OMB 1545-1150 Form Under section 501, 527, or 4947(1) of the Internal Revenue Code (except lack lung enefit trust or private foundation) Sponsoring organizations of donor advised funds and controlling organizations as defined in section 512(13) must file Form 990. All Department of the Treasury other organizations with gross receipts less than $500,000 and total assets less than $1,250,000 at the end of the year may use this form. Open to Pulic Internal Revenue Service The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection A For the 2009 calendar year, or tax year eginning and ending B Check if applicale: Please C Name of organization D Employer identification numer Address use IRS change lael or Name print or GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 change Initial type. return See Numer and street (or P.O. ox, if mail is not delivered to street address) Room/suite E Telephone numer Terminated Specific PO BO 233 Instructions. 770-967-0075 City or town, state or country, and ZIP + 4 Amended return F Group Exemption Application pending GAINESVILLE, GA 30503 Numer Section 501(3) organizations and 4947(1) nonexempt charitale trusts must attach a completed G Accounting method: Cash Accrual Schedule A (Form 990 or 990-EZ). Other (specify) I Wesite: WWW.GAMOUNTAINFOODBANK.ORG H Check if the organization is not J Tax-exempt status (check only one) 501 ( 3 ) (insert no.) 4947(1) or 527 required to attach Schedule B (Form 990, 990-EZ, or 990-PF). K Check if the organization is not a section 509(3) supporting organization and its gross receipts are normally not more than $25,000. A Form 990-EZ or Form 990 return is not required, ut if the organization chooses to file a return, e sure to file a complete return. L Add lines 5, 6, and 7, to line 9 to determine gross receipts; if $500,000 or more, file Form 990 instead of Form 990-EZ $ Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I.) 1 Contriutions, gifts, grants, and similar amounts received ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1 Revenue Expenses Net Assets Short Form Return of Organization Exempt From Income Tax 990-EZ 2009 2 3 4 6 c a c Special events and activities (complete applicale parts of Schedule G). If any amount is from gaming, check here c Gross profit or (loss) from sales of inventory (Sutract line 7 from line 7a) ~~~~~~~~~~~~~~~~~~~ 7c 8 Other revenue (descrie SEE STATEMENT 4 ) 8 1,862. 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 9 166,172. 10 11 18 19 Program service revenue including government fees and contracts ~~~~~~~~~~~~~~~~~~~~~~~ Memership dues and assessments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Investment income 5a Gross amount from sale of assets other than inventory~~~~~~~~~~~~~ Less: cost or other asis and sales expenses ~~~~~~~~~~~~~~~~~ Gain or (loss) from sale of assets other than inventory (Sutract line 5 from line 5a) ~~~~~~~~~~~~~~~ Gross revenue (not including $ of contriutions reported on line 1) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Less: direct expenses other than fundraising expenses ~~~~~~~~~~~~~ Net income or (loss) from special events and activities (Sutract line 6 from line 6a) 7a Gross sales of inventory, less returns and allowances ~~~~~~~~~~~~~ Less: cost of goods sold ~~~~~~~~~~~~~~~~~~~~~~~~~~ Grants and similar amounts paid (attach schedule) 20 Other changes in net assets or fund alances (attach explanation) ~~~~~~~~~~~~~~~~~~~~~~~~ 20 21 Net assets or fund alances at end of year. Comine lines 18 through 20 21 108,866. Part II Balance Sheets. If Total assets on line 25, column (B) are $1,250,000 or more, file Form 990 instead of Form 990-EZ. (See the instructions for Part II.) (A) Beginning of year (B) End of year 22 Cash, savings, and investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 95,197. 22 90,476. 23 Land and uildings ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 23 24 Other assets (descrie SEE STATEMENT 2 ) 2,852. 24 24,302. 25 Total assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 98,049. 25 114,778. 26 Total liailities (descrie SEE STATEMENT 3 ) 7,946. 26 5,912. 27 Net assets or fund alances (line 27 of column (B) must agree with line 21) 90,103. 27 108,866. 932171 02-08-10 LHA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2009) 5a 5 6a 6 ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Benefits paid to or for memers~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess or (deficit) for the year (Sutract line 17 from line 9) ** PUBLIC DISCLOSURE COPY ** Net assets or fund alances at eginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year s return) ~~~~~~~~~~~~~~~~~~~~~~~ 7a 7 3,692. 927. ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 3 4 5c 6c 10 11 18 19 167,099. 160,633. 912. 2,765. 12 Salaries, other compensation, and employee enefits ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 12 82,452. 13 14 15 Professional fees and other payments to independent contractors ~~~~~~~~~~~~~~~~~~~~~~~~ Occupancy, rent, utilities, and maintenance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ SEE STATEMENT 5 Printing, pulications, postage, and shipping ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 14 15 7,264. 2,031. 10,947. 16 Other expenses (descrie SEE STATEMENT 1 ) 16 44,715. 17 Total expenses. Add lines 10 through 16 17 147,409. 18,763. 90,103.
Form 990-EZ (2009) GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Part III Statement of Program Service Accomplishments (See the instructions for Part III.) What is the organization s primary exempt purpose? SEE STATEMENT 9 Descrie what was achieved in carrying out the organization s exempt purposes. In a clear and concise manner, descrie the services provided, the numer of persons enefited, and other relevant information for each program title. 28 SEE STATEMENT 8 Page 2 Expenses (Required for section 501(3) and 501(4) organizations and section 4947(1) trusts; optional for others.) 29 (Grants $ ) If this amount includes foreign grants, check here 28a 66,320. 30 (Grants $ ) If this amount includes foreign grants, check here 29a (Grants $ ) If this amount includes foreign grants, check here 30a 31 Other program services (attach schedule) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (Grants $ ) If this amount includes foreign grants, check here 31a 32 Total program service expenses (add lines 28a through 31a) 32 66,320. Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See the instructions for Part IV.) Contriutions Title and average hours Compensation to employee (e) Expense Name and address per week devoted to (If not paid, enter enefit plans & account and position -0-.) deferred other allowances compensation SEE STATEMENT 7 65,000. 5,628. 932172 02-08-10 Form 990-EZ (2009)
Form 990-EZ (2009) GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Page 3 Part V Other Information (Note the statement requirements in the instructions for Part V.) Yes No 33 Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed description of each activity ~~~~~ 33 34 Were any changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the changes ~~~~~~~~~~ 34 35 36 a 37a 38a 39 41 a c d e 42a 43 c If the organization had income from usiness activities, such as those reported on lines 2, 6a, and 7a (among others), ut not reported on Form 990-T, attach a statement explaining why the organization did not report the income on Form 990-T. Did the organization have unrelated usiness gross income of $1,000 or more or was it suject to section 6033(e) notice, reporting, and proxy tax requirements? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," has it filed a tax return on Form 990-T for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If "Yes," complete applicale parts of Sch. N Enter amount of political expenditures, direct or indirect, as descried in the instructions. ~~~~~ 37a 0. Did the organization file Form 1120-POL for this year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization orrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the period covered y this return? If "Yes," complete Schedule L, Part II and enter the total amount involved ~~~~~~~~~~~~~~ 38 N/A Section 501(7) organizations. Enter: Initiation fees and capital contriutions included on line 9 ~~~~~~~~~~~~~~~~~~~~~ Gross receipts, included on line 9, for pulic use of clu facilities ~~~~~~~~~~~~~~~~~~ 40a Section 501(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 0. ; section 4912 0. ; section 4955 0. Section 501(3) and 501(4) organizations. Did the organization engage in any section 4958 excess enefit transaction during the year or is it 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 990 or 990-EZ? If "Yes," complete Schedule L, Part I ~~~~~~~~~~~ Section 501(3) and 501(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 ~~~~~~~~~~~~~~~ Section 501(3) and 501(4) organizations. Enter amount of tax on line 40c reimursed y the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter transaction? If "Yes," complete Form 8886-T ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 40e List the states with which a copy of this return is filed. GA The organization s ooks are in care of RANDI DYER Telephone no. 770-967-0075 Located at 4515 CANTRELL ROAD, FLOWERY BRANCH, GA ZIP + 4 30542 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 "Yes," enter the name of the foreign country: See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. At any time during the calendar year, did the organization maintain an office outside of the U.S.? ~~~~~~~~~~~~~~~~~~~~ If "Yes," enter the name of the foreign country: Section 4947(1) nonexempt charitale trusts filing Form 990-EZ in lieu of Form 1041 - Check here and enter the amount of tax-exempt interest received or accrued during the tax year ~~~~~~~~~~~~~~~~~ 43 N/A 39a 39 N/A N/A 0. 0. 35a 35 36 37 38a 40 42 42c N/A Yes No 44 45 Did the organization maintain any donor advised funds? If "Yes," Form 990 must e completed instead of Form 990-EZ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is any related organization a controlled entity of the organization within the meaning of section 512(13)? If "Yes," Form 990 must e completed instead of Form 990-EZ Yes No 44 45 Form 990-EZ (2009) 932173 02-08-10
Form 990-EZ (2009) GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Page 4 Part VI Section 501(3) organizations and section 4947(1) nonexempt charitale trusts only. All section 501(3) organizations and section 4947(1) nonexempt charitale trusts must answer questions 46-49 and complete the tales for lines 50 and 51. 46 47 48 49a 50 Did the organization engage in direct or indirect political campaign activities on ehalf of or in opposition to candidates for pulic office? If "Yes," complete Schedule C, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in loying activities? If "Yes," complete Schedule C, Part II ~~~~~~~~~~~~~~~~~~~~~ Is the organization a school as descried in section 170(1)(A)(ii)? If "Yes," complete Schedule E ~~~~~~~~~~~~~~~~ Did the organization make any transfers to an exempt non-charitale related organization? ~~~~~~~~~~~~~~~~~~~~~~ If "Yes," was the related organization a section 527 organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Complete this tale for the organization s five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None." 46 47 48 49a 49 Yes No Name and address of each employee paid more than $100,000 NONE Title and average hours Compensation Contriutions to employee (e) Expense per week devoted to enefit plans & account and position deferred other allowances compensation 51 f Total numer of other employees paid over $100,000 ~~~~~~~~~~~~~~~~ Complete this tale for the organization s five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None." NONE Name and address of each independent contractor paid more than $100,000 Type of service Compensation d Total numer of other independent contractors each receiving over $100,000 ~~~~~~~~~~~~~~ Sign Here 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. = = Signature of officer Type or print name and title Paid Preparer s signature Date Check if selfemployed Preparer s identifying numer (See instr.) Preparer s Use Only BATES CARTER & CO., LLP Firm s name (or yours EIN if self-employed), PO DRAWER 2396 Phone = address, and ZIP + 4 GAINESVILLE, GA. 30503 no. 770-532-9131 May the IRS discuss this return with the preparer shown aove? See instructions Yes No Date Form 990-EZ (2009) 932174 02-08-10
SCHEDULE A (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service Complete if the organization is a section 501(3) organization or a section 4947(1) nonexempt charitale trust. Attach to Form 990 or Form 990-EZ. See separate instructions. OMB 1545-0047 Open to Pulic Inspection Name of the organization Employer identification numer GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Part I 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.) 1 2 3 4 5 6 7 8 9 10 11 e f g h A church, convention of churches, or association of churches descried in section 170(1)(A)(i). A school descried in section 170(1)(A)(ii). (Attach Schedule E.) A hospital or a cooperative hospital service organization descried in section 170(1)(A)(iii). A medical research organization operated in conjunction with a hospital descried in section 170(1)(A)(iii). Enter the hospital s name, city, and state: An organization operated for the enefit of a college or university owned or operated y a governmental unit descried in section 170(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit descried in section 170(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 170(1)(A)(vi). (Complete Part II.) A community trust descried in section 170(1)(A)(vi). (Complete Part II.) An organization that normally receives: (1) more than 33 1/3% of its support from contriutions, memership fees, and gross receipts from activities related to its exempt functions - suject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated usiness taxale income (less section 511 tax) from usinesses acquired y the organization after June 30, 1975. See section 509(2). (Complete Part III.) An organization organized and operated exclusively to test for pulic safety. See section 509(4). 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 509(1) or section 509(2). See section 509(3). 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 - Other 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 509(1) or section 509(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 (i) (ii) (iii) Pulic Charity Status and Pulic Support ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Since August 17, 2006, has the organization accepted any gift or contriution from any of the following persons? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A family memer of a person descried in (i) aove? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A 35% controlled entity of a person descried in (i) or (ii) aove? ~~~~~~~~~~~~~~~~~~~~~~~~ Provide the following information aout the supported organization(s). 2009 (iii) Type of (i) Name of supported (ii) EIN (iv) Is the organization (v) Did you notify the (vi) Is the (vii) organization in col. (i) listed in your organization in col. organization in col. Amount of organization (descried on lines 1-9 (i) organized in the support governing document? (i) of your support? U.S.? aove or IRC section (see instructions) ) Yes No Yes No Yes No 11g(i) 11g(ii) 11g(iii) Yes No Total LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 2009 932021 02-08-10
Schedule A (Form 990 or 990-EZ) 2009 GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Part II Support Schedule for Organizations Descried in Sections 170(1)(A)(iv) and 170(1)(A)(vi) (Complete only if you checked the ox on line 5, 7, or 8 of Part I.) Section A. Pulic Support Calendar year (or fiscal year eginning in) 2005 2006 2007 2008 (e) 2009 (f) Total 1 2 3 4 5 Total. Add lines 1 through 3 ~~~ 6 Pulic support. Sutract line 5 from line 4. Page 2 Calendar year (or fiscal year eginning in) 2005 2006 2007 2008 (e) 2009 (f) Total 7 Amounts from line 4 ~~~~~~~ 75,064. 160,633. 235,697. 8 9 10 11 12 assets (Explain in Part IV.) ~~~~ Total support. Add lines 7 through 10 13 First five years. If the Form 990 is for the organization s first, second, third, fourth, or fifth tax year as a section 501(3) organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 14 15 16a 33 1/3% support test - 2009. If the organization did not check the ox on line 13, and line 14 is 33 1/3% or more, check this ox and 17a 10% -facts-and-circumstances test - 2009. If the organization did not check a ox on line 13, 16a, or 16, and line 14 is 10% or more, 18 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 ~ 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) ~~~~~~~~~~~~ Section B. Total Support Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~ 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 Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~ Pulic support percentage for 2009 (line 6, column (f) divided y line 11, column (f)) ~~~~~~~~~~~~ Pulic support percentage from 2008 Schedule A, Part II, line 14 ~~~~~~~~~~~~~~~~~~~~~ 75,064. 160,633. 235,697. 75,064. 160,633. 235,697. stop here. The organization qualifies as a pulicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 33 1/3% support test - 2008. If the organization did not check a ox on line 13 or 16a, and line 15 is 33 1/3% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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 ~~~~~~~~~~~~~~~ 10% -facts-and-circumstances test - 2008. If the organization did not check a ox on line 13, 16a, 16, or 17a, and line 15 is 10% 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 13, 16a, 16, 17a, or 17, check this ox and see instructions 12 14 15 30,007. 205,690. 991. 1,847. 2,838. 15. 15. 238,550. 7,826. Schedule A (Form 990 or 990-EZ) 2009 % % 932022 02-08-10
Schedule A (Form 990 or 990-EZ) 2009 Page 3 Part III Support Schedule for Organizations Descried in Section 509(2) (Complete only if you checked the ox on line 9 of Part I.) Section A. Pulic Support Calendar year (or fiscal year eginning in) 2005 2006 2007 2008 (e) 2009 (f) Total 1 2 3 4 5 6 The value of services or facilities furnished y a governmental unit to the organization without charge ~ Total. Add lines 1 through 5 ~~~ 7a Amounts included on lines 1, 2, and 3 received from disqualified persons Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year ~~~~~~ c Add lines 7a and 7 ~~~~~~~ 8 Pulic support (Sutract line 7c from line 6.) Calendar year (or fiscal year eginning in) 2005 2006 2007 2008 (e) 2009 (f) Total 9 Amounts from line 6 ~~~~~~~ 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~ Unrelated usiness taxale income (less section 511 taxes) from usinesses acquired after June 30, 1975 ~~~~ c 11 12 13 14 First five years. If the Form 990 is for the organization s first, second, third, fourth, or fifth tax year as a section 501(3) organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 15 Pulic support percentage for 2009 (line 8, column (f) divided y line 13, column (f)) ~~~~~~~~~~~~ 15 % 16 Pulic support percentage from 2008 Schedule A, Part III, line 15 Section D. Computation of Investment Income Percentage 17 18 19a 33 1/3% support tests - 2009. If the organization did not check the ox on line 14, and line 15 is more than 33 1/3%, and line 17 is not 20 Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual grants.") ~~ 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 513 ~~~~~ Tax revenues levied for the organization s enefit and either paid to or expended on its ehalf ~~~~ Section B. Total Support Add lines 10a and 10 ~~~~~~ Net income from unrelated usiness activities not included in line 10, 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, 10c, 11, and 12.) Investment income percentage for 2009 (line 10c, column (f) divided y line 13, column (f)) Investment income percentage from 2008 Schedule A, Part III, line 17 ~~~~~~~~~~~~~~~~~~ 16 ~~~~~~~~ 17 % more than 33 1/3%, check this ox and stop here. The organization qualifies as a pulicly supported organization ~~~~~~~~~~ 33 1/3% support tests - 2008. If the organization did not check a ox on line 14 or line 19a, and line 16 is more than 33 1/3%, and line 18 is not more than 33 1/3%, check this ox and stop here. The organization qualifies as a pulicly supported organization ~~~~ Private foundation. If the organization did not check a ox on line 14, 19a, or 19, check this ox and see instructions 18 % % Schedule A (Form 990 or 990-EZ) 2009 932023 02-08-10
** PUBLIC DISCLOSURE COPY ** Schedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury Internal Revenue Service Name of the organization Schedule of Contriutors Attach to Form 990, 990-EZ, or 990-PF. OMB 1545-0047 2009 Employer identification numer Organization type(check one): GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Filers of: Section: Form 990 or 990-EZ 501( 3 ) (enter numer) organization 4947(1) nonexempt charitale trust not treated as a private foundation 527 political organization Form 990-PF 501(3) exempt private foundation 4947(1) nonexempt charitale trust treated as a private foundation 501(3) taxale private foundation Check if your organization is covered y the General Rule or a Special Rule. Note. Only a section 501(7), (8), or (10) organization can check oxes for oth the General Rule and a Special Rule. See instructions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or property) from any one contriutor. Complete Parts I and II. Special Rules For a section 501(3) organization filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(1) and 170(1)(A)(vi), and received from any one contriutor, during the year, a contriution of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h or (ii) Form 990-EZ, line 1. Complete Parts I and II. For a section 501(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contriutor, during the year, aggregate contriutions of more than $1,000 for use exclusively for religious, charitale, scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III. For a section 501(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contriutor, during the year, contriutions for use exclusively for religious, charitale, etc., purposes, ut these contriutions did not aggregate to more than $1,000. If this ox is checked, enter here the total contriutions that were received during the year for an exclusively religious, charitale, etc., purpose. Do not complete any of the parts unless the General Rule applies to this organization ecause it received nonexclusively religious, charitale, etc., contriutions of $5,000 or more during the year. ~~~~~~~~~~~~~~~~~ $ Caution. An organization that is not covered y the General Rule and/or the Special Rules does not file Schedule B (Form 990, 990-EZ, or 990-PF), ut it must answer "No" on Part IV, line 2 of its Form 990, or check the ox on line H of its Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). LHA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2009) 923451 02-01-10
1 1 Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page of of Part I Name of organization Employer identification numer GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Part I Contriutors (see instructions) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 1 Person Payroll $ 10,000. Noncash (Complete Part II if there is a noncash contriution.) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 2 $ Person Payroll 6,857. Noncash (Complete Part II if there is a noncash contriution.) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 3 Person Payroll $ 53,444. Noncash (Complete Part II if there is a noncash contriution.) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 4 Person Payroll $ 10,000. Noncash (Complete Part II if there is a noncash contriution.) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 5 Person Payroll $ 7,234. Noncash (Complete Part II if there is a noncash contriution.) Name, address, and ZIP + 4 Aggregate contriutions Type of contriution 923452 02-01-10 $ Person Payroll Noncash (Complete Part II if there is a noncash contriution.) Schedule B (Form 990, 990-EZ, or 990-PF) (2009)
1 1 Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page of of Part II Name of organization Employer identification numer GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 Part II Noncash Property (see instructions) from Part I 2 Description of noncash property given PUBLICLY TRADED STOCK FMV (or estimate) (see instructions) Date received $ 6,857. 06/04/09 from Part I 3 Description of noncash property given 2 PALLET JACKS, PALLET SCALE AND RELATED EQUIPMENT FOR HANDLING FOOD DONATIONS. HP PRINTER. $ FMV (or estimate) (see instructions) Date received 13,444. VARIOUS from Part I Description of noncash property given FMV (or estimate) (see instructions) Date received $ from Part I Description of noncash property given FMV (or estimate) (see instructions) Date received $ from Part I Description of noncash property given FMV (or estimate) (see instructions) Date received $ from Part I Description of noncash property given FMV (or estimate) (see instructions) Date received 923453 02-01-10 $ Schedule B (Form 990, 990-EZ, or 990-PF) (2009)
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ OTHER EPENSES STATEMENT 1 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} OFFICE EPENSES 7,549. COMPUTER & WEB EPENSES 3,195. BOARD EPENSES 2,981. MISC PROGRAM EPENSES 84. ADVERTISING & MARKETING 1,274. FOOD DISTRIBUTED 11,435. INSURANCE 3,617. TAES & LICENSES 6,953. COMMUNITY FOUNDATION FEES 1,282. CONFERENCES & TRAVEL 5,784. MISC GENERAL EPENSES 242. DUES & SUBSCRIPTIONS 229. VEHICLE EPENSES 90. }}}}}}}}}}}}}} TOTAL TO FORM 990-EZ, LINE 16 44,715. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ OTHER ASSETS STATEMENT 2 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION BEG. OF YEAR END OF YEAR }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} PLEDGE RECEVIABLES 0. 1,925. FOOD INVENTORY 0. 7,293. OTHER DEPRECIABLE ASSETS 2,852. 15,084. }}}}}}}}}}}}}} }}}}}}}}}}}}}} TOTAL TO FORM 990-EZ, LINE 24 2,852. 24,302. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ OTHER LIABILITIES STATEMENT 3 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION BEG. OF YEAR END OF YEAR }}}}}}}}}}} }}}}}}}}}}}}}} }}}}}}}}}}}}}} ACCOUNTS PAYABLE 7,946. 3,044. PAYROLL LIABILITIES 0. 2,868. }}}}}}}}}}}}}} }}}}}}}}}}}}}} TOTAL TO FORM 990-EZ, LINE 26 7,946. 5,912. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ STATEMENT(S) 1, 2, 3
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ OTHER REVENUE STATEMENT 4 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} INTEREST 1,847. MISC. INCOME 15. }}}}}}}}}}}}}} TOTAL TO FORM 990-EZ, LINE 8 1,862. ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ OCCUPANCY, RENT, UTILITIES AND MAINTENANCE STATEMENT 5 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} DESCRIPTION AMOUNT }}}}}}}}}}} }}}}}}}}}}}}}} DEPRECIATION 1,212. OTHER EPENSES 819. }}}}}}}}}}}}}} TOTAL TO FORM 990-EZ, LINE 14 2,031. ~~~~~~~~~~~~~~ STATEMENT(S) 4, 5
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ INFORMATION REGARDING TRANSFERS ASSOCIATED WITH PERSONAL BENEFIT CONTRACTS STATEMENT 6 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} A) DID THE ORGANIZATION, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT?.................... [ ] YES [ ] NO B) DID THE ORGANIZATION, DURING THE YEAR, PAY PREMIUMS, DIRECTLY OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT?.. [ ] YES [ ] NO ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ STATEMENT(S) 6
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ FORM 990-EZ PART IV - LIST OF OFFICERS, DIRECTORS, STATEMENT 7 TRUSTEES AND KEY EMPLOYEES }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} EMPLOYEE TITLE AND COMPEN- BEN PLAN EPENSE NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT }}}}}}}}}}}}}}}} }}}}}}}}}}} }}}}}}}}}}} }}}}}}}} }}}}}}} ANGELA KAY BLACKSTOCK EECUTIVE DIRECTOR 40.00 65,000. 5,628. 0. RICH WHITE JOHN NI GUS WHALEN RICHARD SARGENT JIM ARENDT ELIZABETH BURNETTE DANNY BERRY WALTHER BOOMERSHINE SUSAN DANIEL ANDERSON FLEN ERICA GLENN JOHN GRAM BRIAN HOLLIS CHAIRMAN 3.00 0. 0. 0. VICE CHAIRMAN SECRETARY TREASURER 2.00 0. 0. 0. 2.00 0. 0. 0. STATEMENT(S) 7
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} SCOTTY JACKSON ROB JOHNSON BILL LIGHTFOOT DEBORAH MACK JIM MATHIS JAMES PERDUE ROBB OWENS PHILLIP SARTAIN JACKIE WALLACE GEORGE WANGEMANN JOHNNY TURNER SANDRA STRINGER 2.00 0. 0. 0. }}}}}}}}}}} }}}}}}}} }}}}}}} TOTALS INCLUDED ON FORM 990-EZ, PART IV 65,000. 5,628. 0. ~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~ STATEMENT(S) 7
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 990-EZ PG 2 STATEMENT 8 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} SERVES AS REDISTRIBUTION ORGANIZATION FOR THE ATLANTA COMMUNITY FOOD BANK, DISTRIBUTING 567,561 POUNDS OF FOOD TO 27 AGENCIES SERVING LOW INCOME RESIDENTS IN NEED OF EMERGENCY ASSISTANCE IN HALL, DAWSON, FORSYTH, LUMPKIN AND UNION COUNTIES. ALSO COLLECTED 11,779 POUNDS OF DONATED FOOD FROM LOCAL BUSINESES AND INDIVIDUALS. STATEMENT(S) 8
GEORGIA MOUNTAIN FOOD BANK, INC. 26-2787610 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} }}}}}}}}}} ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 990-EZ PG 2 STATEMENT 9 }}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}}} THROUGH A NETWORK OF COMMUNITY PARTNERS, THE GEORGIA MOUNTAIN FOOD BANK ADDRESSES HUNGER, HEALTH, AND QUALITY OF LIFE BY SERVING THOSE IN NEED. STATEMENT(S) 9