Form

990-EZ
use IRS label or print or type. See Specific Instructions.

Department of the Treasury Internal Revenue Service

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.

Short Form Return of Organization Exempt From Income Tax

OMB No. 1545-1150

2009
Open to Public Inspection
, 20

A For the 2009 calendar year, or tax year beginning C Name of organization B Check if applicable: Please
Address change Name change Initial return Terminated Amended return Application pending

, 2009, and ending

D Employer identification number

Number and street (or P.O. box, if mail is not delivered to street address) City or town, state or country, and ZIP + 4

F Group Exemption Number G Accounting Method: Other (specify) Cash Accrual

Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-EZ). I Website: J Tax-exempt status (check only one)

501(c) (

(insert no.)

4947(a)(1) or

527

H Check if the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF).

if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000. A K Check 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.)
. . . . . . . . 1 2 3 4

Net Assets

19 20 Other changes in net assets or fund balances (attach explanation) . . . . . . . . . . 21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . 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. (A) Beginning of year (B) End of year (See the instructions for Part II.) 22 22 Cash, savings, and investments . . . . . . . . . . . . . . . . . 23 23 Land and buildings . . . . . . . . . . . . . . . . . . . . . . 24 24 Other assets (describe ) 25 Total assets . . . . . . . . . . . . . . . . . . . . . . . . 25 26 Total liabilities (describe 26 ) Net assets or fund balances (line 27 of column (B) must agree with line 21) . . 27 27 20 21
Cat. No. 10642I Form

Contributions, gifts, grants, and similar amounts received . . . . . . . . . . . Program service revenue including government fees and contracts . . . . . . . Membership dues and assessments . . . . . . . . . . . . . . . . . . Investment income . . . . . . . . . . . . . . . . . . . . . . . 5a Gross amount from sale of assets other than inventory . . . . 5b Less: cost or other basis and sales expenses . . . . . . . . Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . Special events and activities (complete applicable parts of Schedule G). If any amount is from gaming, check here Gross revenue (not including $ of contributions 6a reported on line 1) . . . . . . . . . . . . . . . . . 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) . . 7a 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) . . . . . 8 Other revenue (describe 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 . . . . . . . . . . . . 10 Grants and similar amounts paid (attach schedule) . . . . . . . . . . . . . 11 Benefits paid to or for members . . . . . . . . . . . . . . . . . . . 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . 13 Professional fees and other payments to independent contractors . . . . . . . . 14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . 15 Printing, publications, postage, and shipping . . . . . . . . . . . . . . . 16 Other expenses (describe 17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . . . . . 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree end-of-year figure reported on prior years return) . . . . . . . . . . . . .

Revenue

1 2 3 4 5a b c 6 a

5c

6c

. . . . . . . .

.
)

. . . . . .
)

. . . with . .

7c 8 9 10 11 12 13 14 15 16 17 18

Expenses

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

990-EZ

(2009)

Form 990-EZ (2009)

Page

Part III

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

Expenses (Required for section

What is the organizations primary exempt purpose? Describe what was achieved in carrying out the organizations 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. 28

(Grants $ 29

) If this amount includes foreign grants, check here .

28a

(Grants $ 30

) If this amount includes foreign grants, check here .

29a

30a (Grants $ ) If this amount includes foreign grants, check here . . . . 31 Other program services (attach schedule) . . . . . . . . . . . . . . . . . . . . . 31a (Grants $ ) If this amount includes foreign grants, check here . . . . 32 Total program service expenses (add lines 28a through 31a) . . . . . . . . . . . . . 32 List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See the instructions for Part IV.) 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

Part V
33 34 35 a

Other Information (Note the statement requirements in the instructions for Part V.) Yes No

Did the organization engage in any activity not previously reported to the IRS? If Yes, attach a detailed description of each activity . . . . . . . . . . . . . . . . . . . . . . . . . . . Were any changes made to the organizing or governing documents? If Yes, attach a conformed copy of the changes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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. 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? . . . . . . . . . . . . . . . . .

33 34

b If Yes, has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . 37a 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? . . . . . . . . . . . . . . . . . . 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? . . 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 40a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: ; section 4912 ; section 4955 section 4911 Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit b 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 . . . . . . . . . . . . . . . . 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. . . . . . . . . . . . . . . . . . . . . . List the states with which a copy of this return is filed. 41 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)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 43 At any time during the calendar year, did the organization maintain an office outside of the U.S.? . . If Yes, enter the name of the foreign country: Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041Check here and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . . . . . . 43 c

35a 35b 36 37b 38a

40b

40e

Yes No
42b

42c . . .

Yes No
44 45 Did the organization maintain any donor advised funds? If Yes, Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 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 . . . . . . . . . . . . . . . .
Form

44 45

990-EZ

(2009)

Form 990-EZ (2009)

Page

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 4649b and complete the tables for lines 50 and 51. Yes No

46

46 47 47 Did the organization engage in lobbying activities? If Yes, complete Schedule C, Part II . . . . . . 48 48 Is the organization a school as described in section 170(b)(1)(A)(ii)? If Yes, complete Schedule E . . . . 49a 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

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 . . . . . . . . . . . . . .

f 51

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 (c) Compensation

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

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 Here

Signature of officer Type or print name and title

Date

Paid Preparers Use Only

Preparers signature Firms name (or yours if self-employed), address, and ZIP + 4

Date

Check if selfemployed EIN

Preparer's identifying number (See instructions)

Phone no.

May the IRS discuss this return with the preparer shown above? See instructions

Form 990-EZ (2009)

Yes

No