CARNEY, ROY AND GERROL, P.C COLD SPRING ROAD, SUITE 111 ROCKY HILL, CT

Transcription

1 Form Department of the Treasury Internal Revenue Service A B I J K For the 21 calendar year, or tax year eginning Check if applicale: Address change Name change Initial return Terminated 99 Amended return Application pending Tax-exempt status: Wesite: Form of organization: Part I 1 Activities & Governance Revenue Expenses Net Assets or Fund Balances C Name of organization F Doing Business As Return of Organization Exempt From Income Tax Under section 1(c), 27, or 97(a)(1) of the Internal Revenue Code (except private foundations) Do not enter Social Security numers on this form as it may e made pulic. Information aout Form 99 and its instructions is at Numer and street (or P.O. ox if mail is not delivered to street address) City or town, state or province, country, and ZIP or foreign postal code Name and address of principal officer: Summary 9 NEW HAVEN AVENUE BETH-EL CENTER, INC. MILFORD CT 66, and ending TONI DOLAN 9 NEW HAVEN AVENUE MILFORD CT 66 1 Grants and similar amounts paid (Part I, column (A), lines 1 ) Benefits paid to or for memers (Part I, column (A), line ) Salaries, other compensation, employee enefits (Part I, column (A), lines 1) a Professional fundraising fees (Part I, column (A), line 11e) Total fundraising expenses (Part I, column (D), line 2), Other expenses (Part I, column (A), lines 11a 11d, 11f 2e) Total expenses. Add lines 1 17 (must equal Part I, column (A), line 2) Revenue less expenses. Sutract line 18 from line Room/suite D E Telephone numer G Gross receipts $ OMB Open to Pulic Inspection Employer identification numer H(a) Is this a group return for suordinates? H() Are all suordinates included? 2 Check this ox if the organization discontinued its operations or disposed of more than 2% of its net assets. 6 Numer of voting memers of the governing ody (Part VI, line 1a) Numer of independent voting memers of the governing ody (Part VI, line 1) Total numer of individuals employed in calendar year 21 (Part V, line 2a) Total numer of volunteers (estimate if necessary) a Total unrelated usiness revenue from Part VIII, column (C), line Net unrelated usiness taxale income from Form 99-T, line Prior Year 8 Contriutions and grants (Part VIII, line 1h) Program service revenue (Part VIII, line 2g) Investment income (Part VIII, column (A), lines,, and 7d) Other revenue (Part VIII, column (A), lines, 6d, 8c, 9c, 1c, and 11e) Total revenue add lines 8 through 11 (must equal Part VIII, column (A), line 12) If "," attach a list. (see instructions) Briefly descrie the organization's mission or most significant activities: Total assets (Part, line 16) Total liailities (Part, line 26) Net assets or fund alances. Sutract line 21 from line Part II Signature Block 6 7a 7 Beginning of Current Year Current Year End of Year 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. 9,1 1(c)() 1(c) ( ) (insert no.) 97(a)(1) or 27 H(c) Group exemption numer Corporation Trust Association Other L Year of formation: 198 M State of legal domicile: CT TEMPORARY SHELTER AND MEALS TO HOMELESS AND HUNGRY , 89,691,2,67 1,7 779,,62 968,26 918,67 91, 8,68 6,77 9, ,792 1, 88,612 6, 9,11 1,2,711 12, ,1 12,6 872,8 Sign Here Paid Preparer Use Only Firm's name Signature of officer Type or print name and title Print/Type preparer's name THOMAS D. ROY TONI DOLAN Preparer's signature Date Check if PTIN self-employed Firm's EIN Firm's address Phone no. May the IRS discuss this return with the preparer shown aove? (see instructions) For Paperwork Reduction Act tice, see the separate instructions. Date EECUTIVE DIRECTOR CARNEY, ROY AND GERROL, P.C COLD SPRING ROAD, SUITE 111 ROCKY HILL, CT Form 99 (21)

2 Form 99 (21) Page 2 Part III Statement of Program Service Accomplishments 1 Briefly descrie the organization's mission: Did the organization undertake any significant program services during the year which were not listed on the 2 prior Form 99 or 99-EZ? If "," descrie these new services on Schedule O. Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "," descrie these changes on Schedule O. Descrie the organization's program service accomplishments for each of its three largest program services, as measured y expenses. Section 1(c)() and 1(c)() organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. a (Code: ) (Expenses $ including grants of $ ) (Revenue $ ) ) $ (Revenue ) $ including grants of $ ) (Expenses (Code: c (Code: $ including grants of $ ) ) (Expenses $ ) (Revenue. d Other program services. (Descrie in Schedule O.) (Revenue ) $ (Expenses ) $ including grants of $ e Total program service expenses Form 99 (21) Check if Schedule O contains a response or note to any line in this Part III BETH-EL CENTER, INC TEMPORARY SHELTER AND MEALS TO HOMELESS AND HUNGRY 7,81 9,69 BETH-EL CENTER, INC. (THE "CENTER") WAS ORGANIZED ON NOVEMBER 29, 198 TO PROVIDE TEMPORARY SHELTER AND MEALS TO THE HOMELESS AND HUNGRY IN MILFORD, CONNECTICUT. RESIDENTS ARE PROVIDED CASE MANAGEMENT SERVICES AND REFERRALS TO HELP THEM OBTAIN PERMANENT HOUSING, EMPLOYMENT AND FINANCIAL ASSISTANCE. THE CENTER ALSO REFERS RESIDENTS TO COUNSELING SERVICES TO ADDRESS SUBSTANCE ABUSE AND MENTAL HEALTH ISSUES, AND THE SOUP KITCHEN SERVES MEALS TO THE HUNGRY. THE CENTER OPERATES THE "MEALS TO GO" PROGRAM TO DISTRIBUTE MEALS TO LOW INCOME AND HOMELESS COMMUNITY MEMBERS. APPROIMATELY 2 INDIVIDUALS ARE PROVIDED SHELTER SERVICES AND OVER 2, MEALS ARE SERVED TO THE GREATER COMMUNITY PER YEAR. 7,81

3 Form 99 (21) a 1 1a a Part IV a c d e f BETH-EL CENTER, INC Checklist of Required Schedules Is the organization descried in section 1(c)() or 97(a)(1) (other than a private foundation)? If, complete Schedule A Is the organization required to complete Schedule B, Schedule of Contriutors (see instructions)? Did the organization engage in direct or indirect political campaign activities on ehalf of or in opposition to candidates for pulic office? If, complete Schedule C, Part I Section 1(c)() organizations. Did the organization engage in loying activities, or have a section 1(h) election in effect during the tax year? If "," complete Schedule C, Part II Is the organization a section 1(c)(), 1(c)(), or 1(c)(6) organization that receives memership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "," complete Schedule C, Part III Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distriution or investment of amounts in such funds or accounts? If, complete Schedule D, Part I Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If, complete Schedule D, Part II Did the organization maintain collections of works of art, historical treasures, or other similar assets? If, complete Schedule D, Part III Did the organization report an amount in Part, line 21, for escrow or custodial account liaility; serve as a custodian for amounts not listed in Part ; or provide credit counseling, det management, credit repair, or det negotiation services? If, complete Schedule D, Part IV Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If, complete Schedule D, Part V If the organization's answer to any of the following questions is, then complete Schedule D, Parts VI, VII, VIII, I, or as applicale. Did the organization report an amount for land, uildings, and equipment in Part, line 1? If "," complete Schedule D, Part VI Did the organization report an amount for investments other securities in Part, line 12 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part VII Did the organization report an amount for investments program related in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part VIII Did the organization report an amount for other assets in Part, line 1 that is % or more of its total assets reported in Part, line 16? If "," complete Schedule D, Part I Did the organization report an amount for other liailities in Part, line 2? If "," complete Schedule D, Part Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liaility for uncertain tax positions under FIN 8 (ASC 7)? If "," complete Schedule D, Part Did the organization otain separate, independent audited financial statements for the tax year? If, complete Schedule D, Parts I and II Was the organization included in consolidated, independent audited financial statements for the tax year? If "," and if the organization answered "" to line 12a, then completing Schedule D, Parts I and II is optional Is the organization a school descried in section 17()(1)(A)(ii)? If, complete Schedule E Did the organization maintain an office, employees, or agents outside of the United States? Did the organization have aggregate revenues or expenses of more than $1, from grantmaking, fundraising, usiness, investment, and program service activities outside the United States, or aggregate foreign investments valued at $1, or more? If, complete Schedule F, Parts I and IV Did the organization report on Part I, column (A), line, more than $, of grants or other assistance to or for any foreign organization? If, complete Schedule F, Parts II and IV Did the organization report on Part I, column (A), line, more than $, of aggregate grants or other assistance to or for foreign individuals? If, complete Schedule F, Parts III and IV Did the organization report a total of more than $1, of expenses for professional fundraising services on Part I, column (A), lines 6 and 11e? If, complete Schedule G, Part I (see instructions) Did the organization report more than $1, total of fundraising event gross income and contriutions on Part VIII, lines 1c and 8a? If "," complete Schedule G, Part II Did the organization report more than $1, of gross income from gaming activities on Part VIII, line 9a? If "," complete Schedule G, Part III Did the organization operate one or more hospital facilities? If, complete Schedule H If to line 2a, did the organization attach a copy of its audited financial statements to this return? a 11 11c 11d 11e 11f 12a a a 2 Page Form 99 (21)

4 Form 99 (21) Page a Part IV a c a 6 7 c d 2a BETH-EL CENTER, INC Checklist of Required Schedules (continued) Did the organization report more than $, of grants or other assistance to any domestic organization or government on Part I, column (A), line 1? If, complete Schedule I, Parts I and II Did the organization report more than $, of grants or other assistance to individuals in the United States on Part I, column (A), line 2? If "," complete Schedule I, Parts I and III Did the organization answer to Part VII, Section A, line,, or aout compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "," complete Schedule J Did the organization have a tax-exempt ond issue with an outstanding principal amount of more than $1, as of the last day of the year, that was issued after Decemer 1, 22? If, answer lines 2 through 2d and complete Schedule K. If, go to line 2a Did the organization invest any proceeds of tax-exempt onds eyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt onds? Did the organization act as an on ehalf of issuer for onds outstanding at any time during the year? Section 1(c)() and 1(c)() organizations. Did the organization engage in an excess enefit transaction with a disqualified person during the year? If, complete Schedule L, Part I Is the organization aware that it engaged in an excess enefit transaction with a disqualified person in a prior year, and that the transaction has not een reported on any of the organization's prior Forms 99 or 99-EZ? If "," complete Schedule L, Part I Did the organization report any amount on Part, line, 6, or 22 for receivales from or payales to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, complete Schedule L, Part II Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, sustantial contriutor or employee thereof, a grant selection committee memer, or to a % controlled entity or family memer of any of these persons? If, complete Schedule L, Part III Was the organization a party to a usiness transaction with one of the following parties (see Schedule L, Part IV instructions for applicale filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, or key employee? If "," complete Schedule L, Part IV A family memer of a current or former officer, director, trustee, or key employee? If "," complete Schedule L, Part IV An entity of which a current or former officer, director, trustee, or key employee (or a family memer thereof) was an officer, director, trustee, or direct or indirect owner? If, complete Schedule L, Part IV Did the organization receive more than $2, in non-cash contriutions? If, complete Schedule M Did the organization receive contriutions of art, historical treasures, or other similar assets, or qualified conservation contriutions? If, complete Schedule M Did the organization liquidate, terminate, or dissolve and cease operations? If, complete Schedule N, Part I Did the organization sell, exchange, dispose of, or transfer more than 2% of its net assets? If "," complete Schedule N, Part II Did the organization own 1% of an entity disregarded as separate from the organization under Regulations sections and ? If, complete Schedule R, Part I Was the organization related to any tax-exempt or taxale entity? If, complete Schedule R, Parts II, III, or IV, and Part V, line Did the organization have a controlled entity within the meaning of section 12()(1)? If "" to line a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 12()(1)? If, complete Schedule R, Part V, line Section 1(c)() organizations. Did the organization make any transfers to an exempt non-charitale related organization? If, complete Schedule R, Part V, line Did the organization conduct more than % of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If, complete Schedule R, Part VI Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? te. All Form 99 filers are required to complete Schedule O a 2 2c 2d 2a a 28 28c a Form 99 (21)

5 Form 99 (21) Part V 1a c 2a a a a c 6a 7 a c d e f g h 8 9 a 1 a 11 a 12a Statements Regarding Other IRS Filings and Tax Compliance Check if Schedule O contains a response or note to any line in this Part V Enter the numer reported in Box of Form 196. Enter -- if not applicale Enter the numer of Forms W-2G included in line 1a. Enter -- if not applicale Did the organization comply with ackup withholding rules for reportale payments to vendors and reportale gaming (gamling) winnings to prize winners? Enter the numer of employees reported on Form W-, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered y this return a 26 If at least one is reported on line 2a, did the organization file all required federal employment tax returns? te. If the sum of lines 1a and 2a is greater than 2, you may e required to e-file (see instructions) Did the organization have unrelated usiness gross income of $1, or more during the year? If, has it filed a Form 99-T for this year? If to line, provide an explanation in Schedule O 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 instructions for filing requirements for Form TD F , Report of Foreign Bank and Financial Accounts. Was the organization a party to a prohiited tax shelter transaction 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 transaction? If to line a or, did the organization file Form 8886-T? Does the organization have annual gross receipts that are normally greater than $1,, and did the organization solicit any contriutions that were not tax deductile as charitale contriutions? If, did the organization include with every solicitation an express statement that such contriutions or gifts were not tax deductile? Organizations that may receive deductile contriutions under section 17(c). Did the organization receive a payment in excess of $7 made partly as a contriution and partly for goods and services provided to the payor? If, did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangile personal property for which it was required to file Form 8282? If, indicate the numer of Forms 8282 filed during the year d Did the organization receive any funds, directly or indirectly, to pay premiums on a personal enefit contract? Did the organization, during the year, pay premiums, directly or indirectly, on a personal enefit contract? If the organization received a contriution of qualified intellectual property, did the organization file Form 8899 as required? If the organization received a contriution of cars, oats, airplanes, or other vehicles, did the organization file a Form 198-C? Sponsoring organizations maintaining donor advised funds and section 9(a)() supporting organizations. Did the supporting organization, or a donor advised fund maintained y a sponsoring organization, have excess usiness holdings at any time during the year? Sponsoring organizations maintaining donor advised funds. Did the organization make any taxale distriutions under section 966? Did the organization make a distriution to a donor, donor advisor, or related person? Section 1(c)(7) organizations. Enter: Initiation fees and capital contriutions included on Part VIII, line a Gross receipts, included on Form 99, Part VIII, line 12, for pulic use of clu facilities Section 1(c)(12) organizations. Enter: Gross income from memers or shareholders a Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) Section 97(a)(1) non-exempt charitale trusts. Is the organization filing Form 99 in lieu of Form 11? If, enter the amount of tax-exempt interest received or accrued during the year Section 1(c)(29) qualified nonprofit health insurance issuers. a c BETH-EL CENTER, INC Is the organization licensed to issue qualified health plans in more than one state? te. See the instructions for additional information the organization must report on Schedule O. Enter the amount of reserves the organization is required to maintain y the states in which the organization is licensed to issue qualified health plans Enter the amount of reserves on hand c 1a Did the organization receive any payments for indoor tanning services during the tax year? If "," has it filed a Form 72 to report these payments? If "," provide an explanation in Schedule O Form 99 (21) 1a 1 9 1c 2 a a a c 6a 6 7a 7 7c 7e 7f 7g 7h 8 9a 9 12a 1a 1a 1 Page

6 Form 99 (21) Page 6 Part VI Governance, Management, and Disclosure For each "" response to lines 2 through 7 elow, and for a "" response to line 8a, 8, or 1 elow, descrie the circumstances, processes, or changes in Schedule O. See instructions. Check if Schedule O contains a response or note to any line in this Part VI Section A. Governing Body and Management 1a 2 6 7a 1a Section C. Disclosure Enter the numer of voting memers of the governing ody at the end of the tax year If there are material differences in voting rights among memers of the governing ody, or if the governing ody delegated road authority to an executive committee or similar committee, explain in Schedule O. Enter the numer of voting memers included in line 1a, aove, who are independent Did any officer, director, trustee, or key employee have a family relationship or a usiness relationship with any other officer, director, trustee, or key employee? Did the organization delegate control over management duties customarily performed y or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person? Did the organization make any significant changes to its governing documents since the prior Form 99 was filed? Did the organization ecome aware during the year of a significant diversion of the organization s assets? Did the organization have memers or stockholders? Did the organization have memers, stockholders, or other persons who had the power to elect or appoint one or more memers of the governing ody? Are any governance decisions of the organization reserved to (or suject to approval y) memers, stockholders, or persons other than the governing ody? Did the organization contemporaneously document the meetings held or written actions undertaken during the year y the following: a The governing ody? Each committee with authority to act on ehalf of the governing ody? a 8 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot e reached at the organization s mailing address? If, provide the names and addresses in Schedule O Section B. Policies (This Section B requests information aout policies not required y the Internal Revenue Code.) Did the organization have local chapters, ranches, or affiliates? If, did the organization have written policies and procedures governing the activities of such chapters, affiliates, and ranches to ensure their operations are consistent with the organization's exempt purposes? a Has the organization provided a complete copy of this Form 99 to all memers of its governing ody efore filing the form? Descrie in Schedule O the process, if any, used y the organization to review this Form a c a 16a BETH-EL CENTER, INC Did the organization have a written conflict of interest policy? If, go to line Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? Did the organization regularly and consistently monitor and enforce compliance with the policy? If, descrie in Schedule O how this was done Did the organization have a written whistlelower policy? Did the organization have a written document retention and destruction policy? Did the process for determining compensation of the following persons include a review and approval y independent persons, comparaility data, and contemporaneous sustantiation of the delieration and decision? The organization s CEO, Executive Director, or top management official Other officers or key employees of the organization If to line 1a or 1, descrie the process in Schedule O (see instructions). Did the organization invest in, contriute assets to, or participate in a joint venture or similar arrangement with a taxale entity during the year? If, did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicale federal tax law, and take steps to safeguard the organization s exempt status with respect to such arrangements? List the states with which a copy of this Form 99 is required to e filed Section 61 requires an organization to make its Forms 12 (or 12 if applicale), 99, and 99-T (Section 1(c)()s only) availale for pulic inspection. Indicate how you made these availale. Check all that apply. Own wesite Another's wesite Upon request Other (explain in Schedule O) Descrie in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements availale to the pulic during the tax year. State the name, physical address, and telephone numer of the person who possesses the ooks and records of the organization: TONI DOLAN 9 NEW HAVEN AVENUE MILFORD CT CT 1a a 1a 1 11a 12a 12 12c 1 1 1a 1 16a 16 Form 99 (21)

7 Form 99 (21) Part VII Section A. BETH-EL CENTER, INC Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Check if Schedule O contains a response or note to any line in this Part VII Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this tale for all persons required to e listed. Report compensation for the calendar year ending with or within the organization's tax year. List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -- in columns (D), (E), and (F) if no compensation was paid. List all of the organization's current key employees, if any. See instructions for definition of "key employee." List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportale compensation (Box of Form W-2 and/or Box 7 of Form 199-MISC) of more than $1, from the organization and any related organizations. List all of the organization's former officers, key employees, and highest compensated employees who received more than $1, of reportale compensation from the organization and any related organizations. List all of the organization s former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $1, of reportale compensation from the organization and any related organizations. List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this ox if neither the organization nor any related organizations compensated any current officer, director, or trustee. (A) (B) (C) (D) (E) (F) Name and Title Average Position Reportale Reportale Estimated hours per (do not check more than one compensation compensation from amount of week ox, unless person is oth an from related other (list any hours for officer and a director/trustee) the organization organizations (W-2/199-MISC) compensation from the related (W-2/199-MISC) organization organizations and related elow dotted organizations line) Individual trustee or director Institutional trustee Officer Key employee Highest compensated employee Former (1) GINA DELUCCA DIRECTOR. (2) TYYNE POSTEL-CATAPANO DIRECTOR. () ANTHONY BENEDOSSO DIRECTOR. () DENNIS BROWN DIRECTOR. () DR. ALE QUINTNER DIRECTOR. (6) MARILYN CORMACK PRESIDENT. (7) ELIZABETH CARVETH DIRECTOR. (8) SUZANNE LYNGAAS DIRECTOR. (9) CELESTE LOHRENZ DIRECTOR. (1) RICHARD MEISENHEIMER TREASURER. (11) MICHAEL WILLIAMS SECRETARY. Form 99 (21) Page 7

8 Form 99 (21) BETH-EL CENTER, INC Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII (12) (17) (A) Name and title ED DAVIES (B) Average hours per week (list any hours for related organizations elow dotted line) VICE PRESIDENT (1) SUSAN LAPINE DIRECTOR (1) LOUIS MASSARI DIRECTOR (1) BARBARA VOSBURGH DIRECTOR (16) TONI DOLAN EECUTIVE DIRECTOR Individual trustee or director Institutional trustee Officer (C) Position (do not check more than one ox, unless person is oth an officer and a director/trustee) Key employee Highest compensated employee Former (D) Reportale compensation from the organization (W-2/199-MISC) (E) Reportale compensation from related organizations (W-2/199-MISC) (F) Estimated amount of other compensation from the organization and related organizations ,82 7, (18) (19) Su-total c Total from continuation sheets to Part VII, Section A d Total (add lines 1 and 1c) Total numer of individuals (including ut not limited to those listed aove) who received more than $1, in reportale compensation from the organization 78,82 7, 78,82 7, Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If, complete Schedule J for such individual For any individual listed on line 1a, is the sum of reportale compensation and other compensation from the organization and related organizations greater than $1,? If, complete Schedule J for such individual Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If, complete Schedule J for such person Section B. Independent Contractors 1 Complete this tale for your five highest compensated independent contractors that received more than $1, of compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and usiness address Description of services (C) Compensation 2 Total numer of independent contractors (including ut not limited to those listed aove) who received more than $1, of compensation from the organization Form 99 (21)

9 Form 99 (21) Page 9 Part VIII Contriutions, Gifts, Grants and Other Similar Amounts Program Service Revenue Other Revenue BETH-EL CENTER, INC Statement of Revenue Check if Schedule O contains a response or note to any line in this Part VIII (A) (B) (C) (D) Total revenue Related or Unrelated Revenue exempt function revenue usiness revenue excluded from tax under sections a c Federated campaigns Memership dues Fundraising events a 1 1c 19, d Related organizations d e Government grants (contriutions).... 1e 8,6 f All other contriutions, gifts, grants, and similar amounts not included aove 1f 9,927 g ncash contriutions included in lines 1a-1f: $ 112, h Total. Add lines 1a 1f ,691 Busn. Code 2a.... PROGRAM FEES ,67, c d e f All other program service revenue g Total. Add lines 2a 2f ,67 Investment income (including dividends, interest, and other similar amounts) Income from investment of tax-exempt ond proceeds Royalties (i) Real (ii) Personal 6a Gross rents Less: rental exps. c Rental inc. or (loss) d Net rental income or (loss) a Gross amount from (i) Securities (ii) Other sales of assets other than inventory Less: cost or other asis & sales exps. c Gain or (loss) d Net gain or (loss) a Gross income from fundraising events (not including $ of contriutions reported on line 1c). See Part IV, line a 9,88 Less: direct expenses ,6 c Net income or (loss) from fundraising events ,92 9a Gross income from gaming activities. See Part IV, line a Less: direct expenses c Net income or (loss) from gaming activities a Gross sales of inventory, less returns and allowances a Less: cost of goods sold c Net income or (loss) from sales of inventory Miscellaneous Revenue Busn. Code 11a.. IRS REFUND ,128, c d All other revenue e Total. Add lines 11a 11d , Total revenue. See instructions ,67 9, Form 99 (21)

10 Form 99 (21) Part I BETH-EL CENTER, INC Statement of Functional Expenses Section 1(c)() and 1(c)() organizations must complete all columns. All other organizations must complete column (A). Check if Schedule O contains a response or note to any line in this Part I (A) (B) (C) (D) Do not include amounts reported on lines 6, Total expenses Program service Management and Fundraising 7, 8, 9, and 1 of Part VIII. expenses general expenses expenses 1 Grants and other assistance to governments and organizations in the U.S. See Part IV, line Grants and other assistance to individuals in Page 1 the U.S. See Part IV, line Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 1 and Benefits paid to or for memers Compensation of current officers, directors, trustees, and key employees Compensation not included aove, to disqualified persons (as defined under section 98(f)(1)) and persons descried in section 98(c)()(B) Other salaries and wages Pension plan accruals and contriutions (include section 1(k) and () employer contriutions) Other employee enefits Payroll taxes Fees for services (non-employees): 86,22 6,76 12,98 12,98 2,66 291,78 29,6 1,98 8,18 8,911 8, ,8,8,96 1, a Management Legal ,6 1,6 c Accounting 2,11 2,8, d Loying e Professional fundraising services. See Part IV, line 17 f Investment management fees g Other. (If line 11g amount exceeds 1% of line 2, column (A) amount, list line 11g expenses on Schedule O.), ,121, Advertising and promotion Office expenses 2, 1,177 11,7 2, Information technology 9,26 7, Royalties Occupancy 82,6 7,18 7,6 1, Travel Payments of travel or entertainment expenses for any federal, state, or local pulic officials 19 Conferences, conventions, and meetings, ,11 1, Interest,226 2,827 2, Payments to affiliates Depreciation, depletion, and amortization 2,98,6 6,8 1, Insurance 1, 11,188 1, Other expenses. Itemize expenses not covered aove (List miscellaneous expenses in line 2e. If line 2e amount exceeds 1% of line 2, column (A) amount, list line 2e expenses on Schedule O.) a. CLIENT SERVICES 126,98 126, c d e All other expenses Total functional expenses. Add lines 1 through 2e ,612 7,81 9,62,19 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a comined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 98-72) Form 99 (21)

11 Assets Liailities Net Assets or Fund Balances BETH-EL CENTER, INC Form 99 (21) Page 11 Part Balance Sheet Check if Schedule O contains a response or note to any line in this Part (A) (B) Beginning of year End of year 1 Cash non-interest earing 2, ,6 2 Savings and temporary cash investments 22, ,86 Pledges and grants receivale, net 91, ,69 Accounts receivale, net Loans and other receivales from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L Loans and other receivales from other disqualified persons (as defined under section 98(f)(1)), persons descried in section 98(c)()(B), and contriuting employers and sponsoring organizations of section 1(c)(9) voluntary employees' eneficiary organizations (see instructions). Complete Part II of Schedule L tes and loans receivale, net Inventories for sale or use Prepaid expenses and deferred charges 8, ,7 1a Land, uildings, and equipment: cost or other asis. Complete Part VI of Schedule D 1a 1,21, Less: accumulated depreciation ,8 7, 1c 6, Investments pulicly traded securities Investments other securities. See Part IV, line Investments program-related. See Part IV, line Intangile assets Other assets. See Part IV, line Total assets. Add lines 1 through 1 (must equal line ) , ,2, Accounts payale and accrued expenses 1, ,6 18 Grants payale Deferred revenue 1, , Tax-exempt ond liailities Escrow or custodial account liaility. Complete Part IV of Schedule D Loans and other payales to current and former officers, directors, 2 21 trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L Secured mortgages and notes payale to unrelated third parties 98, , Unsecured notes and loans payale to unrelated third parties Other liailities (including federal income tax, payales to related third 2 parties, and other liailities not included on lines 17-2). Complete Part of Schedule D Total liailities. Add lines 17 through , ,6 Organizations that follow SFAS 117 (ASC 98), check here and complete lines 27 through 29, and lines and. Unrestricted net assets Temporarily restricted net assets Permanently restricted net assets Organizations that do not follow SFAS 117 (ASC 98), check here and complete lines through. Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, uilding, or equipment fund Retained earnings, endowment, accumulated income, or other funds Total net assets or fund alances Total liailities and net assets/fund alances ,2 76, , , ,1 872,8 9,11 1,2,711 Form 99 (21)