Form 990 Department oft" Treasury Internal.Revenue Service A For the 2002 cater B cne1. u.,oeu. Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(7) of the Internal Revenue Code (except black loop benefit trust or private foundation) " The organization may have to use a copy of this realm to satisfy state reporting requirements rieaw C Name of organization ~IR SPINAL INJURY FOUNDATION Min. m..a p m or Number and street (or P O box if mail is not delivered to street address) Room/suite X 11080 CIRCLE POINT ROAD See ~nm BUILDING 2 140 Aun.m.a emno- City or town, state or country, end ZIP + 4 nn I I ~Nal ~Mwe.uen non. LJ D.Mnp -JOSTMINSTER. CO 80020-2755 0 Section 601(e)(3) organizations and 4947(a)(7) nonexempt charitable and 1 spa not applicable to Sechm 577 ppan alum trusts must attach a completed Schedule A (Form 980 or 880 e) is this a group return for affiliates? F] Yes 17X No 0 Web site K Check hem 1 u if the orgenimhan'e gores receipts are normally not more then $25,000 The organization need not file a return with tie IRS but I( tie organization recened a Forth 990 Package b) II Yes " enter number of affiliates Ill in the mail, it should file a return without financial date some states require a complete return I Enter 4-digit GEN L Gross receipts Add lines 6D, Bb, 9D, and 10b to line 12 Ill" e) Are ell effilatea included? Ely-as a No (II No," attach a list See instructions ) d) b this a wpnm renm ow by an 17--1 F-7 M Check " X to attach Sch B D Employer Identification number E Telephone, number If the organization n not required = 990, 990-EZ or 990-PR 1 Contributions, pitta, grants, and similar amounts received STMT 1 a Direct public support 7 a b Indirect public support 7 b e Government contributions (grants) 1 c d talc (.ad him 1. mmupn IC) (m,n s 48,541 nanmn s 2 Program service revenue Including government fees and contracts (from Part VII, line 93) S Membership dues and assessments (y ~ 4 Interest on savings and temporary cash Investments J 5 Dividends and interest from securities 8 a Gross rents 8 a b Less rental expenses 8 b e Net rental income or (lose) (subtract line 6b from line 6a) W c 7 Other investment income (describe > 8 a Gross amount horn said of asset other (N Securities (8) other C than Inventory Ba LIL b Less coat or other teals and sales expenses 8 b e Gain or (lose) (attach schedule) go d Net pain or (lose) (combine line Bc, columns (A) and (B)) B Special eve to e d et (attach schedule) a mcludi p E "MMEIVED xpereb~pn,~ne 1a) 9a N b leas d~~at e~ensee/~"q~r than funaraisiny expenses 9 b e ~Ne1 in~rr~ot~) f~~y~yp~penal events (subtract line 8b from line 9a) 1 a Gross ealee of inventol~0as returns and allowances 0, H oa 9c - - - sales of inventory (attach schedule) (subtract line 11 from line 10a) 11 Other revenue (from Part VII, line 703) 12 Total revenue add lines 1d 2 3 4 5 6c 7, Sd. 9c. 10c, and 11 ) 13 Program eerwces (from line 44, column (B)) q 14 Management and general (from line 44, column (C)) 7 5 Fundraising (from line 44, column (D)) 18 Payments to affiliates (attach schedule) 17 Total expenses add lines 16 and 44 column A ;! 78 Excess or (deficit) for the year (subtract line 77 from line 72) Y ^ 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 20 Other changes in net assets or fund balances (attach explanation) u 2 14 u..1........~.....i....ww..i............~....a..~..,....i.......w.....i...~o ~e....dem JyA For Paperwork Reduction Act Notice, see the separate Instructions. ]E 7010 1000 TR3663 L7698 06/27/2003 09.48 49 V02-6 2 9527 Formsso (sooz) 2 ~V 0) P
75-2985553 Form 990 (2002) Pope 2 22 Grants and allocations (attach schedule) (call, s nonoans 1 ZZ 3, 000 3, 000 8'1'M 2 23 Specific assistance to inamduah (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc 25 28 Other salaries and wages 28 27 Pension plan contributions 27 28 Other employee benefit 28 29 Payroll taxes 29 70 Professional fundraising fees 30 31 Accounting fees 37 109. 109 72 Legal fees 72 4, 259 4, 25-9. 37 Supplies 33 342 342 74 Telephone 34 35 Postage and shipping 35 18 Occupancy 38 37 Equipment rental and maintenance 37 38 Printing and publications 38 39 Travel 39 40 Conferences, conventions, and meetings 317. 317 41 Interest 41 42 Depreciation, depletion, etc (attach schedule) 42 45 omsr.,o.nmmtm..i.n.~ (l~lx.) STDfT 3 3a 17, 724 17, 724 b 3b c d e Statement of Functional Ex enses andsection 4947(e)(1)nonexempt charitable trusts butoptional forothers (Setpage 21o1theinstructions ) Do no` include amounts reported on line (a T~ (B) Program (C) Management 44 Total fu nctiona l e,~apy~eyn,s,~as (add n Nioupn 43) 47c 3d 3e m~romlatollne"a17-is """ 'co" 44 25.751 3,317. 22,434. Joint Costs Check " U if you are following SOP 98-2 All organizations must complete column (A) Columns (B), (C), end (D) are required for section 501(c)(3) end (4) organizations Are any point costs from a combined educational campaign and funaraleirp solicitation reported in (B) Program services? " a Yes ax No If "Yes," enter (q the aggregate amount of these plot costs $, (n) the amount allocated to Program services, $ What is the organization's primary exempt purpose? All organizations must describe their exempt purpose achievement In a clear and concise manner State the number of clients served, publications issued, etc Discuss achievements that ere not measurable (Section 501(c)(3) end (4) organizations and 4947(a)(1) nonexempt ehanhble trust must also enter the amount of grants and allocations to others ) e SEbIItiAAS DESIGNED FOR ATTORNEYS,-CASE _ MANAGERS-INSURANCE----------------- b c d ADJUSTERS, ALLIED HFALTH_PRO-PROFESSIONALS-. - AND - OTHERS - WHO -------------------- WORK - WITH - PATIENTS - OF - SPINAL - INJURY (Grants and alloca4onallocations $ ) --------------------------------------------------------------------------- --------------------------------------------------------------------------- (Grants and allocations $ --------------------------------------------------------------------------- --------------------------------------------------------------------------- (Grand and allocations $ --------------------------------------------------------------------------- --------------------------------------------------------------------------- (Grants and allocations $ e Other program services (attach schedule) (Grants and allocations $ (Required for5ol(c)(7)ana (4)orga,and4947(e)(1) trusts. but opnonei for others ) J~ f Total of Program Service Expenses (should equal line 44, column (B), Program services) " 3, 317 2e,o2o, o0o Form 990 (2002) TR3663 M698 06/27/2003 09 :48 :49 V02-6 2 9527 3
75-2985553 Form 990 (2002) Pege 3 Balance Sheets See page 24 of the instructions Note: Where required, attached schedules end amounts within the description (A) column should be for end-of-ye ar amounts only Beginning of year End of year 45 Cash - non-interest-bearing NONE 45 23 189 48 Savings end temporary cash investments 46 47a Accounts receivable b Less allowance for doubtfu ; account 47b 47c 47a 48a Pledges receivable 48a b Less allowance for doubtful accounts 48b 48c 48 Grants receivable 49 50 Recervables from officers, directors, trustees, and key employees (attach schedule) 50 51a Other notes and loans receivable (attach schedule) d b Less allowance for doubtful accounts 51b 51 c 52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 53 54 Investments - securities (attach schedule) 11, a Cost ~ FMV 54 SSe Investments - land, buildings, and equipment basis b Less accumulated depreciation (attach 51a SSa schedule) 1 55b 55c 58 Investments - other (attach schedule) so 57a Land, buildings, end equipment bass 6 Less accumulated depreciation (attach 57a schedule) 57b 57c 58 Other assets (describe " 58 59 Total assets add lines 45 through 58 must equal line 74 No 59 23, 189 80 Accounts payable and accrued expenses 80 d 63 87 Grants payable 87 82 Deferred revenue 82 Loans from officers, directors, trustees, and key employees (attach z schedule) BJ m 84a Tax-exempt bond liabilities (attach schedule) 84a b Mortgages and other notes payable (attach schedule) 85 Other liabilities (describe " ) 65 84b 88 Total liabilities add lines 60 through 65 ) 66 Organizations that follow SFAS 117, check here " U and complete lines 67 through 69 and lines 73 and 74 d 67 Unrestricted NONE 67 23, 189 88 Temporarily restricted 88 89 Permanency restricted 89 v Organizations that do not follow SFAS 117, check here t ~ and complete lines 70 through 74 0 70 Capital stock, trust principal, or current funds 70 77 Paid-in or capital surplus, or land, building, and equipment fund 71 74 Retained earnings, endowment, accumulated income, or other funds 72 a 77 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72, column (A) must equal line 19, column (B) must equal line 21) NO 73 23, 189 Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments Jsa 7E1030 1 000 TR3663 M698 06/27/2003 09 48 :49 V02-6 2 9527 4
Form 990 75-2985553 per 4 a Total revenue, gains, and other support per audited financial statements " a b Amounts included on line a but not on line 12, Form 990 c (1) Net unrealized gains on Investments 8 (2) Donated services end use of facilities (3) Recovenea of poor year grants $ (4) Other (specify) t Add amounts on lines (1) through (4) "L Line a minus line b d Amounts included on line 12, Form 990 but not on line a (1) Investment expenses not Included on line Bb, Form 890 (Z) Other (specify) S f a b Total expenses and losses per audited financial statements Amounts included on line a but not on line 17, Form 990 (1) Donated services and use of facilities $ (2) Prior year adjustments reported on line 20, form 990 t (S) Losses reported on line 20, Forth 990 S (4) Other (specity) Add amounts on linen (1) through (4) c c Line a minus line b d Amounts included on lion 77, Form 990 but not on line a (1) Investment expenses not included on line 6b, Form 990 f (7) Other (specify) Add amounts on lines (1) and (2) e Total revenue per line 12, Form 990 Add amounts on lines (1) and (2) e Total expenses per line 17, Form 990 (List each one even if not compensated, see page 26 of 75 Did any officer, director, trustee, or key employee receive aggregate compensation o! more than $100,000 from your organization and all related organizations, of which more than $10,000 urns provided by the related organizations? " [::] Yes ax No If "Yes,* attach schedule - see papa 26 of the instructions Forth (2002) JSA 2E1040 1 000 TR3663 M698 06/27/2003 09 :48 :49 V02-6 2 9527 5
7B Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed deecrlphon of each activity 77 Were any changes made in the organizing or governing documents but not reported to the IRS? If 'VOS,' attach a conformed copy of the changes 78a Did the organization have unrelated business prose income of $1,000 a more during the year covered by this return? b If "Yes," has It filed a tax return on Form 990-T for thls year? 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement 80 a Is the organization related (other then by association vnth a statewide or nationwide orpanizahon) through common membership, governing bodies, trustees, officers, ate, to any other exempt w nonexempt organization?,,,, b If "Yes,' enter the name of the organization and check whether R is U exempt or U nonexempt 81 a Enter direct or indirect political expenditures See line 81 instructions b Did the organization file Form 7170-POL for this year? 8Z a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? b II "Yea ; you may indicate the value of these Reins here Do not include thin amount as revenue in Part I w as an expense In Part II (See inewehone in Part III ) 1 821: 83a Did the organization comply with the public inspection requirements for returns end exemption applications? b Did the organization comply with the disclosure requirements relating to quid pre quo contnbuhons? 86a Did the organization solicit any contributions or pitta that were not fax deguehwe'7 b If 'Yes," did the organization include with every solicitation an express statement that each confibuhons or pith were net tax deductible? 88 501(c)(4), (5), or (6) organizations a Were substantially ell dues nondeductible by members? b Did the organization make only in-house lobbying expenditures of $2,000 or leas? If "Yea" urea answered to either 85a or 85b, do not complete BSe through 85h below unless the arpanuahon received a waiver for proxy tax owed for the poor year c Dues, assessments, end similar amounts from members B6, d Section 182(e) lobbying and political expenditures e Aggregate nondeductible amount of section 6033(e)(1)(A) dues nohcea Taxable amount of lobbying and political expenditures (line BSd lean 85e) 85 86,. g Does the organization sleet to pay the section 8033(e) tax on the amount on line 85f7 h If section 8033(e)(1)(A) dues notices were sent, dose the organization agree W add the amount on line &5f W its reasonable estimate al dues allocable to nondeductible lobbying and political expenditures for the following tax year? 88 50f(c)(7) nps Enter a Initiation fees end capital contributions included on line 12 b Gross receipts, included on line 12, for public use of club facilities I 82! 86b 87 501(e)(12) aps Enter a Gross income from members or shareholders b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them ) 88 At any time during the year, did the organization own a 50% or greater interest in e amble corporation or partnership, or en entity disregarded as separate from we organization under Regulations sections 301 7701-2 and 301 7701-37 If -Yes," complete Part IX 89a 501(e)/3J organizations Enter Amount of tax imposed on the orpaniza6on during the year under section 4911 ll~ N/A, section 4912 " N/A, section 4955 b 501(c)(3) and 501(e)(4) ores Did the organization engage in any section 4958 excess benefit transaehon during the year or did it become aware of an excess benefit transaction horn a poor yeah If "Yes." attach a statement explaining each transaction c Enter Amount of tax imposed on the organization managers or disqualified persons during we year under sections 4912, 4955, and 4958 d Enter Amount of tax on line 89c, above, reimbursed by the organization 90 a List the states oath which a copy of this return is filed COLORADO b Number of employees employed in the pay period that Includes March 12, 2002 (See instructions) ~ 90b ~ 81 Thebookaereincareof " MARY CIRILLO 7elephoneno " 303-877-5646 Locatedat1 11080 CIRCLE POINT DA WESTMINSTER, CO ZIP. 4 1 80020 82 Section 4847(x)(1) nonerempt cherrable busts filing Farm 990 m lieu W Form fon -Cheek here and enter the amount of tax-exempt interest received or accrued during the tax year " 19 2 1 N/A III N/A N/A No Form990 (2002) Jsn 2E10/7 1 000 TR3663 M698 06/27/2003 09 49 49 V02-6 2 9527 6
Note Enter pass amounts unless otherwise indicated 89 Program semce revenue a SEMINARS b e d e IF Medicare/Medlcaid payments g Fees and contracts from governmirt agencies 94 Membership dud and assessments 96 Inbnrt on nvtrps and tarriporary "it, ants 96 Dividends and interest from securities 87 Net rental income or (loss) from real estate a debt-financed property b not debt-financed property 88 flat andllncomt or poss) from Personal property 99 Other investment Income 700 Gain or(im)homelaalwmboffer man lmenbry 101 Net income or (loss) from special events 102 Gross profit or (lose) from mice of inventory 109 Other revenue a b c d e 104 Subtotal (add columns (B), (D), end (E)) I 106 Total (add line 104, columns (B), (D), and (E)) Unrelated business inc (p) 9r+ness ~e Amount Note Line 105 plus Inro Id, Pert l, should equal the amount on Giro 12, Pert I ;IUEeA b section 512 513 or 514 ;c usion code Amount (E) Related or exempt function income 399 Line No I Explain how sash activity for which income is reported in column (E) of Part Vil contributed Importantly to the accomplishment nl the oroanizatiori a ey mot ouroosea (other than by orwidina funds for such DufDOSes) of corporation, I P".ndwa `B' I Nature of " ' activities I Total " income ' Information Reg arding Transfers Associated with Personal Bene rt Contracts (See page 33 of the instructions ) (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract's Yes X No (b) Did the organization, during the year, pay premiums, directly or indirect, on a personal benefit contracts Yes X No Note Il "Yes"fo l~le Form 8870 aid Form 4720 see instnichon Under penal6e penury, I declare that I nape examined this EflabGll!(. NC correct. and complete Declaration Of crepe Please Sign Here Paid Preparers 1 ' IQne re roar e nn~ e G Preparere, `/ signature Firm's name (or yours U50 Only J self-employed), ' 17 address end ZIP +4, 2E7050 1 000 TA3663 L4698 06/27/2003 09 :48 :49 V02-6 2
SCHEDULER Organization Exempt Under Section 501(c)(3) (Except Private Foundation) and Section 601(e), 601(Q, 607(k), (Form 990 of 990-EZ) 601(n), or Section 4947(a)(1) Nonexempt Charitable Trust Department of Ne Treasury Supplementary Information - (See separate instructions.) Internal Revenue Service " MUST be eom leted by the above oraamzatione and attached to their Form 990 or! Name o1 the orpaniza6on SPINAL INJURY LUM Compensation of the Five 1 - (See page 1 of the instructions (e) Name and address olmch employee paid more then $50,000 OMB No 1545-0047 2002 est Paid Employees Other Than Officers, Directors, and Trustee: each one If there are none, enter "None' (b) Title and average (d) Contributions is (e) FVenx hours per week-- (c) Compensation employee beoefrt plans 8 account and_ other NONE Total number of other employees paid over $50,000 11 I NONE Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions List each one (whether indnnduals or firms) If there are none, enter "None (e) Name and address of each independent contractor paid mare than $50,000 (b) Type of service I (c) Compensation NONE Total number of others receiving over $50,000 for professional cernces " NONE For Paperwork Reduction Act Notice, spa the instructions for Form 990 end Form 990-EL JSA 2E I210 1 000 Schedule A (Form 990 or 990.EZ) TOOK TR3663 M698 06/27/2003 09 :48 49 V02-6.2 9527
Schedule A (Form 990 or 990-En 2002 Statements About Activities (See page 2 of the instructions ) 75-2985553 1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If Yes; enter the total expenses pall or incurred in connection with the lobbying actnities " E (Mutt equal amounts on line 38, Part VI-A, or line i a Part VI-B ) Organizations that made an election under section 501(h) by filing Form 5768 must complete Part 1-A Other organizations checking 'Yes,' must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities 2 During the year, has the organization, either directly or indirectly, engaged In any of the following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as en officer. director, trustee, majority owner, or principal beneficiary? (If the answer to pry question is 9'e,' attach a detailed statement explaining the trensecnonsj e Sale, exchange, or leasing of pnoperty? page 2 Yes No b Lending of money or other extension of credit? e Furnishing of goods, services, or faciines? d Payment of compensation (or payment or reimbursement of expenses d more than $1,000)? e Transfer of any pert of it income or assets? 3 Does the organization make grants for scholarships. fellowships, student loans, etc? (See Note below ) 1 Do you have a section 403(b) ennulty plan far your employees? Note Attach a statement to explain how the organization determines that individuals OF, Organizations receiving grants U. M, Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions ) The or anization is not a private foundation because R is (Please check only ONE applicable box ) 6 A church, convention of churches, or association of churches Section 170(b)(1)(A)(1) 6 A school Section 770(b)(1)(A)(I) (Also complete Part V ) 7 I I A hospital or a cooperative hospital sernce organization Section 170(b)(1)(A)(ill) 8 e A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) 9 A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ni) Enter the hoaprtal's name, city, and state 1------- 10 E] M organization operated for the benefit of a college or university owned or operated by a povemmental unit Section 170(b)(1)(A)(n) (Also complete the Support Schedule in Part IV-A ) 11 a F~ An organization that normally reserves a substantial part of its support from a governmental unit or from the general public Section 170(b)(7)(A)(r) (Alw complete we Support Schedule in Part IV-A) 11 b A community trust Section 170(b)(1)(A)(H) (Also complete the Support Schedule in Part IV-A ) 7 2 ex M organization that normally reeewea (1) more than 93 113% of its support from contributions, membership fees, and gross 17 F_] receipts from activities related to its charitable, etc, functions - subject to certain exceptions, and (Z) no more than 33 1/7% of its support from gross investment income and unrelated business taxable Income (leas section 511 fax) from businesses enquired by the organization after June 30, 1975 Sea section 509(a)(2) (Also complete the Support Schedule in Part IV-A) M organization that to not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5 through 12 above, or (2) section 501(e)(4), (5), or (6), d they meet the test of section 509(e)(2) (See section 509(a)(3) ) (a) Name(e) of supported organuabon(s) (b) Line number from above 14 r-] An organization organized and operated to test for public safety Section 509(x)(4) (See page 5 of the instructions ) 2E 1720 1 000 Schedule A (Form 8!0 or 8lGFZ) 3003 TA3663 El698 06/27/2003 09 48 49 V02-6 2 9527 9
ScheduleA Form990or990-EZ 2002 75-2985553 e3 akagsupport Schedule (Complete only if you checked a box online 10, 11, or 12 ) (Isepah medliodolaecoundrig. Note You may use the worksheet in the instructions for converting from the accrual to the cash method o! accounting 16 Gifts, grants, and contributions received (Do Total 18 17 Grace receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the 78 Gross income from interest, dividends, amounts received from payments on securities loans (section 512(a)(5)), rents, royalties, and unrelated business taxable income (ses section 511 taxes) from businesses acquired 79 Net income from unrelated business activities not included in line 18 20 Tax revenues levied for the organization's benefit and either paid to it or expended an 21 me value of services or facilities furnished to the organization by a governmental unit without sharps Do not include the value of services or facilities generally furnished to the 77 Other income Attach a schedule Do not include gain or (lose) from sale of woral assets 26 Organizations described on lines 10 or 17 a Enter 2% of amount in column (e), line 24 IJQT. AppI,1,CjEyZ b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts!or 1998 through 2001 exceeded the amount shown in line 28a Do not file this list with your return e Total support for section 509(a)(1) test Enter line 24, column (e) d Add Amounts from column (e) for lines 18 19 e Public support (line 26c minus line 28d total) 22 26b Enter the total of all these eases amounts 27 Organizations described on line 12 a For amounts Included in lines 15, 78, and 17 that were received from a "disqualified person," prepare a list far your records to show the name of, and total amounts received in each year from, sash "disqualified person" Do not file this list with your return Enter the sum of such amounts for each year (2001) (2000) (1999) (1998) b For any amount included in line 17 that was received from each person (other then "disqualified persons'), prepare a list for your records to show the name of, and amount received for each year, that was more than the larger of (7) the amount on line 25 for the year or (Z) $5,000 (Include in the list organizations described in )lose 5 through 11, as well as individuals) Do not file this list with your return After computing the difference between the amount received and the larger amount described in (1) or (Z), enter the sum of these differences (the excess amounts) for each year (2001) (2000) (1999) (1998) c Add Amounts from column (e) for )lose 15 18 d Add Line 27a total 17 20 21 and line 27b total e Public support (line 27c total minus line 27d total) 1 Total support for section 509(a)(2) test Enter amount from line 23, column (e) g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 28 Unusual Grants For an organization described in line 10, 11, or 12 that reserved any unusual grants during 1988 through 2001, prepare a list!or your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of we grant Do not file this tut with your return Do not include these grants in line 16 Jgp Schedule A (Form 990 or 99dEZ) 2071 te17]1 1 000 "I 27f TR3663 Ll698 06/27/2003 09 :48 :49 V02-6 2 9527 10
75-2985553 Schedule A (Form 990 or 990-EZ) 7002 UEM Private School Questionnaire (See page 7 of the instructions ) (To be completed ONLY by schools that checked the box on line 6 in Part IV) NOT APPLICABLE Page 4 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, Yes No other governing instrument, or in a resolution of its governing body 29 30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, end other written communications with the public dealing with student admissions, programs, and scholarships,, 30 31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves 31 If "Yes," please describe, if "No," please explain (If you need more space, attach a separate statement ) ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- 32 Does the organization maintain the following a Records indicating the racial composition of the student body, faculty, and administrative Staff? b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory bass c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships d Copies of all material used by the organization or on its behalf to solicit contributions? 32a 32h 32e 32d 7S If you answered "No" to any of the above, please explain (If you need more space, attach a separate statement) ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- Does the organization discriminate by race in any way with respedto a Students' rights or privileges? b Admissions policies? c Employment of faculty or administrative staff? d Scholarships or other financial assistance e Educational policies? T Use of facili4es? p Athletic programs h Other extracurricular ac4whes? 34a Does the organization receive any financial aid or assistance horn a governmental agency b Has the organization's right to such aid ever been revoked or suspended If you answered "Yes" to either 34a or b, please explain using an attached statement 35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 OS of Rev Proc 75-50. 1975-2 C B 587. covering racial nondiscrimination If "No :" attach an explanation 7E7730 1 000 If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement ) ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- ----------------------------------------------------------------------------- Schedule A (Form HO or 8l 2001 TR3663 Dl698 06/27/2003 09.48 49 V02-6.2 9527 11
Schedule A Form 990or99o-EZ 2002 75-2985553 Page 5 affii Lobbying Expenditures by Electing Public Charities (See page 9 of the Instructions ) (To be completed ONLY by an eligible orpamzabon that filed Form 5768) NOT APPLICABLE Check t a H ii the organization belongs to an affiliated group Check " b if you checked "a" and "limited control" provisions apply Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred ) SB Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 38 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table - IT the amount on line 40 Is - The lobbying nontaxable amount Is - Not over $500,000 20% of the amount on line 40 Over $500,000 but no[ over $1,000,000 $700,000 plus 1591 of the excess over $500 000 Over 51,000,000 but not over $7,500 000 $775 000 glue 10% of lie excess over $7,000 000 Over E'I,500,000 but not over $77,000 000 $225,000 plus 5% of the excess over $1,500,000 Over $17,000,000 $1,000,000 42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38 Caution If there is 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below See the instructions for lines 45 through 50 on pace 11 of the instructions ) Lobbying Expenditures During 4-Year Averaging Period 77 39 47 To be completed for ALL electing orpaniragona Calendar year (or fiscal (a) (b) ear beginning In " 2002 2001 Lobbying nontaxable amount Lobbying ceiling amount (c) I (d) I (e) 2000 1999 Tote Grassroots nontaxable Grassroots ceiling amount Grassroots lobbying is that did not coin During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through we use of a Volunteers b Paid staff or management (Include compensation in expenses reported on lines c through h ) c Media adver4semenis d Mailings to members, legislators, or the public e Publications, or published or broadcast statements f Grants to other organizations for lobbying purposes g Direct contact with legislators, then staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means I Total lobbying expenditures (Add lines e through h ) If "Yes" to any of the above also attach a statement giving a detailed description of NOT APPLICABLE Part VI-A1 (See pane 11 of the instructions Yes No x X X X X X X L11 X Amount Jsn Schedule A (Form 990 or 89DEZ) 7002 7E7740 7 000 ivrbes TR3663 lf698 06/27/2003 09 :48 :49 V02-6 2 9527 12
Schedule A Form 990 or 990-EZ 2002 75-2985553 Page 8 Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructions ) 31 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations? a Transfers from the reporting organization to a noncharitable exempt organization of (I) Cash (II) Other assets Other transactions (I) Sales or exchanges of assets with a noncharitable exempt organization (II) Purchases of assets from a noncharitable exempt organization (III) Rental of facilities, equipment, or other assets (iv) Reimbursement arrangements (v) Loans or loan guarantees (v1) Performance of services or membership or fundraising solicitations Sharing of facilities, equipment, mailing lists, other assets, or paid employees If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value of the goads, other assets, or services given by the reporting organization 11 the organization received lees than fair market value in any 52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 " F ]Yes OX No TR3663 b!698 06/27/2003 09.48 :49 V02-6 2 9527 13
SPINAL INJURY FOUNDATION 75-2985553 FOAM 990. PART II - GRAMS AND ALLOCATIONS PAID DURING THE YEAR REI,kTION9HIP 10 SUBSTANTIAL CONTRIBUTOR RECIPIENT NXIE AIM ADDRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OA CONTRIBUTION AlOUNT GRAMS PAID lii9celi.alle0u9 NONE 501(C)(3) CHARITABLE 3,000 TOTAL CONTRIBUTIONS PAID 3,000 T[i3663 M698 06/27/2003 09 48 49 V02-6 2 9527 1.5 STATEMENT 2
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART II - OTHER EXPENSES MANAGEMENT DESCRIPTION AND GENERAL ----------- ----------- MANAGEMENT FEES 15,067. SUBSONSULTANTS 2,157. MISCELLANEOUS 500. TOTALS 17,724. TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 16 STATEMENT 3
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE THE PURPOSE OF THE SPINAL INJURY FOUNDATION IS TO IMPROVE THE LIVES AND HEALTH OF PATIENTS WITH CHRONIC SPINAL INJURY AND TO PREVENT SPINAL INJURIES THROUGH THE PREVENTION OF SPINAL INJURIES THROUGH THE EDUCATION OF THE GENERAL PUBLIC AND INTERESTED PARTIES, SUCH AS DOCTORS, LAWYERS, AND MEMBERS OF THE INSURANCE INDUSTRY, UTILIZING VARIOUS MEDIA FORMATS, SEMINARS, PUBLICATIONS AND OTHER EDUCATIONAL FORUMS. STATEMENT 4 TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 17
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART V - LIST OF OFFICERS, S, AND TRUSTEES NAME AND ADDRESS ---------------- MICHAEL FREEMAN, PH.D., M.P.H., D.C 2480 LIBERTY ROAD N.E. SALEM, OREGON 97303 EDWARD JACOBSON, PH.D. 9141 GRANT ti135 THORNTON, COLORADO 80229 MILLICENT PURDY 775 HUDSON DENVER, COLORADO 80220 JENNIFER CENTENO 11080 CIRCLE POINT ROAD, #140 WESTMINSTER, COLORADO 80020 CHRISTOPHER J. CENTENO, M.D. 11080 CIRCLE POINT ROAD, #140 WESTMINSTER, COLORADO 80020 MARY CIRILIA, LPN, RHIT 11080 CIRCLE POINT ROAD, #140 WESTMINSTER, COLORADO 80020 TIMOTHY BYRNE 11080 CIRCLE POINT ROAD, Ii140 WESTMINSTER, COLORADO 80020 ROBERT WRIGHT, M.D. 13701 EAST MISSISSIPPI, SUITE 320 AURORA, COLORADO 80012 TITLE AND TIME DEVOTED TO POSITION ------------------- /PRESIDENT / V.P. /SECRETARY TREASURER EXECUTIVE CLINICAL RESEARCH CO TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 18 STATEMENT 5
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART V - LIST OF OFFICERS, S, AND TRUSTEES TITLE AND TIME NAME AND ADDRESS DEVOTED TO POSITION ---------------- ------------------- SCOTT BRANDT, M.D. 13701 EAST MISSISSIPPI, SUITE 320 AURORA, COLORADO 80012 STEVE SHAPIRO, ESQ. 1600 BROADWAY, SUITE 2600 DENVER, COLORADO 80202 STEPHEN SCHMITZ, PH.D. 1919 14TH STREET, #714 BOULDER, COLORADO 80302 JONATHAN WOODCOCK, M.D. 8515 PEARL STREET, N203 THORNTON, COLORADO 80229 CATHLEEN VANBUSKIRK, M.D. 1136 ALPINE AVENUE, SUITE 205 BOULDER, COLORADO 80304 STUART LEVY, M.D. 4101 WEST CONEJOS, #225 DENVER, COLORADO 80204 EMMETT SMITH, O.M.D. 695 COLORADO BOULEVARD, Ii220 DENVER, COLORADO 80246 MICHAEL SHELL, D.O. 1320 VIVIAN STREET LANGMONT, COLORADO 80501 TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 19 STATEMENT 6
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART V - LIST OF OFFICERS, S, AND TRUSTEES TITLE AND TIME NAME AND ADDRESS DEVOTED TO POSITION ---------------- ------------------- JULIE STAPLETON, M.D. 5277 MANHATTAN CIRCLE BOULDER, COLORADO 80301 GREG ROUNDS, R.N. PO BOX 21468 DENVER, COLORADO 80221 CHRISTEL S2CZESNIAK 1939 SOUTH WINONA COURT DENVER, COLORADO 80219 JIM ELLIOT, P.T. 11080 CIRCLE POINT ROAD, #140 WESTMINSTER, COLORADO 80020 GRAND TOTALS TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 20 STATEMENT 7
SPINAL INJURY FOUNDATION 75-2985553 FORM 990, PART VIII - ACCOMPLISHMENT OF EXEMPT PURPOSES EXPLANATION OF HOW EACH ACTIVITY FOR WHICH INCOME LINE IS REPORTED IN COLUMN (E) OF PART VII CONTRIBUTED NO. IMPORTANTLY TO THE ACCOMPLISHMENT OF EXEMPT PURPOSES --- ---------------------------------------------------- THE CORPORATION WAS FORMED EXCLUSIVELY FOR EDUCATIONAL AND CHARITABLE PURPOSES WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, AS AMENDED, AND ITS PRINCIPAL PURPOSE IS TO DO AND PERFORM EVERY ACT OR ACTS NECESSARY, INCIDENTAL TO OR CONNECTED WITH THE FUTHERANCE OR EDUCATIONAL AND CHARITABLE PURPOSES AND GENERALLY TO DO ANYTHING PERMITTED OF A NONPROFIT CORPORATION UNDER THE LAWS OF THE STATE OF COLORADO. THE SEMINARS SHALL BE OF AN EDUCATIONAL OR OTHER CHARITABLE NATURE WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND REGULATIONS THEREOF. STATEMENT 8 TR3663 M698 06/27/2003 09 :48 :49 V02-6.2 9527 21
For 8868 (December 2006) Department of the Treasury Application for Extension of Time To File an Exempt Organization Return " File a for each return OMB No,54s,7o9 If you are filing for en Automatic 1-Month Extension, complete only Part I and check this box If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of the form) Note DonatcompletePartOunlessyouhavealieaBybeeriFpantedanaufavna0c3monlhextenslonmaprcviwslyliled Form 8868. Automatic 3-Month Extension of Time - Only submit original (no copies needed) Note : Form 990-T corporations requesting en automatic 6-month extension - check this box end complete Pert 1 only All other corporations (including Form 990-C filers) must use Form 7004 to request en extension of time to file income tax returns Partnershins. REMICs end trusts must use Form 8736 to request an extension o/ lime to file Form 1065. 1066. or 1041 Type Of Name of EzemptOrpanlaGOn Emplc Pent SPINAL INJURY FOUNDATION 75 File by the due Number, street, and room a suite no If a P O box, see instructions date for Gilrp your retain Sea 11080 CIRCLE POINT ROAD instructions City, town or post office, state, and ZIP code For a foreign address, see InstrueUons WESTDffNSTEER CO 80020-2755 Check type of return to be flied (file a se crate application for each return) 7( Form 990 Forth 990-T (corporation) Forth 4720 e e I I Form 990-BL I I Forth 990-T(sec 407(a) or 408(a) trust) I I Form 5227 Form 99D-EZ Form 9~ TA trust other than above) Form 69 Form 990.PF Form B Form 8870 If the organization does not have an office or place of business m the United States, check this box I- [-] " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If the s for the whole group, check this box " F-1 If it is for part of the group, check this box " and attach a list with the names and EINs of all members the extermon will cover 1 I request an automatic 3-month (6-month, for 990-T corporation) extension of lime until 08/15. 2003 to file the exempt organization retain for the organization named above The extension is for the organ ahon's re4rtn for P, [9 calendar year 2002 or tsz year beginning, and ending 2 If this tax year is for less than 12 months, check reason 11 Initial return D Final return E] Change m accounting period " X 3a If this application is for Forth 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions $ b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit $ e Balance Due Subtract line 3b from line 3a Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFlPS (Electronic Federal Tax Payment System) See instructions $ ' Signature and Verification Under perwtles of perjury I declare that I hae emmined this form, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, correct, end complete, and that I em authorized to prepare flits form Signature " Amoi~ Title " `r// 1 bah " For Paperwork Reduction Act Notice, see Instruction Fam8888 (iz-zooo) JSA zfsos4 + 000 E1698 05/12/2003 17~07~39 V02-6 9527 1