Return of Organization Exempt From Income Tax: Open To Public Inspection
Return of Organization Exempt From Income Tax: Open To Public Inspection
Return of Organization Exempt From Income Tax: Open To Public Inspection
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 2011
benefit trust or private foundation) Open to Public
Department of the Treasury
Internal Revenue Service ▶ The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection
A For the 2011 calendar year, or tax year beginning , 2011, and ending , 20
B Check if applicable: C Name of organization D Employer identification number
Address change Doing Business As
Name change Number and street (or P.O. box if mail is not delivered to street address) Room/suite E Telephone number
Initial return
Terminated City or town, state or country, and ZIP + 4
K Form of organization: Corporation Trust Association Other ▶ L Year of formation: M State of legal domicile:
Part I Summary
1 Briefly describe the organization’s mission or most significant activities:
Activities & Governance
2 Check this box ▶ 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 1a) . . . . . . . . . 3
4 Number of independent voting members of the governing body (Part VI, line 1b) . . . . 4
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) . . . . . 5
6 Total number of volunteers (estimate if necessary) . . . . . . . . . . . . . . 6
7a Total unrelated business revenue from Part VIII, column (C), line 12 . . . . . . . . 7a
b Net unrelated business taxable income from Form 990-T, line 34 . . . . . . . . . 7b
Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) . . . . . . . . . . . .
Revenue
16a Professional fundraising fees (Part IX, column (A), line 11e) . . . . . .
b Total fundraising expenses (Part IX, column (D), line 25) ▶
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–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 . . . . . . . .
Beginning of Current Year End of Year
Fund Balances
Net Assets or
2 Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If “Yes,” describe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in how it conducts, any program
services? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No
If “Yes,” describe these changes on Schedule O.
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 to others, the total expenses, and revenue, if any, for each program service reported.
Institutional trustee
Officer
Key employee
employee
Highest compensated
Former
(describe the organizations compensation
hours for organization (W-2/1099-MISC) from the
related (W-2/1099-MISC) organization
organizations and related
in Schedule organizations
O)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
or director
Individual trustee
Institutional trustee
Officer
Key employee
employee
Highest compensated
Former
(describe the organizations compensation
hours for organization (W-2/1099-MISC) from the
related (W-2/1099-MISC) organization
organizations and related
in Schedule organizations
O)
(15)
(16)
(17)
(18)
(19)
(20)
(21)
(22)
(23)
(24)
(25)
1b Sub-total . . . . . . . . . . . . . . . . . . . . . ▶
c Total from continuation sheets to Part VII, Section A . . . . . ▶
d Total (add lines 1b and 1c) . . . . . . . . . . . . . . . ▶
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 ▶
Yes No
3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated
employee on line 1a? If “Yes,” complete Schedule J for such individual . . . . . . . . . . . . 3
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such
individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual
for services rendered to the organization? If “Yes,” complete Schedule J for such person . . . . . . 5
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax
year.
(A) (B) (C)
Name and business address Description of services Compensation
2 Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 of compensation from the organization ▶
Form 990 (2011)
Form 990 (2011) Page 9
Part VIII Statement of Revenue
(A) (B) (C) (D)
Total revenue Related or Unrelated Revenue
exempt business excluded from tax
function revenue under sections
revenue 512, 513, or 514
1a Federated campaigns . . . 1a
Contributions, Gifts, Grants
and Other Similar Amounts
b Membership dues . . . . 1b
c Fundraising events . . . . 1c
d Related organizations . . . 1d
e Government grants (contributions) 1e
f All other contributions, gifts, grants,
and similar amounts not included above 1f
g Noncash contributions included in lines 1a-1f: $
h Total. Add lines 1a–1f . . . . . . . . . ▶
Business Code
Program Service Revenue
2a
b
c
d
e
f All other program service revenue .
g Total. Add lines 2a–2f . . . . . . . . . ▶
3 Investment income (including dividends, interest,
and other similar amounts) . . . . . . . ▶
4 Income from investment of tax-exempt bond proceeds ▶
5 Royalties . . . . . . . . . . . . . ▶
(i) Real (ii) Personal
6a Gross rents . .
b Less: rental expenses
c Rental income or (loss)
d Net rental income or (loss) . . . . . . . ▶
7a Gross amount from sales of (i) Securities (ii) Other
assets other than inventory
b Less: cost or other basis
and sales expenses .
c Gain or (loss) . .
d Net gain or (loss) . . . . . . . . . . ▶
Other Revenue
1 Total revenue (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . . . 1
2 Total expenses (must equal Part IX, column (A), line 25) . . . . . . . . . . . . . 2
3 Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . . . 3
4 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . . . 4
5 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . 5
6 Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33,
column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Part XII Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . . . . . .
Yes No
1 Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked “Other,” explain in
Schedule O.
2a Were the organization’s financial statements compiled or reviewed by an independent accountant? . . . 2a
b Were the organization’s financial statements audited by an independent accountant? . . . . . . . 2b
c If “Yes” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant? 2c
If the organization changed either its oversight process or selection process during the tax year, explain in
Schedule O.
d If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were
issued on a separate basis, consolidated basis, or both:
Separate basis Consolidated basis Both consolidated and separate basis
3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . . 3a
b If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits 3b
Form 990 (2011)