ORPHANAGE SUPPORT SERVICES ORGANIZATION INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: ORPHANAGE SUPPORT SERVICES ORGANIZATION INC (EIN 82-0507523)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-15
IRS object ID: 201233209349309103
Schema version: 2011v1.3
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 B
Schedule C
Schedule F
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-15T02:21:03-07:00	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	MISKIN ASSOCIATES PA	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 412	AddressLine1
City	RIGBY	City
State	ID	State
ZIP Code	83442	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	820507523	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	ORPHANAGE SUPPORT SERVICES ORGANIZATION INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	ORPH	NameControl
Phone	2083591767	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 345	AddressLine1
City	REXBURG	City
State	ID	State
ZIP Code	83440	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	CORBET MISKIN	Name
Title	DIRECTOR	Title
Phone	2083591767	Phone
Date Signed	2012-11-13	DateSigned

Preparer Preparer

Field	Value	IRS element (for citing)
Name	CORBET MISKIN	Name
Phone	2087459006	Phone
Date Prepared	2012-11-15	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	REX HEAD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	PO BOX 345	AddressLine1
City	Rexburg	City
State	ID	State
ZIP Code	83440	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	900978	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
All Affiliates Included	false	AllAffiliatesIncluded
Organization501c3	X	Organization501c3
Web Site	www.orphanagesupport.org	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1998	YearFormation
State Legal Domicile	ID	StateLegalDomicile
Activity Or Mission Description	TO PROVIDE SUSTAINING SUPPORT TO ORPHANAGES BY ORGANIZING VOLUNTEERS AND BY PROVIDING FOOD, MEDICAL, CLOTHING, AND OTHER SUPPORT	ActivityOrMissionDescription
Nbr Voting Members Governing Body	5	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	4	NbrIndependentVotingMembers
Total Nbr Employees	0	TotalNbrEmployees
Total Nbr Volunteers	357	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	900384	ContributionsGrantsPriorYear
Contributions Grants Current Year	900252	ContributionsGrantsCurrentYear
Program Service Revenue CY	0	ProgramServiceRevenueCY
Investment Income Prior Year	1246	InvestmentIncomePriorYear
Investment Income Current Year	726	InvestmentIncomeCurrentYear
Other Revenue Current Year	0	OtherRevenueCurrentYear
Total Revenue Prior Year	901630	TotalRevenuePriorYear
Total Revenue Current Year	900978	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	114507	SalariesEtcPriorYear
Salaries Etc Current Year	96029	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	732805	OtherExpensePriorYear
Other Expenses Current Year	826014	OtherExpensesCurrentYear
Total Expenses Prior Year	847312	TotalExpensesPriorYear
Total Expenses Current Year	922043	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	54318	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	-21065	RevenuesLessExpensesCY
Total Assets BOY	299216	TotalAssetsBOY
Total Assets EOY	278151	TotalAssetsEOY
Total Liabilities EOY	0	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	299216	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	278151	NetAssetsOrFundBalancesEOY
Mission Description	TO PROVIDE SUSTAINING SUPPORT TO ORPHANAGES BY ORGANIZING VOLUNTEERS AND BY PROVIDING FOOD, MEDICAL, CLOTHING, AND OTHER SUPPORT	MissionDescription
Expense	884122	Expense
Revenue	900252	Revenue
Description	WE PROVIDED VITAL SERVICES TO 15 DIFFERENT ORPHANAGES, WHICH INCLUDED PROVIDING BASIC SERVICES, SUCH AS FEEDING, CHANGING, AND BATHING THE ORPHANS. SERVICES ALSO INCLUDED TEACHING ENGLISH CLASSES AND PROVIDING THERAPY. SIMILAR SERVICES WERE PROVIDED TO SOME HOSPITALS AND PRESCHOOLS AS WELL. IN ADDITION TO THE SERVICE HOURS RENDERED BY 357 VOLUNTEERS, THE ORGANIZATION PREPARED AND COLLECTED ITEMS FOR DONATION, INCLUDING QUILTS, CLOTHES, EDUCATIONAL SUPPLIES, ETC. FURTHERMORE, WE PROVIDED FINANCIAL HELP, MEDICAL CARE, AND FOOD STUFFS ORPHANAGES WITH THOSE NEEDS. TOTAL SERVICE HOURS PROVIDED IN 2011 WAS: 105,472 TOTAL NUMBER OF PEOPLE SERVED IN 2011 WAS: 1,847 TOTAL NUMBER OF VOLUNTEERS IN 2011 WAS: 357 THERE WERE ALSO SIGNIFICANT INTANGIBLE BENEFITS. EACH VOLUNTEER'S INTERACTION WITH PEOPLE IN THE LOCAL COMMUNITY IS CHANGING LOCAL CULTURAL ATTITUDES ABOUT VOLUNTEERISM AND WORKING WITH DISADVANTAGED POPULATIONS. VOLUNTEERS ARE OFTEN ASKED TO SPEAK ABOUT THEIR EXPERIENCES TO CHURCH, YOUTH, AND SCHOOL GROUPS. MANY HAVE FORMALLY PRESENTED THEIR EXPERIENCE WITH HUNDREDS, OR EVEN THOUSANDS, THUS SHARING LESSONS ON SERVICE, THE PLIGHT OF ORPHANED CHILDREN, GLOBAL POVERTY & THE BROTHERHOOD OF MAN WITH A MUCH WIDER AUDIENCE.	Description
Total Program Service Expense	884122	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	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	false	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	true	ForeignOffice
Foreign Activities	true	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	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
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	0	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	0	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	true	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	5	NbrVotingGoverningBodyMembers
Number Independent Voting Members	4	NumberIndependentVotingMembers
Family Or Business Relationship	true	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
Whistleblower Policy	false	WhistleblowerPolicy
Document Retention Policy	false	DocumentRetentionPolicy
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	ID	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	REX HEAD	NamePerson
Telephone Number	2083591767	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	310 NORTH 2ND EAST SUITE 146	AddressLine1
City	REXBURG	City
State	ID	State
ZIP Code	83440	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (6 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	OfficerOfficer	Key EmployeeKeyEmployee	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Individual Trustee Or DirectorIndividualTrusteeOrDirector
AMY DAWSON
TREASURER	40.00	X	X	26024	0	0
REX HEAD
EXECUTIVE DIRECTOR	40.00	X		0	0	9856	X
MELODIE HEAD
DIRECTOR	5.00			0	0	0	X
CORBET MISKIN
DIRECTOR	5.00			0	0	0	X
JESSE SORENSON
DIRECTOR	5.00			0	0	0	X
MIKE LARSEN
DIRECTOR	5.00			0	0	0	X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	26024	TotalReportableCompFromOrg
Total Other Compensation	9856	TotalOtherCompensation
Formers Listed	false	FormersListed
Total Comp GT150 K	false	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources
All Other Contributions	900252	AllOtherContributions
Total Contributions	900252	TotalContributions

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	726	TotalRevenueColumn
Related Or Exempt Function Income	726	RelatedOrExemptFunctionIncome

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	900978	TotalRevenueColumn
Related Or Exempt Function Income	726	RelatedOrExemptFunctionIncome

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	84713	Total
Program Services	66870	ProgramServices
Management And General	17843	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	11316	Total
Program Services	9117	ProgramServices
Management And General	2199	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	2471	Total
Program Services	2471	ProgramServices

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	9561	Total
Program Services	8527	ProgramServices
Management And General	524	ManagementAndGeneral
Fundraising	510	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	47324	Total
Program Services	46357	ProgramServices
Management And General	967	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	221071	Total
Program Services	221056	ProgramServices
Management And General	15	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	3511	Total
Management And General	3511	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
DOS - LABOR & SOCIAL WORKER	106462	106462
DOS - GENERAL SUPPORT	94983	94983
COMMODITIES	79784	78004	1780
TRAINING	58462	58462

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	202385	Total
Program Services	191813	ProgramServices
Management And General	9671	ManagementAndGeneral
Fundraising	901	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	922043	Total
Program Services	884122	ProgramServices
Management And General	36510	ManagementAndGeneral
Fundraising	1411	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	69697	BOY
EOY	58001	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	160959	BOY
EOY	151590	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	68560	LandBuildingsEquipmentBasis

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	68560	BOY
EOY	68560	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	299216	BOY
EOY	278151	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Field	Value	IRS element (for citing)
Do Not Follow SFAS117	X	DoNotFollowSFAS117

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

Field	Value	IRS element (for citing)
BOY	68560	BOY
EOY	68560	EOY

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Field	Value	IRS element (for citing)
BOY	230656	BOY
EOY	209591	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	299216	BOY
EOY	278151	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	299216	BOY
EOY	278151	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	-21065	ReconcilationRevenueExpenses
Method Of Accounting Cash	X	MethodOfAccountingCash
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	false	FSAudited

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Publicly Supported Org170b1 Avi	X	PubliclySupportedOrg170b1Avi

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	689305	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	934826	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	828513	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	900384	CurrentTaxYearMinus1Year
Current Tax Year	901311	CurrentTaxYear
Total	4254339	Total

Total170 Total170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	689305	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	934826	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	828513	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	900384	CurrentTaxYearMinus1Year
Current Tax Year	901311	CurrentTaxYear
Total	4254339	Total

Field	Value	IRS element (for citing)
Amounts Subst Contributors Total	422469	AmountsSubstContributorsTotal
Public Support Total170	3831870	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Current Tax Year Minus4 Years	2074	CurrentTaxYearMinus4Years
Current Tax Year Minus3 Years	2495	CurrentTaxYearMinus3Years
Current Tax Year Minus2 Years	1189	CurrentTaxYearMinus2Years
Current Tax Year Minus1 Year	1246	CurrentTaxYearMinus1Year
Current Tax Year	726	CurrentTaxYear
Total	7730	Total

Field	Value	IRS element (for citing)
Total Support	4262069	TotalSupport
Public Support Pertcentage170	0.89910	PublicSupportPertcentage170
Thirty Three Percnt Tests CY170	X	ThirtyThreePercntTestsCY170
Public Support Total509	3831870	PublicSupportTotal509

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	false	OtherActivities

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

Field	Value	IRS element (for citing)
Region	SOUTH AMERICA	Region
Number Of Offices	2	NumberOfOffices
Type Of Activities Conducted	PROGRAM SERVICE	TypeOfActivitiesConducted
Specific Services Provided	ORPHANAGE SUPPORT THROUGH VOLUNTEERS, CLOTHES, FOOD, MEDICINE AND EDUCATION	SpecificServicesProvided
Total Expenditures	720918	TotalExpenditures

Field	Value	IRS element (for citing)
Subtotal Number Of Offices	2	SubtotalNumberOfOffices
Total Number Of Offices	720918	TotalNumberOfOffices
Total Amount Spent	720918	TotalAmountSpent
No Recipient Over5 K	X	NoRecipientOver5K

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

Field	Value	IRS element (for citing)
Explanation	PART VI, A, LINE 2 REX HEAD AND MELODIE HEAD ARE MARRIED TO EACH OTHER AND ARE ALSO DIRECTORS. PART VI, B, LINE 11 REX HEAD, THE EXECUTIVE DIRECTOR REVIEWS THE TAX RETURN PRIOR TO FILING. PART VI, C, LINE 19 REQUESTS FOR ORGANIZATIONAL DOCUMENTS MAY BE MADE BY TELEPHONE, IN WRITING, OR BY ELECTRONIC SUBMISSION. THE ORGANIZATION RESPONDS TO EACH REQUEST WITHIN A TIMELY MANNER. PART IX, LINE 24e PROGRAM SERVICES - WAGES $37745 DOS - SUPPLIES, DIAPERS, WIPES, ETC $24255 SUPPLIES $22438 DOS - PHYSICAL FACILITIES $22020 DOS - FOOD $21047 DOS - EDUCATION & ACTIVITIES $19783 DOS - MEDICAL $15400 PROGRAM SERVICE EXPENSES $12036 TELEPHONE $8880 BANK SERVICE CHARGES $7077 UTILITIES $6837 DOS - CLOTHING $2460 DOS - SOCIAL WORKER $2288 CONTRACT LABOR $119	Explanation

ORPHANAGE SUPPORT SERVICES ORGANIZATION INC: 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 (6 entries)

Investment Income InvestmentIncome

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Total Revenue TotalRevenue

Other Salaries And Wages OtherSalariesAndWages

Payroll Taxes PayrollTaxes

Fees For Services Legal FeesForServicesLegal

Office Expenses OfficeExpenses

Occupancy Occupancy

Travel Travel

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

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Total Assets TotalAssets

Total Liabilities TotalLiabilities

Paid In Cap Srpls Land Bldg Eqp Fund PaidInCapSrplsLandBldgEqpFund

Retained Earnings Endowment Etc RetainedEarningsEndowmentEtc

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Schedule A IRS990ScheduleA

Gifts Grants Contrib Received170 GiftsGrantsContribReceived170

Total170 Total170

Gross Investment Income170 GrossInvestmentIncome170

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Contributor Name Business ContributorNameBusiness

Contributor Address US ContributorAddressUS

Schedule C IRS990ScheduleC

Schedule F IRS990ScheduleF

Accts Actvs Out US Table AcctsActvsOutUSTable

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

Comments