(pig Return of Organization Exempt From Income Tax Under section 501(¢), 527, oF 4947(a)(1) ofthe Internal Revenue Code (except black lung bonefit trust or private foundation) > The organzaton may have to use 2 copy of vs relumn to salty stale reportng requrements ear ortax year beginning O7/01/12 andending 06/30/13 vom 990. evan Sonn ‘A. For the 2072 eal Bom tayense [Pte on 9p a neice DIABETES FOUNDATION OF MISSISSIPPI nares [Sateen 23-7262987 Ente eae 100 601-957-7878 (lave [_RrpGeraND Ms_ 39157 e cosas 2,232,217 C romcoonomon |" ORY FORTUNE wo) seeagcinmersianes (ver [R) to 800 AVERY BLVD, SUITE 100 HID} Are af states etd? Love One RIDGELAND MS 39157 "Wa" enach oat (eee nemvcaanay iemeame (XL go | [ong See Tene | Ler 4 wsote > WHW.MSDIABETES . ORG M)_cowp exer urts i formeteginaion Capen | [Toes | | eoaen || Oe To veraiomise 1973 [wu somaigaionae MS Part| Summary 1 Bry descnbe te organaatorie mation or most egaricant aces g| THE ORGANIZATIO'5 ‘PRIMARY MISSION 15 TO FURTHER THE GENERAL WELFARE, AND 8 opeRTAKE IN THE PUBLIC INTEREST, ACTIVITIES TO IMPROVE THE WELL-BEING OF 2| PERSONS HAVING DIABETES MELLITUS 5 | 2 creck msbox > [_] sine erganzaton dcontinued is operations or dsposed of mare than 25% oft net assets 82 number ot voting members of he governing body (Part VI hoe 19) : a | 35 B| + saver otndependenvengmembas fhe governg bay (a Ve 8 2/35 | 5 Total numberof nivdvalsempayed in calendar year 2012 (Pa V,bne 2) . pep. B| 6 Total number of volunteers (estimate ifriecessary) 6 | 75, 7a Total uncltes business revenue from Pat Vl, cok (C), ne 12 7a 0 Net unvelate business taxable nome fom Form 9907, ne 34 7 o tg| ® Coniautens and grants (Part Vt, ne 1) 806,443 784,518 2] 9 Program service revenue (Part Vill, bne 29) 95, 830) 111,567 8 10 invosimentincome (Part Vl: Ck GD, wis 9,4 nd 72) 32,599] 34/190 ©) 44. Other revenue (Part Vill, column (A), lines 5, 64, Bc, 9c, 10c, and 11e) 0 12 Toll rovenve = add ines 8 Yvough 44 (must equal Pa Vil, cokirma (A), ne 12 334,872] 330,275 13. Gras and senior amounts paid (Part x, column (A) tes 1-3) @ 14 Benefits paid to or for members (Part 1X, column (A), line 4) 0 g 15. Salanes, other compensation, emiplayée benefits (Part IX, column (A), ines 5-10) 420,651) 397,705 | 16aProfessional fundraising fees (Part 1X, column (A), tne 116) 0 8) Tota ncrasing expenses (Pant X, co (0, ne 25) 75,768 ©] 47 omer expenses (Pat, column (8), nes 112-144, 11+24e) 487,277] 385 18 Total expenses Add nes 13-17 (must equal Part IX, column (A), line 25) 907, 928} 090 = _| 19 Revenue ess expenses Subact ne 18 fom be 12 26, 944] 185 Sng Ture Yr Total assets (Par X, be 16) 2,260, 455) 7a ‘Total habibwes (Part X, bine 28) 47,062! 627 Nel assets or tnd Balances Subract ne 21 fom ine 20 2,213,393) ‘551 Signature Block. ater parler of gona, |decare tat hve armed ina er, mean Secopanyngscheades and daamon anda he es omy Arwedge and Baal #1 <2) _te" irec aa compote Dacrebnc pare ar ban oce) = bandon ueamanon awe prepare has ny aoe <3 Sign ae 3 Here MARY FORTUNE EXECUTIVE VICE PRESIDENT Tire Se Tpataan Bae Tone Re a re to Bisbee Tosa Preparer [srmaace > SUMMERS GREEN € LEROUX, TLP rmuen) — 64-0853461 Use only 625 HIGHLAND COLONY PKWY STE 104 fanwsn _» RIDGELAND, MS 39157-8837 serene 601-982-0825 iay re TS scans eta wh te preparer shown above” eee nrvcons) Tives T Tho For Paperwork Reduction Act Notes, te the separate instructions Iaom 960 0/2) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 2 Partill, Statement of Program Service Accomplishments ‘Check if Schedule O contains a response to any question in this Part II 0 7 Brety describe the organizations msion THE ORGANIZATION'S PRIMARY MISSION IS TO FURTHER THE GENERAL WELFARE, AND UNDERTAKE IN THE PUBLIC INTEREST, ACTIVITIES TO IMPROVE THE WELL-BEING OF PERSONS HAVING DIABETES MELLITUS. "2 Da the arganation undertake any signiicant program services dunng the year which were nt lsted on the nor Form 980 or 990-€27 (1) vee El ne 1"¥es," desenbe these new services on Schedule O Dal the erganzaton cease conducting, or make signifeant changes m how conducts, any program seruces? J] Yes no It"¥es." desenbe these cnanges on Schedule O 4 Desenbe the ecgazaton's program service accomplishments for each offs tree largest program services, a measured by expenses. Secton 501(c(3) and 501(eX4) organzations are requred to report the amount of grants and allocations fo ohers, tne total expenses, and revenve, any, foreach program service reported ‘(Code ViEpenses § ‘B43, 551 _wcutng grants of § ) (Revenue $ 7 PROGRAM SERVICE ONE-INFORMATION AND PATIENT SERVICES-THE ORGANIZATION CONDUCTS A COMPREHENSIVE STATEWIDE DIABETES SCREENING PROGRAM, PROVIDES DIRECT PATIENT SUPPORT BY OBTAINING AND DISTRIBUTING MEDICAL SUPPLIES TO THE INDIGENT POPULATION, AND FUNDS CAMPERSHIPS FOR CHILDREN WITH DIABETES. “4b (Code: Viepenses € 332,854 nciutng ganis of § ) (Revenue § ) PROGRAM SERVICE TWO-RESEARCH, EDUCATION AND AWARENESS-THE ORGANIZATION FUNDS NATIONAL RESEARCH PROGRAMS AND GRANTS, AS WELL AS RESEARCH PERFORMED BY MEDICAL PROFESSIONAL IN MISSISSIPPI. IT ALSO PROVIDES INFORMATION ON DIABETES THROUGH A STATEWIDE TOLL FREE PHONE NUMBER, SPONSORS PUBLIC SERVICE ANNOUNCEMENTS FOR RADIO, TELEVISION, AND PRINT MEDIA, CONDUCTS A DIABETES AWARENESS PROGRAM, AND PROVIDES EDUCATIONAL MATERIAL AND SEMINARS. “4 Gove VEpenses & inaaing eanis of ) (Revenue § > “44: Other program servces (Desoibe m Schedule O) (@xpenses $ including grants of $ (Revenue $. “de Total program service expenses 676, 405 om Fer 990 01)Fowh 990 (2012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 PartlV Checklist of Required Schedules Page 3 1 [she exgarizaton described n section 501(¢K3) or 4947(a)1) (ther than a pavate foundation)? “Yes.” complete Schedule A 2 Inthe organzaton requred to complete Schedule B, Schedule of Contnbutos (see structions)? 2 Dd the organization engage dect or ncrect politcal campaign actives on behalf of rn appastion to candidates for publ offce? If"Yes,” complete Schedule C, Part 4 Section 501(¢)3) organizations. Ox the organation engage lobbying aces, or have a secon 501(h) election effect dung the tx year? "Yes." complete Schedule C, Part I 5 Is the erganzaton a section 501(2X4),601(¢N,S), or 501(€(6) organaton that recenes membership dues, assessments, or simar amounls as defined in Revenue Procedure 96-197 If"Yes,” complete Schedule C, Parti 6 Dadthe organaaton maintain any donor advised funds or any simar funds or accounts for which donors have the rght to prove advice onthe dstnbuton or vestment of amounts such funds or accounts? It "Yes," complete Schedule D. Part! 7 Od the organzaton receve or held a conservaton easement, including easements to preserve open space, the enuronment, sone find areas, or stone structures? "Yes," compte Schedule D, Pat 8 Odthe organzation manian colectons of works of a, historical ireasures, or athe simiar assets? Yes" complete Schedule D, Part 9 Dd the organization repart an amount in Part X, ine 21, for escrow oF custodial account habily, serve a8 @ ‘custodian for amounts not sted m Part X; or prowde credit counseling, debt management, ced rep, oF {eb negataton serves? I1-Yes," complete Schedule D, Part 40. Od the organzaton, rectly or trough a elated organzabon, hold ase n temporanly restncted endowments, permanent endowments, or quast-endowments? "Yes," complele Schedule D, Port V 11 ifthe organzatin's answer to any ofthe flowing questions is "es." then complete Schedule D, Parts Vi, VI. Vl X, 0X as applicable 22 Dad the organation eport an amount fr land, bukings, and equpmentn Part X, ine 10? "Yes," complete Schedule 0, Pat VI 'b_Did ihe ergancaton report an amount for invesiments—other secuntes in Part X, ine 12 that 65% or more ofits total assets reported n Pat X, ne 167 "Yes," complete Schedule D, Part Vit © Os the organzation report an amount fr investmenis—program related in Par X, tne 13 thats 5% or more oft ola assets reported in Pan X, tne 162 "Yes," complete Schedule D, Part Vl 44 Did the organization report an amount for other assets n Part X ine 15 thal is 5% or more of ts total assets reported n Pan X, tne 16? "Yes," complete Schedule D, Part IX {© Os the organcaton eport an amount fr other lables in Pant X, tne 25? "Yes," complete Schedule D, Part Othe organcation’s separate or consohdated franca statements forthe tax year ncude a foctnote that addresses the organization's habit for uncetan tax postions under FIN 48 (ASC 740)? "Yes." complete Schedule D, Part X 42a De he organzaton obtam separate, independent audited fnancal statements forthe tax year? I1-Yes," complete ‘Schedule D, Parts XI and XI 1b Was the organization included in consoldated, ndependent audited fhancalstalements forthe tax year? "Yes," and ‘he exganzation answered "No" to ine 12, then completing Schedule D, Parts X! and Xlisoptenal 13 _Isthe organzabon a schoo! desended im section 170(0)1/A)e)? Yes, complete Schedule E 44a. Di the oxganation mamntan an offce, employees, or agents outside of he Unted States? bd the organzation have aggregate revenues or expenses of more than $10,000 fom grantmaking, {undrasng, business, svestment, and program serve actives outside the Unted Sates, or aggregate {foreign nvestments valed at $100,000 or more? IYes," complete Schedule F, Pars and IV 415 Di the organzavon report on Part IX, column (A), ne 3, more than $5,000 of grants or assistance to any ‘cxganizaon or entity located outside the Unted States? If"Yes,” complete Schedule F, Parts I! and V 16 Did the exganzaton report on Part Ik, column (A), ne 3, more than $5,000 of aggregate grants or assistance to mdvnduals located outside the United States? "Yes," complete Schedule F, Pats Il and IV 417 Dd he ocganzaton report a total of more then $15,000 of expenses for professional fundrasing services on Part X, column (A), ines 6 and 116? i "Yes,” complete Schedule G, Part! (see instructions) 18 Did the erganzation report more than $15,000 toa of fundrasng event gross ncome and contnbubons on Prt Vil, ines 1c and 85? "Yes," compete Schedule G, Part I 49°01 the organization report more than $15,009 of gross come fom gaming aches on Part VI ne Sa It"¥es." complete Schedule G, Parti 20a Did the exganzaion operate one or more hosptal facies? IT"Yes” complete Schedule H bb_11Yes"1o ine 20a, did the organzation attach a copy os audited fancal statements to ths retumn? You] No pelo 10 x nes +10) se aa ie oe foes oe [ae a 12 3 ele o¢ Evry 140 16 16 le oe [oe foe ” | x 19 veloc 208 200 Fem 990 01)oni 9902012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 4 PartlV__ Checklist of Required Schedules (continued) ‘yes | Ne 24 Did the organzahon report more tan $5,000 of grants and other assistance fo any government or organzaton inthe Unted Sates on Pat IX, column (A), ine 17 -Yes," complete Schedule |, Pans! and a x 22 Did the organzaton report more than $5,000 of grants and other assistance to individuals nthe United States (on Part X, column (A), bne 2? If-Yes," complete Schedule I, Parts | and Il 2 x 23 Did he organization answer Yes" to Pat Vil Section A, hoe 3,4, ofS about compensation of he coxgantzation’scurent and former offers, decors, tustees, key employees, and highest compensated ‘employees? If"¥es," complete Schedule J 2 x 24a__Dd the organcaion have 2 tax-exempt bond ssue vith an outstanding pnacpal amount of more than {$100,000 as of he last day ofthe year, that was issued ater December 31, 2002? If"¥es," answer ines 24b tteough 24¢ and complete Schedule K "No go tone 25 mal | x 'b Othe organzation nvest any proceeds of tax-exempt bonds beyond a temporary pened exception? 240 ‘© Ox the organization maintain an escrow account other than a refunding escrow at any tne during the year to defease any tax-exempt bonds? 2c <4 Dad the oxganizabon act as an “on behalf of issuer for bonds outstanding at any ume dung the year? 24a 25a Section 504(cM.) and 501(eK4) organizations. Ox the organization engage an excess benef ansacton ‘wih a iequaiied person dung the year? if"Yes,"complote Schedule L, Part aol | x 1b Is the organization aware tat itengaged in an excess benefit ransacion wih a disqualified person n a pror year, and thatthe wansaction has not been reported on any ofthe organization's pnor Forms 990 or 990-£27 1-Yes," complete Schedule L, Part 2s] | x 26 Was aloan to orby a current or former officer, rector, rustes, Key employee, highest compensated employee, or ‘disqualified person outstanding as of he end of the organzation's tax year? If-Yes," complete Schedule L, Pat 26 x 27 Did the organzationprowde a grantor ther assistance to an officer. rector, tustee, key employee, substantial connbutor or employee thereof, a grant selection commatee member, oro a 35% controled nity oF family member of any ofthese persons? “Yes,” complete Schedule L, Parti 2 x 28 Was the organization a pary toa busness transaction wih one ofthe folowing partes (see Schedule L, Part IV insiructons for appleabe fing tresholds, conditions, and exceptions) 8 Acurrent or former officer, director, ustee, or key employee? If"Yes," complete Schedule L, Part V 200 'b Alani member ofa current or former offcer, director, trustee, oF Key employee? Its," complete Schedule L, Part IV 280) ‘© Anentty of which a curente former oficer,drectr,tustee, or key employee (or a family member thereof) ‘was an officer, director, trustee, or drect of indect owner? if-Yes,” complete Schedule L, Part IV ate. 129 Dud the organizaton receive more than $25,000 n nan-cash contabutons? I"Yes," complete Schedule M 20 | 20 Did the organzation ecewe contnbutons of a, hstoncal treasures, or other similar asses, er quaifed conservation contrbubons? If"Yes," compete Schedule M 20 =z 131i the organzation iqudate, terminate, or dissolve and cease operations” I-¥es,” complete Schedule N, Pert! a4 x 32 Did he organaaton set, exchange, dispose of, or ransfer more than 25% of ts net assets? If "Yes, complete Schedule N, Parti 32 x 233 _Did the organcaton own 100% of an entity dsregarded as separate rom the organzaton under Regulabons sections 201.770%-2 and 301 7701-3? it"Yes," complete Schedule R, Part | 2 x 34 Was tne organization celated to any tax-exempt or taxable eniy? if-¥es," complete Schedule R Parts I Il orl¥, and Pant, tne + 34 x 353. Did the argancaton have @contoled ently vathn the meaning of section 512(0)13)? asa) |X. 1b t1*¥es" to tne 35, did the exgancaton ewe any payment fom or engage any rensacton wth @ controled ently wits the meaning of section 512(b)(13)? "Yes." complete Schedule R, Pat V, ine 2 as) 36 Section 504(c\2) organizations. Ot the organzation make any transfers to an exempt non-chantable ‘elated organization? If"Yes.” complete Schedule R, Part V, tne 2 36 x 37 Dd the organizaton conduct more than 5% ofits actwies through an ently thal snot related organization ‘and that treated asa partnersip for federal ncame tax purposes? If“Yes,” complete Schedule R, Poa vt ar x 138 Did he organizaton complete Schedule O and prove explanatons in Schedule O for Pan Vi, ines 118 and 4197 Note. Al Form 990 fiers are equred to complete Schadule O we] x Fem 990 351)Form 990 (2012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 PartV, Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response to any question in this Part V Page 5 aa aa 4a 128 13 Enter the number reported n Box 3 of Form 1096 Enter-0- not applicable 42 Enter the numberof Forms W-2G included n ine 1a Enter-0-sf not applicable 4 id the organtzaton comply unh backup woking rules fr reportable payments to vendors and ‘portable gaming (gaming) wnnngs to prize winners? te Enter the numberof employees reported on Form W-3, Transmit of Wage and Tax ‘Statements, ted fr the calendar year ending wth or win the year covered by his tum alo atleast one i reported on ine 23, id the organization fle al requred federal employment ax etvns? Note. ifthe sum of ines 1 and 2a ie greater than 250, you may be required lo e-e (see structions) ‘id the erganzaton have unrelated business gross income of $1,000 or more dunng the year? 3a x 11°¥es,"has fled a Form 990-1 for this year? I(-No,” provide an explanation in Schedule O 2b ‘Atany time dunng the calendar year, did the organization have an terest no @ signature or other authonty ‘over, a financial account aforegn county (such 38 @ bank account, secures account, or oherfinancal ‘account? 4a x 1°Yes enter the name ofthe foreign country De ‘See structions fo fing requrements for Foe TD F 90-22 1, Report of Foreign Bank and Financial Accounts \Was the organzaton a pat toa prohtsted tax shelter ransacton at anytime dung the tax year? ‘id any taxable party not the organization that «was ors a party ta a prohibited tax seller ransacton? 3. "Yes" tone 62oF 5b, dd the organization fhe Form 8886-1? Does the ergarizaton have annual gross recep that are normally greater than $100,000, and id the ‘exganizaton solitary contnbutons that were not tax deductible as chantable cantnbutons? "Yes," dd the oxganzaton include wath every solicaton an express statement thal such contnbutons or 9s wore not tax deductible? es (Organizations that may receive deductible contributions under section 170(c). ia the organization receve a payment excess of $75 made party as contnbuton and party or goods and sennces proved tothe payor? A x "Yes," did the oxgancaton not the donor of the valve of he goods or services provided” 7 (id the organezation sel, exchange, or otherwise dispose of tangible personal propery for which i was. Fequire to fle Form 8282? re x Yes ndcata the numberof Forms 8282 fled dunng the year 7 1ié the organzaton receve any funds, directly or nary 10 pay premiums on a personal benefit contract? te id the oranezaton, duneg the year, pay premums, recy or ndrecty, on a personal benefit contract? pelo Ea the erganzation recerved a contnbution of qualified mneletual property, cid te organizaton fle Form 8899 as requred? 79 the organzation receved a contribution of cars, boas, arplanes, or other vehicles, dd the orgarzation fle a Form 1088-6? ‘Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting ‘organizations. Di he supporting organization, of a donor advised fund maintamed by & sponsoang ‘erganzaton, have excess business holdings at any me cunng the year? Sponsoring organizations maintaining donor advised funds. Did the xganation make any taxable distnbutions under section 49687 id the ganization make ackstnbuton te a donor, dona advisor, of related person” oy Section 601(¢)7) organizations. Enter Intaton fees and capital contnbutons included on Part Vl ine 12 408 (Gross receps, included on Form 990, Part Vl ine 12, for pubic use of cub feces “0b Section 601(c)12) organizations. Enter (Gross income from members or shareholders ata {Gross income from other sources (D0 not et amounts due or paid to cher sources against amounts due o ceed from them ) stb Section 4947(a)(1) non-exempt charitable trusts. she organization fing Form 990 in heu of Form 1041? 120 It-¥es," enter the amount of tax-exempt ntareatracewed oF accrued dunng the yea 12 Section 501(c)(29) qualified nonprofit heath insurance Issuers. Is the organzation hcensed to issue qualified heath plans m more than one state? "a Note. See the nsruchons for additonal information the organization must report an Schedule O Enter the amount of reserves the o;ganzaton s requed to maint by the slates ia which te organtaton i Heensed to setue qualifies health plans 130) Enter the amount of eserves on hand te. the organzaton rece any payments for indoor tanning serwces dung the tax year? jal | lv-¥es," hae eda Form 720 to repor these payments? "No," prowde an explanation m Schedule O 140) Fe 990 30%Fomi 990 Qo!) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 6 PartVL Governance, Management, and Disclosure For each "Yes" response to ines 2 Uwrough 7b below, and for a°No™ response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O See structions (Check i Schedule O contamns a response to any question in ths Part VI x Section A. Governing Body and Management Yes] No. 12 Enter the number of vung members ofthe governing body atthe end ofthe tx year 40 | 35 there are matenaldferences a votng nghts among members ofthe governing body, oF ifthe governing body delegated broad authony to an execute commtee or smiat Commitee, explain a Schedule O 'b_ Enter the number of voting members included mn tne 19, above, who are independent a» | 35 2 Did any ofcer, director, trustee, or key emplayee have a family relationship ora business relatonsiip wth any oer office, crector, trustee, or key employee?” 2 x 3 Did the exganzation delegate contro over management utes customanly performed by or under the deck superusion of officers, directors, or tustees, or key employees to a management company o other person? 3 x 4 Did the exganzation make any sgnficant changes tots goverming documents since the prior Form 990 ws led? 4 x '5 Did the exganvzation become aware dunng the year ofa significant diversion ofthe orgarzaton's assets? 5 x 6 0d the organization hava members or stockholders? 6 x Ta Did the eganzatin have members, slockholders, other persons who had the power lo elect oF appoint ‘one or more members ofthe governing body? ta = 1b Ave any governance decisions of he organizaton reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? » = 8 Did the exganization contemporancously document the meetings held or wniten actions undertaken dunng the yearby the fallow 8 The governing body? oa | x 1b Each commitee win autnonty to act on behalf of the governing body? a» |X 9 Isthere any officer, decor, ust, or key employee listed n Part Vil, Secton A, who cannot be reached at the erganizabon's masing address? I"Yes,"provde the names and addresses m Schedule O ° x Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.) No ‘10a 0d the organcaton have local chapters, branches, or afiates? 70a, x 'b 11-¥es7 ad the ocganzaton have writen potces and procedures governing the aches of such chapter, afates, and branches fo ensure ther operation are consistent with he organizations exempt purposes? 10» ‘11a Has the organization provided a complete copy of this Form 990 to all members os governing body before fg the form? sia] 1b Descnbe in Schedule © the process, any, used by the organzation to revew this Frm $80 ‘12a Did ihe oxganzaton have awrien confit of terest poly? "No," goto ine 13 saa] x 1b. Were officers, directors, or tustees, and key employees required to disclose annually interests that could gue nse to cones? 20] X, © Did the oxgancation regularly and consistent manor and enforce compliance wrth the poicy?If*Yes,” desenbe im Schedule O how ths was done se| x. 42D the organization have a writen whistleblower poley? aX 44 _Dadthe organization have a writen document retention and desructon policy? 4 LX. 15. Didthe process for determing compensaton ofthe folowing persons include arewew and approval by independent persons, comparabity dta, and contemporaneous substanaton ofthe deliberation and decision? 12 The organzation’s CEO, Executive Drecior. or top management official ssa] x Other officers or key employees ofthe organzaton 10] X, ites" wine 1590150, desenbe he process in Schade O (se nstucons) 162 Did ne organcaton nvest in connbule ase, or partopale a jon venture or sna axrangement ‘tha taxable erty dung the year? sea] | x bb i1-¥e5 aed te orgencaton olow a itn ply or procedure requing the organizton to evaluate ds paruepaton ont venture artangements under appleable federal ax law, nd take sles 0 sleguar the cxganzaton's exempt sats wi respect such arangements? 100 Section C. Disclosure 47 Lest he sates wth whch a copy oft Form 990 requred tobe flea ® MS 18 Secon 6104 requres an organzaton to make ts Forms 1023 (or 102 aptesbe), 990, nd 90-7 (Sechon S01) on) avaiable for pubhe napecten lccale how you made these avalabe. Check al hata [Town wetste [-) anohers webste BE] Upon request [_] Other (explanin Schedule 0) 19 _Descrbeim Schedule © wheter (and i'0, how), the orgnzaon made ls governing documents, cnt of erst poy and fnancal statements avaiable tothe publ during the tx year 20. State te name, physical address, and telephone numberof the person who possesses the books and records of the organzaton ® MARY FORTUNE 800 AVERY BOULEVARD, SUITE 100 RIDGELAND MS 39157 601-957-7878 one Fen 990 01)Fort 9902012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 7 Part Vi] Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule © contains a response to any question in this Part Vil l Section A. _ Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees ‘1a Complete ths table oral persons requred tobe isted Report compensation forthe calendar year ending wih or wan the ‘Organization's tx year ‘st al ofthe erganzaton’s current offcers, dvectors,tstees (whether ndvaduals oF organzatons), regards of amount of ‘compensation Enter-0-mn columns (0) (2), and (F) no compensation was paid \Ust all of he organzaton's currant key employees, any See instructs for defiion of "key employee «List the organizaton’ five current highest compensated employees (other than an ofcer, directo, lustee, or key employee) ‘whe received reportable compensation (Bax'5 af Form W-2 andlor Box 7 of Farm 1089-MSC) of moce than $100,000 from the ‘xganaton and any related organations '¢ Lista ofthe organzaton’s former offcers, key employees, and highest compensated employees who recened more than '5100,000 of repontabie compensation Wom the orgarzation and any related organcratone ‘¢ Lista of he organaton's former directors or trustees thal ceed. nthe capacty aa former director or tustew of the ‘oxgSncation, more than §10,000 of reparable compensation Wm the organization and any elaed arganatons {ist persons nthe folowing order indrvdual ustees or directors, insttubonal trustees, officers, key employees, aghest compensated employees, and former such persons “1 Check ts box nether the organzaton nor any related organzaions compensated any cutentofcer, director, or tustee “ ® © o © a SSE | wepTeee | | SEE ie (story evecare te nt, “ames (PETE) 8] eg]g | wont FAG sooams el E] | fea] * ome 2 a (@RICK CARLTON, JH, M.D- 0.00 PRESIDENT 0:00 |x 9 ol o @C.3. CHEN, HD. 0.00 PRESIDENT-ELECT 0.00 |x | o| oO (@)CHUCK BEARMAN 0.00 BOARD OF DIRECTORS 0:00 |x o 9 o (CYNTHIA GORDON 0.00 BOARD OF DIRECTORS 0:00 |x ol 9 ° (S)DOZLE WARRINGTON 0.00 DIRECTOR 0:00 |x o 0 ° (@ROY WARD 0.00 cuarm 0:00 |x o 0 ° (WARREN JONES, Mi 0.00 BOARD OF DIRECTORS 0:00 |x 9 0 ° (@THOMAS E. KING, |JR 0.00 BOARD OF DIRECTORS 0:00 |x 9 d o (GUY L BOYLL IIT 0.00 BOARD OF DIRECTORS. 0.00 |x | | oO (10) JOHN PEARSON 0.00 ‘TREASURER 0:00 |x ol ol o (yLEANNE BREWER 0.00 BOARD OF DIRECTORS 0:00 |x 0 o © oe Fon 980 513Fo 9902012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 8 Patt Vil_* Section A. Officers, Directors, Trustes, Key Employees, and Highest Compensated Employees Cone] rs ° © 7 ce irate) 1 H 3 GqSHETEA BROWNING 0.00 BOARD OF DIRECTORS 0:00 |x. o 0 0 (i)CHARLIE MOZINGO 0.00 BOARD OF DIRECTORS 0:00 |x 0 o o (SUZANNA BAKER 0.00 BOARD OF DIRECTORS 0:00 |x. 0 0 o (9 JEFF CHRISTIE 0.00 BOARD OF DIRECTORS 0:00 |x. 0 0 o (i) SHERRY COOK 0.00 BOARD OF DIRECTORS 0:00 |x. ol dl o (mT MARK EARL 0.00 BOARD OF DIRECTORS 0100 |x dl o ° (WILLIAM E LAWSO} 0.00 BOARD OF DIRECTORS 0100 |x d o ° (iyDAVID MAJURE IT 0.00 BOARD OF DIRECTORS 0.00 |x | 0! 0 1b Sub-total a Total fom continuation sheets to Pat Vi Section A > 33,567] 6,713 d_Total (add lines 1b and 1c) > 83, 567] 16,713 2 Total number of maiwduals (duding but nat lated fo these Isled above) whe recowed more than $100,000 8 separable compensation from the organzaton Pe Yes] No 3 Did the oqganzaton list any former officer, ctor, or trustee, key employee, or highest compen: employee on ine 18? "Yes, complete Schedule J for such ndwidual 3 x 4 Forany ndraual sted on ine 1a, the sum of reportable compensation and other compensation from the fexganation and related organzatons greater than $150,000? "Yes," complete Scher J fr such inal 4 x 5 Did any person iste on ine 1arecewe or accrue compensation ftom any unrelated organization or nda for sennoes rendered tothe organuzaton? "Yes," complete Schedule J for such person 5 x ‘Seation B. Independent Contractors “1 Complete ts abe {or your fve highest compensated independant coniraclors thal recawed more tan $100,000 of Compensation fiom the organtation. Report compensation forthe calendar year ending wih or wit the organization's tx year ane anette tess ecru sence Gaon 2 Total numberof ndapendent conracors (cluding bul not imied to those Iisied above) who recanved mere than $100,000 of compensation fom the organzation > ° om Fon 890 255Fom 990 (2012) DIABETES FOUNDATION OF MISSISSIPPI _23-7262987 Page 8 Part Vil_* Section A Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (contaued) i @ a o oy @QDANIEL MCCALL 0.00 BOARD OF DIRECTORS 9.00 |x o| | 0 (4ROD MOORE 0.00 BOARD OF DIRECTORS 0.00 |x | | 0 (PAUL 5 MURPHY 0.00 BOARD OF DIRECTORS 0.00 |x | ol o (s)MARCIE ROBERTSON 0.00 BOARD OF DIRECTORS 0.00 |x | | o (MARY FORTUNE 50.00 Execurrve vice prest | 0.00 x 83,567 o| 16,713 a7 ay ry 1b Sub-total > 83,567] 16,713 ‘© Total from continuation sheets to Part Vil, Section A » 1d Total (add tines 1b and te) > 2 Total numberof menaduals (dking Bul Aa ated To Those Tsled above) who recawed more tan $100,000 eparable compensation fom the organzaton > ex Ne 3 De the organzaton ht any former officer, drector. oF rusts, key employee, or highest compensated ‘employee on ine 12? If-Yes," complete Schedule J for such wndwidual 3 4 For any moivdual sted on ine ta, she sum of reportable compensation and other compensaon from the ‘organization and related organizations greater than $150,000? "Yes," complete Schedule J fr such| ‘ndvdual 4 5 _Dedany person iste on ne 1a receive or accrue compensation from any unrelated organization or ndual for senvces rendered tothe organizaon? If-Yes,- complete Schedule J for such person 5 ‘Section B. Independent Contractors “1 Complete this able for your five highest compensated ndependent contracore thal received more than $100,000 of ‘compensation liom the organzation Report compensation fr tha calendar year ending vth or win the organzalion's tax year ane has sss egal ss comfatcn 2 Total number of dependent sonvaciors (eluding bul nol hmied to these Tsled above) who received more tian $100,000 of compensation fom the organzahon om Fam 990 a017Fon $90 (012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 9 Part Vill Statement of Revenue Check f Schedule O contams a response to any question in this Part Vil 2 ‘otto raliooee nied ete Federated compara 2 033] Membership ves te 2,550] Fundraing events te 509,057] Relates organzatons 14 oonmengrstonsoss) — te aoe encore 9.90 aeomarmmwerrecemaon [af 260,019] So tocanamucninacinn et 5 15, 960| 3] rota Add ines tani > 784,518] B| 2 necromation rons 300094 ___11, 289 111,289] 2| > sass of worenais 4512111 276 279] 3| 4 s| ° § B| 1 Atcier program serace verve E |g Tota Aas nes 20-21 . ia, 567] 3 Investment come (nding Gwends vers and other sir arouis) > 34,190 34,190 4 ncame fom investment of txcexempt bond proceeds. 5 Royates, > a cree 69 Gross rents us tort tae ete Net renal nome o 8a > 7a Gosmenttea[ psec ma bb crore tase © Ganor oss) 4 Net gan oF oss) > «| 82 Gras ncone fom teary eens 2) ~ acusog s 509,057 é « coninbuons reported on ine t). 2] seePanv,ina 8 | 301, 942] | > Less rect menses »| 301, 942| € Nelincome or (oss) Kom fndrasing vents > 82 Gres mane tom gang aces See Pan ne 1 | 1 Less drect expenses 5 € Nelicame or oss) tom gaming achvbes > 40a Geos sles of inventory, ess ters ad atowances | Leas cos of goods std ol ¢_ Nel came or oss) fom sales of vena > Tia ° 4 Aomer everve Total. Add ines N0-116 > 42_ Total revenue, See nsinuctons > 330,273] 145,757] a] 3 Fon 98030Foun 990 (2012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 10 Part IX Statement of Functional Expenses ‘Secon 501(63) and 501(¢\4)organtzatons must complete allclumns Allother organizations mus! comple column (A) ‘Check f Schedule O cantans a response 1 ary question i ths Part IX 'Do not include amounts reported on lines 6b, vo en oes = ne Tb, Bh, 95, and 106 of Part Vil. “come sewn on 4 Grant and ther assistance to goverment ard cevancatens ithe U'S Seo Pat WV, ne 21 2. Grants and other assistance to indian the US See PantV, tne 22 ‘3 Granis and the assistance to governments, erganzatons, ond indus outside tne US See Part V, nes 15 and 16 4 Benefits pa oor for members 5 Compensation of curent offers, directors, trustees, and key employees {6 Compensston rot nuded toe o dsqueied persons (as detinod ude section 4851) a petsonsdesenbed nsecten 4958(118) 7. Other salanes and wages 294, 980| 205,859) 33,030 5 {8 Pension pla cca and contbutons (acute secton 401) and 4030) employer conten) 46,942, 34,268) 5,633) 9 Other employee benefits 29,108] 21,249] 3,493) 10 Payot taxes 26,675] 19/473] 3,201 11. Fees for servces (nonemployees) Management Lega! ‘Accounting i9,415| 17,862 a2 O72 Loving Professonaundasing Sevens. Se8 Pat W, ne 1? a Investment management fees Cie ig au ete 5 25. (anoint tn i espera on Ses 0) 12 Advertsing and promaton 13 Offce expenses 10, 801 3,937 ‘324 540 14 tofrmation technology 18 Royaties 46 Occupancy 47,338 43,551 1,420] 2,367 47 Travel 18 Payments of tavel or entetanment expenses. {or any federal, state, or ocal pubic offaals, 49 Conferences, conventions, and meetings 67,939] 67,939) 20. interest 21. Payments oafates 22 Deprecaben, depletion, and amortzaton 753] 692 23] 38 23 Insurance 24 Other expenses lame expenses not covered shove (st mscelareos expenses nine 240 ine 2e aunt exceeds 10% of ne 25, colra (A) amount tine 240 expenses on ScheuleO) PUBLIC EDUCATION EXPENSES 221, 161 221, 161 PATIENT SUPPLIES 25,747] 25, 747| ‘TELEPHONE 4,255| 3,914 128 213 BANK CHARGES 2,805] 2, 582| 83] 140 Alloher expenses 2,174] 2,173 ea uncon expenses Aides | oh He ‘B00 , 090) 676, 405| 47, 917] 75, 768 ‘oit cost. Compl is ine ci the ‘erganzabonveparted coun 8) art casts {roma camboededueaorlconpagn and ‘unéresngsootabon Checks |] {otowng SOP 88 2(ASC 98-720) = Fon S80 ost 41 366 002 Jalal [alfom 990 20%) _ DIABETES FOUNDATION OF MISSISSIPPI _23-7262987 : Page 14 PartX Balance She Checks Schedule conten a response lo any quesbon nbs Pat X a e Begins of year Endotyear 1 Caeh—nonseterestBeanng 960, 435] 1 1,043,170 2. Savngs and temporary cash vestments 593,967] 2 598,779 2 Pledges and grants recenable, not 3 44 Accounts ecenabe r 5 Loans and oherecevables fom curen and fomer offers, decors, trustees, hey employes, ana hghest compensated employees Compete Pal of Schedule L 5 6 Loans and cher recewabies tom other equaled person (a defined under secon 4958(0(1), persons desorbed n secon 495638), and contrautng employers and sponsoring organzations of secon 501(0(8) vointary enpoyees beneinary 2 | cxganzatons (68 matctons) Complete Par I of Schedule L « 3 | 7 Notes and loans recawable, net 7 | 5 tnvemtones for ste or use 985) 985 rapa expenses and dered charges 3 ‘0a Lene, buldings, and equ ment ost or cher basis Complete Pat Vi of Schedule D 40 97,271 1b Less accumulated deprecsabon 40b 95,055] 2,998} 106 2,216 “1 tnvestments—pubsoy traded secuntes 702,070) 11 794,028 Investments—cthe secuntes. See Pan, ne 11 12 Investments—program related See Pat, hoe 11 13 Intangible aeets 14 (tne assets, See Part V, ne 1 15 “Total assets. Add fs 1 through 15 (rust equa ine 34 2,260, 455| 16| 2,439,178 ‘Accounts payable and accrued expenses 18,562 17 8,080 Grants payable 18 Deferred everue 28, 500) 19 21,547 Taxexem bond kabities 20 Escrow or eustodal account abity Complete Part V of Schedule O 21 Loans and oer payebesoczrent ana former oflces,drectors, trustees, key employees, highest compensated employees, and ésquatid persons. Complete Pat I of Schedule L 2 Secured mortgages and noes payable tourette urd partes 23 LUnsecied nots and loans payable to urelted thd pares 24 (ner kabities Gncludng federal income tax, payables to elated hed pares, ard other habiiesnotncuded on ines 17-24) Complete Part X ot Scnedie D 2s 26 Total liabilities. Add ines 17 trough 25 TT, 062 26 25, 627 ‘Organizations that follow SFAS 117 (ASC 858), check here> [and | complete tines 27 through 29, and tines 23 and 34 Bl ar Unesinced net assets 2,213,393] | 2,409,551 B28. Temporariyrestcted net assets 28 329. Permanent restncted net assets 29 2] Organizations that do not follow SFAS 117 (ASC 958), check here ® [and 3 | complete ines 20 through 34 $30 Capital stock or trust pnncipal, or current funds 30 B31 Padun or capita surplus, o and, building, or equipment fund 3 5B] 52 Rotaned earnngs, endowment accumulated income or other funds 32 33. Total net assets ound balances 2,213, 393| a3| 2,409,551 24 Toll hbites and nel assetaund balances 2,260, 455| «| 2,439,178 rom 990 aor,Foi 9902012) DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 12 Part Xl Reconciliation of Net Assets Check i Schedule O contains a response to any question this Part X1 Teal revenue (must aqul Part Vl colin (A), koe 2) Total expenses (must equal Pat X, column (A, be 25) Revenue ss expenses Subtact ine 2 om ie Net assets or und balances at begnng of year (must equal Pat X, tne 39, column (A) Netunaizes gans (sees) on investments Donated sernces and use of facies Investment expenses Por pend adjustments Ctra changes in nel assets orf balances (expla n Schedule O) Net assets or fund balances at end of year Combe ines 3 hough 9 (must equat Part, Ene 39, column () wo] 2,409,552 Part Xil_ Financial Statements and Reporting ‘Check if Schedule © contains a response to any question in this Part XiL O Yes] Wo 930 ‘800 130, S| 4 Accounting methed used io prepare the Farm 990 [-] Cash BR) Acoust] onner ire organization changed fs method of accounting Kom 9 poe year or checked “Oe, exolan Scheid O 2a Were the organaators franca statements compted or revewed by an iependent sezounant? al |x 11Yes, check 3 box betow ondcate whether the Manca statements forthe year were comple or temewad ona separate bass, conskdated bat, o both (TT Seperate bess (-] Consoldated bass [_| Bat consohdted and separate bess Wier he oganiatin’ inancal statements audtedby an dependent accountant? |x 11-¥ee; checkbox below io meicate whether the fancal statements forthe year were ated on separate bens, consokdated bans, or bath (3 separate tess [-] Consoidated base [| Bot consohdated and separate bass € "Yes" tone 28 oF 2, does he organization have acommitee thal assumes responsi or oversight ‘ofthe aud, evew, or camaton of te franca slalements and slachon of en independent accountant? 2e| X ite organzaton changed exerts overoght proces o selection process dung the tx year, expan n Schedule O 20. Aaa rat of a federal ard, was the orpanatonrequed {o undergo an au or aud et fon ‘he Sngle Aut Act and ONS Crear A199? PS b tt-¥es" dd te ormanzabon undergo the requred autor aus? Ihe organzaton dt ol undergo the ced a rads, expan why n Schade O and describe any ses aken to undergo such audits 2» rom 990 1)SCHEDULE A {Ferm 90 or 8042) Public Charity Status and Public Support © | one nese Complete ifthe organization sa section S01(c) organlzation ora section 2012 12047(a)(1) nonexempt chartable trust. Depa Ta Open to Public Depemer enone Attach to Form 990 or Form 990-62. > See separate instructions, eenetace an tte ogttaton Taye nea mmr DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Part! Reason for Public Charity Status (All organizations must complete this part ) See instructions ‘The erganzatons no private foundetion because ts: (For ines 1 through 11, check anly one box ) [] Achurch, convention of churches, or assocaton of churches described in section 170(b)(1/AN. 27] scoot deserted n section 470(0(1)ANG). (Mach Schedule E) 3] Anospta or a cooperative hasptal serveeorganzatondesenbedin ection 17O(B\ NANI). 4 C] Aimceseochugucn pts const ett dered m esten 700}SHAN Ene orp an, cy, and state 5 [[] Amorganzaton operated forthe benef of 3 cotege or unversty owned or operated by a governmental unt deserved a section 170(K AN. (Compete Pati) 6 [] Atederal state, orca goverment or governmental unt descnbed in section 170( KAN) 7 BR] an cxganuaton mat nomalyrecenes a substantial pat of suppor rm 9 governmental unt or rom he genera uble deserted m section 17(0)1HAN%). (Complete Par I) 8 [] Acommunty st desensedm section 170(0K")). (Complete Part) ©) Anoxgenzaton at narmalyrecewes (1) more than 33 19% of support om contnuns, memberspfes, and goes ‘recep rom aces clatad tots exer functions —aubyect o carta exceptions, and (2) no more than 33 1% of Support om gross mvesment come and uvelated business taxable income (es secon 511 ax) Kom busesses acqured bythe rganzation afer Jue 20, 175 See section 5092). (Complete Pant!) 10 [] Amorgenzaton ogenzed and operated excusnely to tat for publ safely See section SOO(a4) 11 [[) Anorganization organized and operated exclusively for the benefit of, to perform the functions of, oo cary out the purpotes fone of more pubic supported organizations deserted m section 609(a() or secon SOQ(a)2) See section 500(a)(), Check ne box that deseres the type cf supporing erganzaton and complet nes fe hugh 9h a Eltperb [] type L) Type i Functonay megrated 4 [_) Type ti-Nonfunctonaly tegrated © [1 bynes box, cry thal he organation# nt controled deecly or indrecly by one or mare daquaed persons cer tan foundabon manspers and cher han one or moe pubic supported erancatons descnbedn secon SOM} secon 5053)2) 1 time organization recewed a witen determination fom the IRS Mas 9 Type, Type, or Type Ml supporting cxgenzabon, check ns ox a Soe August 17, 2006, has the orgnzaton acoeped any gf or connbuton fom any of the folowing persons? (). Aperson vino drecby or ndecly conte, ether alone or together wih persons dsenbed (hand (a) below, te govering ody of he suppeted organzaten? (i) famiy member ofa person described n () above? (uy 35% contotedentiy of person deserved i () or) above? hs bb __Provde the folowng information abou he supported oraanaabon(s) Oe ot nest en Wr yecagnenen ] peneagmeam | wosnoh |_ wane | owsmamaraowny oom (momecanmerts | ea Qiccinyor | Peeps aspanon oat ee Sowrme secon | gowenrnesamee | ter | onan ‘(908 Instructions) a a x sae > Us? a @ o o © Tota For Paperwork Reduction Act Notice, see the Instructions for ‘Schedule A (Form 990 oF 990-2) 2012 Form 990 oF 990-2.Schiedue A Foxm 990 or 990-62) 2012 23-7262987 DIABETES FOUNDATION OF MISSISSIPPI Page 2 Part ll Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)vi) (Complete only if you checked the box on line 5, 7, or 8 of Part | or if the organization failed to qualify under Part lil f the organization fails to qualify under the tests listed below, please complete Part Il) Section A. Public Support ‘Galendar yar (or fiscal year beginning in) > way2008 2008 (2010 (201 (ez ‘Teal 1. Gis, grants, contnbutons, and rmemioersmip fees recawod (Do not tnetude any “unusual grants") 106, 525 seal 909,090] 10,7431 774,934 2 Taxrevenues lewed forthe organization's benef and ether pad To or expended on ts behalf 3 The vale of servces or facibes furmshed by a governmental unt to the ‘xganaton wthout charge 4 Total Ada tines 1 through 3 706,525 seal 309,098] 310,743) 774,936] 4,086,786 5 The parton of total contnbutons by leach person (ober than 2 ‘overnmental unit or publicly Supported organtatn) cued on Ine {that exceeds 2% ofthe amount shown on ine 11, cura () 345,624 5 _Pubile support. Subtract ne om ned 3,240,922 Section B. Total Support ‘Galendar year (or fiscal year beginning in) > 12)2008 (2008. (2010 (2018 (202 ‘rear 7 Amounts fom moe 4 706,525] 804,64 909 859) 910,743] 774,936] 4,096,746 8 Gross ncome from interest, dondends, payments recewed on secuntes loans, Fonts, oyalbes and wicome Kom sma sowses 32,23] 60, 860 107, 63 39,593 100,162| e303 9 Netincome fom unrelated business ‘cts, whether or not the business 's regulary camed on 40 otherincome Do not elude gain oF loss kom the sale of capa ascets Grplanin Pat) 11 Total support. Add ines 7 through 10 42 Gross recep rom related actus, etc (soe nstructens) 2 413. Firstfive years. ifthe Form 900 or he organization's first, second, thr, fourth, or fith tax year as a secon SOCKS) cxganzation, check us box and stop here Section C. Computation of Public Support Percentage 14 Pubic suppor percentage for 2012 (ine 6, column () dived by ine 1, column (D) 4 a4. 0% 415 Public suppor percentage from 2011 Schedule A, Par I, ne 14 15 96.17% 46a 33119% support test—-2012. the organization de nt check the Box on ine 13, and ine 14 ¢ 33 19% or mare, check ts box and stop here. The organzation qualifies asa publy supported organzation > x bb 33.419% support test—2011. Ihe organcaton didnot check a box on ine 13 oF 168, and ne 15 839 19% or more, — check ts box and stop here. Te organzaton qualifies as a publicly supported organzation >oO 17a 10%facts-and.circumstances test—2012. Ifthe orgarrzaton thd not check a box on ine 13,163, or 18b, and tne 1416 10% or more, and the ecanizaton meets the “ocs-and-crcumstances" tes, check vs box and stop here. Explain in Part IV how the erganzation meets the “acts-and.crcumstances" test The organization qualifies as @ publicly supported coxganaation >o b 10%iacts-and-circumstances test—2041. fhe organization dis not check a box on ne 13,169, 16b, oF 17a, and ine 151s 10% or more, and fhe organization meets the “lacts-and-crcumstances” test, check this box and stop here. Explain n Part V how the organzaton meets the acte-and-orcumstances" test The organization quoi as a publoy supported organzation 418 Private foundation. Ifthe organization dh not check a box on ine 13, 162,160, 17a, oF 17b, check this box and see ‘Schedule A (Form 890 or 890-€2) 2012seve Aim st0 99062) 2012 DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 rae Part Il Support Schodule for Organizations Described in Section 609(a)(2) {Complete ony you checked tne box on ine 8 of Part | or the organization faed to quality under Part I ifthe organization fais to qualy under the test sted below, please compete Prt) Secon A Public Support Se ps realy begining) > — [To 5500 | — 3569 —| eps —] ano eT + Git gan, cowiaans endmenteshe Sees obese oon 2 Semmens rte Sioa etapa ae Eee Bt toe Sener 3. Gross ecops rom aches that ar not an vated Wade or buses under secten 813 4 Tax revenues ened for he organzaton's benefit and ether pat to-or expended on ts behalf 5 Thevatve of seruices or facies fumshed by a governmental unt to the organzaton witout charge 6 Total. Add ines 1 through § 7a Amounts ncuded on tines 1,2, and 3 recevod rom dequaiies persone 1b Amounts ncudedcn tines 2 and recaved tom ober tan dsqualied Persons hat exon tho greater of $5,000 {oF % lB amount on he 13 fre yaar © Addines 7a and 70 8 Public support (Subtract ine 7 rom line 6) Section B, Total Support Caondar year (or fiscal year begining in) > 22008, 2008, (e200 jz e201 Teal ‘9 Amounts fom ine 6 10a Grsssncome om terest, dents, payments ecawodcnsecuties ars, rents, rojas and name om sar sources Unrelated business taxable income (ess section 511 taxes) fom businesses. ‘cqured ater June 30, 1975 © Add ines 103 and 100 11 Netncame tom uel business ches not neue ine 10, wheter (natin busness guar camed on 42, Ofherincame. Do not include gain of tose from the sal of capital asseta Gounnten) 13, Tota suppor. (Ads hes 9, 08.11, ad 12) 14 Firattve years. lhe Form 00:8 for he organzabo's Wr cand rd uth of your aw secionSOTEND) rgerzaon, check ts box ad stop hore Sa] Section C. Computation of Public Support Percentage: 15 Publ suport percentage or 2042 (ine 8 cab (exe by ine 3, canny ra = 16 Publ suport prconiage om 2011 Sched A, Pat Ine 15 i % Section D. Computation of Investment Income Percentage 17 Investment come percentage for 2012 (ne 1, cla () ded by ine 13, cla Op @ = 18 Investment come percentage fom 2011 Sched , Pa Ii, ne 17 8 % 180 33 179% support teats—2012 Ihe orgenzaton dda check he Box on ine 14, nd ine 18s ore han 39-19%, ant ne 17 isnot more han 99 12%, check hs box and stop hee. The organization qsifies a a pbc supported pansion yo ») 35:19% suppor tests—20"t. the organza di ot cack a Box one 14 or ine 18a, and ne 16s move than 33 13% on ‘ine 181 nt more than 38%, check ths box and stop here. The eranizabon ques a «pub sonpored osenzaton rp 20 _ Private foundation the rganzaton dd no check ox on ine 14, 18a, or 1h, check ts box and se0 mstucions Tj ‘Schedule A (Form 990 or $90-£2) 201‘Schedule A Form 990 or 990-62) 2012__ DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Page 4 PartIV Supplemental Information. Complete this part to provide the explanations required by Part Il, line 10, Part Il, ine 17a or 17b; and Part Ii, ine 12 Also complete this part for any additional information (See instructions) oa ‘Schedule A (Form 990 oF 990-62) 2042SCHEDULE D Supplemental Financial Statements Louse 180067 (Form 990) > Complete ifthe organization answered “Yes,” to Form 990, 2012 meinen tes tas by ties t¥d, tt, 14, Tarr 2b. | —opente pubis Pesaran ‘Satan te Form 900; Soe sopra nstutons. inegecton tone onan ose rato mer DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Part! Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts, Complete # the ‘organization answered "Yes to Form 990, Part IV, line 6. “oll umber at nd of year ‘Aggregate contnbwons to (ung yen ‘Aagrepate grais rom (duong yea) ‘Aggregate value at end of year Othe organization frm a donor and donor adwsors wring thal the asses held w door edeed {unde are te organzaton's propery, subject ote organization's excsve legal con? [vee (J no 6 Ome organization for a grantees, donors, and done advaors i wing tat gran funds canbe used only or harable purposes and not forthe bene of he donor a donor adoro fr any oer pupose conferring mmpermssible prvate benefit? [1 ves [71 we Part ll Conservation Easements, Complete i the organzaton answered "Yes" fo Form 990, Pant IV, ine 7 1 Puspose() of conservabon easements hed bythe opanzaton (check al ha pp) Preservaen of fnd for pub use (e , rereaton or edveaton) Preservaton ofan hstoncaly mpertant and area Protechon of natal at Preservaton of cred stone svete Preservation of open space 2 Complete ines 2a rough 2 ne organaaton hela a quated conservation cotrbuon nthe fom of conservation tsscment on heat Gayo he tx year ida the End ofthe Tax Year 2 Tota numberof conservation easements = Tal acreage resnced by conservation easements 20 Number of coneervaton easements on acerifed histone sructre cluded (3) 26 {Number of conservation easements nuded i (e) aequred afer 81776, and nt on Instone truce sted fhe Natonal Register 24 3 Number of conervaton easements modied, ranlemed, elessed, exingushed, or erminsed bythe orpanaaton dung the taxyear 44 Nebr of tates where property sutyect to conservation easement located > 5 Does the organaton havea wntlen poy garg the ped mononng, nspecon, handing of volstone, and enforcarent ofthe conservaion easements hots? (vee 1) wo 6 Stand vouter hours devoted io montorig, nepectng, and enoreng enservaon easements ding Ihe year > 7 Amount of expenses ncured in montonng, nspecing, and enforang conervaton easements dung he year rs 8 Does each conservaton easement reported on ine (8) above sats the requirements of secon 170448) (@ and secton170¢ 40)? Cl vee 1) ne ‘9 In Part Xl, desende how the xganczaon reports conservation easements in ls revenve and expense statement, and balance sheet, and mclude, applicable, the ext ofthe footnote fo the organization's financial statements that dacenbes the cexganzaton's accountng for conservation easements Partili Organizations Maintaining Collections of Art, Historical Treasures, or Other Simi Complete if the organization answered "Yes" to Form 990, Part IV, line 8, 42 the ocganzatonelecod, a3 permatied under SFAS 116 (ASC 958), nt to report ns revenue satement and balance sheet works of at stoncal easures, or aher smilar assets held for pubke extsbtion, education, or research in furtherance of public sence, prow, Par Xil the text of he focinote to is fnancial statements that describes these lems tthe ocganzaton elected, a8 permed under SFAS 116 (ASC. 958), to reports revenue statement and balance sheet works ofa hstoncal treasures, or olher sumilar assets held for publ exhibition, education, or research in furtherance of public sence, prove the folowng amounts relaing to these tems (Revenues included in Ferm 990, Part Vil, koe 1 ms (i) Assets metuded m Form 990, Part X ms 2. fthe organization received or hed works of at, hstoncal treasure, or other similar assets for fnancal gan, provide the fotiowng amounts requred o be reported under SFAS 116 (ASC 958) relatng to these ems r Assats, {8 Revenues included m Form 990, Pat Vl ne 1 ms b_Assets cluded mn Form 990, Part X ps For Paperwork Reduction Act Notice, soo the Instructions Yor Form 880. ‘Schedule D Form 990) 2078‘Schédule D (Form 990) 2012 DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 _" Page 2 Part lll Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) 3 Uang he oganzator'sacqustion accession, and oer recré,eheck any of he folwng tal area gical ue of ts {eeton temo (tock al ht SPB 2 [[] Pubic exon 4 Loan or exchange programs [7] sero ceseren @ Loner ¢ [] Preservation for ttre generations 4 Promde e desenpion of te organzaton’s calesions end explan how hey further he orenastons exempt purpose in Part xi 8 Dung the yard te pension set or eceve donations of a, Nloncl treasures, o oer sender asses lobe aol 1 se nds athe han o be maylaned as pat ol he organators colecbon? Tyee [1 no Part lV Escrow and Custodial Arrangements. Complete if the organization answered "Ves" to Form 990, Part IV, line 9, or teported an amount on Form 990, Part X, line 21 7a ee esganzaton an agen, ules custodian or cher mlemedary for connbuions or oer asses not ‘cued on Form 880, PaX? Dives 1 ne b 11*¥es" explain ne arangement Part Xi and complete the folowing table meant « epinang bance 7 4 Adidas dr he yes 18 © Dstrevons dunn he yer te 1 ending balance “ 2a Dare xgancatn dean amu on Fa 90, Pa Xe 217 Live [ye b_-Yea” expla he aargemen\ in Pa Xl. Check here he exlanaion hasbeen rowed Pat Xt PartV Endowment Funds. Compete if the organization answered "Yes" fo Form 950, Pan lV, ne 70 wep a ene epee eee rere 42 Begining of year balance 'b Contnbutions © Netinwestment eamnngs, ans, and losses Grants or scholarships © Other expenditures for facies and programs Administrative expenses 9 End of year balance 2 Prone the estimated percentage ofthe curren yearend balan (ne 19, column (a) held ae {8 Board designated or quast-endowment > % 'b Permanent endowment * {© Temporanlyresincted endowment * ‘The percentages in ines 23,2, and 2c should equal 100% 3 Are there endowment funds not the possession of the organization that are held and scemnsterad forthe ‘oxganaation by yes | wo (unrelated oeganzatons, sat (i) related organzatons saci 'b if-¥es" to dat), are the related organzations listed as requred on Schedule R? ab 4 _Desenbe m Part Xillthe nlended uses ofthe organtzaton's endowment funds Part Vi___Land, Buildings, and Equipment. See Form 990, Part X, ine 10. Descent ney (a) cota ae (2) Cat oot oe ereamases oom Ya Land Buldings Leasehold mprovements Equpment 97,271 95, 055) 2,216 2 Other ‘Total. Aad ines Ta twough Te (Calura (@) must equal Farm 090, Par X_ column (B) ine TO{S)) > 2,216 ‘Schedule O (Form 990) 2012Senéaue 0 am 990)2012_DIABETES FOUNDATION OF MISSISSIPPI _23-7262987 _"__pago3 Part Vil_~ Investments—Other Securities. See Form 990, Part X, ne 12 terns ey ito Toe ace GH Franca donvawwes (2) Closey-ld equty interests (9) Otmer “ ® © © © © © o 0 ‘otal. (Cournn (b) must equal Form 880, Pan X, col @) ine 12) > Part Vill__Investments—Program Related. See Form 990, Pan X, ine 15 To anos atan m 8) @ 40) “Total (Gatun (B) must equal Form 990, Pan X, eat (B) ine 13 PartIX__ Other Assets. See Form 990, Part x, fine 15 > @ z or 5) 6) 2) @ ‘) 0 “Tota. (Cohn (B) must equal Form 980, Pad X, eat (B) ine 15 PartX Other Liabilities. See Form 990, Part X, ine 25 Z (0) Deeg etsy [Federal ncome taxes a0) ay ‘otal. (Couran (6) must equal Form 990, Pan X, cal (@) ine 25 > 2. FIN 48 (ASC 740) Footnote In Pant Xl, prove the text of the Tovinte lo the organsaton’s franca staements thal report the organcatows sabity for uncatan tax posdions under FIN 48 (ASC 740)_Check here the text of he footnote has been proved in Pat XI ow ‘Schedule D (Form 990) 2012seieaio0Gum9o 20% DIABETES FOUNDATION OF MISSISSIPPI__23-7262987 age Part X!_ Reconciliation of Revenue per Audited Financial Statements With Revenue por Return 1 Tolalivnus gored ce! supper pe! adie earl stmerls i 996,248 2 Amour eden et utet on Far 80, Por ine 12 > Nel umesan gra on eters 2 65,973 © ond verves and wn ces Fa € ecorenes lor yr gt = 4 ner Dercben Pa i) 2 Add ines 2a trough 38 2s 65,973 2 neti 2e tom ne 4 . 930,275 4 Amaia ete on Fer 60, Pan Vt 12 bt ao ne ‘s Inesmeexencesel lve on Fom 80 Pot ne To = > Omer Ocoee) a @ fines a nd ab : Tell vvene Aa ines 3rd. (Ths must equal Form 980, Pa tn 12) : 330,275 Part XI. Reconciliation of Expenses por Audited Financial Statements With Expenses per Return Total expenses andlsees pe sued hance satenets 1 798,337 2. nent mcd ne! bt aon Frm 60, Pa, ie 25 + Oonued tren an nef cues aa > Proryearotnets. 2 © Otter nes rs 4 omer (Omsrbew Pant x) 2 Addins Ze trough 28 ms 3 Suneetine 2e rom ine A 755,337 4 mous ned on Far 90, Pat Xn 25, bt nt on ne ‘> Imosmet expenses net neue on Far 000, Patil ne Tb “a & er (ecco Pan) a BES] © Addins fa ana tb tc 753 1 Tetalemetes Al es 3 dA, (Ths us eg Farm 80, Pa tn 8) . 300,080 Part Xl Supplomental information envi ej anes deacon eured or PONT Ins. 5 wd, Po Wes To anda, BoAW. es and Pan, nwt PotX tne 2 Par Xi tes 24 ot, and Pa hes 2 ana sb Ao compt th ats poe ay atonal ‘maton PART XI, LINE 48 - REVENUE AMOUNTS INCLUDED ON RETURN - OTHER NET UNREALIZED GAINS ON INVESTMENTS $ oO PART XII, LINE 48 - EXPENSE AMOUNTS INCLUDED ON RETURN - OTHER BOOK / TAX DEPRECIATION DIFFERENCE $ 753 ‘Schedule D (Form 990) 2012sclaqde 0(Gum se 20%2 DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 ees Part XIN Supplemental information (contrived) ‘Shed O (Form 990) 2012SCHEDULE G ‘Supplemental Information Regarding “1 cw i ses0007 (Form 980 or $90-£2) Fundraising or Gaming Activitie 2012 Tisch totam Selerformiants bs epaelescion: =n aaeeet ance DIABETES FOUNDATION OF MISSISSIPPI 2377262987 Fundraising Activities. Complete if the organization answered "Yes" to Form 980, Part IV, line 17. Form 990-E2 filers are not required to complete this part 7_nicate whether the organization razed funds through any ofthe flowing actives Check al that apply Part | J ma sotetatons ¢ C1 soiictaton of non-government grants 1b [] tnteret and email sobotatons + CZ Sotictaton of government grants © L Phone sotetations 2 C) Specia undraising events 4 [] person sotctatons 28 Did the ocanzation have a wnten or oral agreement wath any mdivdual(neluding oficers, directors, ustees g Yes ‘or key employees listed in Form 990, Part Vil) or entity n connection with professional fundraising services? O wo 'b If-¥es, hat he fen highest paid indnnduals or entites (undraeere) pursuant to agreements undet which the fundrleer 6 Be compensated at least $5,000 by fhe organzaton Ria a ee (ynaneanecetat tae | cesrecnote ‘ereores ‘cranes Barats nrcomy | rwter | tamacny indacer coro Yes] No 1 2 3 4 5 6 7 8 9 10 Totar > ‘3 Lata sates m which the organization registered or Keeneed 10 sobol corinbuions or has been noted te exemp rom regsivaton or heensing The Instructions for Form 990 or S90-EZ, ‘Schedule G Form 990 oF S90-EZ) 2072SchiaduloG (Form 990 or 9902) 2012_ DIABETES FOUNDATION OF MISSISSIPPI__23-7262987__Page2 Parti Fundraising Events. Complete if the organization answered Yes" to Form 990, Part IV, line 18, or reported ‘more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b List events with gross receipts greater than $5,000 wees! ee (cone wens paccuus pau | 6 enon 3 1 Gross recent 341,839) 241,116 228,044 810,999 2 Less Contnbutons 209,596) 133, 073| 166, 390| 509,057 =e 132,243 108, o4s| e1,654| 301,942 4 Cash prizes 5 Noncash pnzes | © Renvtaciy costs 10, 000) 6,750 16,750 BY rent antoevragee 15,500 32, 000) 16,250 63,750 By «eect 10, 000] 10,000 8 Other direct expenses ; 116,743 56,045] 38, 654] 221,442 410 Dect expense summary Ad ines 4 trough 9. column (8) > 301, 94: 414 Netincome summary Combe ine 3 columa (3), and ine 10 > Partill Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a. wm a woe | Sunmnatn Revenue 4 Gross revenue. 2 Cash przes 3 Noncash prizes 4. Rentfacity coste Diect Expenses 5 on doc expenses T] vee “THE “He * © Vounter bor No No Ne 7 Direct expense summary Add ines 2 through $m column (8) > 8. Net gammng income summary Combine ine 1 column d and ine 7 >» 9 Enter the state(s) m which the organization operates gaming actus 2 lathe organation lcensed to operate gaming aciwtes 9 each ofthese states? I ves No b IPN, expan ‘10a Wire any ofthe ganzaton's gaming icenses revoked, suspended or teunated dung the tax year? (vee C7 wo IC-Yes, explain a ‘Schedule G (Form 990 or 8902) 2072‘Schdte G (Form 990 oF 990-£2) 2012 DIABETES FOUNDATION OF MISSISSIPPI 23-7262987" __Page3 " 2 2 » “ 6 Does the rganzaton opera gang aves wih nonmembers? Lives LJ Ne ls the oranzaon a gramir benefoary or uses ofa trust oa member of partnership ocher erty sermed to drt chaabe gang? Indeate he percentage of amg activity operated in “he erganaatr' octty 120 % an ouside tacity 130 %. Enter the name and adress ofthe person wh prepares the organization's gamngtpecal evens books and tecondn name > dares Coes ne erganaton have a contac with a party om whom the rganzaton caves gaming revenue? C1 ves Ono {es enter amount of gaming revenue receved by he erganaaton ® —§ aed ne amount ot garngrevemse eared byte turd pary 8 ies enter ame and adres of te pty ame > ress > erg manager fermabon ame > Gaming manager compensavon Desenpion of services provided 1) ovectovticer CO emooyee Ly ndopendentconractor Mandatory dstibutons tebe organza equred under sae law o make charable sinbutons fom the gaming prooteds to retain the state gaming hoense? 1 ves [] no Enter the amount of dsinbutions requred understate lao be dstnbuted to other exempt organzatons oF spent.n the organization's own exempt actuites dunng the tax year __$ PartIV Supplemental Information. Complete this part {6 provide the explanations required by Part, ine 2b, columns (ii) and (v), and Part Ill, ines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable Also complete this part to provide any additional information (see instructions) ‘Schedule G Form 990 oF 890-62) 2012fered Noneash Contributions a Form 990) : d > complet ine opntons saute Yeon Fm 2012 8, Pat tne 39 938 ‘Open To Pubiie ‘ener sone acnte Fm 0 Inspection DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 Part! “Types of Property © ° sen rote a) 4 At Works of art 2 At-Hitoneal teasures 3 An—Fractonal merests 44 Books and publeatins 5 Clotwng and househols 008s 6 Cars and other veces xa 15,960] NADA. 7. Boats and panes {8 Intetectual property 9 Secunties—Pubey vaded 10. Secuntes—Ciosey hel stock 44 Secunves—Parinershp, LC, orvustmerests 12 Secunves—Miscetaneous 413. Qualifed conservation contabston Histone structures 14 Quatfed conservation contnston Other 15 Real estate—Residentat 18 Real estate—Commeraal 47 Realestate—Other 18 Cotectbies 19. Food mvenion 20. Drugs and mesial suppies x [ar 24,582| DONOR COST 24 Taxidermy 22 Historical artifacts 23° Scenic specmens 24 Archeslogea! afacts 25. One b( SUPPLIES eas 181,158] RETAIL VALUE 28 Oner®( EDUCATIONAL Mar)[_X_| 2 2,400] DONOR COST 27 Ober ®( ) 28 _Oher( d 23 Number of Forms 6283 recewed by the argarzaion dung te tax year for connbuitons for wien the orgentaion completed Form 8283, Pat IV, Donee Acknowledgement 2 Yes [No ‘30a Dung the year. ithe organzation recewe by coninbuton any property reported Part |, nes 1-28 that :tmmust hold for atleast three years rom the date ofthe ital contnbuton, and which nt requred to be sed for exempt purposes forthe entire hoking pond? 308 x 1b 1f"¥e8" desenbe the arrangement in Part I 31 Does the organzaton have a oft acceptance poly that requres he review of any nonstandard contributions? 4 x 32a Does the erganzatin hire or use Bird partes or related organtzabons io sol, process, oF sel noncash contributions? 32a x 1b i-Yes" desenbe m Partit {33 Ifthe ergancaton dd not report an amount m column (cor a typeof property fr which column (a) 6 checked, deserbe Partisosiueu yor smcory _ DIABETES FOUNDATION OF MISSISSIPPI__23-7262987 : rage 2 Parti Supplemental Information. Complete this part to provide the information required by Part, ines 30b, 325, “and 33, and whether the organization is reporting in Part |, column (b), the number of contributions, the umber of items received, or a combination of both_Also complete this part for any additional information ‘sehen Form 98) 20)‘SCHEDULE O ‘Supplemental Information to Form 990 or 990-EZ [oe eset — (Form 999 or 990-62) Complete to provide information for responses to specific questions on 2012 sett remy orm 980 or 990-62 orto provide ary additional information Sareea ‘Bona Revene seven > Attach to Form 990 or 990-E2. Inepection DIABETES FOUNDATION OF MISSISSIPPI 2371262987 FORM 990, PART VI, LINE 11B - ORGANIZATION'S PROCESS TO REVIEW FORM 990 ‘A COPY OF THE FORM 990 IS AVAILABLE FOR REVIEW DURING NORMAL BUSINESS HOURS AT THE ORGANIZATION'S OFFICE FORM 990, PART VI, LINE 12C - ENFORCEMENT OF CONFLICTS POLICY OFFICERS, DIRECTORS, AND KEY EMPLOYEES ANNUALLY REVIEW AND EXECUTE, BY SIGNATURE AND DATE, THE CONFLICT OF INTEREST POLICY FORM 990, PART VI, LINE 15A - COMPENSATION PROCESS FOR TOP OFFICIAL THE ORGANIZATION'S EXECUTIVE COMMITTEE REVIEWS THE PERFORMANCE OF THE EXECUTIVE DIRECTOR AND, BASED ON HER PERFORMANCE, APPROVES, BY MAJORITY VOTE, ANY COMPENSATION ADJUSTMENTS. FORM 990, PART VI, LINE 15B - COMPENSATION PROCESS FOR OFFICERS THE EXECUTIVE DIRECTOR CONDUCTS ANNUAL PERFORMANCE EVALUATIONS FOR OTHER KEY EMPLOYEES AND, BASED ON PERFORMANCE, MAKES THE DECISION REGARDING ANY COMPENSATION ADJUSTMENTS . FORM 990, PART VI, LINE 19 - GOVERNING DOCUMENTS DISCLOSURE EXPLANATION THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR REVIEW DURING NORMAL BUSINESS HOURS AT THE ORGANIZATION'S OFFICE FORM 990, PART XI, LINE 9 - RECONCILIATION OF CHANGES - OTHER NET UNREALIZED GAINS ON INVESTMENTS s ° For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-22. “Schedule O (Farm 980 or 990-E2) (2012)sete 0 Gum 90 or 90-62) 2012 page 2 a DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 BOOK / TAX DEPRECIATION DIFFERENCE $ 753 FORM 990, PART XI, LINE 9 - OTHER CHANGES IN NET ASSETS EXPLANATION BOOK DEPRECIATION $ 753 ‘Schedule O Form 990 oF 990-EZ) (2012)(esa) aL 0 3rv-3ONaN34IO On ve 0 Ve6 19 Nad $5056 zal ELZ¥6 Lie SW10L ¥69't zee a6 ove blozezy = Suv3AS as S¥BLNWOO 1130 XIS ¥26'sz 0 ¥26'St vee'sz Lo0zezi9. SUV3AS as AYO WONOH £002 sess 0 ses's sess yoozuzie © SUV3AS 1s walgoo ozr'zz ° ozv'zz Ozr'zz = SNOIVA SUYBALS © BG00Z~=—LN3dIND3 HALNdNOO 8 LNBWdINDS 301440 zay'se 0 zer'se zav'se SNOVA SUVBALS 1S LNaWdIND’ YaLNdNOD B LNAWdINO 301430 NOliviogud3a NOIViOsudad NOLviowudag 1809 GauinbOV Sdr1___GOHLaW NOILanwosaa aaLvInWNoOY YW3A.LNMYND GaLWINNOOW ‘aiva eboz ‘oe NN hoz ‘oe ANNE Troe "Or NT FWMOSHOSSSaVINOMVIOTNdsG} ‘ONT TadaISSISSIN JO NOILVANNOS S3LaIaVIG; Application for Extension of Time To File an ‘wm 8868 Exempt Organization Return mone ws09 ecsamen ofne Tatry > File separate application for each return, * you re fing foram Antomatie 3. Month Extension, complete only Part 1 and checks bor BI + styevare fing for an Additonal Not Automatic) 3-Month Extension, complete only Part (on page 2 ofthe fom) ‘Do not complete Part unless you have aendy been granted an automate non exension on 3 rewoush led Form 8858 Electronic fing (e-il). You can electrorcally fle Form 8868 you need a 3-month automatic extension of tme to fe (6 months for 8 corporation requiced to fe Form 990-7), or an additonal (ot automatic) -month extension af ime You can eleconcaly le Form £8868 to request an extension of ime lo fe any ofthe forms listed un Part or Part I wih he exception of Form 8870, information Return for Translors Associated With Cestan Personal Benefit Contacts, which must be sent to the IRS paper formal (see smstnvebons) For more detals on the electronic fling of his form, vst wuts govlefie and cick on ele fr Charis & Nonpeois Part! Automatic 3-Month Extension of Time. Only submit original (no copies needed) ‘corporation required to fe Form 990-T and requesting an automate 6-month extension ~ check this box and complete >O Part only ‘Ab other corporations (cluding 1120-C filers), partnership, REMICs, and rusts musl use Fotm 700s to request an extension of ime to file income tax reas. ter filers identiying number, soe instructions, Type or | ame clone ogoriaon or oer er, se insntons Eloy enufcatonromber EN) of int : DIABETES FOUNDATION OF MISSISSIPPI 23-7262987 rieeyme | number, set and room or site ne. a P.O. bo. se nstucions Soaaleecrtyaunber SN) stsiem | 800 AVERY BOULEVARD 100 ‘rarer, | cy. oom or post fice, sale, and ZP code Far Tan ares, sos ance met | RIDGELAND MS 39157 «Ente the Return code rhe eum tha ts application fr (We a separate apphaton for ach etary (oy ‘elation tues] Anntcaion atm tao Code _| teFor ode orn 90 Foam S60ED 01 | Ferm s207 open wr Fem 99080 02 | Fom 1041-0 nm oom 4720 da a3 | Fox a720 08 Fon 90-7 04 Farm 5227 10 Foxm 00-7 Goo 0a) or 26 05 | Fam 060 mT orm 990: (us oa than above 05 [Fox e070 12 MARY FORTUNE 800 AVERY BOULEVARD, SUITE 100 + Thetess oem inocaeot P REDGELAND Ms 39157 Telephone No. & 601-957-7878 Facto. + the crgniaton does not have an fice or pace of business the United States, checks box oO + itis is fora Group Retum, enter te erganizatots four dot Group Exemption Number (SEN) wis forthe whole group. checks box [ } lis tor pan ofthe gr. checks box L] andattach 2st nh the names and Eilts ofall mambers th etonsion fo “1 {request an tiomatc men (6 months ora corporation requred Io Re Form 950.1) enenaon ome unit 02/18/14 to file he exempt organization return for the organization named above The extension 1s forthe ergancaton'sretun for > [1 catendar year or > [R] taxyeardegnng 07/01/12 , andendng 06/30/13 2 ihe tax year entered in ine 1 is for less than 12 months, check reason teat return [[] Finat retum ‘Change in accounting penod. aif thes applicabon i for Form 990-6, 990-PF, 990-7, 4720, oF 6069, ertar the teniaive tax, ess ny, onelundable codis See astuctens zals 1b ts application for Form 990-PF, 990-1. 4720, or 6069, enter any elundable reds and stated tax payments made include any put year overpayment alowed as a cred wo |s {© Balance due. Subtract tne 3b rom ine 3a Include your payment with ths form, required. by usNG : EFTPS (Electrone Federal Tax Payment System) See mstuchons ac|s fo make an electome fund withdrawal veh hs Foc G868, coe Form 8453 EO and Foun 8879.0 for payment nstuchons auton. you ae gor