SAMARITAN CAREGIVERS INCORPORATED: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: SAMARITAN CAREGIVERS INCORPORATED (EIN 35-1999781)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-05-10
IRS object ID: 201201319349300930
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule D
Schedule G
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-05-10T10:21:29-04:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	T&C TAX SERVICE INC	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	1722 E HOFFER ST	AddressLine1
City	KOKOMO	City
State	IN	State
ZIP Code	46902	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	351999781	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	SAMARITAN CAREGIVERS INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	SAMA	NameControl
Phone	7654537611	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2705 S BERKLEY RD 3C	AddressLine1
City	Kokomo	City
State	IN	State
ZIP Code	46902	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	JAMEY HENDERSON	Name
Title	EXECUTIVE DIRECTOR	Title
Date Signed	2012-05-07	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	RICHARD A COMOGLIO	Name
Phone	7654521500	Phone
Date Prepared	2012-05-07	DatePrepared

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	JAMEY HENDERSON	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2705 S BERKLEY RD 3C	AddressLine1
City	Kokomo	City
State	IN	State
ZIP Code	46902	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	137807	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1996	YearFormation
State Legal Domicile	IN	StateLegalDomicile
Activity Or Mission Description	SAMARITAN CAREGIVER VOLUNTEERS PROVIDE FREE HELP WITH NONMEDICAL EVERYDAY ACTIVITIES TO HOWARD COUNTY RESIDENTS, 50 AND OVER, STILL LIVING AT HOME, TO SUPPORT INDEPENDENCE	ActivityOrMissionDescription
Nbr Voting Members Governing Body	19	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	19	NbrIndependentVotingMembers
Total Nbr Employees	3	TotalNbrEmployees
Total Nbr Volunteers	367	TotalNbrVolunteers
Total Gross UBI	29751	TotalGrossUBI
Contributions Grants Prior Year	78621	ContributionsGrantsPriorYear
Contributions Grants Current Year	99334	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	4957	InvestmentIncomePriorYear
Investment Income Current Year	-517	InvestmentIncomeCurrentYear
Other Revenue Prior Year	35324	OtherRevenuePriorYear
Other Revenue Current Year	29751	OtherRevenueCurrentYear
Total Revenue Prior Year	118902	TotalRevenuePriorYear
Total Revenue Current Year	128568	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	89609	SalariesEtcPriorYear
Salaries Etc Current Year	88248	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	25357	TotalFundrsngExpCurrentYear
Other Expense Prior Year	30698	OtherExpensePriorYear
Other Expenses Current Year	32746	OtherExpensesCurrentYear
Total Expenses Prior Year	120307	TotalExpensesPriorYear
Total Expenses Current Year	120994	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	-1405	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	7574	RevenuesLessExpensesCY
Total Assets BOY	193559	TotalAssetsBOY
Total Assets EOY	199252	TotalAssetsEOY
Total Liabilities BOY	10359	TotalLiabilitiesBOY
Total Liabilities EOY	8478	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	183200	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	190774	NetAssetsOrFundBalancesEOY
Mission Description	VOLUNTEER ELDERLY CAREGIVERS	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	63991	Expense
Description	A SOCIAL SERVICE ORGANIZATION COMMITTED TO IMPROVING/MAINTAIN THE	Description
Total Program Service Expense	63991	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	false	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	false	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	true	FundraisingActivities
Gaming	false	Gaming
Hospital	false	Hospital
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	false	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	false	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	false	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	3	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	true	NonDeductibleContributions
Non Deductible Disclosure	true	NonDeductibleDisclosure
Excess Business Holdings	false	ExcessBusinessHoldings
Taxable Distributions	false	TaxableDistributions
Distribution To Donor	false	DistributionToDonor
Indoor Tanning Services	false	IndoorTanningServices
Nbr Voting Governing Body Members	19	NbrVotingGoverningBodyMembers
Number Independent Voting Members	19	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	IN	StatesWhereCopyOfReturnIsFiled

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	JAMEY HENDERSON	NamePerson
Telephone Number	7654537611	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2705 S BERKLEY	AddressLine1
City	KOKOMO	City
State	IN	State
ZIP Code	46902	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA

Field	Value	IRS element (for citing)
Name Person	JAMEY HENDERSO	NamePerson
Title	EXECUTIVE DIR	Title
Average Hours Per Week	40	AverageHoursPerWeek
Officer	X	Officer
Reportable Comp From Organization	42708	ReportableCompFromOrganization
Reportable Comp From Related Orgs	0	ReportableCompFromRelatedOrgs
Other Compensation	0	OtherCompensation

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	42708	TotalReportableCompFromOrg
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
Related Organizations	24890	RelatedOrganizations
Government Grants	5910	GovernmentGrants
All Other Contributions	68534	AllOtherContributions
Total Contributions	99334	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	-517	TotalRevenueColumn
Related Or Exempt Function Income	-517	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Gross Income Fundraising Events	38990	GrossIncomeFundraisingEvents
Fundraising Direct Expenses	9239	FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	29751	TotalRevenueColumn
Unrelated Business Revenue	29751	UnrelatedBusinessRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	128568	TotalRevenueColumn
Related Or Exempt Function Income	-517	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	29751	UnrelatedBusinessRevenue

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	80191	Total
Program Services	40866	ProgramServices
Management And General	20270	ManagementAndGeneral
Fundraising	19055	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	1632	Total
Program Services	832	ProgramServices
Management And General	413	ManagementAndGeneral
Fundraising	387	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	6425	Total
Program Services	3274	ProgramServices
Management And General	1527	ManagementAndGeneral
Fundraising	1624	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	1812	Total
Program Services	1211	ProgramServices
Management And General	601	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1497	Total
Program Services	763	ProgramServices
Management And General	378	ManagementAndGeneral
Fundraising	356	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	5523	Total
Program Services	2815	ProgramServices
Management And General	1396	ManagementAndGeneral
Fundraising	1312	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2407	Total
Program Services	1609	ProgramServices
Management And General	798	ManagementAndGeneral

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	422	Total
Program Services	282	ProgramServices
Management And General	140	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	4870	Total
Program Services	3255	ProgramServices
Management And General	1615	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	2617	Total
Program Services	1334	ProgramServices
Management And General	662	ManagementAndGeneral
Fundraising	621	Fundraising

Other Expenses OtherExpenses (4 entries)

TotalTotal
2922
2714
829
593

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	6540	Total

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	120994	Total
Program Services	63991	ProgramServices
Management And General	31646	ManagementAndGeneral
Fundraising	25357	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	37662	BOY
EOY	17567	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	38385	BOY
EOY	62560	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	733	BOY
EOY	731	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	143978	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	31696	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	110376	BOY
EOY	112282	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	6403	BOY
EOY	6112	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	193559	BOY
EOY	199252	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	10359	BOY
EOY	8478	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	10359	BOY
EOY	8478	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	183200	BOY
EOY	190774	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	183200	BOY
EOY	190774	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	193559	BOY
EOY	199252	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	7574	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	true	AccountantCompileOrReview
FS Audited	false	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org509a2	X	PubliclySupportedOrg509a2

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	92072	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	170109	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	107705	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	78621	CurrentTaxYearMinus1Year
Current Tax Year	96871	CurrentTaxYear
Total	545378	Total

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	41684	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	35096	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	44643	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	46931	CurrentTaxYearMinus1Year
Current Tax Year	38990	CurrentTaxYear
Total	207344	Total

Total509 Total509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	133756	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	205205	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	152348	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	125552	CurrentTaxYearMinus1Year
Current Tax Year	135861	CurrentTaxYear
Total	752722	Total

Field	Value	IRS element (for citing)
Public Support Total509	752722	PublicSupportTotal509

Gross Investment Income509 GrossInvestmentIncome509

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2169	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	-10715	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	11058	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4957	CurrentTaxYearMinus1Year
Current Tax Year	1946	CurrentTaxYear
Total	9415	Total

Investment Income And UBTI InvestmentIncomeAndUBTI

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2169	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	-10715	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	11058	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	4957	CurrentTaxYearMinus1Year
Current Tax Year	1946	CurrentTaxYear
Total	9415	Total

Total Support Total TotalSupportTotal

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	135925	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	194490	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	163406	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	130509	CurrentTaxYearMinus1Year
Current Tax Year	137807	CurrentTaxYear
Total	762137	Total

Field	Value	IRS element (for citing)
Public Support Percentage509	0.98760	PublicSupportPercentage509
Prior Year Support Percentage	0.98940	PriorYearSupportPercentage
Investment Income Percentage	0.01240	InvestmentIncomePercentage
Prior Yr Invest Income Percentage	0.01060	PriorYrInvestIncomePercentage
Thirty Three Percnt Tests CY509	X	ThirtyThreePercntTestsCY509

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Disclosed Orgs Legal Control	true	DisclosedOrgsLegalControl
Disclosed For Charitable Purposes	true	DisclosedForCharitablePurposes
Written Policy Monitoring	true	WrittenPolicyMonitoring
Included On FS	false	IncludedOnFS

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	119770	InvestmentCostOrOtherBasis
Depreciation	10739	Depreciation
Book Value	109031	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	24208	InvestmentCostOrOtherBasis
Depreciation	20957	Depreciation
Book Value	3251	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	112282	TotalOfBookValueLandBuildings
Total Revenue	128568	TotalRevenue
Total Expenses	120994	TotalExpenses
Excess Or Deficit For Year	7574	ExcessOrDeficitForYear
Excess Or Deficit Per FS	7574	ExcessOrDeficitPerFS

Schedule G IRS990ScheduleG

Field	Value	IRS element (for citing)
Agreement Ref Fundraising	false	AgreementRefFundraising

Events Information EventsInformation

Field	Value	IRS element (for citing)
Name Of Event1	DUCK DERBY	NameOfEvent1
Gross Receipts Event1	38990	GrossReceiptsEvent1
Gross Revenue Event1	38990	GrossRevenueEvent1
Other Direct Expenses Event1	9239	OtherDirectExpensesEvent1
Gross Receipts Total	38990	GrossReceiptsTotal
Gross Revenue Total Events	38990	GrossRevenueTotalEvents
Other Direct Expenses Total Events	9239	OtherDirectExpensesTotalEvents
Direct Expense Summary Events	9239	DirectExpenseSummaryEvents
Net Income Summary	29751	NetIncomeSummary

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

ExplanationExplanation
THE TAX RETURN IS REVIEWED BY THE GOVERNING BOARD IN COMPLIANCE WITH
THE APPLICABLE BYLAWS IN WHICH THE FINANCIALS ARE RECONCILED WITH THE
TAX RETURN.
CONFLICT OF INTEREST DISCLOSURES ARE MADE BY EACH BOARD MEMBER/OFFICER
EACH YEAR UPON REVIEW OF THE TAX RETURN AND FINANCIALS.

SAMARITAN CAREGIVERS INCORPORATED: Form 990, tax year 2011

Return header ReturnHeader

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Preparer Firm US Address PreparerFirmUSAddress

Filer Filer

Name Name

US Address USAddress

Officer Officer

Preparer Preparer

Form 990 IRS990

Address Principal Officer US AddressPrincipalOfficerUS

The Books Are In Care Of TheBooksAreInCareOf

Address US AddressUS

Form990 Part VII Section A Form990PartVIISectionA

Investment Income InvestmentIncome

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Total Revenue TotalRevenue

Comp Current Officers Directors CompCurrentOfficersDirectors

Pension Plan Contributions PensionPlanContributions

Payroll Taxes PayrollTaxes

Fees For Services Accounting FeesForServicesAccounting

Advertising Advertising

Office Expenses OfficeExpenses

Occupancy Occupancy

Conferences Meetings ConferencesMeetings

Depreciation Depletion DepreciationDepletion

Insurance Insurance

Other Expenses OtherExpenses (4 entries)

All Other Expenses AllOtherExpenses

Total Functional Expenses TotalFunctionalExpenses

Cash Non Interest Bearing CashNonInterestBearing

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Other Assets Total OtherAssetsTotal

Total Assets TotalAssets

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Total Liabilities TotalLiabilities

Unrestricted Net Assets UnrestrictedNetAssets

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Schedule A IRS990ScheduleA

Gifts Grants Contrib Received509 GiftsGrantsContribReceived509

Gross Receipts From Admissions GrossReceiptsFromAdmissions

Total509 Total509

Gross Investment Income509 GrossInvestmentIncome509

Investment Income And UBTI InvestmentIncomeAndUBTI

Total Support Total TotalSupportTotal

Schedule D IRS990ScheduleD

Buildings Buildings

Equipment Equipment

Schedule G IRS990ScheduleG

Events Information EventsInformation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

Comments