OMB No. 1545-0047

Form 990 Return of Organization Exempt From Income Tax

Under section 501(c) of the Internal Revenue Code (except black lung benefit trust or private foundation) or section 4947(a)(1) charitable trust

Department of the Treasury

Internal Revenue Service Note: You may have to use a copy of this return to satisfy state reporting requirements.

For the calendar year 1991, or fiscal year beginning , 1991, and ending , 19

Name of organization C Employer identification number Please

use IRS

label or

print or

type. See

Specific

Instructions.

Number and street (or P.O. box no. if mail is not delivered to street address) D State registration number

City, town, or post office, state, and ZIP code If application for exemption is pending,

check here ©

E

Accounting method: Cash Accrual

Other (specify) ©

Check type of organization—Exempt under section © 501(c)( ) (insert number), G

OR © section 4947(a)(1) charitable trust

F

If either answer in H is “Yes,” enter four-digit group

exemption number (GEN) ©

H Is this a group return filed for affiliates? Yes No I

If “Yes,” enter the number of affiliates for which this return is filed: ©

Is this a separate return filed by a group affiliate? Yes No J If address changed, check box ©

K Check here © if your gross receipts are normally not more than $25,000. You do not have to file a completed return with IRS; but if you

received a Form 990 Package in the mail, you should file a return without financial data. Some states require a completed return.

Note: Form 990EZ may be used by organizations with gross receipts less than $100,000 and total assets less than $250,000 at end of year.

Section 501(c)(3) organizations and 4947(a)(1) trusts must also complete and attach Schedule A (Form 990).

Statement of Revenue, Expenses, and Changes in Net Assets or Fund Balances

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

a Direct public support 1a

b Indirect public support 1b

c Government grants 1c

d Total (add lines 1a through 1c) (attach schedule—see instructions) 1d

2 Program service revenue (from Part VII, line 93) 2

3 Membership dues and assessments (see instructions) 3

4 Interest on savings and temporary cash investments 4

5 Dividends and interest from securities 5

6a Gross rents 6a

b Less: rental expenses 6b

c Net rental income or (loss) 6c

7 Other investment income (describe © ) 7

(A) Securities (B) Other Gross amount from sale of assets other

than inventory 

8a

8a

Revenue

b Less: cost or other basis and sales expenses 8b

c Gain or (loss) (attach schedule) 8c

d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d

9 Special fundraising events and activities (attach schedule—see instructions):

Gross revenue (not including $ of contributions reported on line 1a) 

a

9a

b Less: direct expenses 9b

c Net income 9c

10a Gross sales less returns and allowances 10a

b Less: cost of goods sold 10b

c Gross profit or (loss) (attach schedule) 10c

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 Program services (from line 44, column (B)) (see instructions) 13

14 Management and general (from line 44, column (C)) (see instructions) 14

15 Fundraising (from line 44, column (D)) (see instructions) 15

16 Payments to affiliates (attach schedule—see instructions) 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 74, column (A)) 19

Net

Assets

20 Other changes in net assets or fund balances (attach explanation) 20

21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21

For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Cat. No. 11282Y Form 990 (1991)

This Form is

Open to Public

Inspection

A

B

Room/suite

Part I
Form 990 (1991) Page 2

Statement of

Functional Expenses

All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501(c)(3)

and (c)(4) organizations and 4947(a)(1) charitable trusts but optional for others. (See instructions.)

Do not include amounts reported on line

6b, 8b, 9b, 10b, or 16 of Part I.

(C) Management

and general

(B) Program

services (A) Total (D) Fundraising

22 Grants and allocations (attach schedule) 

23 Specific assistance to individuals

24 Benefits paid to or for members

25 Compensation of officers, directors, etc. 

26 Other salaries and wages 

27 Pension plan contributions 

28 Other employee benefits 

29 Payroll taxes 

30 Professional fundraising fees

31 Accounting fees 

32 Legal fees 

33 Supplies 

34 Telephone 

35 Postage and shipping 

36 Occupancy 

Expenses

37 Equipment rental and maintenance 

38 Printing and publications 

39 Travel 

40 Conferences, conventions, and meetings 

41 Interest 

42 Depreciation, depletion, etc. (attach schedule) 

43 Other expenses (itemize): a 

b

c

d

e

f

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 instructions.)

Expenses Describe what was achieved in carrying out your exempt purposes. Fully describe the services provided; the number

of persons benefited; or other relevant information for each program title. Section 501(c)(3) and (4) organizations

and section 4947(a)(1) charitable trusts must also enter the amount of grants and allocations to others.

a

(Grants and allocations $ )

b

c

d

e Other program services (attach schedule) (Grants and allocations $ )

f Total (add lines a through e) (should equal line 44, column (B)) ©

(Required for 501(c)(3)

and (4) organizations and

4947(a)(1) trusts; optional

for others.)

Part III

Part II

(Grants and allocations $ )

(Grants and allocations $ )

(Grants and allocations $ )
Form 990 (1991) Page 3

Balance Sheets

(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—noninterest-bearing 45

46 Savings and temporary cash investments 46

47a Accounts receivable 47a

b Less: allowance for doubtful accounts 47b 47c

48a Pledges receivable 48a

b Less: allowance for doubtful accounts 48b 48c

49 Grants receivable 49

50 Receivables due from officers, directors, trustees, and key employees

(attach schedule) 50

51a Other notes and loans receivable (attach schedule) 51a

b Less: allowance for doubtful accounts 51b 51c

52 Inventories for sale or use 52

53 Prepaid expenses and deferred charges 53

54 Investments—securities (attach schedule) 54

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

b Less: accumulated depreciation (attach schedule) 57b 57c

58 Other assets (describe © ) 58

59 Total assets (add lines 45 through 58) (must equal line 75) 59

Liabilities

60 Accounts payable and accrued expenses 60

61 Grants payable 61

62 Support and revenue designated for future periods (attach schedule) 62

63 63 Loans from officers, directors, trustees, and key employees (attach schedule)

64 Mortgages and other notes payable (attach schedule) 64

65 Other liabilities (describe © ) 65

66 Total liabilities (add lines 60 through 65) 66

Fund Balances or Net Assets

Organizations that use fund accounting, check here © and complete

lines 67 through 70 and lines 74 and 75 (see instructions).

67a Current unrestricted fund 67a

b Current restricted fund 67b

68 Land, buildings, and equipment fund 68

69 Endowment fund 69

70 Other funds (describe © ) 70

Organizations that do not use fund accounting, check here © and

complete lines 71 through 75 (see instructions).

71 Capital stock or trust principal 71

72 Paid-in or capital surplus 72

73 Retained earnings or accumulated income 73

74

74 Total fund balances or net assets (add lines 67a through 70 OR lines 71

through 73: column (A) must equal line 19 and column (B) must equal

line 21)

75 Total liabilities and fund balances/net assets (add lines 66 and 74) 75

Part IV

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 your return is complete and accurate and fully describes your organization’s programs

and accomplishments.
Form 990 (1991) Page 4

List of Officers, Directors, and Trustees (List each one even if not compensated. See instructions.)

(B) Title and average hours per

week devoted to position

(C) Compensation

(if not paid, enter

zero)

(D) Contributions to

employee benefit

plans

(E) Expense

account and other

allowances

(A) Name and address

Other Information

Yes No

76 Did you engage in any activity not previously reported to the Internal Revenue Service? 76

If “Yes,” attach a detailed description of each activity.

77 Were any changes made in the organizing or governing documents, but not reported to IRS? 77

If “Yes,” attach a conformed copy of the changes.

78a Did your organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a

b If “Yes,” have you filed a tax return on Form 990-T, Exempt Organization Business Income Tax Return, for this year? 78b

c At any time during the year, did you own a 50% or greater interest in a taxable corporation or partnership? 78c

If “Yes,” complete Part IX.

79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? (See instructions.) 79

If “Yes,” attach a statement as described in the instructions.

Are you 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? (See instructions.)

80a

80a

If “Yes,” enter the name of the organization ©

and check whether it is exempt OR nonexempt.

b

81a Enter amount of political expenditures, direct or indirect, as described in the instructions 81a

b Did you file Form 1120-POL, U.S. Income Tax Return for Certain Political Organizations, for this year? 81b

Did you 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 for reporting in Part III

b

82b

83a Did anyone request to see either your annual return or exemption application (or both)? 83a

b If “Yes,” did you comply as described in the instructions? (See General Instruction L.) 83b

84a Did you solicit any contributions or gifts that were not tax deductible? 84a

If “Yes,” did you include with every solicitation an express statement that such contributions or gifts were

not tax deductible? (See General Instruction M.) 

b

84b

Section 501(c)(5) or (6) organizations.—Did you spend any amounts in attempts to influence public opinion

about legislative matters or referendums? (See instructions and Regulations section 1.162-20(c).) 

85a

85a

b If “Yes,” enter the total amount spent for this purpose 85b

86 Section 501(c)(7) organizations.—Enter:

a Initiation fees and capital contributions included on line 12 86a

b Gross receipts, included on line 12, for public use of club facilities (See instructions.) 86b

Does the club’s governing instrument or any written policy statement provide for discrimination against any

person because of race, color, or religion? (See instructions.) 

c

86c

87 Section 501(c)(12) organizations.—Enter amount of:

a Gross income received from members or shareholders 87a

Gross income received from other sources (Do not net amounts due or paid to other

sources against amounts due or received from them.) 

b

87b

88 Public interest law firms.—Attach information described in the instructions.

89 List the states with which a copy of this return is filed ©

90 During this tax year did you maintain any part of your accounting / tax records on a computerized system? 90

91 The books are in care of © Telephone no. ©

Located at © ZIP code ©

92 Section 4947(a)(1) charitable trusts filing Form 990 in lieu of Form 1041, U.S. Fiduciary Income Tax Return, should check here ©

and enter the amount of tax-exempt interest received or accrued during the tax year © 92

( )

Part VI

Part V
Form 990 (1991) Page 5

Analysis of Income-Producing Activities

Excluded by section 512, 513, or 514 (e)

Related or exempt

function income

(See instructions.)

Unrelated business income Enter gross amounts unless otherwise

indicated. (c)

Exclusion code

(b)

Amount

(d)

Amount

(a)

Business code 93 Program service revenue:

(a)

(b)

(c)

(d)

(e)

(f)

(g) Fees 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:

(a) debt-financed property 

(b) not debt-financed property 

98 Net rental income or (loss) from personal property 

99 Other investment income 

100 Gain or (loss) from sales of assets other than inventory

101 Net income from special fundraising 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

Explain how each activity for which income is reported in column (e) of Part VII contributed importantly to the

accomplishment of your exempt purposes (other than by providing funds for such purposes). (See instructions.)

Line No.

Ä

Information Regarding Taxable Subsidiaries (Complete this Part if you answered “Yes” to question 78c.)

End-of-year

assets

Total

income

Nature of

business activities

Percentage of

ownership interest

Name, address, and employer identification

number of corporation or partnership

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 © Signature of officer Date Title

Preparer’s Date

signature Check if Paid self-employed ©

Preparer’s

Use Only Firm’s name (or ZIP code

yours if self-employed)

and address

Part IX

Part VIII

Part VII

©

©

©