Fillable Form 20: 02 Return of Organization Exempt From (IRS)

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Form 20: 02 Return of Organization Exempt From (IRS)

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Part I
OMB No. 1545-0047
Return of Organization Exempt From Income Tax990Form
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
The organization may have to use a copy of this return to satisfy state reporting requirements.
For the 2002 calendar year, or tax year beginning , 2002, and ending , 20
D Employer identification number
Name of organization
Please
use IRS
label or
print or
type.
See
Specific
Instruc-
tions.
E Telephone number
Number and street (or P.O. box if mail is not delivered to street address)
City or town, state or country, and ZIP + 4
Check here
if the organization’s gross receipts are normally not more than $25,000. The
organization need not file a return with the IRS; but if the organization received a Form 990 Package
in the mail, it should file a return without financial data. Some states require a complete return.
Revenue, Expenses, and Changes in Net Assets or Fund Balances (See page 17 of the instructions.)
Contributions, gifts, grants, and similar amounts received:1
1a
Direct public support
a
1b
Indirect public support
b
1c
Government contributions (grants)
c
1d
Total (add lines 1a through 1c) (cash $ noncash $ )
d
2
Program service revenue including government fees and contracts (from Part VII, line 93)
2
3
Membership dues and assessments
3
4
Interest on savings and temporary cash investments
4
5
Dividends and interest from securities
5
6a
Gross rents
6a
6b
Less: rental expenses
b
6c
Net rental income or (loss) (subtract line 6b from line 6a)
c
7
Other investment income (describe
)
7
(B) Other(A) Securities
Gross amount from sales of assets other
than inventory
8a
8a
Revenue
8b
Less: cost or other basis and sales expenses
b
8c
Gain or (loss) (attach schedule)
c
8d
Net gain or (loss) (combine line 8c, columns (A) and (B))
d
Special events and activities (attach schedule)9
Gross revenue (not including $ of
contributions reported on line 1a)
a
9a
9b
Less: direct expenses other than fundraising expenses
b
9c
Net income or (loss) from special events (subtract line 9b from line 9a)
c
10a
Gross sales of inventory, less returns and allowances
10a
10b
Less: cost of goods sold
b
10c
Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a)
c
11
Other revenue (from Part VII, line 103)
11
12
Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11)
12
13
13 Program services (from line 44, column (B))
14
Management and general (from line 44, column (C))
14
15
Fundraising (from line 44, column (D))
15
16
Payments to affiliates (attach schedule)
16
Expenses
17 Total expenses (add lines 16 and 44, column (A))
17
18
Excess or (deficit) for the year (subtract line 17 from line 12)
18
19
Net assets or fund balances at beginning of year (from line 73, column (A))
19
Net Assets
20
20 Other changes in net assets or fund balances (attach explanation)
21
21
Net assets or fund balances at end of year (combine lines 18, 19, and 20)
Form 990 (2002)For Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 11282Y
A
C
Room/suite
Accounting method:
F
K
B
Check if applicable:
Final return
Amended return
Address change
Organization type (check only one)
G
Enter 4-digit GEN
I
501(c) ( )
5274947(a)(1) or
H(a)
Yes No
Is this a group return for affiliates?
If “Yes,” enter number of affiliates
Is this a separate return filed by an
organization covered by a group ruling?
H(b)
H(d)
(insert no.)
Yes No
Initial return
Name change
Are all affiliates included?
(If “No,” attach a list. See instructions.)
H(c)
Yes No
H and I are not applicable to section 527 organizations.
● Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable
trusts must attach a completed Schedule A (Form 990 or 990-EZ).
Open to Public
Inspection
Check
if the organization is not required
to attach Sch. B (Form 990, 990-EZ, or 990-PF).
M
()
Application pending
Cash Accrual
Other (specify)
Web site:
L
Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12
J
20
02
Page 2Form 990 (2002)
Statement of
Functional Expenses
All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501(c)(3) and (4) organizations
and section 4947(a)(1) nonexempt charitable trusts but optional for others. (See page 21 of the instructions.)
Do not include amounts reported on line
6b, 8b, 9b, 10b, or 16 of Part I.
(C) Management
and general
(B) Program
services
(D) Fundraising(A) Total
Grants and allocations (attach schedule)22
23 Specific assistance to individuals (attach schedule)
Benefits paid to or for members (attach schedule)24
Compensation of officers, directors, etc.25
Other salaries and wages26
Pension plan contributions27
Other employee benefits28
Payroll taxes29
Professional fundraising fees30
Accounting fees31
Legal fees32
Supplies33
Telephone 34
Postage and shipping35
Occupancy36
Equipment rental and maintenance37
Printing and publications38
Travel39
Conferences, conventions, and meetings40
Interest 41
Depreciation, depletion, etc. (attach schedule)
42
Other expenses not covered above (itemize): a
43
b
c
d
e
Total functional expenses (add lines 22 through 43). Organizations
completing columns (B)-(D), carry these totals to lines 13—15
44
Statement of Program Service Accomplishments (See page 24 of the instructions.)
Program Service
Expenses
What is the organization’s primary exempt purpose?
(Grants and allocations $ )
Other program services (attach schedule)
Total of Program Service Expenses (should equal line 44, column (B), Program services)
(Required for 501(c)(3) and
(4) orgs., and 4947(a)(1)
trusts; but optional for
others.)
Part III
Part II
If “Yes,” enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ ;
Yes No
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43a
44
43b
43c
43d
43e
Joint Costs. Check
if you are following SOP 98-2.
(cash $ noncash $ )
All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number
of clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4)
organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.)
(iii) the amount allocated to Management and general $ ; and (iv) the amount allocated to Fundraising $
a
b
c
d
e
f
(Grants and allocations $ )
(Grants and allocations $ )
(Grants and allocations $ )
(Grants and allocations $ )
Form 990 (2002)
Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services?
Overset 1 pica.
Form 990 (2002) Page 3
Balance Sheets (See page 24 of the instructions.)
(B)
End of year
(A)
Beginning of year
Note: Where required, attached schedules and amounts within the description
column should be for end-of-year amounts only.
Assets
45
Cash—non-interest-bearing
45
46
46 Savings and temporary cash investments
47a
Accounts receivable
47a
47c47b
Less: allowance for doubtful accounts
b
48a
Pledges receivable
48a
48b 48c
Less: allowance for doubtful accounts
b
49
Grants receivable
49
50 Receivables from officers, directors, trustees, and key employees
(attach schedule)
50
51a
51a
Other notes and loans receivable (attach
schedule)
51b 51c
b Less: allowance for doubtful accounts
52
52 Inventories for sale or use
53
53 Prepaid expenses and deferred charges
54
54 Investments—securities (attach schedule)
Investments—land, buildings, and
equipment: basis
55a
55a
Less: accumulated depreciation (attach
schedule)
b
55b 55c
56
Investments—other (attach schedule)
56
57a
Land, buildings, and equipment: basis
57a
57c
57b
Less: accumulated depreciation (attach
schedule)
b
58
Other assets (describe
)58
Total assets (add lines 45 through 58) (must equal line 74)59
59
Liabilities
60
Accounts payable and accrued expenses
60
61
Grants payable
61
62
Deferred revenue
62
63
Loans from officers, directors, trustees, and key employees (attach
schedule)
63
64a
Tax-exempt bond liabilities (attach schedule)
64a
65
Other liabilities (describe
)65
Total liabilities (add lines 60 through 65)66
66
Part IV
64b
Mortgages and other notes payable (attach schedule)
b
Net Assets or Fund Balances
Organizations that do not follow SFAS 117, check here
67
67 Unrestricted
68
68 Temporarily restricted
69
69 Permanently restricted
70
70 Capital stock, trust principal, or current funds
71
71 Paid-in or capital surplus, or land, building, and equipment fund
72
72 Retained earnings, endowment, accumulated income, or other funds
73
73 Total net assets or fund balances (add lines 67 through 69 or lines
70 through 72;
column (A) must equal line 19; column (B) must equal line 21)
74
74
Total liabilities and net assets / fund balances (add lines 66 and 73)
and
Organizations that follow SFAS 117, check here
and complete lines
67 through 69 and lines 73 and 74.
complete lines 70 through 74.
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a
particular organization. How the public perceives an organization in such cases may be determined by the information presented
on its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization’s
programs and accomplishments.
Cost FMV
Form 990 (2002) Page 4
List of Officers, Directors, Trustees, and Key Employees
(List each one even if not compensated; see page 26 of
the instructions.)
(B) Title and average hours per
week devoted to position
(C) Compensation
(If not paid, enter
-0-.)
(D) Contributions to
employee benefit plans &
deferred compensation
(E) Expense
account and other
allowances
(A) Name and address
NoYes
Part V
Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your
organization and all related organizations, of which more than $10,000 was provided by the related organizations?
If “Yes,” attach schedule—see page 26 of the instructions.
Reconciliation of Revenue per Audited
Financial Statements with Revenue per
Return (See page 26 of the instructions.)
a
b
c
d
e
(1)
(2)
(3)
Reconciliation of Expenses per Audited
Financial Statements with Expenses per
Return
(4)
(1)
(2)
a
b
c
d
e
(1)
(2)
(3)
(4)
(1)
(2)
Part IV-BPart IV-A
75
Total revenue, gains, and other support
per audited financial statements
Amounts included on line a but not on
line 12, Form 990:
Net unrealized gains
on investments
Donated services
and use of facilities
Recoveries of prior
year grants
Other (specify):
Add amounts on lines (1) through (4)
Line a minus line b
Amounts included on line 12,
Form 990 but not on line a:
Investment expenses
not included on line
6b, Form 990
Other (specify):
Add amounts on lines (1) and (2)
Total revenue per line 12, Form 990
(line c plus line d)
a
b
c
d
e
$
$
$
$
$
$
Total expenses and losses per
audited financial statements
Amounts included on line a but not
on line 17, Form 990:
Donated services
and use of facilities
Prior year adjustments
reported on line 20,
Form 990
Losses reported on
line 20, Form 990
Other (specify):
Add amounts on lines (1) through (4)
Line a minus line b
Amounts included on line 17,
Form 990 but not on line a:
Investment expenses
not included on line
6b, Form 990
Other (specify):
Add amounts on lines (1) and (2)
Total expenses per line 17, Form 990
(line c plus line d)
$
$
$
$
$
$
a
b
c
d
e
Form 990 (2002)
Form 990 (2002) Page 5
Other Information (See page 27 of the instructions.)
76
Did the organization engage in any activity not previously reported to the IRS? If “Yes,” attach a detailed description of each activity
76
77
77 Were any changes made in the organizing or governing documents but not reported to the IRS?
If “Yes,” attach a conformed copy of the changes.
78a
78a
Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return?
78b
If “Yes,” has it filed a tax return on Form 990-T for this year?
b
At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or
partnership, or an entity disregarded as separate from the organization under Regulations sections
301.7701-2 and 301.7701-3? If “Yes,” complete Part IX
79
79
Was there a liquidation, dissolution, termination, or substantial contraction during the year? If “Yes,” attach a statement
Is the organization related (other than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization?
80a
80a
If “Yes,” enter the name of the organization
and check whether it is exempt or nonexempt.
b
81a
81a Enter direct or indirect political expenditures. See line 81 instructions
81b
Did the organization file Form 1120-POL for this year?
b
Did the organization receive donated services or the use of materials, equipment, or facilities at no charge
or at substantially less than fair rental value?
82a
82a
If “Yes,” you may indicate the value of these items here. Do not include this amount
as revenue in Part I or as an expense in Part II. (See instructions in Part III.)
b
82b
Did the organization comply with the public inspection requirements for returns and exemption applications?83a
83a
Did the organization solicit any contributions or gifts that were not tax deductible?84a
84a
If “Yes,” did the organization include with every solicitation an express statement that such contributions
or gifts were not tax deductible?
b
84b
501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members?
85
85a
Did the organization make only in-house lobbying expenditures of $2,000 or less?b
86
501(c)(7) orgs. Enter: a Initiation fees and capital contributions included on line 12
b Gross receipts, included on line 12, for public use of club facilities
501(c)(12) orgs. Enter: a Gross income from members or shareholders
87
87a
Gross income from other sources. (Do not net amounts due or paid to other
sources against amounts due or received from them.)
b
87b
88
List the states with which a copy of this return is filed
88
90a
91
Located at
Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041—Check here
92
92
and enter the amount of tax-exempt interest received or accrued during the tax year
Part VI
Yes No
85b
Dues, assessments, and similar amounts from membersc
85c
Section 162(e) lobbying and political expenditures
d
85d
Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices
e
85e
Taxable amount of lobbying and political expenditures (line 85d less 85e)
f
85f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f?
h
If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its
reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax
year?
85g
85h
86a
86b
If “Yes” was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization
received a waiver for proxy tax owed for the prior year.
ZIP + 4
Did the organization comply with the disclosure requirements relating to quid pro quo contributions?b
83b
The books are in care of
Telephone no.
()
501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under:
; section 4912
; section 4955
501(c)(3) and 501(c)(4) orgs. Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If “Ye s,” attach
a statement explaining each transaction
Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4955, and 4958
89a
b
c
section 4911
89b
Enter: Amount of tax on line 89c, above, reimbursed by the organization
d
b
Number of employees employed in the pay period that includes March 12, 2002 (See instructions.)
90b
Form 990 (2002)
Page 6Form 990 (2002)
Analysis of Income-Producing Activities (See page 31 of the instructions.)
Excluded by section 512, 513, or 514
(E)
Related or
exempt function
income
Unrelated business income
Note: Enter gross amounts unless otherwise
indicated.
(C)
Exclusion code
(B)
Amount
(D)
Amount
(A)
Business code
Program service revenue:93
a
b
c
d
e
f
Fees and contracts from government agencies
94
Membership dues and assessments
95 Interest on savings and temporary cash investments
96 Dividends and interest from securities
97
Net rental income or (loss) from real estate:
debt-financed property
not debt-financed property
98 Net rental income or (loss) from personal property
Other investment income99
100
Gain or (loss) from sales of assets other than inventory
101
Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory
103 Other revenue: a
b
c
d
e
104
Subtotal (add columns (B), (D), and (E))
105
Total (add line 104, columns (B), (D), and (E))
Note: Line 105 plus line 1d, Part I, should equal the amount on line 12, Part I.
Relationship of Activities to the Accomplishment of Exempt Purposes (See page 32 of the instructions.)
Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization’s exempt purposes (other than by providing funds for such purposes).
Line No.
Information Regarding Taxable Subsidiaries and Disregarded Entities (See page 32 of the instructions.)
(E)
End-of-year
assets
(D)
Total income
(C)
Nature of activities
(B)
Percentage of
ownership interest
(A)
Name, address, and EIN of corporation,
partnership, or disregarded entity
Part IX
Part VIII
Part VII
a
b
g
%
%
%
%
Medicare/Medicaid payments
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
(b)
(a)
Information Regarding Transfers Associated with Personal Benefit Contracts (See page 33 of the instructions.)
Part X
NoYes
NoYes
Note: If “Yes” to (b), file Form 8870 and Form 4720 (see instructions).
Date
EIN
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.
Please
Sign
Here
Type or print name and title.
DateSignature of officer
Preparer’s
signature
Check if
self-
employed
Paid
Preparer’s
Use Only
Firm’s name (or yours
if self-employed),
address, and ZIP + 4
Preparer’s SSN or PTIN (See Gen. Inst. W)
Phone no.
()
Form 990 (2002)
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Form 20: 02 Return of Organization Exempt From (IRS)

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Completed 19 May 2021

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