Form 990-Ez - Short Form Return Of Organization Exempt From Income Tax Page 4

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Form 990-EZ (2010)

Page

Yes No

Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)?

a Did the organization receive any payment from or engage in any transaction with a controlled entity within the

meaning of section 512(b)(13)? If “Yes,” Form 990 and Schedule R may need to be completed instead of

Form 990-EZ (see instructions) .

45a

Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition

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

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 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

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

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

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

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.”

(b) Title and average

(d) Contributions to

(e) Expense

(a) Name and address of each employee paid more

employee benefit plans &

hours per week

account and

deferred compensation

than $100,000

devoted to position

other allowances

Total number of other employees paid over $100,000

▶

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

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

▶

Did the organization complete Schedule A? Note: All section 501(c)(3) organizations and 4947(a)(1)

nonexempt charitable trusts must attach a completed Schedule A .

Yes

▶

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

Type or print name and title

Preparer's signature

Date

PTIN

Print/Type preparer’s name

Paid

Check