A For the 2011 calendar year, or tax year beginning 10/01 B Check if applicable:

Size: px
Start display at page:

Download "A For the 2011 calendar year, or tax year beginning 10/01 B Check if applicable:"

Transcription

1 Form 99-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 99 (see instructions). All other organizations with gross receipts less than $2, and total assets less than $5, at the end of the year may use this form. The organization may have to use a copy of this return to satisfy state reporting requirements. OMB No Open to Public Inspection A For the 211 calendar year, or tax year beginning 1/1, 211, and ending 9/3, 2 12 B Check if applicable: Address change Name change C Name of organization UAB Diabetes Trust Foundation Number and street (or P.O. box, if mail is not delivered to street address) Room/suite D Employer identification number E Telephone number Initial return th Avenue South Suite 13A Terminated City or town, state or country, and ZIP + 4 Amended return F Group Exemption Application pending Birmingham, AL 3525 Number G Accounting Method: Cash Accrual Other (specify) H Check if the organization is not I Website: required to attach Schedule B J Tax-exempt status (check only one) 51(c)(3) 51(c) ( ) (insert no.) 4947(a)(1) or 527 (Form 99, 99-EZ, or 99-PF). K Check if the organization is not a section 59(a)(3) supporting organization or a section 527 organization and its gross receipts are normally not more than $5,. A Form 99-EZ or Form 99 return is not required though Form 99-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return. L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $2, or more, or if total assets (Part II, line 25, column (B) below) are $5, or more, file Form 99 instead of Form 99-EZ $ 29,38 Revenue Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.) Check if the organization used Schedule O to respond to any question in this Part I Contributions, gifts, grants, and similar amounts received Program service revenue including government fees and contracts Membership dues and assessments Investment income a Gross amount from sale of assets other than inventory.... 5a b Less: cost or other basis and sales expenses b c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a).... 5c 6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than $15,) a b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,).. 6b c Less: direct expenses from gaming and fundraising events... 6c d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) d 7 a Gross sales of inventory, less returns and allowances a b Less: cost of goods sold b c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) c 8 Other revenue (describe in Schedule O) Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and ,38 1 Grants and similar amounts paid (list in Schedule O) , 11 Benefits paid to or for members Salaries, other compensation, and employee benefits Professional fees and other payments to independent contractors Occupancy, rent, utilities, and maintenance Printing, publications, postage, and shipping Other expenses (describe in Schedule O) Total expenses. Add lines 1 through ,37 18 Excess or (deficit) for the year (Subtract line 17 from line 9) , Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year s return) ,527 2 Other changes in net assets or fund balances (explain in Schedule O) , Net assets or fund balances at end of year. Combine lines 18 through ,934 For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 1642I Form 99-EZ (211) Expenses Net Assets 25,793 3,515

2 Form 99-EZ E-filing Receipt - IRS Status: Accepted Subject: Form 99-EZ E-filing Receipt - IRS Status: Accepted From: Date: 8/7/13 9:4 AM To: Organization: UAB Diabetes Trust Foundation EIN: Return Type: Form 99-EZ Return Year: 211 Submission ID: c Return Timestamp: 8/7/213 9:59:17 AM Accepted Date: 8/7/213 Thank you for using the 99 Online system for preparing and electronically filing your Form 99 EZ return. This contains some important identifying information about the return we transmitted. You may want to keep this in case you need to contact the IRS regarding your return. The return described above was transmitted to the IRS. The IRS has ACCEPTED the return. Congratulations. NOTE: The IRS does NOT reject returns for being late. If this return was transmitted to the IRS after the due date, and your organization has not filed a Form 8868 (Request for Extension), you may receive a letter from the IRS indicating whether your organization owes any penalties or other fees. Please visit to stay informed of enhancements to our efiling systems. Once again, thank you for using the 99 Online system e-file.form99.org technical support Phone: (toll free) 1 of 1 8/7/13 9:8 AM

3 Form 99-EZ (211) Page 2 Part II Balance Sheets. (see the instructions for Part II.) Check if the organization used Schedule O to respond to any question in this Part II (A) Beginning of year (B) End of year 22 Cash, savings, and investments , Land and buildings Other assets (describe in Schedule O) See. Schedule... O,. Statement , Total assets , Total liabilities (describe in Schedule O) , Net assets or fund balances (line 27 of column (B) must agree with line 21).. 289, Part III Statement of Program Service Accomplishments (see the instructions for Part III.) Check if the organization used Schedule O to respond to any question in this Part III.. What is the organization s primary exempt purpose? See Schedule O, Statement 2 Describe the organization s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title. 28 Support for the University of Alabama at Birmingham for its scientific and educational functions, specifically related to diabetes research, education, treatment and prevention. 74, , , , ,934 Expenses (Required for section 51(c)(3) and 51(c)(4) organizations and section 4947(a)(1) trusts; optional for others.) 29 (Grants $ 2, ) If this amount includes foreign grants, check here a 2, 3 (Grants $ ) If this amount includes foreign grants, check here a (Grants $ ) If this amount includes foreign grants, check here.... 3a 31 Other program services (describe in Schedule O) (Grants $ ) If this amount includes foreign grants, check here a 32 Total program service expenses (add lines 28a through 31a) , Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (see the instructions for Part IV.) Check if the organization used Schedule O to respond to any question in this Part IV (a) Name and address (b) Title and average hours per week devoted to position Carol Garrison President/Director, th Avenue South Suite 13A, Birmingham, AL 3525 Richard Marchase Interim President/Director, th Avenue South Suite 13A, Birmingham, AL Richard Margison Vice President/Director, th Avenue South Suite 13A, Birmingham, AL Marsha Hire Director, th Avenue South Suite 13A, Birmingham, AL 3525 T Michael Goodrich Director, th Avenue South Suite 13A, Birmingham, AL 3525 Rebecca Reardon Director, th Avenue South Suite 13A, Birmingham, AL 3525 Christopher Clifford Associate Vice President, th Avenue South Suite 13A, Birmingham, AL 3525 W John Daniel Secretary, th Avenue South Suite 13A, Birmingham, AL 3525 Jodie Mote Treasurer & Controller, th Avenue South Suite 13A, Birmingham, AL 3525 Terri Alexander Associate Secretary, th Avenue South Suite 13A, Birmingham, AL 3525 Tonya Zwiebel Associate Treasurer, th Avenue South Suite 13A, Birmingham, AL 3525 (c) Reportable compensation (Forms W-2/199-MISC) (if not paid, enter --) (d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation Form 99-EZ (211)

4 Form 99-EZ (211) Page 3 Part V Other Information (Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V Yes No 33 Did the organization engage in any significant activity not previously reported to the IRS? If Yes, provide a detailed description of each activity in Schedule O Were any significant changes made to the organizing or governing documents? If Yes, attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule O (see instructions) a Did the organization have unrelated business gross income of $1, or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? a b If Yes, to line 35a, has the organization filed a Form 99-T for the year? If No, provide an explanation in Schedule O 35b c Was the organization a section 51(c)(4), 51(c)(5), or 51(c)(6) organization subject to section 633(e) notice, reporting, and proxy tax requirements during the year? If Yes, complete Schedule C, Part III c 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If Yes, complete applicable parts of Schedule N a Enter amount of political expenditures, direct or indirect, as described in the instructions. 37a b Did the organization file Form 112-POL for this year? b 38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?. 38a b If Yes, complete Schedule L, Part II and enter the total amount involved b 39 Section 51(c)(7) organizations. Enter: a Initiation fees and capital contributions included on line a b Gross receipts, included on line 9, for public use of club facilities b 4 a Section 51(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ; section 4912 ; section 4955 b Section 51(c)(3) and 51(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 99 or 99-EZ? If Yes, complete Schedule L, Part I b c Section 51(c)(3) and 51(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and d Section 51(c)(3) and 51(c)(4) organizations. Enter amount of tax on line 4c reimbursed by the organization e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If Yes, complete Form 8886-T e 41 List the states with which a copy of this return is filed. 42a The organization's books are in care of Jodie Mote Telephone no Located at th Avenue South Suite 13A, Birmingham, AL 3525 ZIP b At any time during the calendar year, did the organization have an interest in or a signature or other authority over Yes No a financial account in a foreign country (such as a bank account, securities account, or other financial account)? 42b If Yes, enter the name of the foreign country: See the instructions for exceptions and filing requirements for Form TD F , Report of Foreign Bank and Financial Accounts. c At any time during the calendar year, did the organization maintain an office outside the U.S.? c If Yes, enter the name of the foreign country: 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 99-EZ in lieu of Form 141 Check here and enter the amount of tax-exempt interest received or accrued during the tax year Yes No 44 a Did the organization maintain any donor advised funds during the year? If Yes, Form 99 must be completed instead of Form 99-EZ a b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 99 must be completed instead of Form 99-EZ b c Did the organization receive any payments for indoor tanning services during the year? c d If "Yes" to line 44c, has the organization filed a Form 72 to report these payments? If "No," provide an explanation in Schedule O d 45 a Did the organization have a controlled entity within the meaning of section 512(b)(13)? a 45 b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If Yes, Form 99 and Schedule R may need to be completed instead of Form 99-EZ (see instructions) b Form 99-EZ (211)

5 Form 99-EZ (211) Page 4 46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for public office? If Yes, complete Schedule C, Part I Part VI Yes No Section 51(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 51(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47 49b and 52, and complete the tables for lines 5 and 51. Check if the organization used Schedule O to respond to any question in this Part VI Yes No 47 Did the organization engage in lobbying activities or have a section 51(h) election in effect during the tax year? If Yes, complete Schedule C, Part II Is the organization a school as described in section 17(b)(1)(A)(ii)? If Yes, complete Schedule E a Did the organization make any transfers to an exempt non-charitable related organization? a b If Yes, was the related organization a section 527 organization? b 5 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $1, of compensation from the organization. If there is none, enter None. None (a) Name and address of each employee paid more than $1, (b) Title and average hours per week devoted to position (c) Reportable compensation (Forms W-2/199-MISC) (d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation f Total number of other employees paid over $1, Complete this table for the organization's five highest compensated independent contractors who each received more than $1, of compensation from the organization. If there is none, enter None. None (a) Name and address of each independent contractor paid more than $1, (b) Type of service (c) Compensation d Total number of other independent contractors each receiving over $1,.. 52 Did the organization complete Schedule A? Note: All section 51(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A Yes No Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Sign Here Paid Preparer Use Only Signature of officer Jodie Mote, Treasurer & Controller Type or print name and title Print/Type preparer s name Preparer's signature Date Date Check if self-employed Firm s name Firm's EIN Firm's address Phone no. May the IRS discuss this return with the preparer shown above? See instructions Yes No PTIN Form 99-EZ (211)

6 SCHEDULE A (Form 99 or 99-EZ) Department of the Treasury Internal Revenue Service Name of the organization Public Charity Status and Public Support Complete if the organization is a section 51(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. Attach to Form 99 or Form 99-EZ. See separate instructions. Employer identification number OMB No Open to Public Inspection UAB Diabetes Trust Foundation Part I Reason for Public Charity Status (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.) 1 A church, convention of churches, or association of churches described in section 17(b)(1)(A)(i). 2 A school described in section 17(b)(1)(A)(ii). (Attach Schedule E.) 3 A hospital or a cooperative hospital service organization described in section 17(b)(1)(A)(iii). 4 A medical research organization operated in conjunction with a hospital described in section 17(b)(1)(A)(iii). Enter the hospital s name, city, and state: 5 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 17(b)(1)(A)(iv). (Complete Part II.) 6 A federal, state, or local government or governmental unit described in section 17(b)(1)(A)(v). 7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 17(b)(1)(A)(vi). (Complete Part II.) 8 A community trust described in section 17(b)(1)(A)(vi). (Complete Part II.) 9 An organization that normally receives: (1) more than 33 1 /3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions subject to certain exceptions, and (2) no more than 33 1 /3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 3, See section 59(a)(2). (Complete Part III.) 1 An organization organized and operated exclusively to test for public safety. See section 59(a)(4). 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 59(a)(1) or section 59(a)(2). See section 59(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h. a Type I b Type II c Type III Functionally integrated d Type III Other e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 59(a)(1) or section 59(a)(2). f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box g Since August 17, 26, has the organization accepted any gift or contribution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and Yes No (iii) below, the governing body of the supported organization? g(i) (ii) A family member of a person described in (i) above? g(ii) (iii) A 35% controlled entity of a person described in (i) or (ii) above? g(iii) h Provide the following information about the supported organization(s). (i) Name of supported organization University of (A) Alabama at Birmingham (B) (C) (D) (E) (ii) EIN (iii) Type of organization (described on lines 1 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? Yes No Yes No Yes No 6 (vii) Amount of support 2, Total For Paperwork Reduction Act Notice, see the Instructions for Form 99 or 99-EZ. 2, Cat. No F Schedule A (Form 99 or 99-EZ) 211

7 Version A, cycle 1 Schedule A (Form 99 or 99-EZ) 211 Page 2 Part II Support Schedule for Organizations Described in Sections 17(b)(1)(A)(iv) and 17(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.) Section A. Public Support Calendar year (or fiscal year beginning in) (a) 27 (b) 28 (c) 29 (d) 21 (e) 211 (f) Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")... 2 Tax revenues levied for the organization s benefit and either paid to or expended on its behalf... 3 The value of services or facilities furnished by a governmental unit to the organization without charge Total. Add lines 1 through The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) Public support. Subtract line 5 from line 4. Section B. Total Support Calendar year (or fiscal year beginning in) (a) 27 (b) 28 (c) 29 (d) 21 (e) 211 (f) Total 7 Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated business activities, whether or not the business is regularly carried on Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) Total support. Add lines 7 through 1 12 Gross receipts from related activities, etc. (see instructions) First five years. If the Form 99 is for the organization s first, second, third, fourth, or fifth tax year as a section 51(c)(3) organization, check this box and stop here Section C. Computation of Public Support Percentage 14 Public support percentage for 211 (line 6, column (f) divided by line 11, column (f)) % 15 Public support percentage from 21 Schedule A, Part II, line % 16 a 33 1 /3% support test 211. If the organization did not check the box on line 13, and line 14 is 33 1 /3% or more, check this box and stop here. The organization qualifies as a publicly supported organization b 33 1 /3% support test 21. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1 /3% or more, check this box and stop here. The organization qualifies as a publicly supported organization a 1%-facts-and-circumstances test 211. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 1% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization b 1%-facts-and-circumstances test 21. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 1% or more, and if the organization meets the facts-and-circumstances test, check this box and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a publicly supported organization Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions Schedule A (Form 99 or 99-EZ) 211

8 Schedule A (Form 99 or 99-EZ) 211 Page 3 Part III Support Schedule for Organizations Described in Section 59(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) Section A. Public Support Calendar year (or fiscal year beginning in) (a) 27 (b) 28 (c) 29 (d) 21 (e) 211 (f) Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") 2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization s tax-exempt purpose... 3 Gross receipts from activities that are not an unrelated trade or business under section Tax revenues levied for the organization s benefit and either paid to or expended on its behalf... 5 The value of services or facilities furnished by a governmental unit to the organization without charge Total. Add lines 1 through a Amounts included on lines 1, 2, and 3 received from disqualified persons. b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5, or 1% of the amount on line 13 for the year c Add lines 7a and 7b Public support (Subtract line 7c from line 6.) Section B. Total Support Calendar year (or fiscal year beginning in) (a) 27 (b) 28 (c) 29 (d) 21 (e) 211 (f) Total 9 Amounts from line a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources. b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 3, c Add lines 1a and 1b Net income from unrelated business activities not included in line 1b, whether or not the business is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) Total support. (Add lines 9, 1c, 11, and 12.) First five years. If the Form 99 is for the organization s first, second, third, fourth, or fifth tax year as a section 51(c)(3) organization, check this box and stop here Section C. Computation of Public Support Percentage 15 Public support percentage for 211 (line 8, column (f) divided by line 13, column (f)) % 16 Public support percentage from 21 Schedule A, Part III, line % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 211 (line 1c, column (f) divided by line 13, column (f)) % 18 Investment income percentage from 21 Schedule A, Part III, line % 19a 33 1 /3% support tests 211. If the organization did not check the box on line 14, and line 15 is more than 33 1 /3%, and line 17 is not more than 33 1 /3%, check this box and stop here. The organization qualifies as a publicly supported organization. b 33 1 /3% support tests 21. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1 /3%, and line 18 is not more than 33 1 /3%, check this box and stop here. The organization qualifies as a publicly supported organization 2 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions Schedule A (Form 99 or 99-EZ) 211

9 Schedule A (Form 99 or 99-EZ) 211 Page 4 Part IV Supplemental Information. Complete this part to provide the explanations required by Part II, line 1; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions). Schedule A (Form 99 or 99-EZ) 211

10 SCHEDULE O (Form 99 or 99-EZ) Department of the Treasury Internal Revenue Service Name of the organization UAB Diabetes Trust Foundation Supplemental Information to Form 99 or 99-EZ Complete to provide information for responses to specific questions on Form 99 or 99-EZ or to provide any additional information. Attach to Form 99 or 99-EZ. Form 99-EZ, Part I, Line 1 - Contributions in support of the UAB Comprehensive Diabetes Center Employer identification number OMB No Open to Public Inspection Form 99-EZ, Part I, Line 2 - Unrealized gains/losses on investments Form 99-EZ, Part II, Line 26 - Cash value of Life Insurance Policies held for UAB For Paperwork Reduction Act Notice, see the Instructions for Form 99 or 99-EZ. Cat. No. 5156K Schedule O (Form 99 or 99-EZ) (211)

11 Schedule O, Statement 1 UAB Diabetes Trust Foundation Form: 99-EZ Page: 2 Line Number: Part II Line 24 Other Assets Structured Explanation Description EOY Amount Cash Value of Life Insurance Gifts Held for UAB 125,389 Charitable Remainder Trust 241,864 Accounts receivable 2,72 Total: 369,325 Page: 1

12 Schedule O, Statement 2 UAB Diabetes Trust Foundation Form: 99-EZ Page: 2 Line Number: Part III Primary Exempt Purpose Primary Exempt Purpose To support for the University of Alabama at Birmingham and its scientific and educational functions, specifically related to diabetes research, education, treatment and prevention. Page: 2

Short Form Return of Organization Exempt From Income Tax

Short Form Return of Organization Exempt From Income Tax Form 99-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private

More information

Client Copy KOPERNIK KOPERNIK SOLUTIONS 125 COURT STREET STE 10DS BROOKLYN, NY 11201 917-975-6352

Client Copy KOPERNIK KOPERNIK SOLUTIONS 125 COURT STREET STE 10DS BROOKLYN, NY 11201 917-975-6352 2009 TA RETURN Client Copy Client: Prepared for: KOPERNIK KOPERNIK SOLUTIONS 125 COURT STREET STE 10DS BROOKLYN, NY 11201 917-975-6352 Prepared by: Chunyee W. Miot CPA PC CHUNYEE W MIOT CPA PC 626 RECORP

More information

Short Form Return of Organization Exempt From Income Tax

Short Form Return of Organization Exempt From Income Tax Form 990-EZ PUBLIC DISCLOSURE COPY ** PUBLIC DISCLOSURE COPY ** Short Form Return of Organization Exempt From Income Tax Under section 501, 527, or 4947(1) of the Internal Revenue Code (except private

More information

l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492179004143

l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492179004143 l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492179004143 Form 990-EZ IN Department of the Treasury Internal Revenue Service Short Form OMB 1545-1150 Return of Organization Exempt From

More information

Form 990-EZ and supplemental forms and schedules. Sign and date: An officer must sign and date Form 990-EZ on page 4.

Form 990-EZ and supplemental forms and schedules. Sign and date: An officer must sign and date Form 990-EZ on page 4. Federal Filing Instructions 2014 Name(s) as shown on return Your Social Security Number Date to file by: 08-17-2015 Form to be filed: Form 990-EZ and supplemental forms and schedules Sign and date: An

More information

Short Form OMB No 1545-1150 Return of Organization Exempt From Income Tax 2011. and endina 06-30-2012

Short Form OMB No 1545-1150 Return of Organization Exempt From Income Tax 2011. and endina 06-30-2012 l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492286001092 990.EZ Short Form OMB 1545-1150 Return of Organization Exempt From Income Tax 2011 Form Under section 501 (c), 527, or 4947 (

More information

lefile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492221000650 1 Contributions, gifts, grants, and similar amounts received 1

lefile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492221000650 1 Contributions, gifts, grants, and similar amounts received 1 lefile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492221000650 Form 990-EZ IN Department of the Treasury Internal Revenue Service Short Form OMB No 1545-1150 Return of Organization Exempt From

More information

Short Form. Return of Organization Exempt From Income Tax

Short Form. Return of Organization Exempt From Income Tax I Form 990-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 501(c ), 527, or 4947( a)(1) of the Internal Revenue Code (except

More information

24465 22 22553 23 Land and buildings... 23 24 Other assets (describe INSTRUMENTS MUSIC UNIFORMS TRAILER ) 8000 24 9605

24465 22 22553 23 Land and buildings... 23 24 Other assets (describe INSTRUMENTS MUSIC UNIFORMS TRAILER ) 8000 24 9605 all) 0 0N -44 Short Form Return of Organization Exempt From Income Tax 990^F1 Form Under section 501 (c), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

More information

13 Professional fees and other payments to independent contractors... 13 7,000... 14 20,358

13 Professional fees and other payments to independent contractors... 13 7,000... 14 20,358 CU c%j Fom, 990 ^EZ Short Form Return of Organization Exempt From Income Tax Under section 501 (c), 527, or 4947 (a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-0047 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 2010 benefit trust or private foundation)

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit

More information

Form 990-EZ Checklist

Form 990-EZ Checklist Pickens Snodgrass Koch LLP Form 990-EZ Checklist Please also complete Form 990-EZ Supplemental Schedules Checklist Revised 11/24/2008 1. Name of Organization 2. Organization exempt status (please circle)

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-0047 Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 2011 benefit trust or private foundation)

More information

FEELEY & DRISCOLL, P.C. CERTIFIED PUBLIC ACCOUNTANTS/BUSINESS CONSULTANTS 200 PORTLAND STREET BOSTON, MA

FEELEY & DRISCOLL, P.C. CERTIFIED PUBLIC ACCOUNTANTS/BUSINESS CONSULTANTS 200 PORTLAND STREET BOSTON, MA FEELEY & DRISCOLL, P.C. CERTIFIED PUBLIC ACCOUNTANTS/BUSINESS CONSULTANTS 200 PORTLAND STREET BOSTON, MA 02114 617-742-7788 AUGUST 8, 2013 CHRISTOPHER ATTLES CAMP HALE ALUMNI ASSOCIATION 566 COLUMBUS AVE

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-47 Form 99 Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 215 Do not enter social security

More information

0 BOX 1920 212-840-51 35 OAmended Lions return. or ASSOCIATION print or MONITORING EAU,& /O DGA SECURITY SYSTEMS, INC. 20-8098207

0 BOX 1920 212-840-51 35 OAmended Lions return. or ASSOCIATION print or MONITORING EAU,& /O DGA SECURITY SYSTEMS, INC. 20-8098207 i Form r 990-EZ ^D Return ojb^jw^n a1onxempt From Income Tax Under section 501(c), 527, or 4947( a)(1) of the Internal Revenue Code ( except black lung benefit trust or private foundation) Sponsoring organizations

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-47 Form 99 Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 214 Do not enter social security

More information

Other (specify), H Check III-, if the organization is not I Website :

Other (specify), H Check III-, if the organization is not I Website : L c w 0 For, 990-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 501(c ), 527, or 4947( a)(1) of the Internal Revenue Code

More information

... 1 2 Program service revenue including government fees and contracts 2 3 Membership dues and assessments..

... 1 2 Program service revenue including government fees and contracts 2 3 Membership dues and assessments.. 990 -^Z Short Form Return of Organization Exempt From Income Tax Form Under section 501(c ), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Sponsoring

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-0047 Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 2014 Do not enter social security

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 99 Return of Organization Exempt From Income Tax OMB No. 1545-47 Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung 21 benefit trust or private foundation) Open

More information

Small Business Services 112 Krog Street, Ste# 17 Atlanta, GA 30307 (404) 873-0470 info@smallbizservices.com

Small Business Services 112 Krog Street, Ste# 17 Atlanta, GA 30307 (404) 873-0470 info@smallbizservices.com Small Business Services 112 Krog Street, Ste# 17 Atlanta, GA 30307 (404) 873-0470 info@smallbizservices.com May 16, 2011 Global Soap Project Inc. P.O. Box 94021 Atlanta, GA 30318 Dear John E. Parkerson,

More information

c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) 70,712 6c

c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) 70,712 6c l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492074007020 Form 990-EZ IN Department of the Treasury Internal Revenue Service Short Form OMB No 1545-1150 Return of Organization Exempt

More information

RESCUED AND ADOPTED OUT DOGS AND CATS; AIDED IN THE SPAYING AND NEUTERING OF THE ANIMALS WHEN APPROPRIATE TO LOW-INCOME FAMILIES

RESCUED AND ADOPTED OUT DOGS AND CATS; AIDED IN THE SPAYING AND NEUTERING OF THE ANIMALS WHEN APPROPRIATE TO LOW-INCOME FAMILIES Form 990 (2013) H A L O 86-0832160 Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III..................................................

More information

TO IMPROVE THE HEALTH OF CHILDREN BY PROVIDING THEM THE MOTIVATION, TOOLS AND SUPPORT TO LIVE HAPPIER AND HEALTHIER LIFESTYLES.

TO IMPROVE THE HEALTH OF CHILDREN BY PROVIDING THEM THE MOTIVATION, TOOLS AND SUPPORT TO LIVE HAPPIER AND HEALTHIER LIFESTYLES. Form 990 (2014) Marathon Kids, Inc. 06-1722171 Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III 1 Briefly describe

More information

A For the 2011 calendar year, or tax year beginning, 2011, and ending, D Employer identification number. 27-4205517 Name change

A For the 2011 calendar year, or tax year beginning, 2011, and ending, D Employer identification number. 27-4205517 Name change Form 990-EZ Department of the Treasury Internal Revenue Service A For the 2011 calendar year, or tax year beginning, 2011, and ending, B Check if applicable: C Name of organization D Employer identification

More information

2013 Exempt Organization Business Tax Return prepared for: THE ARC OF COLORADO 1580 LOGAN STREET, #730 DENVER, CO 80203-1942

2013 Exempt Organization Business Tax Return prepared for: THE ARC OF COLORADO 1580 LOGAN STREET, #730 DENVER, CO 80203-1942 201 Exempt Organization Business Tax Return prepared for: THE ARC OF COLORADO 1580 LOAN STREET, #70 DENVER, CO 8020-1942 BENZ SEYFERT & COMPANY, INC. 1620 WASHINTON AVE OLDEN, CO 80401 Form 990 Department

More information

Charitable Activities Section Oregon Department of Justice

Charitable Activities Section Oregon Department of Justice Form CT-12 For Oregon Charities Section I. General Information 1. THE KYRON HORMAN FOUNDATION 1338 SW VIOLET CT BEAVERTON, OR 978-514 RECEDED Charitable Activities Section Oregon Department of Justice

More information

990^EZ. Short Form Return of Organization Exempt From Income Tax 'ADAMS POOL CORPORATION 3DG R (781) 863-5319 101415.97 25 119284.

990^EZ. Short Form Return of Organization Exempt From Income Tax 'ADAMS POOL CORPORATION 3DG R (781) 863-5319 101415.97 25 119284. 990^EZ Short Form Return of Organization Exempt From Income Tax OMB No 1545-1150 20005 Form Under section 501 (c), 527, or 4947 (a)(1) of the Internal Revenue Code (except black lung benefit trust or private

More information

4 a (Code: ) (Expenses $ 184,481 including grants of $ ) (Revenue $ 5,645 ) 4 c (Code: ) (Expenses $ 24,587 including grants of $ ) (Revenue $ 0 )

4 a (Code: ) (Expenses $ 184,481 including grants of $ ) (Revenue $ 5,645 ) 4 c (Code: ) (Expenses $ 24,587 including grants of $ ) (Revenue $ 0 ) Form 990 (2013) Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III............. 1 Briefly describe the organization

More information

and ending '

and ending ' l efile GRAPHIC p rint - DO NOT PROCESS As Filed Data - DLN: 93492133018683 Form 990-EZ IN Department of the Treasury Internal Revenue Service Short Form OMB No 1545-1150 Return of Organization Exempt

More information

Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support

Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support 2009 Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless

More information

Short Form Return of Organization Exempt From Income Tax

Short Form Return of Organization Exempt From Income Tax I I C (r. or, c_ - Ct Form 990_EZ Short Form Return of Organization Exempt From Income Tax OMB No. 1545-1150 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code 2009 (except black lung

More information

Inspection A For the 2014 calendar year, or tax year beginning Jul 1, 2014, and ending Jun 30, 2015

Inspection A For the 2014 calendar year, or tax year beginning Jul 1, 2014, and ending Jun 30, 2015 Form 990 OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2014 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) G Do not enter social security

More information

Instructions for Schedule A (Form 990 or 990-EZ)

Instructions for Schedule A (Form 990 or 990-EZ) 2010 Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service A For the 2011 calendar year, or tax year beginning, 2011, and ending, B Check if applicable: C D Employer Identification Number Address change

More information

Open to Public Inspection A For the 2011 calendar year, or tax year beginning B Check if applicable: C Name of organization

Open to Public Inspection A For the 2011 calendar year, or tax year beginning B Check if applicable: C Name of organization Form 990 Department of the Treasury Internal Revenue Service Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service A For the 2006 calendar year, or tax year beginning, 2006, and ending, B Check if applicable: C D Employer Identification Number Please use

More information

Instructions for Schedule A (Form 990 or 990-EZ)

Instructions for Schedule A (Form 990 or 990-EZ) 2011 Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless

More information

SEE SCHEDULE O SEE SCHEDULE O 1,321,367.

SEE SCHEDULE O SEE SCHEDULE O 1,321,367. Form 990 (2011) ERCES SOCIETY, INC. 51-0175253 Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response to any question in this Part III....................................................

More information

F Group Exemption Appdlication ttons. OAKLAND, CA 94621-1 4 60

F Group Exemption Appdlication ttons. OAKLAND, CA 94621-1 4 60 , 990 -EZ Short Form OMB No 1545-1150 Return of Organization Exempt From Income Tax Form Under section 501(c ), 527, or 4947( a)(1) of the Internal Revenue Code ^oo Q (except black lung benefit trust or

More information

Forms 990 and 990-PF for Tax Exempt Organizations Arkansas Federal Tax Institute December 5, 2014. By Michelle C. Mann, CPA JPMS Cox, PLLC

Forms 990 and 990-PF for Tax Exempt Organizations Arkansas Federal Tax Institute December 5, 2014. By Michelle C. Mann, CPA JPMS Cox, PLLC Forms 990 and 990-PF for Tax Exempt Organizations Arkansas Federal Tax Institute December 5, 2014 By Michelle C. Mann, CPA JPMS Cox, PLLC Tax Exempt Entity Forms Form 990 (expanded for 2008 forward) Form

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service For the 2011 calendar year, or tax year beginning, 2011, and ending, B Check if applicable: C D Employer Identification Number ddress change

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service A For the 2011 calendar year, or tax year beginning, 2011, and ending, B Check if applicable: C D Employer Identification Number Address change

More information

For the 2014 calendar year, or tax year beginning

For the 2014 calendar year, or tax year beginning Form 99 OMB. - Department of the Treasury Internal Revenue Service A B For the calendar year, or tax year beginning C Check if applicable: Address change Name change Initial return Return of Organization

More information

COUNTY ROAD BEN LOMOND GUN CLUB, INC LIZABETH CO Number lop,

COUNTY ROAD BEN LOMOND GUN CLUB, INC LIZABETH CO Number lop, Form 4 990-EZ Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947 ( a)(1) of the Internal Revenue Code ( except black lung benefit trust or private foundation) Sponsoring

More information

Number, street, and room or suite no. If a P.O. box, see the instructions. City or town, state or province, country, and ZIP or foreign postal code

Number, street, and room or suite no. If a P.O. box, see the instructions. City or town, state or province, country, and ZIP or foreign postal code Form 1065 Department of the Treasury Internal Revenue Service A Principal business activity U.S. Return of Partnership Income For calendar year 2015, or tax year beginning, 2015, ending, 20. Information

More information

U.S. Income Tax Return for an S Corporation

U.S. Income Tax Return for an S Corporation Form 1120S U.S. Income Tax Return for an S Corporation Do not file this form unless the corporation has filed or is attaching Form 2553 to elect to be an S corporation. Information about Form 1120S and

More information

990^EZ. H Check 3q if the organization I Website : 10- wwf Lakesherwoodacres. com

990^EZ. H Check 3q if the organization I Website : 10- wwf Lakesherwoodacres. com 990^EZ Short Form Return of Organization Exempt From Income Tax Form Under section 501(c ), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Sponsoring

More information

PALO ALTO, CA 94301 949-667-0796. 2 Check this box G if the organization discontinued its operations or disposed of more than 25% of its net assets.

PALO ALTO, CA 94301 949-667-0796. 2 Check this box G if the organization discontinued its operations or disposed of more than 25% of its net assets. Form 990 OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2013 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) G Do not enter Social Security

More information

Instructions for Schedule A (Form 990 or 990-EZ)

Instructions for Schedule A (Form 990 or 990-EZ) 2012 Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax PUBLIC DISCLOSURE COPY OMB No. 545-47 Form 99 Return of Organization Exempt From Income Tax Under section 5(c), 527, or 4947(a)() of the Internal Revenue Code (except private foundations) 23 Do not enter

More information

01^ 1k 990-EZ. ated 12-11 43RD AVENUE 718-361-0145 1 13141020 759639 PMT77017.04 2009.04050 UNITED UNION OF ROOFERS - L PMT77011.

01^ 1k 990-EZ. ated 12-11 43RD AVENUE 718-361-0145 1 13141020 759639 PMT77017.04 2009.04050 UNITED UNION OF ROOFERS - L PMT77011. i m O Form 990-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code ( except

More information

Instructions for IRS Form 990-EZ

Instructions for IRS Form 990-EZ Overview These instructions are intended to help clarify and supplement the Instructions for Form 990-EZ as published by the IRS. They are not intended to replace those instructions. Both the form and

More information

Instructions for Schedule A (Form 990 or 990-EZ)

Instructions for Schedule A (Form 990 or 990-EZ) 2014 Instructions for Schedule A (Form 990 or 990-EZ) Public Charity Status and Public Support Department of the Treasury Internal Revenue Service Section references are to the Internal Revenue Code unless

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Termination Please use IRS label or print or type. See specific Instructions. Return of Organization Exempt From Income Tax Amended return G Gross receipts $ 591,316. Application pending F Name

More information

Short Form Return of Organization Exempt From Income Tax 990-EZ 2009

Short Form Return of Organization Exempt From Income Tax 990-EZ 2009 OMB 1545-1150 Form Under section 501, 527, or 4947(1) of the Internal Revenue Code (except lack lung enefit trust or private foundation) Sponsoring organizations of donor advised funds and controlling

More information

U.S. Corporation Income Tax Return For calendar year 2015 or tax year beginning, 2015, ending, 20

U.S. Corporation Income Tax Return For calendar year 2015 or tax year beginning, 2015, ending, 20 Form 1120 Department of the Treasury Internal Revenue Service A Check if: 1a Consolidated return (attach Form 851). b Life/nonlife consolidated return... 2 Personal holding co. (attach Sch. PH).. 3 Personal

More information

The Public Support Test What a Grant Seeker Should Know

The Public Support Test What a Grant Seeker Should Know I. Overview: Why Public Support is Important The Public Support Test What a Grant Seeker Should Know Organizations that seek grants from foundations are usually principally interested in obtaining the

More information

Instructions for Form 990-EZ

Instructions for Form 990-EZ 2013 Instructions for Form 990-EZ Department of the Treasury Internal Revenue Service Short Form Return of Organization Exempt From Income Tax Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue

More information

Short Form ... 23 24 Other assets (describe ) 24 25 Total assets

Short Form ... 23 24 Other assets (describe ) 24 25 Total assets W It C CC C. C 990 Short Form OMB No 15451150 Return of Organization Exempt From Income Tax Form EZ Under section 501(c ), 527, or 4947 (a)(1) of the Internal Revenue Code R008 (except black lung benefit

More information

QUALIFYING FOR PUBLIC CHARITY STATUS: The Section 170(b)(1)(A)(vi) and 509(a)(1) Test and the Section 509(a)(2) Test

QUALIFYING FOR PUBLIC CHARITY STATUS: The Section 170(b)(1)(A)(vi) and 509(a)(1) Test and the Section 509(a)(2) Test QUALIFYING FOR PUBLIC CHARITY STATUS: The Section 170(b)(1)(A)(vi) and 509(a)(1) Test and the Section 509(a)(2) Test Tax-exempt status under Section 501(c)(3) of the Internal Revenue Code permits a charitable

More information

33182 25 37604 26 Total liabilities (describe ) - 26 - - 27 Net assets or fund balances ine 27 of column (B) must ag ree with line 21 ) 33182 27

33182 25 37604 26 Total liabilities (describe ) - 26 - - 27 Net assets or fund balances ine 27 of column (B) must ag ree with line 21 ) 33182 27 assets_ TU CIQ 6Sa Z Form 990^EZ Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private

More information

F Group Exemption Application p endin g

F Group Exemption Application p endin g C-J er) lu z 990-EZ Short Form Return of Organization Exempt From Income Tax Form Under section 501 (c), 527, or 4947 (a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

More information

OMB No. 1545-0047 Form 990. Return of Organization Exempt From Income Tax. Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code

OMB No. 1545-0047 Form 990. Return of Organization Exempt From Income Tax. Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code OMB. 1545-0047 Form 990 Return of Organization Exempt From Income Tax 2012 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code Department of the Treasury Internal Revenue Service (except

More information

P.O. BOX 3870 360.337.2978 SILVERDALE, WA 98383-3870

P.O. BOX 3870 360.337.2978 SILVERDALE, WA 98383-3870 Form 990 Department of the Treasury Internal Revenue Service OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2014 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except

More information

Open to Public Inspection A For the 2015 calendar year, or tax year beginning, 2015, and ending,

Open to Public Inspection A For the 2015 calendar year, or tax year beginning, 2015, and ending, Form 990 Department of the Treasury Internal Revenue Service OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2015 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except

More information

PUBLIC DISCLOSURE COPY Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation

PUBLIC DISCLOSURE COPY Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation 11/7/2016 12:44:04 PM 1 2015 Return Lumina Foundation for Education, Inc. 35-1813228 Form 990-PF PUBLIC DISCLOSURE COPY Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation

More information

2015 EXEMPT ORGANIZATION INCOME TAX RETURN CHECKLIST (FORM 990)

2015 EXEMPT ORGANIZATION INCOME TAX RETURN CHECKLIST (FORM 990) 2015 EXEMPT ORGANIZATION INCOME TAX Client Name and Number: Prepared by: Date: Reviewed by: Date: 100) GENERAL INFORMATION DONE N/A 101) Determine if the organization is exempt from filing an exempt organization

More information

990-EZ. Short Form Return of Organization Exempt From Income Tax Form 75-0832625 (972) 403-7018

990-EZ. Short Form Return of Organization Exempt From Income Tax Form 75-0832625 (972) 403-7018 990-EZ Short Form Return of Organization Exempt From Income Tax Form Under section 501 (c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) Sponsoring

More information

or Section 4947(a)(1) Trust Treated as Private Foundation

or Section 4947(a)(1) Trust Treated as Private Foundation Form 990-PF Department of the Treasury Internal Revenue Service OMB No. 1545-0052 Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation 2013 G Do not enter Social Security

More information

NON-PROFIT TAX EXEMPT STATUS

NON-PROFIT TAX EXEMPT STATUS INTELLECTUAL PROPERTY AND TRANSACTIONAL LAW CLINIC NON-PROFIT TAX EXEMPT STATUS INTRODUCTORY OVERVIEW In order for an organization to qualify as a tax-exempt organization, it must meet the qualifications

More information

Form 990 Return of Organization Exempt From Income Tax

Form 990 Return of Organization Exempt From Income Tax OMB No. 1545-47 Form 99 Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) 214 Do not enter social security

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service G The organization may have to use a copy of this return to satisfy state reporting requirements. A For the 2011 calendar year, or tax year

More information

Form 1023-EZ Streamlined Application for Reinstatement of Tax-Exempt Status For Organizations within 15 months of Revocation

Form 1023-EZ Streamlined Application for Reinstatement of Tax-Exempt Status For Organizations within 15 months of Revocation Form 1023-EZ Streamlined Application for Reinstatement of Tax-Exempt Status For Organizations within 15 months of Revocation Dear PTA Leader: The IRS has released their new Form 1023-EZ to facilitate the

More information

OBICI HEALTHCARE FOUNDATION, INC.

OBICI HEALTHCARE FOUNDATION, INC. OBICI HEALTHCARE FOUNDATION, INC. Electronic Filing https://gosystemrs.fasttax.com/elfcumulativehistory.asp?acct=2502&year=2014&loc=... Page 1 of 1 11/13/2015 Cumulative e-file History 2014 Federal Locator:

More information

Note: Page 1 of 6 Instructions for Form CHAR500 (rev. 2010)

Note: Page 1 of 6 Instructions for Form CHAR500 (rev. 2010) New York State Department of Law (Office of the Attorney General) Charities Bureau - Registration Section Instructions for Form CHAR500 Annual Filing for Charitable Organizations www.charitiesnys.com Contents:

More information

Club & LSC Financial Management. Jill J. Goodwin, CPA Waugh & Goodwin, LLP jgoodwin@waughgoodwinllp.com

Club & LSC Financial Management. Jill J. Goodwin, CPA Waugh & Goodwin, LLP jgoodwin@waughgoodwinllp.com Club & LSC Financial Management Jill J. Goodwin, CPA Waugh & Goodwin, LLP jgoodwin@waughgoodwinllp.com Form 990 Forms 1099 and W 2 State taxes Other current issues TAX ISSUES Form 990 File Form 990, 990

More information

Government Copy. Community Culinary School of Charlotte, Inc. 2401-A Distribution Street Charlotte, NC 28203 704.375.4500

Government Copy. Community Culinary School of Charlotte, Inc. 2401-A Distribution Street Charlotte, NC 28203 704.375.4500 2013 TA RETURN Government Copy Client: Prepared for: 6250 Community Culinary School of Charlotte, Inc. 2401-A Distribution Street Charlotte, NC 28203 704.375.4500 Prepared by: Terry W. Lancaster C. DeWitt

More information

PRIVATE FOUNDATION CAUTION: The purposes of this memorandum are to assist you, the directors of your private foundation, and your accountant in:

PRIVATE FOUNDATION CAUTION: The purposes of this memorandum are to assist you, the directors of your private foundation, and your accountant in: CHERRY CREEK CORPORATE CENTER 4500 CHERRY CREEK DRIVE SOUTH #600 DENVER, CO 80246-1500 303.322.8943 WWW.WADEASH.COM DISCLAIMER Material presented on the Wade Ash Woods Hill & Farley, P.C., website is intended

More information

INSTRUCTIONS FOR FILING THE BELK FOUNDATION FORM 990PF - RETURN OF PRIVATE FOUNDATION FOR THE PERIOD ENDED MAY 31, 2015

INSTRUCTIONS FOR FILING THE BELK FOUNDATION FORM 990PF - RETURN OF PRIVATE FOUNDATION FOR THE PERIOD ENDED MAY 31, 2015 INSTRUCTIONS FOR FILING THE BELK FOUNDATION FORM 990PF - RETURN OF PRIVATE FOUNDATION FOR THE PERIOD ENDED MAY 31, 2015 ************************* SIGNATURE... THE ORIGINAL RETURN SHOULD BE SIGNED (USING

More information

Open to Public Inspection A For the 2013 calendar year, or tax year beginning 7/01, 2013, and ending 6/30, 2014 B Check if applicable: C

Open to Public Inspection A For the 2013 calendar year, or tax year beginning 7/01, 2013, and ending 6/30, 2014 B Check if applicable: C Form 990 OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2013 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) G Do not enter Social Security

More information

(c) Compensation. (b) Title and average hours per week devoted to position. Type or print name and title tp sel^ck if Pre arer s Identdy mg.

(c) Compensation. (b) Title and average hours per week devoted to position. Type or print name and title tp sel^ck if Pre arer s Identdy mg. Form 990-EZ (2008) Page 4 Part VI Section 501 (c)(3) organizations only. All section 501(c)(3) organizations must answer questions 46-49 and complete the tables for lines 50 and 51., 46 Did the organization

More information

NUVASIVE SPINE FOUNDATION

NUVASIVE SPINE FOUNDATION NUVASIVE SPINE FOUNDATION KPMG LLP 355 S. Grand Avenue, Suite 2000 Los Angeles, CA 90071 Telephone 213-972-4000 Fax 213-630-2279 Private The Nuvasive Spine Foundation 7475 LUSK BOULEVARD Enclosed are the

More information

Inspection A For the 2013 calendar year, or tax year beginning, 2013, and ending, B Check if applicable: C 45-1611066 ROSS, CA 94957 415-386-1200

Inspection A For the 2013 calendar year, or tax year beginning, 2013, and ending, B Check if applicable: C 45-1611066 ROSS, CA 94957 415-386-1200 Form 990 OMB No. 1545-0047 Return of Organization Exempt From Income Tax 2013 Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) G Do not enter Social Security

More information

Short Form. OMB No 1545-1150 Return of Organization Exempt From Income Tax Under section 501 (c), 527, or 4947(aXl) of the Internal Revenue Code

Short Form. OMB No 1545-1150 Return of Organization Exempt From Income Tax Under section 501 (c), 527, or 4947(aXl) of the Internal Revenue Code cc r clk 0 LU Z Z V Form 990 -EZ Short Form OMB No 1545-1150 Return of Organization Exempt From Income Tax Under section 501 (c), 527, or 4947(aXl) of the Internal Revenue Code 2005 (except black lung

More information

SIGNATURE... THE ORIGINAL RETURN SHOULD BE SIGNED (USING FULL NAME AND TITLE) AND DATED BY AN AUTHORIZED OFFICER OF THE ORGANIZATION.

SIGNATURE... THE ORIGINAL RETURN SHOULD BE SIGNED (USING FULL NAME AND TITLE) AND DATED BY AN AUTHORIZED OFFICER OF THE ORGANIZATION. INSTRUCTIONS FOR FILING PARK FOUNDATION, INC. FORM 990PF - RETURN OF PRIVATE FOUNDATION FOR THE PERIOD ENDED DECEMBER 31, 2014 ************************* SIGNATURE... THE ORIGINAL RETURN SHOULD BE SIGNED

More information

Instructions for Form 990-N and 990-EZ. For Additional Information Contact 990help@pta.org

Instructions for Form 990-N and 990-EZ. For Additional Information Contact 990help@pta.org Instructions for Form 990-N and 990-EZ For Additional Information Contact 990help@pta.org Table of Contents Frequently Asked Questions... 2 E-Postcard 990 N... 4 Required Information... 4 Form 990-N: Step

More information

1. The organization mission or most significant activities that you wish to highlight this year:

1. The organization mission or most significant activities that you wish to highlight this year: Form 990 Questionnaire For All Organizations Core Form Heading & Pt I Summary 1. The organization mission or most significant activities that you wish to highlight this year: 2. Total number of volunteers

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 990 Department of the Treasury Internal Revenue Service Terminated Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black

More information

Return of Organization Exempt From Income Tax

Return of Organization Exempt From Income Tax Form 99 Return of Organization Exempt From Income Tax OMB No. 1545-47 Under section 51(c), 57, or 4947(a)(1) of the Internal Revenue Code (except black lung 1 benefit trust or private foundation) Open

More information

Sample Tax Return Robb Stark:

Sample Tax Return Robb Stark: Sample Tax Return Robb Stark: Robb s Swarthmore Account information: 212 13 213 14 $47,88 Swarthmore Scholarship $47,758 Swarthmore Scholarship $5, Pell Grant $4, Pell Grant $1, Rotary Club Scholarship

More information

Instructions for Schedule L (Form 990 or 990-EZ)

Instructions for Schedule L (Form 990 or 990-EZ) 2010 Instructions for Schedule L (Form 990 or 990-EZ) Transactions With Interested Persons Department of the Treasury Internal Revenue Service State whether the transaction has been Section references

More information

Short Form Form 990-EZ Return of Organization Exempt From Income Tax

Short Form Form 990-EZ Return of Organization Exempt From Income Tax Short Form Form 990-EZ Return of Organization Exempt From Income Tax Under serbon 501(c). 527. or 4947(aXl) d the brcem Revenue Code OMB No 1545.1150 2008 (oooept blank king benefit trust or private foundation)

More information

Form 990 and Tax Update Olivia A. Hutton, CPA

Form 990 and Tax Update Olivia A. Hutton, CPA Form 990 and Tax Update Olivia A. Hutton, CPA Certified Public Accountants and Consultants Connecting depth and insight with community values. Your 990 should prove that you are: Organized and operated

More information

Return of Private Foundation

Return of Private Foundation Form 990-PF Department of the Treasury Internal Revenue Service I Return of Private Foundation OMB No. 1545-0052 I or Section 4947(a)(1) Trust Treated as Private Foundation Do not enter Social Security

More information

U.S. Property and Casualty Insurance Company Income Tax Return. For calendar year 2014, or tax year beginning, 2014, and ending, 20.

U.S. Property and Casualty Insurance Company Income Tax Return. For calendar year 2014, or tax year beginning, 2014, and ending, 20. Form 1120-PC Department of the Treasury Internal Revenue Service A Check if: 1 Consolidated return (attach Form 851). 2 Life-nonlife consolidated return.. 3 Schedule M-3 (Form 1120-PC) attached... U.S.

More information

4 c (Code: ) (Expenses $ including grants of $ ) (Revenue $ )

4 c (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) Form 990 (2013) Page 2 Part III Statement of Program Service Accomplishments Check if Schedule O contains a response or note to any line in this Part III............. 1 Briefly describe the organization

More information

Short Form Return of Organization Exempt From Income Tax

Short Form Return of Organization Exempt From Income Tax Short Form Return of Organization Exempt From Income Tax OMB No. 1545-1150 Form Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except lack lung enefit trust or 990-EZ private foundation)

More information