990'EZ ^'1. Short Form Return of Organization Exempt From Income Tax

Transcription

1 ^'1 Form 99'EZ Department of the Treasury Internal Revenue Serece Short Form Return of Organization Exempt From Income Tax Under section 51(c), 527, or 4947( a)(1) of the Internal Revenue Code (except lack lung enefit trust or private foundation) Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512()(13) must file Form 99 (see instructions) All other organizations with gross receipts less than $2, and total assets less than $5, at the end of the year may use this form The organization may have to use a copy of this return to satisfy state reporting requirements OMB No A For the 21 calendar year, or tax year eginning JULY 1, 21, and B Check if applicale C Name of organization q Address change RANCHO DE LOS PENASQUITOS TOWN COUNCIL q Name change Numer and street (or P ox, if mail is not delivered to street address) Roc JUNE3,2 11 D Employer identification numer q Initial return PO BOX q Terminated City or town, state or country, and ZIP + 4 q Amended return Il Aool,cationoendma SAN DIEGO, CA F Group Exemption Numer G Accounting Method LJ Cash Lj Accrual Other (specify) H Check (J if the organization is not I Wesite : required to attach Schedule B J Tax-exempt status (check only one) - 51 (c)(3) q 51(c) ( ) I (insert no) q 4947(a)(1) or q 527 (Form 99, 99-EZ, or 99-PF) K Check q if the organization is not a section 59(a)(3) supporting organization and its gross receipts are normally not more than $5,. A Form 99-EZ or Form 99 return is not required though Form 99-N (e-postcard) may e required (see instructions) But if the organization chooses to file a return, e sure to file a complete return L Add lines 5, 6c, and 7, to line 9 to determine gross receipts If gross receipts are $2, or more, or if total assets (Part II, line 25, column (B) elow) are $5, or more, file Form 99 instead of Form 99-EZ $ Rium Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.) Check if the organization used Schedule to respond to any question in this Part I n 1 Contriutions, gifts, grants, and similar amounts received ,351 2 Program service revenue including government fees and contracts Memership dues and assessments Investment income a Gross amount from sale of assets other than inventory.. ( 5a Less' cost or other asis and sales expenses c Gain or (loss) from sale of assets other than inventory (Sutract line 5 from line 5a).... 5c 6 Gaming and fundraising events a Gross income from gaming (attach Schedule G if greater than $15,) a d Gross income from fundraising events (not including $ of contriutions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contriutions exceeds $15,) ,913 c Less. direct expenses from gaming and fundraising events... 6c 34,894 d Net income or (loss) from gaming and fundraising events (add lines 6a and 6 and sutract line 6c) d a Gross sales of inventory, less returns and allowances. 7a Less. cost of goods sold c Gross profit or (loss) from sales of inventory (Sutract line 7 from line 7a) c 8 Other revenue (descrie in Schedule ) Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and ,37 1 Grants and similar amounts paid (list in Schedule O) - 1 5,638 RECEIVED 11 Benefits paid to or for memers N 12 Salaries, other compensation, and employee enefits Professional fees and other payments to independent contr, ors NOV p C 14 Occupancy, rent, utilities, and maintenance.... a 14 6 W 15 Printing, pulications, postage, and shipping Other expenses (descrie in Schedule ) ,4 17 Total expenses. Add lines 1 throu g h ,91 18 Excess or (deficit) for the year (Sutract line 17 from line 9) N 19 Net assets or fund alances at eginning of year (from line 27, column (A)) (must agree with y end-of-year figure reported on prior year's return) ,466 2 Other changes in net assets or fund alances (explain in Schedule ) Z 21 Net assets or fund alances at end of year Comine lines 18 throug h ,926 For Paperwork Reduction Act Notice, see the separate instructions. Cat No Form 99-EZ (21)

2 Form 99 - EZ (21) Page 2 Balance Sheets. (see the instructions for Part II.) Check if the organization used Schedule to respond to any question in this Part II F-1 (A) Beginning of year ( B) End of year 22 Cash, savings, and investments , , Land and uildings Other assets (descrie in Schedule ) Total assets Total liailities (descrie in Schedule ) Net assets or fund alances (line 27 of column (B) must agree with line 21).. 7, ,926 Statement of Program Service Accomplishments (see the instructions for Part III.) Check if the organization used Schedule to respond to any question in this Part III.. What is the organization's primary exempt purpose? Descrie what was achieved in carrying out the organization's exempt purposes. In a clear and concise manner, descrie the services provided, the numer of persons enefited, and other relevant information for each program title Expenses (Required for section 51 (c)(3) and 51 (c)(4) organizations and section 4947( a)(1) trusts, optional for others ) (Grants $ If this amount includes foreig n g rants, check here. q Grants $ If this amount includes foreig n g rants, check here. q 3 8a 9a (Grants $ ) If this amount includes foreign grants, check here. 31 Other program services (descrie in Schedule ) (Grants $ If this amount includes foreig n g rants, check here. q.. q 31a 32 Total program service expenses (add lines 28a through 31 a) - 32 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 to respond to any question in this Part IV q (a) Name and address ANDY BERG SALIX 19, SAN DIEGO, CA RICHARD LAMBERTUS ANDORA WAY, SAN DIEGO, CA CYNDY MAC SHANE PASEO CEVERA, SAN DIEGO, CA MIKE SHOECRAFT GAINSBOROUGH AVE., SAN DIEGO, CA GARY PEHAIM GREENBERG WAY, SAN DIEGO, CA () Title and average hours per week devoted to position PRESIDENT VICE PRESIDENT SECRETARY GRANT CHAIRMAN TREASURER (c) Compensation ( if not paid, enter --.) a (4 Contriutions to employee enefit plans & deferred compensation (e) Expense account and other allowances Form 99-EZ (21)

3 Form 99- EZ (21) Page 3 Other Information (Note the statement requirements in the instructions for Part V.) Check if the organization used Schedule to respond to any question in this Part V q a 36 37a 38a 39 a 4a c d e 41 42a 43 c Did the organization engage in any activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization ' s name Otherwise, explain the change on Schedule (see instructions) If the organization had income from usiness activities, such as those reported on lines 2, 6a, and 7a (among others), ut not reported on Form 99-T, explain in Schedule why the organization did not report the income on Form 99-T. Did the organization have unrelated usiness gross income of $1, or more or was it a section 51(c)(4), 3 51 (c )(5), or 51 (c)(6) organization suject to section 633 (e) notice, reporting, and proxy tax requirements? 35a If "Yes," has it filed a tax return on Form 99 -T for this year (see instructions )? Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets 3 during the year? If " Yes, " complete applicale parts of Schedule N Enter amount of political expenditures, direct or indirect, as descried in the instructions. 37a Did the organization file Form 112-POL for this year? J 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? 38a 3 If "Yes," complete Schedule L, Part II and enter the total amount involved Section 51 (c)(7) organizations. Enter: Initiation fees and capital contriutions included on line a Gross receipts, included on line 9, for pulic use of clu facilities Section 51(c)(3) organizations. Enter amount of tax imposed on the organization during the year under: section 4911 ; section 4912 ; section 4955 Section 51 (c)(3) and 51 (c)(4) organizations. Did the organization engage in any section 4958 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 99 or 99 - EZ? If " Yes, " complete Schedule L, Part I Section 51 (c)(3) and 51 (c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and Section 51 (c)(3) and 51 (c)(4) organizations. Enter amount of tax on line 4c reimursed y the organization All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter transaction? If "Yes," complete Form T e 3 List the states with which a copy of this return is filed. The organization ' s ooks are in care of GARY PEHAIM Telephone no Located at PO BOX 72783, SAN DIEGO, CA 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 Yes No account)? If "Yes," enter the name of the foreign country- See the instructions for exceptions and filing requirements for Form TD F , Report of Foreign Bank and Financial Accounts. 1 At any time during the calendar year, did the organization maintain an office outside of the U.S.? c 3 If "Yes," enter the name of the foreign country: Section 4947 (a)(1) nonexempt charitale trusts filing Form 99 - EZ in lieu of Form Check here... q and enter the amount of tax-exempt interest received or accrued during the tax year N/A Yes No 44a Did the organization maintain any donor advised funds during the year? If "Yes," Form 99 must e completed instead of Form 99-EZ a 3 Did the organization operate one or more hospital facilities during the year? If "Yes," Form 99 must e completed instead of Form 99-EZ J c Did the organization receive any payments for indoor tanning services during the year? c d If "Yes" to line 44c, has the organization filed a Form 72 to report these payments'? If "No," provide an explanation in Schedule d Yes No 3 Form 99-EZ (21)

4 Form 99-EZ (21) Page 4 Yes No 45 Is any related organization a controlled entity of the organization within the meaning of section 512()(13)? 45 3 a Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512()(13)? If "Yes," Form 99 and Schedule R may need to e completed instead of Form 99-EZ (see instructions) a 3 46 Did the organization engage, directly or indirectly, in political campaign activities on ehalf of or in opposition to candidates for pulic office? If "Yes," complete Schedule C, Part I J CEBU Section 51(c)( 3) organizations and section 4947 (a)(1) nonexempt charitale trusts only. All section 51(c)(3) organizations and section 4947(a)(1) nonexempt charitale trusts must answer questions and 52, and complete the tales for lines 5 and 51. Check if the organization used Schedule to respond to any question in this Part VI q Yes No 47 Did the organization engage in loying activities? If "Yes," complete Schedule C, Part II Is the organization a school as descried in section 17()(1)(A)(I)? If "Yes," complete Schedule E a Did the organization make any transfers to an exempt non-charitale related organization? a If "Yes," was the related organization a section 527 organization? Complete this tale for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $1, of compensation from the organization. If there is none, enter "None." (a) Name and address of each employee paid more than $1, NONE () Title and average hours per week devoted to position (c) Compensation (d) Contriutions to employee enefit plans & deferred compensation (e) Expense account and other allowances f Total numer of other employees paid over $1, Complete this tale for the organization's five highest compensated independent contractors who each received more than $1, of compensation from the organization. If there is none, enter "None." NONE (a) Name and address of each independent contractor paid more than $1, () Type of service (c) Compensation d Total numer of other independent contractors each recelvln 52 Did the organization complete Schedule A? Note : All section nonexempt charitale t rusts must attach a completed Sched Under penalties of perjury, I are that I have exa ed this return, i n c -Old true, correct, and com I Declaration of arepa other than off is e;7 r Sign `" ' -51g-nature of offic Here GARY PEHA), TREASURER Paid Preparer Use Only Type or print name and title Pnnt/Type preparer's name Firm's name Preparer's signature the IRS discuss this return with the preparer shown

5 SCHEDULE A OMB No (Form 99 or99 - EZ) Pulic Charity Status and Pulic Support 21 Complete if the organization is a section 51(c )(3) organization or a section 4947 ( a)(1) nonexempt charitale trust. e -. Department of the Treasury Internal Revenue Service Do- Attach to Form 99 or Form 99 - EZ. IN- See separate instructions. Name of the organization Employer identification numer RANCHO DE LOS PENASQUITOS TOWN COUNCIL JUM Reason for Pulic Charity Status (All organizations must complete this part.) See instructions. The organization is not a private foundation ecause it is: (For lines 1 through 11, check only one ox.) 1 q A church, convention of churches, or association of churches descried in section 17 ( )(1)(A)(i). 2 q A school descried in section 17( )(1)(A)(ii). (Attach Schedule E) 3 q A hospital or a cooperative hospital service organization descried in section 17 ( )(1)(A)(iii). 4 q A medical research organization operated in conjunction with a hospital descried in section 17 ( )(1)(A)(iii). Enter the hospital' s name, city, and state: q An organization operated for the enefit of a college -g- e -o_-r- or - university owned or operated y a governmental unit descried in section 17 ( )(1)(A)(iv ). (Complete Part II ) 6 q A federal, state, or local government or governmental unit descried in section 17 ( )(1)(A)(v). 7 An organization that normally receives a sustantial part of its support from a governmental unit or from the general pulic descried in section 17 ( )(1)(A)(vi ). (Complete Part II.) 8 q A community trust descried in section 17()(1)(A)(vi ). (Complete Part II.) 9 q An organization that normally receives: (1) more than 331/3% of its support from contriutions, memership fees, and gross receipts from activities related to its exempt functions-suject to certain exceptions, and (2) no more than 33'/a% of its support from gross investment income and unrelated usiness taxale income (less section 511 tax) from usinesses acquired y the organization after June 3, See section 59(a )(2). (Complete Part III.) 1 q An organization organized and operated exclusively to test for pulic safety. See section 59(a)(4). 11 q 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 59(a)(1) or section 59(a)(2). See section 59(a )(3). Check the ox that descries the type of supporting organization and complete lines 11 a through 11 h. (A) a q Type I q Type II c q Type III-Functionally integrated d q Type III-Other e q By checking this ox, I certify that the organization is not controlled directly or indirectly y one or more disqualified persons other than foundation managers and other than one or more pulicly supported organizations descried in section 59(a)(1) or section 59(a)(2). f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this ox q g Since August 17, 26, has the organization accepted any gift or contriution from any of the following persons? h (i) (i) A person who directly or indirectly controls, either alone or together with persons descried in (ii) and Yes No (III) elow, the governing ody of the supported organization? (i) (ii) A family memer of a person descried in (i) aove? (^^) (iii) A 35% controlled entity of a person descried in (I) or (it) aove? ttgp^^) Provide the following information aout the supported organization(s). Name of supported organization (ii) EIN (in) Type of organization (descried on lines 1-9 aove or IRC section (see instructions )) (iv) Is the organization in col (i) listed in your governing document? (v) Did you notify the organization in col (i) of your support9 (vi) Is the organization in col (i) organized in the U S Yes No Yes No Yes No (vii) Amount of support (B) (C) (D) (E) Total For Paperwork Reduction Act Notice, see the Instructions for Cat No 11285E Schedule A (Form 99 or 99 - EZ) 21 Form 99 or 99-EZ.

6 Schedule A (Form 99 or 99Q-E21 21 Page 2 LEM Support Schedule for Organizations Descried in Sections 17()( 1)(A)(iv) and 17 ()(1)(A)(vi) (Complete only if you checked the ox on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed elow, please complete Part III.) Section A. Pulic Support Calendar year (or fiscal year eginning in) (a) 26 () 27 (c) 28 (d) 29 (e) 21 (f) Total 1 Gifts, grants, contriutions, and memership fees received (Do not include any "unusual grants.")... 2 Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf 3 The value of services or facilities furnished y a governmental unit to the organization without charge... 4 Total. Add lines 1 through The portion of total contriutions y each person (other than a governmental unit or pulicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. 6 Pulic support Sutract line 5 from line 4. Section B. Total Support Calendar year (or fiscal year eginning in) 7 Amounts from line Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated usiness activities, whether or not the usiness is regularly carried on Other income. Do not include gain or loss from the sale of capital assets ( Explain in Part IV) (a) 26 () 27 ( c) 28 (d) 29 (e) 21 (f) Total Total support. Add lines 7 through 1 Gross receipts from related activities, etc. (see instructions ) First five years. If the Form 99 is for the organization's first, second, third, fourth, or fifth tax year as a section 51(c)(3) organization, check this ox and stop here q section c. computation of Pulic support Percentage 14 Pulic support percentage for 21 (line 6, column (f) divided y line 11, column (f)) 14 % 15 Pulic support percentage from 29 Schedule A, Part II, line % 16a 33 1 /3% support test-21. If the organization did not check the ox on line 13, and line 14 is 331,3% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization q 331/3% support test- 29. If the organization did not check a ox on line 13 or 16a, and line 15 is 331/3% or more, check this ox and stop here. The organization qualifies as a pulicly supported organization q 17a 1%-facts-and - circumstances test-21. If the organization did not check a ox on line 13, 16a, or 16, and line 14 is 1% or more, and if the organization meets the "facts-and-circumstances" test, check this ox and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a pulicly supported organization q 1%-facts - and-circumstances test-29. If the organization did not check a ox on line 13, 16a, 16, or 17a, and line 15 is 1% or more, and if the organization meets the "facts-and-circumstances" test, check this ox and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a pulicly supported organization q 18 Private foundation. If the organization did not check a ox on line 13, 16a, 16, 17a, or 17, check this ox and see instructions q Schedule A (Form 99 or 99-EZ) 21

7 Schedule A (Form 99 or 99 - EZ) 21 Page 3 Support Schedule for Organizations Descried in Section 59(a)(2) (Complete only if you checked the ox on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed elow, please complete Part II.) Section A. Pulic Support Calendar year (or fiscal year eginning in) (a) 26 () 27 (c) 28 (d) 29 (e) 21 (f) Total 1 Gifts, grants, contriutions, and memership fees received (Do not include any 'unusual grants') 2 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... 3 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 5 The value of services or facilities furnished y a governmental unit to the organization without charge. 6 Total. Add lines 1 through a Amounts included on lines 1, 2, and 3 received from disqualified persons. Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5, or 1 % of the amount on line 13 for the year c Add lines 7a and Pulic support (Sutract line 7c from Section B. Total Support Calendar year (or fiscal year eginning in) 9 Amounts from line 6.. 1a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Unrelated usiness taxale income (less section 511 taxes) from usinesses acquired after June 3, c Add lines 1a and 1 O 11 Net income from unrelated usiness activities not included in line 1, whether or not the usiness is regularly carried on 12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) Total support. (Add lines 9, 1c, 11, and 12 ) (a) 26 () 27 (c) 28 (d) 29 (e) 21 (f) Total 14 First five years. If the Form 99 is for the organization's first, second, third, fourth, or fifth tax year as a section 51(c)(3) organization, check this ox and stop here Section C. Computation of Pulic Support Percentage 15 Pulic support percentage for 21 (line 8, column (f) divided y line 13, column (f)).. 15 % 16 Pulic support percentage from 29 Schedule A, Part III, line % Section D. Computation of Investment Income Percentage 17 Investment income percentage for 21 (line 1 Oc, column (f) divided y line 13, column (f)) % 18 Investment income percentage from 29 Schedule A, Part III, line % 19a 33 1 /3% support tests If the organization did not check the ox on line 14, and line 15 is more than 331/3%, and line 17 is not more than 331/3%, check this ox and stop here. The organization qualifies as a pulicly supported organization. fl 331/3% support tests If the organization did not check a ox on line 14 or line 19a, and line 16 is more than 331/3%, and line 18 is not more than 331/3%, check this ox and stop here. The organization qualifies as a pulicly supported organization D 2 Private foundation. If the orga nization did not check a ox on l ine 14, 19a, or 19, check this ox and see instructions Schedule A (Form 99 or 99-EZ) 21

8 Schedule A (Form 99 or 99-EZ ) 21 Page 4 Supplemental Information. Complete this part to provide the explanations required y Part II, line 1; Part II, line 17a or 17; and Part III, line 12. Also complete this part for any additional information. (See instructions) Schedule A (Form 99 or 99-EZ) 21