Form 990 Return of Organization Exempt From Income Tax Under Sect

OMB No. 1545-0047

990

Form

Return of Organization Exempt From Income Tax

2009

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation)
Department of the Treasury
Internal Revenue Service

A

©

The organization may have to use a copy of this return to satisfy state reporting requirements.

For the 2009 calendar year, or tax year beginning

B Check if applicable:
Address change
Name change
Initial return
Terminated
Amended return
Application pending

I
J
K

Website: ©
Form of organization:

501(c) (

)§ (insert no.)

, 20
D Employer identification number
E

Room/suite

Telephone number

(

)

G Gross receipts $

F Name and address of principal officer:

Tax-exempt status:

Part I

, 2009, and ending

Please C Name of organization
use IRS
Doing Business As
label or
print or
Number and street (or P.O. box if mail is not delivered to street address)
type.
See
Specific
City or town, state or country, and ZIP + 4
Instructions.

Open to Public
Inspection

4947(a)(1) or

H(b) Are all affiliates included?
Yes
If “No,” attach a list. (see instructions)

527

H(c) Group exemption number

Corporation

Trust

Association

Other

©

No

Yes

H(a) Is this a group return for affiliates?

L Year of formation:

No

©

M State of legal domicile:

Summary

Net Assets or
Fund Balances

Expenses

Revenue

Activities & Governance

1 Briefly describe the organization’s mission or most significant activities:

2
3
4
5
6
7a
b
8
9
10
11
12

if the organization discontinued its operations or disposed of more than 25% of its net assets.
Check this box ©
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of employees (Part V, line 2a)
Total number of volunteers (estimate if necessary)
Total gross unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, line 34

3
4
5
6
7a
7b

Prior Year

Current Year

Beginning of Current Year

End of Year

Contributions and grants (Part VIII, line 1h)
Program service revenue (Part VIII, line 2g)
Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12 )

13 Grants and similar amounts paid (Part IX, column (A), lines 1–3)
14 Benefits paid to or for members (Part IX, column (A), line 4)
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)
16a Professional fundraising fees (Part IX, column (A), line 11e)
b Total fundraising expenses (Part IX, column (D), line 25) ©
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)
19 Revenue less expenses. Subtract line 18 from line 12
20 Total assets (Part X, line 16)
21 Total liabilities (Part X, line 26)
22 Net assets or fund balances. Subtract line 21 from line 20

Part II

Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign
Here

Paid
Preparer’s
Use Only

©
©

Signature of officer

Date

Type or print name and title

Preparer’s
signature

©

Firm’s name (or yours
if self-employed),
address, and ZIP + 4

Date

©

Check if
selfemployed

©

Preparer’s identifying number
(see instructions)

EIN

©

Phone no.

© (

May the IRS discuss this return with the preparer shown above? (see instructions)
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

)

Yes
Cat. No. 11282Y

Form

990

No
(2009)

Form 990 (2009)

Part III

Page

2

Statement of Program Service Accomplishments

1

Briefly describe the organization’s mission:

2

Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ?
Yes
No
If “Yes,” describe these new services on Schedule O.
Did the organization cease conducting, or make significant changes in how it conducts, any program
services?
Yes
No
If “Yes,” describe these changes on Schedule O.
Describe the exempt purpose achievements for each of the organization’s three largest program services by expenses.
Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and
allocations to others, the total expenses, and revenue, if any, for each program service reported.

3

4

4a (Code:

) (Expenses $

including grants of $

) (Revenue $

)

4b (Code:

) (Expenses $

including grants of $

) (Revenue $

)

4c (Code:

) (Expenses $

including grants of $

) (Revenue $

)

4d Other program services. (Describe in Schedule O.)
(Expenses $
including grants of $
4e Total program service expenses ©

) (Revenue $

)
Form

990

(2009)

Form 990 (2009)

Part IV
1

Page

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,”
complete Schedule A
Is the organization required to complete Schedule B, Schedule of Contributors?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
candidates for public office? If “Yes,” complete Schedule C, Part I
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete
Schedule C, Part II
Section 501(c)(4), 501(c)(5), and 501(c)(6) organizations. Is the organization subject to the section 6033(e)
notice and reporting requirement and proxy tax? If “Yes,” complete Schedule C, Part III

2
3
4
5
6

Did the organization maintain any donor advised funds or any similar funds or accounts where donors have
the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,”
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 “Yes,” complete Schedule D, Part II

7
8
9

10
11
●
●
●
●
●
●
12
12A

3

Checklist of Required Schedules

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,”
complete Schedule D, Part III
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part
X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IV
Did the organization, directly or through a related organization, hold assets in term, permanent, or
quasi-endowments? If “Yes,” complete Schedule D, Part V
Is the organization’s answer to any of the following questions “Yes”? If so, complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If “Yes,” complete
Schedule D, Part VI.
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses
the organization’s liability for uncertain tax positions under FIN 48? If “Yes,” complete Schedule D, Part X.
Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” complete
Schedule D, Parts XI, XII, and XIII.
Yes
No
Was the organization included in consolidated, independent audited financial statements for the tax year?
12A
If “Yes,” completing Schedule D, Parts XI, XII, and XIII is optional.

Yes

No

990

(2009)

1
2
3
4
5

6
7
8

9
10
11

12

13
13 Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
14a
14a Did the organization maintain an office, employees, or agents outside of the United States?
b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising,
14b
business, and program service activities outside the United States? If “Yes,” complete Schedule F, Part I
15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any
15
organization or entity located outside the United States? If “Yes,” complete Schedule F, Part II
16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance
16
to individuals located outside the United States? If “Yes,” complete Schedule F, Part III
17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services
17
on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on
18
Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II
19 Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
If “Yes,” complete Schedule G, Part III
19
20 Did the organization operate one or more hospitals? If “Yes,” complete Schedule H
20
Form

Form 990 (2009)

Part IV
21
22
23

Page

4

Checklist of Required Schedules (continued)

Did the organization report more than $5,000 of grants and other assistance to governments and organizations
in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II
Did the organization report more than $5,000 of grants and other assistance to individuals in the
United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization’s current and former officers, directors, trustees, key employees, and highest compensated
employees? If “Yes,” complete Schedule J

Yes

No

990

(2009)

21
22

23

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines
24b through 24d and complete Schedule K. If “No,” go to line 25
24a
24b
b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
c Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
d Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?
25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction
with a disqualified person during the year? If “Yes,” complete Schedule L, Part I
b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a
prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or
990-EZ? If “Yes,” complete Schedule L, Part I
26
27

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or
disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L, Part II
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contributor, or a grant selection committee member, or to a person related to such an individual?
If “Yes,” complete Schedule L, Part III

Was the organization a party to a business transaction with one of the following parties (see Schedule L,
Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV
b A family member of a current or former officer, director, trustee, or key employee? If “Yes,” complete
Schedule L, Part IV
c An entity of which a current or former officer, director, trustee, or key employee of the organization (or a
family member) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L,
Part IV

24c
24d
25a

25b
26

27

28

29
30
31
32
33
34
35
36
37

38

Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
conservation contributions? If “Yes,” complete Schedule M
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete
Schedule N, Part II
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II,
III, IV, and V, line 1
Is any related organization a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete
Schedule R, Part V, line 2
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related
organization? If “Yes,” complete Schedule R, Part V, line 2
Did the organization conduct more than 5% 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 “Yes,” complete Schedule R,
Part VI
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and
19? Note. All Form 990 filers are required to complete Schedule O.

28a
28b

28c
29
30
31
32
33
34
35
36

37
38
Form

Form 990 (2009)

Part V

Page

Yes

1a Enter the number reported in Box 3 of Form 1096, Annual Summary and Transmittal of
1a
U.S. Information Returns. Enter -0- if not applicable
1b
b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable
c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable
gaming (gambling) winnings to prize winners?
2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return 2a
b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file this return. (see
instructions)
3a Did the organization have unrelated business gross income of $1,000 or more during the year covered by
this return?
b If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O
4a 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 bank account, securities account, or other financial
account)?
b 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.
5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?
b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
c If “Yes” to line 5a or 5b, did the organization file Form 8886-T, Disclosure by Tax-Exempt Entity Regarding
Prohibited Tax Shelter Transaction?
6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible?
b If “Yes,” did the organization include with every solicitation an express statement that such contributions or
gifts were not tax deductible?
7 Organizations that may receive deductible contributions under section 170(c).
a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods
and services provided to the payor?
b If “Yes,” did the organization notify the donor of the value of the goods or services provided?
c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282?
7d
d If “Yes,” indicate the number of Forms 8282 filed during the year
e Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal
benefit contract?
f Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
g For all contributions of qualified intellectual property, did the organization file Form 8899 as required?
h For contributions of cars, boats, airplanes, and other vehicles, did the organization file a Form 1098-C as
required?
8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting
organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring
organization, have excess business holdings at any time during the year?
9
a
b
10
a
b
11
a
b

5

Statements Regarding Other IRS Filings and Tax Compliance

Sponsoring organizations maintaining donor advised funds.
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
Section 501(c)(7) organizations. Enter:
10a
Initiation fees and capital contributions included on Part VIII, line 12
10b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
Section 501(c)(12) organizations. Enter:
11a
Gross income from members or shareholders
Gross income from other sources (Do not net amounts due or paid to other sources against
11b
amounts due or received from them.)
12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
b If “Yes,” enter the amount of tax-exempt interest received or accrued during the year
12b

No

1c

2b

3a
3b

4a

5a
5b
5c
6a

6b

7a
7b
7c

7e
7f
7g
7h

8
9a
9b

12a
Form

990

(2009)

Page 6
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and
for a “No” response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in
Schedule O. See instructions.
Section A. Governing Body and Management

Form 990 (2009)

Part VI

Yes

No

Yes

No

1a
1b

1a Enter the number of voting members of the governing body
b Enter the number of voting members that are independent
2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
any other officer, director, trustee, or key employee?
3 Did the organization delegate control over management duties customarily performed by or under the direct
supervision of officers, directors or trustees, or key employees to a management company or other person?
4 Did the organization make any significant changes to its organizational documents since the prior Form 990 was filed?
5 Did the organization become aware during the year of a material diversion of the organization’s assets?
6 Does the organization have members or stockholders?
7a Does the organization have members, stockholders, or other persons who may elect one or more members
of the governing body?
b Are any decisions of the governing body subject to approval by members, stockholders, or other persons?
8 Did the organization contemporaneously document the meetings held or written actions undertaken during
the year by the following:
a The governing body?
b Each committee with authority to act on behalf of the governing body?
9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached
at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O

2
3
4
5
6
7a
7b

8a
8b
9a

Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
10a Does the organization have local chapters, branches, or affiliates?
b If “Yes,” does the organization have written policies and procedures governing the activities of such chapters,
affiliates, and branches to ensure their operations are consistent with those of the organization?
11 Has the organization provided a copy of this Form 990 to all members of its governing body before filing the
form?
11A Describe in Schedule O the process, if any, used by the organization to review this Form 990.
12a Does the organization have a written conflict of interest policy? If “No,” go to line 13
b Are officers, directors or trustees, and key employees required to disclose annually interests that could give
rise to conflicts?
c Does the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,”
describe in Schedule O how this is done
13 Does the organization have a written whistleblower policy?
14 Does the organization have a written document retention and destruction policy?
15 Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a The organization’s CEO, Executive Director, or top management official
b Other officers or key employees of the organization
If “Yes” to line 15a or 15b, describe the process in Schedule O. (See instructions.)
16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year?
b If “Yes,” has the organization adopted a written policy or procedure requiring the organization to evaluate
its participation in joint venture arrangements under applicable federal tax law, and taken steps to safeguard
the organization’s exempt status with respect to such arrangements?

10a
10b
11
12a
12b
12c
13
14

15a
15b

16a

16b

Section C. Disclosure
17
18

19
20

List the states with which a copy of this Form 990 is required to be filed ©
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only)
available for public inspection. Indicate how you make these available. Check all that apply.
Own website
Another’s website
Upon request
Describe in Schedule O whether (and if so, how), the organization makes its governing documents, conflict of interest
policy, and financial statements available to the public.
State the name, physical address, and telephone number of the person who possesses the books and records of the
organization: ©
Form

990

(2009)

Form 990 (2009)

Part VII

Page

7

Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated
Employees, and Independent Contractors

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the
organization’s tax year. Use Schedule J-2 if additional space is needed.
● List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
● List all of the organization’s current key employees. 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 reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 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
$100,000 of reportable 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 $10,000 of reportable 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 box if the organization did not compensate any current officer, director, or trustee.

Former

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

Key employee

(E)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)

Highest compensated
employee

(D)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)

Officer

(C)
Position (check all that apply)
Institutional trustee

(B)
Average
hours per
week

Individual trustee
or director

(A)
Name and Title

Form

990

(2009)

Form 990 (2009)

Part VII

Page

8

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

Former

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

Key employee

(E)
Reportable
compensation
from related
organizations
(W-2/1099-MISC)

Highest compensated
employee

(D)
Reportable
compensation
from
the
organization
(W-2/1099-MISC)

Officer

(C)
Position (check all that apply)
Institutional trustee

(B)
Average
hours per
week

Individual trustee
or director

(A)
Name and title

©
1b Total
2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 in
reportable compensation from the organization ©

Yes No
3

Did the organization list any former officer, director or trustee, key employee, or highest compensated
employee on line 1a? If “Yes,” complete Schedule J for such individual

3

4

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from
the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such
4
individual
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization for
services rendered to the organization? If “Yes,” complete Schedule J for such person
5
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of
compensation from the organization.
(A)
Name and business address

2

(B)
Description of services

(C)
Compensation

Total number of independent contractors (including but not limited to those listed above) who received
more than $100,000 in compensation from the organization ©
Form

990

(2009)

Form 990 (2009)

Part VIII

Page

Program Service Revenue

Contributions, gifts, grants
and other similar amounts

(A)
Total revenue

1a
Federated campaigns
1b
Membership dues
1c
Fundraising events
1d
Related organizations
1e
Government grants (contributions)
All other contributions, gifts, grants,
1f
and similar amounts not included above
g Noncash contributions included in lines 1a-1f: $
h Total. Add lines 1a–1f

(B)
Related or
exempt
function
revenue

(C)
Unrelated
business
revenue

(D)
Revenue
excluded from tax
under sections
512, 513, or 514

1a
b
c
d
e
f

©
Business Code

2a
b
c
d
e
f All other program service revenue
g Total. Add lines 2a–2f
3
4
5

©

Investment income (including dividends, interest, and
©
other similar amounts)
Income from investment of tax-exempt bond proceeds ©
©
Royalties
(i) Real

6a
b
c
d

(ii) Personal

Gross Rents
Less: rental expenses
Rental income or (loss)
Net rental income or (loss)

7a Gross amount from sales of
assets other than inventory

©

(i) Securities

(ii) Other

b Less: cost or other basis
and sales expenses
c Gain or (loss)
d Net gain or (loss)
Other Revenue

9

Statement of Revenue

©

8a Gross income from fundraising
events (not including $
of contributions reported on line 1c).
See Part IV, line 18
a
b
b Less: direct expenses
c Net income or (loss) from fundraising events

©

9a Gross income from gaming activities.
See Part IV, line 19
a
b Less: direct expenses
b
c Net income or (loss) from gaming activities

©

10a Gross sales of inventory, less
a
returns and allowances
b
b Less: cost of goods sold
c Net income or (loss) from sales of inventory
Miscellaneous Revenue

11a
b
c
d All other revenue
e Total. Add lines 11a–11d
12 Total revenue. See instructions.

©

Business Code

©
©
Form

990

(2009)

Form 990 (2009)

Part IX

Page

10

Statement of Functional Expenses

Section 501(c)(3) and 501(c)(4) organizations must complete all columns.
All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
1
2
3

4
5
6

7
8
9
10
11
a
b
c
d
e
f
g
12
13
14
15
16
17
18
19
20
21
22
23
24

(A)
Total expenses

(B)
Program service
expenses

(C)
Management and
general expenses

(D)
Fundraising
expenses

Grants and other assistance to governments and
organizations in the U.S. See Part IV, line 21
Grants and other assistance to individuals in
the U.S. See Part IV, line 22
Grants and other assistance to governments,
organizations, and individuals outside the
U.S. See Part IV, lines 15 and 16
Benefits paid to or for members
Compensation of current officers, directors,
trustees, and key employees
Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)
Other salaries and wages
Pension plan contributions (include section 401(k)
and section 403(b) employer contributions)
Other employee benefits
Payroll taxes
Fees for services (non-employees):
Management
Legal
Accounting
Lobbying
Professional fundraising services. See Part IV, line 17
Investment management fees
Other
Advertising and promotion
Office expenses
Information technology
Royalties
Occupancy
Travel
Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings
Interest
Payments to affiliates
Depreciation, depletion, and amortization
Insurance
Other expenses. Itemize expenses not
covered above. (Expenses grouped together
and labeled miscellaneous may not exceed
5% of total expenses shown on line 25 below.)

a
b
c
d
e
f All other expenses
25 Total functional expenses. Add lines 1 through 24f
26 Joint costs. Check here ©
if following
SOP 98-2. Complete this line only if the
organization reported in column (B) joint costs
from a combined educational campaign and
fundraising solicitation
Form

990

(2009)

Form 990 (2009)

Part X

Page

(A)
Beginning of year

1
2
3
4
5

Net Assets or Fund Balances

Liabilities

Assets

6

Cash—non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
Accounts receivable, net
Receivables from current and former officers, directors, trustees, key
employees, and highest compensated employees. Complete Part II of
Schedule L
Receivables from other disqualified persons (as defined under section
4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete
Part II of Schedule L

7
8
9
10a

Notes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
Land, buildings, and equipment: cost or 10a
other basis. Complete Part VI of Schedule D
10b
b Less: accumulated depreciation
11
Investments—publicly traded securities
12
Investments—other securities. See Part IV, line 11
13
Investments—program-related. See Part IV, line 11
14
Intangible assets
15
Other assets. See Part IV, line 11
16
Total assets. Add lines 1 through 15 (must equal line 34)
17
18
19
20
21
22

Accounts payable and accrued expenses
Grants payable
Deferred revenue
Tax-exempt bond liabilities
Escrow or custodial account liability. Complete Part IV of Schedule D
Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L

23
24
25
26

Secured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third parties
Other liabilities. Complete Part X of Schedule D
Total liabilities. Add lines 17 through 25
Organizations that follow SFAS 117, check here
complete lines 27 through 29, and lines 33 and 34.

27
28
29

30
31
32
33
34

11

Balance Sheet

©

Unrestricted net assets
Temporarily restricted net assets
Permanently restricted net assets
Organizations that do not follow SFAS 117, check here
and complete lines 30 through 34.

(B)
End of year

1
2
3
4

5

6
7
8
9

10c
11
12
13
14
15
16
17
18
19
20
21

22
23
24
25
26

and
27
28
29
©

Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
Total net assets or fund balances
Total liabilities and net assets/fund balances

30
31
32
33
34
Form

990

(2009)

Form 990 (2009)

Part XI
1

2a
b
c

d

3a
b

Page

12

Financial Statements and Reporting

Cash
Accrual
Other
Accounting method used to prepare the Form 990:
If the organization changed its method of accounting from a prior year or checked “Other,” explain in
Schedule O.
Were the organization’s financial statements compiled or reviewed by an independent accountant?
Were the organization’s financial statements audited by an independent accountant?
If “Yes” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight 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
Schedule O.
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were
issued on a consolidated basis, separate basis, or both:
Separate basis
Consolidated basis
Both consolidated and separate basis
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133?
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

Yes

No

990

(2009)

2a
2b
2c

3a
3b
Form