Form 990-EZ

Department of the Treasury 

Internal Revenue Service

Short Form 

Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code 

(except black lung benefit trust or private foundation) 

© 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 less than $1,250,000 at the end of the year may use this form. 

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

OMB No. 1545-1150

2009

Open to Public 

Inspection 

A For the 2009 calendar year, or tax year beginning , 2009, and ending , 20 

B Check if applicable: 

Address change

Name change

Initial return

Terminated

Amended return

Application pending

Please 

use IRS 

label or 

print or 

type. 

See 

Specific 

Instructions.

C Name of organization 

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

City or town, state or country, and ZIP + 4 

D Employer identification number 

E Telephone number 

F Group Exemption 

Number ©

● Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach 

a completed Schedule A (Form 990 or 990-EZ). 

G Accounting Method: 

Other (specify) ©

Cash Accrual

H Check © if the organization is not 

required to attach Schedule B (Form 990, 

990-EZ, or 990-PF). 

I Website: ©

J Tax-exempt status (check only one) — 501(c) ( ) § (insert no.) 4947(a)(1) or 527 

K Check © 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 file a return, be sure to file 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 © $ 

Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I.) Revenue 

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

2 Program service revenue including government fees and contracts . . . . . . . . . 2 

3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . 3 

4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . 4 

5 a 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 (Subtract line 5b from line 5a) . . . . 5c 

6 Special events and activities (complete applicable parts of Schedule G). If any amount is from gaming, check here ©

a Gross revenue (not including $ of contributions 

reported on line 1) . . . . . . . . . . . . . . . . . 6a 

b Less: direct expenses other than fundraising expenses . . . . 6b 

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

7 a 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 (Subtract line 7b from line 7a) . . . . . . . 7c 

8 Other revenue (describe © ) 8 

9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 . . . . . . . . . . . . . © 9 

Expenses 

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 

15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . . . 15 

16 Other expenses (describe © ) 16 

17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . . . . . . © 17 

Net Assets 

18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 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 

21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . © 21 

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 II.) (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 Total liabilities (describe © ) 26 

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

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat. No. 10642I Form 990-EZ (2009) 
Form 990-EZ (2009) Page 2 

Part III Statement of Program Service Accomplishments (See the instructions for Part III.) 

What is the organization’s primary exempt purpose? 

Describe what was achieved in carrying out the organization’s 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) trusts; optional 

for others.) 

28 

(Grants $ ) If this amount includes foreign grants, check here . . . . © 28a 

29 

(Grants $ ) If this amount includes foreign grants, check here . . . . © 29a 

30 

(Grants $ ) If this amount includes foreign grants, check here . . . . © 30a 

31 Other program services (attach schedule) . . . . . . . . . . . . . . . . . . . . .

(Grants $ ) If this amount includes foreign grants, check here . . . . © 31a 

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

Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See the instructions for Part IV.) 

(a) Name and address 

(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 

Form 990-EZ (2009) 
Form 990-EZ (2009) Page 3 

Part V Other Information (Note the statement requirements in the instructions 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 

34 Were any changes made to the organizing or governing documents? If “Yes,” attach a conformed copy of

the changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 

35 If 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. 

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? . . . . . . . . . . . . . . . . . 35a 

b If “Yes,” has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . 35b 

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 . . . . . . . . . . . . . 36 

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

b Did the organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . . . 37b 

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? . . 38a 

b If “Yes,” complete Schedule L, Part II and enter the total 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 

40 a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: 

section 4911 © ; section 4912 © ; section 4955 ©

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 . . . . . . . . . . . . . . . . 40b 

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, and 4958 . . . . . . . . . . . . . . . . . . . . . . . ©

d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c 

reimbursed by the organization . . . . . . . . . . . . . . . . . ©

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 

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

42a The organization's books are in care of © Telephone no. ©

Located at © ZIP + 4 ©

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)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No 

42b 

If “Yes,” enter the name of the foreign country: ©

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.? . . . . 42c 

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 . . . . . . ©

and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . © 43 

Yes No 

44 Did the organization maintain any donor advised funds? If “Yes,” Form 990 must be completed instead of 

Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 

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 . . . . . . . . . . . . . . . . 45 

Form 990-EZ (2009) 
Form 990-EZ (2009) Page 4 

Part VI 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.

46 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to 

candidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . .

Yes No

46 

47 Did the organization engage in lobbying activities? If “Yes,” complete Schedule C, Part II . . . . . . 47 

48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . 48 

49 a Did the organization make any transfers to an exempt non-charitable related organization? . . . . . . 49a 

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.” 

(a) Name and address of each employee paid more 

than $100,000 

(b) Title and average 

hours per week 

devoted to position 

(c) Compensation (d) Contributions to 

employee benefit plans & 

deferred compensation 

(e) Expense 

account and 

other allowances 

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. 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 

d Total number of other independent contractors each receiving over $100,000 . . ©

Sign 

Here 

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. 

© Date 

© Type or print name and title

Paid 

Preparer’s 

Use Only 

Preparer’s 

signature © Date Check if 

selfemployed ©

Preparer's identifying number (See instructions)

Firm’s name (or 

yours if self-employed), 

address, and ZIP + 4 © EIN ©

Phone no. ©

May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . . . . © Yes No

 Form 990-EZ (2009) 

Signature of officer