Document 6430074

IReturn
Shgrt
Fgrm
oMe
No
1545-1150
of Organization Exempt From Income Tax
Form under section 5o1(c),
527, or 4947(ax1) of ing internal Reyenue code
(except black lung benefit trust or pnvate foundation)
G
* Sponsoring organizations of donor advised funds and controlling organizations as defined in section 512(b)(13) must file
Form 990 All other organizations with gross receipts less than $500,000 and total assets 0 t P bl­
less than
$1,250,000
atofthe
year
userequirements
this form pec
0 fu
* The organization
may have
to use a copy
thisend
returnoftothe
satisfy
statemay
reporting
Ionlc
Department of the Treasury
Internal Revenue Service
B Check if applicable
Address change
Name change
Please
use IRS
lebel or
1063 30TH STREET (309) 325-7236
mms- F Group Exemption
Initial feiumeeor
Termination
Specific
Amended return
C Name of orgamzahon D Employer identification number
PROSTATITIS
FOUNDATION 36-4034576
Number and street (or P O box, if mail is not delivered to street address) Room/suite E Telephone number
Instmc- City or town, state or country, and ZIP + 4
Application Pending SMITHSHIRE IL 6 14 7 8 Number *
A For the 2009 calendar (ear, or tax year beginning , 2009, and ending
0 Section 507(c)(3) organizations and 4.947(a)(1) nonexempt charitable trusts G Accountlng methodf E Cash E Accfual
must attach a completed Schedule A (F omr 9.90 or 9.90-ED. Other (specify) *
H Check * IZ-I if the organization is not
IJ Tax-exem
website:
v N/A re%uired to attach Schedule B (Form 990,
tstatus (check only one) - Q 501(c) ( 3 ) * (insert no) Q4947(a)(1) or Q 527 99 EZ* or 990"PF)
K Check
*LIE
if the990-EZ
organization
is 990
not areturn
section
509(a)(3)
supporting
its gross
receipts
are be
normally
than return
$25,000
A orm
or Form
is not
required,
but if theorganization
organizationand
chooses
to file
a return,
sure to not
file more
a complete
instead of Form 990-EZ * $ 12 I 444
L Add lines 5b, 6b, and 7b, to line 9 to determine gross receipts, if $500,000 or more, file Form 990
lParii
I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I.)
Contributions, gifts, grants, and similar amounts received . - . 1 3 , 633
1
Q -­
Program service revenue including government fees and contracts. 2 7 , 881
2
4
Membership
dues and assessments .
Investment income
5a
Gross amount from sale of assets other than inventory 5a
3
b Less cost or other basis and sales expenses
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a)
6
I 5bI
reported on line 1) 6a
Gross revenue (not including $ of contributions
b Less direct expenses other than fundraising expenses . 6b
c Net income or (loss) from special events and activities (Subtract line 6b from line Sa) .
7a
b
Gross sales of inventory, less returns and allowances 7a
Less. cost of oods sold I 7b
Other revenue (describe * )
Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 *
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a)
11
X 12
Grants and similar amounts paid (attach schedule) . -, . . .. . . . . . . . . .. .
Benefits paid to or for members .
Salaries, other compensation, and employee benefits " . A " "An A
19
Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year
figure reported on prior year"s return) ,
8
9
12, 444
10
500
13
,
14
,9
15 ,
18 ,
5 499
369
Occupancy, rent, utilities, and maintenance
. 1"" 1 7
*sr
Printing, publications, postage, and shipping
. . ..
Other changes in net assets or fund balances (attach explanation) . .
7c
12
Professional fees and other payments to independent contr s . A
Other
(describe
* See
Other
Statement
N gr ". T"
Totalexpenses
expenses.
Add
lines
10Expenses
through
16 . . fs..
. ),
Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . .
ee
11
13
14
15
16
17
18
32?
5c
Special events and activities (complete applicable parts of Schedule G) If any amount is from gaming, check here * U
a
8
9
10
930
16
17
7 289
3,019
20,276
-7 832
FT
84, 205
P
20
ro
AA AL...
r
-at
L
AA
ii
A..x
,...r*i..1
n
x4
-----..
l
5
- -...-ns1­
..
Cash, savings, and investments 84 , 205 .
Net assets or fund balances at end of year Combine lines 18 through 20
* 21
76,373
IPBI1 ll I BalanC8 Sheets. lf Total
assets
lineiii
25,iviis
columniui
(B)raii
are $1,250,000
or molre,
file Form 990
Blon
Lal
(Occ
nic
iii
11./ i ufu
Dcuiiiiuiiu
uiinstead
veal of Form 990-EZ
22
23
24
25
26
27
Land
and
buildings
0
,
Other
assets
(describe
*
)
.
0
.
Total
assets
84
,
2
0
5
.
Total liabilities (describe * ) 0 ,
ip-r i:iiu ui -veal
22
23
24
25
26
27
76, 373
0.
0.
76, 373
0.
Net assets or fund balances (line 27 of column (B) must agree with line 21) 84 , 205 .
76, 373
BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Form 990-EZ (2009)
TEEA0812 01/30/10
( i h d tth t " t . I I d , an a sec o
F0rm,990-EZ (2009) PROSTATITIS FOUNDATION 3 6 - 4 0 3 4 57 6 Paqe 2
IPart Ill I Statement of Program Service Accomplishments (See the instructions.) Re ulreggvresgggon
program title f0f Oi GFS)
What is the organization s primary exempt purpose? RESEARCH GRANTS FOR MEDICAL RESEARCH g01?c)(3)t and (4)d t
533353t42a$.Y3ie1Cpl%t?a.Q ti?S%"32.85f ofep3522233422fi5J,e3?p.iR3Fi2i55an?.2f3f?5t?0"n fS?%2l2?i ""a""e* 25%v@ti*??fi32, 0pi.0*n2i
28 BE $.31-XBQPL 9E&N?L*LI515*LA. ETSEBE . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- ­
-(Grants $ 500 . ) If this amount includes foreign grants, check here * lj 28a 500 .
29
(Grants $ ) If this amount includes foreign grants, check here . * EI 29a
30
If this amount includes foreign grants, check here *U 30a
31(Grants
Other$ )program
services (attach schedule) . . .
(Grants $ ) If this amount includes foreign grants, check here . . * U 31 a
32 Total rogram seniice expenses (add lines 28a through 31a) * 32 500 .
lfPaI*lsl)/asf LiSf Of OffiCerS, Dir8Ct0rS, Trustees, and Key Empl0yeeS. List each one even if not compensated. (See the instrs.)
(b) devoted
Title and not
average
(c)-0-.)
Compensation
Sd) Contributions
to (e)otEx
account
(a) Name and address per week
paid,hours
enter
emp oyee(If
benefit
plans and and
erllense
allowances
to position deferred compensation
EE QHQEE .R. 1EE.NFE1lFE1l"1. . . . .- ­
SMITHSHIRE, IL 61478 30.00 0. 0. 0.
.19 5.3. 2 QT.H. ETL- . . . . . . . . . .- - PRESIDENT
CLARK HICKMAN, PHD
sm-.1.oU1s, 14063121 15.00 o. o. o.
2327 PALM my coum* ssc/-rREAs
SEBRING FL 33870 20.00 0. 0. 0.
.39 91. HEILUBQL. 3151.595 .RP- - - - - V- PRES ­
335.111-EX .HE1iTLE.N1iENl1"1 .M.- 12 -. - - ­
DAVE W. TRISSEL
2110. I&V*LNX.C.IBQ11E . . . . . . .- - MEMBER
AUSTIN, TX78745 5.00 0. 0. 0.
TIM MCLAREN
KANKAKEE, IL60901 0.00 0. 0. 0.
32 @7."5.VL-- 50.17215 . . . . . . . .- - MEMBER
All -iIi Ii
BAA TEE/xoaiz oi/so/io Form 990-EZ (2009)
Form 990-EZ (2009) PROSTATITIS FOUNDATION 36 -4034576 Page 3
IPart V I Other Information (Note the statement requirements in the instrs for Part V.)
Yes No
33 Did the organization engage in any activity not previously reported to the IRS? If "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 the changes
35 lf the organization had income from business activities, such as those reported on lines 2, 6a, 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.
reporting, and proxy tax requirements? . . . . .
a Did the organization have unrelated business gross income of $1,000 or more or was it subject to section 6033(e) notice,
33
X
34 X
maj
1.1L
36 X
H
37b-xl
ash
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
37a Enter amount of political expenditures, direct or indirect, as described in the instructions *I 37al O .
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 period covered by this return?
amount involved 38b
gs: I
i.aL.......*.l
38a
b If "Yes," complete Schedule L, Part ll and enter the total
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 . 39b
40a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under.
section 4911 * , section 4912 * 5 section 4955 *
b transaction
Section 501(c)(3)
the organization
eniage
any sectionwith
4958
excess benefit
duringand
the 501(c)(4)
year or is organizations
it aware that itDid
engaged
in an excess
enefitintransaction
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 .
-.-4.
40b
c Section
501(c)(3)
and 501(c)(4)
organizations.
Enter
tax imposed
on 4955,
organization
managers
or disqualified
persons
uring the
yearamount
underofsections
4912,
and 958 *
by the organization . . *
d Section 501 (c)(3) and 501(c)(4) organizations Enter amount of tax on line 4Oc reimbursed
EX
shelter transaction? lf "Yes," complete Form 6-T . . . .
e All organizations At any time during the tax gg-zgir, was the organization a party to a prohibited tax
41 List the states wrth which a copy of this return is filed * Illinois
40e
42a The organization"s
books are in care of * QQQH-AEE -1112111433-N13I5NL1* -------------------- g - Telephone no r -(g gs-) 22.5: 22.35 - ­
Located at* 1063 30TH STREET, SMITHSHIRE IL ziP+4 e 61478
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 account)? .
If "Yes," enter the name of the foreign country? ss to
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of a 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?
I I I1.
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here .
3F10 BRIEF IFIB afT1OUl"1l Of l8X-GXQITIDI IFIISY(-ESI FSCEIVEG OT BCCFUSG ClUflF1Q the 13X yeafP. . 43
of Form 9 0-EZ ,
44 Did the organization maintain any donor advised funds? If "Yes," Form 990 must be completed instead
45 ls any related organization a controlled entt of th t th th f t 512 b 13 ? I " "
-Vi
No
H­
45 X
BAA 1Eif.Aoai2 or/so/io Form 990-EZ (2009)
Form 990 must be completed instead of Folrgci 990-tliigrgamza Ion WI In e meaning 0 Sec Ion ( X ) f Yes"
Form 990-EZ (2009) PROSTATITIS FOUNDATION 3 6 -4 034 57 6 Page 4
IPart"VI 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
46-49b and complete the tables for lines 50 and 51.
for public office? If "Yes," complete Schedule C art l .... ..
46 Did the organization engage in direct or indirect golitical campaign activities on behalf of or in opposition to candidates
47 Did the organization engage in lobbying activities? lf "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
49a Did the organization make any transfers to an exempt non-charitable related organization?
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 "
(b) Title andpaid
average
(c) Compensation
Contributions
to emJJIoyee
(e) Expense
(a) Name and address of each employee
hours
per week(d)benefit
plans
an account
and
more than $100,000 devoted to position deferred compensation other allowances
NONE
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. lf there is none, enter "None,"
(a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation
F9113 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- ­
Sign
PSignature
, I 5t/4?-7/0
Here
of ofticer page
d Total number of other independent contractors each receiving over $100,000 *
Under penalties of perpury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
true, correct, and complete Declaration ol preparer (other than officer) is based on all information ot which preparer has any knowledge
Si na ure "
, MICHAEL HENNENFENT
Type or print name and title
paid Pfepqfef-S
,W we gglwemployed
?Sf:sa.i1lfuLls,fi2l""g"um"
Preg 1 03/13/10
*
arelfs Fsrm"s name (or WALTE S CCOUNTING AND TAX
Use Z"f"iE"1Sf0"y"e?i3",f" * 375 E BROADWAY s-r Em .
BAA Form 990-EZ (2009)
Unly Sfilf? am" RQSEVILLE 11. 61473 -9162 phone no - (309) 426-2013­
*/lay the IPS discuss th:s return *:.-:th thc preparer sho.-fn above? See instructions . *E Yes E No
TEEAOSIZ Ol/30/10
OMB No 1545-0047
(?,ErlfnE92g-ll-rggg-EZ) Public Charity Status and Public Support
" t Complete if the organization is a section 501(c)(D3)
organization
or a section
4947(a)(1)
, Public 5
nonexempt
charita
Ie trust.
,frm
nspection :
Eiigr1ir$T1i32f/gfirigesgrfficsgw * Attach to Form 990 or Form 990-EZ. * See separate instructions.
Name of the organization Employer identification number
36-4034576
PROSTATITIS FOUNDATION
I"Part I * I Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is (For lines 1 through 11, check only one box.)
1
in A church, convention of churches or association of churches described in section 170(b)(1)(A)(i).
2 iz­ A school described in section 170(b)(1)(A)(ii). (Attach Schedule E )
A hospital or 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(bX1)(A)(iii) Enter the hospital"s
1
5
6
7
8
9
10
11
name, city, and state. - - - - - * - - - - - - - - - * - - - - - - - - - - - * - - - - - - - * * - - - - - - -- -" - - - - -- ­
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
Z in section 170(bX1)(A)(vi). (Complete Part ll.)
: A community trust described in section 170(b)(1)(A)(vi). (Complete Part ll )
i 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 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.
a ljType I b ljType Il c U Type III - Functionally integrated d lj Type Ill- Other
e * By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other
fiwggidation managers and other than one or more publicly supported organizations described In section 509(a)(1) or section
check this box . . .
a.
If the organization received a written determination from the IRS that is a Type I, Type ll or Type Ill supporting organization, EI
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? . . . ­
No
(ii) a family member of a person described in (i) above?
(iii) a 35% controlled entity of a person described in (i) or (ii) above? 11 g (iii)
Provide the following information about the supported organizations.
(i) Name
of Supported
(ii) EIN
ofanization
organization
(iv)the
ls organization
the (v) Did you
notify (vi) Is in
thecol
Organization
(described
on (iii)
linesType
1-9 or
in col
in organization
(vii) Amount of Support
above or IRC .section 8) listed in your col (i) of (i) organized in the
(see instructions)) governsng
your support? U S 7
document?
Yes No Yes No
Yes No
. *. ,, ,.33
tort
H M,
1 .ggttezg
A. ,- WW,-­
K
Total is -- i -- 1"" iw * " ,, , ,L ,W J ff: " it. :il f mils * *ri*-*ei -*r iff f wi"-"*g.Ji
BAA For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Fomi 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 2009
TEEA0401 02/05/ I 0
schedule A (Form 990 or 990-Ez) 2009 PRos*rA-1-1-rrs Fouunivrrou 36 -4034576 i Page 2
IPartYII ISupport Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
b (Complete only if you checked the box on line 5, 7, or 8 of Part I )
Section A. Public Support
Calendar
(or fiscal
200(d)2009
T0iBI
beginning in)year
, (a) 2005
(b) 2006year
(c) 2007
8 (e) (f)
not include *unusual grants I
1 Gifts, grants, contributions and
membership fees received (Do
2 Tax revenues levied for the
org1anization"s
and
eit er paid to it benefit
or expended
on its behalf
3 The value of services or
facilities furnished to the
organization by a governmental
unit without charge. Do not
include the value of services or
facilities generally furnished to
the public without charge
4 Total. Add lines 1-through 3
5 The portion of total
contributions by each person
(other than a governmental
unit or publicly supported
organization) included on line 1
that exceeds 2% of the amount
shown on line 11, column (f)
9 9:3 gf, We $3?
from line 4 . .f it
6 Public support. Subtract line 5
Section B. Total Support
gggmgfggyfngf S" "Sci" Ye" (a) 2005 (b) 2006 (C) 2007 (ci) 2008 (e) 2009 (f) Toiai
7 Amounts from line 4 ..
8 Gross income from interest,
dividends, payments received
on securities loans, rents,
royalties and income form
similar sources
9 Net income from unrelated
business activities, whether or
not the business is regularly "
carried on
10 Other income. Do not include
gain or loss from the sale of
capital assets (Explain in
Part IV.) .
13 d " I " . " . A iji
11 Total
supgort.
Add lines 7
through
1
12 Gross receipts from related act ities, etc. (see instructions) , I 12
iv
First five years. lf the Form 990 is for the organization"s first second third fourth or fifth tax year as a section 501(c)(3)
organization, check this box an stop here.
Section C. Computation of Public Support Percentage
15
Public
support
percentage
A,line
Part
line (f)
14. 15
14 Public
support
percentage
for 2009 from
(line 6, 2008
columnSchedule
(f) divided by
11,ll,
column
14 I%
%
16a 33-1/3 support test - 2009. If the organization did not check the box on line 13, and the line 14 is 33-1/3 % or more, check this box
and stop here. The organization qua ifies as a publicly supported organization. * EI
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 qua ities as a publicly supported organization. . . * D
17a 10%-facts-and-circumstances test - 2009 If the organization did not check a box on line 13, 16a, or l6b, and line 14 is 10%
or more, and if the organization meets the "facts-and-circumstances" test, check this bex and step here. Explain in Part IV how
U19 OYQBHIZBIIOD ITISGIS U18 TBCIS-BUG-CIYCUITISIZTICES (BSI ITIS OfQaI"lIZ3IlOl"l qUaIlfI6S BS 3 DUDIlCly SUDDOYIGG OYQZFIIZBIIOFL P E
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 the
r
BAA Schedule A (Form 990 or 990-EZ) 2009
18 Private
foundation.
If the
did not check a box
on line,
16a, 16b, 17a,
or 17b,ascheck
this boxsupported
and see instructions
organization
meets
theorganization
"facts-and-circumstances*
test.
The 13,
organization
qualifies
a publicly
organization * H
TEEAO402 10/08/09
Schedule A (Form 990 Or 990-EZ) 2009 PROSTATITIS FOUNDATION 36 -4034 576 Page 3
Raft III ISupport 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 Support
ceiendar year (er fiseei yr beginning my (5) 2005 (13) 2006 (9 2007 (Q) 2008 (9) 2009 (9 Total
1 Giftsbgragts,fcontributioncs
mem ers i ees receive
arlsd
o
not includegunusual grantsfs 30,994. 27,032. 28,121. 19,879. 11,454. 117,480.
2 Gross receipts from
admissions, merchandise sold
or sen/ices performed, or
facilities furnished in a activity
that is related to the
organizations tax-exempt
purpose . . . .
3 Gross receipts from activities that are
not an unrelated trade or business
under section 513 .
4 Tax revenues levied for the
or anization"s benefit and
eit?-ier paid to or expended on
its behalf
5 The value of services or
facilities furnished by a
governmental unit to the
organization without charge
persons . 0 . 0 ­
6 Total. Add Iines1 lhrough5 30,994. 27,032. 28,121. 19,879. 11,454. 117,480.
year 0 . 0 ­
7a Amounts included on lines 1,
2, 3 received from disqualified
b Amounts included on lines 2
and 3 received from other than
disqualified persons that
exceed the greater of 1% of
the amount on line 13 for the
c
Add
lines
7a
and
7b
O
.
0
­
8 Public support (Subtract line We "ii te ,se . ...M
7c from line 6) X W sy 117,480­
Section B. Total Support
Calendar year (or fiscal yr beginning in) * (a) 2005 (b) 2006 (c) 2007 (Q) 2008 (5) 2009 (9 Total
9 Amountsfromline6 . 30,994. 27,032. 28,121. 19,879. 11,454. 117,480.
10a Gross income from interest,
dividends, payments received
on securities loans, rents,
royalties and income form
Slmllalsoufces 1,525. 2,596. 2,647. 1,792. 990. 9,550.
b Unrelated business taxable
income (less section 511
taxes) from businesses
acquired after June 30, 1975
cAddlines10aand10b .. 1,525. 2,596. 2,647. 1,792. 990. 9,550.
11 Net income from unrelated business
activities not included inline 10b,
whether or not the business is
regularly carried on .
12 Other income. Do not include
gain or loss from the sale of
capital assets (Explain in
Part IV.)
13 Total support. (eaainse, ioe ii,ena iz) 127 , 030 .
organization, check this box and stop here . * U
Section C. Computation of Public Support Percentage
14 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)
16
Public
support
percentage
2008
Schedule
Ill,column
line 15
15 Public
support
percentage
for 2009from
(line 8,
column
(f) dividedA,byPart
line 13,
(f))16
1593
* 92. 26
. 48%
%
C4-nOnAn-u
IN f*nnAnnn*a&:nn nf
Jiibtlvll
IJ. UUIIIHULCEIUII
UIlnnunefrvunn*
lllvwatlllvllsIna-Aryan
lllvvlllvDfgvnnn-u*ar1rg
I bl vvllmuql,
18
Investment
income
percentage
from
2008
Schedule
A,byPart
lll,column
line 17
6 7. 74
17 Investment
income
percentage
for 2009 (line
10c,
column
(f) divided
line 13,
(f))18
* 17
. 52%
%
19a 33-1/3 support tests - 2009. If 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 qualifies as a publicly supported organization * lil
b 33-1/3 support tests - 2008. If the organization did not check a box on line 14 or 19a, and line 16 is more than 33-1/3%, and line 18
20 Private
foundation.
If the organization
didand
notstop
check
a box
line 14, 19a,qualifies
or 19b, as
check
this boxsupported
and see instructions
is not more
than 33-1/3%,
check this ox
here.
Theonorganization
a publicly
organization* * H
BAA TEE/10403 02/is/io Schedule A (Form 990 or 990-EZ) 2009