SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
DUBOIS COUNTY COMMUNITY FOUNDATION INC
 
Employer identification number

35-1990305
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B MEMBERS OF THE FINANCE COMMITTEE ARE FIRST PROVIDED A DRAFT TO REVIEW. UPON APPROVAL THE FINAL 990 VERSION IS PRESENTED TO THE BOARD AS A RECOMMENDATION FOR APPROVAL BY THE FINANCE COMMITTEE
FORM 990, PART VI, SECTION B, LINE 12C MEMBERS ARE REQUIRED TO SIGN AN ANNUAL CONFLICT OF INTEREST POLICY ACCEPTANCE AS WELL AS A DISCLOSURE AND CONFIDENTIALITY STATEMENT. FOR APPROPRIATE TOPICS OR DECISIONS, DISCLOSURES OF CONFLICTS ARE NOTED AND DECLARED AT EVERY MEETING HELD AT THE FOUNDATION AND RECORDED IN THE MINUTES.
FORM 990, PART VI, SECTION B, LINE 15A MEMBERS OF THE EXECUTIVE COMMITTEE MEET ANNUALLY TO EVALUATE THE PERFORMANCE OF THE EXECUTIVE DIRECTOR AND DISCUSS COMPENSATION ISSUES. EVALUATION TOOLS AND BENCHMARK SALARIES OF REGIONAL COMMUNITY FOUNDATION EXECUTIVE DIRECTOR'S ARE USED IN THEIR REVIEW PROCESS.
FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS DISCLOSURE EXPLANATION AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9: SFAS 136 ADJ. -183,880. CHANGE IN SPLIT INTEREST 17,694. CHANGE IN DISCOUNT OF CONTRIBUTIONS RECEIVABLE 1,031. PRIOR PERIOD ADJUSTMENT FOR CONSOLIDATION 0.
FORM 990, PART XII, LINE 2C THE PROCESS THE BOARD TAKES IN THE OVERSIGHT OF THE AUDIT AND SELECTION OF AN INDEPENDENT ACCOUNTANT DID NOT CHANGE DURING THE YEAR.
EXPLANATION FOR AMENDED FORM 990 FORM 990 IS BEING AMENDED TO CORRECT SCHEDULE I.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


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