D Employer identification number

E State registration number

Check © if exemption

application is pending

F

Type of organization— © Exempt under section 501(c)( ) § (insert number) OR © section 4947(a)(1) nonexempt charitable trust

Enter the organization’s 1995 gross receipts (add back lines 5b, 6b, and 7b, to line 9) © $

Short Form 

Return of Organization Exempt From Income Tax

OMB No. 1545-1150

Form 990-EZ Under section 501(c) of the Internal Revenue Code (except black lung benefit trust or

private foundation) or section 4947(a)(1) nonexempt charitable trust

Department of the Treasury

Internal Revenue Service

A For the 1995 calendar year, OR tax year beginning , 1995, and ending , 19

Please Name of organization

use IRS

label or

print or

type.

See

Specific

Instructions.

Number and street (or P.O. box, if mail is not delivered to street address)

City, town or post office, state, and ZIP code

Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions on pages 9–13.)

1 Contributions, gifts, grants, and similar amounts received (attach schedule) 1

2 Program service revenue including government fees and contracts 2

3 Membership dues and assessments 3

4 Investment income 4

5a Gross amount from sale of assets other than inventory 5a

b Less: cost or other basis and sales expenses 5b

c Gain or (loss) from sale of assets other than inventory (line 5a less line 5b) (attach schedule) 5c

6 Special events and activities (attach schedule):

a Gross revenue (not including $ of contributions

Revenue

reported on line 1) 6a

b 6b

c Net income or (loss) from special events and activities (line 6a less line 6b) 6c

7a Gross sales of inventory, less returns and allowances 7a

b Less: cost of goods sold 7b

c Gross profit or (loss) from sales of inventory (line 7a less line 7b) 7c

8 Other revenue (describe © ) 8

9 Total revenue (add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8) © 9

10 Grants and similar amounts paid (attach schedule) 10

11 Benefits paid to or for members 11

12 Salaries, other compensation, and employee benefits 12

13 Professional fees and other payments to independent contractors 13

14 Occupancy, rent, utilities, and maintenance 14

Expenses

15 Printing, publications, postage, and shipping 15

16 Other expenses (describe © ) 16

17 Total expenses (add lines 10 through 16) © 17

18 Excess or (deficit) for the year (line 9 less line 17) 18

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) 19

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

Net Assets

21 Net assets or fund balances at end of year (combine lines 18 through 20) © 21

Balance Sheets—If Total assets on line 25, column (B) are $250,000 or more, file Form 990 instead of Form 990-EZ.

(A) Beginning of year (B) End of year

22 Cash, savings, and investments 22

23 Land and buildings 23

24 Other assets (describe © ) 24

25 Total assets 25

26 26

27 Net assets or fund balances (line 27 of column (B) must agree with line 21) 27

For Paperwork Reduction Act Notice, see page 1 of the separate instructions.

© For organizations with gross receipts less than $100,000 and total assets less

than $250,000 at the end of the year.

Check © 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, the organization should file a return without financial data. Some states require a complete return.

This Form is

Open to Public

Inspection

C

Part II

Part I

Room/suite

G Accounting method: Cash Accrual Other (specify) ©

I

J

If $100,000 or more, the organization must file Form 990 instead of Form 990-EZ.

Less: direct expenses other than fundraising expenses

K

Total liabilities (describe © )

Cat. No. 10642I Form 990-EZ (1995)

© The organization may have to use a copy of this return to satisfy state reporting requirements.

Note: Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts MUST attach a completed Schedule A (Form 990).

Enter four-digit group exemption

number (GEN)

H

B Check if:

Initial return

Final return

Amended return

(required also for

State reporting)

Change of address
Form 990-EZ (1995) Page 2

Statement of Program Service Accomplishments (See instructions on page 13.) Expenses

Describe what was achieved in carrying out the organization’s exempt purposes. Fully describe the

services provided, the number of persons benefited, or other relevant information for each program title.

28

(Grants $ )

29

(Grants $ )

30

(Grants $ )

31 Other program services (attach schedule) (Grants $ )

32 Total program service expenses (add lines 28a through 31a) ©

List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated. See instructions on page 13.)

(C) Compensation

(If not paid,

enter -0-.)

(D) Contributions to

employee benefit plans &

deferred compensation

(E) Expense

account and

other allowances

(B) Title and average

hours per week

devoted to position

(A) Name and address

Other Information (See instructions on pages 14–16.) 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 but not reported to the IRS?

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

If the organization had income from business activities, such as those reported on lines 2, 6, and 7 (among others), but NOT

reported on Form 990-T, attach a statement explaining your reason for not reporting the income on Form 990-T.

35

During the year covered by this return, did the organization have unrelated business gross income of $1,000 or more or incur

liability for the section 6033(e) tax on lobbying and political expenditures?

a

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

36 Was there a liquidation, dissolution, termination, or substantial contraction during the year? (If “Yes,” attach a statement.)

37a Enter amount of political expenditures, direct or indirect, as described in the instructions. © 37a

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

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 unpaid at the start of the period covered by this return?

b If “Yes,” attach the schedule specified in the line 38 instructions and enter the amount involved 38b

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

a Initiation fees and capital contributions included on line 9 39a

b Gross receipts, included on line 9, for public use of club facilities 39b

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

because of race, color, or religion? (If “Yes,” attach statement.)

c

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

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

Located at ©

Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041, U.S. Income Tax Return for Estates and Trusts.—Check here ©

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

42

42

Date

EIN ©

( )

Part V

Part IV

Part III

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.

(See Specific Instructions, page 8.)

Please

Sign

Here © Signature of officer Date Type or print name and title.

Preparer’s

signature

Check if

selfemployed ©

Paid

Preparer’s

Use Only

Firm’s name (or

yours if self-employed)

and address

©

©

©

(Required for 501(c)(3)

and (4) organizations

and 4947(a)(1) trusts;

optional for others.)

ZIP code ©

Preparer’s social security no.

ZIP code ©

Printed on recycled paper

What is the organization’s primary exempt purpose?

28a

29a

30a

31a

32

38a