Public Inspection Copy

Transcription

1 Form Pulic Inspection Copy Check if applicale: Department of the Treasury Internal Revenue Service A B G I 990-EZ For the 0 calendar year, or tax year eginning C Name of organization Address change Name change Initial return Final return/terminated Amended return Application pending Accounting Method: Wesite: Short Form Return of Organization Exempt From Income Tax Under section 0(c),, or 9(a)() of the Internal Revenue Code (except private foundations) Do not enter social security numers on this form as it may e made pulic. Go to for instructions and the latest information. 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, and ending Room/suite 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 through For Paperwork Reduction Act tice, see the separate instructions. Telephone numer OMB. -0 F Group Exemption Numer Check if the organization is not required to attach Schedule B (Form 990, 990-EZ, or 990-PF). J Tax-exempt status (check only one) 0(c)() 0(c) ( ) (insert no.) 9(a)() or K Form of organization: Corporation Trust Association Other L Add lines, c, and to line 9 to determine gross receipts. If gross receipts are $00,000 or more, or if total assets (Part II, column (B) elow) are $00,000 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) 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 from line a) c Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than $,000)... a Gross income from fundraising events (not including $,0 of contriutions from fundraising events reported on line ) (attach Schedule G if the sum of such gross income and contriutions exceeds $,000) ,099 c Less: direct expenses from gaming and fundraising events c,0 d Net income or (loss) from gaming and fundraising events (add lines a and and sutract line c) d a Gross sales of inventory, less returns and allowances a Less: cost of goods sold c Gross profit or (loss) from sales of inventory (Sutract line from line a) c Other revenue (descrie in Schedule O)... 9 Total revenue. Add lines,,,, c, d, c, 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 0 through Excess or (deficit) for the year (Sutract line from line 9) Net assets or fund alances at eginning of year (from line, column (A)) (must agree with 9 0 Net Assets Expenses Revenue HEARTLIGHT CENTER, INC. 0 E. DARTMOUTH AVENUE DENVER CO 00-0 Cash Accrual Other (specify) H D E 0 Open to Pulic Inspection Employer identification numer ,0 0,,9 -, 09, 00, 90,9,0,0,9,9 Form 990-EZ (0)

2 Form 990-EZ (0) (A) Beginning of year Pulic Inspection Copy 0 Check if the organization used Schedule O to respond to any question in this Part III.... What is the organization's primary exempt purpose? SEE SCHEDULE O Descrie the organization's program service accomplishments for each of its three largest program services, as measured y expenses. In a clear and concise manner, descrie the services provided, the numer of persons enefited, and other relevant information for each program title (Grants $ ) If this amount includes foreign grants, check here a 9.. SEE SCHEDULE O (Grants $ ) If this amount includes foreign grants, check here a 0.. SEE SCHEDULE O Part II Part III Balance Sheets (see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part II (B) End of year 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 of column (B) must agree with line ) Statement of Program Service Accomplishments (see the instructions for Part III) SEE SCHEDULE O Page Expenses (Required for section 0(c)() and 0(c)() organizations; optional for (Grants $ ) If this amount includes foreign grants, check here a Other program services (descrie in Schedule O).. (Grants $ 00 ) If this amount includes foreign grants, check here a, Total program service expenses (add lines a through a) , 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) Health enefits, (a) Name and title hours per week compensation contriutions to employee (e) Estimated amount of devoted to position (Forms W-/099-MISC) enefit plans, and other compensation (if not paid, enter -0-) deferred compensation,0,9 0,0, 9,,,0,9,9 JENNIFER A. MCBRIDE EECUTIVE DIRECTOR 0.00, 0 0 EMILY JOHNSON EMPLOYEE.00, 0 0 JILL HEAP PRESIDENT JAMES P. MCCONATY VICE PRESIDENT GLORIA PADILLA DE GARCIA TREASURER JUNE SEPPA DIRECTOR BARBARA WILCO DIRECTOR TOM DUNN DIRECTOR STEPHANIE HEITKEMPER DIRECTOR EFFIE KAVADAS-WILSON DIRECTOR MARLENE SEWARD DIRECTOR AMY URLACHER DIRECTOR others.) Form 990-EZ (0)

3 Form 990-EZ (0) Part V 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 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 $,000 or more during the year from usiness activities (such as those reported on lines, a, and a, among others)? a If, to line a, has the organization filed a Form 990-T for the year? If, provide an explanation in Schedule O c Was the organization a section 0(c)(), 0(c)(), or 0(c)() organization suject to section 0(e) notice, reporting, and proxy tax requirements during the year? If, complete Schedule C, Part III c 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.... a Did the organization file Form 0-POL for this year? a Did the organization orrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the tax year covered y this return? a If, complete Schedule L, Part II and enter the total amount involved Section 0(c)() organizations. Enter: a Initiation fees and capital contriutions included on line a Gross receipts, included on line 9, for pulic use of clu facilities a Section 0(c)() organizations. Enter amount of tax imposed on the organization during the year under: section 9 ; section 9 ; section 9 Section 0(c)(), 0(c)(), and 0(c)(9) organizations. Did the organization engage in any section 9 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 990 or 990-EZ? If, complete Schedule L, Part I c Section 0(c)(), 0(c)(), and 0(c)(9) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 9, Did the organization engage in any significant activity not previously reported to the IRS? If, provide a detailed Pulic description of each activity in Schedule Inspection O Copy Were any significant changes made to the organizing or governing documents? If, attach a conformed Page d 9, and Section 0(c)(), 0(c)(), and 0(c)(9) organizations. Enter amount of tax on line 0c 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 -T e List the states with which a copy of this return is filed NONE a The organization's ooks are in care of HEARTLIGHT CENTER, INC Telephone no E. DARTMOUTH AVENUE Located at DENVER CO.... 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 FinCEN Form, Report of Foreign Bank and Financial Accounts (FBAR). c At any time during the calendar year, did the organization maintain an office outside the United States? c If "," enter the name of the foreign country: Section 9(a)() nonexempt charitale trusts filing Form 990-EZ in lieu of Form 0 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 990 must e completed instead of Form 990-EZ a Did the organization operate one or more hospital facilities during the year? If "," Form 990 must e completed instead of Form 990-EZ c Did the organization receive any payments for indoor tanning services during the year? c d If "" to line c, has the organization filed a Form 0 to report these payments? If "," provide an explanation in Schedule O d a Did the organization have a controlled entity within the meaning of section ()()? Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section ()()? If "," Form 990 and Schedule R may need to e completed instead of Form 990-EZ (see instructions) a Form 990-EZ (0)

4 Form 990-EZ (0) 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 9a 0 Pulic Section 0(c)() organizations Inspection only Copy All section 0(c)() organizations must answer questions 9 and, and complete the tales for lines 0 and. 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 0(h) election in effect during the tax year? If, complete Schedule C, Part II Is the organization a school as descried in section 0()()(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 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 $00,000 of compensation from the organization. If there is none, enter ne. NONE (a) Name and title of each employee. 9a 9 Page () Average (c) Reportale (d) Health enefits, hours per week compensation (e) Estimated amount of contriutions to employee devoted to position (Forms W-/099-MISC) enefit plans, and other compensation deferred compensation f Total numer of other employees paid over $00, Complete this tale for the organization's five highest compensated independent contractors who each received more than $00,000 of compensation from the organization. If there is none, enter ne. (a) Name and usiness address of each independent contractor () Type of service (c) Compensation NONE d Total numer of other independent contractors each receiving over $00, Did the organization complete Schedule A? te: All section 0(c)() organizations 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 Firm's name Signature of officer Type or print name and title Print/Type preparer's name Firm's address JENNIFER A. MCBRIDE Preparer's signature Date EECUTIVE DIRECTOR Date Firm's EIN Phone no. Check if self-employed PRESTON L. HOFER, CPA PRESTON L. HOFER, CPA // P00090 HARPER HOFER & ASSOCIATES, LLC TH STREET, STE 0 DENVER, CO 00 May the IRS discuss this return with the preparer shown aove? See instructions PTIN Form 990-EZ (0)

5 Form 990-EZ (0) (A) Beginning of year Pulic Inspection Copy Check if the organization used Schedule O to respond to any question in this Part III.... What is the organization's primary exempt purpose? Descrie the organization's program service accomplishments for each of its three largest program services, as measured y expenses. In a clear and concise manner, descrie the services provided, the numer of persons enefited, and other relevant information for each program title. Part II Part III Balance Sheets (see the instructions for Part II) Check if the organization used Schedule O to respond to any question in this Part II (B) End of year 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 of column (B) must agree with line ) Statement of Program Service Accomplishments (see the instructions for Part III) (Grants $ ) If this amount includes foreign grants, check here a (Grants $ ) If this amount includes foreign grants, check here a (Grants $ ) If this amount includes foreign grants, check here a Other program services (descrie in Schedule O).. (Grants $ ) If this amount includes foreign grants, check here a Total program service expenses (add lines a through a) 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) Health enefits, (a) Name and title hours per week compensation contriutions to employee (e) Estimated amount of devoted to position (Forms W-/099-MISC) enefit plans, and other compensation (if not paid, enter -0-) deferred compensation. Page Expenses (Required for section 0(c)() and 0(c)() organizations; optional for JOHN VELDKAMP DIRECTOR others.) Form 990-EZ (0)

6 SCHEDULE A (Form 990 or 990-EZ) Department of the Treasury Internal Revenue Service Pulic Inspection Copy Employer identification numer Name of the organization Part I (i) Name of supported organization Pulic Charity Status and Pulic Support Complete if the organization is a section 0(c)() organization or a section 9(a)() nonexempt charitale trust. Attach to Form 990 or Form 990-EZ. 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 through, check only one ox.) OMB Open to Pulic Inspection A church, convention of churches, or association of churches descried in section 0()()(A)(i). A school descried in section 0()()(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).) A hospital or a cooperative hospital service organization descried in section 0()()(A)(iii). A medical research organization operated in conjunction with a hospital descried in section 0()()(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 0()()(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit descried in section 0()()(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 0()()(A)(vi). (Complete Part II.) A community trust descried in section 0()()(A)(vi). (Complete Part II.) 9 An agricultural research organization descried in section 0()()(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture (see instructions). Enter the name, city, and state of the college or university: An organization that normally receives: () more than /% of its support from contriutions, memership fees, and gross receipts from activities related to its exempt functions suject to certain exceptions, and () no more than /% of its support from gross investment income and unrelated usiness taxale income (less section tax) from usinesses acquired y the organization after June 0, 9. See section 09(a)(). (Complete Part III.) (A) An organization organized and operated exclusively to test for pulic safety. See section 09(a)(). 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 09(a)() or section 09(a)(). See section 09(a)(). Check the ox in lines a through d that descries the type of supporting organization and complete lines e, f, and g. a Type I. A supporting organization operated, supervised, or controlled y its supported organization(s), typically y giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B. Type II. A supporting organization supervised or controlled in connection with its supported organization(s), y having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C. c Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E. d Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distriution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V. e Check this ox if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization. f Enter the numer of supported organizations g Provide the following information aout the supported organization(s). (ii) EIN Go to for instructions and the latest information. (iii) Type of organization (descried on lines 0 aove (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions) (B) (C) (D) (E) Total For Paperwork Reduction Act tice, see the Instructions for Form 990 or 990-EZ. Schedule A (Form 990 or 990-EZ) 0

7 Schedule A (Form 990 or 990-EZ) 0 Section A. Pulic Support Inspection Copy Part II Support Schedule for Organizations Descried in Sections 0()()(A)(iv) and 0()()(A)(vi) (Complete only if you checked the ox on line,, 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.) Calendar year (or fiscal year eginning in) Gifts, grants, contriutions, and memership fees received. (Do not include any "unusual grants.") (a) 0 () 0 (c) 0 (d) 0 (e) 0 (f) Total Page 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 through The portion of total contriutions y each person (other than a governmental unit or pulicly supported organization) included on line that exceeds % of the amount shown on line, column (f) Pulic support. Sutract line from line. Section B. Total Support Calendar year (or fiscal year eginning in) 0 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 VI.) Total support. Add lines through 0 (a) 0 () 0 (c) 0 (d) 0 (e) 0 Gross receipts from related activities, etc. (see instructions) First five years. If the Form 990 is for the organization s first, second, third, fourth, or fifth tax year as a section 0(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage Pulic support percentage for 0 (line, column (f) divided y line, column (f)) Pulic support percentage from 0 Schedule A, Part II, line a /% support test 0. If the organization did not check the ox on line, and line is /% or more, check this (f) Total % % a ox and stop here. The organization qualifies as a pulicly supported organization /% support test 0. If the organization did not check a ox on line or a, and line is /% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization %-facts-and-circumstances test 0. If the organization did not check a ox on line, a, or, and line is 0% or more, and if the organization meets the "facts-and-circumstances" test, check this ox and stop here. Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a pulicly supported organization %-facts-and-circumstances test 0. If the organization did not check a ox on line, a,, or a, and line is 0% or more, and if the organization meets the "facts-and-circumstances" test, check this ox and stop here. Explain in Part VI 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, a,, a, or, check this ox and see instructions Schedule A (Form 990 or 990-EZ) 0

8 Schedule A (Form 990 or 990-EZ) 0 Page Part III Support Schedule for Organizations Descried in Section 09(a)() (Complete only if you checked the ox on line 0 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) Pulic Inspection Copy 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 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 through a Amounts included on lines,, and received from disqualified persons.... Amounts included on lines and received from other than disqualified persons that exceed the greater of $,000 or % of the amount on line for the year. c Add lines a and Pulic support. (Sutract line c from line.) Section B. Total Support Calendar year (or fiscal year eginning in) 9 0a Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources. Unrelated usiness taxale income (less section taxes) from usinesses acquired after June 0, c Add lines 0a and Net income from unrelated usiness activities not included in line 0, 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 VI.) Total support. (Add lines 9, 0c,, and.) , 0,,9,,0, First five years. If the Form 990 is for the organization s first, second, third, fourth, or fifth tax year as a section 0(c)() organization, check this ox and stop here Section C. Computation of Pulic Support Percentage Pulic support percentage for 0 (line, column (f) divided y line, column (f)) Pulic support percentage from 0 Schedule A, Part III, line Section D. Computation of Investment Income Percentage Investment income percentage for 0 (line 0c, column (f) divided y line, column (f)) Investment income percentage from 0 Schedule A, Part III, line a /% support tests 0. If the organization did not check the ox on line, and line is more than /%, and line is not more than /%, check this ox and stop here. The organization qualifies as a pulicly supported organization /% support tests 0. If the organization did not check a ox on line or line 9a, and line is more than /%, and line is not more than /%, 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, 9a, or 9, check this ox and see instructions (a) 0 () 0 (c) 0 (d) 0 (e) 0 (a) 0 () 0 (c) 0 (d) 0 (e) 0 (f) Total, 0,,0,90 0,,09, 0,99,,,9 0, 9, 0,,9,,0,,000,000 0,000,000,000 0,000, (f) Total 9, 0,,9,,0, 9. % 9. % % % Schedule A (Form 990 or 990-EZ) 0

9 Schedule A (Form 990 or 990-EZ) 0 Page Part IV Supporting Organizations (Complete only if you checked a ox in line on Part I. If you checked a of Part I, complete Sections A and B. If you checked of Part I, complete Sections A and C. If you checked c of Part I, complete Pulic Sections A, D, and E. If you Inspection checked d of Part I, complete Sections A and D, Copy and complete Part V.) Section A. All Supporting Organizations a c a c a c 9a c 0a Are all of the organization s supported organizations listed y name in the organization s governing documents? If "," descrie in Part VI how the supported organizations are designated. If designated y class or purpose, descrie the designation. If historic and continuing relationship, explain. Did the organization have any supported organization that does not have an IRS determination of status under section 09(a)() or ()? If "," explain in Part VI how the organization determined that the supported organization was descried in section 09(a)() or (). Did the organization have a supported organization descried in section 0(c)(), (), or ()? If "," answer () and (c) elow. Did the organization confirm that each supported organization qualified under section 0(c)(), (), or () and satisfied the pulic support tests under section 09(a)()? If "," descrie in Part VI when and how the organization made the determination. Did the organization ensure that all support to such organizations was used exclusively for section 0(c)()(B) purposes? If "," explain in Part VI what controls the organization put in place to ensure such use. Was any supported organization not organized in the United States ("foreign supported organization")? If "," and if you checked a or in Part I, answer () and (c) elow. Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If "," descrie in Part VI how the organization had such control and discretion despite eing controlled or supervised y or in connection with its supported organizations. Did the organization support any foreign supported organization that does not have an IRS determination under sections 0(c)() and 09(a)() or ()? If "," explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 0(c)()(B) purposes. Did the organization add, sustitute, or remove any supported organizations during the tax year? If "," answer () and (c) elow (if applicale). Also, provide detail in Part VI, including (i) the names and EIN numers of the supported organizations added, sustituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as y amendment to the organizing document). Type I or Type II only. Was any added or sustituted supported organization part of a class already designated in the organization's organizing document? Sustitutions only. Was the sustitution the result of an event eyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitale class enefited y one or more of its supported organizations, or (iii) other supporting organizations that also support or enefit one or more of the filing organization s supported organizations? If "," provide detail in Part VI. Did the organization provide a grant, loan, compensation, or other similar payment to a sustantial contriutor (defined in section 9(c)()(C)), a family memer of a sustantial contriutor, or a % controlled entity with regard to a sustantial contriutor? If "," complete Part I of Schedule L (Form 990 or 990-EZ). Did the organization make a loan to a disqualified person (as defined in section 9) not descried in line? If "," complete Part I of Schedule L (Form 990 or 990-EZ). Was the organization controlled directly or indirectly at any time during the tax year y one or more disqualified persons as defined in section 9 (other than foundation managers and organizations descried in section 09(a)() or ())? If "," provide detail in Part VI. Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If "," provide detail in Part VI. Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal enefit from, assets in which the supporting organization also had an interest? If "," provide detail in Part VI. Was the organization suject to the excess usiness holdings rules of section 9 ecause of section 9(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If "," answer 0 elow. Did the organization have any excess usiness holdings in the tax year? (Use Schedule C, Form 0, to determine whether the organization had excess usiness holdings.) a c a c a c 9a 9 9c 0a 0 Schedule A (Form 990 or 990-EZ) 0

10 Schedule A (Form 990 or 990-EZ) 0 Page Part IV a Supporting Organizations (continued) Pulic Inspection Copy Section B. Type I Supporting Organizations c Has the organization accepted a gift or contriution from any of the following persons? A person who directly or indirectly controls, either alone or together with persons descried in () and (c) elow, the governing ody of a supported organization? A family memer of a person descried in (a) aove? A % controlled entity of a person descried in (a) or () aove? If "" to a,, or c, provide detail in Part VI. Did the directors, trustees, or memership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization s directors or trustees at all times during the tax year? If "," descrie in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization s activities. If the organization had more than one supported organization, descrie how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year. Did the organization operate for the enefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If "," explain in Part VI how providing such enefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. Section C. Type II Supporting Organizations Were a majority of the organization s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization s supported organization(s)? If "," descrie in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). Section D. All Type III Supporting Organizations Did the organization provide to each of its supported organizations, y the last day of the fifth month of the organization s tax year, (i) a written notice descriing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization s governing documents in effect on the date of notification, to the extent not previously provided? Were any of the organization s officers, directors, or trustees either (i) appointed or elected y the supported organization(s) or (ii) serving on the governing ody of a supported organization? If "," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s). By reason of the relationship descried in (), did the organization s supported organizations have a significant voice in the organization s investment policies and in directing the use of the organization s income or assets at all times during the tax year? If "," descrie in Part VI the role the organization s supported organizations played in this regard. Section E. Type III Functionally-Integrated Supporting Organizations Check the ox next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions). a The organization satisfied the Activities Test. Complete line elow. The organization is the parent of each of its supported organizations. Complete line elow. c The organization supported a governmental entity. Descrie in Part VI how you supported a government entity (see instructions). a c Activities Test. Answer (a) and () elow. a Did sustantially all of the organization s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted sustantially all of its activities. a Did the activities descried in (a) constitute activities that, ut for the organization s involvement, one or more of the organization s supported organization(s) would have een engaged in? If "," explain in Part VI the reasons for the organization s position that its supported organization(s) would have engaged in these activities ut for the organization s involvement. Parent of Supported Organizations. Answer (a) and () elow. a Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI. a Did the organization exercise a sustantial degree of direction over the policies, programs, and activities of each of its supported organizations? If "," descrie in Part VI the role played y the organization in this regard. Schedule A (Form 990 or 990-EZ) 0

11 Schedule A (Form 990 or 990-EZ) 0 Page Part V Type III n-functionally Integrated 09(a)() Supporting Organizations Check here if the organization satisfied the Integral Part Test as a qualifying trust on v. 0, 90 (explain in Part VI).See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E. Pulic Inspection Copy Section A - Adjusted Net Income Net short-term capital gain Recoveries of prior-year distriutions Other gross income (see instructions) Add lines through. Depreciation and depletion Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) Other expenses (see instructions) Adjusted Net Income (sutract lines, and from line ). Section B - Minimum Asset Amount Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): a c d e Average monthly value of securities Average monthly cash alances Fair market value of other non-exempt-use assets Total (add lines a,, and c) Discount claimed for lockage or other factors (explain in detail in Part VI): Acquisition indetedness applicale to non-exempt-use assets Sutract line from line d. Cash deemed held for exempt use. Enter -/% of line (for greater amount, see instructions). Net value of non-exempt-use assets (sutract line from line ) Multiply line y.0. Recoveries of prior-year distriutions Minimum Asset Amount (add line to line ) Section C - Distriutale Amount Adjusted net income for prior year (from Section A, line, Column A) Enter % of line. Minimum asset amount for prior year (from Section B, line, Column A) Enter greater of line or line. Income tax imposed in prior year Distriutale Amount. Sutract line from line, unless suject to emergency temporary reduction (see instructions). Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see instructions). Schedule A (Form 990 or 990-EZ) 0 a c d (A) Prior Year (A) Prior Year (B) Current Year (optional) (B) Current Year (optional) Current Year

12 Schedule A (Form 990 or 990-EZ) 0 Part V Section D - Distriutions 9 0 a c d e f g h i j a c a c d e Type III n-functionally Integrated 09(a)() Supporting Organizations (continued) Current Year Amounts paid to supported organizations to accomplish exempt purposes Amounts Pulic paid to perform activity that directly Inspection furthers exempt purposes of supported Copy organizations, in excess of income from activity Administrative expenses paid to accomplish exempt purposes of supported organizations Amounts paid to acquire exempt-use assets Qualified set-aside amounts (prior IRS approval required) Other distriutions (descrie in Part VI). See instructions. Total annual distriutions. Add lines through. Distriutions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions. Distriutale amount for 0 from Section C, line Line amount divided y line 9 amount (i) Section E - Distriution Allocations (see instructions) Excess Distriutions Distriutale amount for 0 from Section C, line Underdistriutions, if any, for years prior to 0 (reasonale cause required-explain in Part VI). See instructions. Excess distriutions carryover, if any, to 0: From 0 From From From Total of lines a through e Applied to underdistriutions of prior years Applied to 0 distriutale amount Carryover from 0 not applied (see instructions) Remainder. Sutract lines g, h, and i from f. Distriutions for 0 from Section D, line : $ Applied to underdistriutions of prior years Applied to 0 distriutale amount Remainder. Sutract lines a and from. Remaining underdistriutions for years prior to 0, if any. Sutract lines g and a from line. For result greater than zero, explain in Part VI. See instructions. Remaining underdistriutions for 0. Sutract lines h and from line. For result greater than zero, explain in Part VI. See instructions. Excess distriutions carryover to 0. Add lines j and c. Breakdown of line : Excess from 0 Excess from Excess from Excess from Excess from (ii) Underdistriutions Pre-0 (iii) Distriutale Amount for 0 Page Schedule A (Form 990 or 990-EZ) 0

13 Schedule A (Form 990 or 990-EZ) 0 Part VI Supplemental Information. Provide the explanations required y Part II, line 0; Part II, line a or ; Part III, line ; Part IV, Section A, lines,,, c,, c, a,, 9a, 9, 9c, a,, and c; Part IV, Section B, lines and ; Part IV, Section C, line ; Part IV, Section D, lines and ; Part IV, Section E, lines c, a,, a and ; Part V, line ; Part V, Section B, line e; Part V, Section D, lines,, and ; and Part V, Section E, lines,, and. Also complete this part for any additional information. (See instructions.) Pulic Inspection Copy Page Schedule A (Form 990 or 990-EZ) 0

14 Schedule B (Form 990, 990-EZ, OMB. -00 Department of the Treasury Internal Revenue Service Pulic Inspection Copy Name of the organization Schedule of Contriutors or 990-PF) Attach to Form 990, Form 990-EZ, or Form 990-PF. Go to for the latest information. Organization type (check one): 0 Employer identification numer Filers of: Section: Form 990 or 990-EZ 0(c)( ) (enter numer) organization 9(a)() nonexempt charitale trust not treated as a private foundation political organization Form 990-PF 0(c)() exempt private foundation 9(a)() nonexempt charitale trust treated as a private foundation 0(c)() taxale private foundation Check if your organization is covered y the General Rule or a Special Rule. te: Only a section 0(c)(), (), or (0) organization can check oxes for oth the General Rule and a Special Rule. See instructions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contriutions totaling $,000 or more (in money or property) from any one contriutor. Complete Parts I and II. See instructions for determining a contriutor's total contriutions. Special Rules For an organization descried in section 0(c)() filing Form 990 or 990-EZ that met the /% support test of the regulations under sections 09(a)() and 0()()(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line, a, or, and that received from any one contriutor, during the year, total contriutions of the greater of () $,000; or () % of the amount on (i) Form 990, Part VIII, line h; or (ii) Form 990-EZ, line. Complete Parts I and II. For an organization descried in section 0(c)(), (), or (0) filing Form 990 or 990-EZ that received from any one contriutor, during the year, total contriutions of more than $,000 exclusively for religious, charitale, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III. For an organization descried in section 0(c)(), (), or (0) filing Form 990 or 990-EZ that received from any one contriutor, during the year, contriutions exclusively for religious, charitale, etc., purposes, ut no such contriutions totaled more than $,000. If this ox is checked, enter here the total contriutions that were received during the year for an exclusively religious, charitale, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization ecause it received nonexclusively religious, charitale, etc., contriutions totaling $,000 or more during the year $ Caution: An organization that isn't covered y the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF), ut it must answer on Part IV, line, of its Form 990; or check the ox on line H of its Form 990-EZ or on its Form 990-PF, Part I, line, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). For Paperwork Reduction Act tice, see the instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (0)

15 Schedule B (Form 990, 990-EZ, or 990-PF) (0) Name of organization HEARTLIGHT CENTER, INC. Part I Pulic Inspection Copy Contriutors (see instructions). Use duplicate copies of Part I if additional space is needed. (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution , $ PAGE OF Page Employer identification numer -0 Person Payroll ncash (Complete Part II for noncash contriutions.) (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution , $ Person Payroll ncash (Complete Part II for noncash contriutions.) (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution ,000 $ Person Payroll ncash (Complete Part II for noncash contriutions.) (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution ,000 $ Person Payroll ncash (Complete Part II for noncash contriutions.) (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution ,00 $ Person Payroll ncash (Complete Part II for noncash contriutions.) (a) () (c) (d). Name, address, and ZIP + Total contriutions Type of contriution $ Person Payroll ncash (Complete Part II for noncash contriutions.) Schedule B (Form 990, 990-EZ, or 990-PF) (0)