Return of Organization Exempt from Income Tax

Transcription

1 Form 990 Rturn of Organization Exmpt from Incom Tax Undr sction 501(c), 527, or 4947(a)('1) of th Intrnal Rvnu Cod (xcpt lack lung nfit trust or privat foundation) Dpartmnt of th Trasury Intrnal Rvnu Srvic ~ Th organization may hav to us a copy of this rturn to satisfy stat rporting r~ A For th 2003 calndar ar, or tax yar ginning, 2003, and B Chck if applical Addrss mang Nam chang Plas or print ty P. or S Initial rturn spcific mstruc- Final rturn lions. Amndd rturn u Application pnding G W sit : " N/A FOCUS ON CHILDREN 65 EAST 600 NORTH WELLSVILLE, UT " Sction 501(cX3) organizations and 4947(a~) nonxmpt charital trusts must attach a compltd Schdul A (Form 990 or 990-EZ). OMB No Opn to Pulic Inspction D Employr Idntification Numr F Accounting mthod : Othr (spcify) H and I ar not applical to sction 527 organizations H (a) Is this a group rturn for affiliats H () If 'Ys.' ntr numr of affiliats 0' Z Cash 11 Accrual ~ Ys X No H (C) Ar all affiliats includd LJ Ys L-J No I. J Organization ty E ~ J (If 'No,' attach a list S instructions ) (Chck onl y on ~ 501(c) ~ (insrt no) 4947(a)(1) or H (d) i5 this a sparat rturn fild y an K Chck hr O Hif th organization's gross rcipts ar normally not mor than organization covrd y a group rulings n Ys IX No $25,000. Th organization nd not fil a rturn with th IRS, ut if th organization rcivd a Form 990 Packag m th mad, it should fil a rturn without financial data 1 Numr 10. Som stats rquir a complt rturn. L Gross rcipts Add lins and lo to lin , 709. Chck - U if th organization is not rquird to attach Schdul B (Form 990, 990-EZ, or 990-PFD. Part 1 Rvnu, Expnss, and Changs in Nt Assts or Fund Balancs s instructions) 1 Contriutions, gifts, grants, and similar amounts rcivd : a Dirct pulic support 1 a 62, 394. Indirct pulic support 1 c Govrnmnt contriutions (grants) 1 c d Total (add a l1 cj (cash $ 62,394. noncash q ) 2 Program srvic rvnu including govrnmnt fs and contracts (from Part VII, lin 93) 3 Mmrship dus and assssmnts 4 Intrst on savings and tmporary cash invstmnts. 5 Dividnds and intrst from scuritis 6a Gross rnts 6a Lss rntal xpnss 6 c Nt rntal incom or (loss) (sutract lin 6 from lin 6a) R 7 Othr invstmnt incom (dscri DO ) E (A) Scuritis (B) Othr 8a Gross amount from sals of assts othr than invntory 8a Lss cost or othr asis and sals xpnss 8 c Gain or (loss) (sttach schdui~ 8c d Nt gain or (loss) (comin lin 8c, columns (A) and (B)) 9 Spcial vnts and activitis (attach schdul) If any amount is from gaming, chck hr a Gross rvnu (not including $ of contriutions rportd on lin la) Lss : dirct xpnss othr than fundraising xpnss c Nt or (loss) from spcial vnts (sutract lin 9 from lin 9a) 9c 10a Gro s salsr j!jv r urn and allowancs I 10al 33,788a C=) Ls c I 10j 20,000. C=) c Gros it or I s from sals of in n ttach schdul) (sutract lin lo from lin 10a) STATEMENT 1 10c N 11 Ot v4w*rjn 7ABNO 11 3) 12 To I r niip,46-jda.11ns 1 d, 2 5, 6c, 7, 8d, 9c, I Oc, and 11) 13 Fir ram QGJDL VN hur, -o c I n (13)) JE x 14 3nagm 3 n ol 44, column (Q) P a g AMM4$1 E 15 Fundraising (from lin 44, column (D)) IN (=j 16 Paymnts to affiliats (attach schdul) LLJ5 17 Total xpnss (add lins 16 and 44, column (A)).PP -JA 18 Excss or (dficit) for th yar (sutract lin 17 from lin 12) t 19 Nt assts or fund alancs at ginning of yar (from lin 73, column (A)) i s T E T 20 Othr changs in nt assts or fund alancs (attach xplanation) S 21 Nt assts or fund alancs at nd of yar (comin lins 18, 19, and 20) BAA For Paprwork Rduction Act Notic, s th sparat instructions. TEEA0107L 10/03/03 9a E Tlphon numr 1d c 7 8d 62, , , , , , ,790. 7, , ,260. Form 990 (2003)

2 990 (2003) FOCUS ON Pag 2 [part t1 I Statmnt of Functional E; I15S All organizations must complt column (A). Columns (B), (C), and (D) ar rquird for sction 501(c)(3) and organizations and sction 4947(a)(1) nonxmpt charital trusts ut optional for othrs Do not includ amounts rportd on lin 66, 86, 9, 10, or 16 of Part I 22 Grants and allocations (aft sch) (cash $ non-cash $ ) 23 Spcific assistanc to individuals (aft sch) ST 2 24 Bnfits paid to or for mmrs (aft sch) 25 Compnsation of officrs, dirctors, tc 26 Othr salaris and wags 27 Pnsion plan contriutions 28 Othr mploy nfits 29 Payroll taxs 30 Profssional fundraising fs 31 Accounting ts 32 Lgal fs 33 Supplis 34 Tlphon 35 Postag and shipping 36 Occupancy 37 Equipmnt rntal and maintnanc 38 Printing and pulications 39 Travl 40 Confrncs, convntions, and mtings 41 Intrst 42 Dprciation, dpltion, tc (attach schdul) 43 Othr xpnss not covrd aov (itmiz) a SEE STATEMENT 3 (A) Total (B) Program (C) Managmnt srvics and gnral , , , , , , , ~ 40, , , , , , a1 399, , , ,335. 2, ,134. 4, , ,179. 6,259. 2, , , ,863. D Fundraising c d Total functional xpnss (add lins 22-43) Organizations complting columns (B) - (D) carry ths totals to lins l , , , Joint Costs. Chck - if you ar following SOP 98-2 Ar any point costs from a comind ducational campaign and fundraising solicitation rportd in (B) Program srvics? I-F] Ys N No If 'Ys,' ntr (i) th aggrgat amount of ths point costs $ ; (ii) th amount allocatd to Program srvics $, (iii) th amount allocatd to Managmnt and gnral $ ; and (iv) th amount allocatd to Fundraising $ Part III I Statmnt of Program Srvic Accomplishmnts What is th organization's primary xmpt purpos? ~ HUMANITARIAN ADOPTION SERVICE Program Srvic Expnss (Rquird for 501(c)(3) and A11 organizations must dscri thir xmpt purpos achivmnts in a clar and concis mannr. Stat th numr of (4) organizations and clints srvd pulications issud, tc. Discuss achivmnts that ar not masural (Sction 501(c)(3) & (4) organ- 4947(a)(1) trusts, ut optional for othrs ) izations and 4~347(a)(1) nonxmpt charital trusts must also ntr th amount of grants & allocations ~o othrs.) a PROVIDING HUMANITARIAN ADOPTION SERVICES (Grants and allocations $ ) c d (Grants and allocations $ ) (Grants and allocations $ ) (Grants and allocations $ Othr program srvics (Grants and allocations $ f Total of Program Srvic Expnss (should qual lin 44, column (B), Program srvics) BAA TEEA0702L 10/03/03 145, , 631. Form 990 (2003)

3 " Forrrs'990 (203) FOCUS ON CHILDREN Pag 3 Part IV Balanc Shts s Instructions) Not : Whr rquird, attachd schduls and amounts within th dscription (A) (B) column should for nd-of-yar amounts only. Bginning of yar End of yar 45 Cash - non-intrst-aring 73, , Savings and tmporary cash invstmnts 46 47a Accounts rcival 47a Lss. allowanc for doutful accounts 47 47c 48a Pldgs rcival 48a Lss allowanc for doutful accounts 48 48c 49 Grants rcival Rcivals from officrs, dirctors, trusts, and ky mploys (attach schdul) a Othr nots & loans rcival (attach sch) 51 a s Lss : allowanc for doutful accounts c 52 Invntoris for sal or us 52 45, Prpaid xpnss and dfrrd chargs Invstmnts - scuritis (attach schdul) ~~ Cost ~ FMV 54 55a Invstmnts - land, uildings, & quipmnt: asis 55a Lss' accumulatd dprciation (attach schdul) 55 55c 56 Invstmnts - othr (attach schdul) 56 57a Land, uildings, and quipmnt asis 57a 23,322. Lss accumulatd dprcation (attach schdul) STATEMENT ,598. 7, c 5, Othr assts (dscri 0- ) 65, Total assts (add lins 45 through 58) (must qual lin 74) 145, , Accounts payal and accrud xpnss Grants payal Dfrrd rvnu 62 s 63 Loans from officrs, dirctors, trusts, and ky mploys (attach schdul) L 63 64a Tax-xmpt ond liailitis (attach schdul) T 64a Mortgags and othr nots payal (attach schdul) 64 s 65 Othr liailitis (dscri - SEE STATEMENT 5 ) 2, ,828. a 66 Total liailitis add lins 60 through 65 2, ,828. Organizations that follow SFAS 117, chck hr N- Hand complt lins 67 through 69 and lins 73 and Unrstrictd Tmporarily rstrictd Prmanntly rstrictd 69 Organizations that do not follow SFAS 117, chck hr ~ X and complt lins 70 through Capital stock, trust principal, or currnt funds Paid-in or capital surplus, or land, uilding, and quipmnt fund Rtaind arnings, ndowmnt, accumulatd incom, or othr funds 142, , Total nt assts or fund alancs (add lins 67 through 69 or lins 70 through 72, column (A) must qual lin 19, column (B) must qual lin 21) 142, , Total liailitis and nt assts/fund alancs (add lins 66 and 73) 145, ,088. Form 990 is availal for pulic inspction and, for som popl, srvs as th primary or sol sourc of information aout a particular organization. How th pulic prcivs an organization in such cass may dtrmind y th information prsntd on its rturn Thrfor, plas mak sur th rturn is complt and accurat and fully dscris, in Part III, th organization's programs and accomplishmnts BAA TEEA0103L 10101t03

4 " Fornri 990 (2003) FOCUS ON CHILDREN Pag4 Rconciliation of Rvnu pr Auditd part V-B Rconciliation of Expnss pr Auditd Financial Statmnts with Rvnu Financial Statmnts with Expnss pr Rturn (S instructions.) pr Rturn a Total rvnu, gains, and othr support pr auditd financial statmnts Amounts includd on lin a ut not on lin 12, Form 990 (1) Nt unralizd gains on invstmnts $ (2) Donatd srvics and us of facilitis $ (3) Rcovris of prior yar grants $ (4) Othr (spafy)~ 0-1 a1 793,709 a Total xpnss and losss pr auditd financial statmnts ~ a 785, 790. Amounts includd on lin a ut not on lin 17, Form 990 : (1) Donatd srvics and us of facilitis $ (2) Prior yar adjust- ' mnu rportd on lin 20, Form 990 $ (3) Losss rportd on c lin 20, Form 990 $ (4) Othr (spcify). Add amounts on lins (1) through (4) c Lin a minus lin. d Amounts includd on lin 12, Form 990 ut not on lin a : (1) Invstmnt xpnss not includd on lin 6, Form 990 $ (2) Othr (spcify) Add amounts on lins (1) through (4) d Amounts includd on lin 17 Form 990 ut not on lin a: Invstmnt xpnss not includd on lin 6, Form 990 $ (2) Othr (spcify) : ~ 793, 709. c Lin a minus lin No. c 785, 790. Add amounts on lins (1) and (2) 0-I d Add amounts on lins (1) and (2) Total rvnu pr lin 12, Form Total xpnss pr lin 17, Form 990 (lin c plus lin d) " 793, lin c plus lin d ,790. Pa~'t Y List of Officrs, Dirctors, Trusts, and Ky Em to 5 (List ach on vn if not compnsatd, s instructions ) (B) Titl and avrag hours (C) Compnsation (D) Contriutions to (E) Expns (A) Nam and addrss pr wk dvotd (if not paid, mploy nfit account and othr to position ntr -0-) plans and dfrrd allowancs compnsation KAREN BANKS PRESIDENT 24, P.O. BOX COKEVILLE, WY DANALEE THORNOCK SECRETARY 14, P.O. BOX COKEVILLE, WY Did any officr, dirctor, trust, or ky mploy rciv aggrgat compnsation of mor than $100,000 from your organization and all rlatd organizations, of which mor than $10,000 was providd y th rlatd organizations? ~ ~ Ys X No If 'Ys,' attach schdul - s instructions. BAA Form 990 (2003) TEEA0104L 10/02103

5 " Forrra 990 (2003) FOCUS ON CHILDREN Part V1 Othr Information s instructions.) Ys 76 Did th organization ngag in any activity not prviously rportd to th IRS If 'Ys,' attach a dtaild dscription of ach activity 76 X 77 Wr any changs mad in th organizing or govrning documnts ut not rportd to th IRS 77 X If 'Ys,' attach a conformd copy of th changs. 78a Did th organization hav unrlatd usinss gross incom of $1,000 or mor during th yar covrd y this rturn? 78a X If 'Ys,' has it fild a tax rturn on Form 990-T for this yars 78 N,IA 79 Was thr a liquidation, dissolution, trmination, or sustantial contraction during th yars If 'Ys,' attach a statmnt 79 I I X 80a Is th organization rlatd (othr than y association with a statwid or nationwid organization) through common mmrship, govrning odis, trusts, officrs, tc, to any othr xmpt or nonxmpt organization? 80a X If 'Ys,' ntr th nam of th organization - N/A and chck whthr it is T] xmpt or If 'Ys,' you may indicat th valu of ths itms hr Do not includ this amount as rvnu in Part I or as an xpns m Part I!. (S instructions m Part III ) a Did th organization comply with th pulic inspction rquirmnts for rturns and xmption applications? Did th organization comply with th disclosur rquirmnts rlating to quid pro quo contriutions? nonxmpt 81 a Entr dirct and indirct political xpnditurs S lin 81 instructions 81 a 0. Did th organization fil Form 1120-POL for this yar? 81 X 82 a Did th or ganization rciv donatd srvics or th us of matrials, quipmnt, or facilitis at no charg or at sustantially lss than fair rntal valus 82a1 I X 83a X 83 X 84a Did th organization solicit any contriutions or gifts that wr not tax dductil? 84a X If 'Ys,' did th organization includ with vry solicitation an xprss statmnt that such contriutions or gifts wr not tax dductil (c)(4), (5), or (6) organizations a Wr sustantially all dus nondductil y mmrs? Did th organization mak only in-hous loying xpnditurs of $2,000 or lss? If 'Ys' was answrd to ithr 85a or 85, do not complt 85c through 85h low unlss th organization rcivd a waivr for proxy tax owd for th prior yar. 84 NIA 85a N A 85 N TA c Dus, assssmnts, and similar amounts from mmrs 85c N/A d Sction 162() loying and political xpnditurs 85d N/A Aggrgat nondductil amount of sction 6033()(1)(A) dus notics 85 N/A f Taxal amount of loying and political xpnditurs (lin 85d lss 85) 85f N/A g Dos th organization lct to pay th sction 6033() tax on th amount on lin 85f? h If sction 6033()(1)(A) dus notics wr snt, dos th organization agr to add th amount on lin 85f to its rasonal stimat of dus allocal to nondductil loying and political xpnditurs for th following tax yar? (c)(7) organizations. Entr : a Initiation fs and capital contriutions includd on lin 12 86a N/A Gross rcipts, includd on lin 12, for pulic us of clu facilitis 86 N/A (c)(12) organizations. Entr a Gross incom from mmrs or sharholdrs 87a N/A 85h1 NIA N,YA Gross incom from othr sourcs. (Do not nt amounts du or paid to othr sourcs against amounts du or rcivd from thm ) 871 N/A 88 At any tim during th yar, did th organization own a 50% or gratr intrst in a taxal corporation or partnrship, or an ntity disrgardd as sparat from th organization undr Rgulations sctions and ? If 'Ys,' complt Part IX I 8$ I I X 89a 501(c)(3) organizations. Entr Amount of tax imposd on th organization during th yar undr. sction , N/A, sction 4912 a- N/A, sction 4955 N 501(c)(3) and 501(c)(4) organizations Did th organization ngag in any sction 4958 xcss nfit transaction during th yar or did it com awar of an xcss nfit transaction from a prior yar? If 'Ys,' attach a statmnt xplaining ach transaction I 891 N1A c Entr. Amount of tax imposd on th organization managrs or disqualifid prsons during th yar undr sctions 4912, 4955, and N/A d Entr : Amount of tax on lin 89c, aov, rimursd y th organization 0. N/A 90a List th stats with which a copy of this rturn is fild I- NONE Numr of mploys mployd in th pay priod that includs March 12, 2003 (S instructions ) Th ooks ar in car of - KAREN BANKS Tlphon numr ~ locatd at - 65 EAST NORTH WELLSVILLE, UT ZIP + 4, Sction 4947(a)(1) nonxmpt charital trusts filing Form 990 m liu of Form 1Q41- Chck hr N/A I and ntr th amount of tax-xmpt intrst rcivd or accrud during th tax " I 92 N/A BAA Form 990 (2003) TEEA0105L 12/23/03

6 " Form 990 (2003) FOCUS ON CHILDREN Pag 6 Part VIl Analysis of Incom-Producin g Activitis s instructions) Unrlatd usinss incom Excludd sction 512, 513, or 514 Not : Entr gross amounts unlss (A) (B) (C) (D) Rlatd or xmpt othrwis indicatd Businss cod Amount Exclusion cod Amount function incom 93 Program srvic rvnu - a c d f Mdicar/Mdicaid paymnts g Fs & contracts from govrnmnt agncis 94 Mmrship dus and assssmnts 717, Intrst on savings & tmporary cash invmnts 96 Dividnds & intrst from scuritis 97 Nt rntal incom or (loss) from ral stata dt-financd proprty not dt-financd proprty 98 Nt rntal incom or (loss) from prs prop 99 Othr invstmnt incom 100 Gain or (loss) from sals of assts othr than invntory 101 Nt incom or (loss) from spcial vnts 102 Gross profit or (loss) from sals of invntory 13, Othr rvnu a c d 104 Sutotal (add columns (B), (D), and (E)) ~~ 717, , Total (add lin 104, columns (B), (D), and (E)) ~ 731,315. Not: Lin 105 plus lin Id, Part l, should qual th amount on lin 12, Part l. Part VIII Rlationship of Activitis to th Accomplishmnt of Exm pt Purposs (s instructions) Lin No. N/A Explain how ach activity for which incom is rportd in column (E) of Part VII contriutd importantly to th accomplishmnt of th organization's xmpt purposs (othr than y providing funds for such purposs). (A) (B) (C) (D) (E) Nam, addrss, and EIN of corporation, partnrship, or disrgardd ntity N/A Prcntag of ownrship intrst Natur of activitis Total incom End-of-yar assts 0 Prt X Information Rgarding Transfrs Associatd with a Did th organization, during th yar, rciv any funds, dirctly or indirctly, to pay Did th organization, during th yar, pay prmiums, dirctly or in Not: If 'Ys' to ), fil Form 8870 and Form 4720 s Instructions Undr pnaltis of prjurv I dclar that I hav xamind this rturn, including tru, corrct, an ompl3 Dclaation of prparr (othr than officr) is asd ~~/.A PI as ~ ~ 4~ ic, r' Sign Signatur officr Hr 0' BEN BANKS, PRESIDENT Typ or print nam and titl Bnfit Contracts Paid Pr- PBCr'S US Only BAA Prparr's signatur I" RIC CPA Firm's nam (o~ COOK D(9R'IG~i~T~1 & ASSOCIATES yours mployd)if t 632 NORTH MAIN ZdPd s4s, and LOGAN, UT

7 120'03 FEDERAL STATEMENTS PAGE 1 CLIENT FOCUCHIL FOCUS ON CHILDREN /01/04 02:49PM STATEMENT 1 FORM 990, PART I, LINE 10 GROSS PROFIT (LOSS) FROM SALES OF INVENTORY MERCHANDISE $ 33,788. GROSS SALES $ 33,788. LESS RETURNS & ALLOWANCES 0. NET SALES $ 33,788. LESS COST OF GOODS SOLD 20,000. GROSS PROFIT FROM SALES OF INVENTORY $ 13,788. STATEMENT 2 FORM 990, PART Ii, LINE 23 SPECIFIC ASSISTANCE TO INDIVIDUALS MEDICAL, DENTAL AND HOSPITAL EXPENSES PROFESSIONAL FEES PAID $ 95, ,331. TOTAL $ 145,631. STATEMENT 3 FORM 990, PART II, LINE 43 OTHER EXPENSES (A) (B) (C) (D) PROGRAM MANAGEMENT TOTAL SERVICES & GENERAL FUNDRAISING ADVERTISING 4,747. 4,747. BANK & FINANCE FEES 1,312. 1,312. COMPUTER SUPPLIES 2,250. 2,250. DUES AND SUBSCRIPTIONS EDUCATION 3,910. 3,910. FOREIGN EXPENSES INSURANCE 138,494. 9, ,494. 9,522. INTERNET LICENSE AND PERMITS 5,641. 5,641. NOTARY/AUTHENTICATION 29, ,583. OFFICE EXPENSES 10, ,252. PROFESSIONAL FEES 181, ,669. TOOLS 3,015. 3,015. TRANSLATION EXPENSES 6,965. 6,965. UTILITIES 1,685. 1,685. TOTAL $ 399,863. $ 0. $ 399,863. $ 0.

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