Document 6426292

A,
i l, i
l
1
OMB No 1545-1150
Returnsection
of Organization
Exempt
From of
Income
Tax Revenue Code
, form Under
501(c), 527,
or 4947(a)(1)
the Internal
(except black lung benetit trust or private foundation)
P Sponsoring organizations of donor advised funds and controlling organizations as defined in section .
512(b)(13) must tile Form 990 All other organizations with gross receipts less than $500,000 and total Open to Public
Depanmeni
ol the Treasury assets less than $1 ,250.000 at the end of the year may use this form Ins ection
iniernai Revenue service P The organization may have to use a copy of this retum to satisfy state reporting requirements p
For the 2009 calen
Check if applicable
Address change
ame change
itial return
erminated
mended return
dar ear, or tax year beginning - - and ending
Please
C Name ol organization D Employer identification number
use IRS
label or
print or
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
Number and street (or P O box, il mail is not delivered to street address) Room/suite E Telephone number
WPS
See
Specific
Instruc­
O
Application pending tions
PO BOX 136
(937) 378-6853
Cliy, (Own, Of C0uI1ify Si6iE ZIP + 4 F Group Exemption
45121 Number
GEORGETOWN
P
Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach G Accounting Method iii Cash L-I Accrual
a completed Schedule A (Form 990 or 990-EZ). Other (specify) P
H Check P if the organization is not
I Website: P N/A required to attach Schedule
B (Form 990,
art I "
J Tax-exemptstatus(checkonlyone)- 501(c)( 3 )4(inserin0)i:l 4947(a)(1) or E527 990-52-of 990"PF)
K Check P ij if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000
A Form 990-EZ or Form 990 return is not required, but if the organization chooses to hte a return, be sure to tile a complete return
L Add lines 5b, 6b, and 7b. to line 9 to determine gross receipts, if $500,000 or more, file Form 990 instead of Form 990-EZ P $ 65,079
...2
Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I )
Contributions, gifts, grants, and similaramounts received. . . . . . . . . 1 4,200
2 Program service revenue including government fees and contracts . . .
Investment income . . . . . . . . . . . ,
3 Membership dues and assessments . . . . . . . . .
4
2015
b Less
or other
basis
sales
. . . . .. .. ., m
5a
Grosscost
amount
from sale
of and
assets
otherexpenses
than inventory
5a 0
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . 5c 0
6 Special events and activities (complete applicable parts of Schedule G) If any amount is from gaming, check here P Li
a Gross revenue (not including $ of contributions
reported on line 1) . . 6a 25,346
6c ,
. . ). 7c
0
8
.
0
1110
12 ,
b Less direct expenses other than fundraising expenses . H 3,235
c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) . . .
bc Gross
Less
cost of goods sold . . . . . . .
profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .
7a Gross sales of inventory, less returns and allowances , 7a ,
8 Other revenue (describe b See Attached Statement
..
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 . . P 9
10 Grants and similar amounts paid (attach schedule) . .
11 Benefits paid to or for members . . . .
12 Salaries, other compensation, and employee benefits . . . .
22111
33 518
61,844
31 134
13 Professional fees and other payments to independent contractors . . 13 2,598
14 Occupancy, rent, utilities, and maintenance . . . . . . . 14 17,769
15 Printinqd-publications, postage, and shipping . . . 15 7,927
REGEiP
ses(E,escribe
P See Attached. .Statement
) 1665,838
6,410
aT -"*
: dd lines10through16.
. . . . . P 17
26 )
ao
igclissgipgije
forthe
(Subtract
line
17agree
from
line 9) . . . . 18 -3,994
Q t sMQW
s r -i balances
at beginning E*
of year
(fromyear
line 27,
column (A))
(must
with
. end-of-year fig reported on prior year"s return) . . . . . . . . . . . . . . . . 19 69,349
. i 6"*-lit:
.Wbalances
s"lTi net
balances
(attach
explanation)
. 20 0
ez E-i-gk):
:- - --i
at assets
end of orfund
year. Combine
lines
18 through
20 . . . .. .. .. 5. .21. .65,355
Part II Balance Sheets. If Total assets on line 25, column (B) are $1,250,000 or more, file Form 990 instead of Form 990-EZ.
(See the instructions for Part Il ) (A) Beginning Of year
22 16,807
7,251
Cash,
savings,
and investments
. .. .. .16,807
. . 13,397 23
Land
and
buildings
.
.
40,000 24 42,001
24 Other assets (describe * INVESTMENTS )
25
25 66,059
Total liabilities (describe P AQCCOUNTS PAYABLE 855 26 704
Net assets or fund balances (line 27 of column (Q) must agree with line 21) . 69,349 27 65,355
For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions
22
23
(B) End of year
Total assets . . . . . . . 70,204
27
(HTA)
Form 990-EZ (zoos)
,1
I
D
Form 990-EZ (2009) CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 2
I
M Statement of Program Service Accomplishments (See the instructions for Part III.)
What is the organizations primary exempt purpose? ASSIST WOMEN,MEN AND FAMILIES IN CRISIS PREG
Describe what was achieved in carrying out the organizations exempt purposes. In a clear and concise
manner, describe the services provided, the number of persons benefited, and other relevant information for
each program title
Expenses
(Required for section
501(c)(3) and 501(c)(4)
organizations and section
4947(a)(1) tnists. optional
for others )
28 ----------------------------------------------------------------------- - ­
(Grants $ 0 ) If this amount includes foreign grants, check here . . -i""lI"I 283
0
29 I - - - - - - . - - . - - . - - . - . - - - - - - - - - . - - - - - - - - - - - - - - - - - - - . - - - . . - - - - - . - U - - . - . - - - -U
(Grants $ 0 ) If this amount includes foreign grants, check here . .
*lj 29a
O
30 - - - - . - - U . - - - - - - - - - - - - - - . - - - - - - - - . - - - - - - - - - . - - . - - - - - - - - - - . - - - - . . - - - U . - - . - - - --­
(Grants $ 0 ) If this amount includes foreign grants, check here . . "fi :wa
31 Otherprogram services (attach schedule) . . . . . . . .
(Grants $ 0 ) If this amount includes foreign grants, check here . . . .fl-:I 31a
0
32
32 Total rogram service expenses (add lines 28a through 31a)
mp List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See th e instructions for Part IV )
0
0
(b) Title and average (c) Compensation (d) Contributions to (e) Expense
(a) Name and address hours per week (lf not paid, employee benetit plans & account
and
other allowances
Tiiie CHAIR
100
O
0
0
100
O
0
0
100
0
0
0
1.00
0
0
0
1.00
0
0
0
Hr/wx 1 OO
0
0
O
11,774
O
0
15 O0
16,275
0
0
I-ir/wx .OO
0
0
0
0
0
0
0
0
0
0
0
O
0
0
0
0
0
0
Hr/vvx .OO
0
0
0
Hr/wx .O0
0
0
O
O
0
O
0
0
I-if/wx
BAN DX M@BQl3I.5BT.5. ........................... . ­
Tiiie V CHAIR
i-if/wx
.SEBI Q/IH./5LL ................................... - .
Tiiie SEC
Hr/wx
.BI.L.U.E. .BURTQN ................................. - ­
Title TREAS
Hr/vi/K
.DAVID .SHARE .................................. - .
Title BOARD MEM
Hr/WK
D QI?QTI."I.Y .VI/.Il-.3.Q.N ............................. - ­
B 5.55996. -l./I.QI3.QB.EB.T.S. ........................ - ­
.T./.XII/.III/I.P.I ELYM 5.55.53 ............................ . ­
deferred compensation
enter -0-.)
devoted to position
.J.QHN-5E.N DEB .................................. - ­
me BOARD MEM
Tiiie CLIENT SERV DIR
i-if/vi/K 12 O0
Tiiie DIRECTOR
I-if/wx
Title
i-ir/wif .00
Hr/vvx .00
Title
Title
I-ir/wx 00
Title
I-if/wx .00
I-ir/wx .00
Title
I
Title
Title
Title
Title
Hr/WK .O0
I-ir/WK .00
Title
0
Form 990-EZ (2009)
­
u
1
Poms-Ez izoogi cRisis PREGNANCY CENTER oF BROWN couNW 31-1348780 page 3
Other Information (Note the statement requirements in the instructions for Part V.)
thechanges.....
33 Did the organization engage in any activity not previously reported to the IRS? lf "Yes," attach a detailed
description of each activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
34 Were any changes made to the organizing or governing documents? If "Yes," attach a conformed copy of
35 If the organization had income from business activities, such as those reported on lines 2, Sa, and 7a (among others), but
not reported on Form 990-T, attach a statement explaining why the organization did not report the income on Form 990-T
a Did the organization have unrelated business gross income of $1,000 or more or was it subject to section
6033(e) notice, reporting, and proxy tax requirements? . . . . . . . . . . . . .
b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . .
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 . . . . . . . . . . .
37 a Enter amount of political expenditures, direct or indirect, as described in the instructions P 37a I
b Did the organization file Form 1120-POL for this year? . . . . . . . . . .
38 a 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 period covered by this return?
b If "Yes," complete Schedule L, Part ll and enter the total amount involved
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 . . . . . .
aab 0
@
S-.S0
Yes N
33 X
34 X
*DX
il
35a
35b
36 X
37b X
38a
40 a Section 501(c)(3) organizations Enter amount of tax imposed on the organization during the year under"
section 4911 P 5 section 4912 P , section 4955 P
b Section 501(c)(3) and 501 (c)(4) organizations Did the organization engage in any section 4958 excess benefit
transaction during the year or is it 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 . . . . . . . . . . . . .
4Ob X
c Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax imposed on
organization managers or disqualified persons during the year under sections 4912,
4955,and4958 . .. .. .... .. .... P
d Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax on line 40c
reimbursed by the organization . . . . . . . . . . .P
e All organizations At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? If "Yes," complete Form 8886-T . . . . . . . . . . . . . .
40e X
41 List the states with which a copy of this return is filed. P
account)? ..
42 H The 0f9ef"ZeU0f1"S DOOKS ere in Cafe Of * TM/IMA. *SP1-.YM6$.S.EB. ............... .- Telephone U0- * .--.(9?.7).3?f3:@3f3.5.9:
LOC-Bled el * ,$914. .S.C,Q.FflE.L.D. BD ,,,,,,,, -,QiIy,Bll?,L,EY ............. ..$T.,.Q,H-- ZIP + 4 * 453.51 .............. -.
b 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
If "Yes," enter the name of the foreign country. P
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.? . .
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 . . . .
i
i
and enterthe amountoftax-exempt interest received oraccrued during thetaxyear. . . . . .bl 43 IN/A
44 Did the organization maintain any donor advised funds? lf "Yes," Form 990 must be completed instead of
Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . .
45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If
"Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . .
N0
B- X
45 x
Form 990-EZ (2009)
t
1
F0fm 990-EZ (2009) CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 4
Part VI Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section
n
501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 46-49b
and complete the tables for lines 50 and 51
Yes
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
46
candidates for public office? lf "Yes," complete Schedule C, Part I
Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part ll
48
ls the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . .
49 a Did the organization make any transfers to an exempt non-charitable related organization?. . .
I 47
47
48
49a
49b
Complete this table for the organizations five highest compensated employees (other than officers, directors, truste es and key
employees) who each received more than $100,000 of compensation from the organization. If there is none, enter " None?
b lf "Yes," was the related organization a section 527 organization? .
50
(b) Title and average (c) Compensation (d) Contributions to
(e) Expense
(a) Name and address ol each employee paid more hours per week employee benefit plans & account and
than $100,000 devoted to position deterred compensation other allowances
N90? .............. - ,sir ,,,,,,,,,,,,,,,,,,,,, ,, T-iie
City
ST ZIP Hr/WK
ST ZIP Hr/WK
- - . - - - . - - . - - - - - - - - -"Str-U--no-"U"---H--N Title
ST ZIP Hr/WK
- - . - - . - - . - - - - - - - - - ---Str--U-U"---U"-----up Title
ST ZIP Hr/WK
- - - - . - . . - - - - - - . . . - ---Str---H-nn"-U"--"U Title
ST ZIP Hr/WK
f
Total number of other employees paid over $100,000 .
. .N.3."J@
City
. .N.@."J@
City
. .N.3."3@
City
. .NPFJQ
City
- .Na."J%
00
0
O
.O0
O
0
OO
0
0
00
0
0
O0
O
O
. - - - - - - - - - - - - - - - - . ---Str"nn--"nu"-"nn Title
P
51 Complete this table for the organizations 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 (b) Type of service (c) Compensation
. .N.3."J@
City
. .N.a."3@
City
. .N.a."?Q
City
. .Na."J*2
City
sr zip
..................................
ST zip
..................................
sr zip
..................................
sr zip
N90? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- 59* . . . . . . . . . . . . . . . . .- ­
sr zip
.Str ................. . ­
. .N.a."3@
City
d Total number of other independent contractors each receiving over $100,000
P
pt Inf"/zyazo//J
Under penalties of perjury. l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge
and beli f, it is true, corre - - plete Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge
Sign
Here
P.
, Type or pnnt name and tide
Paid
prepafer-S , Date
gg?-Ck 4/22/2010
If Preparefs identifying
number
, signature
, *-/-N-/
employed
s (See instruciiorisi
EIN P
Ureparer
S Firm
S flame (Or y0Uf$ JI
ge Only
if self-employed),
Y address, and zip + 4 1627 Grunwald CV, Fayetteville , OH 45118 Phone "0 P (513) 875-2299
May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . . PIZI Yes CI No
Form 990-EZ (2009)
SCHEDULE A . . . OMB N0 1545-0047
(Fomfsso or 990-Ez)
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
Depanmem of the Treasury 4947(a)(1) nonexempt charitable trust. Qpen tg Public
imemei Revenue Semee b Attach to Form 990 or Form 990-EZ. P See separate instructions. Inspection
Name of the organization Employer identification number
31­ 1348780
CRl SIS PREGNANCY CENTER OF BROWN COUNTY
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The org-a-nization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E )
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the
hospitals name, city, and state: --------------------------------------------------------------- U
5
6
7
8
9
.L
10
III
F11 E
An organization operated for the benefit of a college or university owned or operated by a governmental unit described
in section 170(b)(1)(A)(iv). (Complete Part ll )
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part ll )
A community trust described in section 170(b)(1)(A)(vi). (Complete Part ll.)
An organization that normally receives" (1) more than 33 1/3 % of its support from contributions, membership fees, and gross
receipts from activities related to its exempt functions-subject to certain exceptions, and (2) no more than 33 1/3 % of its
support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975 See section 509(a)(2). (Complete Part Ill.)
An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the
purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section
509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.
. e E a E Typel b lj Typell c E Type Ill-Functionally integrated d lj Type lll-Other
lf
9
By checking this box, l certify that the organization is not controlled directly or indirectly by one or more disqualified
persons other than foundation managers and other than one or more publicly supported organizations described in section
509(a)(1) or section 509(a)(2).
organization,
checkthis
box . . . . from
. . .the. .IRS
. .that
. . it. is. a. Type
. I, Type ll, or Type Ill supporting lj
If the organization received
a written determination
Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
and (iii) below, the governing body of the supported organization? . . .
(ii) A family member of a person described in (i) above? . . . . . . 11 ii
(iii) A 35% controlled entity of a person described in (i) or (ii) above?. . . . . . . . . 11 iii
h
Provide the following information about the supported organization(-sl).
or
amzanon
the organization
in
9 above
or IRC section goveming
document? col (I) of your
(iii) Type of organization (iv Is the organization v Did ou
noti
Y
(I) Name of supponed (H) EIN (described on lines 1-9 in col (i) listed in your
(see instructions)) support?
Yes No Yes No
(vi) Is the
organization in col
(I) organized in the
US?
(vii) Amount of
suppon
Yes No
0
0
0
0
0
Total
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ
(HTA)
O
Schedule A (Form 990 or 990-EZ) 2009
Scheduie A (Form 990 N990-Ez) 2009 CRisis PREGNANCY CENTER oF eRowN CouNTY 31-1348780 Page 2
E suppen seheeiuie for organizations Described in seeiions11o(b)(1)(A)(iv)and 11o(b)(1)(A)(vi)
- (Complete only if you checked the box on line 5, 7, or 8 of Part I.)
Section A. Public Support
Calendar year (or fiscal year beginning in) P (5) 2005 (Q) 2006 (E) 2007 (dj 2008 (5) 2009 (f) Total
1 Gifts, grants, contributions, and
include any "unusual grants ") 0
membership fees received. (Do not
its behalf . . . . . . . . . . 0
2 Tax revenues levied for the organization"s
benefit and either paid to or expended on
3 The value of services or facilities
organization
without
Charge
.
.
.
0
4 Total. Add lines 1 through 3 . . 0 0 0 0 0 O
furnished by a governmental unit to the
5 The portion of total contributions by each
person (other than a governmental unit
6Public
7 . support
m Subtract line 5 fro line 4. 0
or publicly supported organization)
included on line 1 that exceeds 2% of the
amount shown on line 11, Column (f) .
Section B. Total Support
7 AmountsfromIine4. . . . . . 0 O O O 0 0
Calendar year (or fiscal year beginning in) P (Q) 2005 (p) 2006 (Q) 2007 (Q) 2008 (E) 2009 (f) Total
sources
.
.
.
.
O
regularly carried on . . . . . 0
8 Gross income from interest, dividends,
payments received on securities loans,
rents, royalties and income from similar
9 Net income from unrelated business
activities, whether or not the business is
inAdd
Part
. . . .10O0
11(Explain
Total support.
linesIV)
7 through
10 Other income Do not include gain or
loss from the sale of capital assets
12 Gross receipts from related activities, etc (see instructions) . . . . . . . . . . . . . . 12 I
13 First five years. If the Form 990 is for the organization"s first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization,checkthisboxandstophere. . . . . . . . . . . . . . . . . . . . . . . . . . .PD
Section C. Computation of Public Support Percentage
14 Public support percentage for 2009 (line 6, column (f) divided byline 11, column (f)) . . . . 14 0.00%
15 Public support percentage from 2008 Schedule A, Part ll, line 14 . . . . . . . * I 0 00%
16a 33 1/3% support test-2009. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box.­
and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . .P ­
b 33 1/3% support test-2008. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this*
box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . b
17a 10%-facts-and-circumstances test-2009. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10%
or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how
the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization. . D *­
b 10%-facts-and-circumstances test-2008. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10%
or more, and if the organization meets the "facts-and-Circumstances" test, check this box and stop here. Explain in Part IV how-p
the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly supported organization . .D
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a ,or 17b, check this box and see instructions . . . . P -s
Schedule A (Form 990 or 990-EZ) 2009
Schedule A (F0fm 990 Of 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 3
Part Ill Support Schedule for Organizations Described in Section 509(a)(2)
- (Complete only if you checked the box on line 9 of Part I.)
Section A. Public Sup-port
Calendar year (or fiscal year beginning in) P (3) 2005 (p) 2006 (Q 2007 (Q) 2008 (g) 2009 (f) Total
1 Gifts, grants, contributions, and
include any "unusual grants.") . . . . O
organizations tax-exempt purpose O
membership fees received. (Do not
2 Gross receipts from admissions, merchandise
sold or services performed, or facilities furnished
in any activity that is related to the
its
behalf
.
.
.
.
O
organization without charge . . . 0
unrelated trade or business under section 513 0
3 Gross receipts from activities that are not an
4 Tax revenues levied for the organization"s
benefit and either paid to or expended on
5 The value of services or facilities
furnished by a governmental unit to the
6 Total. Add lines 1 through 5 0 0 0 O 0 0
received from disqualified persons 0
amount
13. .for
0
N c Add
lineson
7a line
and 7b
. . .the
. . Oyear
0 0 O. .O. O
7a Amounts included on lines 1, 2, and 3
b Amounts included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% of the
line
6
)
.
.
.
.
.
.
0
9 Amounts from line 6 . . . . 0 0 0 0 0 0
8
Public support (Subtract line 7c from
Section B. Total Support
Calendar year (or fiscal year beginning in) P (E) 2005 (Q) 2006 (S) 2007 (Q) 2008 (5) 2009 (f) Total
sources. . . . . . . . . 0
10a Gross income from interest, dividends,
payments received on securities loans,
rents, royalties and income from similar
b Unrelated business taxable income (less
section 511 taxes) from businesses
June
cacquired
Add lines after
10a and
10b30,
. . 01975
0 0 0. 0. 0
0
carried
on
.
0
(Explain in Part IV.). . . . . 0
11 Net income from unrelated business
activities not included in line 10b,
whether or not the business is regularly
12
13
14
Other income Do not include gain or
loss from the sale of capital assets
and12) 0 0 0 O 0 0
Total support. (Add lines 9, 10c, 11,
First five years. If the Form 990 is for the organizations first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization,checkthisboxandstophere. . . .. ...... ... . ..............bl:-I
Section C. Computation of Public Support Percentage
15 Public support percentage for 2009 (line 8, column (f) divided byline 13, column (f)) . . . 15 0.00%
S " D. C " f I I P
16 Public support percentage from 2008 Schedule A, Part lll, line 15 . . . , 16 , O 00%
ection omputation o nvestment ncome ercentage
17 Investment income percentage for 2009 (line 10c, column (f) divided by line 13, column (f)) . . 17 0 00%
18 Investment income percentage from 2008 Schedule A, Part Ill, line 17 . . . . . . . . . . . E 0.00%
19a 33 1/3% support tests-2009. lf the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is
not more than 33 1/3%, check this box and stop here. The organization qualities as a publicly supported organization . . . .P lj
b 33 1/3% support tests-2008. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and
line 18 is not more than 33 1/3%, check this box and stop here. The organization qualities as a publicly supported organization . . . . . P E
20 Private foundation. lf the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions . . . P
Schedule A (Form 990 or 990-EZ) 2009
Sflhedule A (F0ffT1 990 Of 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31 -1 348780 Page 4
Part IV Supplemental Information. Complete this part to provide the explanations required by Part II, line 103
Part Il, line 17a or 17bg and Part III, line 12. Provide any other additional information. See instructions.
Schedule A (Form 990 or 990-EZ) 2009
SCHEDULE
(Form 990 or 990-EZ) G Supplemental Information Regarding OMBN" 154500"
Fundraising or Gaming Activities
Department ol the Treasury . . ,
Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the Open T0 Public
Internal Revenue Semce organization entered more than $15,000 on Form 990-EZ, line 6a. lnspectlon
Name of the organization Employer identification number
CRISIS PREGNANCYP Attach
CENTER
BROWN
COUNTY
31-1348780
to Form 990 orOF
Form 990-EZ
P See separate
Instructions. 4
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1,
8
Indicate whether the organization raised funds through any of the following activities. Check all that apply
lj Mail solicitations e lj Solicitation of non-government grants
b lj Internet and email solicitations f lj Solicitation of governmentgrants
C D Phone solicitations g Special fundraising events
d EI In-person solicitations
2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
b
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes El No
If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.
(i) Name ol individual (ii) Activity (iii) Did fundraiser have (iv) Gross receipts (V) Amour" pald to (vl) Amount paid to
or entity (fundraiser) custody or control of from activity (or retamed by) (or retained by)
co i In organization
contributions? fu"dra"sTr(")Sted
Yes No
l
l
i
0O O
0 O0
FUND RAisERs X 25,346
ALL
0 25,346
O
0
0
0
0
O
O
0
O
O
0
0
0
O
0
0O 00 00
Total . . . . . P 25,346 0
25,346
3
List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from
registration or licensing
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule G (Form 990 or 990-EZ) 2009
(HTA)
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
schedule
G (Form 990 of 990-Ez) zoos Page 2
Part Il Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported
more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1 (b) Event #2 (c) Other events (d) Total events
O
0
00
(add col (a) through
(event type) (total number)
Gross receipts
Less Charitable
contributions
Gross income (line 1
minus line 2)
Cash prizes
wi (Cl)
00
O
O
0
0
Noncash prizes
O
Rent/facility costs .
0
Food and beverages .
0
Entertainment . .
0
+­
.Pt 0)
0
Other direct expenses .
11
Elm
Directexpense summary. Add lines4through9in column (d). . . . . . . . . .
Net income summary. Combine line 3, column (Q), and line 10. . . . . . . . . . . . . P
(a) Bingo (b) Pull tabs/instant (c) Other gaming
bingo/progressive bingo
-.­
0
Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or rep orted more
than $15,000 on Form 990-EZ, line 6a.
(d) Total gaming (add
col (a) through col (c))
Gross revenue .
0
Cash prizes
O
Noncash prizes .
O
Rent/facility costs
O
Other direct expenses .
0
Yes ------ H"/0 ljYes ------ no/0 EYes ------ U"/0
Volunteer labor E No lj No E No
Direct expense summary Add lines 2 through 5 in column (d) . . . . . P g O)
Net gaming income summary Combine line 1, column d, and line 7 . . P 0
Yes No
9
Enter the state(s) in which the organization operates gaming activities: ---------------------------- U
ls the organization licensed to operate gaming activities in each of these states? . . .
9a
If "No," explain.
10a Were any of the organization"s gaming licenses revoked, suspended or terminated during the tax year?
10a
If "Yes," explain.
11
Does the organization operate gaming activities with nonmembers"7 . . . . . . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . . . . .
11
12
Schedule G (Form 990 or 990-EZ) 2009
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
Schedule
G (Form 990 or 990-EZ) 2009 Page
3
Yes No
13
Indicate the percentage of gaming activity operated in.
3
b
14
The organization"s facility . . . . . . . . . . . . . 13a %
An
outside facility . . . . . . . . . . . . . . . . . m %
Enter the name and address of the person who prepares the organization"s gaming/special events books
and records
revenue? ..
Name P ----------------------------------------------------------------------------------------- -­
Address P -------------------------------------------------------------------------------------- - ­
15a Does the organization have a contract with a third party from whom the organization receives gaming
b
WC
. 15a
If "Yes," enter the amount of gaming revenue received by the organization P $ ------------ U and the
amount of gaming revenue retained by the third party P $ ------------­
If "Yes," enter name and address of the third party
Name P
Address P -------------------------------------------------------------------------------------- -­
16
Gaming manager information
Name P
Gaming manager compensation P $ ------------------ --Q
Description of services provided P --------------------------------------------------------------- U
E Director/officer E Employee lj Independent contractor
17
Mandatory distributions
a is the organization required under state law to make charitable distributions from the gaming proceeds to N g - M Y
retainthestategamingIicense"7. . . . . . . . . . . . . . . . . . . . . . . . . . 17a
b
Enter the amount of distributions required under state law to be distributed to other exempt organizations
or spent in the organization"s own exempt activities during the tax year P $
Schedule G (Form 990 or 990-EZ) 2009
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
P.art I, Line 8 (990-EZ) - Other Revenue
donation Income
33,518
Amount
Descriptuon
32,404
1,114
on-IERINCOME v- -W * 4 W
-9-W --- ­, ­
l3. C .. ,..M...*-.-*
11
.EL
-.M -.., -,W,.--MC -,--.--*
1.4.---.-----------.--­
.12
T " - *"""*""
16
18
19
20 flfm" "fff ij, C --- ­
9
10
11
12
13
14
15
16
17
18
19
20
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
o
1
Travel . . . . .
. Par1 L Line 16 (990-EZ) - Other Expenses
1
-2
Meals and entertainment
4
Fundraising. ..... .. .. .
Amortization
5
Conferences, conventions, and meetings . .
3
6
1
6,410
0
Depreciation
Depletion . . . .. .. ,. ..
Interest . .. . . .
Supplies
Telephone . .
0
a Equipment rental and maintenance
9
10
11
12 Unrelated business
13 CENTER EXPENSES
14
15
income taxes .
ADVERTISTNG " T- " T- "fu -"M , --fu" -,MM wwf.-"
QHARILQLETBQQITAX. ------ 2­
1s PRIOGRAM ExPENsEs
11
18
19
20
ARCH-GRANT.EXEEf*EE-Qfafflf-fi"--"H-- "Q7-QQ." *.­
9
10
11
12
13
14
15
16
17
18
19
20
21
21
22
23
so
22
23
24
25
26
27
28
29
30
31
31
32
32
24
2s
26
21
28
29
0
1,619
304
50
237
4,200
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780
IY
i Part II, Line 24 (990-EZ)
- Other Assets
40,000 End
42,001
Description
Beginning
INVESTMENTS 40,000 42,001
T
. -.-.-- .- .-.. --.
.Q . .---.-. ,. -­
L --.-.s-.-.-- - ­
12
13
L
-.--.-..-A
,LL - - ------..-.- -­
.LL
- , --------E­
15
11
19
3.0. -V M- ­
CRISIS PREGNANCY CENTER OF BROWN COUNTY 31 1348780
1Q
s ,U
s
.Part Il, Line 26 (990-EZ) - Liabilities
AQCCOUNTSPAYABLE
855 704
855 704
Descnpuon Bemnnmg En