f

.-.
. •;
·'

Short Form 0MB No 1545-1150

990•EZ Return of OrganizationExempt From Income Tax

~arm
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
~©10
• Sponsoring orgarnzatIonsof donor advised funds, organizations that operate one or more hospital faclhtles,
and certaln controlling organizations as defined m section 512(b)(13)must file Form 990 (see Instructions) Open to Public
All other organizations with gross receipts less than $200,000 and total assets less than $500,000
Departmentof the Treasury at the end of the year may use this form. Inspection
InternalRevenueSeMce • The organization may have to use a copy of this return to satisfy state reporting requ,rements.
, 2010, and ending
8 Check II applicable

D Address change
D Name change
D Initialreturn
D Terminated
D Amended return F Group Exemption
Appllcatlon pending Number •
H Check • 'f the organization Is not
required to attach Schedule B
)• insert n D 527 (Form 990, 990-EZ, or 990-PF).
K Check •
1fthe organization Is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50,000. A
Form 990-EZ or Form 990 return is not required though Form 990-N (a-postcard) may be required (see instructions). But if the organization chooses
to file a return, be sure to file a complete return.
L Add lines Sb, 6c, and 7b, to line 9 to detem11negross receipts. If gross receipts are $200,000 or more, or 1ftotal assets (Part II,
line 25, column (Bl below) are $500,000 or more, file Form 990 instead of Form 990-EZ . • $
•@II Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions
Check if the organization used Schedule O to respond to any question in this Part I
for Part 1.)

1 Contributions, gifts, grants, and similar amounts received . 1

2 Program service revenue including government fees and contracts 2
3 Membership dues and assessments . 3
4 Investment income 4
5a Gross amount from sale of assets other than inventory 1--S_a-+--------i
b Less: cost or other basis and sales expenses . .__5_b_._
______ -l __ 4
c Gain or 0oss) from sale of assets other than inventory (Subtract line 5b from line,5a) Sc
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than f j/

GI
:I $15,000) . Sa
.__..__ ______ -! • % $
C
b Gross income from fundraising events (not including $ ________ of contributions
i
a: from fundraising events reported on line 1) (attach Schedule G if the t q ¢
;
sum of such gross income and contributions exceeds $15,000) . 6b
l---+---------1
c Less: direct expenses from gaming and fundraising events ._6_c-'----------1 t
.__ d Net income or 0oss) from gaming and fundraising events (add lines 6a and 6b and subtract •' .
..,_
C> line 6c) 6d
~
7a Gross sales of inventory, less returns and allowances . , . 1--7_a-+--------1 ' . ~

rr- b Less: cost of goods sold .__7_b_._

______ _
i=l c Gross profit or 0oss) from sales of inventory (Subtract line 7b from line 7a) . 7c
~

•-
8 Other revenue (describe in Schedule 0) . 8
~ 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 --:--.-.--.--··--·-·~·=- . • 9

Ol
10 Grants and similar amounts paid 0ist in Schedule 0) [I . . [P/IE.C;:
A./ED. 10
w
2;:
11
en 12
Benefits paid to or for members .
Salaries, other compensation, and employee benefits .
~
!
~·r· · · ,:. '-:-"~
<.:>
co.1 • • • • • • • • Cf.I
11
12
GI
2:: 1 "-i"! 0
<C
en 13
C Professional fees and other payments to independent contractor;s, P,
n
R.2.®.2-flft .. ,. 13
(.)
GI
C. 14 Occupancy, rent, utilities, and maintenance . l!, ~ L. . . . . ~1 14
m; >(
w 15 Printing, publications, postage, and shipping . . · 00/0~~;i-LJ.,C:
"'---' 15
16 Other expenses (describe in Schedule 0) . ~P • ~
·-·=·~·-·~ 16
17
18
Total expenses. Add lines 10 through 16 .
Excess or (deficit) for the year (Subtract line 17 from line 9)
• 17
18
~en 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
en I !£-
'
end-of-year figure reported on prior year's return) 19
ct
Gi 20 Other changes in net assets or fund balances (explain in Schedule 0) . 20
z 21 Net assets or fund balances at end of ear. Combine lines 18 throu h 20 • 21
For Paperwork Reduction Act Notice, see the separate instructions. Cat No 106421
 ;

Form99Q-EZ(2010) Was
Balance Sheets. (see t
I Cc,c2/ C/4
instructions for Part II.)
6 Page 2

Check if the organization used Schedule O to respond to any question in this Part II . .
(A) Beginning of year
. .
-•
22 Cash, savings, and investments
23 Land and buildings . . . . .
24 Other assets (describe in Schedule 0)
25 Total assets. . . . . . . . .
26 Total liabilities (describe in Schedule 0)
27 Net assets or fund balances (line 27 of column (8) must agree with line 21)
Statement of Program Service Accomplishments (see the instructions for Part 111.) Expenses
Check if the organization used Schedule Oto respond to any question in this Part Ill (Requiredtor section
..--~--P.iirt 501(c)(3)and 501(c)(4)
What is the organization's primary exempt purpose? e organizationsand section
Describe what was achieved in carrying out the organization'sexempt purposes. In a clear and concise manner, 4947(a)(1) trusts, optional
the services provided, the number of persons benefited, and other relevantinformationfor each program title. for others.)

28

Grants $ If this amount includes foreign grants, check here . . . . • D 28a

29

Grants $ ) If this amount includes foreign grants, check here . . . . • D 29a

30

(Grants $ ) If this amount includes foreign grants, check here

31 Other program services (describe in Schedule 0) . . . . . . . . . . . .
30a ••
Grants $ If this amount includes foreign rants, check here 31a ••
32 Total program service expenses (add lines 28a through 31a) . . . . . . . . 32 •
List of Officers,Directors,Trustees,and Key Employees.List each one even 1fnot compensated. (seethe instructions for Part IV.)
Check if the organization used Schedule O to respond to any question in this Part IV . . . . . . . . . •
(bl Title and average (cl Compensation (cl)Contnbut1ons
to (el Expense
(al Name and address hours per week (If not paid, employeebenefitplans& account and
devoted to pos1t1on enter-0-.l deferredcompensat1on other allowances

0 0

Form 990-EZ (2010)

 J

Form 990-EZ (2010) Page 3

Other lnformatio ( ote the statement requirement in the instructions for Part V.)
Check if the organiza ion used Schedule O to respond to any question in this Part V . . ·D
Yes No
33 Did the organization engage in any activity not previously reported to the IRS? If "Yes," provide a detailed
description of each activity in Schedule O . . . . . . . . . . . . . . . . . . . . . . 33
l----+--+--1--.,...
34 Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed
copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the
change on Schedule O (see instructions) . . . . . . . . . . . . . . . . . . . . . .
35 If the organizationhad incomefrom businessactIvItIes,such as those reportedon lines 2, 6a, and 7a (amongothers),but
not reportedon Form990-T,explainIn ScheduleO why the organizationdid not reportthe incomeon Form990-T.
a Did the organization have unrelated business gross income of $1,000 or more or was it a section 501(c)(4),
501 (c)(5), or 501 (c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements? 35a
1----+--+---
b If "Yes," has it filed a tax return on Form 990-T for this year (see instructions)? . . . . . . . . . . 1-3_5_b-+--+---
36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets
during the year? If "Yes," complete applicable parts of Schedule N . . . . . . . 36
1----+-=--,,,t-~-,
37a Enter amount of political expenditures, direct or indirect, as described In the instructions. .._3_7_a_,_•
_ _,_..c:._--1
b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . .
38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?
b If "Yes," complete Schedule L, Part II and enter the total amount involved i.,,,3,,,:8c...:b+--H"""4-f,----liF
39 Section 501 (c)(7) organizations. Enter:
a Initiation fees and capital contributions included on line 9 . . . . . .
b Gross receipts, included on line 9, for public use of club facilities
40a Section 501 (c)(3) organizations. Enter amount of tax imposed on the organization during the ye u der:
•
section 4911 _..,..._..,......--t---- ; section 4912 • ){/ff ;
section 4955 • N/ ft
b Section 501(c)(3) ana 1(c (4) organizations. Did the orga'rJTatlon engage in any section 4958 'efciss benefit
transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been
reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I . . . . . 40b
!-,---+--+--~
c Section 501 (c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on ·:)4 ¾.
organization managers or disqualified persons during the year under sections 4912, .,-.. : ~ ;,,. tt • ·' if

d
nd
~~!~;o~ 5~~~c~(~) ~n~
~01(c)(~) .or~an;za~io~s.. E~te; amount of tax on l;ne. :Oc_____ l/__ :~':· ~:- ·: .. :
reimbursed by the organization . . . . . . . . . . . . . . • • • • ------"'"'--D "' I·4 :,
e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter ~i-----1-~=
transaction? If "Yes," complete Form 8886-T. . . . . . . . . . . . . . . . . . . . . . 40e
41 •
List the states with which a copy of this return is filed. Ok, e
'---'---'-,,C-:.~

42a • ------~~---
The organization'_sbooks are in car,i of ..-..-. -.,-r,ra-
Y- ..-..
•~-.. -T-el-ep_h_o-ne-no-.-~c=
....,.....""[..._.._r$7'-~==:-~.:...::;..·· •--,
..
••:c:~c-::.~:;;-
•• --•• ...,
•••.....,
.... .?= ..~=~
..--.~=
Located at • .Jf-;301. .....l!J.L~~.lj),_ ... .Bu.,
...~.:,1.... . .. ..!.!1.. .J!,;...r~... ZIP + 4 -;l.aa.C>-3 • ...
........
b At any time during the calendar year, did the organizatron have an in rest 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 Yes No
account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42b
If "Yes," enter the name of the foreign country: • i--:--:~e------1-o+::::O.,-

See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank
and Financial Accounts.
c At any time during the calendar year, did the organization maintain an office outside of the U.S.? . . 42c
If "Yes," enter the name of the foreign country: •
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here ... 11/ll.• •
and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . • I 43 I lf/Jt
Yes No
44a Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be I
.X I
completed instead of Form 990-EZ 44a
b Did the organization operate one or more hospital facilities during the year? If 'Yes,• Form 990 must be
completed instead of Form 990-EZ 44b X
C Did the organization receive any payments for indoor tanning services during the year? 44c )C.
d If 'Yes" to line 44c, has the organization filed a Form 720 to report these payments? If 'No,• provide an I
explanation in Schedule 0 44d
Form 990-EZ (2010)
Form 990-EZ (2010) J3£cJ<j>
J,'3/---/J Page 4
Yes No
45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)?
a Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule A may need to be completed instead of
Form 990-EZ (see instructions) . . . . . . . . . . . . . . . . . . . . . . .
46 Did the organization engage, directly or indirectly, in 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 and section 4947(a)(1) nonexempt charitable trusts only. All section
501 (c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b
and 52, and complete the tables for lines 50 and 51.
Check if the organization used Schedule O to respond to any question in this Part VI . . . . . . . . . •
Yes No
47 Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part II 47
48 Is the organization a school as described in section 170(b)(1)(A)(11)?
If "Yes," complete Schedule E 48
49a Did the organization make any transfers to an exempt non-charitable related organization? 49a
b If "Yes," was the related organization a section 527 organization? 49b
50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key
employees) who each received more than $100,000 of compensation from the organization. If there Is none, enter "None."
(bl Title and average (c) Compensation (d) Contnbut1ons
to (el Expense
(a) Name and address of each employee paid more hours per week employeebenefitplans& account and
than $100,000 devoted to position deferredcompensation other allowances

f Total number of other employees paid over $100,000 . . . . • ________ _

51 Complete this table for the organization's five highest compensated independent contractors who each received more than
$100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and address of each Independent contractor paid more than $100,000 (bl Type of service (c) Compensation

d Total number of other independent contractors each receiving over $100,000 . . • ---------------
52 Did the organization complete Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1)
nonexempt charitable trusts must attach a completed Schedule A . . . . . . . . . . . . . • D Yes D No
Under penalties of periury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, 1t1s
true, correct, and complete Declaration of preparer (other than officer) is based on al nforrnabon of which preparer has any knowledge

Sign • --J-A~~~~~~l-c------____l_,,D,--,-!.ar-~as--~~I I__

Here
• ::::,,,A-<~=-.::....,..,..,;.......,,,,."---=...L.:....:~.....,,~-4--~----4,-...L..----=-=-=----=----=----------
=-1T

Paid PrinVType preparer's name Preparer's signature Date Check D if PTIN

Preparer 1-------------~-------------~-----~s_el_f-e_m_p_lo_y_ed~------
__ • ___________________________
Use Only I-F_1rrn_'s_n_a_m_e • ________
Fl_1rrn_'s_E_IN_ _
Firm's address • Phone no
May the IRS discuss this return with the preparer shown above? See instructions • • Yes D No
Form 990-EZ (2010)
,,.,

SCHEDijLEO 0MB No 1545-0047

(Form 990 or 990-EZ) Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on ~©10
Form 990 or 990-EZ or to provide any additional information. Open to Public
Departmentof the Treasury
Internal RevenueSeMce • Attach to Form 990 or 990-EZ. Inspection

27'Jc,::
r :::J?:rpn.$#2$
:::{):-!;hr: ::::
____ e:::::tf,.]
-fi t:>--k.1),: ::::::::::
~nS ll Y'a MC£ _______________________________________________
0
__________ Jf __
d ,66 ____
0 ----------------------------------- _

::::::::::::::
Mea- _(:::::-
~~tt6e s::::::::::::::::::::::::---\dt
/9--?3'<X ___
:E.Y:::::::::::::::
&-,'{f!"C/Ide(ft~-1-------------------------
----------------------
{%1.,
---- ---------
-------------------------

E (~-e-.________________________________________
________________ l ____
37 I _______ eP- ~------------------------

----------
---:---
_c ¥--- Afeit:Jt.,
-a
1

kJ----------------------------------------------:-:~------------------------------

Gf Pi~P,
::::::::::::::
_____ 6 ~11;\~e}:::::::::::::::::::::::::
~__ ::~ ::::::::::::::::::
?t __
:m~-f:ruse:::::::::
:::::::::::::::::::
Ne.rt: _____
1 111 LZf-- fl-:::::::::
___
-----
__________________
zff!&r
___________ &_________
~; --------
-----------------------------------------

efl:3()./---
7G 7____________________ ~
6 _3 d __3:1-
--------------------------------------------------------------

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat No. 51056K Schedule O (Form 990 or 990-EZ) (2010)
 ;,

Page 2

----------------------------------------------------------
lilt----------------------
.............
fu. Y'-1/V\......9'16 -..&.Z-;,1...........
fS r--t::
_DZ ...............
.
n,r--e9,i/61A
------------------------()'!'
------- 1------ f2 r~ cl r------------___, - D10-----------E
e---------------- --
······························'? r ......
·6····················s.··...1r.r:-y_ fr, ~L M!p ..... .
res··· ad are···L. cir'.... s:s··········au
················........·t l .. ll .....
J _________________
C. tL ·d·····
----------------------------------------------------------------------------
C ----------- 5_ -------------------------------

Co MtMt: ~Ee:::::::
ll u :,~c_
::::::::::::::::::::::::::::::: Io::::::::o2Jf d {(Vt 'du
_::::::r~ s!~
v\

Lo (£ 1'--
...........................
....... ...........
5t7vty......... i au_ d ................
':35..a.e.f;;......... .
t-es-/
····
~····--1e y·E/8 i/u·········--:t5
··································· ;d-e······
······

Schedule O (Form 990 or 990-EZ) (2010)