Short Form Return of Organization Exempt From Income Tax

Transcription

1 Form Department of the Treasury Internal Revenue Service A B G I J K L 0-EZ For the 201 calendar year, or tax year eginning Check if applicale: C Name of organization Address change Name change Initial return Terminated Amended return Application pending Accounting Method: Wesite: Do not enter Social Security numers on this form as it may e made pulic. Information aout Form 0-EZ and its instructions is at Numer and street (or P.O. ox, if mail is not delivered to street address) City or town, state or province, country, and ZIP or foreign postal code Tax-exempt status (check only one) 501(c)() 501(c) ( ) (insert no.) 447(a)(1) or Form of organization: Corporation Trust Association Other c d 7a c Short Form Return of Organization Exempt From Income Tax Under section 501(c), 527, or 447(a)(1) of the Internal Revenue Code (except private foundations), and ending Gaming and fundraising events Gross income from gaming (attach Schedule G if greater than $15,000)... Gross income from fundraising events (not including$ from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contriutions exceeds $15,000) Less: direct expenses from gaming and fundraising events a of contriutions Room/suite Gross sales of inventory, less returns and allowances a Less: cost of goods sold Gross profit or (loss) from sales of inventory (Sutract line 7 from line 7a) Other revenue (descrie in Schedule O)... Total revenue. Add lines 1, 2,, 4, 5c, 6d, 7c, and Grants and similar amounts paid (list in Schedule O) Benefits paid to or for memers Salaries, other compensation, and employee enefits Professional fees and other payments to independent contractors Occupancy, rent, utilities, and maintenance Printing, pulications, postage, and shipping Other expenses (descrie in Schedule O).. Total expenses. Add lines 10 through Excess or (deficit) for the year (Sutract line 17 from line ) Net assets or fund alances at eginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year's return) Other changes in net assets or fund alances (explain in Schedule O) Net assets or fund alances at end of year. Comine lines 1 through For Paperwork Reduction Act tice, see the separate instructions. 6 6c Telephone numer 6d 7c OMB F Group Exemption Numer H Check if the organization is not required to attach Schedule B (Form 0, 0-EZ, or 0-PF). Add lines 5, 6c, and 7, to line to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) elow) are $500,000 or more, file Form 0 instead of Form 0-EZ $ Part I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I) Check if the organization used Schedule O to respond to any question in this Part I Contriutions, gifts, grants, and similar amounts received Program service revenue including government fees and contracts Memership dues and assessments Investment income a Gross amount from sale of assets other than inventory a Less: cost or other asis and sales expenses c Gain or (loss) from sale of assets other than inventory (Sutract line 5 from line 5a) c 6 a Net Assets Expenses Revenue LEINGTON FAIRNESS, INC. WEST VINE ST. SUITE 210 LEINGTON KY Cash Accrual Other (specify) Net income or (loss) from gaming and fundraising events (add lines 6a and 6 and sutract line 6c) D E 4,74 26, Open to Pulic Inspection Employer identification numer ,26 1, ,10 41, ,74 1,675 27,50 2,61 56,41

2 22 Cash, savings, and investments Land and uildings Other assets (descrie in Schedule O) Total assets Total liailities (descrie in Schedule O) Net assets or fund alances (line 27 of column (B) must agree with line 21) Part III Statement of Program Service Accomplishments (see the instructions for Part III) Expenses Check if the organization used Schedule O to respond to any question in this Part III.... (Required for section What is the organization's primary exempt purpose? 501(c)() and 501(c)(4) SEE SCHEDULE O organizations and section Descrie the organization's program service accomplishments for each of its three largest program services, 447(a)(1) trusts; optional as measured y expenses. In a clear and concise manner, descrie the services provided, the numer of for others.) persons enefited, and other relevant information for each program title. 2.. PROMOTING PERSONS AND..... ORGANIZATIONS IN..... THE..... COMMUNITY WHO..... HAVE WORKED HARD IN.... THE PAST YEAR FOR GAY, LESBIAN, BISEUAL AND TRANSGENDER (GLBT) EQUALITY THROUGH THE ANNUAL LEINGTON FAIRNESS AWARDS AND OTHER EVENTS (Grants$ ) If this amount includes foreign grants, check here LEINGTON FAIRNESS, INC HOLDS TRAINING SEMINARS REGARDING GLBT ISSUES WITH VARIOUS GROUPS, INCLUDING COLLEGE INSTRUCTORS, PROFESSIONAL GROUPS AND INDIVIDUALS (Grants $ ) If this amount includes foreign grants, check here (Grants$ ) If this amount includes foreign grants, check here a 1 Other program services (descrie in Schedule O).. (Grants $ ) If this amount includes foreign grants, check here a 2 Total program service expenses (add lines 2a through 1a) Part IV List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated see the instructions for Part IV) Check if the organization used Schedule O to respond to any question in this Part IV () Average (c) Reportale (d) Heath enefits, (a) Name and title hours per week compensation contriutions to employee (e) Estimated amount of devoted to position (Forms W-2/10-MISC) enefit plans, and other compensation (if not paid, enter -0-) deferred compensation Part II LEINGTON FAIRNESS, INC Balance Sheets (see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part II (A) Beginning of year (B) End of year 2a 2a Page 2 2,61 56,41 2,61 56, ,61 56,41 10,541 10,541 CRAIG CAMMACK TREASURER DAVID CARPENTER SARABETH BROWNROBIE ROY HARRISON CHAIRPERSON DR. MATTHEW SAVAGE ANDREW TAN BELINDA TARPLEY VICE CHAIR SARA CHRISTENSEN DAVID CUPPS ZACHARY MYERS BRIAN HAWKINS JOSH MERS

3 22 Cash, savings, and investments Land and uildings Other assets (descrie in Schedule O) Total assets Total liailities (descrie in Schedule O) Net assets or fund alances (line 27 of column (B) must agree with line 21) Part III Statement of Program Service Accomplishments (see the instructions for Part III) Expenses Check if the organization used Schedule O to respond to any question in this Part III.... (Required for section What is the organization's primary exempt purpose? 501(c)() and 501(c)(4) organizations and section Descrie the organization's program service accomplishments for each of its three largest program services, 447(a)(1) trusts; optional as measured y expenses. In a clear and concise manner, descrie the services provided, the numer of for others.) persons enefited, and other relevant information for each program title. 2 Part II LEINGTON FAIRNESS, INC Balance Sheets (see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part II (A) Beginning of year (B) End of year (Grants$ ) If this amount includes foreign grants, check here (Grants $ ) If this amount includes foreign grants, check here (Grants$ ) If this amount includes foreign grants, check here a 1 Other program services (descrie in Schedule O).. (Grants $ ) If this amount includes foreign grants, check here a 2 Total program service expenses (add lines 2a through 1a) Part IV List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated see the instructions for Part IV) Check if the organization used Schedule O to respond to any question in this Part IV () Average (c) Reportale (d) Heath enefits, (a) Name and title hours per week compensation contriutions to employee (e) Estimated amount of devoted to position (Forms W-2/10-MISC) enefit plans, and other compensation (if not paid, enter -0-) deferred compensation 0 2a 2a Page AMANDA PARSONS SECRETARY SHERI STREETER

4 Part V LEINGTON FAIRNESS, INC Other Information (te the Schedule A and personal enefit contract statement requirements in the instructions for Part V) Check if the organization used Schedule O to respond to any question in this Part V Did the organization engage in any significant activity not previously reported to the IRS? If, provide a detailed description of each activity in Schedule O Were any significant changes made to the organizing or governing documents? If, attach a conformed copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the change on Schedule O (see instructions) a Did the organization have unrelated usiness gross income of $1,000 or more during the year from usiness activities (such as those reported on lines 2, 6a, and 7a, among others)? a If, to line 5a, has the organization filed a Form 0-T for the year? If, provide an explanation in Schedule O c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization suject to section 60(e) notice, reporting, and proxy tax requirements during the year? If, complete Schedule C, Part III c 6 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If, complete applicale parts of Schedule N a Enter amount of political expenditures, direct or indirect, as descried in the instructions.... 7a Did the organization file Form 20-POL for this year? a Did the organization orrow from, or make any loans to, any officer, director, trustee, or key employeeor were any such loans made in a prior year and still outstanding at the end of the tax year covered y this return? a If, complete Schedule L, Part II and enter the total amount involved Section 501(c)(7) organizations. Enter: a Initiation fees and capital contriutions included on line a Gross receipts, included on line, for pulic use of clu facilities a Section 501(c)() organizations. Enter amount of tax imposed on the organization during the year under: section 4 ; section 412 ; section 455 Section 501(c)() and 501(c)(4) organizations. Did the organization engage in any section 45 excess enefit transaction during the year, or did it engage in an excess enefit transaction in a prior year that has not een reported on any of its prior Forms 0 or 0-EZ? If, complete Schedule L, Part I c Section 501(c)() and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 412, 455, and d Section 501(c)() and 501(c)(4) organizations. Enter amount of tax on line 40c reimursed y the organization.. e All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter transaction? If, complete Form 6-T List the states with which a copy of this return is filed KY 40e 42a The organization's ooks are in care of Telephone no W. MAIN STREET Located at LEINGTON KY.. ZIP 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 ank account, securities account, or other financial account)? If "," enter the name of the foreign country: See the instructions for exceptions and filing requirements for Form TD F , 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.? c If "," enter the name of the foreign country: 4 Section 447(a)(1) nonexempt charitale trusts filing Form 0-EZ in lieu of Form 1041 Check here and enter the amount of tax-exempt interest received or accrued during the tax year a Did the organization maintain any donor advised funds during the year? If "," Form 0 must e completed instead of Form 0-EZ a Did the organization operate one or more hospital facilities during the year? If "," Form 0 must e completed instead of Form 0-EZ c Did the organization receive any payments for indoor tanning services during the year? c d If "" to line 44c, has the organization filed a Form 720 to report these payments? If "," provide an explanation in Schedule O d 45a Did the organization have a controlled entity within the meaning of section 512()(1)? Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512()(1)? If "," Form 0 and Schedule R may need to e completed instead of Form 0-EZ (see instructions) a 45 Page CRAIG CAMMACK

5 46 Did the organization engage, directly or indirectly, in political campaign activities on ehalf of or in opposition to candidates for pulic office? If, complete Schedule C, Part I Part VI 4 4a 50 Section 501(c)() organizations only All section 501(c)() organizations must answer questions 47 4 and 52, and complete the tales for lines 50 and 51. Check if the organization used Schedule O to respond to any question in this Part VI Did the organization engage in loying activities or have a section 501(h) election in effect during the tax year? If, complete Schedule C, Part II Is the organization a school as descried in section 170()(1)(A)(ii)? If, complete Schedule E Did the organization make any transfers to an exempt non-charitale related organization? If, was the related organization a section 527 organization? Complete this tale 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 ne. NONE LEINGTON FAIRNESS, INC (a) Name and title of each employee a 4 Page 4 () Average (c) Reportale (d) Health enefits, hours per week compensation (e) Estimated amount of contriutions to employee devoted to position (Forms W-2/10-MISC) enefit plans, and other compensation deferred compensation f 51 Total numer of other employees paid over $100, Complete this tale 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 ne. NONE (a) Name and usiness address of each independent contractor () Type of service (c) Compensation d Total numer of other independent contractors each receiving over $100, Did the organization complete Schedule A? te. All section 501(c)() organizations and 447(a)(1) nonexempt charitale trusts must attach a completed Schedule A Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the est of my knowledge and elief, it is true, correct, and complete. Declaration of preparer (other than officer) is ased on all information of which preparer has any knowledge. Sign Here Paid Preparer Use Only Signature of officer Type or print name and title Print/Type preparer's name Firm's name Firm's address CRAIG CAMMACK Preparer's signature Date TREASURER Date Firm's EIN Phone no. Check if self-employed DONNA J. SMITH, CPA 05/27/14 P DONNA J. SMITH & COMPANY, PLLC 1 WALTON AVE LEINGTON, KY 4050 May the IRS discuss this return with the preparer shown aove? See instructions PTIN

6 SCHEDULE A (Form 0 or 0-EZ) Department of the Treasury Internal Revenue Service Name of the organization Part I (i) Name of supported organization Pulic Charity Status and Pulic Support Complete if the organization is a section 501(c)() organization or a section 447(a)(1) nonexempt charitale trust. Attach to Form 0 or Form 0-EZ. Information aout Schedule A (Form 0 or 0-EZ) and its instructions is at OMB Employer identification numer Reason for Pulic Charity Status (All organizations must complete this part.) See instructions. The organization is not a private foundation ecause it is: (For lines 1 through, check only one ox.) Open to Pulic Inspection A church, convention of churches, or association of churches descried in section 170()(1)(A)(i). A school descried in section 170()(1)(A)(ii). (Attach Schedule E.) A hospital or a cooperative hospital service organization descried in section 170()(1)(A)(iii). A medical research organization operated in conjunction with a hospital descried in section 170()(1)(A)(iii). Enter the hospital's name, city, and state: An organization operated for the enefit of a college or university owned or operated y a governmental unit descried in section 170()(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit descried in section 170()(1)(A)(v). An organization that normally receives a sustantial part of its support from a governmental unit or from the general pulic descried in section 170()(1)(A)(vi). (Complete Part II.) A community trust descried in section 170()(1)(A)(vi). (Complete Part II.) An organization that normally receives: (1) more than 1/% of its support from contriutions, memership fees, and gross receipts from activities related to its exempt functions suject to certain exceptions, and (2) no more than 1/% of its support from gross investment income and unrelated usiness taxale income (less section 5 tax) from usinesses acquired y the organization after June 0, 175. See section 50(a)(2). (Complete Part III.) 10 e f g h (A) LEINGTON FAIRNESS, INC An organization organized and operated exclusively to test for pulic safety. See section 50(a)(4). An organization organized and operated exclusively for the enefit of, to perform the functions of, or to carry out the purposes of one or more pulicly supported organizations descried in section 50(a)(1) or section 50(a)(2). See section 50(a)(). Check the ox that descries the type of supporting organization and complete lines e through h. a Type I Type II c Type III Functionally integrated d Type III n-functionally integrated By checking this ox, I certify that the organization is not controlled directly or indirectly y one or more disqualified persons other than foundation managers and other than one or more pulicly supported organizations descried in section 50(a)(1) or section 50(a)(2). If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this ox Since August 17, 2006, has the organization accepted any gift or contriution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons descried in (ii) and (iii) elow, the governing ody of the supported organization? (ii) A family memer of a person descried in (i) aove?.. (iii) A 5% controlled entity of a person descried in (i) or (ii) aove? Provide the following information aout the supported organization(s). (ii) EIN (iii) Type of organization (descried on lines 1 aove or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? g(i) g(ii) g(iii) (vii) Amount of monetary support (B) (C) (D) (E) Total For Paperwork Reduction Act tice, see the Instructions for Form 0 or 0-EZ. Schedule A (Form 0 or 0-EZ) 201

7 Schedule A (Form 0 or 0-EZ) 201 LEINGTON FAIRNESS, INC Part II Support Schedule for Organizations Descried in Sections 170()(1)(A)(iv) and 170()(1)(A)(vi) (Complete only if you checked the ox on line 5, 7, or of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed elow, please complete Part III.) Section A. Pulic Support Calendar year (or fiscal year eginning in) (a) 200 () 2010 (c) 20 (d) 2012 (e) 201 (f) Total Page Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual grants.") Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf ,042 20,416 24,00 1,47 75, The value of services or facilities furnished y a governmental unit to the organization without charge Total. Add lines 1 through The portion of total contriutions y each person (other than a governmental unit or pulicly supported organization) included on line 1 that exceeds 2% of the amount shown on line, column (f) Pulic support. Sutract line 5 from line 4. Section B. Total Support Calendar year (or fiscal year eginning in) 10 Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated usiness activities, whether or not the usiness is regularly carried on Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) Total support. Add lines 7 through 10 60,042 20,416 24,00 1,47 75,255 (a) 200 () 2010 (c) 20 (d) 2012 (e) 201 Gross receipts from related activities, etc. (see instructions) First five years. If the Form 0 is for the organization s first, second, third, fourth, or fifth tax year as a section 501(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 14 Pulic support percentage for 201 (line 6, column (f) divided y line, column (f)) % 15 Pulic support percentage from 2012 Schedule A, Part II, line % 16a 1/% support test 201. If the organization did not check the ox on line 1, and line 14 is 1/% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization /% support test If the organization did not check a ox on line 1 or 16a, and line 15 is 1/% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization a 10%-facts-and-circumstances test 201. If the organization did not check a ox on line 1, 16a, or 16, and line 14 is 10% or more, and if the organization meets the facts-and-circumstances test, check this ox and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a pulicly supported 12 (f) Total 75,255 60,042 20,416 24,00 1,47 75,255 75,255 4,22 organization %-facts-and-circumstances test If the organization did not check a ox on line 1, 16a, 16, or 17a, and line 15 is 10% or more, and if the organization meets the facts-and-circumstances test, check this ox and stop here. Explain in Part IV how the organization meets the facts-and-circumstances test. The organization qualifies as a pulicly supported organization Private foundation. If the organization did not check a ox on line 1, 16a, 16, 17a, or 17, check this ox and see instructions Schedule A (Form 0 or 0-EZ) 201

8 Schedule A (Form 0 or 0-EZ) 201 Page Part III Support Schedule for Organizations Descried in Section 50(a)(2) (Complete only if you checked the ox on line of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed elow, please complete Part II.) Section A. Pulic Support Calendar year (or fiscal year eginning in) Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual grants.") Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization s tax-exempt purpose Gross receipts from activities that are not an unrelated trade or usiness under section 51 Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf The value of services or facilities furnished y a governmental unit to the organization without charge Total. Add lines 1 through a Amounts included on lines 1, 2, and received from disqualified persons.... Amounts included on lines 2 and received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 1 for the year. LEINGTON FAIRNESS, INC (a) 200 () 2010 (c) 20 (d) 2012 (e) 201 (f) Total c Add lines 7a and Pulic support (Sutract line 7c from line 6.) Section B. Total Support Calendar year (or fiscal year eginning in) Amounts from line (a) 200 () 2010 (c) 20 (d) 2012 (e) 201 (f) Total 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. Unrelated usiness taxale income (less section 5 taxes) from usinesses acquired after June 0, c Add lines 10a and Net income from unrelated usiness activities not included in line 10, whether or not the usiness is regularly carried on.. 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) Total support. (Add lines, 10c,, and 12.) First five years. If the Form 0 is for the organization s first, second, third, fourth, or fifth tax year as a section 501(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 15 Pulic support percentage for 201 (line, column (f) divided y line 1, column (f)) Pulic support percentage from 2012 Schedule A, Part III, line Section D. Computation of Investment Income Percentage 17 Investment income percentage for 201 (line 10c, column (f) divided y line 1, column (f)) % 1 Investment income percentage from 2012 Schedule A, Part III, line % 1a 1/% support tests 201. If the organization did not check the ox on line 14, and line 15 is more than 1/%, and line 17 is not more than 1/%, check this ox and stop here. The organization qualifies as a pulicly supported organization /% support tests If the organization did not check a ox on line 14 or line 1a, and line 16 is more than 1/%, and line 1 is not more than 1/%, check this ox and stop here. The organization qualifies as a pulicly supported organization Private foundation. If the organization did not check a ox on line 14, 1a, or 1, check this ox and see instructions Schedule A (Form 0 or 0-EZ) % %

9 Schedule A (Form 0 or 0-EZ) 201 Part IV LEINGTON FAIRNESS, INC Page 4 Supplemental Information. Provide the explanations required y Part II, line 10; Part II, line 17a or 17; and Part III, line 12. Also complete this part for any additional information. (See instructions). Schedule A (Form 0 or 0-EZ) 201

10 SCHEDULE G (Form 0 or 0-EZ) Department of the Treasury Internal Revenue Service Name of the organization Part I Supplemental Information Regarding Fundraising or Gaming Activities OMB Complete if the organization answered to Form 0, Part IV, lines 17, 1, or 1, or if the organization entered more than $15,000 on Form 0-EZ, line 6a. 201 Attach to Form 0 or Form 0-EZ. Open to Pulic Information aout Schedule G (Form 0 or 0-EZ) and its instructions is at Inspection Employer identification numer Fundraising Activities. Complete if the organization answered to Form 0, Part IV, line 17. Form 0-EZ filers are not required to complete this part. 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. Mail solicitations Internet and solicitations Phone solicitations In-person solicitations Solicitation of non-government grants Solicitation of government grants Special fundraising events 2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or key employees listed in Form 0, Part VII) or entity in connection with professional fundraising services? If, list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to e compensated at least $5,000 y the organization. (iii) Did fundcol. (v) Amount paid to (vi) Amount paid to raiser have (i) Name and address of individual (iv) Gross receipts (or retained y) (or retained y) or entity (fundraiser) (ii) Activity custody or control of from activity fundraiser listed in organization contriutions? (i) 1 a c d LEINGTON FAIRNESS, INC e f g Total List all states in which the organization is registered or licensed to solicit contriutions or has een notified it is exempt from registration or licensing.. For Paperwork Reduction Act tice, see the Instructions for Form 0 or 0-EZ. Schedule G (Form 0 or 0-EZ) 201.

11 Schedule G (Form 0 or 0-EZ) 201 Page 2 Revenue Part II Fundraising Events. Complete if the organization answered to Form 0, Part IV, line 1, or reported more than $15,000 of fundraising event contriutions and gross income on Form 0-EZ, lines 1 and 6. List events with gross receipts greater than $5, Gross receipts LEINGTON FAIRNESS, INC (a) Event #1 () Event #2 (c) Other events FAIRNESS AWARDS NONE (event type) (event type) (total numer) (d) Total events (add col. (a) through col. (c)) 4,74 4,74 2 Less: Contriutions.. Gross income (line 1 minus line 2) ,74 4,74 4 Cash prizes ncash prizes Direct Expenses 6 7 Rent/facility costs.... Food and everages. Entertainment Other direct expenses 26,744 26,744 Direct Expenses Revenue 10 Part III Direct expense summary. Add lines 4 through in column (d) Net income summary. Sutract line 10 from line, column (d) Gaming. Complete if the organization answered to Form 0, Part IV, line 1, or reported more than $15,000 on Form 0-EZ, line 6a. Gross revenue Cash prizes ncash prizes Rent/facility costs.... (a) Bingo () Pull tas/instant ingo/progressive ingo (c) Other gaming 26,744 22,10 (d) Total gaming (add col. (a) through col. (c)) 5 6 Other direct expenses Volunteer laor % % % 7 Direct expense summary. Add lines 2 through 5 in column (d) Net gaming income summary. Sutract line 7 from line 1, column (d) a 10a Enter the state(s) in which the organization operates gaming activities: Is the organization licensed to operate gaming activities in each of these states? If, explain: Were any of the organization s gaming licenses revoked, suspended or terminated during the tax year? If, explain: Schedule G (Form 0 or 0-EZ) 201

12 Schedule G (Form 0 or 0-EZ) a 14 LEINGTON FAIRNESS, INC Does the organization operate gaming activities with nonmemers? Is the organization a grantor, eneficiary or trustee of a trust or a memer of a partnership or other entity formed to administer charitale gaming? Indicate the percentage of gaming activity operated in: The organization s facility An outside facility Enter the name and address of the person who prepares the organization s gaming/special events ooks and records: 1a 1 Page % % Name Address a c Does the organization have a contract with a third party from whom the organization receives gaming revenue? If, enter the amount of gaming revenue received y the organization $ and the amount of gaming revenue retained y the third party $ If, enter name and address of the third party: Name Address Gaming manager information: Name Gaming manager compensation $ Description of services provided Director/officer Employee Independent contractor 17 a Mandatory distriutions: Is the organization required under state law to make charitale distriutions from the gaming proceeds to retain the state gaming license? Enter the amount of distriutions required under state law to e distriuted to other exempt organizations or spent in the organization s own exempt activities during the tax year $ Part IV Supplemental Information. Provide the explanations required y Part I, line 2, columns (iii) and (v), and Part III, lines,, 10, 15, 15c, 16, and 17, as applicale. Also complete this part to provide any additional information (see instructions).. Schedule G (Form 0 or 0-EZ) 201

13 SCHEDULE O (Form 0 or 0-EZ) Department of the Treasury Internal Revenue Service Name of the organization Supplemental Information to Form 0 or 0-EZ Complete to provide information for responses to specific questions on Form 0 or 0-EZ or to provide any additional information. Attach to Form 0 or 0-EZ. Information aout Schedule O (Form 0 or 0-EZ) and its instructions is at Employer identification numer LEINGTON FAIRNESS, INC FORM 0-EZ, PART I, LINE 16 - OTHER EPENSES OMB Open to Pulic Inspection DESCRIPTION EPENSES AMOUNT BANK SERVICE CHARGES $ 1,21 EDUCATION AND OUTREACH $,0 LICENSES AND FEES $ 15 MARKETING $ 5 MEALS $ 161 SUPPLIES $ 202 TOTAL $ 12,74 FORM 0-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION BEG. OF YEAR END OF YEAR ACCOUNTS PAYABLE AND ACCRUED EPENSES $ 0 $ -6 FORM 0-EZ, PART III - PRIMARY EEMPT PURPOSE TO PROMOTE EQUALITY FOR THE GAY, LESBIAN, BISEUAL AND TRANSGENDER INDIVIDUALS THROUGH EDUCATION AND OUTREACH. For Paperwork Reduction Act tice, see the Instructions for Form 0 or 0-EZ. Schedule O (Form 0 or 0-EZ) (201)