Form 990 Ez - Short Form Return Of Organization Exempt From Income Tax 2012 Page 4
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44
Form 990-EZ (2012)
Page
Yes No
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition
46
to candidates for public office? If “Yes,” complete Schedule C, Part I .
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46
Part VI
Section 501(c)(3) organizations only
All section 501(c)(3) organizations must answer questions 47–49b and 52, and complete the tables for lines
50 and 51
Check if the organization used Schedule O to respond to any question in this Part VI
. . . . . . . . .
Yes No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax
year? If “Yes,” complete Schedule C, Part II
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47
48
48
Is the organization a school as described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
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49 a Did the organization make any transfers to an exempt non-charitable related organization? .
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49a
b If “Yes,” was the related organization a section 527 organization? .
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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.”
(d) Health benefits,
(b) Average
(c) Reportable
(a) Name and title of each employee
contributions to employee
(e) Estimated amount of
hours per week
compensation
paid more than $100,000
benefit plans, and deferred
other compensation
devoted to position
(Forms W-2/1099-MISC)
compensation
None
f
Total number of other employees paid over $100,000
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0
▶
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
None
d Total number of other independent contractors each receiving over $100,000
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0
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Did the organization complete Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1)
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nonexempt charitable trusts must attach a completed Schedule A .
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Yes
No
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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.
Sign
Signature of officer
Date
Here
Michael Kenyon, CFO
Type or print name and title
Preparer's signature
Date
PTIN
Print/Type preparer’s name
Paid
Check
if
self-employed
Preparer
Use Only
Firm’s name
Firm's EIN
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Firm's address
Phone no.
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May the IRS discuss this return with the preparer shown above? See instructions
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Yes
No
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990-EZ
Form
(2012)
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