2013-02-01T14:43:04-06:00 2011-12-31 221478099 COHNREZNICK LLP 1212 6TH AVENUE NEW YORK NY 10036 990 2011-01-01 273530769 AGAHOZO-SHALOM YOUTH VILLAGE INC AGAH 6463817861 498 SEVENTH AVENUE 15TH FLOOR NEW YORK NY 10018 TAMAR COPELAND 6463817861 2013-01-31 1 THOMAS LANNING P00851654 2122970400 2011 2016-02-25 16:41:14Z X TAMAR COPELAND 498 SEVENTH AVENUE 15TH FLOOR NEW YORK NY 10018 14645090 0 X WWW.ASYV.ORG X 2010 DE ASYV IS A COMPREHENSIVE HOME, COMMUNITY, AND HIGH SCHOOL FOR 500 ORPHANS INRWANDA'S EASTERN PROVINCE. 12 12 0 292 0 0 0 14531193 0 0 0 0 0 18621 0 14549814 0 0 0 0 0 1160963 0 0 205333 0 1150414 0 2311377 0 12238437 0 12794756 0 556319 0 12238437 X TO ENABLE ORPHANED AND VULNERABLE YOUTH TO REALIZE THEIR MAXIMUM POTENTIAL BY PROVIDING THEM WITH A SAFE AND SECURE LIVING ENVIRONMENT, HEALTH CARE, EDUCATION AND NECESSARY LIFE SKILLS. EDUCATION AND SERVICE ARE USED TO MODEL AND CREATE SOCIALLY RESPONSIBLE CITIZENS IN RWANDA AND AROUND THE WORLD. 1 0 1892133 ASYV PROVIDES A HIGH SCHOOL EDUCATION, RESIDENTIAL FACILITIES AND THERAPEUTIC TREATMENT TO ORPHANED AND VULNERABLE TEENS IN RWANDA 1892133 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 1 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 11 0 1 0 0 1 RW 0 0 0 1 1 0 0 0 0 X 12 12 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 1 0 0 NY DE X TAMAR M COPELAND 6463817861 498 SEVENTH AVENUE 15TH FLOOR NEW YORK NY 10018 X ANNE E HEYMAN 40.00 X X 0 0 0 BETRAND KAYIRANGA 2.00 X 0 0 0 DEBORAH RATNER 2.00 X 0 0 0 JEAN KAGUBARE 2.00 X 0 0 0 JERILYN MEDREA 2.00 X 0 0 0 JOHN HOOVER 5.00 X X 0 0 0 LAURIE TOLL FRANZ 2.00 X X 0 0 0 LISA ISSROFF 5.00 X 0 0 0 LIZ STERN 2.00 X 0 0 0 SAM MERRIN 2.00 X 0 0 0 STEVE MOSS 2.00 X 0 0 0 TINA WYATT 2.00 X 0 0 0 TAMAR M COPELAND 40.00 X 114493 0 19957 114493 0 19957 1 0 0 0 AMBROSE EMPLOYER GROUP USA LLC 199 WATER ST 2800 NEW YORK NY 10038 CO-EMPLOYMENT SERVICES 139606 1 426837 14104356 9006647 14531193 37000 426837 95276 -58276 -58276 FEE INCOME 541900 66207 66207 FARM INCOME 110000 9024 9024 OTHER 900099 1666 1666 76897 14549814 76897 0 -58276 134450 112558 12034 9858 942507 826247 57409 58851 2542 1552 645 345 63966 39063 16220 8683 17498 10686 4437 2375 29845 29845 16800 16800 100286 49851 20006 30429 46672 15489 21728 9455 3378 3378 57241 53484 1855 1902 92866 78610 14256 33000 33000 223194 223194 68475 64906 3569 FOOD AND SUPPLIES 246129 235267 6723 4139 SPECIAL EVENTS 63808 63808 EQUIPMENT RENTAL 43328 43328 OTHER 37478 20502 4530 12446 87914 84396 476 3042 2311377 1892133 213911 205333 420872 243659 1250140 57133 11046146 223194 0 10822952 0 12794756 0 36369 19950 500000 0 556319 X 11018297 1220140 0 12238437 0 12794756 12238437 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 219677 219677 10765175 207029 10558146 61294 16165 45129 10822952 14549814 2311377 12238437 12238437 14602490 0 14602490 -52676 -52676 14549814 2364053 52676 52676 2311377 0 2311377 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: ASYV IS AN EXEMPT ORGANIZATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ASYV HAS NO UNRECOGNIZED TAX BENEFITS AS OF DECEMBER 31, 2011. SINCE THIS IS THE FIRST YEAR OF OPERATIONS, ASYV HAS NOT YET FILED ANY U.S. FEDERAL OR STATE INCOME TAX RETURNS. GOING FORWARD, MANAGEMENT PLANS TO EVALUATE EXPIRING STATUTES OF LIMITATIONS, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW AND NEW AUTHORITATIVE RULINGS. IF APPLICABLE, ASYV WILL RECOGNIZE INTEREST AND PENALTIES ASSOCIATED WITH TAX MATTERS AS PART OF THE INCOME TAX PROVISION AND INCLUDE ACCRUED INTEREST AND PENALTIES WITH THE RELATED TAX LIABILITY IN THE STATEMENT OF FINANCIAL POSITION. PART XII, LINE 4B - OTHER ADJUSTMENTS: DIRECT FUNDRASING EXPENSES -52,676. PART XIII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRASING EXPENSES 52,676. 1 0 1 0 1 1 1 0 0 0 0 0 0 0 0 0 0 1 EXPLANATION OF NONDISCRIMINATORY POLICY PUBLICATION SCHEDULE E, PART I, LINE 3 THE ORGANIZATION HAS PUBLICIZED OUR POLICY IN THE NEW TIMES NEWSPAPER IN RWANDA. EXPLANATION OF DOCUMENT RETENTION SCHEDULE E, PART I, LINE 4 ALL FULL TIME STAFF AND FACULTY ARE RWANDESE. SUB-SAHARAN AFRICA 1 22 PROGRAM SERVICES PROVIDES A HIGH SCHOOL EDUCATION, RESIDENTIAL FACILITIES AND THERAPEUTIC TREATMENT TO ORPHANED AND VULNERABLE TEENS IN RWANDA. 1600728 1 22 0 0 1 22 1600728 0 1600728 0 0 0 0 0 0 X X X X X X 1 ER EVENT DESIGN INC 208 W 80TH ST 1E NEW YORK NY 10024 EVENT PLANNING 0 463837 42145 421692 463837 42145 421692 NY STAND UP EVENT 463837 426837 37000 42600 31610 21066 463837 426837 37000 42600 31610 21066 95276 -58276 EXPLANATION OF FUNDRAISING PAYMENTS SCHEDULE G, PART I, LINE 2B, COLUMN (V) FUNDRAISER ORGANIZED AND EXECUTED STAND UP EVENT FOR ORGANIZATION. X 1 32000 FAIR MARKET VALUE X 1 8974647 BOOK VALUE 0 0 0 METHOD FOR DETERMINING NUMBER OF CONTRIBUTORS: PART I, COLUMN (B): REPRESENTS NUMBER OF CONTRIBUTIONS AT END OF YEAR. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 ASYV PROVIDES A HIGH SCHOOL EDUCATION, RESIDENTIAL FACILITIES AND THERAPEUTIC TREATMENT TO ORPHANED AND VULNERABLE TEENS IN RWANDA. FORM 990, PART VI, SECTION A, LINE 2 ANNE HEYMAN, BOARD CHAIR, AND SAM MERRIN, BOARD MEMBER, HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM AND REVIEWED BY MANAGEMENT. THEN THE RETURN IS PRESENTED TO THE BOARD FOR REVIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C AT THE ANNUAL BOARD MEETING WHICH IS USUALLY IN FEBRUARY OF EACH YEAR THE OFFICERS, DIRECTORS, ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD ENGAGES A PRO-BONO HUMAN RESOURCES CONSULTANT, TO DETERMINE THE EXECUTIVE DIRECTOR'S COMPENSATION. THEY ALSO CONSULT WITH LEGAL COUNSEL AND COMPARE COMPENSATION TO OTHER ORGANIZATIONS. ORGANIZATIONAL GOALS ARE SET FOR THE EXECUTIVE DIRECTOR, AND EVALUATIONS OF PERFORMANCE ARE DONE ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION (A), (13): TAMAR M. COPELAND, EXECUTIVE DIRECTOR, WAS PAID A SALARY THROUGH JEWISH FUNDERS NETWORK AND AMBROSE EMPLOYER GROUP USA LLC AND DID NOT RECEIVE A W-2 FROM AGAHOZO-SHALOM YOUTH VILLAGE. FORM 990, PART XII, LINE 2C: THE AUDIT COMMITTEE TAKES RESPONSIBILITY FOR THE SELECTION OF AN INDEPENDENT ACCOUNTANT AND OVERSIGHT OF THE AUDIT. FORM 990, PART V, 2A: EMPLOYEES IN THE UNITED STATES ARE PAID THOUGH A THIRD PARTY AND DID NOT RECEIVE A W-2 FROM ASYV. EMPLOYEES IN RWANDA ARE PAID BY ASYV BUT DID NOT RECEIVE A W-2. FORM 990, PART VI, SECTION B, 13, 14: THE DOCUMENT RENTENTION AND WHITLEBLOWER POLICIES REFERENCED IN THE QUESTIONS STATED WERE ALL ADOPTED IN JANUARY 2012.