Form 990-Ez - Return Of Organization Exempt From Income Tax - 2012 Page 3
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15Form 990-EZ (2012)
Page 3
Other Information (Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V ) Check if the organization used Schedule 0 to respond to any question in this Part V
.F
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a
detailed description of each activity in Schedule 0
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33
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy
of the amended documents if they reflect a change to the organization's name Otherwise, explain the change
on Schedule 0 (see instructions)
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34
No
35a Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others )?
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35a
No
b If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule 0 35b
c
Was the organization a section 501 (c)(4), 501 (c)(5), or 501(c)(6) organization subject to section 6033(e)
notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
No
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
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36
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions 0-
1 37a
b
Did the organization file Form 1120 -POL for this year?
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37b
No
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 tax year covered by this return?
38a
No
b If "Yes," complete Schedule L, Part II and enter the total amount involved
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38b
39
Section 501(c)(7) organizations Enter
a
Initiation fees and capital contributions included on line 9
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39a
b Gross receipts, included on line 9, for public use of club facilities
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39b
40a Section 501(c)(3) organizations Enter amount of tax imposed on the organization during the year under
section 49111111111
, section 4912 1111111
, section 4955 1111111
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 did it engage in an excess benefit transaction in a prior year that has not been
reported on any of its prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I
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40b
No
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
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d
Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax on line 40c reimbursed by the organization
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e All organizations At any time during the tax year, was the organization a party to a prohibited tax shelter
40e
No
transaction? If "Yes," complete Form 8886-T
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41
List the states with which a copy of this return is filed 1Pr
42a
The organization's books are in care ofd STEVE TONKIN
Telephone no lk- (720) 515-1177
Located ate 14154 W CORNELLAVE Denver, CO
ZIP +4
JPP
80228
b At any time during the calendar year, did the organization have an interest in or a signature or other authority
Yes
No
over a financial account in a foreign country (such as a bank account, securities account, or other financial
account) ?
42b
No
If "Yes," enter the name of the foreign country 0-
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 the U S ?
42c
No
If "Yes," enter the name of the foreign country 0-
43
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 -Check here
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and enter the amount of tax-exempt interest received or accrued during the tax year
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I 43
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990- EZ
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44a
N o
b
Did the organization operate one or more hospital facilities during the year? If "Yes,"Form 990 must be completed
instead of Form 990-EZ
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44b
N o
c
Did the organization receive any payments for indoor tanning services during the year? .
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44c
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No, "provIde an
explanation in Schedule 0
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44d
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)? .
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45a
No
45b 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)
45b
No
Form 990-EZ (2012)
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