2011-08-12T10:14:33-05:00 2010-09-30 DIXON HUGHES GOODMAN LLP ONE WEST FOURTH STREET SUITE 700 WINSTONSALEM NC 27101 990 2009-10-01 566001467 WINSTON-SALEM INDUSTRIES FOR THE BLIND INC WINS 3367590551 7730 NORTH POINT DRIVE WINSTONSALEM NC 27106 DAVID HORTON 3367590551 2011-08-09 1 David Vogler 3367148100 2009 2016-02-24 21:20:13Z DAVID HORTON 7730 NORTH POINT DRIVE WINSTONSALEM NC 27106 116281163 0 X WWW.WSIFB.COM X 1936 NC TO TRAIN AND EMPLOY BLIND AND VISUALLY-IMPAIRED INDIVIDUALS. 24 21 882 86 247672 234272 234160 590447 0 -25900 -24834 26658579 31308013 26866839 31873626 15779 20417 0 14752651 17896943 0 249253 9579118 9781657 24347548 27699017 2519291 4174609 33189585 41217493 15022139 18893665 18167446 22323828 to provide opportunities for persons who are blind or visually-impaired and are in need of training, employment and services. 0 0 23125162 20417 31000002 operation of a qualified abilityone agency that provides training and employment for the blind and visually-impaired. Through these efforts, we sell merchandise that is produced by our employees, most of whom are blind or visually-impaired. We also operate stores that sell products made by the blind and visually-impaired along with other merchandise. The results of these efforts are the employment of 440 individuals who are blind and the generation of approximately 618,000 blind direct labor hours. 23125162 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 0 0 0 1 1 0 0 0 0 1 0 0 0 1 142 0 1 882 1 1 1 0 0 0 0 0 0 0 0 24 21 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X SAM D GEORGE JR CFO 3367590551 7730 NORTH POINT DRIVE WINSTONSALEM NC 27106 KAREN CAREY 1.00 X 0 0 0 JAMIE DEAN 1.00 X 0 0 0 JUDY BULLARD 1.00 X 0 0 0 JOHN GOOGE 1.00 X 0 0 0 DAVID GOOGE 1.00 X 0 0 0 PATRICK GRANTHAM 1.00 X 0 0 0 ANN JOHNSTON 1.00 X 0 0 0 HARVEY McINTYRE 1.00 X 0 0 0 ANN PARKER 1.00 X 0 0 0 SHIRLEY SHOUSE 1.00 X 0 0 0 MARK TONNESEN 1.00 X 0 0 0 SUSAN HAUSER 1.00 X 0 0 0 W LOUIS BISSETTE JR 1.00 X 0 0 0 DR KERRY COLLINS 1.00 X 0 0 0 ALAN DALLA PALU 1.00 X 0 0 0 CAROLYN MYERS 1.00 X 0 0 0 RICHARD SIEG 1.00 X 0 0 0 MIKE FAIRCLOTH 1.00 X 0 0 0 KATHRYN GARNER 1.00 X 0 0 0 DAVID PLYLER 1.00 X 0 0 0 JOHN BRAIS 1.00 X 0 0 0 JEFF CLARK 1.00 X 0 0 0 ANNE MACLEOD 1.00 X 0 0 0 BOB NEWELL 1.00 X 0 0 0 DANIEL BOUCHER 40.00 X 338865 0 158940 DAVID HORTON 40.00 X 201665 0 145353 JESUS A MANGUEL 40.00 X 193638 0 70094 JEANNE WILKINSON 40.00 X 123081 0 52851 SAM D GEORGE JR 40.00 X 134779 0 69957 PAMELA MILLER 40.00 X 82116 0 57703 DANIEL KELLY 40.00 X 112682 0 70854 JERRY O'HAGAN 40.00 X 142534 0 78911 RANDY BUCKNER 40.00 X 96853 0 57155 LILA GOODWIN 40.00 X 109659 0 24363 KATHLEEN BURKE 40.00 X 103289 0 23296 SILAS MARTIN 40.00 X 94324 0 31430 1542308 0 752322 9 0 1 0 WINSTON PERSONNEL GROUP 253 EXECUTIVE PARK BLVD WINSTONSALEM NC 27113 TEMPORARY EMPLOYEES 1564251 KELLY SERVICES INC PO BOX 530437 ATLANTA GA 303530437 TEMPORARY EMPLOYEES 1000869 GOODWILL INDUSTRIES OF NWNC PO BOX 4299 WINSTONSALEM NC 271154299 TEMPORARY EMPLOYEES 786650 THE OPPORTUNITIES GROUP INC 415 CLAREMONT AVE UNIT 4-C MONTCLAIR NJ 07042 SALES CONSULTING 471605 NASH FINCH CS DRAWER 100782 ATLANTA GA 303840782 SALES/MARKETING 366465 8 10000 580447 39875 590447 11939 11939 2000 38773 -36773 -36773 -36773 115088903 84368764 30720139 30720139 PASS-THROUGH INCOME 900099 527535 279863 247672 MISCELLANEOUS INCOME 900099 60339 60339 587874 31873626 31000002 247672 35505 12400 12400 8017 8017 1026399 511319 515080 6487879 5362005 988070 137804 8786897 8252618 489627 44652 1595768 1519117 70199 6452 80243 80243 144752 144752 2400 2400 1318261 1257916 60345 109085 41951 67134 50301 50293 8 689023 544154 144869 38572 38572 4236570 4236570 1025669 874456 151213 29975 29975 UNRELATED BUSINESS TAX 246500 246500 SUPPLIES 594320 527175 67145 EMPLOYEE ACTIVITIES 202787 202787 POSTAGE & SHIPPING 197511 193921 3590 TELEPHONE 194079 147845 46234 621609 601962 19647 27699017 23125162 4324602 249253 2731800 5803875 113829 259168 9302365 10093192 220041 226334 200000 200000 8441510 10841643 172296 217503 20786703 8108696 11421003 12678007 586741 897771 33189585 41217493 13227049 17366286 1536646 1527379 258444 0 15022139 18893665 X 17962416 21896057 31222 241517 173808 186254 18167446 22323828 33189585 41217493 X 0 1 1 X 0 X 824650 647329 829152 234160 590447 3125738 57007508 78839410 80729748 100769704 115088903 432435273 57832158 79486739 81558900 101003864 115679350 435561011 112845 94711 153475 575 34750 396356 0 112845 94711 153475 575 34750 396356 435164655 108868 32264 9802 9984 11939 172857 159656 159656 108868 32264 9802 9984 171595 332513 30423 85754 -43586 233809 340202 646602 57971449 79604757 81525116 101247657 116191147 436540126 0.99680 0.99730 0.00080 0.00070 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 2400 0 0 2400 0 177462 12446 15169 1371 203706 151643 23170 3679 1030 177462 1.00000 1 0 1639893 1639893 7736139 3359750 4376389 1603110 122463 1480647 7619874 3543103 4076771 2187687 1083380 1104307 12678007 31873626 27699017 4174609 19414 -37641 -18227 4156382 31853934 19414 183021 -258900 -56465 31910399 -36773 -36773 31873626 27697552 183021 74414 257435 27440117 258900 258900 27699017 Part V, Line 4: Description of Intended Use of Endowment Funds: THE ENDOWMENT IS ESTABLISHED TO PROVIDE A PERMANENT FUND WHICH MAY BE USED TO SUPPORT THE ONGOING NEEDS OF WINSTON-SALEM INDUSTRIES FOR THE BLIND, INC. Part X: Description of Uncertain Tax Positions Under FIN 48: WINSTON-SALEM INDUSTRIES FOR THE BLIND, INC. (IFB) IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. IFB QUALIFIES FOR CHARITABLE CONTRIBUTION DEDUCTIONS UNDER SECTION 170(B)(1)(A) AND HAS BEEN CLASSIFIED AS AN ORGANIZATION OTHER THAN A PRIVATE FOUNDATION UNDER SECTION 509 (A)(1). ALTHOUGH MANAGEMENT HAS DETERMINED THAT IT IS MORE LIKELY THAN NOT TO MAINTAIN ITS TAX-EXEMPT STATUS, THE FINANCIAL STATEMENTS REFLECT A PROVISION AND LIABILITY FOR FEDERAL AND STATE INCOME TAXES RESULTING FROM UNRELATED BUSINESS INCOME GENERATED BY PROFITABLE OPERATIONS OF A COMPANY IN WHICH IFB HOLDS A 49% MEMBER INTEREST. EXCEPT FOR THE DISCLOSURE HEREIN, MANAGEMENT HAS DETERMINED THAT THERE ARE NO OTHER MATERIAL UNRECOGNIZED TAX BENEFITS OR OBLIGATIONS AS OF SEPTEMBER 30, 2010. Part XI, Line 8 - Other Adjustments: FASB 158 ADJUSTMENT: -37641. Part XII, Line 2d - Other Adjustments: RECLASS ESTIMATED TAX PAYMENTS TO EXPENSE: -246500. RECLASS GRANTS PAID TO EXPENSE: -12400. Part XII, Line 4b - Other Adjustments: RECLASS LOSS ON DISPOSAL OF FIXED ASSETS TO REVENUE: -36773. Part XIII, Line 2d - Other Adjustments: FASB 158 ADJUSTMENT: 37641. RECLASS LOSS ON DISPOSAL OF FIXED ASSETS TO REVENUE: 36773. Part XIII, Line 4b - Other Adjustments: RECLASS ESTIMATED TAX PAYMENTS TO EXPENSE: 246500. RECLASS GRANTS PAID TO EXPENSE: 12400. 1 GOODWILL OF SOUTH FLORIDA INC 2121 NW 21 STREET MIAMI FL 33142 590866126 501(C)(3) 10000 FMV PONCHO LINERS HAITI EARTHQUAKE RELIEF. 1 0 SCHOLARSHIPS FOR HIGHER EDUCATION 5 4500 TUITION REIMBURSEMENT 4 3517 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization offers two scholarships, one of which is available only to eligible sighted, blind and visually-impaired employees who are full-time and have one year of service and the other scholarship is available only to eligible blind and visually-impaired employees and their dependents. To be eligible for these scholarships a candidate must be accepted to, or currently attending, a post-secondary educational institution. Each candidate must submit a scholarship application, evidence of acceptance or attendance, and the bill for tuition from their respective schools. Scholarship recipients are chosen from the pool of candidates by a committee consisting of Human Resources and Executive management. The amounts of individual scholarship awards are determined based on the individual's cost of tuition and the number of candidates applying for each scholarship. Also provided is tuition reimbursement for sighted, blind and visually-impaired employees. Employees wishing to receive reimbursement must complete a request form detailing the courses they wish to take and how those courses contribute to their current postion within the company. These forms are reviewed and approved by the immediate supervisor and the Employee Relations Manager. Upon completion of the course(s), the employee submits a grade report, and as long as a grade of C or better is received the employee is reimbursed for the cost of tuition. X X X X X 0 0 0 0 0 1 0 0 0 DANIEL BOUCHER 204007 0 106552 0 28306 0 144500 0 14440 0 497805 0 0 0 DAVID HORTON 176315 0 20325 0 5025 0 131046 0 14307 0 347018 0 2300 0 JESUS A MANGUEL 165000 0 17881 0 10757 0 69364 0 730 0 263732 0 0 0 JEANNE WILKINSON 117292 0 5550 0 239 0 52308 0 543 0 175932 0 0 0 SAM D GEORGE JR 125673 0 7764 0 1342 0 55827 0 14130 0 204736 0 0 0 DANIEL KELLY 91515 0 11258 0 9909 0 56846 0 14008 0 183536 0 0 0 JERRY O'HAGAN 126370 0 14725 0 1439 0 71845 0 7066 0 221445 0 0 0 Part I, Line 6 Winston-Salem Industries for the Blind, Inc. maintains the Gainshare Incentive Program for the benefit of all employees including officers, key employees and other highly compensated employees. This incentive program is based on the attainment of operational results that exceed income-related targets established by the organization's Board of Directors. DANIEL BOUCHER LIFE INSURANCE PREMIUMS (SEE DETAILS BELOW) X 226334 226334 0 1 1 226334 SHIRLEY SHOUSE DIRECTOR 1564251 EMPLOYMENT SERVICES PROVIDED BY COMPANIES OWNED BY THE INTERESTED PERSON. 0 DR KERRY COLLINS DIRECTOR 105210 MEDICAL CLINIC SERVICES. 0 X EQUIPMENT 2 39875 COMPARABLE SALES 0 0 0 Form 990, Part VI, Section A, line 2 JOHN GOOGE - MEMBER OF THE BOARD OF DIRECTORS IS THE FATHER OF DAVID GOOGE - MEMBER OF THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 11 After review by financial management personnel at the organization, the Form 990 is distributed to all members of the Audit Committee of the board, the governance body charged with approval of the filing of the return, in advance of a scheduled meeting of the Audit Committee for the purpose of conducting a detailed review of the Form 990. The CFO of the organization and a representative from the organization's tax return preparer meet with the Audit Committee for an in-depth review of the Form 990. From this meeting, the Audit Committee approves the return for filing as prepared, or with agreed-upon changes. Following audit committee approval, a copy of the Form 990 is distributed to all members of the Board of Directors prior to timely filing with the IRS. Form 990, Part VI, Section B, line 12c ON AN ANNUAL BASIS, THE CORPORATE GOVERNANCE COMMITTEE OF THE BOARD OF DIRECTORS DISTRIBUTES A CONFLICT OF INTEREST DISCLOSURE STATEMENT TO ALL BOARD MEMBERS, OFFICERS, AND KEY EMPLOYEES. THE COMMITTEE, ALONG WITH COMPLIANCE PERSONNEL, EXAMINE THE COMPLETED STATEMENTS AND PROMPTLY INVESTIGATE AND RESOLVE ANY REAL OR PERCEIVED CONFLICTS. Form 990, Part VI, Section B, line 15 Annual compensation of the Executive Director and Executive Chairman is set by the Board of Directors. The Board conducts annual performance evaluations of the Executive Director and Executive Chairman, and along with the results of the evaluations, the Board uses periodic compensation surveys conducted by outside consultants and consults comparative compensation data related to the compensation packages of top executives at organizations of similar size and mission, including examination of the organizations' forms 990, in order to determine the compensation of the Executive Director and Executive Chairman on a yearly basis. For other officers and key employees, annual compensation is set by the Executive Director. The Executive Director conducts an annual performance evaluation for each officer and key employee, and along with the results of the evaluation, the Executive Director consults comparative compensation data related to officers and key employees at organizations of similar size and mission, including examination of the organizations' forms 990, in order to determine each officer's and key employee's compensation on a yearly basis. Form 990, Part VI, Section C, line 19 All governing documents are maintained by the executive assistant to the Executive Director. This employee makes these documents available upon request. The financial statements are maintained by the Chief Financial Officer (CFO). The CFO makes these statements, as disclosed in the form 990, available upon request. Also, summarized financial information is included in the organization's annual report. The conflict of interest policy is maintained by the Corporate Governance committee of the Board of Directors. The committee chair makes this policy available upon request. SCHEDULE L, PART II, LOANS TO AND FROM INTERESTED PERSONS: THE RELATED PARTY RECEIVABLE BETWEEN WINSTON-SALEM INDUSTRIES FOR THE BLIND, INC. (IFB) AND DANIEL BOUCHER, AN OFFICER OF THE ORGANIZATION, IS RELATED TO A SPLIT-DOLLAR LIFE INSURANCE AGREEMENT WHEREBY DANIEL BOUCHER OWNS THE LIFE INSURANCE POLICY AND IFB PAYS THE PREMIUMS REQUIRED TO MAINTAIN THE POLICY. IN CONJUNCTION WITH THE AGREEMENT, DANIEL BOUCHER HAS EXECUTED A COLLATERAL ASSIGNMENT IN FAVOR OF IFB THAT SECURES THE REPAYMENT TO IFB OF THE AMOUNT OF PREMIUMS PAID ON THE POLICY. THE RECEIVABLE IS RECORDED AT THE PRESENT VALUE OF PREMIUMS PAID TO DATE BASED ON THE APPLICABLE RISK-FREE RATE OF RETURN AND THE LIFE EXPECTANCY OF THE OFFICER AS DETERMINED BY STANDARD MORTALITY TABLES. A BRIGHTER PATH FOUNDATION 7730 NORTH POINT DRIVE WINSTONSALEM NC 27106 263376328 TO SUPPORT WINSTON-SALEM INDUSTRIES FOR THE BLIND, INC. NC 501(C)(3) 509(A)(3), TYPE I N/A 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 A BRIGHTER PATH FOUNDATION N 163000