HomeMy WebLinkAbout6-30-2022 990 Collective Impact in New Hanover County, Inc - Copy for Public InspectionCheckifself-employed
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Check ifapplicable:
AddresschangeNamechangeInitialreturn
Finalreturn/termin-ated Gross receipts $
AmendedreturnApplica-tionpending Are all subordinates included?
132001 12-09-21
Beginning of Current Year
Paid
Preparer
Use Only
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
| Do not enter social security numbers on this form as it may be made public.Open to Public Inspection| Go to www.irs.gov/Form990 for instructions and the latest information.
A For the 2021 calendar year, or tax year beginning and ending
B C D Employer identification number
E
G
H(a)
H(b)
H(c)
F Yes No
Yes No
I
J
K
Website: |
L M
1
2
3
4
5
6
7
3
4
5
6
7a
7b
a
bAc
t
i
v
i
t
i
e
s
&
G
o
v
e
r
n
a
n
c
e
Prior Year Current Year
8
9
10
11
12
13
14
15
16
17
18
19
Re
v
e
n
u
e
a
bEx
p
e
n
s
e
s
End of Year
20
21
22
Sign
Here
Yes No
For Paperwork Reduction Act Notice, see the separate instructions.
(or P.O. box if mail is not delivered to street address) Room/suite
)501(c)(3) 501(c) ((insert no.) 4947(a)(1) or 527
|Corporation Trust Association OtherForm of organization:Year of formation:State of legal domicile:
|
|
Ne
t
A
s
s
e
t
s
o
r
Fu
n
d
B
a
l
a
n
c
e
s
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.
Signature of officer Date
Type or print name and title
Date PTINPrint/Type preparer's name Preparer's signature
Firm's name Firm's EIN
Firm's address
Phone no.
Form
Name of organization
Doing business as
Number and street Telephone number
City or town, state or province, country, and ZIP or foreign postal code
Is this a group return
for subordinates?Name and address of principal officer:~~
If "No," attach a list. See instructions
Group exemption number |
Tax-exempt status:
Briefly describe the organization's mission or most significant activities:
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 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2021 (Part V, line 2a)
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, Part I, line 11
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
••••••••••••••••••
Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~
Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) •••
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
~~~~~~~~~~~
~~~~~~~~~~~~~
~~~
Professional fundraising fees (Part IX, column (A), line 11e)
Total fundraising expenses (Part IX, column (D), line 25)
~~~~~~~~~~~~~~
Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)
Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 18 from line 12
~~~~~~~~~~~~~
~~~~~~~
••••••••••••••••
Total assets (Part X, line 16)
Total liabilities (Part X, line 26)
Net assets or fund balances. Subtract line 21 from line 20
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~
••••••••••••••
May the IRS discuss this return with the preparer shown above? See instructions •••••••••••••••••••••
LHA Form (2021)
Part I Summary
Signature BlockPart II
990
Return of Organization Exempt From Income Tax990 2021
§
==
999
EXTENDED TO MAY 15, 2023
JUL 1, 2021 JUN 30, 2022
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
PO BOX 7746 919-607-24171,662,585.WILMINGTON, NC 28406LYDIA NEWMAN XSAME AS C ABOVEXWWW.CAPEFEARCOLLECTIVE.ORGX 2019 NC
CFC'S MISSION IS TO SCALE BIGDATA, FUNDRAISING, SOCIAL INNOVATION, AND LARGE-SCALE INITIATIVE
101011130.0.
1,194,366. 660,792.0. 1,017,836.1,987.531.0. -16,574.1,196,353. 1,662,585.0.0.0.0.555,651. 1,116,817.0.0.36,818.359,449. 418,177.915,100. 1,534,994.281,253. 127,591.
759,150. 3,303,681.12,587. 2,429,527.746,563. 874,154.
MEAGHAN DENNISON, CEO
JOHN M. ROBINSON JOHN M. ROBINSON 05/15/23 P01281319BERNARD ROBINSON & COMPANY, LLP 56-0571159PO BOX 19608GREENSBORO, NC 27419-9608 336-294-4494X
SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION
Copy for Public Inspection
Code:Expenses $including grants of $Revenue $
Code:Expenses $including grants of $Revenue $
Code:Expenses $including grants of $Revenue $
Expenses $including grants of $Revenue $
132002 12-09-21
1
2
3
4
Yes No
Yes No
4a
4b
4c
4d
4e
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part III ••••••••••••••••••••••••••••
Briefly describe the organization's mission:
Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ?
If "Yes," describe these new services on Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization cease conducting, or make significant changes in how it conducts, any program services?
If "Yes," describe these changes on Schedule O.
~~~~~~
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.
() () ()
() () ()
() () ()
Other program services (Describe on Schedule O.)
() ()
Total program service expenses |
Form (2021)
2Statement of Program Service AccomplishmentsPart III
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
X
FOUNDED IN 2019, THE CAPE FEAR COLLECTIVE (CFC) IS A COLLECTIVE IMPACT
AND DATA SCIENCE NONPROFIT BACKBONE ORGANIZATION BASED IN WILMINGTON,
NORTH CAROLINA. BORN OUT OF THE CORPORATE SECTOR, CFC'S MISSION IS TO
SCALE BIG DATA, FUNDRAISING, SOCIAL INNOVATION, AND LARGE-SCALE
X
X
1,171,711.1,001,262.
COLLECTIVE IMPACT IN NEW HANOVER COUNTY (DBA CAPE FEAR COLLECTIVE) IS
WORKING ON THE FOLLOWING STRATEGIC PRIORITIES:
DRIVE DATA COLLABORATION AND ECOSYSTEM ALIGNMENT
PROVIDE INSIGHTS TO THE SOCIAL IMPACT SECTOR BY CREATING AN OPEN SOURCE
DATA PLATFORM THAT BUILDS OPERATIONAL EFFICIENCY AND EXPANDS
FUNDRAISING OPPORTUNITIES THAT RESULT IN IMPROVED LIFE OUTCOMES FOR ALL
PEOPLE.
BEAR WITNESS AND AMPLIFY COMMUNITY VOICES
BEAR WITNESS TO THE SYSTEMIC, STRUCTURAL INEQUITIES AND INJUSTICES
FACING THE CAPE FEAR REGION AND AMPLIFY THE VOICES OF CITIZENS,
1,171,711.
SEE SCHEDULE O FOR CONTINUATION(S)
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
4
Copy for Public Inspection
132003 12-09-21
Yes No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
1
2
3
4
5
6
7
8
9
10
Section 501(c)(3) organizations.
a
b
c
d
e
f
a
b
11a
11b
11c
11d
11e
11f
12a
12b
13
14a
14b
15
16
17
18
19
20a
20b
21
a
b
20
21
a
b
If "Yes," complete Schedule A
Schedule B, Schedule of Contributors
If "Yes," complete Schedule C, Part I
If "Yes," complete Schedule C, Part II
If "Yes," complete Schedule C, Part III
If "Yes," complete Schedule D, Part I
If "Yes," complete Schedule D, Part II
If "Yes," complete
Schedule D, Part III
If "Yes," complete Schedule D, Part IV
If "Yes," complete Schedule D, Part V
If "Yes," complete Schedule D,
Part VI
If "Yes," complete Schedule D, Part VII
If "Yes," complete Schedule D, Part VIII
If "Yes," complete Schedule D, Part IX
If "Yes," complete Schedule D, Part X
If "Yes," complete Schedule D, Part X
If "Yes," complete
Schedule D, Parts XI and XII
If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional
If "Yes," complete Schedule E
If "Yes," complete Schedule F, Parts I and IV
If "Yes," complete Schedule F, Parts II and IV
If "Yes," complete Schedule F, Parts III and IV
If "Yes," complete Schedule G, Part I.
If "Yes," complete Schedule G, Part II
If "Yes,"
complete Schedule G, Part III
If "Yes," complete Schedule H
If "Yes," complete Schedule I, Parts I and II
Form 990 (2021)Page
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Is the organization required to complete ? See instructions
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for
public office?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization engage in lobbying activities, or have a section 501(h) election in effect
during the tax year?
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 Rev. Proc. 98-19?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
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?
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures?
Did the organization maintain collections of works of art, historical treasures, or other similar assets?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
Did the organization, directly or through a related organization, hold assets in donor-restricted endowments
or in quasi endowments?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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.
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
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?
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
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?
Did the organization report an amount for other liabilities in Part X, line 25?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
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)?
Did the organization obtain separate, independent audited financial statements for the tax year?
~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Was the organization included in consolidated, independent audited financial statements for the tax year?
~~~~~
Is the organization a school described in section 170(b)(1)(A)(ii)?
Did the organization maintain an office, employees, or agents outside of the United States?
~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~
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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any
foreign organization?
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?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
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 11e? See instructions ~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines
1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~~
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? ~~~~~~~~~~
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or
domestic government on Part IX, column (A), line 1? ~~~~~~~~~~~~~~••••••••••••••
Form (2021)
3Part IV Checklist of Required Schedules
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
5
Copy for Public Inspection
132004 12-09-21
Yes No
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
22
23
24a
24b
24c
24d
25a
25b
26
27
28a
28b
28c
29
30
31
32
33
34
35a
35b
36
37
38
a
b
c
d
a
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations.
a
b
c
a
b
Section 501(c)(3) organizations.
Note:
Yes No
1a
b
c
1a
1b
1c
(continued)
If "Yes," complete Schedule I, Parts I and III
If "Yes," complete
Schedule J
If "Yes," answer lines 24b through 24d and complete
Schedule K. If "No," go to line 25a
If "Yes," complete Schedule L, Part I
If "Yes," complete
Schedule L, Part I
If "Yes," complete Schedule L, Part II
If "Yes," complete Schedule L, Part III
If
"Yes," complete Schedule L, Part IV
If "Yes," complete Schedule L, Part IV
If
"Yes," complete Schedule L, Part IV
If "Yes," complete Schedule M
If "Yes," complete Schedule M
If "Yes," complete Schedule N, Part I
If "Yes," complete
Schedule N, Part II
If "Yes," complete Schedule R, Part I
If "Yes," complete Schedule R, Part II, III, or IV, and
Part V, line 1
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part V, line 2
If "Yes," complete Schedule R, Part VI
Form 990 (2021)Page
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on
Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization's current
and former officers, directors, trustees, key employees, and highest compensated employees?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease
any tax-exempt bonds?
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~
Did the organization engage in an excess benefit
transaction with a disqualified person during the year?
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?
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current
or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35%
controlled entity or family member of any of these persons?~~~~~~~~~~~~~
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee,
creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity (including an employee thereof) or family member of any of these persons? ~~~
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV,
instructions for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
A family member of any individual described in line 28a?
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b?
~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization receive more than $25,000 in non-cash contributions?
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation
contributions?
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization liquidate, terminate, or dissolve and cease operations?
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?
~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3?
Was the organization related to any tax-exempt or taxable entity?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
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 512(b)(13)?
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~
Did the organization make any transfers to an exempt non-charitable related organization?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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? ~~~~~~~~
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19?
All Form 990 filers are required to complete Schedule O •••••••••••••••••••••••••••••••
Check if Schedule O contains a response or note to any line in this Part V •••••••••••••••••••••••••••
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable~~~~~~~~~~
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming
(gambling) winnings to prize winners?•••••••••••••••••••••••••••••••••••••••••••
Form (2021)
4Part IV Checklist of Required Schedules
Part V Statements Regarding Other IRS Filings and Tax Compliance
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
X
X
X
X
X
X
X
XX
XX
XX
X
X
X X
X
X
X
130
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 6
Copy for Public Inspection
132005 12-09-21
Yes No
2
3
4
5
6
7
a
b
2a
Note:
2b
3a
3b
4a
5a
5b
5c
6a
6b
7a
7b
7c
7e
7f
7g
7h
8
9a
9b
a
b
a
b
a
b
c
a
b
Organizations that may receive deductible contributions under section 170(c).
a
b
c
d
e
f
g
h
7d
8
9
10
11
12
13
14
15
16
17
Sponsoring organizations maintaining donor advised funds.
Sponsoring organizations maintaining donor advised funds.
a
b
Section 501(c)(7) organizations.
a
b
10a
10b
Section 501(c)(12) organizations.
a
b
11a
11b
a
b
Section 4947(a)(1) non-exempt charitable trusts. 12a
12b
Section 501(c)(29) qualified nonprofit health insurance issuers.
Note:
a
b
c
a
b
13a
13b
13c
14a
14b
15
16
17
Section 501(c)(21) organizations.
~~~~~~~~~~~~~~
(continued)
e-file.
If "No" to line 3b, provide an explanation on Schedule O
If "No," provide an explanation on Schedule O
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?
Form (2021)
Form 990 (2021)Page
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,
filed for the calendar year ending with or within the year covered by this return~~~~~~~~~~
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
If the sum of lines 1a and 2a is greater than 250, you may be required to See instructions.
~~~~~~~~~~
~~~~~~~~~~~
Did the organization have unrelated business gross income of $1,000 or more during the year?
If "Yes," has it filed a Form 990-T for this year?
~~~~~~~~~~~~~~
~~~~~~~~~~
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)?~~~~~~~
If "Yes," enter the name of the foreign country
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
~~~~~~~~~~~~
~~~~~~~~~
If "Yes" to line 5a or 5b, did the organization file Form 8886-T?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts
were not tax deductible?
~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization notify the donor of the value of the goods or services provided?
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required
to file Form 8282?
~~~~~~~~~~~~~~~
••••••••••••••••••••••••••••••••••••••••••••••••••••
If "Yes," indicate the number of Forms 8282 filed during the year
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
~~~~~~~~~~~~~~~~
~~~~~~~
~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
~
Did a donor advised fund maintained by the
sponsoring organization have excess business holdings at any time during the year? ~~~~~~~~~~~~~~~~~~~
Did the sponsoring organization make any taxable distributions under section 4966?
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
~~~~~~~~~~~~~~~
~~~~~~
Enter:
Gross income from members or shareholders
Gross income from other sources. (Do not net amounts due or paid to other sources against
amounts due or received from them.)
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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 ••••••
Is the organization licensed to issue qualified health plans in more than one state?
See the instructions for additional information the organization must report on Schedule O.
~~~~~~~~~~~~~~~~~~~~~
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 report these payments?
~~~~~~~~~~~~~~~~
~~~~~~~~~
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment(s) during the year?
If "Yes," see the instructions and file Form 4720, Schedule N.
Is the organization an educational institution subject to the section 4968 excise tax on net investment income?
If "Yes," complete Form 4720, Schedule O.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the trust, any disqualified person, or mine operator engage in any
activities that would result in the imposition of an excise tax under section 4951, 4952 or 4953?
If "Yes," complete Form 6069.
5Part V Statements Regarding Other IRS Filings and Tax Compliance
990
J
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
11 X
X
X
XX
X
X
X
XX
X
X
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 7
Copy for Public Inspection
132006 12-09-21
Yes No
1a
1b
1
2
3
4
5
6
7
8
9
a
b
2
3
4
5
6
7a
7b
8a
8b
9
a
b
a
b
Yes No
10
11
a
b
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
a
b
12a
b
c
13
14
15
a
b
16a
b
17
18
19
20
For each "Yes" response to lines 2 through 7b below, and for a "No" response
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions.
If "Yes," provide the names and addresses on Schedule O
(This Section B requests information about policies not required by the Internal Revenue Code.)
If "No," go to line 13
If "Yes," describe
on Schedule O how this was done
(explain on Schedule O)
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 on Schedule O.
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts?
Form (2021)
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part VI •••••••••••••••••••••••••••
Enter the number of voting members of the governing body at the end of the tax year
Enter the number of voting members included on line 1a, above, who are independent
~~~~~~
~~~~~~
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?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization delegate control over management duties customarily performed by or under the direct supervision
of officers, directors, 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?
~~~~~
~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or
persons other than the governing body?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
The governing body?
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
organization's mailing address? •••••••••••••••••
Did the organization have local chapters, branches, or affiliates?
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?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
Describe on Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~~
~~~~~~
Did the organization regularly and consistently monitor and enforce compliance with the policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
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?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a
taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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?••••••••••••••••••••••••••••••••••••
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, 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
Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial
statements available to the public during the tax year.
State the name, address, and telephone number of the person who possesses the organization's books and records |
6Part VI Governance, Management, and Disclosure.
Section A. Governing Body and Management
Section B. Policies
Section C. Disclosure
990
J
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
X
10
10
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
NC
X X X
MEAGHAN DENNISON - 919-607-2417
PO BOX 7746, WILMINGTON, NC 28406
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
8
Copy for Public Inspection
In
d
i
v
i
d
u
a
l
t
r
u
s
t
e
e
o
r
d
i
r
e
c
t
o
r
In
s
t
i
t
u
t
i
o
n
a
l
t
r
u
s
t
e
e
Off
i
c
e
r
Ke
y
e
m
p
l
o
y
e
e
Hig
h
e
s
t
c
o
m
p
e
n
s
a
t
e
d
em
p
l
o
y
e
e
Fo
r
m
e
r
(do not check more than onebox, unless person is both anofficer and a director/trustee)
132007 12-09-21
current
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a
current
current
former
former directors or trustees
(A)(B)(C)(D)(E)(F)
able compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations.
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part VII •••••••••••••••••••••••••••
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 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 key employees, if any. See the instructions for definition of "key employee."
¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received report-
¥ List all of the organization's officers, key employees, and highest compensated employees who received more than $100,000 ofreportable compensation from the organization and any related organizations.
¥ List all of the organization's 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.
See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
PositionName and title Average
hours per
week
(list anyhours for
related
organizations
below
line)
Reportable
compensation
from
theorganization
(W-2/1099-MISC/
1099-NEC)
Reportable
compensation
from related
organizations(W-2/1099-MISC/
1099-NEC)
Estimated
amount of
other
compensationfrom the
organization
and related
organizations
Form (2021)
7Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest CompensatedEmployees, and Independent Contractors
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
(1) NICHOLAS PYLYPIW 40.00
CHIEF DATA OFFICER X 106,388.0. 21,613.
(2) PATRICK BRIEN 40.00
OUTGOING CEO X 95,000.0.0.
(3) MEAGHAN DENNISON 40.00
INCOMING CEO X 79,256.0. 8,795.
(4) LYDIA NEWMAN 1.00
CHAIR X X 0.0.0.
(5) KATE GROAT 1.00
VICE CHAIR X X 0.0.0.
(6) JOE FINLEY 1.00
TREASURER X X 0.0.0.
(7) TERRI EVERETT 1.00
SECRETARY X X 0.0.0.
(8) DINESH APTE 1.00
DIRECTOR X 0.0.0.
(9) DAVIS BRANNAN 1.00
DIRECTOR X 0.0.0.
(10) CHARRISE HART 1.00
DIRECTOR X 0.0.0.
(11) JEANINE MINGE 1.00
DIRECTOR X 0.0.0.
(12) GIRARD NEWKIRK 1.00
DIRECTOR X 0.0.0.
(13) AVERY WASHINGTON 1.00
DIRECTOR X 0.0.0.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 9
Copy for Public Inspection
Fo
r
m
e
r
In
d
i
v
i
d
u
a
l
t
r
u
s
t
e
e
o
r
d
i
r
e
c
t
o
r
In
s
t
i
t
u
t
i
o
n
a
l
t
r
u
s
t
e
e
Off
i
c
e
r
Hig
h
e
s
t
c
o
m
p
e
n
s
a
t
e
d
em
p
l
o
y
e
e
Ke
y
e
m
p
l
o
y
e
e
(do not check more than onebox, unless person is both anofficer and a director/trustee)
132008 12-09-21
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
(B)(C)(A)(D)(E)(F)
1b
c
d
Subtotal
Total from continuation sheets to Part VII, Section A
Total (add lines 1b and 1c)
2
Yes No
3
4
5
former
3
4
5
Section B. Independent Contractors
1
(A)(B)(C)
2
(continued)
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such individual
If "Yes," complete Schedule J for such person
Page Form 990 (2021)
PositionAverage
hours per
week(list any
hours for
related
organizations
below
line)
Name and title Reportable
compensation
from
theorganization
(W-2/1099-MISC/
1099-NEC)
Reportable
compensation
from related
organizations(W-2/1099-MISC/
1099-NEC)
Estimated
amount of
other
compensationfrom the
organization
and related
organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
~~~~~~~~~~ |
•••••••••••••••••••••••• |
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable
compensation from the organization |
Did the organization list any officer, director, trustee, key employee, or highest compensated employee on
line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization
and related organizations greater than $150,000? ~~~~~~~~~~~~~
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services
rendered to the organization? ••••••••••••••••••••••••
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 organization's tax year.
Name and business address Description of services Compensation
Total number of independent contractors (including but not limited to those listed above) who received more than
$100,000 of compensation from the organization |
Form (2021)
8Part VII
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
280,644.0. 30,408.0.0.0.280,644.0. 30,408.
1
X
X
X
NONE
0
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 10
Copy for Public Inspection
Noncash contributions included in lines 1a-1f
132009 12-09-21
Business Code
Business Code
Total revenue.
(A)(B)(C)(D)
1 a
b
c
d
e
f
1
1
1
1
1
1
1
a
b
c
d
e
f
gg
Co
n
t
r
i
b
u
t
i
o
n
s
,
G
i
f
t
s
,
G
r
a
n
t
s
an
d
O
t
h
e
r
S
i
m
i
l
a
r
A
m
o
u
n
t
s
h Total.
a
b
c
d
e
f
g
2
Pr
o
g
r
a
m
S
e
r
v
i
c
e
Re
v
e
n
u
e
Total.
3
4
5
6 a
b
c
d
6a
6b
6c
7 a
7a
7b
7c
b
c
d
a
b
c
8
8a
8b
9 a
b
c
9a
9b
10 a
b
c
10a
10b
Ot
h
e
r
R
e
v
e
n
u
e
11 a
b
c
d
eMi
s
c
e
l
l
a
n
e
o
u
s
Re
v
e
n
u
e
Total.
12
Revenue excludedfrom tax undersections 512 - 514
All other contributions, gifts, grants, and
similar amounts not included above
Gross amount from sales of
assets other than inventory
cost or other basis
and sales expenses
Gross income from fundraising events
See instructions
Form (2021)
Page Form 990 (2021)
Check if Schedule O contains a response or note to any line in this Part VIII •••••••••••••••••••••••••
Total revenue Related or exemptfunction revenue Unrelatedbusiness revenue
Federated campaigns
Membership dues
~~~~~
~~~~~~~
Fundraising events
Related organizations
~~~~~~~
~~~~~
Government grants (contributions)
~
$
Add lines 1a-1f ••••••••••••••••• |
All other program service revenue ~~~~~
Add lines 2a-2f ••••••••••••••••• |
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
~~~~~~~~~~~~~~~~~ |
|
Royalties ••••••••••••••••••••••• |
(i) Real (ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)
~~~~~
~
•••••••••••••• |
(i) Securities (ii) Other
Less:
Gain or (loss)
~~~
~~~~~
Net gain or (loss) ••••••••••••••••••• |
(not
including $of
contributions reported on line 1c). See
Part IV, line 18 ~~~~~~~~~~~~
Less: direct expenses~~~~~~~~~
Net income or (loss) from fundraising events ••••• |
Gross income from gaming activities. See
Part IV, line 19 ~~~~~~~~~~~~
Less: direct expenses
Net income or (loss) from gaming activities
~~~~~~~~
•••••• |
Gross sales of inventory, less returns
and allowances ~~~~~~~~~~~~
Less: cost of goods sold
Net income or (loss) from sales of inventory
~~~~~~~
•••••• |
All other revenue ~~~~~~~~~~~~~
Add lines 11a-11d ••••••••••••••• |
|•••••••••••••
9Part VIII Statement of Revenue
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
X
660,792.
660,792.
DATA SCIENCE EXPERTISE 541690 810,861. 810,861.
MANAGEMENT FEES 531110 202,017. 202,017.
RENTAL INCOME 531110 4,958. 4,958.
1,017,836.
531.531.
PASSTHROUGH INCOME CFC 900099 -6,114. -6,114.
INCOME FROM PARTNERSHI 900099 -10,460. -10,460.
-16,574.
1,662,585.1,001,262.0. 531.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
11
Copy for Public Inspection
Check here if following SOP 98-2 (ASC 958-720)
132010 12-09-21
Total functional expenses.
Joint costs.
(A)(B)(C)(D)
1
2
3
4
5
6
7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24
a
b
c
d
e
25
26
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).
Grants and other assistance to domestic organizations
and domestic governments. See Part IV, line 21
Compensation not included above to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Pension plan accruals and contributions (include
section 401(k) and 403(b) employer contributions)
Professional fundraising services. See Part IV, line 17
(If line 11g amount exceeds 10% of line 25,
column (A), amount, list line 11g expenses on Sch O.)
Other expenses. Itemize expenses not covered above. (List miscellaneous expenses on line 24e. Ifline 24e amount exceeds 10% of line 25, column (A),amount, list line 24e expenses on Schedule O.)
Add lines 1 through 24e
Complete this line only if the organization
reported in column (B) joint costs from a combined
educational campaign and fundraising solicitation.
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part IX ••••••••••••••••••••••••••
Total expenses Program serviceexpenses Management andgeneral expenses Fundraisingexpenses
~
Grants and other assistance to domestic
individuals. See Part IV, line 22 ~~~~~~~
Grants and other assistance to foreign
organizations, foreign governments, and foreign
individuals. See Part IV, lines 15 and 16 ~~~
Benefits paid to or for members~~~~~~~
Compensation of current officers, directors,
trustees, and key employees ~~~~~~~~
~~~
Other salaries and wages ~~~~~~~~~~
Other employee benefits ~~~~~~~~~~
Payroll taxes ~~~~~~~~~~~~~~~~
Fees for services (nonemployees):
Management
Legal
Accounting
Lobbying
~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Investment management fees
Other.
~~~~~~~~
Advertising and promotion
Office expenses
Information technology
Royalties
~~~~~~~~~
~~~~~~~~~~~~~~~
~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Occupancy ~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~Travel
Payments of travel or entertainment expenses
for any federal, state, or local public officials~
Conferences, conventions, and meetings ~~
Interest
Payments to affiliates
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~
Depreciation, depletion, and amortization
Insurance
~~
~~~~~~~~~~~~~~~~~
All other expenses
|
Form (2021)
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
10Statement of Functional ExpensesPart IX
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
165,209. 135,471. 24,781. 4,957.
786,712. 645,104. 118,007. 23,601.
87,888. 72,068. 13,183. 2,637.77,008. 63,147. 11,551. 2,310.
38,610.38,610.6,824.6,824.
4,805. 3,940.721.144.18,012. 4,280. 13,732.5,204.5,204.71,295. 58,542. 12,753.
1,200.984.180.36.
13,392. 11,032. 1,180. 1,180.25,250.25,250.
15,892. 15,708.184.7,070.7,070.
CONTRACTS 119,453. 114,571. 2,929. 1,953.HEALTH OPPORTUNITY PILO 30,323. 30,323.STAFF TRAINING 13,858.13,858.OTHER ADMINISTRATIVE EX 13,646.13,646.33,343. 16,541. 16,802.1,534,994. 1,171,711. 326,465. 36,818.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 12
Copy for Public Inspection
132011 12-09-21
(A)(B)
1
2
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
30
31
32
33
1
2
3
4
5
6
7
8
9
10c
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
a
b
10a
10b
As
s
e
t
s
Total assets.
Li
a
b
i
l
i
t
i
e
s
Total liabilities.
Organizations that follow FASB ASC 958, check here
and complete lines 27, 28, 32, and 33.
27
28
Organizations that do not follow FASB ASC 958, check here
and complete lines 29 through 33.
29
30
31
32
33
Ne
t
A
s
s
e
t
s
o
r
F
u
n
d
B
a
l
a
n
c
e
s
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part X •••••••••••••••••••••••••••••
Beginning of year End of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~
Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~
Loans and other receivables from any current or former officer, director,
trustee, key employee, creator or founder, substantial contributor, or 35%
controlled entity or family member of any of these persons ~~~~~~~~~
Loans and other receivables from other disqualified persons (as defined
under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ~~
Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
Land, buildings, and equipment: cost or other
basis. Complete Part VI of Schedule D
Less: accumulated depreciation
~~~
~~~~~~
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~
Add lines 1 through 15 (must equal line 33) ••••••••••
Accounts payable and accrued expenses
Grants payable
Deferred revenue
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~
Loans and other payables to any current or former officer, director,
trustee, key employee, creator or founder, substantial contributor, or 35%
controlled entity or family member of any of these persons ~~~~~~~~~
Secured mortgages and notes payable to unrelated third parties ~~~~~~
Unsecured notes and loans payable to unrelated third parties ~~~~~~~~
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X
of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines 17 through 25 ••••••••••••••••••
|
Net assets without donor restrictions
Net assets with donor restrictions
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
|
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
~~~~~~~~~~~~~~~
~~~~~~~~
~~~~
Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~
Total liabilities and net assets/fund balances ••••••••••••••••
Form (2021)
11Balance SheetPart X
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
234,668. 1,961,787.
397,584.
37,500.
75,821.5,513.
1,077.1,038.
679,856.
15,892.0.663,964.
50,000.343,426.
0.290,453.
759,150. 3,303,681.
12,587.49,875.
173,735.
1,864,250.
0.341,667.
12,587. 2,429,527.
X
746,563.836,654.
37,500.
746,563.874,154.
759,150. 3,303,681.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
13
Copy for Public Inspection
132012 12-09-21
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Yes No
1
2
3
a
b
c
2a
2b
2c
a
b
3a
3b
Form 990 (2021)Page
Check if Schedule O contains a response or note to any line in this Part XI ••••••••••••••••••••••••••••
Total revenue (must equal Part VIII, column (A), line 12)
Total expenses (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 2 from line 1
Net assets or fund balances at beginning of year (must equal Part X, line 32, 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 on Schedule O)
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32,
column (B))
~~~~~~~~~~~~~~~~~~
••••••••••••••••••••••••••••••••••••••••••••••••
Check if Schedule O contains a response or note to any line in this Part XII •••••••••••••••••••••••••••
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 on Schedule O.
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:
Separate basis Consolidated basis Both consolidated and separate basis
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
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 on Schedule O.
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 OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit
or audits, explain why on Schedule O and describe any steps taken to undergo such audits ••••••••••••••••
Form (2021)
12Part XI Reconciliation of Net Assets
Part XII Financial Statements and Reporting
990
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
1,662,585.1,534,994.127,591.746,563.
0.
874,154.
X
X
X
X
X
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 14
Copy for Public Inspection
(iv) Is the organization listedin your governing document?
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
132021 01-04-22
(i)(iii)(v)(vi)(ii) Name of supported
organization
Type of organization (described on lines 1-10 above (see instructions))
Amount of monetary
support (see instructions)
Amount of other
support (see instructions)
EIN
(Form 990)Complete if the organization is a section 501(c)(3) organization or a section4947(a)(1) nonexempt charitable trust.| Attach to Form 990 or Form 990-EZ. | Go to www.irs.gov/Form990 for instructions and the latest information.
Open to PublicInspection
Name of the organization Employer identification number
1
2
3
4
5
6
7
8
9
10
11
12
section 170(b)(1)(A)(i).
section 170(b)(1)(A)(ii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iii).
section 170(b)(1)(A)(iv).
section 170(b)(1)(A)(v).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(vi).
section 170(b)(1)(A)(ix)
section 509(a)(2).
section 509(a)(4).
section 509(a)(1) section 509(a)(2) section 509(a)(3).
a
b
c
d
e
f
g
Type I.
You must complete Part IV, Sections A and B.
Type II.
You must complete Part IV, Sections A and C.
Type III functionally integrated.
You must complete Part IV, Sections A, D, and E.
Type III non-functionally integrated.
You must complete Part IV, Sections A and D, and Part V.
Yes No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule A (Form 990) 2021
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
A church, convention of churches, or association of churches described in
A school described in (Attach Schedule E (Form 990).)
A hospital or a cooperative hospital service organization described in
A medical research organization operated in conjunction with a hospital described in 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
(Complete Part II.)
A federal, state, or local government or governmental unit described in
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in
(Complete Part II.)
A community trust described in (Complete Part II.)
An agricultural research organization described in operated in conjunction with a land-grant college
or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or
university:
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 (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See
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 or . See Check the box on
lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving
the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting
organization.
A supporting organization supervised or controlled in connection with its supported organization(s), by having
control or management of the supporting organization vested in the same persons that control or manage the supported
organization(s).
A supporting organization operated in connection with, and functionally integrated with,
its supported organization(s) (see instructions).
A supporting organization operated in connection with its supported organization(s)
that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness
requirement (see instructions).
Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III
functionally integrated, or Type III non-functionally integrated supporting organization.
Enter the number of supported organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Provide the following information about the supported organization(s).
LHA
SCHEDULE A
Part I Reason for Public Charity Status.
Public Charity Status and Public Support 2021
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
X
Copy for Public Inspection
Subtract line 5 from line 4.
132022 01-04-22
Calendar year (or fiscal year beginning in)
Calendar year (or fiscal year beginning in) |
2
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
Total.
6 Public support.
(a) (b) (c) (d) (e) (f)
7
8
9
10
11
12
13
Total support.
12
First 5 years.
stop here
14
15
14
15
16
17
18
a
b
a
b
33 1/3% support test - 2021.
stop here.
33 1/3% support test - 2020.
stop here.
10% -facts-and-circumstances test - 2021.
stop here.
10% -facts-and-circumstances test - 2020.
stop here.
Private foundation.
Schedule A (Form 990) 2021
|
Add lines 7 through 10
Schedule A (Form 990) 2021 Page
(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 III. If the organization
fails to qualify under the tests listed below, please complete Part III.)
2017 2018 2019 2020 2021 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
Add lines 1 through 3 ~~~
The portion of total contributions
by each person (other than a
governmental unit or publicly
supported organization) included
on line 1 that exceeds 2% of the
amount shown on line 11,
column (f)~~~~~~~~~~~~
2017 2018 2019 2020 2021 Total
Amounts from line 4 ~~~~~~~
Gross income from interest,
dividends, payments received on
securities loans, rents, royalties,
and income from similar sources ~
Net income from unrelated business
activities, whether or not the
business is regularly carried on ~
Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part VI.) ~~~~
Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~
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 •••••••••••••••••••••••••••••••••••••••••••••|
~~~~~~~~~~~~Public support percentage for 2021 (line 6, column (f), divided by line 11, column (f))
Public support percentage from 2020 Schedule A, Part II, line 14
%
%~~~~~~~~~~~~~~~~~~~~~
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
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 Explain in Part VI how the organization
meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the facts-and-circumstances test, check this box and Explain in Part VI how the
organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization ~~~~~~~~ |
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ••• |
Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
16
Copy for Public Inspection
(Subtract line 7c from line 6.)
Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
amount on line 13 for the year
(Add lines 9, 10c, 11, and 12.)
132023 01-04-22
Calendar year (or fiscal year beginning in) |
Calendar year (or fiscal year beginning in) |
Total support.
3
(a) (b) (c) (d) (e) (f)
1
2
3
4
5
6
7
Total.
a
b
c
8 Public support.
(a) (b) (c) (d) (e) (f)
9
10a
b
c
11
12
13
14 First 5 years.
stop here
15
16
15
16
17
18
19
20
2021
2020
17
18
a
b
33 1/3% support tests - 2021.
stop here.
33 1/3% support tests - 2020.
stop here.
Private foundation.
Schedule A (Form 990) 2021
Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975
Schedule A (Form 990) 2021 Page
(Complete only if you checked the box on line 10 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.)
2017 2018 2019 2020 2021 Total
Gifts, grants, contributions, and
membership fees received. (Do not
include any "unusual grants.")~~
Gross receipts from admissions,merchandise sold or services per-formed, or facilities furnished inany activity that is related to theorganization's tax-exempt purpose
Gross receipts from activities that
are not an unrelated trade or bus-
iness under section 513 ~~~~~
Tax revenues levied for the organ-
ization's benefit and either paid to
or expended on its behalf ~~~~
The value of services or facilities
furnished by a governmental unit to
the organization without charge ~
~~~ Add lines 1 through 5
Amounts included on lines 1, 2, and
3 received from disqualified persons
~~~~~~
Add lines 7a and 7b ~~~~~~~
2017 2018 2019 2020 2021 Total
Amounts from line 6 ~~~~~~~
Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~
~~~~
Add lines 10a and 10b ~~~~~~Net income from unrelated businessactivities not included on line 10b, whether or not the business is regularly carried on ~~~~~~~Other income. Do not include gainor loss from the sale of capitalassets (Explain in Part VI.)~~~~
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 ••••••••••••••••••••••••••••••••••••••••••••••••••••|
Public support percentage for 2021 (line 8, column (f), divided by line 13, column (f))
Public support percentage from 2020 Schedule A, Part III, line 15
~~~~~~~~~~~%
%••••••••••••••••••••
Investment income percentage for (line 10c, column (f), divided by line 13, column (f))
Investment income percentage from Schedule A, Part III, line 17
~~~~~~~~%
%~~~~~~~~~~~~~~~~~~
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 The organization qualifies as a publicly supported organization ~~~~~~~~~~ |
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 The organization qualifies as a publicly supported organization ~~~~ |
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions •••••••• |
Part III Support Schedule for Organizations Described in Section 509(a)(2)
Section A. Public Support
Section B. Total Support
Section C. Computation of Public Support Percentage
Section D. Computation of Investment Income Percentage
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
7,004. 37,500. 634,366. 150,792. 829,662.
1,001,262. 1,001,262.
7,004. 37,500. 634,366.1,152,054. 1,830,924.
7,004. 37,500. 565,451. 77,334. 687,289.
929,596. 929,596.7,004. 37,500. 565,451.1,006,930. 1,616,885.214,039.
7,004. 37,500. 634,366.1,152,054. 1,830,924.
2,100. 1,987. 531. 4,618.
2,100. 1,987. 531. 4,618.
7,004. 39,600. 636,353.1,152,585. 1,835,542.
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 17
Copy for Public Inspection
132024 01-04-21
4
Yes No
1
2
3
4
5
6
7
8
9
10
Part VI
1
2
3a
3b
3c
4a
4b
4c
5a
5b
5c
6
7
8
9a
9b
9c
10a
10b
Part VI
a
b
c
a
b
c
a
b
c
a
b
c
a
b
Part VI
Part VI
Part VI
Part VI
Part VI,
Type I or Type II only.
Substitutions only.
Part VI.
Part VI.
Part VI.
Part VI.
Schedule A (Form 990) 2021
If "No," describe in how the supported organizations are designated. If designated by
class or purpose, describe the designation. If historic and continuing relationship, explain.
If "Yes," explain in how the organization determined that the supported
organization was described in section 509(a)(1) or (2).
If "Yes," answer
lines 3b and 3c below.
If "Yes," describe in when and how the
organization made the determination.
If "Yes," explain in what controls the organization put in place to ensure such use.
If
"Yes," and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
If "Yes," describe in how the organization had such control and discretion
despite being controlled or supervised by or in connection with its supported organizations.
If "Yes," explain in what controls the organization used
to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B)
purposes.
If "Yes,"
answer lines 5b and 5c below (if applicable). Also, provide detail in including (i) the names and EIN
numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action;
(iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action
was accomplished (such as by amendment to the organizing document).
If "Yes," provide detail in
If "Yes," complete Part I of Schedule L (Form 990).
If "Yes," complete Part I of Schedule L (Form 990).
If "Yes," provide detail in
If "Yes," provide detail in
If "Yes," provide detail in
If "Yes," answer line 10b below.
(Use Schedule C, Form 4720, to
determine whether the organization had excess business holdings.)
Schedule A (Form 990) 2021 Page
(Complete only if you checked a box in line 12 on Part I. If you checked box 12a, Part I, complete Sections A
and B. If you checked box 12b, Part I, complete Sections A and C. If you checked box 12c, Part I, complete
Sections A, D, and E. If you checked box 12d, Part I, complete Sections A and D, and complete Part V.)
Are all of the organization's supported organizations listed by name in the organization's governing
documents?
Did the organization have any supported organization that does not have an IRS determination of status
under section 509(a)(1) or (2)?
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)?
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and
satisfied the public support tests under section 509(a)(2)?
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B)
purposes?
Was any supported organization not organized in the United States ("foreign supported organization")?
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign
supported organization?
Did the organization support any foreign supported organization that does not have an IRS determination
under sections 501(c)(3) and 509(a)(1) or (2)?
Did the organization add, substitute, or remove any supported organizations during the tax year?
Was any added or substituted supported organization part of a class already
designated in the organization's organizing document?
Was the substitution the result of an event beyond the organization's control?
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to
anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class
benefited by one or more of its supported organizations, or (iii) other supporting organizations that also
support or benefit one or more of the filing organization's supported organizations?
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor
(as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with
regard to a substantial contributor?
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7?
Was the organization controlled directly or indirectly at any time during the tax year by one or more
disqualified persons, as defined in section 4946 (other than foundation managers and organizations described
in section 509(a)(1) or (2))?
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which
the supporting organization had an interest?
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit
from, assets in which the supporting organization also had an interest?
Was the organization subject to the excess business holdings rules of section 4943 because of section
4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated
supporting organizations)?
Did the organization have any excess business holdings in the tax year?
Part IV Supporting Organizations
Section A. All Supporting Organizations
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 18
Copy for Public Inspection
132025 01-04-22
5
Yes No
11
a
b
c
11a
11b
11cPart VI.
Yes No
1
2
Part VI
1
2
Part VI
Yes No
1
Part VI
1
Yes No
1
2
3
1
2
3
Part VI
Part VI
1
2
3
(see instructions).
a
b
c
line 2
line 3
Part VI
Answer lines 2a and 2b below.Yes No
a
b
a
b
Part VI identify
those supported organizations and explain
2a
2b
3a
3b
Part VI
Answer lines 3a and 3b below.
Part VI.
Part VI
Schedule A (Form 990) 2021
If "Yes" to line 11a, 11b, or 11c, provide
detail in
If "No," describe in how the supported organization(s)effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported
organization, describe how the powers to appoint and/or remove officers, directors, or trustees were allocated among the
supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
If "Yes," explain in
how providing such benefit carried out the purposes of the supported organization(s) that operated,
supervised, or controlled the supporting organization.
If "No," describe in how control
or management of the supporting organization was vested in the same persons that controlled or managed
the supported organization(s).
If "No," explain in how
the organization maintained a close and continuous working relationship with the supported organization(s).
If "Yes," describe in the role the organization's
supported organizations played in this regard.
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year
Complete below.
Complete below.
Describe in how you supported a governmental entity (see instructions).
If "Yes," then in
how these activities directly furthered their exempt purposes,
how the organization was responsive to those supported organizations, and how the organization determined
that these activities constituted substantially all of its activities.
If "Yes," explain in
the reasons for the organization's position that its supported organization(s) would have engaged in
these activities but for the organization's involvement.
If "Yes" or "No" provide details in
If "Yes," describe in the role played by the organization in this regard.
Schedule A (Form 990) 2021 Page
Has the organization accepted a gift or contribution from any of the following persons?
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and
11c below, the governing body of a supported organization?
A family member of a person described on line 11a above?
A 35% controlled entity of a person described on line 11a or 11b above?
Did the governing body, members of the governing body, officers acting in their official capacity, or membership of one ormore supported organizations have the power to regularly appoint or elect at least a majority of the organization's officers,directors, or trustees at all times during the tax year?
Did the organization operate for the benefit of any supported organization other than the supported
organization(s) that operated, supervised, or controlled the supporting organization?
Were a majority of the organization's directors or trustees during the tax year also a majority of the directors
or trustees of each of the organization's supported organization(s)?
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the
organization's tax year, (i) a written notice describing the type and amount of support provided during the prior tax
year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the
organization's governing documents in effect on the date of notification, to the extent not previously provided?
Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported
organization(s) or (ii) serving on the governing body of a supported organization?
By reason of the relationship described on line 2, above, did the organization's supported organizations have a
significant voice in the organization's investment policies and in directing the use of the organization's
income or assets at all times during the tax year?
The organization satisfied the Activities Test.
The organization is the parent of each of its supported organizations.
The organization supported a governmental entity.
Activities Test.
Did substantially all of the organization's activities during the tax year directly further the exempt purposes of
the supported organization(s) to which the organization was responsive?
Did the activities described on line 2a, above, constitute activities that, but for the organization's involvement,
one or more of the organization's supported organization(s) would have been engaged in?
Parent of Supported Organizations.
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or
trustees of each of the supported organizations?
Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each
of its supported organizations?
(continued)Part IV Supporting Organizations
Section B. Type I Supporting Organizations
Section C. Type II Supporting Organizations
Section D. All Type III Supporting Organizations
Section E. Type III Functionally Integrated Supporting Organizations
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
19
Copy for Public Inspection
132026 01-04-22
6
1 Part VI See instructions.
Section A - Adjusted Net Income
1
2
3
4
5
6
7
8
1
2
3
4
5
6
7
8Adjusted Net Income
Section B - Minimum Asset Amount
1
2
3
4
5
6
7
8
a
b
c
d
e
1a
1b
1c
1d
2
3
4
5
6
7
8
Total
Discount
Part VI
Minimum Asset Amount
Section C - Distributable Amount
1
2
3
4
5
6
7
1
2
3
4
5
6
Distributable Amount.
Schedule A (Form 990) 2021
explain in
explain in detail in
Schedule A (Form 990) 2021 Page
Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 ().
All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
(B) Current Year(optional)(A) Prior Year
Net short-term capital gain
Recoveries of prior-year distributions
Other gross income (see instructions)
Add lines 1 through 3.
Depreciation and depletion
Portion of operating expenses paid or incurred for production or
collection of gross income or for management, conservation, or
maintenance of property held for production of income (see instructions)
Other expenses (see instructions)
(subtract lines 5, 6, and 7 from line 4)
(B) Current Year(optional)(A) Prior Year
Aggregate fair market value of all non-exempt-use assets (see
instructions for short tax year or assets held for part of year):
Average monthly value of securities
Average monthly cash balances
Fair market value of other non-exempt-use assets
(add lines 1a, 1b, and 1c)
claimed for blockage or other factors
( ):
Acquisition indebtedness applicable to non-exempt-use assets
Subtract line 2 from line 1d.
Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount,
see instructions).
Net value of non-exempt-use assets (subtract line 4 from line 3)
Multiply line 5 by 0.035.
Recoveries of prior-year distributions
(add line 7 to line 6)
Current Year
Adjusted net income for prior year (from Section A, line 8, column A)
Enter 0.85 of line 1.
Minimum asset amount for prior year (from Section B, line 8, column A)
Enter greater of line 2 or line 3.
Income tax imposed in prior year
Subtract line 5 from line 4, unless subject to
emergency temporary reduction (see instructions).
Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see
instructions).
Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 20
Copy for Public Inspection
132027 01-04-22
7
Section D - Distributions Current Year
1
2
3
4
5
6
7
8
9
10
1
2
3
4
5
6
7
8
9
10
Part VI
Part VI
Total annual distributions.
Part VI
(i)
Excess Distributions
(ii)UnderdistributionsPre-2021
(iii)DistributableAmount for 2021Section E - Distribution Allocations
1
2
3
4
5
6
7
8
Part VI
a
b
c
d
e
f
g
h
i
j
Total
a
b
c
Part VI.
Part VI
Excess distributions carryover to 2022.
a
b
c
d
e
Schedule A (Form 990) 2021
provide details in
describe in
provide details in
explain in
explain in
explain in
Schedule A (Form 990) 2021 Page
Amounts paid to supported organizations to accomplish exempt purposes
Amounts paid to perform activity that directly furthers exempt purposes of supported
organizations, in excess of income from activity
Administrative expenses paid to accomplish exempt purposes of supported organizations
Amounts paid to acquire exempt-use assets
Qualified set-aside amounts (prior IRS approval required - )
Other distributions ( ). See instructions.
Add lines 1 through 6.
Distributions to attentive supported organizations to which the organization is responsive
( ). See instructions.
Distributable amount for 2021 from Section C, line 6
Line 8 amount divided by line 9 amount
(see instructions)
Distributable amount for 2021 from Section C, line 6
Underdistributions, if any, for years prior to 2021 (reason-
able cause required - ). See instructions.
Excess distributions carryover, if any, to 2021
From 2016
From 2017
From 2018
From 2019
From 2020
of lines 3a through 3e
Applied to underdistributions of prior years
Applied to 2021 distributable amount
Carryover from 2016 not applied (see instructions)
Remainder. Subtract lines 3g, 3h, and 3i from line 3f.
Distributions for 2021 from Section D,
line 7:$
Applied to underdistributions of prior years
Applied to 2021 distributable amount
Remainder. Subtract lines 4a and 4b from line 4.
Remaining underdistributions for years prior to 2021, if
any. Subtract lines 3g and 4a from line 2. For result greater
than zero, See instructions.
Remaining underdistributions for 2021. Subtract lines 3h
and 4b from line 1. For result greater than zero,
. See instructions.
Add lines 3j
and 4c.
Breakdown of line 7:
Excess from 2017
Excess from 2018
Excess from 2019
Excess from 2020
Excess from 2021
(continued) Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 21
Copy for Public Inspection
132028 01-04-22
8
Schedule A (Form 990) 2021
Schedule A (Form 990) 2021 Page
Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12;Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C,line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; Part V,Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information.(See instructions.)
Part VI Supplemental Information.
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
SCHEDULE A, LIST OF UNUSUAL GRANTS RECEIVED:
DESCRIPTION: START UP FUNDS
DATE: 07/01/19 AMOUNT: 481937.
DESCRIPTION: START UP FUNDS
DATE: 07/01/19 AMOUNT: 200000.
DESCRIPTION: START UP FUNDS
DATE: 07/01/19 AMOUNT: 100000.
DESCRIPTION: START UP FUNDS
DATE: 05/03/21 AMOUNT: 360000.
DESCRIPTION: START UP FUNDS
DATE: 01/12/21 AMOUNT: 200000.
DESCRIPTION: START UP FUNDS
DATE: 01/09/22 AMOUNT: 200000.
DESCRIPTION: START UP FUNDS
DATE: 02/11/22 AMOUNT: 310000.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 22
Copy for Public Inspection
Department of the TreasuryInternal Revenue Service
132051 10-28-21
OMB No. 1545-0047
Held at the End of the Tax Year
| Complete if the organization answered "Yes" on Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.| Attach to Form 990.|Go to www.irs.gov/Form990 for instructions and the latest information.
(Form 990)
Open to PublicInspection
Name of the organization Employer identification number
(a) (b)
1
2
3
4
5
6
Yes No
Yes No
1
2
3
4
5
6
7
8
9
a
b
c
d
2a
2b
2c
2d
Yes No
Yes No
1
2
a
b
(i)
(ii)
a
b
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule D (Form 990) 2021
Complete if the
organization answered "Yes" on Form 990, Part IV, line 6.
Donor advised funds Funds and other accounts
Total number at end of year
Aggregate value of contributions to (during year)
Aggregate value of grants from (during year)
Aggregate value at end of year
~~~~~~~~~~~~~~~
~~~~
~~~~~~
~~~~~~~~~~~~~
Did the organization inform all donors and donor advisors in writing 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
for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring
impermissible private benefit?••••••••••••••••••••••••••••••••••••••••••••
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (for example, recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of a historically important land area
Preservation of a certified historic structure
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last
day of the tax year.
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 7/25/06, and not on a historic structure
listed in the National Register
~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax
year |
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, handling of violations, and enforcing conservation easements during the year
|
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
| $
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)
and section 170(h)(4)(B)(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 conservation easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
If the organization elected, as permitted under FASB 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.
If the organization elected, as permitted under FASB 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:
Revenue included on Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ |
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 FASB ASC 958 relating to these items:
Revenue included on Form 990, Part VIII, line 1
Assets included in Form 990, Part X
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $
$••••••••••••••••••••••••••••••••••• |
LHA
Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts.
Part II Conservation Easements.
Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
SCHEDULE D Supplemental Financial Statements 2021
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 27
Copy for Public Inspection
132052 10-28-21
3
4
5
a
b
c
d
e
Yes No
1
2
a
b
c
d
e
f
a
b
Yes No
1c
1d
1e
1f
Yes No
(a) (b) (c) (d) (e)
1
2
3
4
a
b
c
d
e
f
g
a
b
c
a
b
Yes No
(i)
(ii)
3a(i)
3a(ii)
3b
(a) (b) (c) (d)
1a
b
c
d
e
Total.
Schedule D (Form 990) 2021
(continued)
(Column (d) must equal Form 990, Part X, column (B), line 10c.)
Two years back Three years back Four years back
Schedule D (Form 990) 2021 Page
Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its
collection items (check all that apply):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange program
Other
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
to be sold to raise funds rather than to be maintained as part of the organization's collection? ••••••••••••
Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or
reported an amount on Form 990, Part X, line 21.
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included
on Form 990, Part X?
If "Yes," explain the arrangement in Part XIII and complete the following table:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amount
Beginning balance
Additions during the year
Distributions during the year
Ending balance
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII
~~~~~
•••••••••••••
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
Current year Prior year
Beginning of year balance
Contributions
Net investment earnings, gains, and losses
Grants or scholarships
~~~~~~~
~~~~~~~~~~~~~~
~~~~~~~~~
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
~~~~~~~~~~~~~
~~~~~~~~
~~~~~~~~~~
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment
Permanent endowment
Term endowment
The percentages on lines 2a, 2b, and 2c should equal 100%.
|%
|%
|%
Are there endowment funds not in the possession of the organization that are held and administered for the organization
by:
Unrelated organizations
Related organizations
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIII the intended uses of the organization's endowment funds.
~~~~~~~~~~~~~~~~~~~~
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property Cost or other
basis (investment)
Cost or other
basis (other)
Accumulated
depreciation
Book value
Land
Buildings
Leasehold improvements
~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~
Equipment
Other
~~~~~~~~~~~~~~~~~
••••••••••••••••••••
Add lines 1a through 1e. |•••••••••••••
2Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets
Part IV Escrow and Custodial Arrangements.
Part V Endowment Funds.
Part VI Land, Buildings, and Equipment.
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
151,466.151,466.401,176. 7,375. 393,801.
127,214. 8,517. 118,697.
663,964.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 28
Copy for Public Inspection
(including name of security)
132053 10-28-21
Total.
Total.
(a) (b) (c)
(1)
(2)
(3)
(a) (b) (c)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(a) (b)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total.
(a) (b) 1.
Total.
2.
Schedule D (Form 990) 2021
(Column (b) must equal Form 990, Part X, col. (B) line 15.)
(Column (b) must equal Form 990, Part X, col. (B) line 25.)
Description of security or category
(Col. (b) must equal Form 990, Part X, col. (B) line 12.) |
(Col. (b) must equal Form 990, Part X, col. (B) line 13.) |
Schedule D (Form 990) 2021 Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
Book value Method of valuation: Cost or end-of-year market value
Financial derivatives
Closely held equity interests
Other
~~~~~~~~~~~~~~~
~~~~~~~~~~~
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
Description of investment Book value Method of valuation: Cost or end-of-year market value
Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
Description Book value
••••••••••••••••••••••••••••|
Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
Description of liability Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Federal income taxes
•••••••••••••••••••••••••••• |
Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the
organization's liability for uncertain tax positions under FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII•
3Part VII Investments - Other Securities.
Part VIII Investments - Program Related.
Part IX Other Assets.
Part X Other Liabilities.
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
343,426. COST
343,426.
DUE FROM RELATED ORGANIZATIONS 289,453.
RESTRICTED CASH 1,000.
290,453.
REFUNDABLE ADVANCES, GRANTS 341,667.
341,667.
X
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
29
Copy for Public Inspection
132054 10-28-21
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d 2e
32e 1
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
1
2
3
4
5
1
a
b
c
d
e
2a
2b
2c
2d
2a 2d
2e 1
2e
3
a
b
c
4a
4b
4a 4b
3 4c.
4c
5
Schedule D (Form 990) 2021
(This must equal Form 990, Part I, line 12.)
(This must equal Form 990, Part I, line 18.)
Schedule D (Form 990) 2021 Page
Complete if the organization answered "Yes" on 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:
~~~~~~~~~~~~~~~~~~~
Net unrealized gains (losses) on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part VIII, line 12, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total revenue. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
•••••••••••••••••
Complete if the organization answered "Yes" on Form 990, Part IV, line 12a.
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
~~~~~~~~~~~~~~~~~~~~~~~~~~
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIII.)
~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines through
Subtract line from line
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Amounts included on Form 990, Part IX, line 25, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIII.)
~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~
Add lines and
Total expenses. Add lines and
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
••••••••••••••••
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b 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.
4Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return.
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return.
Part XIII Supplemental Information.
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
PART X, LINE 2:
IT IS THE ORGANIZATION'S POLICY TO EVALUATE ALL TAX POSITIONS TO IDENTIFY
ANY THAT MAY BE CONSIDERED UNCERTAIN. ALL IDENTIFIED MATERIAL TAX
POSITIONS ARE ASSESSED AND MEASURED BY A MORE-LIKELY-THAN-NOT THRESHOLD TO
DETERMINE IF THE TAX POSITION IS UNCERTAIN AND WHAT, IF ANY, THE EFFECT OF
THE UNCERTAIN TAX POSITION MAY HAVE ON THE FINANCIAL STATEMENTS. NO
MATERIAL UNCERTAIN TAX POSITIONS WERE IDENTIFIED FOR 2022. ANY CHANGES
IN THE AMOUNT OF A TAX POSITION WILL BE RECOGNIZED IN THE PERIOD THE
CHANGE OCCURS.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
30
Copy for Public Inspection
132055 10-28-21
5
Schedule D (Form 990) 2021
(continued)Schedule D (Form 990) 2021 Page Part XIII Supplemental Information
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 31
Copy for Public Inspection
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
132211 11-11-21
Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.| Attach to Form 990 or Form 990-EZ.| Go to www.irs.gov/Form990 for the latest information.Open to PublicInspection
Employer identification number
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule O (Form 990) 2021
Name of the organization
LHA
(Form 990)
SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2021
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:
MANAGEMENT TO A SIX-COUNTY REGION IN SOUTHEASTERN NORTH CAROLINA.
FORM 990, PART III, LINE 1, DESCRIPTION OF ORGANIZATION MISSION:
INITIATIVE MANAGEMENT TO A SIX-COUNTY REGION IN SOUTHEASTERN NORTH
CAROLINA. CFC EMPLOYS DATA SCIENTISTS, STRATEGISTS, JOURNALISTS, AND
PROCESS IMPROVEMENT EXPERTS WHO PARTNER WITH ANCHOR INSTITUTIONS FROM
ACROSS THE REGION. TOGETHER, THEY CREATE SUSTAINABLE IMPACT PROGRAMS
THAT ADDRESS SOCIAL PROGRESS ACROSS A VARIETY OF SECTORS INCLUDING
ECONOMIC DEVELOPMENT, HEALTH AND HUMAN SERVICES, CLIMATE CHANGE AND
HOUSING.
FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS:
PRACTITIONERS, AND ADVOCATES ON THE FRONT LINES OF THIS FIGHT.
ORGANIZE FOR IMPACT...BUILD AN ENDURING TOWN SQUARE
PROMOTE SUSTAINABLE, COMMUNITY-WIDE SYSTEMS AND OPERATIONAL
INFRASTRUCTURE THAT SUPPORT THE SOCIAL IMPACT SECTOR IN NAVIGATING THE
COMPLEXITIES OF THE REGION'S UNIQUE CHALLENGES. BUILD A CULTURE THAT
CHAMPIONS COLLABORATION, EQUITY, AND TRANSPARENCY.
SUPPORT INNOVATION IN THE SOCIAL SECTOR
FOSTER A CULTURE OF INNOVATION BY LEVERAGING RESOURCES AND CULTIVATING
OPPORTUNITIES TO PROMOTE NEW METHODS FOR ACHIEVING SOCIAL PROGRESS.
FORM 990, PART VI, SECTION B, LINE 11B:
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
32
Copy for Public Inspection
132212 11-11-21
2
Employer identification number
Schedule O (Form 990) 2021
Schedule O (Form 990) 2021 Page
Name of the organization COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
FORM 990 IS PREPARED BY AN INDEPENDENT CPA, REVIEWED BY THE TREASURER AND
MADE AVAILABLE TO THE BOARD OF DIRECTORS BY EMAIL NOTIFICATION.
FORM 990, PART VI, SECTION B, LINE 12C:
BOARD MEMBERS ARE REMINDED ON AN ANNUAL BASIS OF THEIR DUTY TO DISCLOSE
POTENTIAL CONFLICTS TO THE EXECUTIVE DIRECTOR AS SOON AS ANY POTENTIAL
CONFLICTS ARISE.
FORM 990, PART VI, SECTION B, LINE 15:
THE BOARD APPOINTS A COMPENSATION COMMITTEE TO DETERMINE THE EXECUTIVE
DIRECTOR'S COMPENSATION BASED ON PUBLICLY-AVAILABLE DOCUMENTS, PERFORMANCE,
AND THE CONSTRAINTS OF THE BUDGET.
FORM 990, PART VI, SECTION C, LINE 18:
AVAILABLE AT GUIDESTAR.ORG OR BY REQUEST FROM THE ORGANIZATION.
FORM 990, PART VI, SECTION C, LINE 19:
AVAILABLE UPON WRITTEN REQUEST.
SCHEDULE A - UNUSUAL GRANTS
FOR THE TAX YEAR ENDED JUNE 30, 2022, SUBSTANTIAL START UP FUNDING WAS
PROVIDED THROUGH MULTI-YEAR PLEDGES BY TWO UNRELATED ENTITIES TOTALING
$510,000. THESE HAVE BEEN CLASSIFED FOR SCHEDULE A SUPPORT CALCULATIONS
AS THEY WERE GRANTED TO KICK-START THE FLEDGLING ORGANIZATION AND WOULD
IN ALL LIKELIHOOD DISQUALIFY THE ORGANIZATION UNDER THE 5-YEAR PUBLIC
SUPPORT TEST.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 33
Copy for Public Inspection
OMB No. 1545-0047
Department of the TreasuryInternal Revenue Service
Section 512(b)(13)
controlled
entity?
132161 11-17-21
SCHEDULE R(Form 990)Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990. Open to PublicInspection| Go to www.irs.gov/Form990 for instructions and the latest information.
Employer identification number
Part I Identification of Disregarded Entities.
(a)(b)(c)(d)(e)(f)
Identification of Related Tax-Exempt Organizations. Part II
(a)(b)(c)(d)(e)(f)(g)
Yes No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule R (Form 990) 2021
|
|
Name of the organization
Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
Name, address, and EIN (if applicable)
of disregarded entity
Primary activity Legal domicile (state or
foreign country)
Total income End-of-year assets Direct controlling
entity
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related tax-exemptorganizations during the tax year.
Name, address, and EIN
of related organization
Primary activity Legal domicile (state or
foreign country)
Exempt Code
section
Public charity
status (if section
501(c)(3))
Direct controlling
entity
LHA
Related Organizations and Unrelated Partnerships 2021
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
CAPE FEAR COLLECTIVE CAPITAL, LLC -
86-3342110, PO BOX 7746, WILMINGTON, NC COLLECTIVE IMPACT IN
28406 AFFORDABLE RENTAL HOUSING NORTH CAROLINA -5,062. 1,812,070.NEW HANOVER COUNTY, INC
CAPE FEAR COLLECTIVE VENTURES, LLC -
86-3352330, PO BOX 7746, WILMINGTON, NC COLLECTIVE IMPACT IN
28406 AFFORDABLE RENTAL HOUSING NORTH CAROLINA 0.50.NEW HANOVER COUNTY, INC
CAPE FEAR AFFORDABLE HOUSING, LLC
PO BOX 7746 COLLECTIVE IMPACT IN
WILMINGTON, NC 28406 AFFORDABLE RENTAL HOUSING NORTH CAROLINA 4,958. 546,303.NEW HANOVER COUNTY, INC
MISSION DRIVEN MOTORS, LLC
PO BOX 7746 COLLECTIVE IMPACT IN
WILMINGTON, NC 28406 AFFORDABLE TRANSPORTATION NORTH CAROLINA 0.0.NEW HANOVER COUNTY, INC
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
34
Copy for Public Inspection
Disproportionate
allocations?
Legaldomicile(state orforeigncountry)
General ormanagingpartner?
Section512(b)(13)controlledentity?
Legal domicile(state orforeigncountry)
132162 11-17-21
2
Identification of Related Organizations Taxable as a Partnership. Part III
(a)(b)(c)(d)(e)(f)(g)(h)(i) (j) (k)
Yes No Yes No
Identification of Related Organizations Taxable as a Corporation or Trust. Part IV
(a)(b)(c)(d)(e)(f)(g)(h) (i)
Yes No
Schedule R (Form 990) 2021
Predominant income(related, unrelated,excluded from tax undersections 512-514)
Schedule R (Form 990) 2021 Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a partnership during the tax year.
Name, address, and EINof related organization Primary activity Direct controllingentity Share of totalincome Share ofend-of-yearassets
Code V-UBIamount in box20 of ScheduleK-1 (Form 1065)
Percentageownership
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a corporation or trust during the tax year.
Name, address, and EINof related organization Primary activity Direct controllingentity Type of entity(C corp, S corp,or trust)
Share of totalincome Share ofend-of-yearassets
Percentageownership
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
CAPE FEAR COLLECTIVE IMPACT
OPPORTUNITY 1, LLC -
85-4312875, PO BOX 7746, AFFORDABLE
WILMINGTON, NC 28406 HOUSING NC N/A RELATED -6,114. 293,834.X N/A X 7.48%
CAPE FEAR COLLECTIVE IMPACT
OPPORTUNITY 2, LLC -
87-4501191, PO BOX 7746, AFFORDABLE
WILMINGTON, NC 28406 HOUSING NC N/A RELATED 0.0.X N/A X .45%
BRICK CAPITAL AND CAPE FEAR
COLLECTIVE HOUSING
INITIATIVE, LLC - 87-4526861, AFFORDABLE
PO BOX 7746, WILMINGTON, NC HOUSING NC N/A RELATED 0.0.X N/A X 50.00%
SEE PART VII FOR CONTINUATIONS
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
35
Copy for Public Inspection
132163 11-17-21
3
Part V Transactions With Related Organizations.
Note:Yes No
1
a
b
c
d
e
f
g
h
i
j
k
l
m
n
o
p
q
r
s
(i) (ii) (iii) (iv) 1a
1b
1c
1d
1e
1f
1g
1h
1i
1j
1k
1l
1m
1n
1o
1p
1q
1r
1s
2
(a)(b)(c)(d)
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021 Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Complete line 1 if any entity is listed in Parts II, III, 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 II-IV?
Receipt of interest, annuities, royalties, or rent from a controlled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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)
Loans or loan guarantees by related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Dividends from related organization(s)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sale of assets to related organization(s)
Purchase of assets from related organization(s)
Exchange of assets with related organization(s)
Lease of facilities, equipment, or other assets to related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Lease of facilities, equipment, or other assets from related organization(s)
Performance of services or membership or fundraising solicitations for related organization(s)
Performance of services or membership or fundraising solicitations by related organization(s)
Sharing of facilities, equipment, mailing lists, or other assets with related organization(s)
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Sharing of paid employees with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Reimbursement paid to related organization(s) for expenses
Reimbursement paid by related organization(s) for expenses
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Other transfer of cash or property to related organization(s)
Other 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 complete this line, including covered relationships and transaction thresholds.
Name of related organization Transactiontype (a-s)Amount involved Method of determining amount involved
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
XXXXX
XXXXX
XXXXX
XX
XX
CAPE FEAR COLLECTIVE IMPACT OPPORTUNITY 1,LLC D 87,278.CASH PAID
CAPE FEAR COLLECTIVE IMPACT OPPORTUNITY 1,
LLC L 81,000.CASH PAID
CAPE FEAR COLLECTIVE IMPACT OPPORTUNITY 2,
LLC D 195,470.CASH PAID
CAPE FEAR COLLECTIVE IMPACT OPPORTUNITY 2,
LLC L 92,917.CASH PAID
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
36
Copy for Public Inspection
Are allpartners sec.501(c)(3)orgs.?
Dispropor-tionateallocations?
General ormanagingpartner?
132164 11-17-21
Yes No Yes No Yes N
4
Part VI Unrelated Organizations Taxable as a Partnership.
(a)(b)(c)(d)(e)(f)(g)(h) (i) (j) (k)
o
Schedule R (Form 990) 2021
Predominant income(related, unrelated,excluded from tax undersections 512-514)
Code V-UBIamount in box 20of Schedule K-1(Form 1065)
Schedule R (Form 990) 2021 Page
Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
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.
Name, address, and EIN
of entity
Primary activity Legal domicile
(state or foreign
country)
Share of
total
income
Share of
end-of-year
assets
Percentage
ownership
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,
INC.83-3263326
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501
37
Copy for Public Inspection
132165 11-17-21
5
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021 Page
Provide additional information for responses to questions on Schedule R. See instructions.
Part VII Supplemental Information
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
PART III, IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS PARTNERSHIP:
NAME, ADDRESS, AND EIN OF RELATED ORGANIZATION:
BRICK CAPITAL AND CAPE FEAR COLLECTIVE HOUSING INITIATIVE,
LLC
EIN: 87-4526861
PO BOX 7746
WILMINGTON, NC 28406
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 38
Copy for Public Inspection
Department of the TreasuryInternal Revenue Service
File by thedue date forfiling yourreturn. Seeinstructions.
123841 01-12-22
| File a separate application for each return.
| Go to www.irs.gov/Form8868 for the latest information.
Electronic filing (e-file).
Type or
print
Application
Is For
Return
Code
Application
Is For
Return
Code
1
2
3a
b
c
3a
3b
3c
$
$
$
Balance due.
Caution:
For Privacy Act and Paperwork Reduction Act Notice, see instructions.8868
www.irs.gov/e-file-providers/e-file-for-charities-and-non-profits.
Form
(Rev. January 2022)OMB No. 1545-0047
You can electronically file Form 8868 to request a 6-month automatic extension of time to file any of the
forms listed below with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit
Contracts, for which an extension request must be sent to the IRS in paper format (see instructions). For more details on the electronic
filing of this form, visit
All corporations required to file an income tax return other than Form 990-T (including 1120-C filers), partnerships, REMICs, and trusts
must use Form 7004 to request an extension of time to file income tax returns.
Name of exempt organization or other filer, see instructions.Taxpayer identification number (TIN)
Number, street, and room or suite no. If a P.O. box, see instructions.
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
Enter the Return Code for the return that this application is for (file a separate application for each return)•••••••••••••••••
Form 990 or Form 990-EZ
Form 4720 (individual)
Form 990-PF
01
03
04
05
06
07
Form 1041-A 08
09
10
11
12
Form 4720 (other than individual)
Form 5227
Form 6069
Form 8870
Form 990-T (sec. 401(a) or 408(a) trust)
Form 990-T (trust other than above)
Form 990-T (corporation)
¥ The books are in the care of |
Telephone No. |Fax No. |
¥ If the organization does not have an office or place of business in the United States, check this box~~~~~~~~~~~~~~~~~ |
¥ If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN). If this is for the whole group, check this
box . If it is for part of the group, check this box and attach a list with the names and TINs of all members the extension is for.||
I request an automatic 6-month extension of time until , to file the exempt organization return for
the organization named above. The extension is for the organization's return for:
|
|
calendar year or
tax year beginning , and ending .
If the tax year entered in line 1 is for less than 12 months, check reason: Initial return Final return
Change in accounting period
If this application is for Forms 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.
Subtract line 3b from line 3a. Include your payment with this form, if required, by
using EFTPS (Electronic Federal Tax Payment System). See instructions.
If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-TE and Form 8879-TE for paymentinstructions.
LHA Form (Rev. 1-2022)
Automatic 6-Month Extension of Time. Only submit original (no copies needed).
8868 Application for Automatic Extension of Time To File anExempt Organization Return
COLLECTIVE IMPACT IN NEW HANOVER COUNTY,INC.83-3263326
PO BOX 7746
WILMINGTON, NC 28406 0 1
MEAGHAN DENNISONPO BOX 7746 - WILMINGTON, NC 28406
919-607-2417
MAY 15, 2023
X JUL 1, 2021 JUN 30, 2022
0.
0.
0.
16320515 252547 112445.0003 2021.05080 COLLECTIVE IMPACT IN NEW HA 11244501 2
Copy for Public Inspection