28 chenango county chapter arc

I .Form CHAR500

This form used forArticle 7-A, EPTL and dual filersreplaces forms CHAR 497, CHAR

010 and CHAR 006)

1. General Information

a. For the fiscal year beginningb. Check if applicable for NYS:

I

Address changeName changeInitial filingFinal filingAmended filingNY registration pending

Annual Filing for Charitable OrganizationsNew York State Department of Law (Office of the Attorney General)

Charities Bureau - Registration Section120 Broadway

New York, NY 10271htto://www.charitiesnvs.com

(dd/yyyy) 01/01 /2Ol2 and e

12/31/2012c. Name of organization

NYS ARC, INC. CHENANGO COUNTY CHAPTER

Number and street (or P.O. box if mail is not delivered to street address)

Room/suite

17 MIDLAND DRIVECity or town, state or country and zip + 4

NORWICH, NY 13815

2012

Open to PublicInspection

d.Fed. employer ID no. (EIN) (##-#######)

16-0970103o. NY State registration no. (##-##-##)

01-32-25f. Telephone number

(607) 334-5366g. Email

NORCWS@CWSPACKAGING. COM

2. Certification - Two Signatures RequiredWe certify under penalties of perjury that we reviewed this rep irtcl rig all attachments, and to the best of our knowledge and belief, theyare true, correct and complete in accor a ith toe a State of New York applicable to this report.

a. President or Authorized Officer y - ILLIAN WHITAKER PRESIDENT

gnature Printed Name Title jate

b. Chief Financial Officer or Treasurer 's nat - —'WKted Iie I .3. Annual Report Exemption Informat n

a. Article 7-A annual report exemption (Article 7-A registrants and dual registrants)Check - if total contributions from NY State (including residents, foundations, corporations, government agencies, etc.) did not exceed

$25,000 and the organization did not engage a professional fund raiser (PFR) or fund raising counsel (FRC) to solicitcontributions during this fiscal year.

NOTE: An organization may claim this exemption if no PFR or FRC was used and either: 1) it received an allocation from a federated fund,United \N, OF incorporated conrrtinity appeal and contributions from all sources did not exceed $25,000 or 2) it received all or substantiallyall of its contributions from one government agency to which it submitted an annual report similar to that required by Article 7-A.

b. EPTL annual report exemption (EPTL registrants and dual registrants)Check — if gross receipts did not exceed $25,000 and the assets (market value) did not exceed $25,000 at any time during this fiscal year.

For EPTL or Article 7-A registrants claiming the annual report exemption under the one law under which they are registered and for dualregistrants claiming the annual report exemptions under both laws, simply complete part 1 (General Information), part 2

(Certification) and part 3 (Annual Report Exemption Information) above.Do not submit a fee, do not complete the following schedules and do not submit any attachments to this form.

4. Article 7-A Schedules

If you did not check the Article 7-A annual report exemption above, complete the following for this fiscal year:a. Did the organization use a professional fund raiser, fund raising counsel or commercial co-venturer for fund raising activity in NY State?

* If "Yes, complete Schedule 4a.b. Did the organization receive government contributions (grants) 7 ................................................

* If 'Yee, complete Schedule 4b.

Yes* nX No

Yes* F1 No

5. Fee Submitted: See last page for summary of fee requirements.

Indicate the filing fee(s) you are submitting along with this form:a. Article 7-A filing fee ................................................... $ 25

Submit only one check or money orderfor the total fee, payable to

b. EPTL filing fee........................................................$ 250. "NYS Department of Law"c. Total fee.............................................................. $ 275.

6. Attachments - For organizations that are not claiming annual report exemptions under both laws, see page 4 for required attachments I

IN NYVA9812L 01/16/13 Form CHAR500 (2012)


16-0970103

Schedule 4b: Government Contributions (Grants)If you checked the box in question 4.b. on page 1, complete the following schedule for each government contribution (grant).cooies of this oaae if necessary to list each aovernment contribution (aranfl seoaratelv.

Government Agency Name Grant Amount

DASNY . $ 250,000.

$$$$$$$$$$$$$$$$$$$$$$$$$$

Is

Total Government Contributions (Grants) $ 250, 000.

IN NYVA9834L 01116113 Form CHAR500 (2012)


16-0970103

5. Fee Instructions

The filing fee depends on the organization's Registration Type. For details on Registration Type and filing fees, see the Instructions forForm CHAR500.

Organization's Registration Type Fee Instructions

• Article 7-A Calculate the Article 7-A filing fee using the table in part a below. The EPTL filing fee is $0.

• EPTL

Calculate the EPTL filing fee using the table in part b below, the Article 7-A filing fee is $0.

• Dual Calculate both the Article 7-A and EPTL filing fees using the tables in parts a and b below. Add theArticle 7-A and EPTL filing fees together to calculate the total fee. Submit a single check or moneyorder for the total fee.

a) Article 7-A filing fee

I Total Support & Revenue I Article 7-A Fee

more than $250,000 $25up to $250,000 * $10

b) ETPL filing fee

Any organization that contracted with or used the services of a professional fundraiser (PFR) or fund raising counsel (FRC) during the reporting period must pay arArticle 7-A filing fee of $25, regardless of total support and revenue.

6. Attachments - Document Attachment Check-List

Check the boxes for the documents you are attaching.

For All Filers

Filing Fee

Single check or money order payable to 'NYS Department of Law'

Copies of Internal Revenue Service Forms

Fxl IRS Form 990All required schedules (includingSchedule B

LI IRS Form 990-T

IRS Form 990-EZ

LI All required schedules (includingSchedule BIRS Form 990-T

IRS Form 990-PFAll required schedules (includingSchedule BIRS Form 990-T

Additional Article 7-A Document Attachment Requirement

Independent Accountant's Report

nX Audit Report (total support & revenue more than $250,000)

LI Review Report (total support & revenue $100,001 to $250,000)

LINo Accountant's Report Required (total support & revenue not more than $100,000)

IN NWA9834L 01/16/13 Form CHAR500 (2012)

CHENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR

RETARDED CHILDREN, INC.

FINANCIAL STATEMENTS

DECEMBER 31, 2012

(:IEENANGO COUNTY CIIAVI'ERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.

CONSOLIDATED FINANCIAL STATEMENTSDECEMBER 31, 2012

INDEX

tage

[-2Independent Auditors' Report

Consolidated Statements of Financial Position as ofDecember 31, 2012 and 2011

Consolidated Statements of Activities for the YearsEnded December 31, 2012 and 2011

Consolidated Statements of Functional Expenses for theYears Ended December 31, 2012 and 2011

Consolidated Statements of Cash Flows for the Years EndedDecember 31, 2012 and 2011

Notes to Consolidated Financial Statements

Independent Auditors' Report on Supplementary Information

Schedule I - Consolidating Statement of Financial Positionas of December 31, 2012

Schedule 2 - Consolidating Statement of Financial Positionas of December 31, 2011

Schedule 3 - Consolidating Statements of Activities for theYears Ended December 31, 2012 and 2011

Schedule 4 - Schedules of Total Revenue for the YearsEnded December 31, 2012 and 2011

Schedule 5 - Consolidating Statement of Functional ExpensesFor the Year Ended December 31, 2012

Schedule 6 - Consolidating Statement of Functional N\perlsesFor the Year Ended December 31, 201l

3-4

5

6

7

8-17

18

19-20

21-22

23

24

25

26

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INDEPENDENT AUDITORS' REPORT

To the Board of DirectorsChenango County ChapterNew York State Associationfor Retarded Children, Inc.

Report on the Financial Statements

We have audited the accompanying consolidated financial statements of the CHENANGO COUNTYCHAPTER NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC. (a non-profitorganization) AND RELATED COMPANIES which comprise the consolidated statements of financialposition as of December 31, 2012 and 2011, and the related consolidated statements of activities, functionalexpenses and cash flows for the years then ended, and the related notes to the consolidated financialstatements.

Management's Responsibility for the Financial Statements

Management is responsible for the preparation and fair presentation of these consolidated financialstatements in accordance with accounting principles generally accepted in the United States of America; thisincludes the design, implementation, and maintenance of internal control relevant to the preparation and fairpresentation of consolidated financial statements that are free from material misstatement, whether due tofraud or error.

Auditors' Responsibility

Our responsibility is to express an opinion on these consolidated financial statements based on ouraudit. We conducted our audit in accordance with auditing standards generally accepted in the UnitedStates of America. Those standards require that we plan anl perform the audit to obtain reasonableassurance about whether the consoiidted financial statements .ire free of material misstatement.

An ,itid it involves performing procedures to obtain audit evidence about the a lflOU n ts .1 nIldisclosures in the consolidated financial statements. The procedti res selected depend on the auditors'judgment, including the a,sesscncnt of the risks of iiiateria I ii isstatenlent of the consolidated financial'.ta teincii ts, whether due to fraud or error, in making those risk assesmcnts, the auditor considers internalcontrol relevant to the entity's iur1p,lr,ItioI1 and fair presentation of the consolidated financial statement inorder to design audit proci'dtin's that .ire appropriate in the circlimst.lnces, but iiot for the purpose ofe\pre'.sing an opinion oil tile i'f1ecliv12ne'. ot the entity's in t('rlhll control. Accordingly, we e pre'.s no suchopinion. An audit ilsut illcludes evaluating the .lpprupri.IteIIe'.S ot IcatIllltiIlg policies iis&'d and theI easun.ihleness of '.igniticallt .lcC oil llIiIli ll t''.till Ill tl'S iiiade by lllIIl.Ig&'ll It' IIt, ,i', will as tv.ilii.itiiig hit ()vt'r,Iiiiuni1Iit,1ti0Il of tlit COIl',(Iiiil,lI('il IlIlIlli 1,11 ',t,lI('lIIi'lit',.

,st' (u,tnih hush t2 • I'll hhti\ 1011 • Nut ti hi. \u,u uuik I hhi-lIl'.iI)

Chenango County ChapterNew York State Associationfor Retarded Children, Inc.

Page l'wo

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basisfor our audit opinion.

Opinion

In our opinion, the consolidated financial statements referred to above present fairly, in all materialrespects, the financial position of Chenango County Chapter New York State Association for RetardedChildren, Inc. and Related Companies as of December 31, 2012 and 2011, and the changes in its net assetsand its cash flows for the years then ended in accordance with accounting principles generally accepted inthe United States of America.

T L,, MS4^j^^ 4MAKER & LYONS, P.C.

Norwich, New YorkMarch 25, 2013

CONSOLIDATED STATEMENTS OF FINANCIAL POSITION

('IIENANGO COUNTY ChAPTER

NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


DECEMBER 31, 2012 AND 2011Restated

2012 2011

ASSETS

Current Assets

Cash and Cash Equivalents

Certificates of Deposit

Accounts Receivable, Net of Allowance for Doubtful Accounts of $30,000

at December 31, 2012 and 2011

Program Receivables

Medicaid Receivable, Net of Allowance for Doubtful Accounts of $13,200

at December 31, 2012 and 2011

Inventory

Prepaid Expenses and Other Assets

Total Current Assets

Investments

Fixed Assets

Land and Land Improvements

Buildings and Improvements

Equipment and Fixtures

Transportation Equipment

Construction in Process

Less: Accumulated Depreciation

Net Fixed Assets

Other Assets

Debt Reserve Fund

Debt Acquisition Costs, Net of Amortization of $59,689 and $52,119 at

December 31, 2012 and 2011, Respectively

Loan to Nonprofit Organization

Total Other Assets

$ 1,064,194 $ 609,668

97,581 609,000

837,749 824,598

488,166 160,683

448,943 520,741

366,117 371,108

103,763 17,942

3,406,513 3,113,740

1,699,169 1,572,869

423,119 432,027

7,016,133 6,843,642

3,674,924 3,462,095

673,500 678,623

577,871 166,371

12,365,547 11,582,758

7,052,098 6,601,751

5,313,449 4,981,007

105,739 105,739

13,997 21,567

10,000 10,000

129,736 137,306

TOTAL ASSETS

$ 10,548,867 $ 9,804,922

See the accom panyilig notes to financial statements.

3

CIIENANGO COUNTY CHAPTER

NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


DECEMBER 31, 2012 AND 2011

Restated

2012 2011

LIABILITIES AND NET ASSETS

Current Liabilities

Current Maturities of Long-Term Debt

$ 185,758 $ 225,503

Line of Credit

310,450 250,250

Accounts Payable 297,931 362,381

Deferred Revenue 123,832 53,959

Accrued Expenses

298,231 266,885

Accrued Payroll and Payroll Taxes

116,951 114,668

Accrued Pension Expense 200,487 276,280

Total Current Liabilities 1,533,640 1,549,926

Other Liabilities

Long-Term Debt - Less Current Maturities

1,014,323 868,998

Accrued Bank Flours

448,946 417,530

Deferred Compensation Payable 259,764 176,395

Total Other Liabilities 1,723,033 1,462,923

Total Liabilities

3,256,673 3,012,849

Net Assets

Teiiporarily Restricted

43,854 43,854

Unrestricted: Board Designated

200,000 200,000

Undesignated

7,048,340 6,548,219

Total Net Assets

7,292,194 6,792,073

'['OTA I LEA B I LITEES AND N El' ASSETS

$ 10,548,867 $ 9,804,922

See the acom pany ing notes In financial sta terneiits.

$ 8,559,8161,985,363

320,83872,62637,793

361,7581,412,272

$ 8,714,1932,060,784

285,93877,31838,363

184,4221,524,467

7,428,4871,798,809

256,39173,27333,808

226,0041,128,477

10,945,249

7,419,0181,677,996

251,84169,03531,817

159,8131,119,315

10,728,835

1,329,022 1,457,515

28,822 20,294

1,357,844 1,477,809

12,303,093 12,206,644

500,121 698,463

6,792,073 6,497,796

- (404,186)

6,792,073 6,093,610

$ 7,292,194 $ 6,792,073

t c.

CIIENANGO COUNTY CFIAI'TERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.

CONSOLIDATED STATEMENTS OF ACTIVITIESFOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011

Restated

2012

2011

Changes in Unrestricted Net Assets:Revenue

ProgramWorkshop, Including Investment Return of $156,168 and $24,815

For The Years Ended December 31, 2012 and 2011, RespectivelySupervised Individual Residential AlternativeSupportive ApartmentsClinicRespite ProgramMedicaid Service CoordinationHabilitation - Day and Residential

Other SupportFoundation Revenue, Including Investment Return of $34,309 and $1,710

For The Years Ended December 31, 2012 and 2011, Respectively

Total Revenue

ExpensesProgram

WorkshopSupervised Individual Residential AlternativeSupportive ApartmentsClinicRespite ProgramMedicaid Service CoordinationI labilitation - Day and Residential

Total Program Expenses

Supporting ServicesManagement and General

Fundraising

Total Supporting Services

Total Expenses

Increase in Unrestricted Net Assets

Net Assets - January 1

Prior Period Adjustment

Net ,\ssets - January 1 Restated

Net Assets - December 31

52,748 19,622

12,803,214 12,905,107

Se the ICCOffl pa flying notes to financial sta tetuents.

5

CIIENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.

CONSOLIDATED STATEMENTS OF FUNCTIONAL EXPENSESFOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011

Restated

2012 2011

Management Management

and and

Program General Fundraising Total Program General Fundraising Total

Compensation and FringeSalaries, Temporary Services and Participant CompensationPayroll Taxes and Fringe

Total Compensation and Fringe

Other ExpensesAmortizationAssessment, Dues and SubscriptionsBad Debt ExpenseCafeteria PurchasesParticipant TransportationDepreciationFoodHousehold SuppliesInsuranceInterest ExpenseOffice Supplies and ExpenseParticipant AllowanceProfessional FeesReal Estate TaxesRecreationRent ExpenseRepairs and MaintenanceMiscellaneous Fundraising ExpensesStaff TrainingSundryTelephoneTherapeutic and DiagnosticTravelUtilitiesVehicle Expense

Program Supplies

Total Other Expenses

TOTAL EXPENSES

$ 5,936,948 $ 762,739 $ 3,047 $ 6,702,734 $ 6,562,490 $ 806,559 $ 9,799 $ 7,378,848

1,527,781 212,121 1,478 1,741,380 1,312,020 221,239 3,019 1,536,278

7,464,729 974,860 4,525 8,444,114 7,874,510 1,027,798 12,818 8,915,126

7,570 - - 7,570 7,570 - - 7,570

60 5,559 - 5,619 2,966 7,303 - 10,269

- - - - 1,427 - - 1,427

69,058 - - 69,058 77,822 - - 77,822

367,686 - - 367,686 334,784 - - 334,784

469,173 56,142 - 525,315 373,162 57,468 - 430,630

112,492 - - 112,492 94,596 - - 94,596

25,118 - - 25,118 27,770 - - 27,770

41,648 17,609 - 59,257 37,190 16,859 - 54,049

65,564 - - 65,564 74,532 - - 74,532

10,658 50,978 - 61,636 17,354 59,723 - 77,077

80,367 - - 80,367 83,080 - - 83,080

31,902 110,204 1,553 143,659 37,693 170,349 1,396 209,438

10,915 - - 10,915 5,167 - - 5,167

12,182 - - 12,182 18,186 - - 18,186

46,000 - - 46,000 - - - -

264,617 15,859 - 280,476 209,132 3,424 - 212,556

- - 22,744 22,744 - - 6,000 6,000

16,488 7,418 - 23,906 10,949 11,859 - 22,808

2,405 36,469 - 38,874 5,413 53,658 - 59,071

26,251 30,627 - 56,878 24,637 26,280 - 50,917

400 2,497 - 2,897 835 2,480 - 3,315

5,583 8,115 - 13,698 16,377 9,580 80 26,037

224,390 - - 224,390 258,246 - - 258,246

42,139 12,685 - 54,824 45,106 10,734 - 55,840

1,547,854 - - 1,547,854 1,090,331 - - 1,090,331

3,480,520 354,162 24,297 3,858,979 2,854,325 429,717 7,476 3,291,518

$ 10,945,249 $ 1,329,022 $ 28,822 $ 12,303,093 $10,728,835 $ 1,457,515 $ 20,294 $ 12,206,644

See the accompanying notes to financial statements.

6

CFIENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.

CONSOLIDATED STATEMENTS OF CASH FLOWSFOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011

Restated

2012 2011

Cash Flows Provided By Operating Activities:Change in Net Assets

Adjustments to Reconcile Change in Net Assetsto Net Cash Provided By Operating Activities

DepreciationAmortizationNet Gain on Fixed AssetsNet (Gain) Loss on InvestmentsChange in Assets and Liabilites:

Accounts Receivable

Program ReceivablesMedicaid ReceivableInventoryPrepaid Expenses and Other AssetsAccounts PayableDeferred RevenueAccrued Expenses and Deferred Compensation PayableAccrued Payroll and Payroll TaxesAccrued Bank Hours

Accrued Pension Expense

Net Cash Provided By Operating Activities

Cash Flows Provided By (Used In) Investing Activities:Fixed Asset AcquisitionsProceeds From Sale of Fixed AssetsCertificates of DepositProceeds From Sale of Investments

Purchases of Investments

Net Cash Used In Investing Activities

Cash Flows Used In Financing Activities:

Proceeds from Line of Credit

Repayment of Debt

Net Cash Provided By (Used In) Financing Activities

Net Increase (Decrease) In Cash

Cash and Cash Equivalents - January 1

Cash and Cash Equivalents - December 31

Supplemental NotesInterest PaidIncome Taxes Paid

$ 500,121 $ 698,463

525,315

430,630

7,570

7,570

(539)

(3,434)

(134,943)

21,163

(13,151) (211,221)

(327,483) 336

71,798 (93,154)

4;991 (209,709)

(85,821) (14,112)

(64,450) 61,341

69,873 31,459

114,715 (143,135)

2,283 8,553

31,416 13,344

(75,793) 30,106

625,902 628,200

(526,660) (1,325,271)

539 3,434

511,419 168,000

199,603 303,883

(190,960) (518,787)

(6,059) (1,368,741)

60,200 250,250

(225,517) (218,362)

(165,317) 31,888

454,526 (708,653)

609,668 1,318,321

$ 1,064,194 $ 609,668

$ 65,564 $ 72,003

See the accompanying notes to financial statements.7

CHENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.

NOTES TO CONSOLIDATED FINANCIAL STATEMENTSDECEMBER 31, 2012

NOTE 1- NATURE OF ORGANIZATION AND SIGNIFICANT ACCOUNTING POLICIES

NATURE OF ORGANIZATION

The Chenango County Chapter New York State Association for Retarded Children, Inc. (theAssociation) is a non-profit entity and is one of 57 county based unincorporated chapters of the affiliate stateassociation, NYSARC, Inc. Each chapter operates facilities for the care, treatment and training of individualswith mental retardation and developmental disabilities. The Association provides services such as homesupport, therapy, treatment, live-in services, residential and day habilitation, training and a simulated workenvironment. The primary funding sources are Medicaid, operating contracts from the Office of People WithDevelopmental Disabilities, and fees for packaging and assembling services. The Association utilizes thebuildings owned by Community Residence, Inc. for certain residential programs. CWS CharitableFoundation, Inc. was established for the purpose of providing centralized planning, management, financialservices and fund raising services to benefit the Association.

The following is a listing of major programs offered by the Association. All programs provideservices to the developmentally disabled population of Chenango County and surrounding areas.

Workshop - a Sheltered Workshop program providing vocational rehabilitation and job readiness training.

Supervised IRA (Individualized Residential Alternative) there are currently four homes providing 24 hourstaff supervision assisting individuals in their activities of daily living.

Supportive Apartments - five 2-bed apartments provide up to 21 hours per week of staff assistance in theactivities of daily living for the more independent population.

Clinic - provides necessary dental services for the developmentally disabled population in and aroundChenango County.

Respite - provides various recreational activities to individuals with disabilities that might otherwise not beaccessible and thereby allows a short break from the daily demands faced by the individuals care providers.

Medicaid Service Coordination - provides assistance in linking the individual with appropriate services andprograms.

Day Habilitation - consists of staff assisted day programs allowing individuals to receive communityintegration while providing various trainings and activities.

SIGNIFICANT ACCOUNTING POLICIES

A. Principles of Consolidation - The accompanying consolidated financial statements reflect theconsolidated financial statements of the Chenango County Chapter New York State Association for RetardedChildren, Inc., Chenango Community Residences, Inc. and CWS Charitable Foundation, Inc. The ChenangoCounty Chapter New York State Association for Retarded Children, Inc., exercises control over and has aneconomic interest in Chenango Community Residences, Inc. and CWS Charitable Foundation, Inc.Therefore, the consolidated financial statements present the financial position, changes in net assets,functional expenses and cash flows of an economic unit rather than a legal unit (hereinafter referred to as theAssociation). All material intercompany accounts and transactions have been eliminated.

IF



NOTE 1- SIGNIFICANT ACCOUNTING POLICIES (Continued)

B. Basis of Accounting - The Association's policy is to prepare its financial statements on theaccrual basis of accounting. Under this method, revenues are recognized as earned and expenses arerecognized as they are incurred.

Expenses are accounted for by program and by function. Expenses directly identified arecharged to specific programs. Salaries, other than management and general, are allocated based uponestimated time spent by the employees on the programs. Management and general expenses are allocatedamong programs based upon the relative direct costs of the various programs.

C. Financial Statement Presentation - The Association is required to report informationregarding its financial position and activities according to three classes of net assets: unrestricted net assets,temporarily restricted net assets, and permanently restricted net assets. As of December 31, 2012 and 2011there were $43,854 of temporarily restricted net assets to be used for the expansion of manufacturingfacilities and no permanently restricted assets. The Association is also required to present a statement of cashflows.

The Board has designated unrestricted net assets to be used for the activities of the CWSCharitable Foundation, Inc. During 2010 the board contributed $100,000 to the foundation and $100,000 wascontributed in a prior year. The designated net assets are based upon the two $100,000 contributions madeby the Association to the Foundation. The Foundation invested the two $100,000 contributions in marketablesecurities. As of December 31, 2012 and 2011 the investment value was over the original contribution andthe board had designated net assets of $200,000.

D. Contributions - Contributions are recognized when the donor makes a promise to give to theAssociation that is, in substance, unconditional. Contributions that are restricted by the donor are reportedas increases in unrestricted net assets if the restrictions expire in the fiscal year in which the contributions arerecognized. All other donor-restricted contributions are reported as increases in temporarily or permanentlyrestricted net assets depending on the nature of the restrictions. When a restriction expires, temporarilyrestricted net assets are reclassified to unrestricted net assets. As of December 31, 2012 and 2011,unrestricted contributions in the amounts of $2,204 and $1,205, respectively, were recognized.

E. Contributed Services - During the years ended December 31, 2012 and 2011, the value ofcontributed services meeting the requirements for recognition in the financial statements were not materialand have not been recorded.

F. Investments - The Association carries investments in marketable securities with readilydeterminable fair values and all debt securities at fair values in the statement of financial position.Unrealized gains and losses are included in the change in net assets in the accompanying statement ofactivities.

G. Taxes - The Internal Revenue Service has determined that the Chenango County Chapter NewYork State Association for Retarded Children Inc. and CWS Charitable Foundation, Inc. are exempt fromtaxes on income generated from activities related to their exempt purposes under Section 501(c)(3) of theInternal Revenue Code. The Internal Revenue Service has determined that Chenango CommunityResidences, Inc. is exempt under Section 501(c)(2) of the Internal Revenue Code. The Organizations are notliable for federal unemployment insurance.

9




H. Uncertainty in Income Taxes - The Association files informational returns in the U.S. federaljurisdiction and New York State jurisdiction. With few exceptions, the Association is no longer subject toU.S. federal or state tax examinations by authorities for years before 2009. The Association has not beeninformed of any tax examinations by either the Internal Revenue Service (IRS) or New York State taxauthorities for any years not barred by statute of limitations.

The Association has adopted the provisions of the Financial Accounting Standards Board(FASB) Accounting Standards Codification (ASC) No. 740, "Income Taxes", as amended by FASBAccounting Standards Update (ASU) No. 2009-06, "Implementation Guidance on Accounting forUncertainty in Income Taxes and Disclosure Amendments for Nonpublic Entities". Management haddetermined there were no liabilities for unrecognized tax benefits as a result of the implementation of FASBASC No. 740, as amended. Furthermore, management has estimated that there are no material unrecognizedtax benefits for either the U.S. federal jurisdiction or New York State jurisdiction for which it is subject toreporting as of December 31, 2012 and 2011.

The Association has not recognized any interest or penalties related to unrecognized taxbenefits in the statement of activities nor has it accrued any in the statement of financial position as ofDecember 31, 2012 and 2011.

I. Inventories - Inventories are stated at the lower of cost (using the first-in, first-out method) ormarket. The Association's inventory consisted primarily of raw materials at December 31, 2012 and 2011.

J. Cash and Cash Equivalents - For purposes of the statement of cash flows, the Associationconsiders all highly liquid instruments purchased with a maturity of three months or less to be cashequivalents.

K. Accounts Receivable/Program and Medicaid Receivables - The Association subcontractspackaging and assembly services with various manufacturers. The Association extends credit to many of itscustomers. The Association accounts for trade receivables under the accrual method of accounting.Therefore, the receivable is recorded at the time of sale. Program and Medicaid receivables representsbalances owed to the Association for services provided to consumers. The Association performs ongoingcredit evaluations and does not require collateral. The Association uses the reserve method to account foruncollectible accounts. Management considers such factors as the age of the accounts receivable, howrecently payments have been received and a customer's ability to pay when reviewing an account forcollectability. Accounts receivable are stated at the amount management expects to collect from outstandingbalances. Management provides for probable uncollectible amounts through a charge to earnings and acredit to the allowance for uncollectible accounts based on the current status of individual accounts.Balances that are still outstanding after management has used reasonable collection efforts are written offthrough a charge to the allowance and a credit to accounts receivable. Receivables have been reduced byallowances for uncollectible accounts in the amount of $43,200 for each of the years ended December 31, 2012and 2011.

L. Property, Plant and Equipment - Property, plant and equipment with a purchased cost basisor fair market value (if donated) of at least $5,000 and an estimated useful life of at least two years wascapitalized. Assets are being depreciated over their estimated useful lives by the straight-line method.Depreciation totaled $525,315 and $430,630 for the years ended December 31, 2012 and 2011, respectively.

ED




M. Construction in Process - Construction in process as of December 31, 2011 consisted of costrelated to various improvements being made to the office and apartments and equipment which werecompleted and placed in service during 2012. Construction in process as of December 31, 2012 consisted ofcosts related to various improvements being made to the office, warehouse, and apartments and equipmentwhich have not been completed or placed in service.

N. Use of Estimates - Management uses estimates and assumptions in preparing financialstatements. Those estimates and assumptions affect the reported amounts of assets and liabilities, thedisclosure of contingent assets and liabilities, and reported revenues and expenses. Significant estimatesused in preparing these financial statements include those assumed in computing the revenue and expensesfor the workshop activities and health care costs under the deferred compensation agreement. It is at leastreasonably possible that the significant estimates used will change within the next year.

0. Accrued Bank Hours - Employees are eligible to bank hours of unused vacation time eachyear if certain criteria are met. After 15 years of full time employment the employee is eligible to be paid outover time all unused banked hours if proper notice is given upon leaving the Association. The Associationestimates this liability for all employees who have reached the 15 years of full time employment requirement.The liability is calculated based on the number of hours banked times the employees' current rate of pay forthe year then ended.

P. Advertising - The Association expenses advertising and marketing expenses as incurred.Advertising and marketing expenses are included in sundry and program supplies in the statement offunctional expenses and totaled $3,126 and $3,240 for the years ended December 31, 2012 and 2011,respectively.

Q. Amortization of Debt Acquisition Costs - The Association has incurred $73,686 in debtacquisition costs in connection with the issuance of bonds and refinancing of notes. Such costs are beingamortized over the life of the bonds and notes payable. Amortization incurred totaled $7,570 for each of theyears ended December 31, 2012 and 2011. Amortization expense will be $5,059,$2,554, $2,554, $2,554 and$1,276 for December 31, 2013, 2014, 2015, 2016 and 2017, respectively.

R. Shipping and Handling Costs - The Association classifies freight billed to customers asprogram revenue for the workshop and the related freight costs as program supplies.

S. Subsequent Events - The Association has evaluated events and transactions that occurredbetween December 31, 2012 and March 25, 2013, which is the date the financial statements were available tobe issued, for possible disclosure and recognition in the financial statements.

NOTE 2- CASH AND CERTIFICATES OF DEPOSIT IN EXCESS OF FEDERALLY INSURED LIMITS

The Association maintains its cash in bank deposit and credit union accounts and certificates ofdeposit that, at times, may exceed federally insured limits. The Association has not experienced any losses inthose accounts. As of December 31, 2012, the Association had on deposit $1,099,252 with local banks andcredit unions of which $730,764 was covered by either Federal Deposit or National Credit Union Insurance.The remainder of the funds is subject to the general credit worthiness and financial stability of the financialinstitutions.

11

CFIENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


NOTE 3- INVESTMENTS

Investment securities are exposed to various risks, such as interest rate, market and credit. Due tothe level of risk associated with certain investment securities and the level of uncertainties related to changesin the fair value of investment securities, it is at least reasonably possible that changes in risks in the nearterm would materially affect the net assets of the Association. At the current time the Association is unsureof the potential investment risk on certain investments due to the changes in the current market conditions.

Investments consisted of the following at December 31:

U.S. Government Securities

Certificates of Deposit

Mutual Funds

Corporate Bonds

Equities

Cost

2012 2011

$ - $ 49,789

46,000 86,000

282,523 145,000

157,070 157,070

838,151 866,594

Fair Value

2012 2011

$ - $ 51,485

46,807 87,433

284,436 144,099

163,153 149,780

1,204,773 1,140,072

$ 1,323,744 $ 1,304,453 $ 1,699,169 $ 1,572,869

Investment return is summarized as follows for the years ended December 31:

2012 2011

Total Realized and Unrealized

Gain (Loss) on Investments

Investment Income:

Interest Income:

Checking and Savings Accounts

Investment Accounts

Dividend Income

Total Investment Income

Total Investment Return

$ 134,943 $ (21,163)

14,286 12,068

9,649 11,767

31,599 23,853

55,534 47,688

$ 190,477 $ 26,525

NOTE 4- DEBT RESERVE FUND

The financing agreements for the NYSARC, Inc DASNY Bond Series 2005A require theAssociation to maintain debt reserve fund for the bonds. The Reserve Funds are a reserve that may be usedfor the payment of principal and interest to the extent that other funds are not available. When the bondsmature, monies in the Reserve Fund will be used to pay the final principal. As of December 31, 2012 and2011, the debt reserve fund was $105,739.

12

* 12 • 1%



NOTE 5- DEFERRED REVENUE

As of December 31, 2012 and 2011 included in deferred revenue is money received that is requiredto be used on capital improvements to the various properties and had not been spent during 2012 and 2011.

NOTE 6- LONG-TERM DEBT

CurrentMaturities Long-Term

Note Payable to a local bank, secured by investments. The note requiresmonthly payments of $4,197, including interest at 6.5% per annum throughJune 2017.

Note Payable to a local bank, secured by investments. Monthly installmentspayable at $4,380 per month, including interest at 6.5% per annum throughOctober 2017 are required.

Note Payable to a local bank, secured by investments. Total loan available upto $700,000 until October 1, 2013. Interest only payments until September 1,2013. Then monthly payments are determined based on a 231 monthamortization. Final payment is due January 1, 2018. Note bears interest atlender's corporate base lending rate plus 50 basis points with a minimuminterest rate of 3.75%. Interest rate as of December 31, 2012 was 3.75%.

Bonds Payable to NYSARC, Inc. Payable in monthly payments of $8,562,including interest at 4.19% per annum through July 2013.

Bonds Payable to NYSARC, Inc. Payable in monthly principal payments of$5,229, plus interest at 4.19% per annum through August 2017.

Total

$ 36,632 $ 192,367

33,798 2741192

2,949 328,149

49,632 -

62,747 219,615

$ 185,758 $ 1,014,323

At December 31, 2012, the future maturities of long-term debt consisted of the following:

20132014201520162017

Thereafter

$ 185,758149,968155,461161,309250,961

296,624

$ 1,200,081

13

CI-IENANGO COUNTY CHAPTERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


NOTE 7- LINE OF CREDIT

The Association had established a $750,000 line of credit with a local bank. The line was increasedto $1,300,000 during 2012. Investments held with the bank secure the line of credit. The interest rate is primeplus .5. At December 31, 2012 and 2011 the balance outstanding was $310,450 and $250,250, respectively.The interest rate at December 31, 2012 was 3.75%.

NOTE 8- PENSION PLAN

The Association has a profit sharing plan with a deferred compensation matching feature for allfull-time staff with over one year of service. Contributions to the plan, net of forfeitures, totaled $177,232 and$273,546 for the years ended December 31, 2012 and 2011, respectively.

NOTE 9- LEASE COMMITMENTS

In August 2006 the Association signed an agreement for nine copiers. Payments were $1,411 permonth until August 2011. During November 2011 the Association signed an agreement for five copiers.Payments are $506 per month until October 2016. June 1, 2012 the Association signed an agreement to leasewarehouse/ storage space. The lease requires monthly rent of $5,750 that is month to month untilJune 1, 2013. Rental expense for the leases totaled $47,592 and $12,300 for the years endedDecember 31, 2012 and 2011, respectively.

Payments under the lease as of December 31 are as follows:

2013 $ 6,0722014 6,0722015 6,072

2016 5,060

$ 23,276

NOTE 10- ECONOMIC DEPENDENCE

Historically, a significant amount of funding for the Association has been derived from New YorkState government and government agencies. While this funding has been available in the past at a consistentlevel, there is 110 guarantee that such funding will continue to be available in the future. Annually, theAssociation must submit cost information to the State. Such information is subject to audit and review by theNew York State Oversight Agency. As such, subsequent audit adjustments are possible but are not expectedby management to be material to the Association's financial statements. Rates of reimbursement are subjectto appeal and subsequent adjustments.

During the years ending December 31, 2012 and 2011, the Association received subcontracting feesof $4,674,552 and $5,257,233, or approximately 78% and 82% of total sales, from five and four companies,respectively.

14



NOTE 11- CONTINGENCIES AND COMMITMENTS

The Association is self-insured in regards to employee dental insurance. Under the plan, theAssociation will provide a maximum dental care benefit of $1,500 per family per year for those employeeswith dependents and a maximum benefit of $750 per employee per year for single employees with nodependents. In addition, the Association will provide a lifetime maximum orthodontic care benefit of $500per person with no annual limit per family. Under the plan, the Association's maximum liability could beapproximately $129,000. Management, based upon historical data on claims filed by its employee base, doesnot expect that the Association's liability will approach this cap. During 2012 and 2011, $16,480 and $5,956 ofclaims, net of employee premiums collected, were paid under the plan, respectively.

In a prior year, the Association signed a multi-year employment agreement with an employeewhich is accounted for as a deferred compensation plan under FASB ASC 710. The agreement entitles theemployee to a longevity incentive which is equal to two weeks of the employee's base salary for every yearthe employee is employed at the Association. The initial agreement was renegotiated with two renewalterms. The first renewal extends the contract to January 1, 2012 and the second renewal extends the contractuntil January 1, 2013 if exercised by the employee and approved by the board by specified dates. The firstrenewal option has been exercised and approved by the board until January 1, 2012. During 2010 the boardapproved a revised contract which expires June 4, 2013. The amount accrued as of December 31, 2010 in theamount of $301,231 was paid during 2011. The amount accrued after December 31, 2010 until the end of thecontract is payable by the December of the year accrued for. The amount payable is two weeks of the basesalary for the year accrued times the portion of the months worked in the year. In addition, the employeecontract provides that if the Association cancels the agreement without cause the Association is required tocontinue a yearly payment of approximately $220,000 including salary and benefits until June 4, 2013. As ofJune 30, 2007 the employee became vested to continue to receive the current level of medical and dentalbenefits for the lifetime of the employee and spouse. The cost of the medical and dental benefits was initiallyrecorded in 2007, which was the estimated liability to be paid out over the lifetime of the employee or spousediscounted to present value. The actuarial calculation of the benefit discounted to present value is $191,764and $176,395 as of December 31, 2012 and 2011, respectively. Total deferred compensation expense for theyears ending December 31, 2012 and 2011 is $58,831 and $39,078, respectively included on the statement offunctional expense as salary expense. The longevity portion of the contract of $8,461was recorded in accruedexpenses as of December 31, 2012 and 2011, respectively. The remaining balance of $259,764 and $176,395 isshown as non-current in the statement of financial position as of December 31, 2012 and 2011, respectively.During September 2011 the Association and Executive Director signed a new contract which took effectJanuary 1, 2012 with the same terms as above. The Executive Director is entitled to $35,000 based on signingthe new contract and extending his terms to March 1, 2014 which was accrued as of December 31, 2011 andrecorded in accrued expenses. The contract requires that he train a replacement for his position and isentitled to $35,000 which was accrued as of December 31, 2012 and included in deferred compensationpayable.

The Association has implemented a health reimbursement plan. The contribution per employee isdetermined annually by the Association. The estimated contribution for 2013 is immaterial.

The Board during 2010 authorized the Association to loan another nonprofit organization up to$100,000. This money is to help the nonprofit cover costs until they can generate revenue. During 2010,$10,000 was loaned to this Organization. No additional amounts were loaned during 2012 and 2011. Norepayment terms have been established at this time. The amount is classified as long term on the statementof financial position since the Association does not expect repayment during 2013.

15

CHENANGO COUNTY CHAFFERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


NOTE 11- CONTINGENCIES AND COMMITMENTS (Continued)

The Association is an unincorporated association that is exempt from income tax as a Section501(c)(3) charitable organization. The Association was issued a certificate of recognition as a chapter ofNYSARC, Inc., a not-for-profit corporation that is also exempt from income tax as a Section 501(c)(3)charitable organization. NYSARC, Inc. has over 50 other chapters. The Association leases some propertyfrom an affiliate, Chenango Community Residences, Inc., a 501(c)(2) not-for-profit corporation. Under theprovisions of some documents of NYSARC, Inc., other property of the Association might be deemed to beheld in trust by NYSARC, Inc. for the beneficial use of the Association. NYSARC, Inc. has stated that becausethe chapters are not incorporated, there is a risk, in some circumstances, that individual chapters, or theirassets, may be exposed to liabilities of other chapters. Such liability, if any, cannot reasonably be estimated ordeterminable at this time. To the Association's knowledge, no such liabilities have been asserted, orthreatened to be asserted, against the Association or its assets, and management of the Association does notbelieve there is a valid basis on which any such liabilities could be imposed against the Association or itsassets. In individual cases, the Association has participated in financing with NYSARC, Inc. in which some ofthe Association's assets are pledged for NYSARC, Inc.'s obligations to a third party, such as the DormitoryAuthority of the State of New York.

The Association has filed a lawsuit against NYSARC, Inc. seeking a judicial declaration that it isautonomous. On October 20, 2011, the Appellate Division, Third Department confirmed that the Associationhas, in fact, a sufficient separate existence from NYSARC, Inc. to be considered an unincorporatedassociation although it is bound by contract to retain its status as a chapter of NYSARC, Inc. NYSARC, Inc.has counterclaimed based on legal theories of conversion and trespass and seeks damages claimed to exceed$10,000,000. The Association believes the counterclaims lack merit, but because it is required to defend them,it sought insurance coverage for both the defense and indemnification from insurance carrier PhiladelphiaInsurance Company. The issue of indemnification of the Association likely will remain outstanding until theNYSARC lawsuit is resolved. Management believes it is likely that the lawsuit in question will be resolved in2013 without any damages assessed against the Association.

NOTE 12- ADMINISTRATIVE FEES PAID TO AFFILIATE

The Chenango County Chapter New York State Association for Retarded Children, Inc. is achapter of the New York State Association for Retarded Children, Inc. and fees are billed to the Chapter.Fees are included in professional fees in the statement of functional expenses and totaled $21,745 and $21,669in 2012 and 2011, respectively. In 2007 the Association ceased paying fees to NYSARC, Inc. Instead, theequivalent of those fees were paid into and maintained in an escrow account pending resolution of thelitigation between these parties. During 2011 the escrow was liquidated and the money was paid toNYSARC, Inc. and NYSARC, Inc. accepted them without comment. To the extent that the Association paidservice fees, they were for advocacy and education services provided by NYSARC, Inc.

NOTE 13- NON CASFI TRANSACTIONS

During the year ended December 31, 2012, the Association paid for building improvements withloan proceeds of $331,097. The money was neither deposited nor disbursed from the Association's checkingaccount and therefore, not reflected in the Statement of Cash Flows.

16

CHENANGO COUNTY CHAFFERNEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.


NOTE 14- FAIR VALUE OF FINANCIAL INSTRUMENTS

Fair values of assets measured utilizing the following levels of the fair value hierarchy:

• Level 1: Quoted prices in active markets for identical assets• Level 2: Observable inputs other than the quoted prices included in Level 1• Level 3: Significant unobservable input

Fixed Income Securities

US Government AgenciesCorporate BondsBank Certificate of Deposit

Equities Common Stock

Consumer DiscretionaryConsumer StaplesEnergyFinancialsHealthcareIndustrialInformation TechnolgyMaterialsTelecommunications Services

Mutual Funds Fixed IncomeMutual Funds Equity

2012 2011

Fair FairValue Level 1 Value Level I

$ - $ - $ 51,485 $ 51,485

163,153 163,153 149,780 149,780

46,807 46,807 87,433 87,433

70,118

70,118

58,720

58,720

109,176

109,176

124,732

124,732

106,803

106,803

107,810

107,810

78,856

78,856

52,587

52,587

72,488

72,488

64,637

64,637

101,086

101,086

92,485

92,485

134,730

134,730

141,914

141,914

36,982

36,982

16,167

16,167

8,654

8,654

8,024

8,024

284,436

284,436

144,099

144,099

485,880

485,880

472,996

472,996

Total

$1,699,169 $1,699,169 $1,572,869 $1,572,869

NOTE 15- PRIOR PERIOD ADJUSTMENT

During 2012, the Association discovered a liability was not recorded for amounts owed to employeesupon leaving the Association assuming certain criteria are met. Therefore, the December 31, 2011 beginninguridesignated net assets has been restated by a reduction of $404,186 to correct the liability as ofDecember 31, 2010. The 2011 financial statements were restated due to this error and has resulted in anincrease of $13,344 to payroll taxes and fringe and a decrease of $13,344 to the ending undesignated netassets as of December 31, 2011 and the change in net assets for the year ended December 31, 2011. As a resultof the change net assets for December 31, 2011 was restated to $698,463.

17

Piaker

imm

& LyonsCERTIFIED PUBUC ACCOUNTANTS

Established in 19-5.5

(607) 336-8008

Fax: (607)336-622-t

\\ehstte: pnlcta.coni

Officers:

Roy E. I'iilhr, CM - lh'Si(!('Jll lXPCUh!','e

.l;ltli(s P. Lewis, (R/.\13V. ('\'S+

Alan D. Piakei, (1l\Ronald L. SimonS, CR\

John R. May, CRAngelo J. Gallo. CR\Richard A. L\ neli. CR\.\niy E. 13ioivn, (R\".Iaiwen E SuIi k, CR\'

Membersbe rs nfl.l,nerbwn Institute of cerli/led Pubhe . IeeountaiitsNew Thrk Stale Sane/u of('ertified Publie.leeountants

lhilip l. Piaker, (P.\

.\htaharn L. Piakei (R\

Of (ounsel:

Allan IL Lyons, CRKeiitwtli L. Coleman, CPA

%%so Licensed in PennsytuaniaAtso Licensed in Marsland

.Ilso ,Il,',nber nfl'NstiuniI .\ssoeiatioui if Certilieil ilnation Analysts

'l'eniisvluaiita Insliltite of Certified I'uhlic Accountants

INDEPENDENT AUDITORS' REPORTON SUPPLEMENTARY INFORMATION

To the Board of DirectorsChenango County ChapterNew York State Associationfor Retarded Children, Inc.

We have audited of the consolidated basic financial statements of CHENANGO COUNTYCHAFFER NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC. AND RELATEDCOMPANIES as of and for years ended December 31, 2012 and 2011, and our report thereon dated March25, 2013, which expressed an unmodified opinion on those financial statements, appears on page 1 and 2.Our audits were conducted for the purpose of forming an opinion on the consolidated financial statementstaken as a whole. The additional information included on Schedules I through 6 is presented for purposes ofadditional analysis and is not a required part of the consolidated financial statements. Such information isthe responsibility of management and was derived from and relates directly to the underlying accountingand other records used to prepare the consolidated financial statements. The information has been subjectedto the auditing procedures applied in the audit of the consolidated financial statements and certainadditional procedures, including comparing and reconciling such information directly to the underlyingaccounting and other records used to prepare the consolidated financial statements or to the consolidated -financial statements themselves, and other additional procedures in accordance with auditing standardsgenerally accepted in the United States of America. In our opinion, the information is fairly stated in allmaterial respects in relation to the consolidated financial statements as a whole.

/

MAKER & LYONS, P.C.

Norwich, New YorkMarch 25, 2013

1$

586 (ounlv Ro;til • PD Box 190 • Xoi'wieh, New \ork 1:3815-0190

SUPPLEMENTAL SCHEDULE 1

SUPPLEMENTAL SCHEDULE 1CHENANGO COUNTY CHAPTER

NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.CONSOLIDATING STATEMENT OF FINANCIAL POSITION

DECEMBER 31, 2012

Chenango Chenango CWS ConsolidatedCounty Community Charitable Statement of

Chapter NYS Residences, Foundation, Consolidation FinancialARC, Inc. Inc. Inc. Eliminations Position

ASSETS

Current AssetsCash and Cash EquivalentsCertificates of DepositAccounts Receivable - NetProgram ReceivablesMedicaid Receivable - NetInventoryPrepaid Expenses and Other Assets


Investments

Fixed AssetsLand and Land ImprovementsBuildings and ImprovementsEquipment and FixturesTransportation EquipmentConstruction in Process

Less: Accumulated Depreciation

Net Fixed Assets

Other AssetsDebt Reserve FundDebt Acquisition Costs,

Net of Amortization of $59,689Loan to Nonprofit OrganizationIntercompany Receivable

Total Other Assets

$ 980,792 $ -$97,581

837,749488,166448,943366,117103,763 -

3,323,111 -

1,462,786 -

403,119 20,000

6,075,197 940,936

3,674,924 -

673,500 -

577,871 -

11,404,611 960,936

6,792,265 259,833

4,612,346 701,103

105,739 -

13,997 -

10,000 -

714,309 -

844,045 -

- $ 1,064,194- 97,581- 837,749- 488,166- 448,943- 366,117

103,763

3,406,513

= 1,699,169

- 423,119- 7,016,133- 3,674,924- 673,500

= 577,871

- 12,365,547

= 7,052,098

5,313,449

- 105,739

- - 13,997

- - •10,000

6,482 (720,791) -

6,482 (720,791)

129,736

83,402 $

83,402

236,383

TOTAL ASSETS $ 10,242,288 $ 701,103 $ 326,267 $ (720,791) $ 10,548,867


19



DECEMBER 31, 2012




Current Liabilities


Line of Credit

Accounts Payable

Deferred Revenue

Accrued Expenses and Other Liabilities



$ 185,758 $ -$ - $ 185,758

310,450 - 310,450

297,931 - 297,931

123,832 - 123,832

294,231 - 4,000 - 298,231

116,951 - 116,951

200,487 - 200,487

Total Current Liabilities 1,529,640 = 4,000 = 1,533,640

Other Liabilities


1,014,323 - - - 1,014,323

Accrued Bank Hours 448,946 - - - 448,946

Deferred Compensation Payable 259,764 - - - 259,764

Intercompany Payable - 720,791 - (720,791) -

Total Other Liabilities 1,723,033 720,791 - (720,791) 1,723,033

Total Liabilities 3,252,673 720,791

4,000 (720,791) 3,256,673

Total Net Assets 6,989,615 (19,688) 322,267 - 7,292,194

TOTAL LIABILITIES ANDNET ASSETS $ 10,242,288 $ 701,103 $ 326,267 $ (720,791) $ 10,548,867


PTO

, ,SUPPLEMENTAL SCHEDULE 2


CONSOLIDATING STATEMENT OF FINANCIAL POSITIONDECEMBER 31, 2011

Restated

Chenango Chenango CWS Consolidated

County Community Charitable Statement ofChapter NYS Residences, Foundation, Consolidation Financial

ARC, Inc. Inc. Inc. Eliminations Position

ASSETS

Current Assets

Cash and Cash EquivalentsCertificates of DepositAccounts Receivable - NetProgram ReceivablesMedicaid Receivable - NetInventoryPrepaid Expenses and Other Assets


Investments

$ 536,723 $609,000824,598160,683520,741371,108

17,942

3,040,795

1,361,526

72,945 $

= 72,945

= 211,343

- $ 609,668- 609,000- 824,598- 160,683- 520,741- 371,108

= 17,942

= 3,113,740

= 1,572,869

Fixed Assets

Land and Land Improvements 403,119 28,908 - 432,027

Buildings and Improvements 5,911,614 932,028 - 6,843,642

Equipment and Fixtures 3,462,095 - - 3,462,095

Transportation Equipment

678,623 - - 678,623

Construction in Process 166,371 - = 166,371

10,621,822 960,936 - 11,582,758

Less: Accumulated Depreciation 6,349,128 252,623 = 6,601,751

Net Fixed Assets 4,272,694 708,313 - 4,981,007

Other AssetsDebt Reserve Fund 105,739 - - - 105,739

Debt Acquisition Costs,Net of Amortization of $52,119 21,567 - - - 21,567

Loan to Nonprofit Organization 10,000 - - - 10,000

Intercompany Receivable 699,082 - 19,710 (718,792) -

Total Other Assets 836,388 - 19,710 (718,792) 137,306

TOTAL ASSETS $ 9,511,403 $ 708,313 $ 303,998 $ (718,792) $ 9,804,922

See the accompanying notes to financial statements.21

1,544,926

868,998 -

417,530 -

176,395 -

- 718,792

1,462,923 718,792

3,007,849 718,792

= 1,549,926

- 868,998

- 417,530

- - 176,395

- (718,792) -

- (718,792) 1,462,923

5,000 (718,792) 3,012,849

- 5,000



DECEMBER 31, 2011Restated




Current Liabilities


Line of Credit

Accounts Payable

Deferred Revenue

Accrued Expenses and Other Liabilities



Total Current Liabilities

Other Liabilities


Accrued Bank Hours

Deferred Compensation Payable

Intercompany Payable

Total Other Liabilities

Total Liabilities

$ 225,503 $ - $ 225,503

250,250 - 250,250

362,381 - 362,381

53,959 - 53,959

261,885

5,000 - 266,885

114,668 - 114,668

276,280

276,280

Total Net Assets 6,907,740 (10,479) 298,998 - 7,196,259

Prior Period Adjustment

(404,186) - - = (404,186)

Restated Total Net Assets 6,503,554 (10,479) 298,998 = 6,792,073

TOTAL LIABILITIES ANDNET ASSETS $ 9,511,403 $ 708,313 $ 303,998 $ (718,792) $ 9,804,922

See the accompanying notes to financial statements. 22

8,559,816 7,433,767 828,986

1,985,363 1,789,600 249,739

320,838 256,391 38,812

72,626 73,273 10,095

37,793 33,808 5,013

361,758 226,004 33,401

1,412,272 1,128,477 157,039

- 8,262,753- 2,039,339- 295,203- 83,368- 38,821- 259,405

= 1,285,516

297,063(53,976)25,635

(10,742)(1,028)

102,353

126,756

8,714,1932,060,784

285,93877,31838,363

184,4221,524,467

7,419,018 989,361

1,667,545 230,712

251,841 37,658

69,035 9,664

31,817 4,751

159,813 23,804

1,119,315 156,121

- 8,408,379 305,814- 1,898,257 162,527- 289,499 (3,561)- 781699 (1,381)- 36,568 1,795- 183,617 805

1,275,436 249,031



CONSOLIDATING STATEMENTS OF ACTIVITIESFOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011

Restated

2012

2011

Program Increase Program

Increase

Revenue Management

(Decrease)

Revenue Management

(Decrease)

and Other

Program and General Fundraising Total

In Net and Other Program and General Fundraising Total

In Net

Support

Expenses Expenses Expenses Expenses

Assets

Support

Expenses Expenses Expenses Expenses Assets

Chenango County Chapter New York StateAssociation for Retarded Children, Inc.

WorkshopSupervised Individual Residential AlternativeSupportive ApartmentsClinicRespite ProgramMedicaid Service Coordination

Habilitation - Day and Residential

Total Chenango County Chapter New York State

Association for Retarded Children, Inc.

Chenango Community Residences, Inc.

CWS Charitable Foundation, Inc.

Combined Totals

Consolidation Eliminations*

Consolidated Totals

12,750,466 10,941,320 1,323,085 - 12,264,405 486,061 12,885,485 10,718,384 1,452,071 - 12,170,455 715,030

10,127 19,336 - - 19,336 (9,209) 8,535 18,986 - - 18,986 (10,451)

58,028 - 5,937 28,822 34,759 23,269 19,622 - 5,444 20,294 25,738 (6,116)

12,818,621 10,960,656 1,329,022 28,822 12,318,500 500,121 12,913,642 10,737,370 1,457,515 20,294 12,215,179 698,463

(15,407) (15,407) - - (15,407) - (8,535) (8,535) - - (8,535) -

$ 12,803,214 $ 10,945,249 $ 1,329,022 $ 28,822 $ 12,303,093 $ 500,121 $ 12,905,107 $ 10,728,835 $ 1,457,515 $ 20,294 $ 12,206,644 $ 698,463

* Consolidation Eliminations are Summarized as Follows:

Chenango County Chapter NYS ARC, Inc. Rent toChenango Community Residences, Inc.

Chenango County Chapter NYS ARC, Inc. Contribution toCWS Charitable Foundation, Inc.

2012 2011

$ 10,127 $ 8,535

5,280 -

$ 15,407 $ 8,535


23



CONSOLIDATING STATEMENTS OF ACTIVITIESFOR THE YEARS ENDED DECEMBER 31, 2012 AND 2011

Restated

2012 2011

Program Increase Program

Increase

Revenue Management

(Decrease) Revenue Management

(Decrease)

and Other Program and General Fundraising Total

In Net and Other Program and General Fundraising Total

In Net

Support

Expenses Expenses Expenses Expenses Assets Support

Expenses Expenses Expenses Expenses

Assets

Chenango County Chapter New York StateAssociation for Retarded Children, Inc.

WorkshopSupervised Individual Residential AlternativeSupportive ApartmentsClinicRespite ProgramMedicaid Service Coordination

Habilitation - Day and Residential

8,559,816 7,433,767 828,986

1,985,363 1,789,600 249,739

320,838 256,391 38,812

72,626 73,273 10,095

37,793 33,808 5,013

361,758 226,004 33,401

1,412,272 1,128,477 157,039

- 8,262,753 297,063- 2,039,339 (53,976)- 295,203 25,635- 83,368 (10,742)- 38,821 (1,028)- 259,405 102,353

- 1,285,516 126,756

8,714,1932,060,784

285,93877,31838,363

184,422

1,524,467

7,419,018 989,361

1,667,545 230,712

251,841 37,658

69,035 9,664

31,817 4,751

159,813 23,804

1,119,315 156,121

- 8,408,379 305,814- 1,898,257 162,527- 289,499 (3,561)- 78,699 (1,381)

36,568 1,795- 183,617 805

= 1,275,436 249,031

Total Chenango County Chapter New York State

Association for Retarded Children, Inc. 12,750,466 10,941,320 1,323,085 - 12,264,405 486,061 12,885,485 10,718,384

1,452,071 - 12,170,455 715,030

Chenango Community Residences, Inc. 10,127

19,336 - - 19,336 (9,209) 8,535 18,986 - 18,986 (10,451)

CWS Charitable Foundation, Inc. 58,028 - 5,937 28,822 34,759 23,269 19,622 - 5,444 20,294 25,738 (6,116)

Combined Totals 12,818,621 10,960,656 1,329,022 28,822 12,318,500 500,121 12,913,642 10,737,370 1,457,515 20,294 12,215,179 698,463

Consolidation Eliminations*

(15,407) (15,407) - - (15,407) - (8,535) (8,535) - - (8,535) -

Consolidated Totals $ 12,803,214 $ 10,945,249 $ 1,329,022 $ 28,822 $ 12,303,093 $ 500,121 $ 12,905,107 $ 10,728,835 $ 1,457,515 $ 20,294 $ 12,206,644 $ 698,463

* Consolidation Eliminations are Summarized as Follows:

Chenango County Chapter NYS ARC, Inc. Rent toChenango Community Residences, Inc.

Chenango County Chapter NYS ARC, Inc. Contribution toCWS Charitable Foundation, Inc.

2012 2011

$ 10,127 $ 8,535

5,280 -

$ 15,407 $ 8,535


23

-$ -$1,150 -

37,213 184,422 1,524,467 -

77,854 $585,148

9,48024,8151,175

25,847644,788

13,5016,437,332

5,065,545

- $ - $ 77,854- - 585,148

8,535 - 18,015- 1,710 26,525- 30 1,205- 17,882 43,729- - 644,788- - 13,501- - 6,437,332- - 5,065,545

JSUPPLEMENTAL SCHEDULE 4


SCHEDULES OF TOTAL REVENUEFOR THE YEAR ENDED DECEMBER 31, 2012

Chenango CWSMedicaid Habilitation Total Community Charitable

Total Supervised Supportive Respite Service Day and ARC Residences, Foundation, Combined

Workshop IRA Apartments Clinic Program Coordination Residential Inc. Inc. Inc. Totals

-$155,844

164,994

-$

10,127

Revenue

Cafeteria SalesParticipant FeesRent Income*

Investment ReturnContributions*

Miscellaneous IncomeGrantsNew York State Direct ContractSheltered Employment ProgramWorkshop Sales

Medicaid Revenue

Total Revenue

$ 71,995 $ - $- 454,188

10,872 -

156,168 -

1,304 -

25,278 30

250,000 -

656,905 -

13,438 -

5,992,470 -

1,381,386 1,531,145 -

- $ - $ - $ - $ 71,995 $

225 2,100 - - 612,357- - - - 10,872- - - - 156,168- - - - 1,304- - 461 200 25,969- - - - 250,000- - - - 656,905- - - - 13,438- - - - 5,992,470

72,401 35,693 361,297 1,412,072 4,958,988 -

- $ 71,995- 612,357- 20,999

34,309 190,477

6,180 7,484

17,539 43,508- 250,000- 656,905- 13,438- 5,992,470

- 4,958,988

$ 8,559,816 $ 1,985,363 $ 320,838 $ 72,626 $ 37,793 $ 361,758 $ 1,412,272 $ 12,750,466 $ 10,127 $ 58,028 $ 12,818,621

Restated

FOR THE YEAR ENDED DECEMBER 31, 2011

$ 77,854 $ $ - $ - $- 437,836 145,972 190

9,480 - - -

24,815 - - -

1,175 - - -

25,847 - - -

644,788 - - -

13,501 - - -

6,437,332 - - -

1,479,401 1,622,948 139,966 77,128 -

Cafeteria SalesParticipant FeesRent Income*

Investment ReturnContributions*

Miscellaneous IncomeNew York State Direct ContractSheltered Employment ProgramWorkshop Sales

Medicaid Revenue

Total Revenue $ 8,714,193 $ 2,060,784 $ 285,938 $ 77,318 $ 38,363 $ 184,422 $ 1,524,467 $ 12,885,485 $ 8,535 $ 19,622 $ 12,913,642

*Includes Intercompany Transactions as Summarized in Supplemental Schedule 3.


24

. I


NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.CONSOLIDATING STATEMENT OF FUNCTIONAL EXPENSES

FOR THE YEAR ENDED DECEMBER 31, 2012

*See Supplemental Schedule 3

Manage- Chenango CWS Consolida-

Medicaid Habilitation ment Total Community Charitable tion Consolida-

Total Supervised Supportive Respite Service Day and Total and Expenses Residences, Foundation, Combined Elimin- tion

Workshop IRA Apartments Clinic Program Coordination Residential Program General ARC, Inc. Inc. Inc. Totals ations* Totals

$ 3,989,143 $ 1,043,808 $ 136,594 $ 48,668 $ 22,788 $ 156,056 $ 539,891 $ 5,936,948 $ 762,739 $ 6,699,687 $ - $ 3,047 $ 6,702,734 $ - $ 6,702,734

793,354 389,378 50,324 9,853 7,454 64,346 213,072 1,527,781 212,121 1,739,902 - 1,478 1,741,380 - 1,741,380

4,782,497 1,433,186 186,918 58,521 30,242 220,402 752,963 7,464,729 974,860 8,439,589 - 4,525 8,444,114 - 8,444,114

5,014 - - - - - 2,556 7,570 - 7,570 - - 7,570 - 7,570

60 - - - - - - 60 5,559 5,619 - - 5,619 - 5,619

69,058 - - - - - - 69,058 - 69,058 - - 69,058 - 69,058

5,280 - - - - - - 5,280 - 5,280 - - 5,280 (5,280) -

120,031 21,144 1,228 - 287 1,810 223,186 367,686 - 367,686 - - 367,686 - 367,686

341,705 63,683 5,602 3,812 - - 47,161 461,963 56,142 518,105 7,210 - 525,315 - 525,315

- 83,840 25,188 - - - 3,464 112,492 - 112,492 - - 112,492 - 112,492

- 13,368 2,073 - - - 9,677 25,118 - 25,118 - - 25,118 - 25,118

28,776 4,646 208 208 - - 6,656 40,494 17,609 58,103 1,154 - 59,257 - 59,257

14,991 37,820 - - - - 12,753 65,564 - 65,564 - - 65,564 - 65,564

8,103 1,594 37 - - 523 401 10,658 50,978 61,636 - - 61,636 - 61,636

- 58,611 21,756 - - - - 80,367 - 80,367 - - 80,367 - 80,367

31,902 - - - - - - 31,902 110,204 142,106 - 1,553 143,659 - 143,659

7,991 70 701 701 - - 1,452 10,915 - 10,915 - - 10,915 - 10,915

940 2,782 263 - - - 8,197 12,182 - 12,182 - - 12,182 - 12,182

56,127 - - - - - - 56,127 - 56,127 - - 56,127 (10,127) 46,000

227,653 11,420 1,055 1,222 - - 20,269 261,619 15,859 277,478 2,998 - 280,476 - 280,476

- - - - - - - - - - 22,744 22,744 - 22,744

13,350 554 79 255 - 233 2,017 16,488 7,418 23,906 - - 23,906 - 23,906

2,337 68 - - - - - 2,405 30,532 32,937 - 5,937 38,874 - 38,874

14,134 5,847 2,208 1,084 - - 2,978 26,251 30,627 56,878 - - 56,878 - 56,878

400 - - - - - - 400 2,497 2,897 - - 2,897 - 2,897

5,153 57 - - - 347 26 5,583 8,115 13,698 - - 13,698 - 13,698

154,985 33,417 6,254 1,332 - - 20,428 216,416 - 216,416 7,974 - 224,390 - 224,390

27,039 3,550 850 - - - 10,700 42,139 12,685 54,824 - - 54,824 - 54,824

1,516,241 13,943 1,971 6,138 3,279 2,689 3,593 1,547,854 - 1,547,854 - - 1,547,854 - 1,547,854

2,651,270 356,414 69,473 14,752 3,566 5,602 375,514 3,476,591 348,225 3,824,816 19,336 30,234 3,874,386 (15,407) 3,858,979

$ 7,433,767 $ 1,789,600 $ 256,391 $ 73,273 $ 33,808 $ 226,004 $ 1,128,477 $10,941,320 $ 1,323,085 $ 12,264,405 $ 19,336 $ 34,759 $12,318,500 $ (15,407) $12,303,093

Compensation and FringeSalaries, Temporary Services and

Participant CompensationPayroll Taxes and Fringe


Other ExpensesAmortizationAssessment, Dues and SubscriptionsBad Debt Expense (Recovery)Cafeteria PurchasesContributionsParticipant TransportationDepreciationFoodHousehold SuppliesInsuranceInterest ExpenseOffice SuppliesParticipant AllowanceProfessional FeesReal Estate TaxesRecreationRent ExpenseRepairs and MaintenanceMiscellaneous Fundraising ExpensesStaff TrainingSundryTelephoneTherapeutic and DiagnosticTravelUtilitiesVehicle ExpenseProgram Supplies


TOTAL EXPENSES


25


NEW YORK STATE ASSOCIATION FOR RETARDED CHILDREN, INC.CONSOLIDATING STATEMENT OF FUNCTIONAL EXPENSES

FOR THE YEAR ENDED DECEMBER 31, 2011Restated

Manage- Chenango CWS Consolida-Medicaid Habilitation ment Total Community Charitable tion Consolida-

Total Supervised Supportive Respite Service Day and Total and Expenses Residences, Foundation, Combined Elimin- tion

Workshop IRA Apartments Clinic Program Coordination Residential Program General ARC, Inc. Inc. Inc. Totals ations* Totals

$ 4,739,676 $ 971,852 $ 134,032 $ 45,765 $ 20,216 $ 110,909 $ 540,040 $ 6,562,490 $ 806,559 $ 7,369,049 $ - $ 9,799 $ 7,378,848 $ - $ 7,378,848

673,842 342,581 48,234 9,104 6,531 45,681 186,047 1,312,020 221,239 1,533,259 - 3,019 1,536,278 - 1,536,278

5,413,518 1,314,433 182,266 54,869 26,747 156,590 726,087 7,874,510 1,027,798 8,902,308 - 12,818 8,915,126 - 8,915,126

5,014 - - - - - 2,556 7,570 - 7,570 - - 7,570 - 7,5702,966 - - - - - - 2,966 7,303 10,269 - - 10,269 - 10,269

1,427 - - - - - - 1,427 - 1,427 - - 1,427 - 1,427

77,822 - - - - - - 77,822 - 77,822 - - 77,822 - 77,822

92,605 16,044 757 - 1,725 697 222,956 334,784 - 334,784 - - 334,784 - 334,784

239,294 67,222 7,067 4,089 - - 47,488 365,160 57,468 422,628 8,002 - 430,630 - 430,630

- 67,332 19,996 - - - 7,268 94,596 - 94,596 - - 94,596 - 94,596

- 13,920 2,434 - - - 11,416 27,770 - 27,770 - - 27,770 - 27,770

24,938 4,376 193 193 - - 6,404 36,104 16,859 52,963 1,086 - 54,049 - 54,049

15,184 44,107 - - - - 15,241 74,532 - 74,532 - - 74,532 - 74,532

13,703 2,458 468 - - - 725 17,354 59,723 77,077 - - 77,077 - 77,077

- 61,933 21,147 - - - - 83,080 - 83,080 - - 83,080 - 83,080

34,993 - 2,700 - - - - 37,693 170,349 208,042 - 1,396 209,438 - 209,438

4,287 36 - - - - 844 5,167 - 5,167 - - 5,167 - 5,167

1,421 2,872 203 - - - 13,690 18,186 - 18,186 - - 18,186 - 18,186

8,535 - - - - - - 8,535 - 8,535 - - 8,535 (8,535) -

181,603 12,035 378 356 - - 13,286 207,658 3,424 211,082 1,474 - 212,556 - 212,556

- - - - - - - - - - - 6,000 6,000 - 6,000

10,949 - - - - - - 10,949 11,859 22,808 - - 22,808 - 22,808

5,387 7 4 6 - 3 6 5,413 48,214 53,627 - 5,444 59,071 - 59,071

14,186 5,232 1,906 817 - - 2,496 24,637 26,280 50,917 - - 50,917 - 50,917

615 120 - - - - 100 835 2,480 3,315 - - 3,315 - 3,315

16,099 16 - - - 262 - 16,377 9,580 25,957 - 80 26,037 - 26,037

175,760 37,895 6,938 1,493 - - 27,736 249,822 - 249,822 8,424 - 258,246 - 258,246

29,004 3,151 892 - - - 12,059 45,106 10,734 55,840 - - 55,840 - 55,840

1,049,708 14,356 4,492 7,212 3,345 2,261 8,957 1,090,331 - 1,090,331 - - 1,090,331 - 1,090,331

2,005,500 353,112 69,575 14,166 5,070 3,223 393,228 2,843,874 424,273 3,268,147 18,986 12,920 3,300,053 (8,535) 3,291,518

$ 7,419,018 $ 1,667,545 $ 251,841 $ 69,035 $ 31,817 $ 159,813 $ 1,119,315 $ 10,718,384 $ 1,452,071 $ 12,170,455 $ 18,986 $ 25,738 $12,215,179 $ (8,535) $12,206,644

Compensation and FringeSalaries, Temporary Services and

Participant CompensationPayroll Taxes and Fringe


Other ExpensesAmortizationAssessment, Dues and SubscriptionsBad Debt ExpenseCafeteria PurchasesContributionsParticipant TransportationDepreciationFoodHousehold SuppliesInsuranceInterest ExpenseOffice SuppliesParticipant AllowanceProfessional FeesReal Estate TaxesRecreationRent ExpenseRepairs and MaintenanceMiscellaneous Fundraising ExpensesStaff TrainingSundryTelephoneTherapeutic and DiagnosticTravelUtilitiesVehicle ExpenseProgram Supplies


TOTAL EXPENSES

*See Supplemental Schedule 3


26

2,298,973. 2,084,260.

8,770,773. 8,738,799.

5,790,832. 6,036,749.

2,218,440.8,009,272—

761,501.inn of Current Year

2,308, 574.8,345, 323.

393,476.End of Year

• Form 990

Department of the TreasuryInternal Revenue Service

Return of Organization Exempt From Income TaxUnder section 501(c), 527, or 4947(aXl) of the Internal Revenue Code

(except black lung benefit trust or private foundation)

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

2012Open to Public

Inspection

A For the 2012 calendar year, or tax ,2012, and endiB Check if applicable:

Address change NYS ARC, INC. CHENANGO COUNTY CHAPTERName change 17 MIDLAND DRIVE

Initial return NORWICH, NY 13815

Terminated

Amended return

[...j Application pending I- Name and address of principal officer: JOHN MCHALE

117 MIDLAND DRIVE NORWICH, NY 1381I Tax-exempt status

[]5O1(c)(3) Li 501(c) ( )' (insert no.) [J4E

J Website:

CWSPACKAGING. COMK Form of organizatii

I Corporation I I Trust I I Association I Other

Part I iSumrr

Employer Identification Number

16-0970103Telephone number

(607) 334-5366

IG Gross receipts $ 12,796,411.H(a) Is this a group return for affiliates? Yes NoH(b) Are all affiliates included? Yes No

If No, attach a list. (see instructions) H)or I 1527

H(c) Group exemption number

L Year of Formation: 1969 I M State of legal domicile: NY

1 Briefly describe the organizations mission or most significant activities: THE MISSION OF THE CHENANGO COUNTYARC IS TO PROVIDE PROGRAMS THAT ARE SPECIFIC TO MEET A CONSUMER'S NEEDS IN THE

A_O_F QCIPL_ REHABILITATION,JOB READINESS TRAINING, EMPLOYMENTORTUOPPNITYJ RESIDENTIAL SERVICES SERVICEQ TQNJ_ DA TIAN

2 eck this boxCh if the organization discontinued its operations or disposed of more than 25% of its net assets.3 Number of voting members of the governing body (Part VI, line la). ................................... .3 94 Number of independent voting members of the governing body (Part VI, line 1 b) 95 Total number of individuals employed in calendar year 2012 (Part V, line 2a)...........................5 2176 Total number of volunteers (estimate if necessary) ...................................................07a Total unrelated business revenue from Part VIII, column (C), line 12 ...................................7a 0.

b Net unrelated business taxable income from Form 990-T, line 34 .......................................7b 0.Prior Year Current Year

8 Contributions and grants (Part VIII, line ih) ......................................... 1, 175 251,304.9 Program service revenue (Part VIII, line 2g).......................................... 6.412.683. 6,339. 652.

10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ........................________________________11 Other revenue (Part VIII, column (A), lines 5, Gd, Sc, 9c, lOc, and l le) ...............12 Total revenue - add lines 8 through ii (must equal Part VIII, column (A), line 12).13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) .....................

14 Benefits paid to or for members (Part IX, column (A), line 4) .........................15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10).....

16a Professional fundraising fees (Part IX, column (A), line lie) .........................

b Total fundraising expenses (Part IX, column (D), line 25)

17 Other expenses (Part IX, column (A), lines ha-lid, hif-24e) ........................18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ............19 Revenue less expenses. Subtract line 18 from line 12 ...............................

I 20 Total assets (Part X, line 16) .......................................................

o 21 Total liabilities (Part X, line 26).....................................................Z%

22 Net assets or fund balances. Subtract line 21 from line 20

6. 921. 084. 6.989.615.Part II I Signature Block

accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, andof which preparer has any knowledge.

SignHere PRESIDENT

lype or print name and title.

Print/Type preparer's nameI Preparer s si at re Date Check Li if I PTIN

Paid ROY E. FULLER, CPA Preparer Firm's name PlANER &

self-employed P00005268

use uniy Firm's address " P0 BOX 190, 58,%2 COUNTY RD 32 Firm's EIN 11 16-1152552NORWICH, NY 0815 Phoneno. (607) 336-8908

May the IRS discuss this return with the preparef shown above? (see instructions) ..................................... [ Yes Li No

BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA01I3L 12/18/12 Form 990 (2012)

a,0

0

adCl)a,

cc

a)

a)

a)

Cl)a,(I)C

0.

Ul

I hathan

Form 990 (2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 2

I Part Ill] Statement of Program Service Accomplishments

Check if Schedule 0 contains a response to any question in this Part Ill ....................................................1 Briefly describe the organizations mission:

SEE—SCHEDULE-0

2 Did the organization undertake any significant program services during the year which were not listed on the priorForm 990 or 990-El' ......................................................................................... . Yes RNoIf 'Yes,' describe these new services on Schedule 0.

3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? Yes RNoIf 'Yes,' describe these changes on Schedule 0.

4 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 and section 4947(a)(1) trusts are required to report the amount of grants and allocations toothers, the total expenses, and revenue, if any, for each program service reported.

4a (Code: )(Expenses $ 3,774,497. including grants of $) )(Revenue $ 2,548,553.)WORKSHOP— PROVIDES —TRAINING & EMPLOYMENT FOR DEVELOPMENTALLY DISABLED INDIVIDUALS. —THE-WORKSHOP— PROVIDES —SERVICES FOR APPROXIMATELY 124 INDIVIDUALS

4b (Code: ) (Expenses $ 2, 045, 991. including grants of $ ) (Revenue $ 2,306, 201. )RESIDENTIAL PROGRAMS PROVIDE VARIOUS LEVELS OF ASSISTANCE TO DEVELOPMENTALLY DISABLEDINDIVIDUALS. 39 INDIVIDUALS 365 DAYS A YEAR.

4c (Code: )(Expenses $ 1,128,477. including grants of $ ) (Revenue $ 1,412,272.

THE RESIDENTIAL/DAY HABILITATION PROGRAM PROVIDES —ACTIVITIES— IN A COMMUNITY ANDOIAL ENVIRONMENT FOR DEVELOPMENTALLY DISABLED INDIVIDUALS. 24 423 UNITS OF SERVICE--

4d Other program services. (Describe in Schedule 0.) SEE SCHEDULE 0(Expenses $ 73,273. including grants of $ ) (Revenue $ 72,626.

4e Total program service expenses P 7, 022, 238.BAA maoioa 08108/12 Form 990 (2012)

S

Form 990 (2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER

16-0970103 Page 3

esI Yes I No

1 Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If 'Yes,' completeScheduleA.........................................................................................................

2 Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)7......................

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidatesfor public office? If 'Yes,' complete Schedule C, Part /................................................................

4 Section 501(c)(3) organizations Did the organization engage in lobbying activities, or have a section 501(h) electionin effect during the tax year? If 'Yes,' complete Schedule C, Part II...................................................

5 Is the organization a section 501 (c)(4), 501 (c)(5), or 501 (c)(6) organization that receives membership dues,assessments, or similar amounts as defined in Revenue Procedure 98-19? If 'Yes,' complete Schedule C, Part Ill.......

EMMMMEII,I.,I.,

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the rightto provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes,' complete Schedule D,Patti.............................................................................................................6

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, theenvironment, historic land areas or historic structures? If 'Yes,' complete Schedule D, Part II........................... 7

8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If 'Yes,'complete Schedule D, Part Ill....................................................................................... 8

9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability; serve as a custodianfor amounts not listed in Part X; or provide credit counseling, debt management credit repair, or debt negotiationservices? If 'Yes, 'complete Schedule D, Part IV .................................................................... . 9

10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments,permanent endowments, or quasi-endowments? If 'Yes,' complete Schedule D, Part V.................................10

11 If the organization's answer to any of the following questions is 'Yes', then complete Schedule D, Parts VI, VII, VIII, IX,or X as applicable.

a Did the organization report an amount for land, buildings and equipment in Part X, line 10? If 'Yes,' complete ScheduleD, Part VI ........................................................................................................

b Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its totalassets reported in Part X, line 16? If 'Yes,' complete Schedule D, Part VII............................................

c Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its totalassets reported in Part X, line 16? If 'Yes,' complete Schedule D, Part VIII...........................................

d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reportedin Part X, line 16? If 'Yes,' complete Schedule D, Part IX............................................................

e Did the organization report an amount for other liabilities in Part X, line 25? If 'Yes,' complete Schedule D, Part X......

Did the organization's separate or consolidated financial statements for the tax year include a footnote that addressesthe organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If 'Yes,' complete Schedule 0, Part X....

12a Did the organization obtain separate, independent audited financial statements for the tax year? If 'Yes,' completeSchedule D, Parts XI, and XII.......................................................................................

11

11

ii

X

X

X

X

X

X

X

X

X

X

lid X

lie X

iii

12a

b Was the organization included in consolidated, independent audited financial statements for the tax year? If 'Yes,' andif the organization answered 'No' to line 12a, then completing Schedule 0, Parts XI and XII is optional.................

13 Is the organization a school described in section 170(b)(1)(A)(ii)? If 'Yes,' complete Schedule E.......................

14a Did the organization maintain an office, employees, or agents outside of the United States? ...........................

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,business, investment, and program service activities outside the United States, or aggregate foreign investments valuedat $100,000 or more? If 'Yes,' complete Schedule F, Parts I and IV..................................................

15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organizationor entity located outside the United States? If 'Yes,' complete Schedule F, Parts II and IV.............................

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance toindividuals located outside the United States? If 'Yes,' complete Schedule F, Parts Ill and IV..........................

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX,column (A), lines 6 and lie? If 'Yes,' complete Schedule G, Part I (see instructions)..................................

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII,lines 1 c and 8a? If 'Yes,' complete Schedule G, Part II..............................................................

i2b X

13 X

14a X

i4b X

15 X

16 X

17 X

18 X

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If 'Yes,'complete Schedule G, Part Ill. ..................................... . ............................................... .19 X

20 a Did the organization operate one or more hospital facilities? If 'Yes,' complete Schedule H.............................20 X

b If 'Yes' to line 20a, did the organization attach a copy of its audited financial statements to this return? .................. 20 b

BAA TEEA0103L 12/13112 Form 990 (2012)

Form 990 (2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER

16-0970103 Page

Checklist of Required Schedules

I IYesI No

21 Did the organization report more than $5,000 of grants and other assistance to governments and organizations in theUnited States on Part IX, column (A), line 1? If 'Yes,' complete Schedule I, Parts I and II. ............................. .21

22 Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on PartIX, column (A), line 2? If 'Yes,' complete Schedule!, Parts / and Ill .................................................. .22

23 Did the organization answer 'Yes' to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's currentand former officers, directors, trustees, key employees, and highest compensated employees? If 'Yes,' completeScheduleJ...........................................................................................................23 X

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as ofthe last day of the year, and that was issued after December 31, 2002? If 'Yes,' answer lines 24b through 24d andcomplete Schedule K. If 'No, 'go to line 25 ............................................................................24a X

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception7 ...................24b

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defeaseanytax-exempt bonds'............................................................................................. 24c

d Did the organization act as an 'on behalf of' issuer for bonds outstanding at any time during the year' ................... 24d

25a Section 501 (cX3) and 501 (cX4) organizations. Did the organization engage in an excess benefit transaction with adisqualified person during the year? If 'Yes,' complete Schedule L, Part I.............................................

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, andthat the transaction has not been reported on any of the organization's prior Forms 990 or 990 .EZ? If 'Yes,' completeScheduleL, Part I. ................................................................................................ . 25b

26 Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, ordisqualified person outstanding as of the end of the organization's tax year? If 'Yes,' complete Schedule L, Part II...... 26

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantialcontributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family memberof any of these persons? If 'Yes,' complete Schedule L, Part Ill....................................................... 27

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IVinstructions for applicable filing thresholds, conditions, and exceptions): -

a A current or former officer, director, trustee, or key employee? If 'Yes,' complete Schedule L, Part IV .................. .28a

b A family member of a current or former officer, director, trustee, or key employee? If 'Yes,' completeSchedule L, Part IV.................................................................................................. 28b

c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an Iofficer, director, trustee, or direct or indirect owner? If 'Yes,' complete Schedule L, Part IV............................

29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes,' complete Schedule M ..............

30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservationcontributions? If 'Yes,' complete Schedule M .......................................................................

31 Did the organization liquidate, terminate, or dissolve and cease operations? If 'Yes,' complete Schedule N, Part I.......

32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If 'Yes,' completeScheduleN, Part II. .......... . .................................................................................... . 32

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections301.7701-2 and 301.7701-3? If 'Yes,' complete Schedule R, Part I.....................................................33 X

34 Was the organization related to any tax-exempt or taxable entity? If 'Yes,' complete Schedule F?, Parts II, Ill, IV,andV, line l......................................................................................................... 34 X

35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? ................................. 35a X

b If 'Yes' to line 35a, did the organization receive any payment from or engage in any transaction with a controlledentity within the meaning of section 512(b)(13)? If 'Yes,' complete Schedule F?, Part V, line 2........................... 35b X

36 Section 501 (cX3) organizations. Did the organization make any transfers to an exempt non-charitable relatedorganization? If 'Yes,' complete Schedule R, Part V, line 2 ............................................................ 36

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that istreated as a partnership for federal income tax purposes? If 'Yes,' complete Schedule R, Part VI ....................... 37

X

!

!

I

X

X

38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 1 lb and 19?Note. All Form 990 filers are required to complete Schedule 0 ............ ...........................................

BAA381 XIForm 990 (2012)

TEEA01 041 08108112

Form 99O(2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page

I PjjJ Statements Regarding Other IRS Filings and Tax ComplianceCheck if Schedule 0 contains a response to any question in this Part V .......................................................

Yes I No

1 a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ............. I lal 136b Enter the number of Forms W-2G included in line 1 a. Enter -0- if not applicable ........... .1 b 0c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming

(gambling) winnings to prize winners? .............................................................................. . 1 c

2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax State-ments, filed for the calendar year ending with or within the year covered by this return.... I 2a 217 *

b If at least one is reported on line 2a, did the organization file all required federal employment tax returns'. ............. . 2b X -Note. If the sum of lines la and 2a is greater than 250, you may be required toe-file. (see instructions)

3 a Did the organization have unrelated business gross income of $1,000 or more during the year? ........................ .3a - X

b If 'Yes' has it filed a Form 990-T for this year? If 'No, 'provide an explanation in Schedule 0............................3b - -

4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, afinancial account in a foreign country (such as a bank account, securities account, or other financial account)' ........... 4a X

b If 'Yes,' enter the name of the foreign country:See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

5 a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year' ....................b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction' ............c If 'Yes,' to line 5a or 5b, did the organization file Form 8886-T' ......................................................

6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization Isolicit any contributions that were not tax deductible as charitable contributions? ...................................... .6a X

b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were Inot tax deductible' .................................................................................................

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive apayment in excess of $75 made partly as a contribution and partly for andandservices provided to the payor' ......................................................................................

b If 'Yes,' did the organization notify the donor of the value of the goods or services provided' ...........................c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file

Form8282'..........................................................................................................d If 'Yes,' indicate the number of Forms 8282 filed during the year .........................I 7de 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' ..............g If the organization received a contribution of qualified intellectual property, did the organization file Form 8399

asrequired' ........................................................................................................h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a

Form1098-C'.....................................................................................................

8 Sponsoring organizations maintaining donor advised funds and section 509(aX3) supporting organizations. Did thesupporting organization, or a donor advised fund maintained by a sponsoring organization, have excess businessholdings at any time during the year'................................................................................

9 Sponsoring organizations maintaining donor advised funds.a Did the organization make any taxable distributions under section 4966' ..............................................b Did the organization make a distribution to a donor, donor advisor, or related person' .................................

10 Section 501(c)(7) organizations. Enter:a Initiation fees and capital contributions included on Part VIII, line 12 ............ ......... .lOab Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities..., lOb

11 Section 501(cX12) organizations. Enter:a Gross income from members or shareholders ........................................... .11 a

b Gross income from other sources (Do not net amounts due or paid to other sourcesagainst amounts due or received from them.) ........................................... .11 b

12 a Section 4947(aXl) non . exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041' .............b If 'Yes,' enter the amount of tax-exempt interest received or accrued during the year ...... . 12b

13 Section 501 (cX29) qualified nonprofit health insurance issuers.

a Is the organization licensed to issue qualified health plans in more than one state'....................................Note. See the instructions for additional information the organization must report on Schedule 0.

b Enter the amount of reserves the organization is required to maintain by the states inwhich the organization is licensed to issue qualified health plans .........................

c Enter the amount of reserves on hand .................................................. HI14a Did the organization receive any payments for indoor tanning services during the tax year' ............................

b If 'Yes,' has it filed a Form 720 to report these payments? If 'No, 'provide an explanation in Schedule 0 ................

X

7e1 IX

7h

12a

BAA TEEA0I05L 08/08112 Form 990 (2012)


FP-art VI Governance, Management and Disclosure For each 'Yes' response to lines 2 through 7b below, and fora 'No' response to line 8a, 8b, or lOb below, describe the circumstances, processes, or changes inSchedule 0. See instructions.Check if Schedule 0 contains a response to any question in this Part VI .....................................................

rnYes I No

1 a Enter the number of voting members of the governing body at the end of the tax year .....rl If there are material differences in voting rights among membersof the governing body, or if the governing body delegated broadauthority to an executive committee or similar committee, explain in Schedule 0.

b Enter the number of voting members included in line la, above, who are independent.....

2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any otherofficer, director, trustee or key employee? ..........................................................................2

3 Did the organization delegate control over management duties customarily performed by or under the direct supervisionof officers, directors or trustees, or key employees to a management company or other person' .......................3

4 Did the organization make any significant changes to its governing documentssince the prior Form 990 was filed 7. ................................................................................ .4

5 Did the organization become aware during the year of a significant diversion of the organization's assets? ...............56 Did the organization have members or stockholders? ..... SEE. SCHEDULE. . 0....................................... 6

7a Did the organization have members, stockhol .ers or other persons who had the power to elect or appoint one or morebodmembers of the governing y?. . SEE. .bC.UEDULE . Q............................................................

b Are any governance decisions of the organization reserved to (or subject to approval by) members,stockholders, or other persons other than the governing body' .......................................................

8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year bythe following:

alhegoverning body? .............................................................................................. .8a X

b Each committee with authority to act on behalf of the governing body' ................................................8 b X

Is there any officer, director or trustee, or key employee listed in Part VII, Section A, who cannot be reached at theorganization's mailing address? If 'Yes, provide the names and addresses in Schedule 0 ..............................9 - X

B. Policies (This Section B reciuests

/ the Internal Revenue Code

7a1 X

7b

II

Yes NolOa X

lObha X

12a X

12b X

lOa Did the organization have local chapters, branches, or affiliates' .....................................................

b If Yes,' did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure theiroperations are consistent with the organization's exempt purposes'..................................................................

11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form' ......................b Describe in Schedule 0 the process, if any, used by the organization to review this Form 990. SEE SCHEDULE o

12a Did the organization have a written conflict of interest policy? If 'No,' go to line 13 ....................................

b Were officers, directors or trustees, and key employees required to disclose annually interests that could give risetoconflicts'.......................................................................................................

c Did the organization regularly and consistent (y monitor and enforce compliance with the policy? If 'Yes,' describe inSchedule 0 how this is done...... SEE. CHEDULE . 0.............................................................12c X

13 Did the organization have a written whistleblower policy? .............................................................13 X14 Did the organization have a written document retention and destruction policy' ........................................14 X

15 Did the process for determining compensation of the following persons include a review and approval by independentpersons, comparability data, and contemporaneous substantiation of the deliberation and decision?

a The organization's CEO, Executive Director, or top management official ..............................................15a Xb Other officers of key employees of the organization . . . SEE. SCHEDULE. U ..........................................15b X

If 'Yes' to line 15a or 15b, describe the process in Schedule 0. (See instructions.)

16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with ataxable entity during the year' .....................................................................................

b If 'Yes,' did the organization follow a written policy or procedure requiring the organization to evaluate itsparticipation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard theorganization's exempt status with respect to such arrangements' ....................................................

on17 List the states with which a copy of this Form 990 is required to be filed NY

18 Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-1 (501 (c)(3)s only) available for publicinspection. Indicate how you make these available. Check all that apply.

Own website Another's website R Upon request F1 Other (explain in Schedule 0)

19 Describe in Schedule 0 whether (and if so, how) the organization makes its governing documents, conflict of interest policy, and financial statements available tothe public during the tax year. SEE SCHEDULE 0

20 State the name, physical address, and telephone number of the person who possesses the books and records of the organization:

DEBRA CARLIN 17 MIDLINE DRIVE NORWICH NY 13815 (607) 334-5366BAA moiom 0ei08n2 Form 990 (2012)

X

Form 990 (2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page

I Part VII I Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, andIndependent ContractorsCheck if Schedule 0 contains a response to any question in this Part VII LI

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees1 a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within theorganization's tax year.

• List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount ofcompensation. Enter -U- in columns (D), (E), and (F) if no compensation was paid.

• List all of the organization's current key employees, if any. See instructions for definition of key employee.'

• List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations.

• List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000of reportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensatedemployees; and former such persons.

[1 Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A)Name and Title

(C) I I(B) Position (do not check more than I (D) I (E)

one box, unless person is both an IAverage officer and a director/trustee) I Reportable I Reportableours per

week (list — — — — —any hoursfor relatedorganiza-

co'ionsbelowdotted

<5line) to- (5

0

(F)Estimated

amount of othercompensation

from theorganizationand related

organizations

the OrQaflizatiOfl related organizations(w-2I199.Mlsc) (w.211o99-Misc)

(1)WILLIAM C. CRAINE 0.5BOARD MEMBER 0

(2)KIM PARKER 0.5BOARD MEMBER 0

(3)ANTHONY SAVITSKY 0.5BOARD MEMBER 0

(4)ANGELA ARCIDIACONO 0.5BOARD MEMBER 0

(5)JAMES FERTIG ESQ. 0.5BOARD MEMBER 0

(6)WILLIAM WHITAKER JR 1PRESIDENT 0

(7)SALLY MERRILL 0.5BOARD MEMBER 0

(8)ROBYN KING 1VICE PRESIDENT 0

(9)WILLIAM WENTZ 1SECRETARY/TREAS 0

(10)JOHN MCHALE 40EXECUTIVE DIREC 0

(11)DEBRA CARLIN 40VP iifN FINA 0

(12)JASON LASICKI 40SALES MANAGER 0

(13)

X

X

X

0.

X

0. 0. 0.

X

0. 0. 0.

X X

0. 0. 0.

X

0. 0. 0.

X X

0. 0. 0.

X X

0. 0. 0.

X

347,441. 0. 62,955.

X

136,612. 0. 23,694.

X 249,881. 0. 20,538.

(14) -- — - -

BAA -rA0107L 12117/12 Form 990 (2012)

(E)Reportable

compensation fromrelated orcianizations

(W_2/]o9.MlSC)

(F)Estimated

amount of othercompensation

from theorganizationand related

organizations


(B) (C)Position

(A) Average (do not check more than one (D)Name and title

hours box, unless person is both an Reportable

per officer and a director/trustee) compensation fromweek

(list any 5l I ics -- the oraanization

hours o. .I 0 I i (W2/th99MlSC)'for

irelated C CD

organizaj , I I

-tionsI

belowi 0

dotted I

I IMIline)

(15)

(16)

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

ib Sub-total ................................................................. 733,934. 0. 107,187.

c Total from continuation sheets to Part VII, Section A ........................0. 0. 0.

d Total (add lines lb and lc) ................................................ 733,934. 0. 107,187.2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation

from the organization 01, 3Yes I No

3 Did the organization list any former officer, director or trustee, key employee, or highest compensated employeeon line 1 a? If 'Yes,' complete Schedule J for such individual .............................................................

4 For any individual listed on line la, is the sum of reportable compensation and other compensation fromthe organization and related organizations greater than $150,000? If 'Yes' complete Schedule J forsuchindividual......................................................................................................

5 Did any person listed on line la receive or accrue compensation from any unrelated organization or individualfor services rendered to the organization? If 'Yes,' complete Schedule J for such person

action B. Indeøendent Contractors

WMWU..IMF

I uompiete tnis tame tor your tive nignest compensateci independent contractors that receivea more tnan I uu,uuucompensation from the organization. Report compensation for the calendar year ending with or within the organization's tax

(A) (B)Name and business address Description of services

D HILLMAN & SONS LLC 3190 WESTLAND DR BOUCKVILLE, NY 13310 CONSTRUCTION

GREENTECH COMPANY 519 ROBERT WILLIAMS ROAD UNADILLA, NY 13849 CONSTRUCTION

2 Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 in compensation from the organization 2

(C)Compensation

331, 097.122.025.

BAA TEEA0108L 01/24113 Form 990 (2012)

Form 990 (2012) NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 9Part VIli l Statement of Revenue

Check if Schedule 0 contains a response to any question in this Part VIII. ................................................... LI(A) (B) (C) (D)

Total revenue Related or Unrelated Revenueexempt business excluded from taxfunction revenue under sectionsrevenue 512, 513, or 514

1 a Federated campaigns ......... .la............. b Membership dues .1 b(5

c Fundraising events .............icd Related organizations ......... .ide Government grants (contributions)......le 250, 000

UJ2I-

= f All other contributions, gifts, grants, andI-o similar amounts not included above ... if 1,304.

g Noncash contributions included in Ins la-if: $___________________h Total. Add lines la-if...............................

Business Code

2a FEES & CONTRACTS GOV AGENCIES 624200 6,241,688. 6,241,688.Uj b CAFETERIASALES 812900 71,995 71,995

C ELLANEOtJSPROGRANINC 624200 25,969. 25,969.LUu de f All other program service revenue.

- g Total. Add lines 2a-2f............................... 6, 339, 652.3 Investment income (including dividends, interest and

other similar amounts) .............................. ..49, 796.4 Income from investment of tax-exempt bond proceeds. .5 Royalties ..........................................

(I) Real I (ii) Personal -

I 6a Gross rents .......... .10,872.1b Less: rental expensesc Rental income or (loss). . . 10,872.

I d Net rental income or (loss)..........................

7a Gross amount from sales of (I) Securities 1 (ii) Other

assets other than inventory. 152,317.1b Less: cost or other basis

and sales expenses ....... .138, 530 c Gain or (loss) ........ .13, 787. d Net gain or (loss)...................................

8a Gross income from fundraising events(not including. $of contributions reported on line ic).

UjSee Part IV, line l8 ................ a__________

b Less: direct expenses .............. b0 c Net income or (loss) from fundraising events.........

9a Gross income from gaming activities.See Part IV, line 19................ a

b Less: direct expenses ..............bc Net income or (loss) from gaming activities..........

iOa Gross sales of inventory, less returnsand allowances .................... a _5, 992, 470.

b Less: cost of goods sold ............ b_3, 919, 082.c Net income or (loss) from sales of inventory .........

Miscellaneous Revenue I Business Code

11ab C

d All other revenue...................

e Total. Add lines ha-lid ............................ ..________12 Total revenue. See instructions ..................... 8,738,

BAA TEEA0109L 12/17/12 Form 990 (2012)

•1.


I Part IX I Statement of Functional ExpensesSection 501(c) (3) and 501(c) (4) organizations must complete all columns. All other organizations must complete column (A).

Check if Schedule 0 contains a response to any question in this Part IX ............................................. .ITDo not include amounts reported on lines 6b,7b, 8b, 9b, and lOb of Part VIII.

1 Grants and other assistance to governmentsand organizations in the United States. SeePart IV, line 21.............................

2 Grants and other assistance to individuals inthe United States. See Part IV, line 22 ......

3 Grants and other assistance to governments,organizations, and individuals outside theUnited States. See Part IV, lines 15 and 16..

4 Benefits paid to or for members ............Compensation of current officers, directors,trustees, and key employees................

6 Compensation not included above, todisqualified persons (as defined undersection 4958(i(1)) and persons describedin section 4958(c)(3)(B).....................

7 Other salaries and wages...................

8 Pension plan accruals and contributions(include section 401(k) and section 403(b)employer contributions).....................

9 Other employee benefits ...................

10 Payroll taxes ..............................

11 Fees for services (non-employees):

a Management ..............................

bLegal ......................................

c Accounting ................................

dLobbying..................................

e Professional fundraising services. See Part IV, line 17.

f Investment management fees...............g Other. (If line hg amt exceeds 10% of line 25, col-

umn (A) amt, list line 119 expenses on Sch 0) ........12 Advertising and promotion..................

13 Office expenses ...........................

14 Information technology.....................

15 Royalties..................................

16 Occupancy ................................

17 Travel.....................................

18 Payments of travel or entertainmentexpenses for any federal, state, or localpublic officials .............................

19 Conferences, conventions, and meetings....20 Interest ...................................

21 Payments to affiliates......................

22 Depreciation, depletion, and amortization.

23 Insurance .................................24 Other expenses. Itemize expenses not

covered above (List miscellaneous expensesin line 24e. If line 24e amount exceeds 10%of line 25, column (A) amount, list line 24eexpenses on Schedule 0.)..................

a PARTICIPANT TRANSPORTATIONb FOODC PARTICIPANT EXPENSESd CAFETERIA COSTe All other expenses.........................

25 Total functional expenses. Add lines 1 through 24e.

26 Joint costs. Complete this line only ifthe organization reported in column (B)joint costs from a combined educationalcampaign and fundraising solicitation.Check here if followingSOP 98-2 (ASC 958-720)...................

Total dxoenses

Program service

Management and

570,702. 7,392

563.310.

0. 0.1 0.

3,989,484. 3,755,021.1 234.463.

130,936. 125,729. 5,207.

986, 021. 864,361. 121,660.

359, 606. 309.389. 50.217.

27,825. 5,358.1 22,467.

33,850. 33,850.

7,629. 7,629.

72,802.

93,249.

2

16.488.1 7.418.564.

112,492.1 112.492.

195.734.

TEEA0110L 12/18112

Form 990 (2012)

67

371,108. ii17,942. 9

4,272,694. lOc1,361,526. 11

1213

14

1,517,812, 15

9,511,403.1,015,214. 17

1853,959. 19

492,396.21

22

852,355. 23

24

176,395. 25

2,590,319. 26

6,877,230. 27

43,854. 28

366,117.103. 763.

4,612,346.

1,781,154.

1.358.546.

331.994.

1,178,537.

3,252. 673.

43,854.

30

3132

6,921,084.9.511.403.

6,989,615.10,242, 288.

Form 990 (2012)

Form 990 012) NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 11

FP-art X Balance Sheet

Check if Schedule 0 contains a response to any question in this Part X .....................................................(A) (B)

Beginning of year End of year

Cash - non-interest . bearing ............................................... .... 2,605 1 2,605.Savings and temporary cash investments ...................................... .1, 143,118 2 1,075,768.Pledges and grants receivable, net ............................................ 3Accounts receivable, net ....................................................... 824,598 4 1 837,749.

123

4

A$SET$

A

T

ES

NET

N0

BAL

C

BAA

5 Loans and other receivables from current and former officers, directors,trustees, key employees, and highest compensated employees. CompletePart II of Schedule L .....................................................

6 Loans and other receivables from other disqualified persons (as defined undersection 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributingemployers and sponsoring organizations of section 501 (c)(9) voluntary employees'beneficiary organizations (see instructions). Complete Part II of Schedule L......

7 Notes and loans receivable, net ...............................................8 Inventories for sale or use ....................................................9 Prepaid expenses and deferred charges .......................................

iQa Land, buildings, and equipment: cost or other basis.Complete Part VI of Schedule D .................... .lOa 11,404, 611.

b Less: accumulated depreciation .....................lOb 6,792,265.11 Investments - publicly traded securities .......................................12 Investments - other securities. See Part IV, line 11 ............................13 Investments - program-related. See Part IV, line 11 ............................14 Intangible assets .............................................................15 Other assets. See Part IV, line 11 .............................................16 Total assets. Add lines 1 through 15 (must equal line 34) .......................17 Accounts payable and accrued expenses ......................................18 Grants payable...............................................................19 Deferred revenue.............................................................20 Tax-exempt bond liabilities ...................................................21 Escrow or custodial account liability. Complete Part IV of Schedule D ...........22 Loans and other payables to current and former officers, directors, trustees,

key employees, highest compensated employees, and disqualified persons.Complete Part II of Schedule L ................................................

23 Secured mortgages and notes payable to unrelated third parties ................24 Unsecured notes and loans payable to unrelated third parties ...................25 Other liabilities (including federal income tax, payables to related third parties,

and other liabilities not included on lines 17-24). Complete Part X of Schedule D.26 Total liabilities. Add lines 17 through 25.......................................

Organizations that follow SFAS 117 (ASC 958), check here Fvl and completelines 27 through 29, and lines 33 and 34.

27 Unrestricted net assets .......................................................28 Temporarily restricted net assets ..............................................29 Permanently restricted net assets .............................................

Organizations that do not follow SFAS 117 (ASC 958), check hereand complete lines 30 through 34.

30 Capital stock or trust principal, or current funds ................................31 Paid-in or capital surplus, or land, building, or equipment fund ..................32 Retained earnings, endowment, accumulated income, or other funds ............33 Total net assets or fund balances .............................................34 Total liabilities and net assets/fund balances ...................................

TEEA011IL 01103/13


I -Part XI I Reconciliation of Net AssetsCheck if Schedule 0 contains a response to any question in this Part Xl ..................................................... U

1 Total revenue (must equal Part VIII, column (A), line 12) .................................................

2 Total expenses (must equal Part IX, column (A), line 25) .................................................

3 Revenue less expenses. Subtract line 2 from line 1 .......................................................

4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..................

5 Net unrealized gains (losses) on investments ............................................................ 2.585.6 Donated services and use of facilities ...................................................................7 Investment expenses...................................................................................8 Prior period adjustments ............................................................................... —417,530.9 Other changes in net assets or fund balances (explain in Schedule 0) .....................................

10 Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33,column(B))...............................................................................................

Reporting

Check if Schedule 0 contains a resoonse to an y auestion in this Part XII ....................................................Yes I No

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,' explainin Schedule 0.

2 a Were the organization's financial statements compiled or reviewed by an independent accountant? ..................... .2 a XIf 'Yes,' check a box below to indicate whether the financial statements for the year were compiled or reviewed on aseparate basis, consolidated basis, or both:

F1 Separate basis [Consolidated basis [Both consolidated and separate basis

b Were the organization's financial statements audited by an independent accountant? ...................................2 b X

If 'Yes,' check a box below to indicate whether the financial statements for the year were audited on a separatebasis, consolidated basis, or both:

Consolidated basisF1 Separate basis [Both consolidated and separate basis * -

c If 'Yes' to line 2a or ?b, 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 accountant7 ..........................2c XIf the organization changed either its oversight process or selection process during the tax year, explainin Schedule 0.

3 a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the SingleAudit Act and OMB Circular A-133' .................................................................................. 3a X

b If 'Yes,' did the organization undergo the required audit or audits? If the organization did not undergo the required auditor audits, explain why in Schedule 0 and describe any steps taken to undergo such audits ..............................

BAA

Form 990 (2012)

TEEA0112L 08109111

SCHEDULE A(Form 990 or 990-EZ)


Public Charity Status and Public Support

Complete if the organization is a section 501 (cX3) organization or a section4947(aXl) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. 1, See separate instructions.

OMB No. 1545-0047

2012Open to Public

Inspection

Name of the organization I Employer identification number

NYS ARC, INC. CHENANGO COUNTY CHAPTER 116-0970103Part I J Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)1 A church, convention of churches or association of churches described in section 170(bX1XAXi).

2 A school described in section 170(bX1XAXii). (Attach Schedule E.)3 A hospital or a cooperative hospital service organization described in section 170(bXlXAXiii).4 A medical research organization operated in conjunction with a hospital described in section 170(bXlXAXiii). Enter the hospital's

name, city, and state:

5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section170(bX1XAXiv). (Complete Part II.)

6 A federal, state, or local government or governmental unit described in section 170(bX1XAXv).7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public described

in section 170(bX1XAXvi). (Complete Part II.)8 [A community trust described in section 170(bX1XAXvi). (Complete Part II.)

9 [M organization that normally receives: (1) more than 33-1/3% of its support from contributions, membership fees, and gross receipts from activitiesrelated to its exempt functions - subject to certain exceptions, and (2) no more than 33-1/3% of its support from gross investment income andunrelated business taxable income (less section 511 tax) from businesses acqired by the organization after June 30, 1975. See section 509(aX2).(Complete Part Ill.)

10 H An organization organized and operated exclusively to test for public safety. See section 509(aX4).11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or carry out the purposes of one or more publicly

supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(aX3). Check the box that describes the type ofsupporting organization and complete lines lie through 11 h.a [Type I b [Type II c [Type Ill - Functionally integrated d [] Type Ill - Non-functionally integrated

e []By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified personsother than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) orsection 509(a)(2).If the organization received a written determination from the IRS that is a Type I, Type II or Type III supporting organization,checkthis box ............................................................................................................

g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?Yes No

(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii)below, the governing body of the supported organization' ...............................................119 O) -

(ii) A family member of a person described in (i) above? ....................................................11 g (ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? ........................................ 11 g (Iii) -Provide the following information about the supported organization(s). -(i) Name of supported (ii) EIN (iii) Type of organization (iv) Is the

organization (described on lines .9 organization inabove or IRC section column (I) listed in(see instructions)) your governing

document?

Yes I No

(A)

(B)

(C)

(D)

(E)

Total I I I IBAA For Paperwork Reduction Ad Notice, see the Instructions for Form 990 or 990-EZ.

g) Did you notify (vi) Is the (vii) Amount of monetary

e organization in organization in support

column (I) of your column (i)support? organized in the

U.S.?

Yes I No I Yes I No

Schedule A (Form 990 or 990 .EZ) 2012

TEEA0401L 08/09/12

Schedule A (Form 990 or 990-EZ) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 2

I -Part II ISupport Schedule for Organizations Described in Sections 170(bX1XAXiv) and 170(bX1XAXvi)(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part Ill. If theorganization fails to qualify under the tests listed below, please complete Part Ill.)

Section A. Public SupportCalendar year (or fiscal year (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (9 Totalbeginning in) I-

1 Gifts, grants, contributions, andmembership fees received. çDo notinclude any 'unusual grants.) ........ .6,061,109. 6,514,850. 6,473,217. 6,336,004. 6,518,961. 31,904,141.

2 Tax revenues levied for theorganization's benefit andeither paid to or expendedon its behalf .................. 0.

3 The value of services orfacilities furnished by agovernmental unit to theorganization without charge.... 0.

4 TotaLAdd lines l through 3... 6,061,109. 6,514,850. 6,473,217. 6,336,004. 6,518,961. 31,904,141.5 The portion of total

contributions by each person(other than a governmentalunit or publicly supportedorganization) included on line 1that exceeds 2% of the amountshown on line 11, column (f).. 0.

6 Public support. Subtract line 5from line 4. ................... 3

Section B. Total SupportCalendar year (or fiscal year (a) 2008 (b)2009 (c) 2010 (d) 2011 (e) 2012 (9 Totalbeginning in) 1,

7 Amounts from line 4 .......... .6,061,109. 6,514,850. 6,473,217. 6,336,004.T6,518,961. 31,904,141.

8 Gross income from interest,dividends, payments receivedon securities loans, rents,royalties and income fromsimilar sources ...............

9 Net income from unrelatedbusiness activities, whether ornot the business is regularlycarried on ....................

10 Other income. Do not includegain or loss from the sale ofcapital assets (Explain inPart lv.)......................

72,616.1 73,631.1 46,951.1 43,801.1 49,796.1 286,795.

[ii

11 Total support. Add lines 7through 10 132,190,936.

12 Gross receipts from related activities, etc (see instructions) .................................................. I 12 124,425,200.

13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3)organization, check this box and stop here LI

ection C. Computation of Public Support Percentage14 Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) ...........................14 99.11%15 Public support percentage from 2011 Schedule A, Part II, line 14 .............................................15 99.05%

16a 33-113% support test —2012. If the organization did not check the box on line 13, and the line 14 is 33-1/3% or more, check this boxand stop here. The organization qualifies as a publicly supported organization ..................................................

b33-113% support test —2011. If the organization did not check a box on line 13 or 16a, and line 15 is 33-1/3% or more, check this boxand stop here. The organization qualifies as a publicly supported organization ...................................................

17a 10%-facts-and-circumstances test —2012. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10%or more, and if the organization meets the 'facts-and-circumstances' test, check this box and stop here. Explain in Part IV howthe organization meets the 'facts-and-circumstances' test. The organization qualifies as a publicly supported organization ......... . LI

b 10%-facts-and-circumstances test - 2011. 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 stop here. Explain in Part IV how theorganization meets the 'facts-and-circumstances' test. The organization qualifies as a publicly supported organization-------------

18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions..

BAA Schedule A (Form 990 or 990-EZ) 2012

TEEA0402L 08/09112


Part Ill Support Schedule for Organizations Described in Section 509(aX2)(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization failsto qualify under the tests listed below, please complete Part II.)

Section A. Public SupportCalendar year (or fiscal yr beginning in) (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (1) Total

1 Gifts, grants, contributionsand membership feesreceived. (Do not includeany unusual grants.') .........

2 Gross receipts from admis-sions, merchandise sold orservices performed, or facilitiesfurnished in any activity that isrelated to the organization'stax-exempt purpose ...........

3 Gross receipts from activitiesthat are not an unrelated tradeor business under section 513.

4 Tax revenues levied for theorganization's benefit andeither paid to or expended onits behalf

5 The value of services orfacilities furnished by agovernmental unit to theorganization without charge....

6 Total. Add lines 1 through 5 7 a Amounts included on lines 1,

2, and 3 received fromdisqualified persons ...........

b Amounts included on lines 2and 3 received from other thandisqualified persons thatexceed the greater of $5,000 or1% of the amount on line 13for the year...................

cAdd lines 7a and 7b...........8 Public support (Subtract line

7c from line 6.)

ection B. Total SuonortCalendar year (or fiscal yr beginning in)

9 Amounts from line €s ..........lOa Gross income from interest,

dividends, payments receivedon securities loans, rents,royalties and income fromsimilar sources ...............

b Unrelated business taxableincome (less section 511taxes) from businessesacquired after June 30, 1975...

cAdd lines lOa and lOb.........11 Net income from unrelated business

activities not included in line lob,whether or not the business isregularly carried on ...............

12 Other income. Do not includegain or loss from the sale ofcapital assets (Explain inPart IV.)......................

13 Total Support (Add ins 9, lOc, 11, and 12.)

2008 I (b) 2009 I (c) 2010 I (d) 2011 1 (e) 2012 I (f) Total

14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3)organization, check this box and stop here .................................................................................

eciion . tomputation OT ruoiic buppori rerceniage15 Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) .......................... L.!!16 Public support percentage from 2011 Schedule A, Part III, line 15 ............................................ I 16

on nvestment Income17 Investment income percentage for 2012 (line lOc, column (f) divided by line 13, column (f)) ....................17

18 Investment income percentage from 2011 Schedule A, Part III, line 17 .........................................18

19a 33-1/3% support tests —2012. If the organization did not check the box on line 14, and line 15 is more than 33-1/3%, and line 17is not more than 33-1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ........... 01 F1

b 33-1/3% support tests - 2011. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33-1/3%, andline 18 is not more than 33-1/3%, check this box and stop here. The organization qualifies as a publicly supported organization....

20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .............

BAA TEEA0403L 08/09/12 Schedule A (Form 990 or 990 .EZ) 2012

T


Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;Part II, line 17a or 17b; and Part Ill, line 12. Also complete this part for any additional information.(See instructions).

BAA

Schedule A (Form 990 or 990-EZ) 2012

TEEA0404L 08/10/12

- (Schedule B(Form 990, 990-EZ,or 990-PF)


Schedule of ContributorsAttach to Form 990, Form 990-EZ, or Form 990-PF

OMB No. 1545-0047

2012Employer Identitication number

16-0970103NYS ARC, INC. CHENANGO COUNTY CHAPTEROrganization type (check one):

Filers of:

Form 990 or 990-EZ

Section:

501 (c)( 3) (enter number) organization

U4947(a)(1) nonexempt charitable trust not treated as a private foundation

U 527 political organization

Form 990 .PF 501 (c)(3) exempt private foundation

U4947(a)(1) nonexempt charitable trust treated as a private foundation

501 (c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule

Note. Only a section 501 (c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General RuleUFor an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one

contributor. (Complete Parts I and II.)

Special Rules

rXj For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 . 1/3% support test of the regulations under sections509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of (1) $5,000 or(2)2% of the amount on (i) Form 990, Part VIII, line lh or (ii) Form 990-EZ, line 1. Complete Parts land II.

UFor a section 501 (c)(7), (8), or (10) organization filing Form 990 or 990 .EZ that received from any one contributor, during the year,total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or educational purposes, orthe prevention of cruelty to children or animals. Complete Parts I, II, and Ill.

UFor a section 501 (c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during the year,contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not total to more than $1 ,000.If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc,purpose. Do not complete any of the parts unless the General Rule applies to this organization because it received nonexclusivelyreligious, charitable, etc, contributions of $5,000 or more during the year..................................... $

Caution: An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B form 990, 990-EZ, or 990 .PF) but it mustanswer No on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does notmeet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990EZ,or 990-PF.

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

TEEA0701L 11/30/12

(a)-----------(b)Number Name, address, and ZIP + 4

(c)(d)Total Type of contribution

contributions

(a)----------(b)Number Name, address, and ZIP + 4

(c) (d)Total Type of contribution

contributions

\.Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Page 1 of

1 of Part Employer identificatic


16-0970103

Part I Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.

(a) (b) (c)

Number Name, address, and ZIP +4 Totalcontributions

(d)Type of contribution

1

(a)Number

DORMITORY AUTHORITY OF THE STATE OFPerson

-------------------------------------- -Payroll [

515 BROADWAY -----------------------------$5.0L00.0. Noncash LI(Complete Part II if there isa noncash contribution.)

(b) (C) (d)Name, address, and ZIP +4 Total Type of contribution

contributions

Person LIPayroll LINoncash

(Complete Part II if there isa noncash contribution.)

-- — — — — — — — — — — — — — — — — — — — — — — — — I s — — — — — — — — — —

Person

Payroll [Noncash


-------------------------- Is----------

Person

Payroll LINoncash


---------------------------5__________

(a) r-Number Name, address, and ZIP +4

(a) (b) (c)Number Name, address, and ZIP + 4 Total

contributions

(d)Type of contribution

(c) (d)Total Type of contribution

contributions

Person . LIPayroll LINoncash LI


Person LIPayroll LI

$ Noncash LI(Complete Part II if there isa noncash contribution.)

TEEA0702L 11/30112 Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page 1 to 1 of Part IIName of organization . Employer identification number

NYS ARC, INC. CHENANGO COUNTY CHAPTER 116-0970103

I Part II I Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.

(a) No. (b) (c) (d)from Description of noncash property given FMV (or estimate) Date receivedPart I (see instructions)

(a) No.fromPart I

N/A

(b)Description of noncash property given

(C) (d)FMV (or estimate) Date received(see instructions)

(a)No.fromPart I


(c) (d)FMV (or estimate) Date received(see instructions)

$

(a)No.fromPart I



(a)No.fromPart I



(a)No.fromPart I



BAA

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

TEEA0703L 11/30/12

(a)No. from

Part I

(b)Purpose of gift

(c)Use of gift

(d)Description of how gift is held

(a)No. from

Part I

(b)Purpose of gift

(c)Use of gift


(a)No. from

Part I

(b)Purpose of gift

(C)Use of gift


Schedule B (Form 990, 990-EZ, or 990-PF) (2012) Page 1 to 1 of Part IIIName of organization Employer identification number

NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103Part Ill I Exclusively religious, charitable, etc, individual contributions to section 501(c)(7), (8) or (10)

organizations that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.For organizations completing Part Ill, enter total of exclusively religious, charitable, etc,contributions of $1,000 or less for the year. (Enter this information once. See instructions.)............ 01 $N/AUse duplicate copies of Part Ill if additional space is needed.

(a) (b) (c) (d)No. from Purpose of gift Use of gift Description of how gift is held

Part

N/A

(e)Transfer of gift

Transferees name, address, and ZIP +4 Relationship of transferor to transferee

(e)Transfer of gift

Transferee's name, address, and ZIP +4

Relationship of transferor to transferee

(e)Transfer of gift

Transferee's name, address, and ZIP +4 Relationship of transferor to transferee

(e)Transfer of gift

Transferee's name, address, and ZIP + 4

Relationship of transferor to transferee

BAA Schedule B (Form 990, 990-EZ, orTEEA0704L 11/30/12

SCHEDULE D(Form 990)

Department of the Treasuryinternal Revenue Service

Supplemental Financial StatementsComplete if the organization answered 'Yes,' to Form 990,

Part IV, lines 6, 7, 8, 9, 10, ha, lib, lic, lid, lie, iif, 12a, or 12b.Attach to Form 990. 1, See separate instructions.

OMB No. 1545-0047

2012Open to Public

NYS ARC, INC. CHENANGO COUNTY CHAPTER 116-0970103Paqj_j Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Comp

the organization answered 'Yes' to Form 990, Part IV, line 6.(a) Donor advised funds (b) Funds and other accounts

1 Total number at end of year ................2 Aggregate contributions to (during year) .....3 Aggregate grants from (during year).........4 Aggregate value at end of year..............

5 Did the organization inform all donors and donor advisors in writing that the assets held in donor advised fundsare the organization's property, subject to the organization's exclusive legal control? ........................... [Yes [ No

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used onlyfor charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferringimpermissible private benefit' .............................................................................. fl Yes

art II I Conservation Easements. Complete if the organization answered 'Yes' to Form 990, Part IV, line 7.1 Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land areaProtection of natural habitat Preservation of a certified historic structurePreservation of open space

2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on thelast day of the tax year.

Held at the End of the Tax Yeara Total number of conservation easements ................................................... [_!b Total acreage restricted by conservation easements ......................................... [_c Number of conservation easements on a certified historic structure included in (a) ............ I 2 c

d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historicstructure listed in the National Register ................................. .................... .2d

3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during thetax year

4 Number of states where property subject to conservation easement is located

5 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations,and enforcement of the conservation easements it holds' .................................................... [Yes

6 Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year

8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(13)(i)and section 170(h)(4)(B)(ii)' ................................................................................ [Yes [ No

9 In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, andinclude, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting forconservation easements.

Part Ill I Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.Complete if the organization answered 'Yes' to Form 990, Part IV, line 8.

1 a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works ofart, historical treasures, or other similar assets held forpublic exhibition, education, or research in furtherance of public service, provide,in Part XIII, the text of the footnote to its financial statements that describes these items.

b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide thefollowing amounts relating to these items:(i) Revenues included in Form 990, Part VIII, line 1 ........................................................ ..

(ii) Assets included in Form 990, Part X................................................................... $2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following

amounts required to be reported under SFAS 116 (ASC 958) relating to these items:a Revenues included in Form 990, Part VIII, line 1 ........................................................... $b Assets included in Form 990, Part X ...................................................................... $

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. TEEA3301L 09/18/12 Schedule D (Form 990) 2012

No

[No

. .

Schedule (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 2

Part Ill Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

3 Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collectionitems (check all that apply):

a Public exhibition dLoan or exchange programs

b Scholarly research e Other

C Preservation for future generations

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose inPart XIII.

5 During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assetsto be sold to raise funds rather than to be maintained as part of the organization's .................... [Yes No

Part IV Escrow and Custodial Arrangements. Complete if the organization answered 'Yes' to Form 990, Part IV, line 9, orreported an amount on Form 990, Part X, line 21.

1 a Is the organization an agent, trustee, custodian, or other intermediary for contributions or other assets not includedonForm 990, Part X' ........................................................................................ [Yes [No

b If 'Yes,' explain the arrangement in Part XIII and complete the following table:

Amount

c Beginning balance ......................................................................... icd Additions during the year ...................................................................ide Distributions during the year ................................................................le

Endingbalance ............................................................................ if

2a Did the organization include an amount on Form 990, Part X, line 21' ...........................................[ Yes Nob If 'Yes,' explain the arrangement in Part XIII. Check here if the explantion has been provided in Part XIII ....................... H

ent Funds. Complete if the organization answered 'Yes' to Form 990, Part IV, line 10.

I (a) Current I (b) Prior year I (C) Two years I (d) Three years I (e) Four years

1 a Beginning of year balance.....

b Contributions .................

c Net investment earnings, gains,and losses

d Grants or scholarships ........

e Other expenditures for facilitiesand programs.................

f Administrative expenses.......

g End of year balance ............_________________

2 Provide the estimated percentage of the current year end balance (line lg, column (a)) held as:

a Board designated or quasi-endowment %

b Permanent endowment 0, %

c Temporarily restricted endowment %

The percentages in lines 2a, 2b, and 2c should equal 100%.

3 a Are there endowment funds not in the possession of the organization that are held and administered for theorganization by: Yes No(i) unrelated organizations .................................................................................... 3a(u)

(ii) related organizations ...................................................................................... .3a(ii)b If 'Yes' to 3a(ii), are the related organizations listed as required on Schedule R' .................................. .3b I

4 Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI I Land, Buildings, and Equipment. See Form 990, Part X, line 10.Description of property (a) Cost or other basis (b) Cost or other (c) Accumulated (d) Book value

(investment) basis (other) depreciation

la Land ...................................... 403,119. 403,119.b Buildings .................................. 6,075,197. 3,499,319 2,575,878.c Leasehold improvements ...................dEquipment ................................ 4,348,424. 3,292,946 1,055,478.e Other...................................... 577,871.1 577,871.

Total. Add lines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).) .................. 01 4, 612, 346.BAA Schedule D (Form 990) 2012

TEEA330 06107/12

Schedule D

Part V1172012 NYS ARC, INC. CHENANGO COUNTY CHAPTER

Investments - Other Securities. See Form 990, Part X, line 12. N/Aa) Description of security or category (b) Book value (C)

(including name of security)

16-0970103 Page

of valuation: Cost or'ear market value

(1) Financial derivatives ................................ ._________________

(2) Closely-held equity interests.........................

(3) Other

(A)

(B)

(C)(D)

(G)

Total. (Column (b) must equal Form 990, Partx, column (B) line 12.7.7Part VIII I Investments - Program Related. See Form 990, Part X

(a) Description of investment type I (b) Book value

(1)

(2)(3)

(4)(5)

(6)

(7)

(8)

(9)

(10)

Total. (Column (b) must eaual Form 990. Part X, column (B) line

(a) Description(1)

(2)(3)CONTRACTS RECEIVABLE(4)DEBT ACQUISITION COSTS(5)DEBT RESERVE FUND(6)DUE FROM CHENANGO COMMUNITY RESID., INC(7)LOAN TO NONPROFIT ORGANIZATION(8)MEDICAID RECEIVABLE(9)

(10)

Total. (Column (b) must equal Form 990, Part X, column (B), line 15.)

(C) Method of valuation: Cost orend-of-year market value

Book value

488,166.13,997.

105,739.714,309.10,000.

448, 943.

1,781,154.

(a) Description of liability (b) Book value

(1) Federal income taxes

(2)DEFERRED COMPENSATION PAYABLE 259,764.(3)(4)

(5)

(6)

(7)

(8)(9)

(10)

(11) ___

Total. (Column (b) must equal Form 990, Part X, column (B) line 25.) ..... 259, 764 2. FIN 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization 's financial statements that reports the organization 's liability for uncertain tax positionsunder FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ................................................................ [1BAA rE303L 12123112 Schedule D (Form 990) 2012

Schedule D (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 4Part Xl I Reconciliation of Revenue per Audited Financial Statements With Revenue per Return N/A

1 Total revenue, gains, and other support per audited financial statements ...................................1

2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:a Net unrealized gains on investments ..........................................2ab Donated services and use of facilities .........................................2bc Recoveries of prior year grants ...............................................2cd Other (Describe in Part XIII.)..................................................2de Add lines 2a through 2d .................................................................................2e

3 Subtract line 2e from line 1 ..............................................................................34 Amounts included on Form 990, Part VIII, line 12, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b .............. .4ab Other (Describe in Part XIII.)..................................................4b c Add lines 4a and 4b .................................................................................... .4c

5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) .............................5

Part Xli I Reconciliation of Expenses per Audited Financial Statements With Expenses per Return N/A1 Total expenses and losses per audited financial statements ...............................................12 Amounts included on line 1 but not on Form 990, Part IX, line 25:

a Donated services and use of facilities .........................................2ab Prior year adjustments .......................................................21,cOther losses .................................................................2cd Other (Describe in Part XIII.)..................................................2de Add lines 2a through 2d .................................................................................2e

3 Subtract line 2e from line 1 ..............................................................................34 Amounts included on Form 990, Part IX, line 25, but not on line 1:

a Investment expenses not included on Form 990, Part VIII, line 7b ..............

.4ab Other (Describe in Part XIII.)................................................. .cAdd lines 4a and 4b ..................................................................................... 4c

5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part!, line 18.) ............................5Part XIII I Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part Ill, lines la and 4; Part IV, lines lb and 2b; Part Vline 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XI I, lines 2d and 4b. Also complete this part to provide any additional information.

BAA

Schedule D (Form 990) 2012

TEEA3304L. 11/30/12

Employer Identificati

16-0970103

SCHEDULEJ(Form 990)


Name of the organization

Compensation InformationFor certain Officers, Directors, Trustees, Key Employees, and Highest

Compensated Employees

Complete if the organization answered 'Yes to Form 990, Part IV, line 23.Attach to Form 990. 0, See separate instructions.

OMB No. 1545.0047

Open:to Public- Inspection

Part II Questions Regarding CompensationYes No

1 a Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, PartVII, Section A, line la. Complete Part Ill to provide any relevant information regarding these items.

[First-class or charter travel [Housing allowance or residence for personal use

[Travel for companions [Payments for business use of personal residence

[Tax indemnification and gross-up payments [Health or social club dues or initiation fees

[Discretionary spending account [Personal services (e.g., maid, chauffeur, chef)

b If any of the boxes on line 1 a are checked, did the organization follow a written policy regarding payment orreimbursement or provision of all of the expenses described above? If 'No,' complete Part Ill to explain ................ .1 b

2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors,trustees, and the CEO/Executive Director, regarding the items checked in line la?....................................

3 Indicate which, if any, of the following the filing organization used to establish the compensation of the organization'sCEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization toestablish compensation of the CEO/Executive Director, but explain in Part Ill.

[Compensation committee [Written employment contract

EJIndependent compensation consultant [Compensation survey or study

[Form 990 of other organizations Approval by the board or compensation committee

4 During the year, did any person listed in Form 990, Part VII, Section A, line la with respect to the filing organizationor a related organization:

a Receive a severance payment or change-of-control payment? ........................................................ 4a

b Participate in, or receive payment from, a supplemental nonqualified retirement plan? .................................4bc Participate in, or receive payment from, an equity-based compensation arrangement7..................................4c

If 'Yes' to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part Ill. PART III

2

X

Only section 501 (cX3) and 501(cX4) organizations must complete lines 5-9.

5 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensationcontingent on the revenues of:

aThe organization7.................................................................................................b Any related organization? .........................................................................................

If 'Yes' to line 5a or 5b, describe in Part Ill PART III

6 For persons listed in Form 990, Part VII, Section A, line la, did the organization pay or accrue any compensationcontingent on the net earnings of:

aThe organization7.................................................................................................b Any related organization? .........................................................................................

If 'Yes' to line 6a or 6b, describe in Part Ill.

5a X5b X

6a X6b X

7 For persons listed in Form 990, Part VII, Section A, line la, did the ART IIIorganization provide any non-fixed Ppayments not described in lines 5 and 6? If 'Yes,' describe in Part Ill ..............................................7 X -

8 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject,to the initial contract exception described in Regulations section 53.4958-4(a)(3)?If 'Yes,' describe in Part Ill .........................................................................................8 - X

9 If 'Yes' to line 8, did the organization also follow the rebuttable presumption procedure described in Regulationssection53.4958-6(c) 7 ............................................................................................. 9

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2012

TEEA4101L 12/10112

Schedule J (Form 990) 2012 NYS ARC, INC. CHENANGO

CHAPTER

16-0970103

2Directors, Trustees, Key Employees, and ensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions onrow (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line la, applicable columns (D) and (E) amounts for that individual.

(B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement (D) Nontaxable (E) Total of (F) Compensation

and other benefits columns(B)(i)-(D) reported as(A) Name and Title Bonus and deferred deferred in priorcompensation incentive reportablecompensation compensation compensation Form 990

JOHN MCHALE (i) _2L2. 385O0. 9Qt539. 410,396. -0.1 EXECUTIVE DIREC ) 0. 0. 0. 0. 0. 0. 0.DEBRA CARLIN (I)

9OO.

26 727. . 7_5L9 160,306. -0.2 VP ADMIN & FINA (h) 0. 0. 0. 0. 0. 0. 0.JASON LASICKI M 64 553. 185328. -Q. 5 4638 270,419. -

3 SALES MANAGER

7

8 ((i)

0.) 0. 0. 0. 0. 0. 0. 0.

(I)4

W5

(i)6 (h)

M

u)

V)9

V)10 (ii)

V)11 ()

(i)12 (u•) ______ ______ ______ ______

M13 ()

M14 (u)

W15 (h)

V)16 (ii) BAA TEEA4102L 12/11(12 Schedule J (Form 990) 2012

Schedule J (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103

Supp lemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines la, ib, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, forPart H. Also complete this part for any additional information.

- - YARIL .LLN C EDSVAS LEMETAQILRJIIENT, QVIIY-BENAT1QN________________________

THE EXECUTIVE DIRECTOR RECEIVED TAXABLE AMOUNTS UNDER SEVERAL ARRANGEMENTS

MAINTAINED IN CONNECTION WITH PRIOR SERVICES AND CURRENT SERVICES. THESE INCLUDED:

. . . LI)_ANLIPLCENTIVE PAYMENT THAT WAS DEFERRED -AND-EARNED IN A-PRIOR YEAR R 3̂, 122QPIL ___________________________

(II) A-RETENTION PAYMENT PAID FOR HIS AGREEMENT TO-STAY ON-WITH THE AGENCY-PAST HIS -------------------------

RETIREMENT AGE ($35,(LO.Q)

NON-QUALIFIED PLAN- L^.8,4j^2)_AND_(Iy)_ OTHER-MISCELLANEOUS PAYMENTS-E.G., -IMPUTED _____________________________

- - - INCOME-FROM AUTOMOBILE-Q^.E, TAXABLE PARTICIPATION IN AGENCY EMPLOYEE PLANS, ETC ----------------------------

___Q27L________________________________________________________________________________

PART 1. LINE 5 - COMPENSATION CONTINGENT ON REVENUES OR RELATED ORGANIZATION

THE SALES MANAGER RECEIVES—COMMISSIONS—AS A PERCENTAGE OF NET CONTRACT SALES

PROCEEDS. THE PERCENTAGES RANGE FROM 1% TO 5% OF NET CONTRACT SALES PROCEEDS. ALL

OTHER COMPENSATION IS SALARY AND NO COMPENSATION IS BASED ON A PERCENTAGE OF AGENCY

REVENUE OR AGENCY PROFITS.

PART LINE J NON-F IXED PAYMENTS NOT LISTED

THE EXECUTIVE DIRECTOR IS ELIGIBLE—FOR—AN INCENTIVE PAYMENT BASED ON PERSONAL AND

ORGANIZATIONAL-PERFORMANCE-GOALS ESTABLISHED BY THE BOARD, -IF AND TO THE EXTENT ----------------------------

THOSE GOALS ARE SATISFIED. BASED ON SATISFACTION/EXCEEDING GOALS IN 20:Ll,

INCENTIVE PAYMENT OF $35,000 WAS PAID IN 2012.BAA Schedule J (Form 990) 2012

TEEA4103L 12/11/12

SCHEDULE K I

(Form 990) Supplemental Information on Tax Exempt BondsComplete if the organization answered 'Yes' to Form 990, Part IV, line 24a. Provide descriptions,

Department of the Treasury explanations, and any additional information in Part VI.Internal Revenue Service Attach to Form 990. 01 See separate instructions.


NYS ARC, INC. CHENANGO COUNTY CHAPTERPart I I Bond Issues

(a) Issuer Name (b) Issuer EIN I (c) CUSIP # I (d) Date issued I (e) Issue price

OMB No. 545-0047

2012 -•

Open to PublicInspection

Employer identification number

16-0970103

(1) Description of purpose (g) (h) On (i) PooledDefeased behalf of financing

issuerYes I No Yes I No Yes I No

A DORMITORY AUTHORITY OF THE 14-6000293 1649

1, 466.124.IREFINANCEBCD

A

1 Amount of bonds retired.................................................................

2 Amount of bonds legally defeased........................................................

3 Total proceeds of issue..................................................................

4 Gross proceeds in reserve funds.........................................................

5 Capitalized interest from proceeds

6 Proceeds in refunding escrows...........................................................

7 Issuance costs from proceeds............................................................

8 Credit enhancement from proceeds

9 Working capital expenditures from proceeds

10 Capital expenditures from proceeds ......................................................

11 Other spent proceeds ...................................................................

12 Other unspent proceeds.................................................................

B

C

13 Year of substantial completion...........................................................

Yes No Yes No Yes No Yes No

14 Were the bonds issued as part of a current refunding issue?

15 Were the bonds issued as part of an advance refunding issue'.............................

16 Has the final allocation of proceeds been made'..........................................

17 Does the organization maintain adequate books and records to support the final allocationofproceeds'.............................................................................

Part HI I Private Business UseA

Yes I No

1 Was the organization a partner in a partnership, or a member of an LLC, which ownedproperty financed by tax-exempt bonds'..................................................

2 Are there any lease arrangements that may result in private business use ofbond-financed property'..................................................................

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990.

B C D

Yes I No I Yes F No I Yes I No

Schedule K (Form 990) 2012

TEEA4401L 01104/13

Schedule K (Form 990) 2012 NYS ARC, INC

1 —n97nln Paae2

Part HI I Private Business Use (Continued)C I D

Yes I No

3a Are there any management or service contracts that may result in private business use ofbond-financed property7 .................................................................

b If 'Yes to line 3a, does the organization routinely engage bond counsel or other outsidecounsel to review any management or service contracts relating to the financed property?...

c Are there any research agreements that may result in private business use ofbond-financed property' .................................................................

d If 'Yes to line 3c, does the organization routinely engage bond counsel or other outside counselto review any research agreements relating to the financed property' .......................

4 Enter the percentage of financed property used in a private business use by entities otherthan a section 501 (c)(3) organization or a state or local government ......................

5 Enter the percentage of financed property used in a private business use as a result ofunrelated trade or business activity carried on by your organization, another section 501 (c)(3organization, or a state or local government ..............................................

6 Total of lines 4 and 5....................................................................7 Does the bond issue meet the private security or payment test' ............................8 a Has there been a sale or disposition of any of the bond-financed property to a nongoven-

mental person other than a 501 (c)(3) organization since the bonds were issued' ............b If 'Yes', to line 8a, enter the percentage of bond-financed property sold or disosed of........

c If 'Yes' to line 8a, was any remedial action taken pursuant to Regulations sections1.141-12 and 1.145-2' ...................................................................

9 Has the organization established written procedures to ensure that all nonqualified bonds ofthe issue are remediated in accordance with the requirements under Regulations sections1.141-12 and 1.145-2' ..................................................... ..............

Part IV I Arbitrage

In

9- I9-I01

0I %.5

01 01 0

.51 .5 -5

1 Has the issuer filed Form 8038-1' ........................................................2 If 'No to line 1, did the following apply?

a Rebate not due yet'.....................................................................b Exception to rebate' ....................................................................

cNo rebate due' .........................................................................

If you checked 'No rebate due' in line 2c, provide in Part VI the date the rebate computationwas performed.

3 Is the bond issue a variable rate issue'...................................................4a Has the organization or the governmental issuer entered into a qualified hedge with respect

to the bond issue'.......................................................................b Name of provider........................................................................cTerm of hedge ..........................................................................d Was the hedge superintegrated? .........................................................e Was the hedge terminated' ..............................................................

BAA Schedule K (Form 990) 2012TEEA4401L 01/04/13

Schedule K (Form 990) 2012 NYS ARC, INC. CHENANCO COUNTY CHAPTER 16-0970103 Page 3Part IV I Arbitage (Continued)

A B D____Yes No Yes No Yes No Yes No

5a Were gross proceeds invested in a guaranteed investment contract (GIC)' ..................b Name of provider........................................................................c Term of GICd Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied'.....________

6 Were any gross proceeds invested beyond an available temporary period' ..................

7 Has the organization established written procedures to monitor the requirements ofsection148 ' ...........................................................................

Part V I Procedures To Undertake Corrective Action

Has the organization established written procedures to ensure that violations of federal tax A B C D

requirements are timely identified and corrected through the voluntary closing agreement program Yes No Yes No Yes No Yes No

if self -remediation is not available under applicable regulations' .................................

[Part VI I Supplemental Information. Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

BAA TEEA4401L 01/04113 Schedule K (Form 990) 2012

SCHEDULE 0(Form 990 or 990-EZ)



Supplemental Information to Form 990 or 990-EZ

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 990-EZ.

OMB No. 1545•0047

2012Open to Public

Inspection


16-0970103

FORM 990, PART III, LINE 1 - ORGANIZATION MISSION

THE MISSION OF THE CHENANGO COUNTY ARC IS TO PROVIDE PROGRAMS THAT ARE SPECIFIC TO

MEET A CONSUMER'S NEEDS -IN-THE-AREAS OF VOCATIONAL REHABILITATION, JOB READINESS

TRAINING, EMPLOYMENT OPPORTUNITY, RESIDENTIAL SERVICES, -SERVICE -COORDINATION,- DAY

HABILITATION AND OTHER SUPPORT-SERVICES -THAT WOULD ALLOW PARTICIPANTS THE

OPPORTUNITY-TO-MEET -THEIR OPTIMUM LEVEL -OF-SUCCESS-AND-INDEPENDENCE. THESE MEASURES

WILL BE DESIGNED TO ENSURE-THAT -PROGRAM-PARTICIPANTS ARE NOT ONLY INVOLVED IN, BUT

ARE MAKING-POSITIVE -CONTRIBUTIONS TO THEIR RESPECTIVE COMMUNITIES.

FORM 990, PART III, LINE 4D - OTHER PROGRAM SERVICES DESCRIPTION

THE -CLINIC-PROGRAM-PROVIDES -DENTAL-CARE -FOR DEVELOPMENTALLY DISABLED INDIVIDUALS.

621 UNITS OF SERVICE WERE PROVIDED.

FORM 990, PART VI, LINE 6- EXPLANATION OF CLASSES OF MEMBERS OR SHAREHOLDER

THE ORGANIZATION HAS FOUR CLASSES OF MEMBERS, - ACTIVE,- LIFE, AT-LARGE AND HONORARY.

NONE OF -THE -CLASSES -OF-MEMBERS-GIVE -THE MEMBERS -THE -RIGHTS-TO APPROVE SIGNIFICANT

DECISIONS OF THE GOVERNING BODY OR SHARE OF THE ORGANIZATION'S -PROFITS-OR EXCESS

DUES OR A SHARE -OF-THE-ORGANIZATION'S NET ASSETS UPON THE ORGANIZATION'S

DISSOLUTION.

ACTIVE-MEMBERS-ARE-THOSE MEMBERS WHO PAY ANNUAL DUES AND ARE IN GOOD STANDING

DETERMINED-ONE-MONTH PRIOR TO THE ACT WHICH GOOD STANDING IS REQUIRED. THESE

MEMBERS HAVE THE RIGHT TO VOTE-AND-HOLD OFFICE EXCEPT THAT NO PERSON WHO IS A PAID _-

EMPLOYEE OF EITHER-THE-ASSOCIATION-OR ONE OF ITS CHAPTERS IS MAY BE AN-OFFICER -

GOVERNOR OR DIRECTOR OF THE ASSOCIATION OR- SUCH -CHAPTER -

LIFE MEMBERS ARE THOSE WHO CONTRIBUTE WITHIN A PERIOD OF ONE YEAR AN AMOUNT FIXED BYBAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. TEEA4901L 12/8112 Schedule 0 (Form 990 or 990-EZ) 2012

Schedule 0 (Form 990 or 990-EZ) 2012Employer identification number


16-0970103

--- FORM 990,IOPART Vl,_ .ki E^^-_g^PLANATN- _F9yI9!Q, loll c cER ivc-----------THE BOARD OF GOVERNORS-AND-WHO-REQUESTS -SUCH STATUS. - LIFE-MEMBERS-SHALL THEREAFTER

BE EXEMPT FROM-THE-PAYMENT-OF DUES-AND-SHALL RETAIN ALL RIGHTS AND PRIVILEGES OF

MEMBERSHIP INCLUDING THE RIGHT TO VOTE-AND-HOLD-OFFICE -

MEMBERS—AT—LARGE ARE PERSONS WHO WOULD—BE ELIGIBLE TO BE ACTIVE —OR—LIFE MEMBERS WHO

RESIDE IN A TERRITORY IN WHICH THERE IS NO CHAPTER AND—ADMITTED —TO—MEMBERSHIP UPON

APPLICATION—IN—WRITING. — THEY RETRAIN ALL PRIVILEGES OF MEMBERSHIP EXCEPT THE RIGHT

TO VOTE AND HOLD OFFICE AND SHALL PAY THE SANE DUES AS AN ACTIVE MEMBER.

HONORARY MEMBERS ARE PERSON WHO HAVE DISTINGUISHED THEMSELVES BY THEIR ATTAINMENTS

IN—THE—FIELD OF DEVELOPMENTALLY DISABLED AND HAVE BEEN—ELECTED—TO SUCH MEMBERSHIP BY

THE BOARD OF GOVERNORS OR BOARD —OF—DIRECTORS OF —THE —CHAPTER. HONORARY MEMBERS DO NOT

PAY DUES AND SHALL—NOT—HAVE —THE RIGHT TO VOTE OR HOLD OFFICE.

FORM 990, PART VI, LINE 7A - HOW MEMBERS OR SHAREHOLDERS ELECT GOVERNING BODY

ACTIVE—AND—LIFE MEMBERS ARE ABLE TO VOTE AND ELECT —MEMBERS—TO THE GOVERNING BODY.

FORM 990, PART VI, LINE 11B - FORM 990 REVIEW PROCESS

MANAGEMENT—AND—THE—BOARD OF DIRECTORS WILL REVIEW THE FORM- 990—PRIOR TO SUBMISSION.

ANY QUESTIONS OR COMMENTS WILL BE DIRECTED TO THE ACCOUNTING FIRM THAT—PREPARES—THE---

RETURN. THE FORM 990 IS MADE AVAILABLE, FOR REVIEW AFTER FILING, TO THOSE BOARD

MEMBERS WHO WERE UNABLE —TO—ATTEND THE MEETING AT WHICH—THE—FORM WAS PRESENTED.

FORM 990, PART VI, LINE 12C - EXPLANATION OF MONITORING AND ENFORCEMENT OF CONFLICTS

EACH YEAR ALL BOARD MEMBERS AND EXECUTIVE MANAGEMENT STAFF COMPLETE CONFLICT OF

INTEREST STATEMENTS. STATEMENTS ARE REVIEWED BY EXECUTIVE COMMITTEE AND EXECUTIVE

DIRECTOR.--ALL—PARTIES—WITH—CONFLICTS ABSTAIN FROM VOTING AND DISCUSSIONS ON MATTERS

WHERE THEY—HAVE —CONFLICT OF —INTEREST -

BAA Schedule 0 (Form 990 or 990-EZ) 2012

TEEA4902L 1218/12

Schedule 0 (Form 990 or

2012

Page 2Name of the organization Employer identification number


16-0970103

FORM 990, PART VI, LINE 15B - COMPENSATION REVIEW & APPROVAL PROCESS - OFFICERS & KEY EMPLOYEES

ANNUALLY THE BOARD OF DIRECTORS WILL REVIEW AND APPROVE THE EXECUTIVE DIRECTOR'S

SALARY THE OTHER SALARIES ARE APPROVED BY THE BOARD WHEN THEY APPROVE THE OVERALL

BUDGET. PERIODICALLY THE BOARD WILL REVIEW COMPARABILITY DATA FOR-THE-EXECUTIVE

DIRECTOR'S-AND-MANAGEMENT EMPLOYEE'S SALARY. MANAGEMENT EMPLOYEES ARE DEBRA CARLIN

AND LISA BERARD. - THIS-WAS-LAST -DONE IN 2011.

FORM 990, PART VI, LINE 19-OTHER ORGANIZATION DOCUMENTS PUBLICLY AVAILABLE

AVAILABLE UPON-REQUEST-AT THE ORGANIZATION'S OFFICE.

BAA

Schedule 0 (Form 990 or 990-EZ) 2012

TEEA4902L 12/8/12

OMB No. 1545-0047

2012Open to Public

Inspection


16-0970103

SCHEDULER(Form 990) Related Organizations and Unrelated Partnerships

Depament of the Treasury Complete if the organization answered 'Yes' to Form 990, Part IV, line 33, 34, 35, 36, or 37.Internal Revenue Service Attach to Form 990. - See separate instructions.Name of the organization


[Part Identification of Disregarded Entities (Complete if the organization answered 'Yes to Form 990, Part IV, line 33.)

(b) (c) (d) (e) (f)Primary activity Legal domicile (state Total income End-of-year assets Direct controlling

or foreign country) I I entity

(a)Name, address, and EIN (if applicable) of disregarded entity

(1)

(2)

(3)

JJ Identification of Related Tax-Exemptone or more related tax-exempt orgar

(a)Name, address, and EIN of related organization

ations (Complete if the organization answered 'Yes' to Form 990, Part IV, line 34 because it hadduring the tax year.)

(b) (c) (d) (e) (1) (g)Primary activity Legal domicile (state Exempt Code Public charity status Direct controlling Sec 512(bX13)

or foreign country) section (if section 501 (c)(3)) entity controlled entity?

Yes I No

(1)CWS CHARITABLE FOUNDATION, INC- 17 MIDLAND DRIVE

NORWICH, NY 1381516-1531603

(2)CHENANGO COMMUNITY RESIDENCES, INC17 MIDLAND DRIVENORWICH, NY 1381551-0239210

(3)

PROVIDE

NYS ARC, INCSCHOLARSHIPS TO

CHENANGOHIGH SCHOOL

COUNTY

NYSARC, INCCHENANGOCOUNTY

LEASES PROPERTY

NY

501(C) (2

CHAPTER X

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. TEEA5001L 12/28/12 Schedule R (Form 990) 2012

Schedule R (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 2

I Part iii I Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered Yes to Form 990, Part IV, line 34because it had one or more related organizations treated as a partnership during the tax year.)

(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k)Name, address, and EIN of Primary activity Legal Direct Predominant income Share of total Share of Dispropor- Code V-UBI General or Percentage

related organization domicile controlling (related, unrelated, income end-of-year tionate amount in box managing ownership 'x

(state or entity excluded from tax assets allocations? 20 of Schedule partner?

foreign under sections______________ K-i (Form

country) 512-514) Yes I No 1065)___

Yes____ _

-No-

(1)

(2)

(3)

Part IV Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered 'Yes' to Form 990, Part IV,line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(g) (h) (icen

)Share of end-of- Pertage Sec 512(b)(13)

year assets ownership controlled entity?

Yes I No

(a) (b) (c) (d) (e) (f)Name, address, and EIN of related organization Primary activity Legal domicile Direct Type of entity Share of

(state or foreign controlling (C corp, S corp, total incomecountry) entity or trust)

(1)

(2)

(3)

BAA TEEA5002L 12/28112 Schedule R (Form 990) 2012

Name of other organization Transaction I Amotype (a-s)

Method of cleterminamount involved

Schedule R (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 3 -

Part V I Transactions With Related Organizations (Complete if the organization answered 'Yes' to Form 990, Part IV, line 34, 35b, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, lii, or IV of this schedule. NoDuring the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity ............................................................................... xb Gift, grant, or capital contribution to related organization(s)...................................................................................................... Xc Gift, grant, or capital contribution from related organization(s)................................................................................................... X

d Loans or loan guarantees to or for related organization(s).......................................................................................................

e Loans or loan guarantees by related organization(s) ............................................................................................................

f Dividends from related organization(s) ......................................................................................................................... Xg Sale of assets to related organization(s) ....................................................................................................................... Xh Purchase of assets from related organization(s) ................................................................................................................ X

i Exchange of assets with related organization(s) ................................................................................................................ XLease of facilities, equipment, or other assets to related organization(s).......................................................................................... X

k Lease of facilities, equipment, or other assets from related organization(s) .......................................................................................

I Performance of services or membership or fundraising solicitations for related organization(s).....................................................................

m Performance of services or membership or fundraising solicitations by related organization(s) .....................................................................

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) .........................................................................

o Sharing of paid employees with related organization(s)..........................................................................................................

p Reimbursement paid to related organization(s) for expenses ....................................................................................................

q Reimbursement paid by related organization(s) for expenses....................................................................................................

r Other transfer of cash or property to related organization(s)..................................................................................................... Xs Other transfer of cash or property from related organization(s)................................................................................................... X

2 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.

CHENANGO COMMUNITY RESIDENCES, INC

714,309.

CHENANGO COMMUNITY RESIDENCES, INC

K

10,127

T

BAA TEEA5003L 12/28112 Schedule R (Form 990) 2012

Schedule R (Form 990) 2012 NYS ARC, INC. CHENANGO COUNTY CHAPTER 16-0970103 Page 4

I Part VI j Unrelated Organizations Taxable as a Partnership (Complete if the organization answered 'Yes to 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 grossrevenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) (b)(b) (c) (d) (e) (f) (g) (h) (i) (j) (k)

Name, address, and EIN of entity Primary activity Legal domicile Predominant Are all partners Share of Share of Dispropor- Code V-UBl General or Percentage

(state or foreign income section total income end-of-year tionate amount in box managing ownershipcountry) (related, unre- 501(cX3) assets allocations? 20 of Schedule partner?

lated, excluded organizations? K-ifrom tax under__________ Form (1065) _ _____

section 512-514) Yes I No Yes I No

______

Yes I No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

BAA TEEA5004L 12/28/12

Schedule R (Form 990) 2012 Page 5

Part VII I Supplemental InformationComplete this part to provide additional information for responses to questions on Schedule R(see instructions).

BAA TEEA5005L 12/28/12 Schedule R (Form 990) 2012

-

Form 868(Rev January 2013)


Application for Extension of Time To File anExempt Organization Return

File a separate application for each return.

OMB No. 1545-1709

• If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ......................................

• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form).

Do not complete Part!l unless you have already been granted an automatic 3-month extention on a previously filed Form 8868.Electronic filing (e-file). You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for acorporation required to file Form 990-1), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 torequest an extension of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for TransfersAssociated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on theelectronic filing of this form, visit www.irs.gov/e file and click on e-file for Charities & Nonprofits.

Part I I Automatic 3-Month Extension of Time. Only submit original (no copies needed).A corporation required to file Form 990-1 and requesting an automatic 6-month extension - check this box and complete Part I only.....

All other corporations (including 1120-C filers), partnerships, REM/Cs, and trusts must use Form 7004 to request an extension of time to fileincome tax returns.

Enter filer's identifying number, see instructionsor other filer, see

I Employer identification number (EIN) or

Type orprint


16-0970103File by the Number, street, and room or suite number. If a P.O. box, see instructions.

due date forfiling yourreturn. See or a foretan address, seeinstructions.

Enter the Return code for the return that this application is for (file a separate application for each return) ..........................

Application Return Application ReturnIs For I Code Is For I Code

070809101112

Form 990 or Form 990-EZForm 990-BLForm 4720 (individual)Form 990-PFForm 990-T (section 401(a) or 408(a) trust)Form 990-T (trust other than above)

• The books are in the care of DEBRA CARLIN

01 Form 990-T (corporation)02 Form 1041-A03 Form 472004 Form 522705 Form 606906 Form 8870

Telephone No.' Q71_334536- FAX No.• If the organization does not have an office or place of business in the United States, check this box ................................. U• 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.... 1, [and attach a list with the names and EINs of all membersthe extension is for.

1 I request an automatic 3-month (6 months for a corporation required to file Form 990-1) extension of timeuntil 8/15 , 20 13 , to file the exempt organization return for the organization named above.The extension is for the organization's return for:

calendar year 20 12 or

F1 tax beginning 20 and ending -,20

2 If the tax year entered in line 1 is for less than 12 months, check reason: [Initial return [Final return[Change in accounting period

3a If this application is for Form 990-BL, 990-PF, 990-1, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions .................................................................

b If this application is for Form 990-PF, 990-1, 4720, or 6069, enter any refundable credits and estimated taxpayments made. Include any prior year overpayment allowed as a credit ................................

c Balance due. Subtract line 3b from line 3a. Include your payment with this form, if required, by usingEFTPS (Electronic Federal Tax Payment System). See instructions .....................................

Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO forpayment instructions.

BAA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev 1-2013)FIFZ0501L 01/21/13

am

"

Form 8868 (Rev 1-2013) Page 2

• If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II and check this box .....................

Note. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.• If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).

Part It Additional (Not Automatic) 3-Month Extension of Time. Only file the original (no copies needed).Enter filer's identifying number, see instructions

Name of exempt organization or other filer, see instructions. identification number (EIN) or

Type orprint

Number, street, and room or suite number. If a P.O. box, see instructions.File by theextendeddue date forfiling yourreturn. Seeinstructions.

PIAKER & LYONS, PC

City, town or post office, state, and ZIP code. For a address, see instructions.

13815

Enter the Return code for the return that this application is for (file a separate application for each return) ..........................

Application Return Application ReturnIs For Code Is For I Code

Form 990 or Form 990-E7

01Form 990-BL

02 Form 1041-A

08Form 4720 (individual)

03 Form 4720

09Form 990-PF

04 Form 5227

10Form 990-T (section 401(a) or 408(a) trust)

05 Form 6069

11

Form 990-T (trust other than above)

06 Form 8870

12

STOP! Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.

• The books are in care of DEBRA CARLINTelephone No. 1, J6Q7 334-5366 FAX No.

• If the organization does not have an oftice or place of business in the United States, check this box ................................• If this is for a Group Return, enter the organizations 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 Fland attach a list with the names and EINs of allmembers the extension is for.

4 I request an additional 3-month extension of time until 11/15 , 20 13.5 For calendar year 2012 , or other tax year beginning , 20 — ,and ending , 206 If the tax year entered in line 5 is for less than 12 months, check reason: Initial return Final return

Change in accounting period7 State in detail why you need the extension.. - ADDITIONAL TIME IS REQUIRED TO GATHER—THE—INFORMATION--.

NECESSARY TO FILE A COMPLETE—AND— ACCURATE —RETURN -

8a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions ...............................................................

b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated taxpayments made. Include any prior year overpayment allowed as a credit and any amount paid previouslywithForm 8868 ......................................................................................

c Balance due. Subtract line Sb from line Ba. Include your payment with this form, if required, by usingEFTPS (Electronic Federal Tax Payment System). See instructions ....................................

Signature and Verification must be completed for Part II only.

Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,correct, and complete, and that I am authorized to prepare this form.

Signature Title 0, PRESIDENT Date 10,

BAA FIFZ0502L 01/21/13 Form 8868 (Rev 1-2013)

COPY OF WITHIN PAPERRECEIVED

NOV 22 2013

NYS OFFICE OF THE ATTORtL 'JECHARITIES BUREAU

28 chenango county chapter arc

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