359,843 4,352 32,364 49,373 51,701

Transcription

1 Forms 99 / 99-EZ Return Summary For calendar year 21, or tax year eginning Denton Assistance Center Inc, and ending Net Asset / Fund Balance at Beginning of Year 11,89 Revenue Contriutions Program service revenue Investment income Capital gain / loss Fundraising / Gaming: Gross revenue Direct expenses Net income Other income Total revenue Expenses Program services Management and general Fundraising Total expenses Excess / (deficit) 1,1 99,699 9,8 286,2 2,6 9,7 1,71 6,81 1,8 21, Changes Net Asset / Fund Balance at End of Year,92 Reconciliation of Revenue Total revenue per financial statements Less: Unrealized gains Donated services Recoveries Other Plus: Investment expenses Other Total revenue per return Reconciliation of Expenses Total expenses per financial statements Less: Donated services Prior year adjustments Losses Other Plus: Investment expenses Other 6,81 Total expenses per return 1,8 Assets Liailities Net assets Beginning Balance Sheet Ending Differences 11,61 7, ,1 11,89,92 21, Miscellaneous Information Amended return Return / extended due date Failure to file penalty 11/1/1

2 Form Department of the Treasury Internal Revenue Service Name of exempt organization Name and title of officer check the ox on line 1a, 2a, a, a, or a, elow, and the amount on that line for the return eing filed with this form was lank, then leave line 1, 2,,, or, whichever is applicale, lank (do not enter --). But, if you entered -- on the return, then enter -- on the applicale line elow. Do not complete more than 1 line in Part I. a a Part I Form 99-PF check here Form 8868 check here Part II 8879-EO For calendar year 21, or fiscal year eginning , 21, and ending , Under penalties of perjury, I declare that I am an officer of the aove organization and that I have examined a copy of the organization s 21 electronic return and accompanying schedules and statements and to the est of my knowledge and elief, they are true, correct, and complete. I further declare that the amount in Part I aove is the amount shown on the copy of the organization s electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO) to send the organization s return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection of the transmission, () the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicale, I authorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct deit) entry to the financial institution account indicated in the tax preparation software for payment of the organization s federal taxes owed on this return, and the financial institution to deit the entry to this account. To revoke a payment, I must contact the U.S. Treasury Financial Agent at no later than 2 usiness days prior to the payment (settlement) date. I also authorize the financial institutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries and resolve issues related to the payment. I have selected a personal identification numer (PIN) as my signature for the organization s electronic return and, if applicale, the organization s consent to electronic funds withdrawal. I authorize to enter my PIN as my signature ERO firm name Enter five numers, ut do not enter all zeros on the organization s tax year 21 electronically filed return. If I have indicated within this return that a copy of the return is eing filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementioned ERO to enter my PIN on the return s disclosure consent screen. As an officer of the organization, I will enter my PIN as my signature on the organization s tax year 21 electronically filed return. If I have indicated within this return that a copy of the return is eing filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I will enter my PIN on the return s disclosure consent screen. Officer's signature } Part III Certification and Authentication ERO's EFIN/PIN. Enter your six-digit electronic filing identification numer (EFIN) followed y your five-digit self-selected PIN. u Do not send to the IRS. Keep for your records. u Information aout Form 8879-EO and its instructions is at IRS e-file Signature Authorization for an Exempt Organization Type of Return and Return Information (Whole Dollars Only) 1a Form 99 check here Total revenue, if any (Form 99, Part VIII, column (A), line 12) a Form 99-EZ check here Total revenue, if any (Form 99-EZ, line 9) a Form 112-POL check here Total tax (Form 112-POL, line 22) Tax ased on investment income (Form 99-PF, Part VI, line ) Balance Due (Form 8868, Part I, line c or Part II, line 8c) Declaration and Signature Authorization of Officer Officer's PIN: check one ox only Date Employer identification numer Patrick Smith Director Check the ox for the return for which you are using this Form 8879-EO and enter the applicale amount, if any, from the return. If you } OMB ,81 Merki & Associates, P.C /1/ do not enter all zeros I certify that the aove numeric entry is my PIN, which is my signature on the 21 electronically filed return for the organization indicated aove. I confirm that I am sumitting this return in accordance with the requirements of Pu. 16, Modernized e-file (MeF) Information for Authorized IRS e-file Providers for Business Returns. ERO's signature } April M. Cain 11/1/1 Date } For Paperwork Reduction Act tice, see ack of form. ERO Must Retain This Form See Instructions Do t Sumit This Form To the IRS Unless Requested To Do So Form 8879-EO (21)

3 Form Department of the Treasury Internal Revenue Service A B I J K Activities & Governance Revenue Expenses Net Assets or Fund Balances For the 21 calendar year, or tax year eginning Check if applicale: Address change Name change Initial return Terminated 99 Amended return Application pending Tax-exempt status: Wesite: u Form of organization: Part I 1 2 C Name of organization F Doing Business As Return of Organization Exempt From Income Tax Under section 1(c), 27, or 97(a)(1) of the Internal Revenue Code (except private foundations) u Do not enter Social Security numers on this form as it may e made pulic. u Information aout Form 99 and its instructions is at Numer and street (or P.O. ox if mail is not delivered to street address) City or town, state or province, country, and ZIP or foreign postal code Name and address of principal officer:, and ending 1(c) ( ) t (insert no.) 97(a)(1) or 27 1 Grants and similar amounts paid (Part I, column (A), lines 1 ) Benefits paid to or for memers (Part I, column (A), line ) Salaries, other compensation, employee enefits (Part I, column (A), lines 1) a Professional fundraising fees (Part I, column (A), line 11e) Total fundraising expenses (Part I, column (D), line 2) u , Other expenses (Part I, column (A), lines 11a 11d, 11f 2e) Total expenses. Add lines 1 17 (must equal Part I, column (A), line 2) Room/suite D E Telephone numer G Gross receipts $ OMB Open to Pulic Inspection Employer identification numer H(a) Is this a group return for suordinates? H() Are all suordinates included? If "," attach a list. (see instructions) H(c) Group exemption numer u Corporation Trust Association Other u L Year of formation: 21 M State of legal domicile: T Summary Briefly descrie the organization's mission or most significant activities: Check this ox u if the organization discontinued its operations or disposed of more than 2% of its net assets. Numer of voting memers of the governing ody (Part VI, line 1a) Numer of independent voting memers of the governing ody (Part VI, line 1) Total numer of individuals employed in calendar year 21 (Part V, line 2a) Total numer of volunteers (estimate if necessary) a Total unrelated usiness revenue from Part VIII, column (C), line Net unrelated usiness taxale income from Form 99-T, line Prior Year rth Elm Denton Assistance Center Inc Serve Denton Denton T 7621 Pat Smith 821 rth Elm Denton T (c)() See Schedule O Contriutions and grants (Part VIII, line 1h) Program service revenue (Part VIII, line 2g) Investment income (Part VIII, column (A), lines,, and 7d) Other revenue (Part VIII, column (A), lines, 6d, 8c, 9c, 1c, and 11e) Total revenue add lines 8 through 11 (must equal Part VIII, column (A), line 12) Revenue less expenses. Sutract line 18 from line Total assets (Part, line 16) Total liailities (Part, line 26) Net assets or fund alances. Sutract line 21 from line Part II Signature Block 6 7a 7 Beginning of Current Year Current Year End of Year Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete. Declaration of preparer (other than officer) is ased on all information of which preparer has any knowledge ,18 216,18 9, ,1,2 171,677 6,81 26, 7,,8 8,16,2 6,21 16,66 1,8 21, 11,61 7, ,1 11,89,92 Sign Here Signature of officer Patrick Smith Type or print name and title Director Print/Type preparer's name Preparer's signature Date Check if PTIN Paid April M. Cain April M. Cain 11/1/1 self-employed P78 Preparer Firm's name } Merki & Associates, P.C. Firm's EIN } Use Only 1 Fulton St., Ste 1 Firm's address } Denton, T 7621 Phone no May the IRS discuss this return with the preparer shown aove? (see instructions) For Paperwork Reduction Act tice, see the separate instructions. Form 99 (21) Date

4 Form 99 (21) Page 2 Part III Statement of Program Service Accomplishments 1 Briefly descrie the organization's mission: Did the organization undertake any significant program services during the year which were not listed on the 2 prior Form 99 or 99-EZ? If "," descrie these new services on Schedule O. Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "," descrie these changes on Schedule O. Descrie the organization's program service accomplishments for each of its three largest program services, as measured y expenses. Section 1(c)() and 1(c)() organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. a (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) ) $ (Revenue ) $ including grants of $ ) (Expenses (Code: c (Code: $ including grants of $ ) ) (Expenses $ ) (Revenue. d Other program services. (Descrie in Schedule O.) (Revenue ) $ (Expenses ) $ including grants of $ e Total program service expenses u Form 99 (21) Check if Schedule O contains a response or note to any line in this Part III See Schedule O 2,6 6,89 In the process of developing a 16-acre central campus location that serves as a community crossroads where people can get the help they need, and the community can contriute through volunteering. Improving organizational cooperation, increasing pulic involvement, and expanding community resources. 2,6 11/1/21 :7 PM

5 Form 99 (21) a 1 1a Part IV a c d e f 2a Checklist of Required Schedules Is the organization descried in section 1(c)() or 97(a)(1) (other than a private foundation)? If, complete Schedule A Is the organization required to complete Schedule B, Schedule of Contriutors (see instructions)? Did the organization engage in direct or indirect political campaign activities on ehalf of or in opposition to candidates for pulic office? If, complete Schedule C, Part I Section 1(c)() organizations. Did the organization engage in loying activities, or have a section 1(h) election in effect during the tax year? If "," complete Schedule C, Part II Is the organization a section 1(c)(), 1(c)(), or 1(c)(6) organization that receives memership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "," complete Schedule C, Part III Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distriution or investment of amounts in such funds or accounts? If, complete Schedule D, Part I Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If, complete Schedule D, Part II Did the organization maintain collections of works of art, historical treasures, or other similar assets? If, complete Schedule D, Part III Did the organization report an amount in Part, line 21, for escrow or custodial account liaility; serve as a custodian for amounts not listed in Part ; or provide credit counseling, det management, credit repair, or det negotiation services? If, complete Schedule D, Part IV Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If, complete Schedule D, Part V If the organization's answer to any of the following questions is, then complete Schedule D, Parts VI, VII, VIII, I, or as applicale. Did the organization report an amount for land, uildings, and equipment in Part, line 1? If "," complete Schedule D, Part VI Did the organization report an amount for investments other securities in Part, line 12 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part VII Did the organization report an amount for investments program related in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part VIII Did the organization report an amount for other assets in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part I Did the organization report an amount for other liailities in Part, line 2? If "," complete Schedule D, Part Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liaility for uncertain tax positions under FIN 8 (ASC 7)? If "," complete Schedule D, Part Did the organization otain separate, independent audited financial statements for the tax year? If, complete Schedule D, Parts I and II Was the organization included in consolidated, independent audited financial statements for the tax year? If "," and if the organization answered "" to line 12a, then completing Schedule D, Parts I and II is optional Is the organization a school descried in section 17()(1)(A)(ii)? If, complete Schedule E Did the organization maintain an office, employees, or agents outside of the United States? Did the organization have aggregate revenues or expenses of more than $1, from grantmaking, fundraising, usiness, investment, and program service activities outside the United States, or aggregate foreign investments valued at $1, or more? If, complete Schedule F, Parts I and IV Did the organization report on Part I, column (A), line, more than $, of grants or other assistance to or for any foreign organization? If, complete Schedule F, Parts II and IV Did the organization report on Part I, column (A), line, more than $, of aggregate grants or other assistance to or for foreign individuals? If, complete Schedule F, Parts III and IV Did the organization report a total of more than $1, of expenses for professional fundraising services on Part I, column (A), lines 6 and 11e? If, complete Schedule G, Part I (see instructions) Did the organization report more than $1, total of fundraising event gross income and contriutions on Part VIII, lines 1c and 8a? If "," complete Schedule G, Part II Did the organization report more than $1, of gross income from gaming activities on Part VIII, line 9a? If "," complete Schedule G, Part III Did the organization operate one or more hospital facilities? If, complete Schedule H If to line 2a, did the organization attach a copy of its audited financial statements to this return? a 11 11c 11d 11e 11f 12a a a 2 Page Form 99 (21)

6 Form 99 (21) Page a Part IV a c a 6 7 c d 2a Checklist of Required Schedules (continued) Did the organization report more than $, of grants or other assistance to any domestic organization or government on Part I, column (A), line 1? If, complete Schedule I, Parts I and II Did the organization report more than $, of grants or other assistance to individuals in the United States on Part I, column (A), line 2? If "," complete Schedule I, Parts I and III Did the organization answer to Part VII, Section A, line,, or aout compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "," complete Schedule J Did the organization have a tax-exempt ond issue with an outstanding principal amount of more than $1, as of the last day of the year, that was issued after Decemer 1, 22? If, answer lines 2 through 2d and complete Schedule K. If, go to line 2a Did the organization invest any proceeds of tax-exempt onds eyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt onds? Did the organization act as an on ehalf of issuer for onds outstanding at any time during the year? Section 1(c)() and 1(c)() organizations. Did the organization engage in an excess enefit transaction with a disqualified person during the year? If, complete Schedule L, Part I. Is the organization aware that it engaged in an excess enefit transaction with a disqualified person in a prior year, and that the transaction has not een reported on any of the organization's prior Forms 99 or 99-EZ? If "," complete Schedule L, Part I Did the organization report any amount on Part, line, 6, or 22 for receivales from or payales to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, sustantial contriutor or employee thereof, a grant selection committee memer, or to a % controlled entity or family memer of any of these persons? If, complete Schedule L, Part III Was the organization a party to a usiness transaction with one of the following parties (see Schedule L, Part IV instructions for applicale filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, or key employee? If "," complete Schedule L, Part IV A family memer of a current or former officer, director, trustee, or key employee? If "," complete Schedule L, Part IV An entity of which a current or former officer, director, trustee, or key employee (or a family memer thereof) was an officer, director, trustee, or direct or indirect owner? If, complete Schedule L, Part IV Did the organization receive more than $2, in non-cash contriutions? If, complete Schedule M Did the organization receive contriutions of art, historical treasures, or other similar assets, or qualified conservation contriutions? If, complete Schedule M Did the organization liquidate, terminate, or dissolve and cease operations? If, complete Schedule N, Part I Did the organization sell, exchange, dispose of, or transfer more than 2% of its net assets? If "," complete Schedule N, Part II Did the organization own 1% of an entity disregarded as separate from the organization under Regulations sections and ? If, complete Schedule R, Part I Was the organization related to any tax-exempt or taxale entity? If, complete Schedule R, Parts II, III, or IV, and Part V, line Did the organization have a controlled entity within the meaning of section 12()(1)? If "" to line a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 12()(1)? If, complete Schedule R, Part V, line Section 1(c)() organizations. Did the organization make any transfers to an exempt non-charitale related organization? If, complete Schedule R, Part V, line Did the organization conduct more than % of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If, complete Schedule R, Part VI Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? te. All Form 99 filers are required to complete Schedule O a 2 2c 2d 2a a 28 28c a Form 99 (21)

7 Form 99 (21) Part V 1a c 2a a a a c 6a a c d e f g h a a a 12a Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response or note to any line in this Part V Enter the numer reported in Box of Form 196. Enter -- if not applicale Enter the numer of Forms W-2G included in line 1a. Enter -- if not applicale Did the organization comply with ackup withholding rules for reportale payments to vendors and reportale gaming (gamling) winnings to prize winners? Enter the numer of employees reported on Form W-, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered y this return If at least one is reported on line 2a, did the organization file all required federal employment tax returns? te. If the sum of lines 1a and 2a is greater than 2, you may e required to e-file (see instructions) Did the organization have unrelated usiness gross income of $1, or more during the year? If, has it filed a Form 99-T for this year? If to line, provide an explanation in Schedule O At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a ank account, securities account, or other financial account)? If, enter the name of the foreign country: u See instructions for filing requirements for Form TD F , Report of Foreign Bank and Financial Accounts. Was the organization a party to a prohiited tax shelter transaction at any time during the tax year? Did any taxale party notify the organization that it was or is a party to a prohiited tax shelter transaction? If to line a or, did the organization file Form 8886-T? Does the organization have annual gross receipts that are normally greater than $1,, and did the organization solicit any contriutions that were not tax deductile as charitale contriutions? If, did the organization include with every solicitation an express statement that such contriutions or gifts were not tax deductile? Organizations that may receive deductile contriutions under section 17(c). Did the organization receive a payment in excess of $7 made partly as a contriution and partly for goods and services provided to the payor? If, did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangile personal property for which it was required to file Form 8282? If, indicate the numer of Forms 8282 filed during the year d Did the organization receive any funds, directly or indirectly, to pay premiums on a personal enefit contract? Did the organization, during the year, pay premiums, directly or indirectly, on a personal enefit contract? If the organization received a contriution of qualified intellectual property, did the organization file Form 8899 as required? If the organization received a contriution of cars, oats, airplanes, or other vehicles, did the organization file a Form 198-C? Sponsoring organizations maintaining donor advised funds and section 9(a)() supporting organizations. Did the supporting organization, or a donor advised fund maintained y a sponsoring organization, have excess usiness holdings at any time during the year? Sponsoring organizations maintaining donor advised funds. Did the organization make any taxale distriutions under section 966? Did the organization make a distriution to a donor, donor advisor, or related person? Section 1(c)(7) organizations. Enter: Initiation fees and capital contriutions included on Part VIII, line Gross receipts, included on Form 99, Part VIII, line 12, for pulic use of clu facilities Section 1(c)(12) organizations. Enter: Gross income from memers or shareholders.. Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.)... Section 97(a)(1) non-exempt charitale trusts. Is the organization filing Form 99 in lieu of Form 11? If, enter the amount of tax-exempt interest received or accrued during the year Section 1(c)(29) qualified nonprofit health insurance issuers. a c Is the organization licensed to issue qualified health plans in more than one state? te. See the instructions for additional information the organization must report on Schedule O. Enter the amount of reserves the organization is required to maintain y the states in which the organization is licensed to issue qualified health plans Enter the amount of reserves on hand a Did the organization receive any payments for indoor tanning services during the tax year? If "," has it filed a Form 72 to report these payments? If "," provide an explanation in Schedule O Form 99 (21) 1a 1 2a 1a 1 11a c 1c 2 a a a c 6a 6 7a 7 7c 7e 7f 7g 7h 8 9a 9 12a 1a 1a 1 Page

8 Form 99 (21) Page 6 Part VI Governance, Management, and Disclosure For each "" response to lines 2 through 7 elow, and for a "" response to line 8a, 8, or 1 elow, descrie the circumstances, processes, or changes in Schedule O. See instructions. Check if Schedule O contains a response or note to any line in this Part VI Section A. Governing Body and Management 1a 2 6 7a 8 9 a 1a Section C. Disclosure Enter the numer of voting memers of the governing ody at the end of the tax year If there are material differences in voting rights among memers of the governing ody, or Enter the numer of voting memers included in line 1a, aove, who are independent Did any officer, director, trustee, or key employee have a family relationship or a usiness relationship with any other officer, director, trustee, or key employee? Did the organization delegate control over management duties customarily performed y or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person? Did the organization make any significant changes to its governing documents since the prior Form 99 was filed? Did the organization ecome aware during the year of a significant diversion of the organization s assets? Did the organization have memers or stockholders? Did the organization have memers, stockholders, or other persons who had the power to elect or appoint one or more memers of the governing ody? Are any governance decisions of the organization reserved to (or suject to approval y) memers, stockholders, or persons other than the governing ody? Did the organization contemporaneously document the meetings held or written actions undertaken during the year y the following: The governing ody? Each committee with authority to act on ehalf of the governing ody? Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot e reached at the organization s mailing address? If, provide the names and addresses in Schedule O Section B. Policies (This Section B requests information aout policies not required y the Internal Revenue Code.) Did the organization have local chapters, ranches, or affiliates? If, did the organization have written policies and procedures governing the activities of such chapters, affiliates, and ranches to ensure their operations are consistent with the organization's exempt purposes? a Has the organization provided a complete copy of this Form 99 to all memers of its governing ody efore filing the form? Descrie in Schedule O the process, if any, used y the organization to review this Form a c a 16a if the governing ody delegated road authority to an executive committee or similar committee, explain in Schedule O. Did the organization have a written conflict of interest policy? If, go to line 1 Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? Did the organization regularly and consistently monitor and enforce compliance with the policy? If, descrie in Schedule O how this was done Did the organization have a written whistlelower policy? Did the organization have a written document retention and destruction policy?... Did the process for determining compensation of the following persons include a review and approval y independent persons, comparaility data, and contemporaneous sustantiation of the delieration and decision? The organization s CEO, Executive Director, or top management official Other officers or key employees of the organization If to line 1a or 1, descrie the process in Schedule O (see instructions). Did the organization invest in, contriute assets to, or participate in a joint venture or similar arrangement with a taxale entity during the year? If, did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicale federal tax law, and take steps to safeguard the organization s exempt status with respect to such arrangements? List the states with which a copy of this Form 99 is required to e filed u Section 61 requires an organization to make its Forms 12 (or 12 if applicale), 99, and 99-T (Section 1(c)()s only) availale for pulic inspection. Indicate how you made these availale. Check all that apply. Own wesite Another's wesite Upon request Descrie in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements availale to the pulic during the tax year. Other (explain in Schedule O) State the name, physical address, and telephone numer of the person who possesses the ooks and records of the organization: u Merki & Associates, P.C. 1 Fulton Denton T ne 1a a 7 8a 8 1a 1 11a 12a 12 12c 1 1 1a 1 16a 16 Form 99 (21)

9 Form 99 (21) Part VII Section A. Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule O contains a response or note to any line in this Part VII Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this tale for all persons required to e listed. Report compensation for the calendar year ending with or within the organization's tax year. List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -- in columns (D), (E), and (F) if no compensation was paid. List all of the organization's current key employees, if any. See instructions for definition of "key employee." List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportale compensation (Box of Form W-2 and/or Box 7 of Form 199-MISC) of more than $1, from the organization and any related organizations. List all of the organization's former officers, key employees, and highest compensated employees who received more than $1, of reportale compensation from the organization and any related organizations. List all of the organization s former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $1, of reportale compensation from the organization and any related organizations. List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this ox if neither the organization nor any related organizations compensated any current officer, director, or trustee. (A) (B) (C) (D) (E) (F) Name and Title Average hours per week (list any hours for related organizations elow dotted line) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) Individual trustee or director Institutional trustee Officer Key employee Highest compensated employee Former Reportale compensation from the organization (W-2/199-MISC) Reportale compensation from related organizations (W-2/199-MISC) Estimated amount of other compensation from the organization and related organizations (1) Patrick Smith Director. (2) Priscilla Sanders Director. () Dale Kimle Immediate Past Chair. () Stan Morton Chairman. () Tim Crouch Vice-Chairman. (6) Michele Barer Treasurer. (7) Joe Ader Director At-Large. (8) John Baines Director At-Large. (9) Kenton Brice Director At-Large. (1) Chuck Carpenter Director At-Large. (11) Ross Chadwick Director At-Large. Form 99 (21) Page 7

10 Form 99 (21) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII (12) 1 Su-total..... u c Total from continuation sheets to Part VII, Section A u d Total (add lines 1 and 1c) u 2 Total numer of individuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organization u (A) Name and title Calvin Clark Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If, complete Schedule J for such individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $1,? If, complete Schedule J for such individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If, complete Schedule J for such person Section B. Independent Contractors (B) Average hours per week (list any hours for related organizations elow dotted line) Director At-Large (1) Charles Crouch One Year Director (1) Roy Culerson Director At-Large (1) Dr. Bruce Eckel Director At-Large (16) Dr. Tom Evenson Vice Chairman (17) Jon Fortune Director At-Large (18) Emilio Gonzalez Director At-Large (19) Kerry Goree Director At-Large Individual trustee or director Institutional trustee Officer (C) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) 1 Complete this tale for your five highest compensated independent contractors that received more than $1, of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and usiness address Description of services Key employee Highest compensated employee Former (D) Reportale compensation from the organization (W-2/199-MISC) (E) Reportale compensation from related organizations (W-2/199-MISC) Estimated amount of other compensation from the organization and related organizations (F) (C) Compensation 2 Total numer of independent contractors (including ut not limited to those listed aove) who received more than $1, of compensation from the organization u Form 99 (21)

11 Form 99 (21) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII (12) 1 Su-total..... u c Total from continuation sheets to Part VII, Section A u d Total (add lines 1 and 1c) u 2 Total numer of individuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organization u (A) Name and title Ricky Grunden Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If, complete Schedule J for such individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $1,? If, complete Schedule J for such individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If, complete Schedule J for such person Section B. Independent Contractors (B) Average hours per week (list any hours for related organizations elow dotted line) Director At-Large (1) Gene Gumfory Director At-Large (1) Jackie Jackson Director At-Large (1) Betty Kay Director At-Large (16) Dorothy Martinez Director At-Large (17) Mary Ann McDuff Director At-Large (18) Dr. Perry McNeill Director At-Large (19) Dr. Bettye Myers Director At-Large Individual trustee or director Institutional trustee Officer (C) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) 1 Complete this tale for your five highest compensated independent contractors that received more than $1, of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and usiness address Description of services Key employee Highest compensated employee Former (D) Reportale compensation from the organization (W-2/199-MISC) (E) Reportale compensation from related organizations (W-2/199-MISC) Estimated amount of other compensation from the organization and related organizations (F) (C) Compensation 2 Total numer of independent contractors (including ut not limited to those listed aove) who received more than $1, of compensation from the organization u Form 99 (21)

12 Form 99 (21) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII (12) 1 Su-total..... u c Total from continuation sheets to Part VII, Section A u d Total (add lines 1 and 1c) u 2 Total numer of individuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organization u (A) Name and title Cale O'Rear Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If, complete Schedule J for such individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $1,? If, complete Schedule J for such individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If, complete Schedule J for such person Section B. Independent Contractors (B) Average hours per week (list any hours for related organizations elow dotted line) Director At-Large (1) Steve Pogue Director At-Large (1) Heather Quinn One Year Director (1) Dr. Darhyl Ramsey Director At-Large (16) Betty Roy Director At-Large (17) Tyler Wood Director At-Large (18) Nancy DiMarco Secretary (19) Stephen Coffey Director At-Large Individual trustee or director Institutional trustee Officer (C) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) 1 Complete this tale for your five highest compensated independent contractors that received more than $1, of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and usiness address Description of services Key employee Highest compensated employee Former (D) Reportale compensation from the organization (W-2/199-MISC) (E) Reportale compensation from related organizations (W-2/199-MISC) Estimated amount of other compensation from the organization and related organizations (F) (C) Compensation 2 Total numer of independent contractors (including ut not limited to those listed aove) who received more than $1, of compensation from the organization u Form 99 (21)

13 Form 99 (21) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII (1) (A) Name and title (B) Average hours per week (list any hours for related organizations elow dotted line) Individual trustee or director Institutional trustee Officer (C) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) Key employee Highest compensated employee Former (D) Reportale compensation from the organization (W-2/199-MISC) (E) Reportale compensation from related organizations (W-2/199-MISC) (F) Estimated amount of other compensation from the organization and related organizations (12) James King Director At-Large. (1) Catherine Nicolosi Director At-Large. (1) Rick White Director At-Large. (16) (17) (18) (19) 1 Su-total..... u c Total from continuation sheets to Part VII, Section A u d Total (add lines 1 and 1c) u 2 Total numer of individuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organization u Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If, complete Schedule J for such individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $1,? If, complete Schedule J for such individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If, complete Schedule J for such person Section B. Independent Contractors 1 Complete this tale for your five highest compensated independent contractors that received more than $1, of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and usiness address Description of services (C) Compensation 2 Total numer of independent contractors (including ut not limited to those listed aove) who received more than $1, of compensation from the organization u Form 99 (21)

14 Form 99 (21) Page 9 Part VIII Contriutions, Gifts, Grants and Other Similar Amounts Program Service Revenue Other Revenue 1a c d e f g h 2a c d e f g 6a c Statement of Revenue Check if Schedule O contains a response or note to any line in this Part VIII Federated campaigns Memership dues Fundraising events Related organizations Government grants (contriutions)... All other contriutions, gifts, grants, and similar amounts not included aove ncash contriutions included in lines 1a-1f: Total. Add lines 1a 1f a 1 1c 1d 1e All other program service revenue f $ Total. Add lines 2a 2f Investment income (including dividends, interest, and other similar amounts) Income from investment of tax-exempt ond proceeds Royalties Gross rents Less: rental exps. Rental inc. or (loss) (i) Real (ii) Personal d Net rental income or (loss) a Gross amount from (i) Securities (ii) Other sales of assets other than inventory Less: cost or other asis & sales exps. u Busn. Code u u u u c Gain or (loss) d Net gain or (loss) u 8a Gross income from fundraising events (not including $ of contriutions reported on line 1c). See Part IV, line a 1,1 Less: direct expenses ,699 c Net income or (loss) from fundraising events u 9a Gross income from gaming activities. See Part IV, line a Less: direct expenses c Net income or (loss) from gaming activities u 1a 11a 12 c c d e Gross sales of inventory, less returns and allowances Less: cost of goods sold Net income or (loss) from sales of inventory Miscellaneous Revenue All other revenue Total. Add lines 11a 11d Total revenue. See instructions a 9,8 u u Busn. Code u u (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt function revenue usiness revenue excluded from tax under sections , ,2 6, Form 99 (21)

15 Form 99 (21) Part I Statement of Functional Expenses Section 1(c)() and 1(c)() organizations must complete all columns. All other organizations must complete column (A). Check if Schedule O contains a response or note to any line in this Part I (A) (B) (C) (D) Do not include amounts reported on lines 6, Total expenses Program service Management and Fundraising 7, 8, 9, and 1 of Part VIII. expenses general expenses expenses 1 2 Grants and other assistance to governments and organizations in the U.S. See Part IV, line Grants and other assistance to individuals in Page 1 the U.S. See Part IV, line Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 1 and Benefits paid to or for memers Compensation of current officers, directors, a c d e f g a c d e 2 26 trustees, and key employees Compensation not included aove, to disqualified persons (as defined under section 98(f)(1)) and persons descried in section 98(c)()(B) Other salaries and wages Pension plan accruals and contriutions (include section 1(k) and () employer contriutions) Other employee enefits Payroll taxes Fees for services (non-employees): Management Legal Accounting Loying Professional fundraising services. See Part IV, line 17 Investment management fees Other. (If line 11g amount exceeds 1% of line 2, column (A) amount, list line 11g expenses on Schedule O.) Advertising and promotion Office expenses Information technology Royalties Occupancy Travel Payments of travel or entertainment expenses for any federal, state, or local pulic officials Conferences, conventions, and meetings.... Interest Payments to affiliates Depreciation, depletion, and amortization.... Insurance Other expenses. Itemize expenses not covered aove (List miscellaneous expenses in line 2e. If line 2e amount exceeds 1% of line 2, column (A) amount, list line 2e expenses on Schedule O.) All other expenses Total functional expenses. Add lines 1 through 2e..... Joint costs. Complete this line only if the organization reported in column (B) joint costs from a comined educational campaign and fundraising solicitation. Check here u if following SOP 98-2 (ASC 98-72) ,977 2,1 2,2 2,2, 1,78 1,78 1,78,6,6,8,8 6,6,, 7,29 2,916, 1,96 1,62 8,8,9 2,8 2, , 1,168 1,167 12,1 6 2,7 9,68 1,711 1, Contriutions 1, 1, Credit Card Fees Bank Service Charges ,8 2,6 9,7 1,71 Form 99 (21)

16 Form 99 (21) Page 11 Assets Liailities Net Assets or Fund Balances Part a Balance Sheet Check if Schedule O contains a response or note to any line in this Part (A) (B) Beginning of year End of year Cash non-interest earing Savings and temporary cash investments Pledges and grants receivale, net. Accounts receivale, net Loans and other receivales from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L..... Loans and other receivales from other disqualified persons (as defined under section 98(f)(1)), persons descried in section 98(c)()(B), and contriuting employers and sponsoring organizations of section 1(c)(9) voluntary employees' eneficiary organizations (see instructions). Complete Part II of Schedule L tes and loans receivale, net.... Inventories for sale or use Prepaid expenses and deferred charges Land, uildings, and equipment: cost or 1 67, ,18 other asis. Complete Part VI of Schedule D a Less: accumulated depreciation , c, Investments pulicly traded securities Investments other securities. See Part IV, line Other assets. See Part IV, line Total assets. Add lines 1 through 1 (must equal line ) , Investments program-related. See Part IV, line Intangile assets ,86 7, Accounts payale and accrued expenses Grants payale Deferred revenue Tax-exempt ond liailities Escrow or custodial account liaility. Complete Part IV of Schedule D Loans and other payales to current and former officers, directors, ,1 trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L Secured mortgages and notes payale to unrelated third parties Unsecured notes and loans payale to unrelated third parties Other liailities (including federal income tax, payales to related third parties, and other liailities not included on lines 17-2). Complete Part of Schedule D Total liailities. Add lines 17 through Organizations that follow SFAS 117 (ASC 98), check here u and complete lines 27 through 29, and lines and. Unrestricted net assets Temporarily restricted net assets... Permanently restricted net assets.. Organizations that do not follow SFAS 117 (ASC 98), check here u and complete lines through. Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, uilding, or equipment fund Retained earnings, endowment, accumulated income, or other funds Total net assets or fund alances.. Total liailities and net assets/fund alances ,22 6,8 96, ,1 11,89 27, ,12 11,89,92 11,61 7,6 Form 99 (21)

17 Form 99 (21) Part I Part II 1 c a 1 Financial Statements and Reporting Check if Schedule O contains a response or note to any line in this Part II Accounting method used to prepare the Form 99: Cash Accrual 2a Were the organization's financial statements compiled or reviewed y an independent accountant? If "," check a ox elow to indicate whether the financial statements for the year were compiled or Were the organization's financial statements audited y an independent accountant? If "," check a ox elow to indicate whether the financial statements for the year were audited on a of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in the Single Audit Act and OMB Circular A-1? If, did the organization undergo the required audit or audits? If the organization did not undergo the Other If the organization changed its method of accounting from a prior year or checked Other, explain in Schedule O. If to line 2a or 2, does the organization have a committee that assumes responsiility for oversight Schedule O. Reconciliation of Net Assets Check if Schedule O contains a response or note to any line in this Part I 1 Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part I, column (A), line 2) Revenue less expenses. Sutract line 2 from line Net assets or fund alances at eginning of year (must equal Part, line, column (A)) Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments Other changes in net assets or fund alances (explain in Schedule O) Net assets or fund alances at end of year. Comine lines through 9 (must equal Part, line, column (B)) reviewed on a separate asis, consolidated asis, or oth: Separate asis Consolidated asis Both consolidated and separate asis Separate asis separate asis, consolidated asis, or oth: Consolidated asis As a result of a federal award, was the organization required to undergo an audit or audits as set forth in Both consolidated and separate asis required audit or audits, explain why in Schedule O and descrie any steps taken to undergo such audits a 2 2c a Page 12 6,81 1,8 21, 11,89,92 Form 99 (21)

18 SCHEDULE A (Form 99 or 99-EZ) Department of the Treasury Internal Revenue Service Name of the organization Part I (i) Name of supported Pulic Charity Status and Pulic Support Complete if the organization is a section 1(c)() organization or a section 97(a)(1) nonexempt charitale trust. u Attach to Form 99 or Form 99-EZ. u Information aout Schedule A (Form 99 or 99-EZ) and its instructions is at Employer identification numer Reason for Pulic Charity Status (All organizations must complete this part.) See instructions. The organization is not a private foundation ecause it is: (For lines 1 through 11, check only one ox.) A church, convention of churches, or association of churches descried in section 17()(1)(A)(i). A school descried in section 17()(1)(A)(ii). (Attach Schedule E.) A hospital or a cooperative hospital service organization descried in section 17()(1)(A)(iii). A medical research organization operated in conjunction with a hospital descried in section 17()(1)(A)(iii). Enter the hospital's name, OMB Open to Pulic Inspection city, and state: An organization operated for the enefit of a college or university owned or operated y a governmental unit descried in section 17()(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit descried in section 17()(1)(A)(v). An organization that normally receives a sustantial part of its support from a governmental unit or from the general pulic descried in section 17()(1)(A)(vi). (Complete Part II.) A community trust descried in section 17()(1)(A)(vi). (Complete Part II.) 9 An organization that normally receives: (1) more than 1/% of its support from contriutions, memership fees, and gross 1 11 e f g h (A) receipts from activities related to its exempt functions suject to certain exceptions, and (2) no more than 1/% of its support from gross investment income and unrelated usiness taxale income (less section 11 tax) from usinesses acquired y the organization after June, 197. See section 9(a)(2). (Complete Part III.) An organization organized and operated exclusively to test for pulic safety. See section 9(a)(). An organization organized and operated exclusively for the enefit of, to perform the functions of, or to carry out the purposes of one or more pulicly supported organizations descried in section 9(a)(1) or section 9(a)(2). See section 9(a)(). Check the ox that descries the type of supporting organization and complete lines 11e through 11h. a Type I Type II c Type III Functionally integrated d Type III n-functionally integrated By checking this ox, I certify that the organization is not controlled directly or indirectly y one or more disqualified persons other than foundation managers and other than one or more pulicly supported organizations descried in section 9(a)(1) or section 9(a)(2). 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 ox Since August 17, 26, has the organization accepted any gift or contriution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons descried in (ii) and (iii) elow, the governing ody of the supported organization? (ii) A family memer of a person descried in (i) aove? (iii) A % controlled entity of a person descried in (i) or (ii) aove? Provide the following information aout the supported organization(s). organization (ii) EIN (iii) Type of organization (descried on lines 1 9 aove 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.? 11g(i) 11g(ii) 11g(iii) (vii) Amount of monetary support (B) (C) (D) (E) Total For Paperwork Reduction Act tice, see the Instructions for Form 99 or 99-EZ. Schedule A (Form 99 or 99-EZ) 21

19 Schedule A (Form 99 or 99-EZ) 21 Part II Support Schedule for Organizations Descried in Sections 17()(1)(A)(iv) and 17()(1)(A)(vi) (Complete only if you checked the ox on line, 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 elow, please complete Part III.) Section A. Pulic Support Calendar year (or fiscal year eginning in) u (a) 29 () 21 (c) 211 (d) 212 (e) 21 (f) Total Page Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual grants.") Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf The value of services or facilities furnished y a governmental unit to the organization without charge Total. Add lines 1 through The portion of total contriutions y each person (other than a governmental unit or pulicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) Pulic support. Sutract line from line. Section B. Total Support Calendar year (or fiscal year eginning in) u 7 8 Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources (a) 29 () 21 (c) 211 (d) 212 (e) 21 (f) Total Net income from unrelated usiness activities, whether or not the usiness 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 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 1(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 1 Pulic support percentage for 21 (line 6, column (f) divided y line 11, column (f)) a Pulic support percentage from 212 Schedule A, Part II, line /% support test 21. If the organization did not check the ox on line 1, and line 1 is 1/% or more, check this % % 17a ox and stop here. The organization qualifies as a pulicly supported organization /% support test 212. If the organization did not check a ox on line 1 or 16a, and line 1 is 1/% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization. 1%-facts-and-circumstances test 21. If the organization did not check a ox on line 1, 16a, or 16, and line 1 is 1% or more, and if the organization meets the facts-and-circumstances test, check this ox and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a pulicly supported organization %-facts-and-circumstances test 212. If the organization did not check a ox on line 1, 16a, 16, or 17a, and line 1 is 1% or more, and if the organization meets the facts-and-circumstances test, check this ox and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a pulicly supported organization Private foundation. If the organization did not check a ox on line 1, 16a, 16, 17a, or 17, check this ox and see instructions Schedule A (Form 99 or 99-EZ) 21

20 Schedule A (Form 99 or 99-EZ) 21 Page Part III Support Schedule for Organizations Descried in Section 9(a)(2) (Complete only if you checked the ox 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 elow, please complete Part II.) Section A. Pulic Support Calendar year (or fiscal year eginning in) u Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual 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 Gross receipts from activities that are not an unrelated trade or usiness under section 1 Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf The value of services or facilities furnished y a governmental unit to the organization without charge a grants.") Total. Add lines 1 through Amounts included on lines 1, 2, and received from disqualified persons Amounts included on lines 2 and received from other than disqualified persons that exceed the greater of $, or 1% of the amount on line 1 for the year... (a) 29 () 21 (c) 211 (d) 212 (e) 21 (f) Total 216,18 11, 216,18 9,8 82,88 1,669 1,7 11,6 216,18 11, 226,687 6,18 917,889 c Add lines 7a and Pulic support (Sutract line 7c from line 6.) Section B. Total Support Calendar year (or fiscal year eginning in) u 9 1a Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.... Unrelated usiness taxale income (less section 11 taxes) from usinesses acquired after June, (a) ,889 () 21 (c) 211 (d) 212 (e) 21 (f) Total 216,18 11, 226,687 6,18 917,889 c Add lines 1a and Net income from unrelated usiness activities not included in line 1, whether or not the usiness 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 9, 1c, 11, 1 First five years. If the Form 99 is for the organization s first, second, third, fourth, or fifth tax year as a section 1(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 1 Pulic support percentage for 21 (line 8, column (f) divided y line 1, column (f)) Pulic support percentage from 212 Schedule A, Part III, line Section D. Computation of Investment Income Percentage a Investment income percentage for 21 (line 1c, column (f) divided y line 1, column (f)) Investment income percentage from 212 Schedule A, Part III, line /% support tests 21. If the organization did not check the ox on line 1, and line 1 is more than 1/%, and line 17 is not more than 1/%, check this ox and stop here. The organization qualifies as a pulicly supported organization /% support tests 212. If the organization did not check a ox on line 1 or line 19a, and line 16 is more than 1/%, and line 18 is not more than 1/%, check this ox and stop here. The organization qualifies as a pulicly supported organization Private foundation. If the organization did not check a ox on line 1, 19a, or 19, check this ox and see instructions and 12.) ,18 11, 226,687 6,18 917, % 1. % Schedule A (Form 99 or 99-EZ) 21 % %

21 Schedule A (Form 99 or 99-EZ) 21 Part IV Supplemental Information. Provide the explanations required y Part II, line 1; Part II, line 17a or 17; and Part III, line 12. Also complete this part for any additional information. (See instructions). Page Schedule A (Form 99 or 99-EZ) 21

22 SCHEDULE D (Form 99) Department of the Treasury Internal Revenue Service Name of the organization Supplemental Financial Statements u Complete if the organization answered, to Form 99, Part IV, line 6, 7, 8, 9, 1, 11a, 11, 11c, 11d, 11e, 11f, 12a, or 12. u Attach to Form 99. u Information aout Schedule D (Form 99) and its instructions is at Employer identification numer OMB Open to Pulic Inspection Part I a c d Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered to Form 99, Part IV, line 6. Total numer at end of year Aggregate contriutions to (during year) Aggregate grants from (during year) (a) Donor advised funds Aggregate value at end of year Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization s property, suject to the organization s exclusive legal control? Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can e used Part II 1 2 only for charitale purposes and not for the enefit of the donor or donor advisor, or for any other purpose conferring impermissile private enefit? Conservation Easements. Complete if the organization answered to Form 99, Part IV, line 7. Purpose(s) of conservation easements held y the organization (check all that apply). Preservation of land for pulic use (e.g., recreation or education) Protection of natural haitat Preservation of open space Preservation of an historically important land area Preservation of a certified historic structure Complete lines 2a through 2d if the organization held a qualified conservation contriution in the form of a conservation easement on the last day of the tax year. Total numer of conservation easements Total acreage restricted y conservation easements Numer of conservation easements on a certified historic structure included in (a) Numer of conservation easements included in (c) acquired after 8/17/6, and not on a historic structure listed in the National Register d Numer of conservation easements modified, transferred, released, extinguished, or terminated y the organization during the 2a 2 2c () Funds and other accounts Held at the End of the Tax Year tax year u Numer of states where property suject to conservation easement is located u Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year u Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year 8 u $ Does each conservation easement reported on line 2(d) aove satisfy the requirements of section 17(h)()(B) (i) and section 17(h)()(B)(ii)? In Part III, descrie how the organization reports conservation easements in its revenue and expense statement, and alance sheet, and include, if applicale, the text of the footnote to the organization s financial statements that descries the organization s accounting for conservation easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered to Form 99, Part IV, line 8. 1a If the organization elected, as permitted under SFAS 116 (ASC 98), not to report in its revenue statement and alance sheet works of art, historical treasures, or other similar assets held for pulic exhiition, education, or research in furtherance of 2 pulic service, provide, in Part III, the text of the footnote to its financial statements that descries these items. If the organization elected, as permitted under SFAS 116 (ASC 98), to report in its revenue statement and alance sheet works of art, historical treasures, or other similar assets held for pulic exhiition, education, or research in furtherance of pulic service, provide the following amounts relating to these items: (i) Revenues included in Form 99, Part VIII, line (ii) Assets included in Form 99, Part If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to e reported under SFAS 116 (ASC 98) relating to these items: a Revenues included in Form 99, Part VIII, line Assets included in Form 99, Part For Paperwork Reduction Act tice, see the Instructions for Form 99. u u u u $ $ $ $ Schedule D (Form 99) 21

23 Schedule D (Form 99) 21 Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) Using the organization s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply): a Pulic exhiition d Loan or exchange programs Scholarly research e Other c Preservation for future generations Provide a description of the organization s collections and explain how they further the organization s exempt purpose in Part III. During the year, did the organization solicit or receive donations of art, historical treasures, or other similar Escrow and Custodial Arrangements. Complete if the organization answered "" to Form 99, Part IV, line 9, or reported an amount on Form 99, Part, line 21. assets to e sold to raise funds rather than to e maintained as part of the organization s collection? Part IV 1a Is the organization an agent, trustee, custodian or other intermediary for contriutions or other assets not included on Form 99, Part? If, explain the arrangement in Part III and complete the following tale: Amount c Beginning alance c d Additions during the year d e Distriutions during the year e f Ending alance f 2a Did the organization include an amount on Form 99, Part, line 21? If, explain the arrangement in Part III. Check here if the explanation has een provided in Part III Part V Endowment Funds. Complete if the organization answered to Form 99, Part IV, line 1. (a) Current year Beginning of year alance Contriutions c Net investment earnings, gains, and 1a losses d Grants or scholarships e Other expenditures for facilities and Page 2 () Prior year (c) Two years ack (d) Three years ack (e) Four years ack f programs Administrative expenses g End of year alance Provide the estimated percentage of the current year end alance (line 1g, column (a)) held as: a Board designated or quasi-endowment u % Permanent endowment u % c Temporarily restricted endowment u % The percentages in lines 2a, 2, and 2c should equal 1%. a Are there endowment funds not in the possession of the organization that are held and administered for the organization y: (i) unrelated organizations a(i) (ii) related organizations.. a(ii) If to a(ii), are the related organizations listed as required on Schedule R?. Descrie in Part III the intended uses of the organization s endowment funds. Part VI Land, Buildings, and Equipment. Complete if the organization answered to Form 99, Part IV, line 11a. See Form 99, Part, line 1. Description of property (a) Cost or other asis () Cost or other asis (c) Accumulated (d) Book value (investment) (other) depreciation 1a Land Buildings c Leasehold improvements d Equipment e Other Total. Add lines 1a through 1e. (Column (d) must equal Form 99, Part, column (B), line 1(c).) u,22 1,877,7,7 Schedule D (Form 99) 21

24 Schedule D (Form 99) 21 Part VII Investments Other Securities. Complete if the organization answered to Form 99, Part IV, line 11. See Form 99, Part, line 12. (a) Description of security or category (including name of security) (1) Financial derivatives (2) Closely-held equity interests () Other (A) (B) (C) (D) (E) (F) (G) (H) Total. (Column () must equal Form 99, Part, col. (B) line 12.) u Part VIII Part I Part (a) Description of investment () Book value (c) Method of valuation: Cost or end-of-year market value Investments Program Related. Complete if the organization answered to Form 99, Part IV, line 11c. See Form 99, Part, line 1. Total. (Column () must equal Form 99, Part, col. (B) line 1.) u () Book value (c) Method of valuation: Cost or end-of-year market value Other Assets. Complete if the organization answered to Form 99, Part IV, line 11d. See Form 99, Part, line 1. (a) Description of liaility (a) Description u Other Liailities. Complete if the organization answered "" to Form 99, Part IV, line 11e or 11f. See Form 99, Part, line 2. Total. (Column () must equal Form 99, Part, col. (B) line 1.) (1) (2) () () () (6) (7) (8) (9) (1) (2) () () () (6) (7) (8) (9) (1) (2) () () () (6) (7) (8) (9) Federal income taxes Total. (Column () must equal Form 99, Part, col. (B) line 2.) u () Book value 2. Liaility for uncertain tax positions. In Part III, provide the text of the footnote to the organization s financial statements that reports the () Book value organization's liaility for uncertain tax positions under FIN 8 (ASC 7). Check here if the text of the footnote has een provided in Part III Page Schedule D (Form 99) 21

25 Schedule D (Form 99) 21 Part I a Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered to Form 99, Part IV, line 12a. 1 Total revenue, gains, and other support per audited financial statements Amounts included on line 1 ut not on Form 99, Part VIII, line 12: c d e Net unrealized gains on investments Donated services and use of facilities Recoveries of prior year grants.. Other (Descrie in Part III.)..... Add lines 2a through 2d Sutract line 2e from line Amounts included on Form 99, Part VIII, line 12, ut not on line 1: a Investment expenses not included on Form 99, Part VIII, line a Other (Descrie in Part III.)..... c Add lines a and c Total revenue. Add lines and c. (This must equal Form 99, Part I, line 12.) Part II Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered "" to Form 99, Part IV, line 12a. 1 Total expenses and losses per audited financial statements Amounts included on line 1 ut not on Form 99, Part I, line 2: a c d e Donated services and use of facilities Prior year adjustments Other losses Other (Descrie in Part III.)..... Add lines 2a through 2d Sutract line 2e from line Amounts included on Form 99, Part I, line 2, ut not on line 1: a Investment expenses not included on Form 99, Part VIII, line a Other (Descrie in Part III.)..... c Add lines a and c Total expenses. Add lines and c. (This must equal Form 99, Part I, line 18.) Part III Supplemental Information Provide the descriptions required for Part II, lines,, and 9; Part III, lines 1a and ; Part IV, lines 1 and 2; Part V, line ; Part, line 2; Part I, lines 2d and ; and Part II, lines 2d and. Also complete this part to provide any additional information. 2a 2 2c 2d 2a 2 2c 2d 1 2e 2e Page Schedule D (Form 99) 21

26 Schedule D (Form 99) 21 Part III Supplemental Information (continued) Page Schedule D (Form 99) 21

27 SCHEDULE G (Form 99 or 99-EZ) Department of the Treasury Internal Revenue Service Name of the organization Part I Supplemental Information Regarding Fundraising or Gaming Activities OMB. 1-7 Complete if the organization answered to Form 99, Part IV, lines 17, 18, or 19, or if the organization entered more than $1, on Form 99-EZ, line 6a. 21 u Attach to Form 99 or Form 99-EZ. Open to Pulic u Information aout Schedule G (Form 99 or 99-EZ) and its instructions is at Inspection Employer identification numer Fundraising Activities. Complete if the organization answered to Form 99, Part IV, line 17. Form 99-EZ filers are not required to complete this part. 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. a Mail solicitations e Solicitation of non-government grants Internet and solicitations f Solicitation of government grants c Phone solicitations g Special fundraising events d In-person solicitations 2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 99, Part VII) or entity in connection with professional fundraising services? If, list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to e compensated at least $, y the organization. (iii) Did fundcol. (i) (v) Amount paid to (vi) Amount paid to raiser have (i) Name and address of individual (iv) Gross receipts (or retained y) (or retained y) or entity (fundraiser) (ii) Activity custody or control of from activity fundraiser listed in organization contriutions? Total List all states in which the organization is registered or licensed to solicit contriutions or has een notified it is exempt from registration or licensing.. For Paperwork Reduction Act tice, see the Instructions for Form 99 or 99-EZ. Schedule G (Form 99 or 99-EZ) 21.

28 Schedule G (Form 99 or 99-EZ) 21 Page 2 Part II Fundraising Events. Complete if the organization answered to Form 99, Part IV, line 18, or reported more than $1, of fundraising event contriutions and gross income on Form 99-EZ, lines 1 and 6. List events with gross receipts greater than $,. (a) Event #1 () Event #2 (c) Other events Gift Card Donat ne (event type) (event type) (total numer) (d) Total events (add col. (a) through col. (c)) Revenue 1 Gross receipts ,1 1,1 2 Less: Contriutions.... Gross income (line 1 minus line 2) ,1 1,1 Cash prizes ncash prizes Direct Expenses Rent/facility costs Food and everages.. Entertainment Other direct expenses 99,699 99,699 Direct Expenses Revenue 1 11 Part III 1 2 Direct expense summary. Add lines through 9 in column (d)..... Net income summary. Sutract line 1 from line, column (d)..... Gaming. Complete if the organization answered to Form 99, Part IV, line 19, or reported more than $1, on Form 99-EZ, line 6a. Gross revenue Cash prizes ncash prizes Rent/facility costs (a) Bingo () Pull tas/instant ingo/progressive ingo (c) Other gaming 99,699,2 (d) Total gaming (add col. (a) through col. (c)) 6 Other direct expenses Volunteer laor % % % Direct expense summary. Add lines 2 through in column (d) Net gaming income summary. Sutract line 7 from line 1, column (d) a Enter the state(s) in which the organization operates gaming activities: Is the organization licensed to operate gaming activities in each of these states?.... If, explain:. 1a. Were any of the organization s gaming licenses revoked, suspended or terminated during the tax year? If, explain:.. Schedule G (Form 99 or 99-EZ) 21

29 Schedule G (Form 99 or 99-EZ) a Indicate the percentage of gaming activity operated in: The organization s facility An outside facility.... Enter the name and address of the person who prepares the organization s gaming/special events ooks and records: Does the organization operate gaming activities with nonmemers? Is the organization a grantor, eneficiary or trustee of a trust or a memer of a partnership or other entity formed to administer charitale gaming? a 1 Page % % Name u Address u a c Does the organization have a contract with a third party from whom the organization receives gaming revenue? If, enter the amount of gaming revenue received y the organization u $ and the amount of gaming revenue retained y the third party u $ If, enter name and address of the third party: Name u Address u Gaming manager information: Name u Gaming manager compensation u $ Description of services provided u Director/officer Employee Independent contractor 17 a Part IV Mandatory distriutions: Is the organization required under state law to make charitale distriutions from the gaming proceeds to retain the state gaming license? Enter the amount of distriutions required under state law to e distriuted to other exempt organizations or spent in the organization s own exempt activities during the tax year u $ Supplemental Information. Provide the explanations required y Part I, line 2, columns (iii) and (v), and Part III, lines 9, 9, 1, 1, 1c, 16, and 17, as applicale. Also complete this part to provide any additional information (see instructions).. Schedule G (Form 99 or 99-EZ) 21

30 SCHEDULE O (Form 99 or 99-EZ) Department of the Treasury Internal Revenue Service Name of the organization 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. u Attach to Form 99 or 99-EZ. u Information aout Schedule O (Form 99 or 99-EZ) and its instructions is at Employer identification numer OMB Open to Pulic Inspection Form 99 - Organization's Mission To help non-profits fulfill their mission in advancing the common good of northern Denton County. To enale community agencies to operate more efficiently and effectively through co-location and collaoration. To etter meet the needs of the disadvantaged in our community. Form 99, Part I, Line 6 Volunteers during 212 helped with fundraising (oth Scrip and Event Planning), worked on the Wheeler Center project, helped with General entity strategic planning, and collecting food. Form 99, Part VI, Line 11 - Organization's Process to Review Form 99 Tax return is provided to the oard of directors for approval at a regular meeting prior to sumission to the IRS. Form 99, Part VI, Line 1 - Compensation Process for Officers Board of directors approves employee compensation annually. Form 99, Part VI, Line 19 - Governing Documents Disclosure Explanation All governing documents, including the annual tax return, are posted to the entity's wesite and are availale upon request. For Paperwork Reduction Act tice, see the Instructions for Form 99 or 99-EZ. Schedule O (Form 99 or 99-EZ) (21)

31 Form Department of the Treasury Internal Revenue Service Name(s) shown on return Business or activity to which this form relates Part I 62 (99) Indirect Depreciation Depreciation and Amortization (Including Information on Listed Property) u See separate instructions. u Attach to your tax return. (a) Description of property () Cost (usiness use only) (c) Elected cost Identifying numer Election To Expense Certain Property Under Section 179 te: If you have any listed property, complete Part V efore you complete Part I. Maximum amount (see instructions) Total cost of section 179 property placed in service (see instructions) Threshold cost of section 179 property efore reduction in limitation (see instructions) Reduction in limitation. Sutract line from line 2. If zero or less, enter Dollar limitation for tax year. Sutract line from line 1. If zero or less, enter --. If married filing separately, see instructions OMB Attachment Sequence. 179, 2,, 7 Listed property. Enter the amount from line Total elected cost of section 179 property. Add amounts in column (c), lines 6 and Tentative deduction. Enter the smaller of line or line Carryover of disallowed deduction from line 1 of your 212 Form Business income limitation. Enter the smaller of usiness income (not less than zero) or line (see instructions) Section 179 expense deduction. Add lines 9 and 1, ut do not enter more than line Carryover of disallowed deduction to 21. Add lines 9 and 1, less line te: Do not use Part II or Part III elow for listed property. Instead, use Part V a 2a c d e f g h i Part II Special depreciation allowance for qualified property (other than listed property) placed in service during the tax year (see instructions) Property suject to section 168(f)(1) election Other depreciation (including ACRS) Part III MACRS Depreciation (Do not include listed property.) (See instructions.) Section A MACRS deductions for assets placed in service in tax years eginning efore If you are electing to group any assets placed in service during the tax year into one or more general asset accounts, check here u Section B Assets Placed in Service During 21 Tax Year Using the General Depreciation System 12-year (a) Classification of property -year property -year property 7-year property 1-year property 1-year property 2-year property 2-year property Residential rental property nresidential real property Class life c -year Part IV Special Depreciation Allowance and Other Depreciation (Do not include listed property.) (See instructions.) () Month and year placed in service (c) Basis for depreciation (usiness/investment use only see instructions) For assets shown aove and placed in service during the current year, enter the (d) Recovery portion of the asis attriutale to section 26A costs period 2 yrs. 27. yrs. 12 yrs. (e) Convention 27. yrs. MM 9 yrs. MM yrs. MM Listed property. Enter amount from line Total. Add amounts from line 12, lines 1 through 17, lines 19 and 2 in column (g), and line 21. Enter here and on the appropriate lines of your return. Partnerships and S corporations see instructions (f) Method MM S/L Section C Assets Placed in Service During 21 Tax Year Using the Alternative Depreciation System Summary (See instructions.) For Paperwork Reduction Act tice, see separate instructions. 2 MM S/L S/L S/L S/L S/L S/L S/L (g) Depreciation deduction 1,16. MQ 2DB 227 2, MQ 2DB 1,1 1,7 1. HY S/L 96 1,17 Form 62 (21)

32 Form 62 (21) Page 2 Part V Listed Property (Include automoiles, certain other vehicles, certain computers, and property used for entertainment, recreation, or amusement.) te: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 2a, 2, columns (a) through (c) of Section A, all of Section B, and Section C if applicale. Section A Depreciation and Other Information (Caution: See the instructions for limits for passenger automoiles.) 2a Do you have evidence to support the usiness/investment use claimed? 2 If "," is the evidence written? (a) () (c) (d) (e) (f) (g) (h) (i) Business/ Type of property Date placed investment use Cost or other asis Basis for depreciation Recovery Method/ Depreciation Elected section 179 (list vehicles first) in service percentage (usiness/investment period Convention deduction cost use only) 2 Special depreciation allowance for qualified listed property placed in service during the tax year and used more than % in a qualified usiness use (see instructions) Property used more than % in a qualified usiness use: % 27 Property used % or less in a qualified usiness use: % % S/L- % S/L- 28 Add amounts in column (h), lines 2 through 27. Enter here and on line 21, page Add amounts in column (i), line 26. Enter here and on line 7, page Section B Information on Use of Vehicles Complete this section for vehicles used y a sole proprietor, partner, or other more than % owner, or related person. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. Total usiness/investment miles driven during (a) () (c) (d) (e) (f) Vehicle 1 Vehicle 2 Vehicle Vehicle Vehicle Vehicle the year (do not include commuting miles) Total commuting miles driven during the year Total other personal (noncommuting) miles driven Total miles driven during the year. Add lines through Was the vehicle availale for personal use during off-duty hours? Was the vehicle used primarily y a more than % owner or related person? Is another vehicle availale for personal use? Section C Questions for Employers Who Provide Vehicles for Use y Their Employees Answer these questions to determine if you meet an exception to completing Section B for vehicles used y employees who are not more than % owners or related persons (see instructions). 7 Do you maintain a written policy statement that prohiits all personal use of vehicles, including commuting, y 8 9 your employees? Do you maintain a written policy statement that prohiits personal use of vehicles, except commuting, y your employees? See the instructions for vehicles used y corporate officers, directors, or 1% or more owners Do you treat all use of vehicles y employees as personal use? Do you provide more than five vehicles to your employees, otain information from your employees aout the use of the vehicles, and retain the information received? Do you meet the requirements concerning qualified automoile demonstration use? (See instructions.) te: If your answer to 7, 8, 9,, or 1 is "," do not complete Section B for the covered vehicles. Part VI Amortization 2 (e) () (c) (d) (f) (a) Amortization Date amortization Amortizale amount Code section period or Amortization for this year Description of costs egins percentage Amortization of costs that egins during your 21 tax year (see instructions): Aunt Bertha Software 8/1/1 7, Amortization of costs that egan efore your 21 tax year Total. Add amounts in column (f). See the instructions for where to report Form 62 (21) 19

33 Year Ended: Decemer 1, Denton Assistance Center Inc 821 rth Elm Denton, T 7621 Electi ng out of Bonus Depreciation Allowance for All Eligile Depreciale Property The taxpayer elects out of first-year onus depreciation allowance under IRC Section 168(k) for all eligile asset classes of depreciale property acquired after Decemer 1, 27. This election applies to all eligile depreciale property placed in service during the tax year.

34 Federal Asset Report Form 99, Page 1 11/1/21 :7 PM Date Bus Sec Basis Asset Description In Service Cost % 179Bonus for Depr PerConv Meth Prior Current -year GDS Property: 2 Computer 1/1/1 6 6 MQ2DB 197 Ipad 12/1/1 6 6 MQ2DB 1,16 1, year GDS Property: Kitchen Equipment 12/1/1 28,8 28,8 7 MQ2DB 1,21 6 Kitchen Furniture 12/1/1,62,62 7 MQ2DB 129 2,182 2,182 1,1 1-year GDS Property: 7 Leasehold Improvements 12/1/1 1,7 1,7 1 HY S/L 1,7 1,7 Prior MACRS: 1 Laptop /22/12 6 HY 2DB Amortization: Aunt Bertha Software 8/1/1 7, 7, 1 MOAmort 19 7, 7, 19 Grand Totals Less: Dispositions and Transfers Less: Start-up/Org Expense Net Grand Totals 2,22 1,92 6 1,711 2,22 1,92 6 1,711

35 AMT Asset Report Form 99, Page 1 11/1/21 :7 PM Date Bus Sec Basis Asset Description In Service Cost % 179Bonus for Depr PerConv Meth Prior Current -year GDS Property: 2 Computer 1/1/1 6 6 MQ1DB 18 Ipad 12/1/1 6 6 MQ1DB 2 1,16 1, year GDS Property: Kitchen Equipment 12/1/1 28,8 28,8 7 MQ1DB Kitchen Furniture 12/1/1,62,62 7 MQ1DB 96 2,182 2, Class Life ADS Property: 7 Leasehold Improvements 12/1/1 1,7 1,7 1 HY S/L 1,7 1,7 Prior MACRS: 1 Laptop /22/12 6 HY 2DB Grand Totals Less: Dispositions and Transfers Net Grand Totals,22,92 6 1,17,22,92 6 1,17

36 Bonus Depreciation Report 11/1/21 :7 PM Date In Tax Bus Tax Sec Current Prior Tax - Basis Asset Property Description Service Cost Pct 179 Exp Bonus Bonus for Depr Activity: Form 99, Page 1 7 Leasehold Improvements 12/1/1 1,7 1,7 1 Laptop /22/12 6 Form 99, Page 1 1,97 1,67 Grand Total 1,97 1,67

37 Depreciation Adjustment Report All Business Activities 11/1/21 :7 PM AMT Adjustments/ Form Unit Asset Description Tax AMT Preferences MACRS Adjustments: Page Laptop Page Computer Page 1 1 Ipad 2 7 Page 1 1 Kitchen Equipment 1, Page Kitchen Furniture Page Leasehold Improvements 1,17 1,17

38 Future Depreciation Report FYE: 12/1/1 Form 99, Page 1 Date In Asset Description Service Cost Tax AMT Prior MACRS: 1 Laptop /22/ Computer 1/1/ Ipad 12/1/ Kitchen Equipment 12/1/1 28,8 7,87,96 6 Kitchen Furniture 12/1/1, Leasehold Improvements 12/1/1 1, ,22 9,8 7,1 Amortization: Aunt Bertha Software 8/1/1 7, 67 7, 67 Grand Totals 2,22 9,82 7,1

39 Name Form 99 For calendar year 21, or tax year eginning Two Year Comparison Report, ending 212 & 21 Taxpayer Identification Numer R e v e n u e E x p e n s e s Other Information 1. Contriutions, gifts, grants Memership dues and assessments Government contriutions and grants Program service revenue Investment income Proceeds from tax exempt onds Net gain or (loss) from sale of assets other than inventory Net income or (loss) from fundraising events Net income or (loss) from gaming Net gain or (loss) on sales of inventory Other revenue Total revenue. Add lines 1 through Grants and similar amounts paid Benefits paid to or for memers Compensation of officers, directors, trustees, etc Salaries, other compensation, and employee enefits Professional fundraising fees Other professional fees Occupancy, rent, utilities, and maintenance Depreciation and Depletion Other expenses Total expenses. Add lines 1 through Excess or (Deficit). Sutract line 22 from line Total exempt revenue Total unrelated revenue Total excludale revenue Total assets Total liailities Retained earnings Numer of voting memers of governing ody Numer of independent voting memers of governing ody Numer of employees Numer of volunteers Differences 216,18 9,8 1, ,1,2 8,69 171,677 6,81 192,8-26, 7, 9,2,8,8,6 12,2 8,8 1,22 2,8-11, ,711 1,1 2,77 8,21 18,17 6,21 1,8 68,17 16,66 21, 12,87 171,677 6,81 192,8 171,677 6,81 192,8 11,61 7,6 22, 782 2,1 1,62 11,89,92 21,

40 Name Form 99T For calendar year 21, or tax year eginning Two Year Comparison Report, ending 212 & 21 Taxpayer Identification Numer R e v e n u e E x p e n s e s T a x & C r e d i t s D u e / R e f u n d 1. Gross profit/loss on usiness activities Capital gains/losses Income/loss from partnerships and S corporations Rental income (net of expense) Unrelated det-financed income (net of expense) Interest, and other income from controlled organizations (net of expense) Investment income of specific organizations (net of expense) Exploited exempt activity income (net of expense) Advertising income (net of expense) Other income Total trade or usiness income. Comine lines 1 through Compensation of officers, directors, and trustees Other salaries and wages Repairs and maintenance Bad dets Interest Taxes and licenses Charitale contriutions Depreciation and Depletion Contriutions to deferred compensation plans Employee enefit programs Other deductions Total deductions. Add lines 12 through Taxale income efore NOL. Sutract line 2 from Net operating loss deduction Specific deduction Unrelated usiness taxale income. 28. Income tax (corporate or trust) Proxy tax Alternative minimum tax Total taxes Other credits General usiness credit Credit for prior year minimum tax Total credits Net tax after credits Recapture taxes Total Taxes Prior year overpayment and estimated tax payments Payment made with extension Backup withholding and foreign withholding Other payments Total payments Balance due/(overpayment) Overpayment applied to next year Penalties Total due/(refund) Differences 1, 1, -1, -1,

41 Form 99 Tax Return History 21 Name Employer Identification Numer Contriutions, gifts, grants ,18 9,8 Memership dues Program service revenue Capital gain or loss Investment income Fundraising revenue (income/loss).... Gaming revenue (income/loss) Other revenue Total revenue Grants and similar amounts paid Benefits paid to or for memers Compensation of officers, etc Other compensation Professional fees Occupancy costs Depreciation and depletion Other expenses Total expenses Excess or (Deficit) Total exempt revenue Total unrelated revenue Total excludale revenue Total Assets Total Liailities Net Fund Balances ,1 171,677 26, 1,22 6 2,72 6,21 16,66 171, ,677 11, ,89 286,2 6,81 7, 1,82 2,8 1,711 8,21 1,8 21, 6,81 6,81 7,6 2,1,92

42 Form Name 99T Tax Return History 21 Employer Identification Numer Business activity profit/loss Capital gains/losses Partner and S Corp gain/loss Rental income* Det-financed income* Controlled organizations income/interest*..... Investment income, specific organizations*.. Exploited exempt activity income*..... Other income Total trade or usiness income.... Compensation of officers, ect Other salaries and wages Repairs and maintenance Bad dets Interest Taxes and licenses Charitale contriutions Depreciation and Depletion Deferred compensation plans Employee enefit programs

43 Form 99T Tax Return History 21 Name Employer Identification Numer Other deductions Net operating loss deduction Specific deduction Income after expense and deductions Income tax (corporate or trust) Other taxes Total taxes General usiness credit Other credits Net tax after credits Estimated tax payments Other payments Balance due/overpayment , -1, 1, -1, * Income shown net of expenses

44 Federal Statements 11/1/21 :7 PM Taxale Interest on Investments Description Unrelated Exclusion Postal Acquired after US Amount Business Code Code Code 6//7 Os ($ or %) Interest Income $ 286 Total $ 286

45 Federal Statements 11/1/21 :7 PM Form 99, Part I, Line 11g - Other Fees for Service (n-employee) Total Program Management & Fund Description Expenses Service General Raising Consulting $, $ $ 2, $ 2, Software Fees 1,6 Total $ 6,6 $ $, $,

46 Federal Statements 11/1/21 :7 PM Schedule A, Part III, Line 1(e) Description Amount Contriutions $ 1, n-governmental Grants 8, Total $ 9,8 Schedule A, Part III, Line 2(e) Description Amount Interest Income $ 286 Gift Card Donations 1,1 Total $ 1,7