefromsimilarsources
9
12,251.
28,918.
28,004.
27,945. 109,437.
Net income from unrelated business
activities, whether or not the
10
business is regularly carried on
Other income. Do not include gain
or loss from the sale of capital
11
Total support. Add lines 7 through 10
assets
(Explain
in
Part
IV.)
I
12 Gross receipts from related activities, etc. (see instructions)
12
13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501 (c)(3)
organization, check this box and stop here
96639050
2 , 698 , 796
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Section C. Computation of Public Support Percentage
99 .
Public support percentage for 2013 (line 6, column (f) divided by line 11, column (f))
14
Public support percentage from 2012 Schedule A, Part II, line 14
99 .
15
16a 33 113% support test 2013. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
stop here. The organization qualifies as a publicly supported organization
b 33 1/3% support test 2012. If the organization did not check a box on line 13 or 1 6a, and line 15 is 33 1/3% or more, check this box
14
15
89
89
%
-
L1
-
and stop here. The organization qualifies as a publicly Supported organization
17a 10% -facts-and-circumstances test 2013. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain in Part IV how the organization
meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization
b 10% -facts-and-circumstances test 2012. If the organization did not check a box on line 13, 1 6a, 1 6b, or 1 7a, and line 15 is 10% or
more, and if the organization meets the “facts-and-circumstances’ test, check this box and stop here. Explain in Part IV how the
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-
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-
organization meets the ‘facts-and-circumstances test. The organization qualifies as a publicly supported organization
18 Private foundation. If the organization did not check a box on line 13, 1 6a, 1 6b, 1 7a, or 1 7b, check this box and see instructions
El
El
Schedule A (Form 990 or 990-EZ) 2013
_____________
_____________________
__________
__________
_____________
______________
__________
_______________
_____________
______________
_____________
____________________
__________
______________
_____________
____________________
__________
_______________
_____________
_____________________
__________
__________
______________
_____________
______________
_____________
____________________
__________
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
JPart Ill I Support Schedule for Organizations Described in Section 509(a)(2)
_______________
_____________
_____________________
__________
38 2027389
Schedule A(Form 990 or 990-EZ) 2013
Page 3
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to
qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
1
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
Gifts, grants, contributions, and
membership fees received. (Do not
include
any
“unusual
grants.’)
2 Gross receipts from admissions,
merchandise sold or services per
formed, 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 bus
iness under section 513
Tate rmvmni i Iv(H fror th rorgmn
4
ization’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 $5000 or 1% of the
amount on line 13 for the year
C
Add lines 7a and 7b
8 Pubirc_support_(Subtpt Ire_7c from_lire_6
Section B. Total Support
Calendar year (or fiscal year beginning in)
9 Amounts from line 6
lOa 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
cAdd lines lOa and lOb
Net income from unrelated business
activities not included in line lOb,
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 IV.)
13 Total support. (Add hoes 9, lOc, 11 and 12)
11
14 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization,
check this box and stop here
El
Section C. Computation of Public Support Percentage
15 Public support percentage for 2013 (line 8, column (f) divided by line 13, column (f))
16 Public support percentage from 2012 Schedule A, Part Ill, line 15
15
%
16
%
Section D. Computation of Investment Income Percentage
Investment income percentage for 2013 (line lOc, column (f) divided by line 13, column (fl)
17
18 Investment income percentage from 2012 Schedule A, Part Ill, line 17
18
19a 33 1/3% support tests 2013. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
17
%
%
-
“
El
b 33 1/3% support tests 2012. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
vatefoundation.lftheoranizationdidnotcheckaboxonline14,19a,or19b,checkthisboxandseeinstructions
332023 09 25 ‘3
Schedule A (Form 990 or 990EZ) 2013
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC
EPart IVJ Supplemental Information, Provide the explanations required by Part
Schedule A (Form 990 or 990EZ) 2013
38 2027389 Page 4
II, line 10; Part II, me 17a or 17b; and Part lH line 12.
Also complete this part for any additional information. (See instructions).
F
990
9070
______________
Schedule of Contributors
Schedule B
(Form 990, 990-EZ,
or 990-PF)
0MB No. 1545OO47
Attach to Form 990, Form 990-EZ, or Form 990-PF.
Information about Schedule B (Form 990, 990-EZ, or 990-PF) and
its instructions is at www.irs.qov/form99O
Department of the Treasury
Internal Revenue Service
2013
Employer identification number
Name of the organization
NORTHWEST MICHIGAN CONMtJNITY ACTION
AGENCY, INC.
38—2027389
Organization type (check one):
Section
Filers ot
Form 990 or 990-EZ
501(c)(
3 ) (enter number) organization
4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
501 (c)(3) exempt private foundation
Form 990-PF
4947(a)(1) nonexempt charitable trust treated as a private foundation
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501 (c)(3) taxable private foundation
Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
El
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one
contributor. Complete Parts I and II.
Special Rules
Ll
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections
509(a)(1) and 1 70(b)(1 )(A)(vi) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or (2) 2%
of the amount on (i) Form 990, Part VIII, line 1 h, or (ii) Form 990-EZ, line 1 Complete Parts I and II.
For a section 501 (c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, or
the prevention of cruelty to children or animals. Complete Parts I, II, and III.
El
For a section 501 (c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,
contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not total to more than $1,000.
If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc.,
purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusively
religious, charitable, etc., contributions of $5,000 or more during the year
$
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990EZ, or 990-PF),
but it must answer No on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990PF, Part I, line 2, to
certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF.
Schedule 8 (Form 990, 99OEZ, or 990-PF) (2013)
Schedule B (Form 990, 990-EZ, or 990-Pfl (2013)
Page
Employer identification number
Name of organization
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY,
Part I
INC.
Contributors
38-2027389
(see instructions). Use duptcate copies of Part I if additional space is needed.
(b)
Name, address, and ZIP +4
(a)
No.
1
U.S.
DEPARTMENT OF AGRICULTURE
1400
INDEPENDENCE AVE.,
WASHINGTON,
$
1,429,726.
(c)
Total contributions
U.S. DEPARTMENT OF ENERGY
1000 INDEPENDENCE AVE.,
S,W.
$
517,476.
3
(b)
Name, address, and ZIP +4
(c)
Total contributions
U.S. DEPARTMENT OF HEALTH AND HUMAN
SERVICES
200 INDEPENDENCE AVE.,
WASHINGTON,
(a)
No.
Person
Payroll
Noncash
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(d)
Type of contribution
Person
Payroll
Noncash
LX]
El
El
(Complete Part II for
noncash contributions.)
WASHINGTON, DC 20585
(a)
No.
(d)
Type of contribution
(Complete Part II for
noncash contributions.)
DC 20250
(b)
Name, address, and ZIP +4
(a)
No.
2
S.W.
(c)
Total contributions
S.W.
$
9,654,938.
(d)
Type of contribution
Person
Payroll
Noncash
LXI
El
El
(Complete Part II for
noncash contributions.)
DC 20201
(c)
Total contributions
(b)
Name, address, and ZIP +4
DEPARTMENT OF HOUSING AND URBAN
DEVELOPMENT
(d)
Type of contribution
U.S.
4
451 7TH STREET,
S.W.
$
1,454,507.
5
(b)
Name, address, and ZIP +4
U.S.
(C)
Total contributions
DEPARTMENT OF VETERANS AFFAIRS
810 VERMONT AVE.,
N.W.
$
689,594.
6
(b)
Name, address, and ZIP +4
(C)
Total contributions
TRAVERSE BAY AREA INTERMEDIATE SCHOOL
DISTRICT
1101 RED DRIVE
TRAVERSE CITY,
(d)
Type of contribution
Person
Payroll
Noncash
LXI
El
El
(Complete Part II for
noncash contributions.)
WASHINGTON, DC 20420
(a)
No.
LXI
El
El
(Complete Part II for
noncash contributions.)
WASHINGTON, DC 20410
(a)
No.
Person
Payroll
Noncash
$
416,334
(d)
Type of contribution
Person
Payroll
Noncash
LXI
El
JJ
(Complete Part II for
noncash contnbutions)
MI 49684
cej
990 990E
990PF 2
3
2
Paqe 2
Schedule B (Form 990, 990EZ, or 990PF) (2013)
Name
of organization
Employer identification number
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Part I
Contributors
38-2027389
(see instructions). Use duplicate copies of Part if additional space s needed.
(b)
(a)
Name,
No.
7
address, and ZIP +4
(c)
(ci)
Total contributions
Type of contribution
CHARLEVOIX-EMMET INTERMEDIATE SCHOOL
DISTRICT
8568 MERCER ROAD
480,486.
$
(b)
(a)
Name,
8
address, and ZIP
+4
13TH STREET
CADILLAC,
(d)
Type of contribution
440,060.
$
9
address, and ZIP
4
BOX 30044
LANSING,
389,582.
address, and ZIP
4
Total
contributions
$
665,700.
El
Noncash
(d)
Type of contribution
Person
Payroll
Noncash
[Xl
El
El
(Complete Part II for
noncash contributions.)
MI 489 09
(b)
Name,
Ll
Payroll
(c)
+
MICHIGAN DEPARTMENT OF HUMAN SERVICES
(a)
Person
(Complete Part II for
noncash contributions.)
P.O. BOX 30037
No.
(d)
Type of contribution
(b)
LANS ING,
El
(c)
MI 4890 9
Name,
Ll
Total contributions
$
(a)
No.
10
+
MICHIGAN STATE HOUSING DEVELOPMENT
AUTHORITY
P.O.
Person
Payroll
Noncash
(Complete Part II for
noncash contributions.)
(b)
Name,
fl
(c)
MI 49601
(a)
No.
El
Noncash
Total contributions
WEXFORD-MISSAUKEE INTERMEDIATE SCHOOL
DISTRICT
9907 E.
L1
(Complete Part II for
noncash contributions.>
CHARLEVOIX, MI 49720
No,
Person
Payroll
address, and ZIP +4
(c)
(d)
Total contributions
Type of contribution
Person
Payroll
Noncash
El
El
El
(Complete Part II for
noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP
+
(c)
Total contributions
4
$
(d)
Type of contribution
Person
Payroll
Noncash
El
El
EJ
(Complete Part II fm
noncash contribubons.)
m’J90 990E
or90PF 20
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Name of organization
Paqe
Employer identification number
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Part II
Noncash Property
3
-
38—2027389
(see instructions) Use duplicate copies of Part II if additional space is needed
(a)
0.
from
Part I
(b)
Description of noncash property given
FMV (or estimate)
(see instructions)
.
(d)
Date received
COMMODITY FOOD
1
912,351.
(a)
No.
from
Part I
(c)
IMV (or estimate)
(bi
.
Description of noncash property given
S
(see instructions)
09/30/14
(dl
Date received
$
(a)
°•
from
Part I
(b)
Description of noncash property given
FMV (or estimate)
(see instructions)
.
(d)
Date received
$
(a)
0.
from
Part I
(b)
Description of noncash property given
FMV (or estimate)
(see instructions)
.
.
(d)
Date received
$
(a)
0.
from
Part I
(b)
Description of noncash property given
FMV (or estimate)
(see instructions)
(d)
Date received
$
(a)
0.
from
Part I
(b)
Description of noncash property given
FMV (or estimate)
(see instructions)
S
(d)
Date received
$
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page
Schedule B (Form 990, 990EZ, or 990PF) (2013)
Name of
organization
4
Employer identification number
NORTHWEST MICHIGAN COMMIJNITY ACTION
AGENCY, INC.
Part III
Exclu lye! religious, charitable, etc. individual contributions to section bUl(c)(,’),
year. omete columns (a) through (e) and the following line
the total of
exclusively
entry.
38-2027389
(d), or (10) organizations that total more than 1 000
For organizations completing
religious, charitable, etc., contributions of $1000 or less for the year.
Use duplicate copies of Part Ill
if
Part Ill,
tor the
enter
(Enterths information once
$________________________________
additional space is needed.
(a) No.
from
Part_I
(b)
Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee’s name, address, and ZIP
(a) No.
from
Part I
+
Relationship of transferor to transferee
4
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee’s name, address, and ZIP
+
4
Relationship of transferor to transferee
(a)No.
(b) Purpose of
(c) Use of gift
gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee’s name, address, and ZIP
+
4
Relationship of transferor to transferee
(a)No.
(b) Purpose of gift
(c) Use of gift
(d) Description of how gift is held
(e) Transfer of gift
Transferee’s name, address, and ZIP
+
4
Relationship of transferor to transferee
--
Schedule B (Form 990, 990-EZ. or 990PF) (20131
__________________
_____
SCHEDULE C
(Form 990 or 990-EZ)
Department of the Treasury
internal Revenue Servce
Political Campaign and Lobbying Activities
OMH No. 1545 0047
2013
For Organizations Exempt From Income Tax Under section 501(c) and section 527
Attach to Form 990 or Form 990-EL
Complete if the organization is described below.
Information about Schedule C (Form 990 or 990-EZ) and its
See separate instructions.
instructions is at
i.aoy/form99O.
Open to Public
Inspection
If the organization answered “Yes,” to Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
• Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
• Section 501(c) (other than section 501 (c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
• Section 527 organizations: Complete Part IA only.
If the organization answered “Yes,’ to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
• Section 501 (c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part Il-A. Do not complete Part li-B.
• Section 501 (c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part li-B. Do not complete Part li-A.
If the organization answered “Yes,” to Form 990, Part IV, line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
• Section 501 (cW4. (5. or (6 oraanizations: Comolete Part III.
Employer identification number
Name of organization
NORTHWEST MICHIGAN CO’flJNITY ACTION
AGENCY,
INC.
38—2027389
I Part I-A I Complete if the organization is exempt under section 501(c) or is a section 527 organization.
1 Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2 Political expenditures
3 Volunteer hours
$
Part I-B j Complete if the organization is exempt under section 501 (c)(3).
$
$
Enter the amount of any excise tax incurred by the organization under section 4955
Enter the amount of any excise tax incurred by organization managers under section 4955
3 If the organization incurred a section 4955 tax, did it file Form 4720 for this year?
4a Was a correction made?
b If Yes,’ describe in Part IV.
1
2
Part I-C I
1
2
Li Yes
Li
Yes
No
No
Complete if the organization is exempt under section 501(c), except section 501 (c)(3).
Enter the amount directly expended by the filing organization for section 527 exempt function activities
Enter the amount of the filing organization’s funds contributed to other organizations for section 527
$
exempt function activities
3 Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 11 20-POL,
linel7b
Li
LL
No
Yes
4 Did the filing organization file Form 1 120-POL for this year?
5 Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing organization
made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political
contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a
political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name
(b) Address
(c) EIN
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
HA
(d) Amount paid from
(e) Amount of political
contributions received and
filing organization’s
promptly and directly
funds. If none, enter -o-.
delivered to a separate
political organization.
If none, enter -0-.
Schedule C (Form 990 or 990EZ) 2013
NORTHWEST MICHIGAN COMMUNITY ACTION
38—2027389
AGENCY, INC.
Part 1J-J Complete if the organization is exempt under section 501(c)(3) and filed Form 5768
(election under section 501(h)).
Schedule C (Form 990 or 990-EZI 2013
A Check
Li
Paae 2
if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group members name, address, EIN,
expenses, and share of excess lobbying expenditures).
8 Check___Li__if the_filing_organization_checked_box A and_limited_control_provisions_apply.
.
.
(a> Filing
organization’s
totals
.
Limits on Lobbying Expenditures
(The term expenditures means amounts paid or incurred.)
(b) Affiliated group
totals
1 a Total lobbying expenditures to influence public opinion (grass roots lobbying)
b Total lobbying expenditures to influence a legislative body (direct lobbying)
c Total lobbying expenditures (add lines 1 a and 1 b)
d Other exempt purpose expenditures
e Total exempt purpose expenditures (add lines ic and ld)
f Lobbying nontaxable amount. Enter the amount from the following table in both columns.
If the amount on line le, column (a) or (b) is:
The lobbying nontaxable amount is:
20% of the amount on line 1 e.
Not over $500,000
$100,000 plus 15% of the excess over $500,000.
Over $500,000 but not over $1,000,000
Over $1,000,000 but not over $1,500,000
$175,000 plus 10% of the excess over $1 ,000,0C
Over $1,500,000 but not over $17,000,000
$225,000 plus 5% of the excess over $1,500,000.
Over $1 7,000,000
$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1 f)
h Subtract line 1 g from line 1 a. If zero or less, enter -0i Subtract line 1 f from line 1 c. If zero or less, enter -0j If there is an amount other than zero on either line 1 h or line 1, did the organization file Form 4720
Li Yes
reporting section 4911 tax for this year?
Li
No
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
• Calendar year
(or fiscal year beginning in)
(a) 2010
(b) 2011
(c) 2012
(d) 2013
(e) Total
2a_Lobbying_nontaxable_amount
b Lobbying ceiling amount
(150% of line 2a, column(e))
c Total lobbying expenditures
d_Grassroots_nontaxable_amount
e Grassroots ceiling amount
(150% of line 2d, column (e))
f Grassroots lobbying expenditures
Schedule C (Form 990 or 990-EZ) 2013
______________
_________________
________________
__________________
NORTHWEST MICHIGAN COMMUNITY ACTION
INC.
382027389 Paae3
exempt under section 501(c)(3) and has NOT flied i-orm (b
(election under section 501(h)).
$heduie C (Form 990 or 990-EZ 2013 AGENCY,
Part H-b j Complete if the organization is
(b)
For each “Yes, response to lines la through ii below, provide in Part IVa detailed description
of the lobbying activity.
1
Yes
No
Amount
During the year, did the filing organization attempt to influence foreign, national, state or
local legislation, including any attempt to influence public opinion on a legislative matter
or referendum, through the use of:
a Volunteers?
b Paid staff or management (include compensation in expenses reported on lines 1 c through 1 i)?
X
X
X
X
X
X
X
X
c Media advertisements?
d Mailings to members, legislators, or the public?
e Publications, or published or broadcast statements?
f Grants to other organizations for lobbying purposes?
g Direct contact with legislators, their staffs, government officials, or a legislative body?
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means?
I Other activities?
j Total. Add lines lcthrough ii
2a Did the activities in line 1 cause the organization to be not described in section 501(c)(3)?
X
75
75
X
b If ‘Yes,’ enter the amount of any tax incurred under section 4912
c If ‘Yes,’ enter the amount of any tax incurred by organization managers under section 4912
d If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year?
IPart Ill-Al Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section
501(c)(6).
Yes
1
2
3
Were substantially all (90% or more) dues received nondeductible by members?
Did the organization make only in-house lobbying expenditures of $2,000 or less?
No
2
3
Did the organization agree to carry over lobbying and political expenditures from the prior year?
Part IiI-bJ Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section
501(c)(6) and if either (a) BOTH Part Ill-A, lines I and 2, are answered “No,” OR (b) Part Ill-A, line 3,
answered “Yes.”
is
—
1
2
_i_.
Dues, assessments and similar amounts from members
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a Current year
b Carryover from last year
c Total
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess
does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political
3
5
expenditure next year?
Taxable amount of lobbying and political expenditures (see instructions)
Part IV
2c
_.
5
Supplemental Information
Provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; Part Il-A (affiliated group list); Part Il-A, line 2; and Part li-B, line 1.
Also, complete this part for any additional information.
PART Il-B,
LINE 1,
LOBBYING ACTIVITIES:
THE ORGANIZATION PAYS DUES TO NATIONAL COMMUNITY ACTION
FOUNDATION A PORTION OF WHICH IS ATTRIBUTABLE TO LOBBYING.
NATIONAL COMMUNITY ACTION FOUNDATION SEEKS TO ENSURE THE FEDERAL
GOVERNMENT HONORS ITS COMMITMENT TO FIGHTING POVERTY,
ESPECIALLY
Schedule C (Form 990
990 EZ) 2013
________________________
NORTHWEST MICHIGAN CONWJNITY ACTION
AGENCY, INC
IV j Supplement& Information (continued)
Schedu’e C (Form 990 or 990-EZ) 2013
TPatt
38 2027389
Page 4
THROUGH THE WORK OF COMMUNITY ACTION AGENCIES.
Schedue C (Form 990 or 990EZ) 2013
_____________
Department of the Treasury
internai Revenue Service
Name of the organization
TPart
I
j
________________________
_______________
________________________
______________________
_______________________
_______________
0MB No. 154S-0047
Supplemental Financial Statements
SCHEDULE D
(Form 990)
_______________________
________________
2013
Complete if the organization answered Yes,’ to Form 990,
Part IV, line 6,7,8,9, 10, ha, lib, hic, lid, lie, hf, i2a, or 12b.
Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at
Open to Public
Inspection
,,.‘
NORTHWEST MICHIGAN CO?’tMUNITY ACTION
AGENCY, INC.
Organizations
Maintaining
Donor Advised
Funds or Other Similar
Employer identification number
38-2027389
Funds or Accounts.compiete
if the
organization answered ‘Yes” to Form 990, Part IV, line 6.
(b) Funds and other accounts
(a) Donor advised funds
Total number at end of year....................................
Aggregate contributions to (during year)
I
2
Aggregate grants from (during year)
Aggregate value at end of year
3
4
5
Did the organization inform all donors and donor advisors in wnting that the assets held in donor advised funds
are the organization’s property, subject to the organization’s exclusive legal control?
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only
6
fnr nk,,ri+,,hia nI,rnncc
,nrl
nryt fnr
tha hnnnf it
nf
tha ,Innnr nr dnnnr orl,,ianr
n, fnr ,n,
j
Conservation
Easements.
El No
El Yes
El No
nthor ni ,rnnen nnnfnrrinn
impermis:epratebenetit
[ Part II
El Yes
Complete if the organization answered “Yes” to Form 990, Part IV, line 7.
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of an historically important land area
Preservation of land for public use (e.g., recreation or education)
Preservation of a certified historic structure
Protection of natural habitat
1
El
El
El
El
El Preservation of open space
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
2
day
of
the
tax
year.
Held at the End of the Tax Year
a
b
c
d
3
2a
2b
2c
Total number of conservation easements
Total acreage restricted by conservation easements
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure
2d
listed in the National Register
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year
4
5
6
7
8
9
Number of states where property subject to conservation easement is located
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds?
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year ‘
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
$
El Yes
El No
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 1 70(h)(4)(B)(i)
Yes
and section 1 70(h)(4)(8)(ii)?
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and
include, if applicable, the text of the footnote to the organization’s financial statements that describes the organization’s accounting for
El
El No
conservation easements.
[Part 111
1
Organizations
Maintaining
Collections
of
Art, Historical
Treasures,
or
Other Similar Assets.
Complete if the organization answered “Yes” to Form 990, Part IV, line 8.
la If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII,
the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical
treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts
relating to these items:
(i) Revenues included in Form 990, Part VIII, line 1
$
(ii) Assets included in Form 990, Part X
$
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide
the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a Revenues included in Form 990, Part VIII, line 1
$
$
b Assets included in Form 990, Part X
.
nA For Paperwork Reduction Act Notice, see the Instructions for Form 990,
.
&heduI D (Form 990 2013
_______________________________________________________
Schedule D (Form 9901 2013
I
Part Ill
3
j
NORTHWEST MICHIGAN CONMUNITY ACTION
AGENCY, INC.
Organizations Maintaining Colleci
Paae2
382027389
Historical Treasures, or Other Similar
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items
(check all that apply):
d
Loan or exchange programs
a
Public exhibition
e
Other
research
b
Scholarly
c
4
5
El
El
El
El
El
Preservation for future generations
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part XIII.
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets
Yes
to be sold to raise funds rather than to be maintained as oart of the oroanization’s collection?
El
Part IV
I
Escrow and Custodial Arrangements.
El
No
El
No
Complete if the organization answered ‘Yes’ to Form 990, Part lv, line 9, or
reported an amount on Form 990, Part X, line 21
la Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
b If “Yes,” explain the arrangement in Part XIII and complete the following table:
El Yes
—
Amount
c
Beginning
balance
.........,.,,,,,,.,
d Additions during the year
e Distributions during the year
ic,
ii
if
Ending balance
2a Did the organization include an amount on Form 990, Part X, line 21?
b If Yes,’ explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII
Part V j Endowment Funds Complete if the organization answered Yes to Form 990 Part IV line 10
(c) Two years back (d) Three years back
(b) Prior year
(a) Current year
f
Li Yes
Li No
El
(e) Four years back
la Beginning of year balance
b Contributions
c Net investment earnings, gains, and losses
d Grants or scholarships
e Other expenditures for facilities
and programs
f
Administrative expenses
g End of year balance
2 Provide the estimated percentage of the current year end balance (line lg, column (a)) held as:
a Board designated or quasi-endowment
b Permanent endowment
c Temporarily restricted endowment
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
(i) unrelated organizations
(ii) related organizations
b If ‘Yes’ to 3a(ii), are the related organizations listed as required on Schedule R?
4 Describe in Part XIII the intended uses of the organization’s endowment funds.
Part VI
I Land,
Buildings, and Equipment.
Complete if the organization answered “Yes” to Form 990, Part IV, line 1 1a. See Form 990, Part X, line 10.
Description of property
la Land
b Buildings
c Leasehold improvements
d Equipment
(a) Cost or other
basis (investment)
(b) Cost or other
basis (other)
(c) Accumulated
depreciation
6,066
1,101,624
507,521
1,572,582
1,053,380
478,687
1,333,041
Total. Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part )( column (B), line 10(c).)
(d) Book value
6,066.
48,244.
28,834.
239,541.
322 68 5
,
Schedule D (Form 990) 2013
NORTHWEST
Schedule D (Form 990) 2013
ft VIl
Investments
-
MICHIGAN
COMMUNITY
ACTION
382027389
AGENCY, INC.
Other Securities.
3
Paae
Complete if the organization answered Yes to Form 990, Part IV, line 11 b. See Form 990, Part X, line 12.
(b) Book value
(c) Method of valuation: Cost or end-of-year market value
(a> Description of security or category (including name of security)
(1) Financial derivatives
(2) Closely-held equity interests
(3) Other
-
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total (Col (b) must equal Form 990 Part X col (B) line 12 )
II-----Part Viii lnvstmnt Prnnrm Rphted
-
Complete if the organization answered ‘Yes” to Form 990, Part IV, line
(a) Description of investment
(b) Book value
ic. See Form 990, Part X, line 13.
(c) Method of valuation: Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total (Col b) must equal Form 990 Part X col (B) line 13
Part IX
)
Other Assets
Complete if the organization answered “Yes’ to Form 990, Part IV, line 11 d. See Form 990, Part X, line 15.
(a) Description
(b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.)
j Part X j Other Liabilities
Complete if the organization answered “Yes’ to Form 990, Part IV, line lie or hf. See Form 990. Part X. line 25.
(a) Description of liability
(b) Book value
1.
(1)
Federal income taxes
(2)
(3)
(4)
..
—
-,
—
(6)
(9)
Total. (Column (b) must equal Form 990, Part IC, col. (B) line 25.)
2.
Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organizations financial statements that reports the
XlllJ
Schedule D (Form 990) 2013
Schedule D (Form 990) 2013
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
382027389
Paoe4
árt XI j Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Complete f the organization answered Yes to Form 990, Part IV, line 12a,
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
1
2
b
Net unrealized gains on nvestments
Donated services and use of facilities
C
Recoveries of prior year grants
a
2a
2b
1
18, 338,403.
2e
T
387,583.
17,950,820.
5
11,929, 502.
7 , 270
380 , 313
2c
.
2d
d Other (Describe in Part XIII.)
e Add lines 2a through 2d
Subtract line 2e from line 1
Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b
b Other (Descnbe n Part XIII.)
C Add lines 4a and 4b
Total revenue. Add lines 3 and 4c. (This must eaual Form 990. Part I. line 12.)
5
3
4
4a
21, 318
-21,318.
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Complete if the organization answered Yes to Form 990, Part IV, line 12a
1
2
—
1
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities
b Prior year adjustments
c Other losses
2a
18 , 2 97 , 8 2 3
380, 313.
2l
2c
2d
d Other (Describe in Part XIII.)
e Add lines 2a through 2d
Subtractline2efromlinel
3
21, 318.
2e
3
Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b
b Other (Describe in Part XIII.)
c Add lines 4a and 4b
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part!, line 18.)
401, 6 3 1.
17,896,192.
4
4a
4b
sIc
0.
17, 8 96 , 19 2.
Part XllIJ Supplemental Information.
Provide the descriptions required for Part II, lines 3,5, and 9; Part III, lines la and 4; Part IV, lines lb and 2b; Part V, line 4; Part X, line 2; Part XI,
lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
PART X,
LINE 2:
THE ORGANIZATION IS REQUIRED TO ASSESS WHETHER IT IS MORE
LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION ON
THE TECHNICAL MERITS OF THE POSITION ASSUMING THE TAXING AUTHORITY HAS
FULL KNOWLEDGE OF ALL INFORMATION.
IF THE TAX POSITION DOES NOT MEET THE
MORE LIKELY THAN NOT RECOGNITION THRESHOLD,
THE BENEFIT OF THAT POSITION
IS NOT RECOGNIZED IN THE CONSOLIDATED FINANCIAL STATEMENTS.
THE
ORGANIZATION HAS DETERMINED THERE ARE NO AMOUNTS TO RECORD AS ASSETS OR
LIABILITIES RELATED TO UNCERTAIN TAX POSITIONS.
FISCAL YEARS ENDED SEPTEMBER 30,
FEDERAL RETURNS FOR THE
2011, AND THEREAFTER REMAIN SUBJECT TO
EXAMINATION BY THE INTERNAL REVENUE SERVICE FOR NORTHWEST MICHIGAN
COMWJNITY ACTION AGENCY,
INC.
Schedule D (Form 990) 2013
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
[Part XIII I Supplemental Information (continued)
ScheduieD(Form99O)2013
PART XI, LINE 4B
LINE 20
CATERING EXPENSES
Page5
OTHER ADJUSTMENTS:
-
CATERING EXPENSES
PART XII,
38—2027389
-21,318.
-
OTHER ADJUSTMENTS:
21,318.
Schedue D (Form 990) 2013
General Information on Grants and Assistance
1
MI 49601
118 5.
MITCHELL
FAMILY
W,
R
2279 S.
AIRPORT
-
PETOSKEY,
INC.
MI 49770
-.
2302164
38
1357148
38 2164580
38
38-1976268
38-2516989
01(C)(3)
01(C)(3>
01(C)(3)
01(C)(3)
01(C)(3)
.
.
.
.
.3
SEE PART IV FOR COLUMN (H) DESCRIPTIONS
.
79,724.
67,612.
33,038.
113,741.
10,000.
Enter total number of section 501 (c)(3) and government organizations listed in the line 1 table
Enter total number of other organizations listed in the line 1 table
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
2
MI 49442
MVSKEGON
271 APPLE AVE.
INC.
DWILL INDUSTRIES OF WEST
-
720 5 ELMWOOD, NO.
TRAVERSE CITY, MI 49684
VERSE AREA
ENS RESOURCE CENTER GRAND
ST.
MICHIGAN,
W
PORTER
NORTHERN MICHIGAN,
423
TRAVERSE CITY, MI 49684
INC.
WMEN’S RESOURCE CENTER OF
CHIGAN,
DWILL INDUSTRIES OF NORTHERN
CADILLAC,
Z
,
RESOURCE CENTER
CADILLAC AREA OASIS
L’
S’
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
.
.,,,.,.-,.
Complete if the organization answered “Yes” to Form 990, Part IV, line 21 or 22.
Attach to Form 990.
Information about Schedule I (Form 990) and its instructions is at
.,-,i&oorr
..-..-.,,U.,......,..-.-.,,
Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States
38 2027389
Employer identification number
Open to Public
nspec on
2013
0MB No 1545-0041
0.
0.
0.
0.
0.
.
.
-
.
,
.
.
EJ No
5
0
Schedule I (Form 990) (2013)
‘AMILIES TO ACHIEVE
SSISTANCE TO VETERAN
ERVICES AND FINANCIAL
ROVIDE COUNSELING
AMILIES OR FAMILIES AT
.SSISTANCE TO HOMELESS
ERVICES AND FINANCIAL
ROVIDE COUNSELING
AMILIES OR FAMILIES AT
SSISTANCE TO HOMELESS
ERVICES AND FINANCIAL
ROVIDE COUNSELING
AMILIES OR FAMILIES AT
.SSISTANCE TO HOMELESS
ERVICES AND FINANCIAL
ROVIDE COUNSELING
AMILIES OR FAMILIES AT
.SSISTANCE TO HOMELESS
ERVICES AND FINANCIAL
ROVIDE COUNSELING
E1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees’ eligibility for the grants or assistance, and the selection
criteria used to award the grants or assistance?
Yes
Describe in Part IV the organization’s procedures for monitoring the use of grant funds in the United States.
2
II] Grants and Other Assistance to Governments and Organizations in the United States. Complete
if the organization answered ‘Yes to Form 990, Part IV, line 21, for any
recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
of
1 (a) Name and address of organization
(b) EIN
(c) IRC section
(d) Amount of
(e) Amount of
(g) Description of
(h) Purpose of grant
or government
if applicable
cash grant
non-cash
non-cash assistance
or assistance
FMV appraisal
assistance
other)
‘art I
lane of the organization
Ir
c.T Sc Treasur
ral Revenue Service
SCHEDULE I
(Form 990)
INC.
6248
350,075.
401,764.
1,272,149.
296,228.
1,519,121.
(c) Amount of
cash grant
(e) Method of va uation
(book, FMV, appraisal, other)
912,351. TATE OF MICHIGAN VALUE
0.
0.
0.
0.
(d) Amount of noncash assistance
LINE 1,
COLUMN (H):
PURPOSE OF GRANT OR ASSISTANCE:
PROVIDE COUNSELING SERVICES AND
FAMILY RESOURCE CENTER
02
0 2913
I INkNCIAL ASSISTANCE TO HOMELESS FAMILIES OR FAMILIES AT RISK OF
1)
IDILLAC AREA OASIS
NAMh OF ORGANIZATION OR GOVERNMENT
PART 11,
CL{PLIANCE WITH REGULATIONS AND GRANT AGREEMENTS OF FUNDING SOURCES.
E ORGANIZATION MONITORS THE USE OF GRANT FUNDS THROUGH
LINE 2:
Supplemental Information. Provide the information required in Part I, line 2, Part Ill, column (b), and any other additional information.
ART I,
I
H ASSISTANCE
2954
ER ANERICANS ASSISTANCE
LPart IV
0
3118
37
6028
(b) Number of
recipients
SING ASSISTANCE
rHERIZATION/ENERGY ASSISTANCE
IMtJNIIY SERVICES ASSISTANCE
(a) Type of grant or assistance
Part Ill can be duplicated if additional space is needed.
[PJ Grants and Other Assistance to Individuals in the United States. Complete if the organization answered Yes’ to Form 990, Part IV, line 22.
edu€J(Form99O)(2013)
NORTHWEST MICHIGAN CONMUNITY ACTION
AGENCY,
Paae2
Schedule I (Form 990) (2013)
OMMODITY FOOD ASSISTANCE
(f) Description of non-cash assistance
38—2027389
NORTHWEST MICHIGAN COMMUNITY ACTION
(a) Type of grant or assistance
c-:1LD EDUCATION ASSISTANCE
I
1,054.
(b) Number of
recipients
744,437.
Amount of
cash grant
(C)
0.
(d) Amount of noncash assistance
AGENCY, INC.
Schedule l(Form99O)
Part III I Continuation of Grants and Other Assistance to Individua’s in the United States (Schedule (Form 990) Part Ill)
(e) Method of
valuation (book, FMV,
appraisal. other)
Paqe2
Schedule I (Form 990)
(f) Description of non-cash assistance
38—2027389
Schedulel(Form99O)
Part IV
I
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
38—2027389
Paqe2
Supplemental Information
HOMELESSNESS.
NAME OF ORGANIZATION OR GOVERNMENT:
GOODWILL INDUSTRIES OF NORTHERN MICHIGAN,
(H)
PURPOSE OF GRANT OR ASSISTANCE:
INC.
PROVIDE COUNSELING SERVICES AND
FINANCIAL ASSISTANCE TO HOMELESS FAMILIES OR FAMILIES AT RISK OF
HOMELESSNESS.
NAME OF ORGANIZATION OR GOVERNMENT:
WOMEN’S RESOURCE CENTER OF NORTHERN MICHIGAN,
(H)
PURPOSE OF GRANT OR ASSISTANCE:
INC.
PROVIDE COUNSELING SERVICES AND
FINANCIAL ASSISTANCE TO HOMELESS FAMILIES OR FAMILIES AT RISK OF
HOMELESSNESS.
NAME OF ORGANIZATION OR GOVERNMENT:
WOMEN’S RESOURCE CENTER GRAND TRAVERSE AREA
(H)
PURPOSE OF GRANT OR ASSISTANCE:
PROVIDE COUNSELING SERVICES AND
FINANCIAL ASSISTANCE TO HOMELESS FAMILIES OR FAMILIES AT RISK OF
HOMELESSNESS.
NAME OF ORGANIZATION OR GOVERNMENT:
GOODWILL INDUSTRIES OF WEST MICHIGAN,
(H)
PURPOSE OF GRANT OR ASSISTANCE:
INC.
PROVIDE COUNSELING SERVICES AND
FINANCIAL ASSISTANCE TO VETERAN FAMILIES TO ACHIEVE HOUSING STABILITY.
Schedue I (Form 990)
Noncash Contributions
SCHEDULE M
(Form 990)
Complete if the organizations answered
Department of the Treasury
internal Revenue Service
Name
1
Open to Public
Attach to Form 990.
I’”q
about Schedule M (Form 990 and its instructions is at
“.
(a)
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
ire
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Types of Property
Check if
applicable
1
2013
Yes” on Form 990, Part IV, lines 29 or 30.
of the organization
I Part 1
2
0MB No. 1545-0047
(b)
Inspection
Ulrnrm’.e.e;
Employer identification number
38—2027389
(c)
(d)
Number of
Noncash contribution
contributions or
amounts reported on
items contributed Form 990, Part VIII, line 1 q
Art Works of art
Art Historical treasures
Art Fractional interests
Books and publications
Clothing and household goods
Cars and other vehicles
Boats and planes
Intellectual property
Securities Publicly traded
Securities Closely held stock
Securities Partnership, LLC, or
trust interests
Securities- Miscellaneous
Qualified conservation contribution
Historic structures
Qualified conservation contribution Other
Real estate Residential
Real estate Commercial
Real estate Other
Collectibles
X
1
912,351.
Food inventory
Drugs and medical supplies
Taxidermy
Historical artifacts
Scientific specimens
Archeological artifacts
X
295
14,738.
Other
( SUPPLIES
)
Other
Other
Other
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement
29
Method of determining
noncash contribution amounts
-
-
-
-
-
-
-
-
-
3TATE OF MI VALUE
OST OF DONATED PROP
0
—
Yes No
During the year, did the organization receive by contribution any property reported in Part I, lines 1 28, that it must hold for
at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for
X
the entire holding period?
30a
Yes,
describe
the
arrangement
in
Part
II.
b If
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
X
contributions?
32a
If
Yes,
describe
in
Part
II.
b
33 If the organization did not report an amount in column (c) for a type of property for which column (a) is checked,
describe in Part II.
LHA
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Schedule M (Form 990) (2013)
30a
-
—
—
—
NORTHWEST MICHIGAN CONMEJNITY ACTION
AGENCY, INC.
Supplemental Information Provide the information required by Part I lines 30b 32b
38—2027389
Paqe2
and 33 and whether the organization
is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete
this part for any additional information.
Schedule M (Form9gO)(2013)
[!j
SCHEDULE M,
PART I,
COLUMN
(B):
NUMBER OF CONTRIBUTORS OF SUPPLIES DETERMINED BY AVERAGE
CONTRIBUTION OF $50.
332142 09013
Schedule M (Form 990) (2013)
to Form 990 or 990-EZ
Supplemental Information
responses to specific questions on
SCHEDULE 0
Complete to provide information for
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
(Form 990 or 990-Ez)
Department of the Treasury
nterna Revenue Service
Information about Schedule 0 tForm 990 or 990 EZI and its instructions is at uv
PART III,
FORM 990,
/
i.v r
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Name of the organizatbn
LINE 1,
,QQ()
0MB No. 1545-0047
20 13
Open to Public
Inspection
Employer identification number
38-2027389
DESCRIPTION OF ORGANIZATION MISSION:
PROGRAMS IN THE 10 COUNTIES OF NORTHWEST MICHIGAN THE ORGANIZATION
SERVES.
PART III,
FORM 990,
LINE 4B,
PROGRAM SERVICE ACCOMPLISHMENTS:
RECEIVING PROGRAM SERVICES IS 3,118.
PART III,
FORM 990,
FOOD PROGRAMS
HELPS
-
LINE 4D,
OTHER PROGRAM SERVICES:
INCLUDES THE EMERGENCY FOOD ASSISTANCE PROGRAM THAT
SUPPLEMENT THE DIETS OF LOW-INCOME NEEDY PEOPLE,
ELDERLY,
INCLUDING THE
BY PROVIDING THEM WITH EMERGENCY FOOD AND NUTRITION ASSISTANCE
AT NO COST.
COMMODITY SUPPLEMENTAL FOOD PROGRAM IS A NUTRITION
EDUCATION PROGRAM THAT PROVIDES SUPPLEMENTAL FOODS WHICH HELP PROMOTE
GOOD HEALTH FOR WOMEN,
INFANTS,
CHILDREN,
TOTAL
AND SENIORS.
HOUSEHOLDS RECEIVING PROGRAM SERVICES IS 6,248.
EXPENSES
$
1,473,283.
OLDER AMERICANS
-
INCLUDING GRANTS OF
$
1,262,426.
REVENUE
$
1,200.
PREPARATION AND SERVING OF HOME DELIVERED AND
CONGREGATE SENIOR MEALS BY THREE ORGANIZATION OPERATED KITCHENS AND
CONTRACTED MEAL PROVIDERS. MEALS ON WHEELS DELIVERED 159,596 MEALS TO
1,170 HOMEBOUND SENIORS.
TWENTY-SEVEN CONGREGATE LUNCHEON CENTERS
PROVIDED 43,590 MEALS TO 1,784 SENIORS.
EXPENSES
$
1,091,088.
INCLUDING GRANTS OF
WEATHERIZATION/ENERGY ASSISTANCE
-
$
401,764,
$
305,138.
WEATHERIZATION IS THE NECESSARY WORK
LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
-
REVENUE
Schedule 0 (Form 990 or 990-EZ) (2013)
_________
Schedule 0 (Form 990 or 990EZ) (2013)
Page 2
Employer identification number
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Name of the organization
38—2027389
NEEDED TO IMPROVE THE PERFORMANCE OF A HOME OR BUILDING.
INCLUDE SUCH THINGS AS AIR SEALING,
REPLACEMENT,
PRESSURE BALANCING,
INSULATION,
MEASURES MAY
WINDOW/DOOR
DUCT SEALING AND INSULATION,
ETC.
THESE MEASURES ARE COMPLETED IN ACCORDANCE TO STATE AND LOCAL CODES,
AND TO THE NATIONAL RENEWABLE ENERGY LABORATORY’S STANDARD WORK
SPECIFICATIONS.
ENERGY ASSISTANCE IS ASSISTANCE AVAILABLE FOR
DELIVERED FUELS AND METERED UTILITIES USED FOR HOME HEATING.
EXPENSES
FORM 990,
$
504,031.
PART VI,
THE FORM 990
INCLUDING GRANTS OF
SECTION B,
$
296,228.
REVENUE
$
850.
LINE 11:
IS PRESENTED TO NORTHWEST MICHIGAN COMMUNITY
ACTION AGENCY,
INC.
BOARD OF DIRECTORS FOR REVIEW AND APPROVAL BEFORE
FILING WITH THE INTERNAL REVENUE SERVICE.
FORM 990,
PART VI,
SECTION B,
LINE 12C:
THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY AT THE
BOARD OF DIRECTORS SEMINAR.
BOARD MEMBERS DISCLOSE CONFLICTS OF INTEREST
TO THE BOARD OR SIGN A STATEMENT AFFIRMING NO CONFLICT OF INTEREST.
AN
INDIVIDUAL WITH A CONFLICT OF INTEREST MAY NOT PARTICIPATE IN DISCUSSION OF
THE MATTER WITH WHICH THE CONFLICT ARISES AND SHALL ABSTAIN FROM VOTING ON
THE MATTER.
MINUTES SHALL INDICATE THE DISCLOSED CONFLICT OF INTEREST IN
THE MATTER BEING CONSIDERED BY THE BOARD,
IN THE DISCUSSION,
WHETHER SAID MEMBER PARTICIPATED
AND THAT SAID MEMBER ABSTAINED FROM VOTING ON THE
MATTER.
FORM 990,
PART VI,
SECTION B,
LINE 15:
THE ORGANIZATION PARTICIPATES IN A NUMBER OF WAGE STUDIES AND
THE SALARIES OF KEY EMPLOYEES ARE LARGELY DETERMINED BY THE HEAD START
Sd
ule 0
,0 o 990 Fl) (2
Schedu’e 0 (Form 990 or990-EZ) (2013)
Name of the organization
Page 2
Employer identification number
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
38-2027389
THE EXECUTIVE COMMITTEE USES WAGE COMPARABILITY INFORMATION TO
BUDGET.
DETERMINE ANNUAL CHANGES
DIRECTOR.
(IF ANY)
TO THE COMPENSATION OF THE EXECUTIVE
THE EXECUTIVE COMMITTEE’S RECOMMENDATIONS ARE PRESENTED TO THE
FULL BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL.
THE EXECUTIVE DIRECTOR
THEN DEVELOPS THE SALARY SCHEDULE FOR THE REMAINING EMPLOYEES OF THE
ORGANIZATION.
FORM 990,
PART VI,
SECTION C,
LINE 19:
THE NORTHWEST MICHIGAN COMMUNITY ACTION AGENCY,
INC.
(NNCAA)
WEB SITE HOME PAGE LISTS THE TELEPHONE NUMBER, ADDRESS AND BUSINESS HOURS
OF THE ORGANIZATION’S MAIN OFFICE WHERE THE BOARD OF DIRECTORS MINUTES,
CONFLICT OF INTEREST POLICY, AUDITED FINANCIAL STATEMENTS AND 990 TAX
RETURN CAN BE ACCESSED.
FORM 990,
PART XII,
LINE 2C:
THE EXECUTIVE DIRECTOR PROVIDES MONTHLY FINANCIAL AND
THE
PROGRAMMATIC REPORTS TO ALL MEMBERS OF THE BOARD FOR REVIEW.
EXECUTIVE COMMITTEE IS INFORMED OF THE PROGRESS REGARDING PREPARATION
FOR THE AUDIT.
THE AUDIT FIRM REPORTS THE RESULTS OF THE AUDIT TO THE
EXECUTIVE COMMITTEE AND THE FULL BOARD OF DIRECTORS AT THE COMPLETION
OF FIELD WORK.
THE AUDIT IS PLACED FOR COMPETITIVE BIDDING TO CONTRACT FOR A FIVE YEAR
TERM.
THE AUDIT PROPOSALS ARE SCORED ON A POINTS SYSTEM BASED ON
SEVERAL CRITERIA.
THE EXECUTIVE COMMITTEE PARTICIPATES IN THE SCORING
EVALUATION AND REPORTS THE COMMITTEE’S RECOMMENDATION TO THE FULL BOARD
OF DIRECTORS FOR APPROVAL OR FUTHER CONSIDERATIONS
Sc
F
990
990 E7)(20
AGENCY,
INC.
-
49686
ERVICES
1EATHERIZATION/REHABILITATI
(b)
Primary activity
26 4003450,
49686
-
REDIT COUNSELING
14
LHA
(c)
Legal domicile (state or
foreign country)
ICHIGAN
SEE PART VII FOR CONTINUATIONS
Paperwork Reduction Act Notice, see the Instructions for Form 990.
MI
3963 THREE MILE ROAD N.,
TRAVERSE CITY,
INC.
(b)
Primary activity
(a)
Name, address, and EIN
of related organization
organizations during the tax year.
CONMUNITY ACTION CREDIT COUNSELING,
(1
IICHIGAN
(c)
Legal domicile (state or
foreign country)
WAIW
(d)
Total income
0.
-6,941.
(e)
End-of-year assets
GENCY,
INC.
OMMUNITY ACTION
ORTHWEST MICHIGAN
(f)
Direct controlling
entity
38-2027389
Open to Public
Inspection
Employer identification number
2013
0MB No. 1545-0047
01(C)(3)
Exempt Code
section
(d)
SINE 7
Public charity
status (if section
501 (c)(3))
(e)
x
yes
entity?
No
Section
2lb613,
controlled
Schedule R (Form 990) 2013
OMMUNITY ACTION
II CHIGAN
TORTHWEST
Direct controlling
entity
(f)
Identification of Related Tax-Exempt Organizations Complete if the organization answered ‘Yes’ on Form 990, Part IV, line 34 because it had one or more related tax-exempt
MI
3963 THREE MILE ROAD N.,
LLC
(a)
Name, address, and EIN (if applicable)
of disregarded entity
TIJVERSE CITY,
F-
Form 990) and its instructions is at
Identification of Disregarded Entities Complete if the organization answered ‘Yes” on Form 990, Part IV, line 33.
0377643,
Part II
Information about S’°”’
“Complete if the organization answered Yes” on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
i. Attach to Form 990.
See separate instructions.
Related Organizations and Unrelated Partnerships
NORTHWEST MICHIGAN CO’fl4TJNITY ACTION
iNNOVATIVE ENERGY MANAGEMENT,
Part I
Name of the organization
O 0 ci the Treanurt
al Reoriue &rvice
Ito
HEDULE R
o m 990)
2 03
Part v
(b)
Primary activity
(c)
country)
Lecjal
domicile
(state or
foreign
(d)
Direct controlling
entity
(e)
Predominant income
(related, unrelated
excluded from tax under
sections 512.514)
38—2027389
(f)
Share of total
income
(g)
Share of
endof-year
assets
Yes
No
—
allocali000s
DispropoSonate
(h)
page
(i)
(k)
(j)
General or Percentage
Code V-UBl
amount in box managing ownership
20 of Schedule EtnfI
K1 (Form 1065) fe? No
Yes on Form 990, Part IV, line 34 because it had one or more related
213
(a)
Name, address, and EIN
of related organization
(b)
Primary activity
country)
foreign
Legal domicile
(state or
(c)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
—_______________
(f)
Share of total
income
(h)
Percentage
ownership
Yes
—
(i)
No
Section
bl2lbXl3l
controlled
entity?
Schedule R (Form 990)2013
(g)
Share of
endofyear
assets
Identification of Related Organizations Taxable as a Corporation or Trust Complete if the organization answered ‘Yes” on Form 990, Part IV, line 34 because it had one or more related
organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN
of related organization
NORTHWEST MICHIGAN COMMUNITY ACTION
INC.
AGENCY,
edu e R (Form 9901 2013
of Related Organizations Taxable as a Partnership Complete if the organization answered
Part in Identification
organizations treated as a partnership during the tax year.
Drjidends from related organization(s)
g Saie of assets to related organization(s)
h Purchase of assets from related organization(s)
i Exchange of assets with related organization(s)
Lease of facilities, equipment, or other assets to related organization(s)
.
.
.
.
j6)
(5)
.
.
.
.
.
.
.
.
.
.
d3 o-i2 13
(a)
Name of related organization
(b)
Transaction
type (a.s)
(c)
Amount involved
is
.Ji_
Ja.
J.i
—
—
Yes
X
2L..
X
X
X
2L..
X
—
No
Page3
Schedule R (Form 990)2013
(d)
Method of determining amount involved
.
...!Z.
...12.
..IL
1k
.J.L.
.JL.
ig
ih
j..
j..
j.
38—2027389
Other transfer of cash or property to related organization(s)
.)ther transfer of cash or property from related organization(s)
If the answer to any of the above is ‘Yes.’ see the instructions for information on who must comolete this line, including covered relationships and transaction thresholds.
p Reimbursement paid to related organization(s) for expenses
i Reimbursement paid by related organization(s) for expenses
...
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
o Sharing of paid employees with related organization(s)
k Lease of facilities, equipment, or other assets from related organization(s)
I Performance of services or membership or fundraising solicitations for related organization(s)
m Performance of services or membership or fundraising solicitations by related organization(s)
(4)
(3)
(2)
(1)
Transactions With Related Organizations Complete if the organization answered ‘Yes’ on Form 990, Part IV, line 34, 35b, or 36.
te. Complete line 1 if any entity is listed in Parts II, Ill, or IV of this schedule
During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts Il-IV?
Receipt of (I) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity
b Gift, grant, or capital contribution to related organization(s)
Gift, grant, or capital contribution from related organization(s)
Loans or loan guarantees to or for related organization(s)
o Loans or loan guarantees by related organization(s)
Part V
ScIedule R(Form99O)2013
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Unrelated Organizations Taxable as a Partnership Complete if the organization answered Yes’ on Form 990, Part IV, line 37.
382O27389
Paae4
Schedule R (Form 990)2013
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue)
that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(j)
(k)
(I)
(h)
(f)
(g)
(e)
(d)
(c)
(b)
(a)
Are all
Gener& or Percentage
Dispropor
Code V-UBI
Share of
Predominant income parrera see
Share of
Legal domicile
Primary activity
Name, address, and EIN
tionate amount in box 20 managing
(related unrelated,
501(cll3)
ownership
end-of-year
total
(state or foreign
of entity
allocatiorsn of Schedule K-i portn
excludd from tax
i0
assets
income
country)
1065)
(Form
under section 512-514)
.,
No
Part VI
ScheduleR(Form99O)2013
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
NORTHWEST MICHIGAN COMMUNITY ACTION
AGENCY, INC.
Supplemental Information
ScheduleR(F0rm990)2013
382O27389
Page5
Provide additional information for responses to questions on Schedule R (see instructions).
PART II,
IDENTIFICATION OF RELATED TAX-EXEMPT ORGANIZATIONS:
NAME OF RELATED ORGANIZATION:
CONMUNITY ACTION CREDIT COUNSELING,
INC.
DIRECT CONTROLLING ENTITY: NORTHWEST MICHIGAN COMMUNITY ACTION AGENCY,
INC.
e
e
Fo
gqO2OlS
________
____________________
Form
(Rev. January2014)
Application for Extension of Time To File an
Exempt Organization Return
Department of the Treasury
internal Revenue Service
File a separate application for each return.
Information about Form 8868 and its instructions is at www.irs.gov/form8a68
8868
0MB No. 1545-1709
• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box
• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.
Electronic filing (e-file) You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation
required to file Form 990-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension
of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain
Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form,
visit www.irs.gov/efile and click on e-file for Charities & Nonprofits.
[Part
Automatic 3-Month Extension of Time.
I
Only submit original (no copies needed).
A corporation required to file Form 990-T and requesting an automatic 6-month extension check this box and complete
Partlonly
All other corporations (including 1120-C filers, partnerships, REM!Cs, and trusts must use Form 7004 to request an extension of time
to file income tax returns.
Enter filer’s
-
-
fr4ntifuinq
number
Employer identification number (EIN) or
Type or
Name of exempt organization or other filer, see instructions.
print
NORTHWEST MICHIGAN COM4UNITY ACTION
AGENCY, INC.
Fiie by the
due date for
38—2027389
Social security number (SSN)
Number, street, and room or suite no. If a P.O. box, see instructions.
fiiingyour
return. See
3963 THREE MILE ROAD N
instructions.
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
TRAVERSE CITY, MI
49686
I0I1I
Enter the Return code for the return that this application is for (file a separate application for each return)
Return
Application
Code
Is For
Form 990 or Form 990-EZ
Form 990-BL
Form 4720 (individual)
01
02
03
04
Form 990-PF
Form 990-T (sec. 401 (a) or 408(a) trust)
Form 990-T (trust other than above)
05
06
Return
Code
Application
Is For
Form 990-T (corporation)
07
Form 1041-A
Form 4720 (other than individual)
08
09
Form 5227
Form 6069
Form 8870
10
DANIEL DEWEY
THREE MILE ROAD
• Thebooksareinthecareof 3963
N.
11
12
TRAVERSE CITY,
—
49686
MI
FaxNo.
TelephoneNo.- 231947—3780
• If the organization does not have an office or place of business in the United States, check this box
If this is for the whole group, check this
• If this is for a Group Return, enter the organization’s four digit Group Exemption Number (GEN)
and attach a list with the names and EINs of all members the extension is for.
If it is for oart of the orouo. check this box
box ‘
-
El
-
1
I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time until
MAY 15 , 2 0 15
to file the exempt organization return for the organization named above. The extension
is for the organization’s return for:
,
[El calendar year
r.L1 taxyearbeginning
2
or
OCT
1,
2013
,andending
If the tax year entered in line 1 is for less than 12 months, check reason:
Change in accounting period
SEP
El
30,
Initial return
2014
El
Final return
El
3a
b
If this application is for Forms 990-BL. 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions.
If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit.
3a
$
0
3b
$
0
Balance due. Subtract line 3b from line 3a. Include your payment with this form, if required,
0
3c
$
by using EFIPS (Electronic Federal Tax Payment System). See instructions.
Caution. If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-EQ and Form 8879-EQ for payment
instructions.
c
LHA
323811
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form 8868 (Rev. 1-2014)