Short Form Return of Organization Exempt From Income Tax

Transcription

1 Form Deprtment of the Tresury Internl Revenue Servie A B For the 0 lenr yer, or tx yer eginning Chek if pplile: C Nme of orgniztion Aress hnge Nme hnge Initil return Finl return/ terminte n ening OMB. -0 Open to Puli Inspetion D Employer ientifition numer Amene return City or town, stte or provine, ountry, n ZIP or foreign postl oe F Group Exemption Applition pening Phoenix, AZ 00 Numer G Aounting Metho: Csh Arul Other (speify) H Chek if the orgniztion is I Wesite: not require to tth Sheule B J Tx-exempt sttus (hek only one) 0()() 0() ( ) (insert no.) 9()() or (Form 990, 990-EZ, or 990-PF). K Form of orgniztion: Corportion Trust Assoition Other L Revenue Expenses Net Assets 9 0 Totl revenue. A lines,,,,,,, n Oupny, rent, utilities, n mintenne ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Printing, pulitions, postge, n shipping ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other expenses (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ See Sheule O Totl expenses. A lines 0 through 9 0 Uner setion 0(),, or 9()() of the Internl Revenue Coe (exept privte fountions) Do not enter soil seurity numers on this form s it my e me puli. Informtion out Form 990-EZ n its instrutions is t Numer n street (or P.O. ox, if mil is not elivere to street ress) 0 N Alvro A lines,, n to line 9 to etermine gross reeipts. If gross reeipts re $00,000 or more, or if totl ssets (Prt II, For Pperwork Reution At tie, see the seprte instrutions. Room/suite E Telephone numer olumn (B) elow) re $00,000 or more, file Form 990 inste of Form 990-EZ $ Prt I Revenue, Expenses, n Chnges in Net Assets or Fun Blnes (see the instrutions for Prt I) LHA 990-EZ Chek if the orgniztion use Sheule O to respon to ny question in this Prt I Contriutions, gifts, grnts, n similr mounts reeive Progrm servie revenue inluing government fees n ontrts ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~ Memership ues n ssessments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Investment inome Gross mount from sle of ssets other thn inventory ~~~~~~~~~~~~~ Less: ost or other sis n sles expenses ~~~~~~~~~~~~~~~~~ Gin or (loss) from sle of ssets other thn inventory (Sutrt line from line ) ~~~~~~~~~~~~~~~ Gming n funrising events Gross inome from gming (tth Sheule G if greter thn $,000) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross inome from funrising events (not inluing $ from funrising events reporte on line ) (tth Sheule G if the sum of suh gross inome n ontriutions exees $,000) Less: iret expenses from gming n funrising events ~~~~~~~~~~~~~~ ~~~~~~~~~~ of ontriutions Net inome or (loss) from gming n funrising events ( lines n n sutrt line ) Gross sles of inventory, less returns n llownes ~~~~~~~~~~~~~ Less: ost of goos sol ~~~~~~~~~~~~~~~~~~~~~~~~~~ Gross profit or (loss) from sles of inventory (Sutrt line from line ) Other revenue (esrie in Sheule O) Short Form Return of Orgniztion Exempt From Inome Tx Fountion Fountion MyBillofRights.org ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Grnts n similr mounts pi (list in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Benefits pi to or for memers~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Slries, other ompenstion, n employee enefits ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Professionl fees n other pyments to inepenent ontrtors ~~~~~~~~~~~~~~~~~~~~~~~~ Exess or (efiit) for the yer (Sutrt line from line 9) Net ssets or fun lnes t eginning of yer (from line, olumn (A)) (must gree with en-of-yer figure reporte on prior yer's return) Other hnges in net ssets or fun lnes (explin in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes t en of yer. Comine lines through Form 990-EZ (0) FOUNDATION FOUNDATION DBA 0

2 Fountion Fountion Form 990-EZ (0) MyBillofRights.org 0-9 Pge Prt II Blne Sheets (see the instrutions for Prt II) Chek if the orgniztion use Sheule O to respon to ny question in this Prt II (A) Beginning of yer (B) En of yer Csh, svings, n investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0.. Ln n uilings ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other ssets (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Totl ssets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0.. Totl liilities (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~ Net ssets or fun lnes (line of olumn (B) must gree with line ) 0.. Prt III Sttement of Progrm Servie Aomplishments (see the instrutions for Prt III) Expenses Chek if the orgniztion use Sheule O to respon to ny question in this Prt III (Require for setion 0()() n 0()() Wht is the orgniztion's primry exempt purpose? See Sheule O orgniztions; optionl for Desrie the orgniztion's progrm servie omplishments for eh of its three lrgest progrm servies, s mesure y expenses. In ler n onise others.) mnner, esrie the servies provie, the numer of persons enefite, n other relevnt informtion for eh progrm title. Monument esign evelopment fees 9 (Grnts $ ) If this mount inlues foreign grnts, hek here Wesite esign n mintne 0 (Grnts $ ) If this mount inlues foreign grnts, hek here 9 (Grnts $ ) If this mount inlues foreign grnts, hek here Other progrm servies (esrie in Sheule O) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (Grnts $ ) If this mount inlues foreign grnts, hek here Totl progrm servie expenses ( lines through ) 0. Prt IV List of Offiers, Diretors, Trustees, n Key Employees (list eh one even if not ompenste - see the instrutions for Prt IV) Chek if the orgniztion use Sheule O to respon to ny question in this Prt IV () Nme n title () Averge hours () Reportle () Helth enefits, (e) Estimte ompenstion (Forms ontriutions to per week evote to W-/099-MISC) employee enefit mount of other position (if not pi, enter -0-) plns, n eferre ompenstion ompenstion Chris Dikey Presient Dvi Dikey Vie Presient Form 990-EZ (0) FOUNDATION FOUNDATION DBA 0

3 Fountion Fountion Form 990-EZ (0) MyBillofRights.org 0-9 Pge Prt V Other Informtion (te the Sheule A n personl enefit ontrt sttement requirements in the instrutions for Prt V) Chek if the orgniztion use Sh. O to respon to ny question in this Prt V 9 Di the orgniztion file Form 0-POL for this yer? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Di the orgniztion engge in ny signifint tivity not previously reporte to the IRS? If "," provie etile esription of eh tivity in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Were ny signifint hnges me to the orgnizing or governing ouments? If "," tth onforme opy of the mene ouments if they reflet hnge to the orgniztion's nme. Otherwise, explin the hnge on Sheule O (see instrutions) ~~~~~~ Di the orgniztion hve unrelte usiness gross inome of $,000 or more uring the yer from usiness tivities (suh s those reporte on lines,, n, mong others)? If "" to line, hs the orgniztion file Form 990-T for the yer? If "," provie n explntion in Sheule O ~~~~~~~~~~~ Ws the orgniztion setion 0()(), 0()(), or 0()() orgniztion sujet to setion 0(e) notie, reporting, n proxy tx requirements uring the yer? If "," omplete Sheule C, Prt III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion unergo liquition, issolution, termintion, or signifint isposition of net ssets uring the yer? If "," omplete pplile prts of Sheule N Enter mount of politil expenitures, iret or iniret, s esrie in the instrutions ~~~~~ 0. Di the orgniztion orrow from, or mke ny lons to, ny offier, iretor, trustee, or key employee or were ny suh lons me in prior yer n still outstning t the en of the tx yer overe y this return? If "," omplete Sheule L, Prt II n enter the totl mount involve ~~~~~~~~~~~~~~ N/A Setion 0()() orgniztions. Enter: Initition fees n pitl ontriutions inlue on line 9 ~~~~~~~~~~~~~~~~~~~~~ Gross reeipts, inlue on line 9, for puli use of lu filities ~~~~~~~~~~~~~~~~~~ 0 Setion 0()() orgniztions. Enter mount of tx impose on the orgniztion uring the yer uner: setion 9 0. ; setion 9 0. ; setion 9 0. Setion 0()(), 0()(), n 0()(9) orgniztions. Di the orgniztion engge in ny setion 9 exess enefit trnstion uring the yer, or i it engge in n exess enefit trnstion in prior yer tht hs not een reporte on ny of its prior Forms 990 or 990-EZ? If "," omplete Sheule L, Prt I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()(), 0()(), n 0()(9) orgniztions. Enter mount of tx impose on orgniztion mngers or isqulifie persons uring the yer uner setions 9, 9, n 9 ~~~~~ Setion 0()(), 0()(), n 0()(9) orgniztions. Enter mount of tx on line 0 reimurse y the orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ All orgniztions. At ny time uring the tx yer, ws the orgniztion prty to prohiite tx shelter trnstion? If "," omplete Form -T ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0e List the sttes with whih opy of this return is file AZ The orgniztion's ooks re in re of Chris Dikey Telephone no Lote t 0 N IH # PB, Austin, T ZIP + 0 At ny time uring the lenr yer, i the orgniztion hve n interest in or signture or other uthority over finnil ount in foreign ountry (suh s nk ount, seurities ount, or other finnil ount)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "," enter the nme of the foreign ountry: See the instrutions for exeptions n filing requirements for FinCEN Form, Report of Foreign Bnk n Finnil Aounts (FBAR). At ny time uring the lenr yer, i the orgniztion mintin n offie outsie of the U.S.? ~~~~~~~~~~~~~~~~~~~~ If "," enter the nme of the foreign ountry: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 9()() nonexempt hritle trusts filing Form 990-EZ in lieu of Form 0 - Chek here n enter the mount of tx-exempt interest reeive or rue uring the tx yer ~~~~~~~~~~~~~~~~~ N/A 9 9 N/A N/A N/A -- Di the orgniztion mintin ny onor vise funs uring the yer? If "," Form 990 must e omplete inste of Form 990-EZ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion operte one or more hospitl filities uring the yer? If "," Form 990 must e omplete inste of Form 990-EZ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny pyments for inoor tnning servies uring the yer? ~~~~~~~~~~~~~~~~~~~~~~~~ If "" to line, hs the orgniztion file Form 0 to report these pyments? If "," provie n explntion in Sheule O ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion hve ontrolle entity within the mening of setion ()()? ~~~~~~~~~~~~~~~~~~~~~~~~ Di the orgniztion reeive ny pyment from or engge in ny trnstion with ontrolle entity within the mening of setion ()()? If "," Form 990 n Sheule R my nee to e omplete inste of Form 990-EZ (see instrutions) Form 990-EZ (0) FOUNDATION FOUNDATION DBA 0

4 Form 990-EZ (0) 0 Fountion Fountion MyBillofRights.org 0-9 Di the orgniztion engge, iretly or iniretly, in politil mpign tivities on ehlf of or in opposition to nites for puli offie? If "," omplete Sheule C, Prt I Prt VI Setion 0()() orgniztions only All setion 0()() orgniztions must nswer questions -9 n, n omplete the tles for lines 0 n. If "," ws the relte orgniztion setion orgniztion? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Pge Chek if the orgniztion use Sheule O to respon to ny question in this Prt VI Di the orgniztion engge in loying tivities or hve setion 0(h) eletion in effet uring the tx yer? If "," omplete Sh. C, Prt II Is the orgniztion shool s esrie in setion 0()()(A)(ii)? If "," omplete Sheule E ~~~~~~~~~~~~~~~~~~~ 9 Di the orgniztion mke ny trnsfers to n exempt non-hritle relte orgniztion? ~~~~~~~~~~~~~~~~~~~~~~ 9 Complete this tle for the orgniztion's five highest ompenste employees (other thn offiers, iretors, trustees n key employees) who eh reeive more thn $00,000 of ompenstion from the orgniztion. If there is none, enter "ne." () Nme n title of eh employee () Averge hours () Reportle () Helth enefits, (e) Estimte ompenstion (Forms ontriutions to per week evote to W-/099-MISC) employee enefit mount of other position plns, n eferre ompenstion ompenstion NONE 9 f Totl numer of other employees pi over $00,000 ~~~~~~~~~~~~~~~~ Complete this tle for the orgniztion's five highest ompenste inepenent ontrtors who eh reeive more thn $00,000 of ompenstion from the orgniztion. If there is none, enter "ne." NONE () Nme n usiness ress of eh inepenent ontrtor () Type of servie () Compenstion Di the orgniztion omplete Sheule A? te. All setion 0()() orgniztions must tth -- Totl numer of other inepenent ontrtors eh reeiving over $00,000 ~~~~~~~~~~~~~~ omplete Sheule A Uner penlties of perjury, I elre tht I hve exmine this return, inluing ompnying sheules n sttements, n to the est of my knowlege n elief, it is true, orret, n omplete. Delrtion of preprer (other thn offier) is se on ll informtion of whih preprer hs ny knowlege. Sign Here = = Signture of offier Chris Dikey, Exe Diretor Type or print nme n title Print/Type preprer's nme Preprer's signture Dte Chek if PTIN Jeffrey M. Rose, Jeffrey M. Rose, self- employe Pi C.P.A. C.P.A. 0// P0090 Preprer Firm's nme J. M. ROSE Firm's EIN 9-0 Use Only 9 9 Firm's ress 9 P.O. Box 9 Phone no. () Wooln Hills, CA 9 My the IRS isuss this return with the preprer shown ove? See instrutions Dte Form 990-EZ (0) FOUNDATION FOUNDATION DBA 0

5 SCHEDULE A OMB. -00 (Form 990 or 990-EZ) Complete if the orgniztion is setion 0()() orgniztion or setion 9()() nonexempt hritle trust. Deprtment of the Tresury Atth to Form 990 or Form 990-EZ. Open to Puli Internl Revenue Servie Informtion out Sheule A (Form 990 or 990-EZ) n its instrutions is t Inspetion Nme of the orgniztion Employer ientifition numer Prt I The orgniztion is not privte fountion euse it is: (For lines through, hek only one ox.) 9 0 e f g A hurh, onvention of hurhes, or ssoition of hurhes esrie in A shool esrie in setion 0()()(A)(ii). (Atth Sheule E.) setion 0()()(A)(i). A hospitl or oopertive hospitl servie orgniztion esrie in setion 0()()(A)(iii). A meil reserh orgniztion operte in onjuntion with hospitl esrie in setion 0()()(A)(iii). Enter the hospitl's nme, ity, n stte: An orgniztion operte for the enefit of ollege or university owne or operte y governmentl unit esrie in setion 0()()(A)(iv). (Complete Prt II.) A feerl, stte, or lol government or governmentl unit esrie in setion 0()()(A)(v). An orgniztion tht normlly reeives sustntil prt of its support from governmentl unit or from the generl puli esrie in setion 0()()(A)(vi). (Complete Prt II.) A ommunity trust esrie in setion 0()()(A)(vi). (Complete Prt II.) An orgniztion tht normlly reeives: () more thn / of its support from ontriutions, memership fees, n gross reeipts from tivities relte to its exempt funtions - sujet to ertin exeptions, n () no more thn / of its support from gross investment inome n unrelte usiness txle inome (less setion tx) from usinesses quire y the orgniztion fter June 0, 9. See setion 09()(). (Complete Prt III.) An orgniztion orgnize n operte exlusively to test for puli sfety. See setion 09()(). An orgniztion orgnize n operte exlusively for the enefit of, to perform the funtions of, or to rry out the purposes of one or more pulily supporte orgniztions esrie in setion 09()() or setion 09()(). See setion 09()(). Chek the ox in lines through tht esries the type of supporting orgniztion n omplete lines e, f, n g. Type I. A supporting orgniztion operte, supervise, or ontrolle y its supporte orgniztion(s), typilly y giving the supporte orgniztion(s) the power to regulrly ppoint or elet mjority of the iretors or trustees of the supporting orgniztion. You must omplete Prt IV, Setions A n B. Type II. A supporting orgniztion supervise or ontrolle in onnetion with its supporte orgniztion(s), y hving ontrol or mngement of the supporting orgniztion veste in the sme persons tht ontrol or mnge the supporte orgniztion(s). You must omplete Prt IV, Setions A n C. Type III funtionlly integrte. A supporting orgniztion operte in onnetion with, n funtionlly integrte with, its supporte orgniztion(s) (see instrutions). Puli Chrity Sttus n Puli Support Fountion Fountion MyBillofRights.org Reson for Puli Chrity Sttus (All orgniztions must omplete this prt.) See instrutions. You must omplete Prt IV, Setions A, D, n E. Type III non-funtionlly integrte. A supporting orgniztion operte in onnetion with its supporte orgniztion(s) tht is not funtionlly integrte. The orgniztion generlly must stisfy istriution requirement n n ttentiveness requirement (see instrutions). You must omplete Prt IV, Setions A n D, n Prt V. Chek this ox if the orgniztion reeive written etermintion from the IRS tht it is Type I, Type II, Type III funtionlly integrte, or Type III non-funtionlly integrte supporting orgniztion. Enter the numer of supporte orgniztions ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provie the following informtion out the supporte orgniztion(s). (i) Nme of supporte (ii) EIN (iii) Type of orgniztion (iv) Is the orgniztion (v) Amount of monetry (vi) Amount of orgniztion (esrie on lines -9 liste in your support (see other support (see governing oument? ove or IRC setion Instrutions) Instrutions) (see instrutions)) Totl LHA For Pperwork Reution At tie, see the Instrutions for Form 990 or 990-EZ Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

6 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Prt II Support Sheule for Orgniztions Desrie in Setions 0()()(A)(iv) n 0()()(A)(vi) Clenr yer (or fisl yer eginning in) Totl. A lines through ~~~ Puli support. Sutrt line from line. Clenr yer (or fisl yer eginning in) 9 0 Totl support. A lines through 0 () 00 () 0 () 0 () 0 (e) 0 (f) Totl Pge () 00 () 0 () 0 () 0 (e) 0 (f) Totl First five yers. If the Form 990 is for the orgniztion's first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, hek this ox n stop here Setion C. Computtion of Puli Support Perentge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ Puli support perentge from 0 Sheule A, Prt II, line ~~~~~~~~~~~~~~~~~~~~~ (Complete only if you heke the ox on line,, or of Prt I or if the orgniztion file to qulify uner Prt III. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt III.) Setion A. Puli Support Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Tx revenues levie for the orgniztion's enefit n either pi to or expene on its ehlf ~~~~ The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ The portion of totl ontriutions y eh person (other thn governmentl unit or pulily supporte orgniztion) inlue on line tht exees of the mount shown on line, olumn (f) ~~~~~~~~~~~~ Setion B. Totl Support Amounts from line ~~~~~~~ Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ Net inome from unrelte usiness tivities, whether or not the usiness is regulrly rrie on ~ Other inome. Do not inlue gin or loss from the sle of pitl ssets (Explin in Prt VI.) ~~~~ Gross reeipts from relte tivities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ / support test - 0. If the orgniztion i not hek ox on line or, n line is / or more, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 0 -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,, or, n line is 0 or more, n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt VI how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~ 0 -fts-n-irumstnes test - 0. If the orgniztion i not hek ox on line,,, or, n line is 0 or more, n if the orgniztion meets the "fts-n-irumstnes" test, hek this ox n stop here. Explin in Prt VI how the orgniztion meets the "fts-n-irumstnes" test. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~ Privte fountion. If the orgniztion i not hek ox on line,,,, or, hek this ox n see instrutions / support test - 0. If the orgniztion i not hek the ox on line, n line is / or more, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

7 Sheule A (Form 990 or 990-EZ) 0 Prt III Support Sheule for Orgniztions Desrie in Setion 09()() Clenr yer (or fisl yer eginning in) The vlue of servies or filities furnishe y governmentl unit to the orgniztion without hrge ~ Totl. A lines through ~~~ Amounts inlue on lines,, n reeive from isqulifie persons Amounts inlue on lines n reeive from other thn isqulifie persons tht exee the greter of $,000 or of the mount on line for the yer ~~~~~~ A lines n ~~~~~~~ Puli support (Sutrt line from line.) Clenr yer (or fisl yer eginning in) 9 Amounts from line ~~~~~~~ 0 Gross inome from interest, iviens, pyments reeive on seurities lons, rents, roylties n inome from similr soures ~ () 00 () 0 () 0 () 0 (e) 0 (f) Totl () 00 () 0 () 0 () 0 (e) 0 (f) Totl hek this ox n stop here Setion C. Computtion of Puli Support Perentge Puli support perentge from 0 Sheule A, Prt III, line Setion D. Computtion of Investment Inome Perentge 0 (Complete only if you heke the ox on line 9 of Prt I or if the orgniztion file to qulify uner Prt II. If the orgniztion fils to qulify uner the tests liste elow, plese omplete Prt II.) Setion A. Puli Support Gifts, grnts, ontriutions, n memership fees reeive. (Do not inlue ny "unusul grnts.") ~~ Gross reeipts from missions, merhnise sol or servies performe, or filities furnishe in ny tivity tht is relte to the orgniztion's tx-exempt purpose Gross reeipts from tivities tht re not n unrelte tre or usiness uner setion ~~~~~ Tx revenues levie for the orgniztion's enefit n either pi to or expene on its ehlf ~~~~ Setion B. Totl Support Unrelte usiness txle inome (less setion txes) from usinesses quire fter June 0, 9 ~~~~ A lines 0 n 0 ~~~~~~ Net inome from unrelte usiness tivities not inlue in line 0, whether or not the usiness is regulrly rrie on ~~~~~~~ Other inome. Do not inlue gin or loss from the sle of pitl ssets (Explin in Prt VI.) ~~~~ Totl support. (A lines 9, 0,, n.) First five yers. If the Form 990 is for the orgniztion's first, seon, thir, fourth, or fifth tx yer s setion 0()() orgniztion, Pge Puli support perentge for 0 (line, olumn (f) ivie y line, olumn (f)) ~~~~~~~~~~~~ Investment inome perentge for 0 (line 0, olumn (f) ivie y line, olumn (f)) Investment inome perentge from 0 Sheule A, Prt III, line ~~~~~~~~~~~~~~~~~~ ~~~~~~~~ 9 / support tests - 0. If the orgniztion i not hek the ox on line, n line is more thn /, n line is not more thn /, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~~~~~~~ / support tests - 0. If the orgniztion i not hek ox on line or line 9, n line is more thn /, n line is not more thn /, hek this ox n stop here. The orgniztion qulifies s pulily supporte orgniztion ~~~~ Privte fountion. If the orgniztion i not hek ox on line, 9, or 9, hek this ox n see instrutions Sheule A (Form 990 or 990-EZ) 0

8 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Prt IV Supporting Orgniztions ouments? If "" esrie in Prt VI how the supporte orgniztions re esignte. If esignte y lss or purpose, esrie the esigntion. If histori n ontinuing reltionship, explin. uner setion 09()() or ()? If "," explin in Prt VI how the orgniztion etermine tht the supporte orgniztion ws esrie in setion 09()() or (). Di the orgniztion hve supporte orgniztion esrie in setion 0()(), (), or ()? () n () elow. orgniztion me the etermintion. supporte orgniztion? If "," esrie in Prt VI how the orgniztion h suh ontrol n isretion espite eing ontrolle or supervise y or in onnetion with its supporte orgniztions. Type I or Type II only. Ws ny e or sustitute supporte orgniztion prt of lss lrey Sustitutions only. Ws the sustitution the result of n event eyon the orgniztion's ontrol? If "," nswer (B) purposes? If "," explin in Prt VI wht ontrols the orgniztion put in ple to ensure suh use. Ws ny supporte orgniztion not orgnize in the Unite Sttes ("foreign supporte orgniztion")? "" n if you heke or in Prt I, nswer () n () elow. to ensure tht ll support to the foreign supporte orgniztion ws use exlusively for setion 0()()(B) purposes. (Complete only if you heke ox on line of Prt I. If you heke of Prt I, omplete Setions A n B. If you heke of Prt I, omplete Setions A n C. If you heke of Prt I, omplete Setions A, D, n E. If you heke of Prt I, omplete Setions A n D, n omplete Prt V.) Setion A. All Supporting Orgniztions Are ll of the orgniztion's supporte orgniztions liste y nme in the orgniztion's governing Di the orgniztion hve ny supporte orgniztion tht oes not hve n IRS etermintion of sttus Di the orgniztion onfirm tht eh supporte orgniztion qulifie uner setion 0()(), (), or () n stisfie the puli support tests uner setion 09()()? If "," esrie in Prt VI when n how the Di the orgniztion ensure tht ll support to suh orgniztions ws use exlusively for setion 0()() Di the orgniztion hve ultimte ontrol n isretion in eiing whether to mke grnts to the foreign Di the orgniztion support ny foreign supporte orgniztion tht oes not hve n IRS etermintion uner setions 0()() n 09()() or ()? If "," explin in Prt VI wht ontrols the orgniztion use Di the orgniztion, sustitute, or remove ny supporte orgniztions uring the tx yer? If "," nswer () n () elow (if pplile). Also, provie etil in Prt VI, inluing (i) the nmes n EIN numers of the supporte orgniztions e, sustitute, or remove, (ii) the resons for eh suh tion, (iii) the uthority uner the orgniztion's orgnizing oument uthorizing suh tion, n (iv) how the tion ws omplishe (suh s y menment to the orgnizing oument). esignte in the orgniztion's orgnizing oument? Di the orgniztion provie support (whether in the form of grnts or the provision of servies or filities) to nyone other thn () its supporte orgniztions; () iniviuls tht re prt of the hritle lss enefite y one or more of its supporte orgniztions; or () other supporting orgniztions tht lso support or enefit one or more of the filing orgniztion's supporte orgniztions? Prt VI. If If "," provie etil in Di the orgniztion provie grnt, lon, ompenstion, or other similr pyment to sustntil ontriutor (efine in IRC 9()()(C)), fmily memer of sustntil ontriutor, or -perent ontrolle entity with regr to sustntil ontriutor? If "," omplete Prt I of Sheule L (Form 990). Di the orgniztion mke lon to isqulifie person (s efine in setion 9) not esrie in line? If "," omplete Prt I of Sheule L (Form 990). 9 Ws the orgniztion ontrolle iretly or iniretly t ny time uring the tx yer y one or more isqulifie persons s efine in setion 9 (other thn fountion mngers n orgniztions esrie in setion 09()() or ())? If "," provie etil in Prt VI. Di one or more isqulifie persons (s efine in line 9()) hol ontrolling interest in ny entity in whih the supporting orgniztion h n interest? If "," provie etil in Prt VI. Di isqulifie person (s efine in line 9()) hve n ownership interest in, or erive ny personl enefit from, ssets in whih the supporting orgniztion lso h n interest? If "," provie etil in Prt VI. 0 Ws the orgniztion sujet to the exess usiness holings rules of IRC 9 euse of IRC 9(f) (regring ertin Type II supporting orgniztions, n ll Type III non-funtionlly integrte supporting orgniztions)? If "," nswer () elow. Di the orgniztion hve ny exess usiness holings in the tx yer? etermine whether the orgniztion h exess usiness holings.) (Use Sheule C, Form 0, to Pge Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

9 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Prt IV Supporting Orgniztions (ontinue) A fmily memer of person esrie in () ove? A ontrolle entity of person esrie in () or () ove? If "" to,, or, provie etil in Prt VI. Setion B. Type I Supporting Orgniztions Hs the orgniztion epte gift or ontriution from ny of the following persons? A person who iretly or iniretly ontrols, either lone or together with persons esrie in () n () elow, the governing oy of supporte orgniztion? Di the iretors, trustees, or memership of one or more supporte orgniztions hve the power to regulrly ppoint or elet t lest mjority of the orgniztion's iretors or trustees t ll times uring the tx yer? If "," esrie in Prt VI how the supporte orgniztion(s) effetively operte, supervise, or ontrolle the orgniztion's tivities. If the orgniztion h more thn one supporte orgniztion, esrie how the powers to ppoint n/or remove iretors or trustees were llote mong the supporte orgniztions n wht onitions or restritions, if ny, pplie to suh powers uring the tx yer. Di the orgniztion operte for the enefit of ny supporte orgniztion other thn the supporte orgniztion(s) tht operte, supervise, or ontrolle the supporting orgniztion? Prt VI If "," explin in how proviing suh enefit rrie out the purposes of the supporte orgniztion(s) tht operte, supervise, or ontrolle the supporting orgniztion. Setion C. Type II Supporting Orgniztions Were mjority of the orgniztion's iretors or trustees uring the tx yer lso mjority of the iretors or trustees of eh of the orgniztion's supporte orgniztion(s)? If "," esrie in Prt VI how ontrol or mngement of the supporting orgniztion ws veste in the sme persons tht ontrolle or mnge the supporte orgniztion(s). Setion D. Type III Supporting Orgniztions Di the orgniztion provie to eh of its supporte orgniztions, y the lst y of the fifth month of the orgniztion's tx yer, () written notie esriing the type n mount of support provie uring the prior tx yer, () opy of the Form 990 tht ws most reently file s of the te of notifition, n () opies of the orgniztion's governing ouments in effet on the te of notifition, to the extent not previously provie? Were ny of the orgniztion's offiers, iretors, or trustees either (i) ppointe or elete y the supporte orgniztion(s) or (ii) serving on the governing oy of supporte orgniztion? If "," explin in Prt VI how the orgniztion mintine lose n ontinuous working reltionship with the supporte orgniztion(s). By reson of the reltionship esrie in (), i the orgniztion's supporte orgniztions hve signifint voie in the orgniztion's investment poliies n in ireting the use of the orgniztion's inome or ssets t ll times uring the tx yer? If "," esrie in Prt VI the role the orgniztion's supporte orgniztions plye in this regr. Setion E. Type III Funtionlly-Integrte Supporting Orgniztions Chek the ox next to the metho tht the orgniztion use to stisfy the Integrl Prt Test uring the yer The orgniztion stisfie the Ativities Test. Complete line elow. The orgniztion is the prent of eh of its supporte orgniztions. Complete line elow. The orgniztion supporte governmentl entity. Desrie in Prt VI how you supporte government entity (see instrutions). Ativities Test. Answer () n () elow. Di sustntilly ll of the orgniztion's tivities uring the tx yer iretly further the exempt purposes of the supporte orgniztion(s) to whih the orgniztion ws responsive? If "," then in Prt VI ientify those supporte orgniztions n explin how these tivities iretly furthere their exempt purposes, how the orgniztion ws responsive to those supporte orgniztions, n how the orgniztion etermine tht these tivities onstitute sustntilly ll of its tivities. Di the tivities esrie in () onstitute tivities tht, ut for the orgniztion's involvement, one or more of the orgniztion's supporte orgniztion(s) woul hve een engge in? If "," explin in Prt VI the resons for the orgniztion's position tht its supporte orgniztion(s) woul hve engge in these tivities ut for the orgniztion's involvement. Prent of Supporte Orgniztions. Answer () n () elow. Di the orgniztion hve the power to regulrly ppoint or elet mjority of the offiers, iretors, or trustees of eh of the supporte orgniztions? Provie etils in Di the orgniztion exerise sustntil egree of iretion over the poliies, progrms, n tivities of eh of its supporte orgniztions? If "," esrie in Prt VI Prt VI. the role plye y the orgniztion in this regr. (see instrutions): Pge Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

10 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Prt V Type III n-funtionlly Integrte 09()() Supporting Orgniztions Chek here if the orgniztion stisfie the Integrl Prt Test s qulifying trust on v. 0, 90. See instrutions. All Setion A - Ajuste Net Inome Ajuste Net Inome (sutrt lines, n from line ) Setion B - Minimum Asset Amount e other Type III non-funtionlly integrte supporting orgniztions must omplete Setions A through E. Net short-term pitl gin Reoveries of prior-yer istriutions Other gross inome (see instrutions) A lines through Depreition n epletion Portion of operting expenses pi or inurre for proution or olletion of gross inome or for mngement, onservtion, or mintenne of property hel for proution of inome (see instrutions) Other expenses (see instrutions) Aggregte fir mrket vlue of ll non-exempt-use ssets (see instrutions for short tx yer or ssets hel for prt of yer): Averge monthly vlue of seurities Averge monthly sh lnes Fir mrket vlue of other non-exempt-use ssets Totl ( lines,, n ) Disount lime for lokge or other ftors (explin in etil in Prt VI): Aquisition ineteness pplile to non-exempt-use ssets Sutrt line from line Csh eeme hel for exempt use. Enter -/ of line (for greter mount, see instrutions). Net vlue of non-exempt-use ssets (sutrt line from line ) Multiply line y.0 Reoveries of prior-yer istriutions Minimum Asset Amount ( line to line ) (A) Prior Yer (A) Prior Yer (B) Current Yer (optionl) (B) Current Yer (optionl) Pge Setion C - Distriutle Amount Current Yer Ajuste net inome for prior yer (from Setion A, line, Column A) Enter of line Minimum sset mount for prior yer (from Setion B, line, Column A) Enter greter of line or line Inome tx impose in prior yer Distriutle Amount. Sutrt line from line, unless sujet to emergeny temporry reution (see instrutions) Chek here if the urrent yer is the orgniztion's first s non-funtionlly-integrte Type III supporting orgniztion (see instrutions). Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

11 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Prt V Type III n-funtionlly Integrte 09()() Supporting Orgniztions (ontinue) Setion D - Distriutions 9 0 Other istriutions (esrie in Prt VI). See instrutions. Totl nnul istriutions. A lines through. (provie etils in Prt VI). See instrutions. Setion E - Distriution Allotions (see instrutions) e f g h i j e Amounts pi to supporte orgniztions to omplish exempt purposes Amounts pi to perform tivity tht iretly furthers exempt purposes of supporte orgniztions, in exess of inome from tivity Aministrtive expenses pi to omplish exempt purposes of supporte orgniztions Amounts pi to quire exempt-use ssets Qulifie set-sie mounts (prior IRS pprovl require) Distriutions to ttentive supporte orgniztions to whih the orgniztion is responsive Distriutle mount for 0 from Setion C, line Line mount ivie y Line 9 mount Distriutle mount for 0 from Setion C, line Uneristriutions, if ny, for yers prior to 0 (resonle use require-see instrutions) Exess istriutions rryover, if ny, to 0: From 0 Totl of lines through e Applie to uneristriutions of prior yers Applie to 0 istriutle mount Crryover from 009 not pplie (see instrutions) Reminer. Sutrt lines g, h, n i from f. Distriutions for 0 from Setion D, line : $ Applie to uneristriutions of prior yers Applie to 0 istriutle mount Reminer. Sutrt lines n from. Remining uneristriutions for yers prior to 0, if ny. Sutrt lines g n from line (if mount greter thn zero, see instrutions). Remining uneristriutions for 0. Sutrt lines h n from line (if mount greter thn zero, see instrutions). Exess istriutions rryover to 0. A lines j n. Brekown of line : Exess from 0 Exess from 0 (i) Exess Distriutions (ii) Uneristriutions Pre-0 Current Yer (iii) Distriutle Amount for 0 Pge Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

12 Fountion Fountion Sheule A (Form 990 or 990-EZ) 0 MyBillofRights.org 0-9 Pge Prt VI Supplementl Informtion. Provie the explntions require y Prt II, line 0; Prt II, line or ; n Prt III, line. Also omplete this prt for ny itionl informtion. (See instrutions) Sheule A (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

13 SCHEDULE G OMB. -00 (Form 990 or 990-EZ) Complete if the orgniztion nswere "" to Form 990, Prt IV, lines,, or 9, or if the orgniztion entere more thn $,000 on Form 990-EZ, line. Deprtment of the Tresury Atth to Form 990 or Form 990-EZ. Open to Puli Internl Revenue Servie Informtion out Sheule G (Form 990 or 990-EZ) n its instrutions is t Inspetion Nme of the orgniztion Employer ientifition numer Prt I Funrising Ativities. Complete if the orgniztion nswere "" to Form 990, Prt IV, line. Form 990-EZ filers re not require to omplete this prt. Inite whether the orgniztion rise funs through ny of the following tivities. Chek ll tht pply. Mil soliittions Internet n emil soliittions Phone soliittions In-person soliittions Supplementl Informtion Regring Funrising or Gming Ativities Fountion Fountion MyBillofRights.org Di the orgniztion hve written or orl greement with ny iniviul (inluing offiers, iretors, trustees or e f g Soliittion of non-government grnts Soliittion of government grnts Speil funrising events key employees liste in Form 990, Prt VII) or entity in onnetion with professionl funrising servies? If "," list the ten highest pi iniviuls or entities (funrisers) pursunt to greements uner whih the funriser is to e ompenste t lest $,000 y the orgniztion (i) Nme n ress of iniviul or entity (funriser) (ii) Ativity (iii) Di funriser hve ustoy or ontrol of ontriutions? (iv) Gross reeipts from tivity (v) Amount pi to (or retine y) funriser liste in ol. (i) (vi) Amount pi to (or retine y) orgniztion Totl List ll sttes in whih the orgniztion is registere or liense to soliit ontriutions or hs een notifie it is exempt from registrtion or liensing. LHA For Pperwork Reution At tie, see the Instrutions for Form 990 or 990-EZ. Sheule G (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

14 Sheule G (Form 990 or 990-EZ) 0 Prt II Funrising Events. Revenue Pge Complete if the orgniztion nswere "" to Form 990, Prt IV, line, or reporte more thn $,000 of funrising event ontriutions n gross inome on Form 990-EZ, lines n. List events with gross reeipts greter thn $,000. Gross reeipts ~~~~~~~~~~~~~~ Fountion Fountion MyBillofRights.org 0-9 () Event # () Event # () Other events omey onert (event type) (event type) (totl numer) () Totl events ( ol. () through ol. ()) Less: Contriutions ~~~~~~~~~~~ Gross inome (line minus line ) Csh prizes ~~~~~~~~~~~~~~~ Diret Expenses nsh prizes ~~~~~~~~~~~~~ Rent/fility osts ~~~~~~~~~~~~ Foo n everges ~~~~~~~~~~ Entertinment ~~~~~~~~~~~~~~ 9 0 Other iret expenses ~~~~~~~~~~ Diret expense summry. A lines through 9 in olumn () ~~~~~~~~~~~~~~~~~~~~~~~~ Net inome summry. Sutrt line 0 from line, olumn () Prt III Gming. Complete if the orgniztion nswere "" to Form 990, Prt IV, line 9, or reporte more thn $,000 on Form 990-EZ, line. Revenue () Pull ts/instnt () Bingo ingo/progressive ingo Gross revenue () Other gming () Totl gming ( ol. () through ol. ()) Diret Expenses Csh prizes ~~~~~~~~~~~~~~~ nsh prizes ~~~~~~~~~~~~~ Rent/fility osts ~~~~~~~~~~~~ Other iret expenses Volunteer lor ~~~~~~~~~~~~~ Diret expense summry. A lines through in olumn () ~~~~~~~~~~~~~~~~~~~~~~~~ Net gming inome summry. Sutrt line from line, olumn () 9 Enter the stte(s) in whih the orgniztion onuts gming tivities: Is the orgniztion liense to onut gming tivities in eh of these sttes? If "," explin: ~~~~~~~~~~~~~~~~~~~~ 0 Were ny of the orgniztion's gming lienses revoke, suspene or terminte uring the tx yer? If "," explin: ~~~~~~~~~ Sheule G (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

15 Sheule G (Form 990 or 990-EZ) 0 Does the orgniztion onut gming tivities with nonmemers? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the orgniztion grntor, enefiiry or trustee of trust or memer of prtnership or other entity forme to minister hritle gming? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Inite the perentge of gming tivity onute in: The orgniztion's fility Fountion Fountion MyBillofRights.org 0-9 Pge ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ An outsie fility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the nme n ress of the person who prepres the orgniztion's gming/speil events ooks n reors: Nme Aress Does the orgniztion hve ontrt with thir prty from whom the orgniztion reeives gming revenue? ~~~~~~ If "," enter the mount of gming revenue reeive y the orgniztion of gming revenue retine y the thir prty $. If "," enter nme n ress of the thir prty: $ n the mount Nme Aress Gming mnger informtion: Nme Gming mnger ompenstion $ Desription of servies provie Diretor/offier Employee Inepenent ontrtor Mntory istriutions: Is the orgniztion require uner stte lw to mke hritle istriutions from the gming proees to retin the stte gming liense? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the mount of istriutions require uner stte lw to e istriute to other exempt orgniztions or spent in the orgniztion's own exempt tivities uring the tx yer $ Prt IV Supplementl Informtion. Provie the explntions require y Prt I, line, olumns (iii) n (v), n Prt III, lines 9, 9, 0,,,, n, s pplile. Also provie ny itionl informtion (see instrutions) Sheule G (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

16 Fountion Fountion Sheule G (Form 990 or 990-EZ) MyBillofRights.org 0-9 Prt IV Supplementl Informtion (ontinue) Pge Sheule G (Form 990 or 990-EZ) FOUNDATION FOUNDATION DBA 0

17 SCHEDULE O (Form 990 or 990-EZ) Deprtment of the Tresury Internl Revenue Servie Nme of the orgniztion Supplementl Informtion to Form 990 or 990-EZ OMB Complete to provie informtion for responses to speifi questions on Form 990 or 990-EZ or to provie ny itionl informtion. Atth to Form 990 or 990-EZ. Open to Puli Informtion out Sheule O (Form 990 or 990-EZ) n its instrutions is t Inspetion Fountion Fountion Employer ientifition numer MyBillofRights.org 0-9 Form 990-EZ, Prt I, Line, Other Expenses: Desription of Other Expenses: Amount: Progrm purpose expenses. Filing fees 0. Bnk hrges. Promotionl mterils 9. Offie expense 9. Wesite n soil mei 9. Trvel 00. Donor mintenne. Totl to Form 990-EZ, line 9. Form 990-EZ, Prt III, Primry Exempt Purpose - Promote the wreness of the ill of rights Form 990-EZ, Prt V, Informtion Regring Personl Benefit Contrts: The orgniztion i not, uring the yer, reeive ny funs, iretly, or iniretly, to py premiums on personl enefit ontrt. The orgniztion, i not, uring the yer, py ny premiums, iretly, or iniretly, on personl enefit ontrt. LHA For Pperwork Reution At tie, see the Instrutions for Form 990 or 990-EZ. Sheule O (Form 990 or 990-EZ) (0) FOUNDATION FOUNDATION DBA 0