Part I

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) nonexempt charitable trust

Department of the Treasury

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

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

Name of organization D Employer identification number Please

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) E State registration number

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

G Type of organization—©

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

exemption number (GEN) ©

H(a) 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 an organization covered by a group ruling? Yes No

Check here © 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 it received

a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return.

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

Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions on pages 9–14.)

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

a Direct public support 1a

b Indirect public support 1b

c Government contributions (grants) 1c

1d

d Total (add lines 1a through 1c) (attach schedule of contributors)

2 Program service revenue including government fees and contracts (from Part VII, line 93) 2

3 Membership dues and assessments 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) (subtract line 6b from line 6a) 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 events and activities (attach schedule)

Gross revenue (not including $ of

contributions reported on line 1a)

a

9a

b Less: direct expenses other than fundraising expenses 9b

c Net income or (loss) from special events (subtract line 9b from line 9a) 9c

10a Gross sales of inventory, less returns and allowances 10a

b Less: cost of goods sold 10b

c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 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)) 13

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

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

Expenses

16 Payments to affiliates (attach schedule) 16

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 73, 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 (1995)

This Form is

Open to Public

Inspection

A

C

Room/suite

Check © if exemption application

is pending

F

(b)

(c)

K

Cash Accrual

Other (specify) ©

B Check if:

Initial return

Final return

Amended return

(required also for

State reporting)

Change of address

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

J Accounting method:

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

(cash $ noncash $ )
Form 990 (1995) 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 (4)

organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others. (See instructions on page 14.)

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 (attach schedule)

24 Benefits paid to or for members (attach schedule)

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

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

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 on page 17.)

Program Service

Expenses What is the organization’s primary exempt purpose? ©

(Grants and allocations $ )

Other program services (attach schedule)

Total of Program Service Expenses (should equal line 44, column (B), Program services) ©

(Required for 501(c)(3) and

(4) orgs., and 4947(a)(1)

trusts; but optional for

others.)

Part III

Part II

If “Yes,” enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services $ ;

Yes No

22

23

24

25

26

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43a

44

43b

43c

43d

43e

Reporting of Joint Costs.—Did you report in column (B) (Program services) any joint costs from a combined

educational campaign and fundraising solicitation? ©

(cash $ noncash $ )

All organizations must describe their exempt purpose achievements. State the number of clients served,

publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) organizations

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

(iii) the amount allocated to Management and general $ ; and (iv) the amount allocated to Fundraising $

a

b

c

d

e

f

(Grants and allocations $ )

(Grants and allocations $ )

(Grants and allocations $ )

(Grants and allocations $ )
Form 990 (1995) Page 3

Balance Sheets (See instructions on pages 17-19.)

(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—non-interest-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 from officers, directors, trustees, and key employees

(attach schedule) 50

51a

51a Other notes and loans receivable (attach

schedule)

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

57b 57c

Less: accumulated depreciation (attach

schedule)

b

58 Other assets (describe © ) 58

59 Total assets (add lines 45 through 58) (must equal line 74) 59

Liabilities

60 Accounts payable and accrued expenses 60

61 Grants payable 61

62 Deferred revenue 62

63

Loans from officers, directors, trustees, and key employees (attach

schedule)

63

64a Tax-exempt bond liabilities (attach schedule) 64a

65 Other liabilities (describe © ) 65

66 Total liabilities (add lines 60 through 65) 66

Part IV

b Mortgages and other notes payable (attach schedule) 64b

Net Assets or Fund Balances Organizations that do not follow SFAS 117, check here ©

67 Unrestricted 67

68 Temporarily restricted 68

69 Permanently restricted 69

70 Capital stock, trust principal, or current funds 70

71 Paid-in or capital surplus, or land, bldg., and equipment fund 71

72 Retained earnings, accumulated income, endowment, or other funds 72

73

73 Total net assets or fund balances (add lines 67 through 69 OR lines

70 through 72; column (A) must equal line 19 and column (B) must

equal line 21)

74 Total liabilities and net assets/fund balances (add lines 66 and 73) 74

and

Organizations that follow SFAS 117, check here © and complete lines

67 through 69 and lines 73 and 74.

complete lines 70 through 74.
Form 990 (1995) Page 4

List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see instructions

on page 19.)

(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

(A) Name and address

Yes No

Part V

Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your

organization and all related organizations, of which more than $10,000 was provided by the related organizations? ©

If “Yes,” attach schedule—see instructions on page 20.

Reconciliation of Revenue per Audited

Financial Statements with Revenue per

Return

a

b

c

d

e

(1)

(2)

(3)

Reconciliation of Expenses per Audited

Financial Statements with Expenses per

Return

(4)

(1)

(2)

a

b

c

d

e

(1)

(2)

(3)

(4)

(1)

(2)

Part IV-A Part IV-B

75

Total revenue, gains, and other support

per audited financial statements ©

Amounts included on line a but not on

line 12, Form 990:

Net unrealized gains

on investments

Donated services

and use of facilities

Recoveries of prior

year grants

Other (specify):

Add amounts on lines (1) through (4) ©

Line a minus line b ©

Amounts included on line 12,

Form 990 but not on line a:

Investment expenses

not included on line

6b, Form 990

Other (specify):

Add amounts on lines (1) and (2) ©

Total revenue per line 12, Form 990

(line c plus line d) ©

a

b

c

d

e

$

$

$

$

$

$

Total expenses and losses per

audited financial statements ©

Amounts included on line a but not

on line 17, Form 990:

Donated services

and use of facilities

Prior year adjustments

reported on line 20,

Form 990

Losses reported on

line 20, Form 990

Other (specify):

Add amounts on lines (1) through (4)©

Line a minus line b ©

Amounts included on line 17,

Form 990 but not on line a:

Investment expenses

not included on line

6b, Form 990

Other (specify):

Add amounts on lines (1) and (2) ©

Total expenses per line 17, Form 990

(line c plus line d) ©

$

$

$

$

$

$

a

b

c

d

e
Form 990 (1995) Page 5

Other Information (See instructions on pages 20–23.)

76

Did the organization engage in any activity not previously reported to the IRS? If “Yes,” attach a detailed

description of each activity

76

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

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

78a

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

this return?

78b

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

year?

b

At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or

partnership? If “Yes,” complete Part IX

79

79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If “Yes,” attach

a statement

Is the organization 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? 

80a

80a

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

and check whether it is exempt OR nonexempt.

b

81a

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

instructions for line 81

81b Did the organization file Form 1120-POL, U.S. Income Tax Return for Certain Political Organizations, for

this year?

b

Did the organization 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 the organization comply with the public inspection requirements for returns and exemption applications? 83a

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

If “Yes,” did the organization include with every solicitation an express statement that such contributions

or gifts were not tax deductible?

b

84b

85 Section 501(c)(4), (5), or (6) organizations.—a Were substantially all dues nondeductible by members? 85a

b Did the organization make only in-house lobbying expenditures of $2,000 or less?

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

b Gross receipts, included on line 12, for public use of club facilities

87 Section 501(c)(12) organizations.—Enter: a Gross income from members or shareholders 87a

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

against amounts due or received from them.)

b

87b

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

88

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

89

88

90

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

Located at © 

Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041, U.S. Income Tax Return for Estates

and Trusts.—Check here ©

92

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

( )

Part VI Yes No

85b

c Dues, assessments, and similar amounts from members 85c

d Section 162(e) lobbying and political expenditures 85d

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e

f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f

g Does the organization elect to pay the section 6033(e) tax on the amount in 85f?

h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 85f to its

reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following

tax year?

85g

85h

86a

86b

If “Yes” was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization

received a waiver for proxy tax owed for the prior year.

a Initiation fees and capital contributions included on line 12

ZIP code ©

b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b
Form 990 (1995) Page 6

Analysis of Income-Producing Activities (See instructions on pages 23–24.)

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

Related or

exempt function

income

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

Fees and contracts 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:

debt-financed property

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 or (loss) from special 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 the organization’s exempt purposes (other than by providing funds for such purposes). (See instructions on page 24.)

Line No.

Ä

Information Regarding Taxable Subsidiaries (Complete this Part if the “Yes” box on line 88 is checked.)

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. (See Specific Instructions, page 9.)

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 EIN ©

yours if self-employed)

and address

Part IX

Part VIII

Part VII

©

©

©

Date

ZIP code ©

Preparer’s social security no.

a

b

g

Printed on recycled paper

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