TAX RETURN FILING INSTRUCTIONS ** FORM 990 PUBLIC DISCLOSURE COPY ** FOR THE YEAR ENDING

Transcription

1 TA RETURN FILING INSTRUCTIONS ** FORM 990 PUBLIC DISCLOSURE COPY ** FOR THE YEAR ENDING ~~~~~~~~~~~~~~~~~ Deemer, 0 Prepared for Prepared y National Non Profit For Amerians With Disailities, In. 90 Chestnut St No. C Clearwater, FL 76 CBIZ MHM, LLC 77 Feather Sound Drive, Suite 00 Clearwater, FL 76 Amount due or refund Make hek payale to Mail tax return and hek (if appliale) to Not appliale Not appliale Not appliale Return must e mailed on or efore Speial Instrutions Not appliale This return has een prepared for eletroni filing. If you wish to have it transmitted eletronially to the IRS, please sign, date, and return Form 8879-EO to our offie. We will then sumit the eletroni return to the IRS. Do not mail a paper opy of the return to the IRS. Return Form 8879-EO to us y August 7,

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3 Form 990 (0) WITH DISABILITIES, INC Part III Statement of Program Servie Aomplishments Chek if Shedule O ontains a response or note to any line in this Part III Briefly desrie the organization s mission: TO PROMOTE, FURTHER AND SUPPORT SELECTED CHARITABLE ACTIVITIES AND ORGANIZATIONS THAT PROVIDE GOODS, SERVICES OR FUNDING FOR INDIVIDUALS THAT MEET THE SOCIAL SECURITY DEFINITION OF DISABLED. Page a Did the organization undertake any signifiant program servies during the year whih were not listed on the prior Form 990 or 990-EZ? If "Yes," desrie these new servies on Shedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ease onduting, or make signifiant hanges in how it onduts, any program servies? ~~~~~~ If "Yes," desrie these hanges on Shedule O. Desrie the organization s program servie aomplishments for eah of its three largest program servies, as measured y expenses. Setion 0()() and 0()() organizations are required to report the amount of grants and alloations to others, the total expenses, and revenue, if any, for eah program servie reported. ( Code: ) ( Expenses $ 78,767. inluding grants of $ 78,767. ) ( Revenue $ ) THE NNAD PROMOTES AND SUPPORTS CHARITABLE ACTIVITIES AND ORGANIZATIONS THAT PROVIDE GOODS, SERVICES, OR FUNDING FOR THE UNDERPRIVILEDGED, THE DISADVANTAGED, AND FOR INDIVIDUALS OF ANY AGE WHO ARE DISABLED. ACTIVITIES INCLUDE: Yes Yes No No. PROVIDING GRANTS TO LOCAL NON-PROFITS SERVING DISABLED PERSONS. PROMOTING ACTIVITIES AND EFFORTS OF LOCAL NON-PROFITS. PROVIDING MATCH GRANTS TO LOCAL NON-PROFITS. TEAMING WITH LOCAL NON-PROFITS IN SUPPORTING THEIR EFFORTS. SUPPORTING FUND RAISERS OF LOCAL NON-PROFITS ( Code: ) ( Expenses $ inluding grants of $ ) ( Revenue $ ) NNAD IS THE TRUSTEE OF THE GUARDIAN POOLED TRUST AND VARIOUS THIRD-PARTY SPECIAL NEEDS TRUSTS. THE GUARDIAN POOLED TRUST WAS ESTABLISHED BY NNAD IN 00 PURSUANT TO FEDERAL LAW UNDER OBRA 99. THE THIRD-PARTY TRUSTS ARE FOR PARENTS AND FAMILY MEMBERS WHO WANT TO PROVIDE FOR A PERSON WITH SPECIAL NEEDS. TWO ADDITIONAL CO-TRUSTEES HAVE BEEN NAMED BY NNAD FOR THE GUARDIAN POOLED TRUST AND EACH OF THE INDIVIDUAL THIRD-PARTY TRUSTS. THE TERMS "SPECIAL NEEDS", "SUPPLEMENTAL NEEDS", AND "SUPPLEMENTAL CARE" TRUSTS REFER TO A SPECIFIC TYPE OF TRUST WHICH ALLOWS A PERSON WITH A DISABILITY TO KEEP BENEFITING FROM HIS OR HER OWN ASSETS WHILE STILL QUALIFYING FOR OR MAINTAINING ELIGIBILITY FOR PUBLIC BENEFIT ( Code: ) ( Expenses $ inluding grants of $ ) ( Revenue $ ) d e Other program servies (Desrie in Shedule O.) ( Expenses $ inluding grants of $ ) ( Revenue $ ) Total program servie expenses 78,767. SEE SCHEDULE O FOR CONTINUATION(S) Form 990 (0)

4 Form 990 (0) WITH DISABILITIES, INC Part IV Cheklist of Required Shedules a a d e f 0a Is the organization desried in setion 0()() or 97(a)() (other than a private foundation)? If "Yes," omplete Shedule A~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to omplete Shedule B, Shedule of Contriutors? ~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in diret or indiret politial ampaign ativities on ehalf of or in opposition to andidates for puli offie? If "Yes," omplete Shedule C, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()() organizations. Did the organization engage in loying ativities, or have a setion 0(h) eletion in effet during the tax year? If "Yes," omplete Shedule C, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization a setion 0()(), 0()(), or 0()(6) organization that reeives memership dues, assessments, or similar amounts as defined in Revenue Proedure 98-9? If "Yes," omplete Shedule C, Part III ~~~~~~~~~~~~~~ Did the organization maintain any donor advised funds or any similar funds or aounts for whih donors have the right to provide advie on the distriution or investment of amounts in suh funds or aounts? If "Yes," omplete Shedule D, Part I Did the organization reeive or hold a onservation easement, inluding easements to preserve open spae, the environment, histori land areas, or histori strutures? If "Yes," omplete Shedule D, Part II~~~~~~~~~~~~~~ Did the organization maintain olletions of works of art, historial treasures, or other similar assets? If "Yes," omplete Shedule D, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part, line, for esrow or ustodial aount liaility; serve as a ustodian for amounts not listed in Part ; or provide redit ounseling, det management, redit repair, or det negotiation servies? If "Yes," omplete Shedule D, Part IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization, diretly or through a related organization, hold assets in temporarily restrited endowments, permanent endowments, or quasi-endowments? If "Yes," omplete Shedule D, Part V ~~~~~~~~~~~~~~~~~~~~~~~~ If the organization s answer to any of the following questions is "Yes," then omplete Shedule D, Parts VI, VII, VIII, I, or as appliale. Did the organization report an amount for land, uildings, and equipment in Part, line 0? If "Yes," omplete Shedule D, Part VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for investments - other seurities in Part, line that is % or more of its total assets reported in Part, line 6? If "Yes," omplete Shedule D, Part VII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for investments - program related in Part, line that is % or more of its total assets reported in Part, line 6? If "Yes," omplete Shedule D, Part VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for other assets in Part, line that is % or more of its total assets reported in Part, line 6? If "Yes," omplete Shedule D, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount for other liailities in Part, line? If "Yes," omplete Shedule D, Part ~~~~~~ Did the organization s separate or onsolidated finanial statements for the tax year inlude a footnote that addresses the organization s liaility for unertain tax positions under FIN 8 (ASC 70)? If "Yes," omplete Shedule D, Part ~~~~ Did the organization otain separate, independent audited finanial statements for the tax year? If "Yes," omplete Shedule D, Parts I and II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization inluded in onsolidated, independent audited finanial statements for the tax year? If "Yes," and if the organization answered "No" to line a, then ompleting Shedule D, Parts I and II is optional ~~~~~ Is the organization a shool desried in setion 70()()(A)(ii)? If "Yes," omplete Shedule E ~~~~~~~~~~~~~~ a Did the organization maintain an offie, employees, or agents outside of the United States? ~~~~~~~~~~~~~~~~ Did the organization have aggregate revenues or expenses of more than $0,000 from grantmaking, fundraising, usiness, investment, and program servie ativities outside the United States, or aggregate foreign investments valued at $00,000 or more? If "Yes," omplete Shedule F, Parts I and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part I, olumn (A), line, more than $,000 of grants or other assistane to or for any foreign organization? If "Yes," omplete Shedule F, Parts II and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part I, olumn (A), line, more than $,000 of aggregate grants or other assistane to or for foreign individuals? If "Yes," omplete Shedule F, Parts III and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $,000 of expenses for professional fundraising servies on Part I, olumn (A), lines 6 and e? If "Yes," omplete Shedule G, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $,000 total of fundraising event gross inome and ontriutions on Part VIII, lines and 8a? If "Yes," omplete Shedule G, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $,000 of gross inome from gaming ativities on Part VIII, line 9a? If "Yes," omplete Shedule G, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization operate one or more hospital failities? If "Yes," omplete Shedule H ~~~~~~~~~~~~~~~~ If "Yes" to line 0a, did the organization attah a opy of its audited finanial statements to this return? a d e f a a a Yes Page No 0 Form 990 (0)

5 Form 990 (0) WITH DISABILITIES, INC Part IV Cheklist of Required Shedules (ontinued) a d a Setion 0()(), 0()(), and 0()(9) organizations. Did the organization engage in an exess enefit transation with a disqualified person during the year? If "Yes," omplete Shedule L, Part I ~~~~~~~~~~~~~~~~ a Did the organization report more than $,000 of grants or other assistane to any domesti organization or domesti government on Part I, olumn (A), line? If "Yes," omplete Shedule I, Parts I and II ~~~~~~~~~~~~~~ Did the organization report more than $,000 of grants or other assistane to or for domesti individuals on Part I, olumn (A), line? If "Yes," omplete Shedule I, Parts I and III ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Setion A, line,, or aout ompensation of the organization s urrent and former offiers, diretors, trustees, key employees, and highest ompensated employees? If "Yes," omplete Shedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a tax-exempt ond issue with an outstanding prinipal amount of more than $00,000 as of the last day of the year, that was issued after Deemer, 00? If "Yes," answer lines through d and omplete Shedule K. If "No", go to line a ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest any proeeds of tax-exempt onds eyond a temporary period exeption? ~~~~~~~~~~~ Did the organization maintain an esrow aount other than a refunding esrow at any time during the year to defease any tax-exempt onds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization at as an "on ehalf of" issuer for onds outstanding at any time during the year? ~~~~~~~~~~~ Is the organization aware that it engaged in an exess enefit transation with a disqualified person in a prior year, and that the transation has not een reported on any of the organization s prior Forms 990 or 990-EZ? If "Yes," omplete Shedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report any amount on Part, line, 6, or for reeivales from or payales to any urrent or former offiers, diretors, trustees, key employees, highest ompensated employees, or disqualified persons? If "Yes," omplete Shedule L, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization provide a grant or other assistane to an offier, diretor, trustee, key employee, sustantial ontriutor or employee thereof, a grant seletion ommittee memer, or to a % ontrolled entity or family memer of any of these persons? If "Yes," omplete Shedule L, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization a party to a usiness transation with one of the following parties (see Shedule L, Part IV instrutions for appliale filing thresholds, onditions, and exeptions): A urrent or former offier, diretor, trustee, or key employee? If "Yes," omplete Shedule L, Part IV ~~~~~~~~~~~ A family memer of a urrent or former offier, diretor, trustee, or key employee? If "Yes," omplete Shedule L, Part IV ~~ An entity of whih a urrent or former offier, diretor, trustee, or key employee (or a family memer thereof) was an offier, diretor, trustee, or diret or indiret owner? If "Yes," omplete Shedule L, Part IV~~~~~~~~~~~~~~~~~~~~~ Did the organization reeive more than $,000 in non-ash ontriutions? If "Yes," omplete Shedule M ~~~~~~~~~ Did the organization reeive ontriutions of art, historial treasures, or other similar assets, or qualified onservation ontriutions? If "Yes," omplete Shedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and ease operations? If "Yes," omplete Shedule N, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization sell, exhange, dispose of, or transfer more than % of its net assets? If "Yes," omplete Shedule N, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 00% of an entity disregarded as separate from the organization under Regulations setions and ? If "Yes," omplete Shedule R, Part I ~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization related to any tax-exempt or taxale entity? If "Yes," omplete Shedule R, Part II, III, or IV, and Part V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a Did the organization have a ontrolled entity within the meaning of setion ()()? ~~~~~~~~~~~~~~~~~~ If "Yes" to line a, did the organization reeive any payment from or engage in any transation with a ontrolled entity within the meaning of setion ()()? If "Yes," omplete Shedule R, Part V, line ~~~~~~~~~~~~~~~~~~~ Setion 0()() organizations. Did the organization make any transfers to an exempt non-haritale related organization? If "Yes," omplete Shedule R, Part V, line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ondut more than % of its ativities through an entity that is not a related organization and that is treated as a partnership for federal inome tax purposes? If "Yes," omplete Shedule R, Part VI ~~~~~~~~ Did the organization omplete Shedule O and provide explanations in Shedule O for Part VI, lines and 9? Note. All Form 990 filers are required to omplete Shedule O a d a 6 7 8a a 6 7 Yes Page No 8 Form 990 (0)

6 Form 990 (0) WITH DISABILITIES, INC Page Part V Statements Regarding Other IRS Filings and Tax Compliane Chek if Shedule O ontains a response or note to any line in this Part V a Enter the numer reported in Box of Form 096. Enter -0- if not appliale ~~~~~~~~~~~ a Enter the numer of Forms W-G inluded in line a. Enter -0- if not appliale ~~~~~~~~~~ Did the organization omply with akup withholding rules for reportale payments to vendors and reportale gaming If at least one is reported on line a, did the organization file all required federal employment tax returns? ~~~~~~~~~~ Note. If the sum of lines a and a is greater than 0, you may e required to e-file (see instrutions) ~~~~~~~~~~~ 7 Organizations that may reeive dedutile ontriutions under setion 70(). a Did the organization reeive a payment in exess of $7 made partly as a ontriution and partly for goods and servies provided to the payor? 9 d e f g a a Setion 97(a)() non-exempt haritale trusts. Is the organization filing Form 990 in lieu of Form 0? If "Yes," enter the amount of tax-exempt interest reeived or arued during the year N/A a a (gamling) winnings to prize winners? a Enter the numer of employees reported on Form W-, Transmittal of Wage and Tax Statements, filed for the alendar year ending with or within the year overed y this return ~~~~~~~~~~ Did the organization have unrelated usiness gross inome of $,000 or more during the year? ~~~~~~~~~~~~~~ If "Yes," has it filed a Form 990-T for this year? If "No," to line, provide an explanation in Shedule O ~~~~~~~~~~ a At any time during the alendar year, did the organization have an interest in, or a signature or other authority over, a finanial aount in a foreign ountry (suh as a ank aount, seurities aount, or other finanial aount)?~~~~~~~ If "Yes," enter the name of the foreign ountry: J See instrutions for filing requirements for FinCEN Form, Report of Foreign Bank and Finanial Aounts (FBAR). a Was the organization a party to a prohiited tax shelter transation at any time during the tax year? ~~~~~~~~~~~~ Did any taxale party notify the organization that it was or is a party to a prohiited tax shelter transation? ~~~~~~~~~ If "Yes," to line a or, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6a Does the organization have annual gross reeipts that are normally greater than $00,000, and did the organization soliit any ontriutions that were not tax dedutile as haritale ontriutions? If "Yes," did the organization inlude with every soliitation an express statement that suh ontriutions or gifts were not tax dedutile? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization notify the donor of the value of the goods or servies provided? Note. See the instrutions for additional information the organization must report on Shedule O. Did the organization reeive any payments for indoor tanning servies during the tax year? ~~~~~~~~~~~~~~~~ If "Yes," has it filed a Form 70 to report these payments? If "No," provide an explanation in Shedule O a a ~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization sell, exhange, or otherwise dispose of tangile personal property for whih it was required to file Form 88? ~~~~~~~~~~~~~~~ If "Yes," indiate the numer of Forms 88 filed during the year ~~~~~~~~~~~~~~~~ Did the organization reeive any funds, diretly or indiretly, to pay premiums on a personal enefit ontrat? Did the organization, during the year, pay premiums, diretly or indiretly, on a personal enefit ontrat? 7d 0a 0 a ~~~~~~~ ~~~~~~~~~ If the organization reeived a ontriution of qualified intelletual property, did the organization file Form 8899 as required? ~ h If the organization reeived a ontriution of ars, oats, airplanes, or other vehiles, did the organization file a Form 098-C? 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained y the N/A sponsoring organization have exess usiness holdings at any time during the year? ~~~~~~~~~~~~~~~~~~~ Sponsoring organizations maintaining donor advised funds. Did the sponsoring organization make any taxale distriutions under setion 966? ~~~~~~~~~~~~~~~~~~~ N/A Did the sponsoring organization make a distriution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~ N/A 0 Setion 0()(7) organizations. Enter: a Initiation fees and apital ontriutions inluded on Part VIII, line ~~~~~~~~~~~~~~~ N/A Gross reeipts, inluded on Form 990, Part VIII, line, for puli use of lu failities ~~~~~~ Setion 0()() organizations. Enter: a Gross inome from memers or shareholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ N/A Gross inome from other soures (Do not net amounts due or paid to other soures against amounts due or reeived from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Setion 0()(9) qualified nonprofit health insurane issuers. Is the organization liensed to issue qualified health plans in more than one state? ~~~~~~~~~~~~~~~~~~~~~ N/A Enter the amount of reserves the organization is required to maintain y the states in whih the organization is liensed to issue qualified health plans ~~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves on hand~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ a a a 6a 6 7a 7 7 7e 7f 7g 7h 8 9a 9 a a a Yes No N/A N/A Form 990 (0)

7 Form 990 (0) WITH DISABILITIES, INC Page 6 Part VI Governane, Management, and Dislosure For eah "Yes" response to lines through 7 elow, and for a "No" response to line 8a, 8, or 0 elow, desrie the irumstanes, proesses, or hanges in Shedule O. See instrutions. Chek if Shedule O ontains a response or note to any line in this Part VI Setion A. Governing Body and Management a Enter the numer of voting memers of the governing ody at the end of the tax year ~~~~~~ If there are material differenes in voting rights among memers of the governing ody, or if the governing 6 8 a 9 Is there any offier, diretor, trustee, or key employee listed in Part VII, Setion A, who annot e reahed at the organization s mailing address? If "Yes," provide the names and addresses in Shedule O Setion B. Poliies (This Setion B requests information aout poliies not required y the Internal Revenue Code.) a a 6a exempt status with respet to suh arrangements? Setion C. Dislosure 7 List the states with whih a opy of this Form 990 is required to e filed JFL ody delegated road authority to an exeutive ommittee or similar ommittee, explain in Shedule O. Enter the numer of voting memers inluded in line a, aove, who are independent ~~~~~~ persons other than the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization ontemporaneously doument the meetings held or written ations undertaken during the year y the following: Desrie in Shedule O the proess, if any, used y the organization to review this Form 990. Did the organization have a written onflit of interest poliy? If "No," go to line ~~~~~~~~~~~~~~~~~~~~ Were offiers, diretors, or trustees, and key employees required to dislose annually interests that ould give rise to onflits? ~~~~~~ Did the organization regularly and onsistently monitor and enfore ompliane with the poliy? If "Yes," desrie in Shedule O how this was done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ for puli inspetion. Indiate how you made these availale. Chek all that apply. Own wesite Another s wesite Upon request Other (explain in Shedule O) Did any offier, diretor, trustee, or key employee have a family relationship or a usiness relationship with any other offier, diretor, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization delegate ontrol over management duties ustomarily performed y or under the diret supervision of offiers, diretors, or trustees, or key employees to a management ompany or other person? ~~~~~~~~~~~~~~ Did the organization make any signifiant hanges to its governing douments sine the prior Form 990 was filed? ~~~~~ Did the organization eome aware during the year of a signifiant diversion of the organization s assets? ~~~~~~~~~ Did the organization have memers or stokholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a Did the organization have memers, stokholders, or other persons who had the power to elet or appoint one or more memers of the governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Are any governane deisions of the organization reserved to (or sujet to approval y) memers, stokholders, or The governing ody? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Eah ommittee with authority to at on ehalf of the governing ody? a ~~~~~~~~~~~~~~~~~~~~~~~~~~ 0a Did the organization have loal hapters, ranhes, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization have written poliies and proedures governing the ativities of suh hapters, affiliates, and ranhes to ensure their operations are onsistent with the organization s exempt purposes? ~~~~~~~~~~~~~ a Has the organization provided a omplete opy of this Form 990 to all memers of its governing ody efore filing the form? Did the organization have a written whistlelower poliy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written doument retention and destrution poliy? ~~~~~~~~~~~~~~~~~~~~~~ Did the proess for determining ompensation of the following persons inlude a review and approval y independent persons, omparaility data, and ontemporaneous sustantiation of the delieration and deision? The organization s CEO, Exeutive Diretor, or top management offiial Other offiers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" to line a or, desrie the proess in Shedule O (see instrutions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest in, ontriute assets to, or partiipate in a joint venture or similar arrangement with a taxale entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization follow a written poliy or proedure requiring the organization to evaluate its partiipation in joint venture arrangements under appliale federal tax law, and take steps to safeguard the organization s Setion 60 requires an organization to make its Forms 0 (or 0 if appliale), 990, and 990-T (Setion 0()()s only) availale Desrie in Shedule O whether (and if so, how) the organization made its governing douments, onflit of interest poliy, and finanial statements availale to the puli during the tax year. State the name, address, and telephone numer of the person who possesses the organization s ooks and reords: TRAVIS FINCHUM - (77) CHESTNUT ST, CLEARWATER, FL a 7 8a 8 9 0a 0 a a a 6a 6 Yes Yes No No Form 990 (0)

8 Form 990 (0) WITH DISABILITIES, INC Page 7 Part VII Compensation of Offiers, Diretors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contrators Chek if Shedule O ontains a response or note to any line in this Part VII Setion A. Offiers, Diretors, Trustees, Key Employees, and Highest Compensated Employees a Complete this tale for all persons required to e listed. Report ompensation for the alendar year ending with or within the organization s tax year. List all of the organization s urrent offiers, diretors, trustees (whether individuals or organizations), regardless of amount of ompensation. Enter -0- in olumns (D), (E), and (F) if no ompensation was paid. List all of the organization s urrent key employees, if any. See instrutions for definition of "key employee." List the organization s five urrent highest ompensated employees (other than an offier, diretor, trustee, or key employee) who reeived reportale ompensation (Box of Form W- and/or Box 7 of Form 099-MISC) of more than $00,000 from the organization and any related organizations. List all of the organization s former offiers, key employees, and highest ompensated employees who reeived more than $00,000 of reportale ompensation from the organization and any related organizations. List all of the organization s former diretors or trustees that reeived, in the apaity as a former diretor or trustee of the organization, more than $0,000 of reportale ompensation from the organization and any related organizations. List persons in the following order: individual trustees or diretors; institutional trustees; offiers; key employees; highest ompensated employees; and former suh persons. Chek this ox if neither the organization nor any related organization ompensated any urrent offier, diretor, or trustee. (A) (B) (C) (D) (E) (F) Name and Title Average hours per week (list any hours for related organizations elow line) Position (do not hek more than one ox, unless person is oth an offier and a diretor/trustee) Individual trustee or diretor Institutional trustee Offier Key employee Highest ompensated employee Former Reportale ompensation from the organization (W-/099-MISC) Reportale ompensation from related organizations (W-/099-MISC) Estimated amount of other ompensation from the organization and related organizations () LARRY R. POTEET.00 PRESIDENT () TRAVIS FINCHUM.00 SECRETARY/TREASURER () KATHY WILDER.00 DIRECTOR Form 990 (0)

9 WITH DISABILITIES, INC Form 990 (0) Page 8 Part VII Setion A. Offiers, Diretors, Trustees, Key Employees, and Highest Compensated Employees (ontinued) (A) (B) (C) (D) (E) (F) Name and title Average Position (do not hek more than one Reportale Reportale Estimated hours per ox, unless person is oth an ompensation ompensation amount of week offier and a diretor/trustee) from from related other (list any the organizations ompensation hours for organization (W-/099-MISC) from the related (W-/099-MISC) organization organizations and related elow organizations line) Individual trustee or diretor Institutional trustee Offier Key employee Highest ompensated employee Former d Su-total~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total from ontinuation sheets to Part VII, Setion A ~~~~~~~~~~ Total (add lines and ) Did the organization list any former offier, diretor, or trustee, key employee, or highest ompensated employee on line a? If "Yes," omplete Shedule J for suh individual ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did any person listed on line a reeive or arue ompensation from any unrelated organization or individual for servies rendered to the organization? If "Yes," omplete Shedule J for suh person Setion B. Independent Contrators Total numer of individuals (inluding ut not limited to those listed aove) who reeived more than $00,000 of reportale ompensation from the organization For any individual listed on line a, is the sum of reportale ompensation and other ompensation from the organization and related organizations greater than $0,000? If "Yes," omplete Shedule J for suh individual~~~~~~~~~~~~~ Complete this tale for your five highest ompensated independent ontrators that reeived more than $00,000 of ompensation from the organization. Report ompensation for the alendar year ending with or within the organization s tax year (A) (B) (C) Name and usiness address NONE Desription of servies Compensation Yes No Total numer of independent ontrators (inluding ut not limited to those listed aove) who reeived more than $00,000 of ompensation from the organization 0 Form 990 (0)

10 Form 990 (0) WITH DISABILITIES, INC Part VIII Statement of Revenue Contriutions, Gifts, Grants and Other Similar Amounts Program Servie Revenue Other Revenue a d e f g Nonash ontriutions inluded in lines a-f: $ h a d e f g 6 a d d 8 a 9 a 0 a a d Government grants (ontriutions) All other ontriutions, gifts, grants, and similar amounts not inluded aove ~~ a d e e Total. Add lines a-d ~~~~~~~~~~~~~~~ Total revenue. See instrutions. f Total. Add lines a-f Business Code Total. Add lines a-f a a a Business Code Page 9 Chek if Shedule O ontains a response or note to any line in this Part VIII (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exluded exempt funtion usiness from tax under setions revenue revenue - Federated ampaigns Memership dues ~~~~~~ ~~~~~~~~ Fundraising events ~~~~~~~~ Related organizations ~~~~~~ All other program servie revenue ~~~~~ Investment inome (inluding dividends, interest, and other similar amounts) ~~~~~~~~~~~~~~~~~ Inome from investment of tax-exempt ond proeeds Royalties Gross rents ~~~~~~~ Less: rental expenses~~~ Rental inome or (loss) ~~ Net rental inome or (loss) 7 a Gross amount from sales of assets other than inventory Less: ost or other asis and sales expenses ~~~ Gain or (loss) ~~~~~~~ (i) Real (ii) Personal (i) Seurities (ii) Other Net gain or (loss) Gross inome from fundraising events (not inluding $ of ontriutions reported on line ). See Part IV, line 8 ~~~~~~~~~~~~~ Less: diret expenses~~~~~~~~~~ Net inome or (loss) from fundraising events Gross inome from gaming ativities. See Part IV, line 9 ~~~~~~~~~~~~~ Less: diret expenses ~~~~~~~~~ Net inome or (loss) from gaming ativities Gross sales of inventory, less returns and allowanes ~~~~~~~~~~~~~ Less: ost of goods sold ~~~~~~~~ Net inome or (loss) from sales of inventory Misellaneous Revenue All other revenue ~~~~~~~~~~~~~ 80,67. 80,67. 80, Form 990 (0)

11 Form 990 (0) WITH DISABILITIES, INC Part I Statement of Funtional Expenses Setion 0()() and 0()() organizations must omplete all olumns. All other organizations must omplete olumn (A). Chek if Shedule O ontains a response or note to any line in this Part I Do not inlude amounts reported on lines 6, (A) (B) (C) (D) Total expenses Program servie Management and Fundraising 7, 8, 9, and 0 of Part VIII. expenses general expenses expenses Grants and other assistane to domesti organizations and domesti governments. See Part IV, line ~ 78, , a d e f g a d Grants and other assistane to domesti individuals. See Part IV, line ~~~~~~~ Grants and other assistane to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines and 6 ~~~ Benefits paid to or for memers ~~~~~~~ Compensation of urrent offiers, diretors, trustees, and key employees ~~~~~~~~ Compensation not inluded aove, to disqualified persons (as defined under setion 98(f)()) and persons desried in setion 98()()(B) Other salaries and wages ~~~~~~~~~~ Pension plan aruals and ontriutions (inlude setion 0(k) and 0() employer ontriutions) Loying ~~~~~~~~~~~~~~~~~~ Professional fundraising servies. See Part IV, line 7 Investment management fees ~~~~~~~~ Other. (If line g amount exeeds 0% of line, olumn (A) amount, list line g expenses on Sh O.) Insurane ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not overed aove. (List misellaneous expenses in line e. If line e amount exeeds 0% of line, olumn (A) amount, list line e expenses on Shedule O.) ~~ e All other expenses Total funtional expenses. Add lines through e 6 Joint osts. Complete this line only if the organization reported in olumn (B) joint osts from a omined eduational ampaign and fundraising soliitation. Chek here if following SOP 98- (ASC 98-70) ~~~ Other employee enefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~ Fees for servies (non-employees): Management ~~~~~~~~~~~~~~~~ Legal ~~~~~~~~~~~~~~~~~~~~ Aounting ~~~~~~~~~~~~~~~~~ Advertising and promotion ~~~~~~~~~ Offie expenses~~~~~~~~~~~~~~~ Information tehnology ~~~~~~~~~~~ Royalties ~~~~~~~~~~~~~~~~~~ Oupany ~~~~~~~~~~~~~~~~~ Travel ~~~~~~~~~~~~~~~~~~~ Payments of travel or entertainment expenses for any federal, state, or loal puli offiials Conferenes, onventions, and meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Payments to affiliates ~~~~~~~~~~~~ Depreiation, depletion, and amortization ~~,7., Page 0 8,0. 78,767.,6. 0. Form 990 (0)

12 Form 990 (0) WITH DISABILITIES, INC Part Balane Sheet Assets Liailities Net Assets or Fund Balanes Chek if Shedule O ontains a response or note to any line in this Part Cash - non-interest-earing ~~~~~~~~~~~~~~~~~~~~~~~~~ Savings and temporary ash investments ~~~~~~~~~~~~~~~~~~ Pledges and grants reeivale, net Total assets. Add lines through (must equal line ) Total liailities. Add lines 7 through 0a 0 Organizations that follow SFAS 7 (ASC 98), hek here omplete lines 7 through 9, and lines and. and omplete lines 0 through. ~~~~~~~~~~~~~~~~~~~~~ Aounts reeivale, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other reeivales from urrent and former offiers, diretors, trustees, key employees, and highest ompensated employees. Complete Part II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other reeivales from other disqualified persons (as defined under setion 98(f)()), persons desried in setion 98()()(B), and ontriuting employers and sponsoring organizations of setion 0()(9) voluntary employees enefiiary organizations (see instr). Complete Part II of Sh L ~~ Notes and loans reeivale, net ~~~~~~~~~~~~~~~~~~~~~~~ Inventories for sale or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ Prepaid expenses and deferred harges 0a Land, uildings, and equipment: ost or other asis. Complete Part VI of Shedule D Less: aumulated depreiation ~~~~~~~~~~~~~~~~~~ ~~~ ~~~~~~ Investments - pulily traded seurities ~~~~~~~~~~~~~~~~~~~ Investments - other seurities. See Part IV, line ~~~~~~~~~~~~~~ Investments - program-related. See Part IV, line ~~~~~~~~~~~~~ Intangile assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets. See Part IV, line ~~~~~~~~~~~~~~~~~~~~~~ Aounts payale and arued expenses ~~~~~~~~~~~~~~~~~~ Grants payale ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax-exempt ond liailities ~~~~~~~~~~~~~~~~~~~~~~~~~ Esrow or ustodial aount liaility. Complete Part IV of Shedule D ~~~~ Loans and other payales to urrent and former offiers, diretors, trustees, key employees, highest ompensated employees, and disqualified persons. Complete Part II of Shedule L ~~~~~~~~~~~~~~~~~~~~~~~ Seured mortgages and notes payale to unrelated third parties ~~~~~~ Unseured notes and loans payale to unrelated third parties ~~~~~~~~ Other liailities (inluding federal inome tax, payales to related third parties, and other liailities not inluded on lines 7-). Complete Part of Shedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Unrestrited net assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Temporarily restrited net assets and ~~~~~~~~~~~~~~~~~~~~~~ Permanently restrited net assets ~~~~~~~~~~~~~~~~~~~~~ Organizations that do not follow SFAS 7 (ASC 98), hek here Capital stok or trust prinipal, or urrent funds ~~~~~~~~~~~~~~~ Paid-in or apital surplus, or land, uilding, or equipment fund ~~~~~~~~ Retained earnings, endowment, aumulated inome, or other funds ~~~~ Total net assets or fund alanes ~~~~~~~~~~~~~~~~~~~~~~ Total liailities and net assets/fund alanes (A) (B) Beginning of year End of year,86., ,86. 6, Page ,86.,98.,86.,98.,86.,98. Form 990 (0) 0-07-

13 Form 990 (0) WITH DISABILITIES, INC Page Part I Reoniliation of Net Assets Chek if Shedule O ontains a response or note to any line in this Part I a Total revenue (must equal Part VIII, olumn (A), line ) Total expenses (must equal Part I, olumn (A), line ) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Sutrat line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net assets or fund alanes at eginning of year (must equal Part, line, olumn (A)) ~~~~~~~~~~ Net unrealized gains (losses) on investments Donated servies and use of failities Investment expenses Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other hanges in net assets or fund alanes (explain in Shedule O) ~~~~~~~~~~~~~~~~~~~ 0 Net assets or fund alanes at end of year. Comine lines through 9 (must equal Part, line, olumn (B)) 0,98. Part II Finanial Statements and Reporting Chek if Shedule O ontains a response or note to any line in this Part II Yes No Aounting method used to prepare the Form 990: Cash Arual Other If the organization hanged its method of aounting from a prior year or heked "Other," explain in Shedule O. Were the organization s finanial statements ompiled or reviewed y an independent aountant? ~~~~~~~~~~~~ If "Yes," hek a ox elow to indiate whether the finanial statements for the year were ompiled or reviewed on a separate asis, onsolidated asis, or oth: Separate asis Consolidated asis Both onsolidated and separate asis Were the organization s finanial statements audited y an independent aountant? ~~~~~~~~~~~~~~~~~~~ If "Yes," hek a ox elow to indiate whether the finanial statements for the year were audited on a separate asis, onsolidated asis, or oth: Separate asis Consolidated asis Both onsolidated and separate asis If "Yes" to line a or, does the organization have a ommittee that assumes responsiility for oversight of the audit, review, or ompilation of its finanial statements and seletion of an independent aountant?~~~~~~~~~~~~~~~ If the organization hanged either its oversight proess or seletion proess during the tax year, explain in Shedule O. a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit At and OMB Cirular A-? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Shedule O and desrie any steps taken to undergo suh audits ,67. 8, ,86. a a 0. Form 990 (0) 0-07-

14 OMB No SCHEDULE A (Form 990 or 990-EZ) Puli Charity Status and Puli Support Complete if the organization is a setion 0()() organization or a setion 0 97(a)() nonexempt haritale trust. Department of the Treasury Attah to Form 990 or Form 990-EZ. Open to Puli Internal Revenue Servie Information aout Shedule A (Form 990 or 990-EZ) and its instrutions is at Inspetion Name of the organization NATIONAL NON PROFIT FOR AMERICANS Employer identifiation numer WITH DISABILITIES, INC Part I Reason for Puli Charity Status (All organizations must omplete this part.) See instrutions. The organization is not a private foundation eause it is: (For lines through, hek only one ox.) a d e f g A hurh, onvention of hurhes, or assoiation of hurhes desried in setion 70()()(A)(i). A shool desried in setion 70()()(A)(ii). (Attah Shedule E.) A hospital or a ooperative hospital servie organization desried in setion 70()()(A)(iii). A medial researh organization operated in onjuntion with a hospital desried in setion 70()()(A)(iii). Enter the hospital s name, ity, and state: An organization operated for the enefit of a ollege or university owned or operated y a governmental unit desried in setion 70()()(A)(iv). (Complete Part II.) A federal, state, or loal government or governmental unit desried in setion 70()()(A)(v). An organization that normally reeives a sustantial part of its support from a governmental unit or from the general puli desried in setion 70()()(A)(vi). (Complete Part II.) A ommunity trust desried in setion 70()()(A)(vi). (Complete Part II.) An organization that normally reeives: () more than /% of its support from ontriutions, memership fees, and gross reeipts from ativities related to its exempt funtions - sujet to ertain exeptions, and () no more than /% of its support from gross investment inome and unrelated usiness taxale inome (less setion tax) from usinesses aquired y the organization after June 0, 97. See setion 09(a)(). (Complete Part III.) An organization organized and operated exlusively to test for puli safety. See setion 09(a)(). An organization organized and operated exlusively for the enefit of, to perform the funtions of, or to arry out the purposes of one or more pulily supported organizations desried in setion 09(a)() or setion 09(a)(). See setion 09(a)(). Chek the ox in lines a through d that desries the type of supporting organization and omplete lines e, f, and g. Type I. A supporting organization operated, supervised, or ontrolled y its supported organization(s), typially y giving the supported organization(s) the power to regularly appoint or elet a majority of the diretors or trustees of the supporting organization. You must omplete Part IV, Setions A and B. Type II. A supporting organization supervised or ontrolled in onnetion with its supported organization(s), y having ontrol or management of the supporting organization vested in the same persons that ontrol or manage the supported organization(s). You must omplete Part IV, Setions A and C. Type III funtionally integrated. A supporting organization operated in onnetion with, and funtionally integrated with, its supported organization(s) (see instrutions). You must omplete Part IV, Setions A, D, and E. Type III non-funtionally integrated. A supporting organization operated in onnetion with its supported organization(s) that is not funtionally integrated. The organization generally must satisfy a distriution requirement and an attentiveness requirement (see instrutions). You must omplete Part IV, Setions A and D, and Part V. Chek this ox if the organization reeived a written determination from the IRS that it is a Type I, Type II, Type III funtionally integrated, or Type III non-funtionally integrated supporting organization. Enter the numer of supported organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the following information aout the supported organization(s). (i) Name of supported (ii) EIN (iii) Type of organization (iv) Is the organization (v) Amount of monetary (vi) Amount of organization (desried on lines -9 listed in your support (see other support (see governing doument? aove or IRC setion Instrutions) Instrutions) (see instrutions)) Yes No Total LHA For Paperwork Redution At Notie, see the Instrutions for Form 990 or 990-EZ Shedule A (Form 990 or 990-EZ) 0

15 Shedule A (Form 990 or 990-EZ) 0 WITH DISABILITIES, INC Page Part II Support Shedule for Organizations Desried in Setions 70()()(A)(iv) and 70()()(A)(vi) (Complete only if you heked the ox on line, 7, or 8 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 omplete Part III.) Setion A. Puli Support Calendar year (or fisal year eginning in) Total. Add lines through ~~~ 6 Puli support. Sutrat line from line. Calendar year (or fisal year eginning in) assets (Explain in Part VI.) ~~~~ Total support. Add lines 7 through 0 (a) 00 () 0 () 0 (d) 0 (e) 0 (f) Total (a) 00 () 0 () 0 (d) 0 (e) 0 (f) Total 69,.,9. 00,000., ,67.,7,8. First five years. If the Form 990 is for the organization s first, seond, third, fourth, or fifth tax year as a setion 0()() 7a 0% -fats-and-irumstanes test - 0. If the organization did not hek a ox on line, 6a, or 6, and line is 0% or more, 8 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") ~~ Tax revenues levied for the organization s enefit and either paid to or expended on its ehalf ~~~~ The value of servies or failities furnished y a governmental unit to the organization without harge ~ The portion of total ontriutions y eah person (other than a governmental unit or pulily supported organization) inluded on line that exeeds % of the amount shown on line, olumn (f) ~~~~~~~~~~~~ Setion B. Total Support Amounts from line ~~~~~~~ Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures ~ Net inome from unrelated usiness ativities, whether or not the usiness is regularly arried on ~ Other inome. Do not inlude gain or loss from the sale of apital 69,.,9. 00,000., ,67.,7,8. 69,.,9. 00,000., ,67.,7,8. Gross reeipts from related ativities, et. (see instrutions) ~~~~~~~~~~~~~~~~~~~~~~~ /% support test - 0. If the organization did not hek a ox on line or 6a, and line is /% or more, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part VI how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~ 0% -fats-and-irumstanes test - 0. If the organization did not hek a ox on line, 6a, 6, or 7a, and line is 0% or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part VI how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization ~~~~~~~~ Private foundation. If the organization did not hek a ox on line, 6a, 6, 7a, or 7, hek this ox and see instrutions 6,06.,,9.,7,8. organization, hek this ox and stop here Setion C. Computation of Puli Support Perentage Puli support perentage for 0 (line 6, olumn (f) divided y line, olumn (f)) ~~~~~~~~~~~~ 99. Puli support perentage from 0 Shedule A, Part II, line ~~~~~~~~~~~~~~~~~~~~~ a /% support test - 0. If the organization did not hek the ox on line, and line is /% or more, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Shedule A (Form 990 or 990-EZ) 0 % %

16 Shedule A (Form 990 or 990-EZ) 0 Part III Support Shedule for Organizations Desried in Setion 09(a)() Calendar year (or fisal year eginning in) 6 The value of servies or failities furnished y a governmental unit to the organization without harge ~ Total. Add lines through ~~~ 7a Amounts inluded on lines,, and reeived from disqualified persons Amounts inluded on lines and reeived from other than disqualified persons that exeed the greater of $,000 or % of the amount on line for the year ~~~~~~ Add lines 7a and 7 ~~~~~~~ 8 Puli support (Sutrat line 7 from line 6.) Calendar year (or fisal year eginning in) 9 Amounts from line 6 ~~~~~~~ 0a Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures ~ Unrelated usiness taxale inome (less setion taxes) from usinesses aquired after June 0, 97 ~~~~ (a) 00 () 0 () 0 (d) 0 (e) 0 (f) Total (a) 00 () 0 () 0 (d) 0 (e) 0 (f) Total First five years. If the Form 990 is for the organization s first, seond, third, fourth, or fifth tax year as a setion 0()() organization, hek this ox and stop here Setion C. Computation of Puli Support Perentage 6 Puli support perentage from 0 Shedule A, Part III, line Setion D. Computation of Investment Inome Perentage 7 8 Page Puli support perentage for 0 (line 8, olumn (f) divided y line, olumn (f)) ~~~~~~~~~~~~ % 9a /% support tests - 0. If the organization did not hek the ox on line, and line is more than /%, and line 7 is not 0 (Complete only if you heked the ox on line 9 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 omplete Part II.) Setion A. Puli Support Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") ~~ Gross reeipts from admissions, merhandise sold or servies performed, or failities furnished in any ativity that is related to the organization s tax-exempt purpose Gross reeipts from ativities that are not an unrelated trade or usiness under setion ~~~~~ Tax revenues levied for the organization s enefit and either paid to or expended on its ehalf ~~~~ Setion B. Total Support Add lines 0a and 0 ~~~~~~ Net inome from unrelated usiness ativities not inluded in line 0, whether or not the usiness is regularly arried on ~~~~~~~ Other inome. Do not inlude gain or loss from the sale of apital assets (Explain in Part VI.) ~~~~ Total support. (Add lines 9, 0,, and.) Investment inome perentage for 0 (line 0, olumn (f) divided y line, olumn (f)) Investment inome perentage from 0 Shedule A, Part III, line 7 ~~~~~~~~~~~~~~~~~~ 6 ~~~~~~~~ 7 % more than /%, hek this ox and stop here. The organization qualifies as a pulily supported organization ~~~~~~~~~~ /% support tests - 0. If the organization did not hek a ox on line or line 9a, and line 6 is more than /%, and line 8 is not more than /%, hek this ox and stop here. The organization qualifies as a pulily supported organization~~~~ Private foundation. If the organization did not hek a ox on line, 9a, or 9, hek this ox and see instrutions 8 % % Shedule A (Form 990 or 990-EZ) 0