Return of Organization Exempt From Income Tax

Transcription

1 Part I 1 22 Part II Sign Hr Paid Prparr Us Only 99 Rturn of Organization Exmpt From Inom Tax Undr stion 51(), 52, or 494(a)(1) of th Intrnal Rvnu Cod (xpt lak lung nfit trust or privat foundation) A For th 211 alndar yar, or tax yar ginning, 211, and nding, 2 B Form Dpartmnt of th Trasury Intrnal Rvnu Srvi Sam as C aov kysforthhomlss.org 2 VA Summary Brifly dsri th organization's mission or most signifiant ativitis: Aid Homlss Srvi Organizations 2 Chk this ox if th organization disontinud its oprations or disposd of mor than 25% of its nt assts. 3 Numr of voting mmrs of th govrning ody (Part VI, lin 1a) Numr of indpndnt voting mmrs of th govrning ody (Part VI, lin 1) Total numr of individuals mployd in alndar yar 211 (Part V, lin 2a) Total numr of voluntrs (stimat if nssary)... 6 a Total unrlatd usinss rvnu from Part VIII, olumn (C), lin a Nt unrlatd usinss taxal inom from Form 99-T, lin a Total assts (Part, lin 16)... Total liailitis (Part, lin 26)... Nt assts or fund alans. Sutrat lin 21 from lin 2... Signatur Blok For Paprwork Rdution At ti, s th sparat instrutions. Th organization may hav to us a opy of this rturn to satisfy stat rporting rquirmnts. Contriutions and grants (Part VIII, lin 1h) Program srvi rvnu (Part VIII, lin 2g) Invstmnt inom (Part VIII, olumn (A), lins 3, 4, and d)... Othr rvnu (Part VIII, olumn (A), lins 5, 6d, 8, 9, 1, and 11)... Total rvnu - add lins 8 through 11 (must qual Part VIII, olumn (A), lin 12)... Grants and similar amounts paid (Part I, olumn (A), lins 1-3) Bnfits paid to or for mmrs (Part I, olumn (A), lin 4) Salaris, othr ompnsation, mploy nfits (Part I, olumn (A), lins 5-1)... Profssional fundraising fs (Part I, olumn (A), lin 11) Total fundraising xpnss (Part I, olumn (D), lin 25) Othr xpnss (Part I, olumn (A), lins 11a-11d, 11f-24)... 2, Total xpnss. Add lins 13-1 (must qual Part I, olumn (A), lin 25)... Rvnu lss xpnss. Sutrat lin 18 from lin May th IRS disuss this rturn with th prparr shown aov? (s instrutions) 211 Opn to Puli Insption C Nam of organization KEYS for th Homlss Foundation In D Employr idntifiation no. Nam hang Numr and strt (or P.O. ox if mail is not dlivrd to strt addrss) Room/suit E Tlphon numr Amndd rturn Annandal, VA 223 G Gross ripts $ F K Form of organization: Corporation Trust Assoiation Othr L Yar of formation: M Stat of lgal domiil: A G t o i v v i r t n i a n s & R v n u E x p n s s Chk if applial: Addrss hang Initial rturn Doing Businss As Trminatd City or town, stat or ountry, and ZIP + 4 Appliation pnding Nam and addrss of prinipal offir: Valri Johnson H(a) Is this a group rturn for affiliats? Prior Yar OMB I Tax-xmpt status: 51()(3) 51() ( ) (insrt no.) 494(a)(1) or 52 H() Ar all affiliats inludd? Ys If "," attah a list. (s instrutions) J Wsit: H() Group xmption numr Ys Ys Currnt Yar Nt Bginning of Currnt Yar End of Yar Assts or Fund Balans 2 21 Undr pnaltis of prjury, I dlar that I hav xamind this rturn, inluding aompanying shduls and statmnts, and to th st of my knowldg and lif, it is tru, orrt, and omplt. Dlaration of prparr (othr than offir) is asd on all information of whih prparr has any knowldg. Signatur of offir Typ or print nam and titl Dat Print/Typ prparr's nam Prparr's signatur Chk if PTIN Tim Arromi Tim Arromi slf-mployd P Firm's nam Firm's addrss Firm's EIN Phon no. Dat Harling Lan (3) Valri Johnson Valri Johnson, Exutiv Dirtor Arromi and Assoiats LLC 869 Sond Avnu 5B Silvr Spring MD , , ,415 2, ,26 265,415 19,6 16,6 226, , , ,453 6,122 3,962 15,51 16,5 5,2 2,863 9,45 13,

2 KEYS for th Homlss Foundation In Pag 2 Part III Statmnt of Program Srvi Aomplishmnts Chk if Shdul O ontains a rspons to any qustion in this Part III... 1 Brifly dsri th organization's mission: Aid Homlss Srvi Organizations Did th organization undrtak any signifiant program srvis during th yar whih wr not listd on th prior Form 99 or 99-EZ?... If "Ys," dsri ths nw srvis on Shdul O. Did th organization as onduting, or mak signifiant hangs in how it onduts, any program srvis?... If "Ys," dsri ths hangs on Shdul O. Dsri th organization's program srvi aomplishmnts for ah of its thr largst program srvis, as masurd y xpnss. Stion 51()(3) and 51()(4) organizations and stion 494(a)(1) trusts ar rquird to rport th amount of grants and alloations to othrs, th total xpnss, and rvnu, if any, for ah program srvi rportd. Ys Ys 4a (Cod: ) (Expnss $ 243,382 inluding grants of $ ) (Rvnu $ ) Distriution ntwork providing vryday asi houshold goods to mt ral lif nds. Work with ovr 3 haritis aring ovr 25, popl. 4 (Cod: ) (Expnss $ inluding grants of $ ) (Rvnu $ ) 4 (Cod: ) (Expnss $ inluding grants of $ ) (Rvnu $ ) 4d 4 Othr program srvis. (Dsri in Shdul O.) (Expnss $ inluding grants of $ ) (Rvnu $ ) Total program srvi xpnss 243,382

3 KEYS for th Homlss Foundation In Pag 3 Part IV Chklist of Rquird Shduls 1 Is th organization dsrid in stion 51()(3) or 494(a)(1) (othr than a privat foundation)? If "Ys," omplt Shdul A Is th organization rquird to omplt Shdul B, Shdul of Contriutors? (s instrutions)? Did th organization ngag in dirt or indirt politial ampaign ativitis on half of or in opposition to andidats for puli offi? If "Ys," omplt Shdul C, Part I Stion 51()(3) organizations. Did th organization ngag in loying ativitis, or hav a stion 51(h) ltion in fft during th tax yar? If "Ys," omplt Shdul C, Part II Is th organization a stion 51()(4), 51()(5), or 51()(6) organization that rivs mmrship dus, a Did th organization rport an amount for land, uildings, and quipmnt in Part, lin 1? If "Ys," omplt Shdul D, Part VI... 11a Did th organization rport an amount for invstmnts - othr suritis in Part, lin 12 that is 5% or mor of its total assts rportd in Part, lin 16? If "Ys," omplt Shdul D, Part VII Did th organization rport an amount for invstmnts - program rlatd in Part, lin 13 that is 5% or mor of its total assts rportd in Part, lin 16? If "Ys," omplt Shdul D, Part VIII d Did th organization rport an amount for othr assts in Part, lin 15 that is 5% or mor of its total assts rportd in Part, lin 16? If "Ys," omplt Shdul D, Part I... 11d Did th organization rport an amount for othr liailitis in Part, lin 25? If "Ys," omplt Shdul D, Part f Did th organization's sparat or onsolidatd finanial statmnts for th tax yar inlud a footnot that addrsss th organization's liaility for unrtain tax positions undr FIN 48 (ASC 4)? If "Ys," omplt Shdul D, Part... 11f 12a Did th organization otain sparat, indpndnt auditd finanial statmnts for th tax yar? If "Ys," omplt Shdul D, Parts I, II, and III... 12a Was th organization inludd in onsolidatd, indpndnt auditd finanial statmnts for th tax yar? If "Ys," and if th organization answrd "" to lin 12a, thn omplting Shdul D, Parts I, II, and III is optional Is th organization a shool dsrid in stion 1()(1)(A)(ii)? If "Ys," omplt Shdul E a Did th organization maintain an offi, mploys, or agnts outsid of th Unitd Stats?... 14a Did th organization hav aggrgat rvnus or xpnss of mor than $1, from grantmaking, a assssmnts, or similar amounts as dfind in Rvnu Produr 98-19? If "Ys," omplt Shdul C, Part III... Did th organization maintain any donor advisd funds or any similar funds or aounts for whih donors hav th right to provid advi on th distriution or invstmnt of amounts in suh funds or aounts? If "Ys," omplt Shdul D, Part I... Did th organization riv or hold a onsrvation asmnt, inluding asmnts to prsrv opn spa, th nvironmnt, histori land aras, or histori struturs? If "Ys," omplt Shdul D, Part II... Did th organization maintain olltions of works of art, historial trasurs, or othr similar assts? If "Ys," omplt Shdul D, Part III... Did th organization rport an amount in Part, lin 21; srv as a ustodian for amounts not listd in Part ; or provid rdit ounsling, dt managmnt, rdit rpair, or dt ngotiation srvis? If "Ys," omplt Shdul D, Part IV... Did th organization, dirtly or through a rlatd organization, hold assts in tmporarily rstritd ndowmnts, prmannt ndowmnts, or quasi-ndowmnts? If "Ys," omplt Shdul D, Part V... If th organization's answr to any of th following qustions is "Ys," thn omplt Shdul D, Parts VI, VII, VIII, I, or as applial. fundraising, usinss, invstmtnt, and program srvi ativitis outisd th Unitd Stats, or aggrgat forign invstmnts valud at $1, or mor? If "Ys,' omplt Shdul F, Parts I and IV Did th organization rport on Part I, olumn (A), lin 3, mor than $5, of grants or assistan to any organization or ntity loatd outsid th Unitd Stats? If "Ys," omplt Shdul F, Parts II and IV Did th organization rport on Part I, olumn (A), lin 3, mor than $5, of aggrgat grants or assistan to individuals loatd outsid th Unitd Stats? If "Ys," omplt Shdul F, Parts III and IV Did th organization rport a total of mor than $15, of xpnss for profssional fundraising srvis on Part I, olumn (A), lins 6 and 11? If "Ys," omplt Shdul G, Part I (s instrutions)... 1 Did th organization rport mor than $15, total of fundraising vnt gross inom and ontriutions on Part VIII, lins 1 and 8a? If "Ys," omplt Shdul G, Part II Did th organization rport mor than $15, of gross inom from gaming ativitis on Part VIII, lin 9a? If "Ys," omplt Shdul G, Part III Did th organization oprat on or mor hospital failitis? If "Ys," omplt Shdul H... 2a If "Ys" to lin 2a, did th organization attah its auditd finanial statmnts to this rturn? Ys

4 KEYS for th Homlss Foundation In Pag 4 Part IV Chklist of Rquird Shduls (ontinud) a d 25a Part IV instrutions for applial filing thrsholds, onditions, and xptions): a A urrnt or formr offir, dirtor, trust, or ky mploy? If "Ys," omplt Shdul L, Part IV... 28a A family mmr of a urrnt or formr offir, dirtor, trust, or ky mploy? If "Ys," omplt Shdul L, Part IV An ntity of whih a urrnt or formr offir, dirtor, trust, or ky mploy (or a family mmr throf) was an offir, dirtor, trust, or dirt or indirt ownr? If "Ys," omplt Shdul L, Part IV Did th organization riv mor than $25, in non-ash ontriutions? If "Ys," omplt Shdul M Did th organization riv ontriutions of art, historial trasurs, or othr similar assts, or qualifid onsrvation ontriutions? If "Ys," omplt Shdul M Did th organization liquidat, trminat, or dissolv and as oprations? If "Ys," omplt Shdul N, Part I Did th organization sll, xhang, dispos of, or transfr mor than 25% of its nt assts? If "Ys," omplt Shdul N, Part II Did th organization own 1% of an ntity disrgardd as sparat from th organization undr Rgulations stions and ? If "Ys," omplt Shdul R, Part I Was th organization rlatd to any tax-xmpt or taxal ntity? If "Ys," omplt Shdul R, Parts II, III, IV, and V, lin a Did th organization hav a ontrolld ntity within th maning of stion 512()(13)?... 35a Did th organization riv any paymnt from or ngag in any transation with a ontrolld ntity within th maning of stion 512()(13)? If "Ys," omplt Shdul R, Part V, lin Stion 51()(3) organizations. Did th organization mak any transfrs to an xmpt non-harital rlatd organization? If "Ys," omplt Shdul R, Part V, lin Did th organization ondut mor than 5% of its ativitis through an ntity that is not a rlatd organization 38 Did th organization rport mor than $5, of grants and othr assistan to any govrnmnt or organization in th Unitd Stats on Part I, olumn (A), lin 1? If "Ys," omplt Shdul I, Parts I and II... Did th organization rport mor than $5, of grants and othr assistan to individuals in th Unitd Stats on Part I, olumn (A), lin 2? If "Ys," omplt Shdul I, Parts I and III... Did th organization answr "Ys" to Part VII, Stion A, lin 3, 4, or 5 aout ompnsation of th organization's urrnt and formr offirs, dirtors, trusts, ky mploys, and highst ompnsatd mploys? If "Ys," omplt Shdul J... Did th organization hav a tax-xmpt ond issu with an outstanding prinipal amount of mor than $1, as of th last day of th yar, that was issud aftr Dmr 31, 22? If "Ys," answr lins 24 through 24d and omplt Shdul K. If "," go to lin Did th organization invst any prods of tax-xmpt onds yond a tmporary priod xption?... Did th organization maintain an srow aount othr than a rfunding srow at any tim during th yar to dfas any tax-xmpt onds?... Did th organization at as an "on half of" issur for onds outstanding at any tim during th yar?... Stion 51()(3) and 51()(4) organizations. Did th organization ngag in an xss nfit transation with a disqualifid prson during th yar? If "Ys," omplt Shdul L, Part I... Is th organization awar that it ngagd in an xss nfit transation with a disqualifid prson in a prior yar, and that th transation has not n rportd on any of th organization's prior Forms 99 or 99-EZ? If "Ys," omplt Shdul L, Part I... Was a loan to or y a urrnt or formr offir, dirtor, trust, ky mploy, highly ompnsatd mploy, or disqualifid prson outstanding as of th nd of th organization's tax yar? If "Ys," omplt Shdul L, Part II... Did th organization provid a grant or othr assistan to an offir, dirtor, trust, ky mploy, sustantial ontriutor or mploy throf, a grant sltion ommitt mmr, or to a 35% ontrolld ntity or family mmr of any of ths prsons? If "Ys," omplt Shdul L, Part III... Was th organization a party to a usinss transation with on of th following partis (s Shdul L, and that is tratd as a partnrship for fdral inom tax purposs? If "Ys," omplt Shdul R, Part VI... 3 Did th organization omplt Shdul O and provid xplanations in Shdul O for Part VI, lins 11 and 19? t. All Form 99 filrs ar rquird to omplt Shdul O a d 25a Ys

5 KEYS for th Homlss Foundation In Pag 5 Part V Statmnts Rgarding Othr IRS Filings and Tax Complian Chk if Shdul O ontains a rspons to any qustion in this Part V... 1a 2a 3a 4a 5a 6a a Did th organization riv a paymnt in xss of $5 mad partly as a ontriution and partly for goods and srvis providd to th payor?... If "Ys," did th organization notify th donor of th valu of th goods or srvis providd?... Did th organization sll, xhang, or othrwis dispos of tangil prsonal proprty for whih it was rquird to fil Form 8282?... d If "Ys," indiat th numr of Forms 8282 fild during th yar... d Did th organization riv any funds, dirtly or indirtly, to pay prmiums on a prsonal nfit ontrat?... f Did th organization, during th yar, pay prmiums, dirtly or indirtly, on a prsonal nfit ontrat?... g If th organization rivd a ontriution of qualifid intlltual proprty, did th organization fil Form 8899 as rquird?.. h If th organization rivd a ontriution of ars, oats, airplans, or othr vhils, did th organization fil a Form 198-C?... 8 Sponsoring organizations maintaining donor advisd funds and stion 59(a)(3) supporting organizations. Did th supporting organization, or a donor advisd fund maintaind y a sponsoring organization, hav xss usinss holdings at any tim during th yar? Sponsoring organizations maintaining donor advisd funds. a Did th organization mak any taxal distriutions undr stion 4966?... 9a Did th organization mak a distriution to a donor, donor advisor, or rlatd prson? Stion 51()() organizations. Entr: a Initiation fs and apital ontriutions inludd on Part VIII, lin a Gross ripts, inludd on Form 99, Part VIII, lin 12, for puli us of lu failitis Stion 51()(12) organizations. Entr: a Gross inom from mmrs or sharholdrs... 11a Gross inom from othr sours (Do not nt amounts du or paid to othr sours against amounts du or rivd from thm.) a Stion 494(a)(1) non-xmpt harital trusts. Is th organization filing Form 99 in liu of Form 141?... 12a If "Ys," ntr th amount of tax-xmpt intrst rivd or arud during th yar Stion 51()(29) qualifid nonprofit halth insuran issurs. a Is th organization linsd to issu qualifid halth plans in mor than on stat?... 13a t. S th instrutions for additional information th organization must rport on Shdul O. 14a Entr th numr rportd in Box 3 of Form 196. Entr -- if not applial... 1a 3 Entr th numr of Forms W-2G inludd in lin 1a. Entr -- if not applial... 1 Did th organization omply with akup withholding ruls for rportal paymnts to vndors and rportal gaming (gamling) winnings to priz winnrs?... Entr th numr of mploys rportd on Form W-3, Transmittal of Wag and Tax Statmnts, fild for th alndar yar nding with or within th yar ovrd y this rturn... 2a If at last on is rportd on lin 2a, did th organization fil all rquird fdral mploymnt tax rturns?... t. If th sum of lins 1a and 2a is gratr than 25, you may rquird to -fil. (s instrutions) Did th organization hav unrlatd usinss gross inom of $1, or mor during th yar?... If "Ys," has it fild a Form 99-T for this yar? If "," provid an xplanation in Shdul O... At any tim during th alndar yar, did th organization hav an intrst in, or a signatur or othr authority ovr, a finanial aount in a forign ountry (suh as a ank aount, suritis aount, or othr finanial aount)?... If "Ys," ntr th nam of th forign ountry: S instrutions for filing rquirmnts for Form TD F , Rport of Forign Bank and Finanial Aounts. Was th organization a party to a prohiitd tax shltr transation at any tim during th tax yar?... Did any taxal party notify th organization that it was or is a party to a prohiitd tax shltr transation?... If "Ys," to lin 5a or 5, did th organization fil Form 8886-T?... Dos th organization hav annual gross ripts that ar normally gratr than $1,, and did th organization soliit any ontriutions that wr not tax ddutil?... If "Ys," did th organization inlud with vry soliitation an xprss statmnt that suh ontriutions or gifts wr not tax ddutil?... Organizations that may riv ddutil ontriutions undr stion 1(). Entr th amount of rsrvs th organization is rquird to maintain y th stats in whih th organization is linsd to issu qualifid halth plans Entr th amount of rsrvs on hand Did th organization riv any paymnts for indoor tanning srvis during th tax yar?... 14a If "Ys," has it fild a Form 2 to rport ths paymnts? If "," provid an xplanation in Shdul O a 3 4a 5a 5 5 6a 6 a f g h Ys

6 KEYS for th Homlss Foundation In Pag 6 Part VI Govrnan, Managmnt, and Dislosur For ah "Ys" rspons to lins 2 through low, and for a "" rspons to lin 8a, 8, or 1 low, dsri th irumstans, prosss, or hangs in Shdul O. S instrutions. Chk if Shdul O ontains a rspons to any qustion in this Part VI... Stion A. Govrning Body and Managmnt 1a ommitt, xplain in Shdul O. Entr th numr of voting mmrs inludd in lin 1a, aov, who ar indpndnt Did any offir, dirtor, trust, or ky mploy hav a family rlationship or a usinss rlationship with any othr offir, dirtor, trust, or ky mploy? Did th organization dlgat ontrol ovr managmnt dutis ustomarily prformd y or undr th dirt suprvision of offirs, dirtors, or trusts, or ky mploys to a managmnt ompany or othr prson? Did th organization mak any signifiant hangs to its govrning doumnts sin th prior Form 99 was fild? Did th organization om awar during th yar of a signifiant divrsion of th organization's assts? Did th organization hav mmrs or stokholdrs?... 6 a Did th organization hav mmrs, stokholdrs, or othr prsons who had th powr to lt or appoint on or mor mmrs of th govrning ody?... a Ar any govrnan disions of th organization rsrvd to (or sujt to approval y) mmrs, stokholdrs, or prsons othr than th govrning ody?... 8 Did th organization ontmporanously doumnt th mtings hld or writtn ations undrtakn during th yar y th following: a Th govrning ody?... Eah ommitt with authority to at on half of th govrning ody?... 9 Is thr any offir, dirtor, trust, or ky mploy listd in Part VII, Stion A, who annot rahd at th organization's mailing addrss? If "Ys," provid th nams and addrsss in Shdul O... Stion B. Poliis (This Stion B rqusts information aout poliis not rquird y th Intrnal Rvnu Cod.) 1a 11a 12a Did th organization rgularly and onsistntly monitor and nfor omplian with th poliy? If "Ys," dsri in Shdul O how this was don Did th organization hav a writtn whistllowr poliy? Did th organization hav a writtn doumnt rtntion and dstrution poliy? Did th pross for dtrmining ompnsation of th following prsons inlud a rviw and approval y a 16a partiipation in joint vntur arrangmnts undr applial fdral tax law, and tak stps to safguard th organization's xmpt status with rspt to suh arrangmnts?... Stion C. Dislosur 1 List th stats with whih a opy of this Form 99 is rquird to fild Entr th numr of voting mmrs of th govrning ody at th nd of th tax yar If thr ar matrial diffrns in voting rights among mmrs of th govrning ody, or If th govrning ody dlgatd road authority to an xutiv ommitt or similar Did th organization hav loal haptrs, ranhs, or affiliats?... If "Ys," did th organization hav writtn poliis and produrs govrning th ativitis of suh haptrs, affiliats, and ranhs to nsur thir oprations ar onsistnt with th organization's xmpt purposs?... Has th organization providd a omplt opy of this Form 99 to all mmrs of its govrning ody for filing th form?.. Dsri in Shdul O th pross, if any, usd y th organization to rviw this Form 99. Did th organization hav a writtn onflit of intrst poliy? If "," go to lin Wr offirs, dirtors or trusts, and ky mploys rquird to dislos annually intrsts that ould giv ris to onflits? indpndnt prsons, omparaility data, and ontmporanous sustantiation of th dliration and dision? Th organization's CEO, Exutiv Dirtor, or top managmnt offiial... Othr offirs or ky mploys of th organization... If "Ys" to lin 15a or 15, dsri th pross in Shdul O (s instrutions.) Did th organization invst in, ontriut assts to, or partiipat in a joint vntur or similar arrangmnt with a taxal ntity during th yar?... If "Ys," did th organization follow a writtn poliy or produr rquiring th organization to valuat its Stion 614 rquirs an organization to mak its Forms 123 (or 124 if applial), 99, and 99-T (Stion 51()(3)s only) availal for puli insption. Indiat how you mak ths availal. Chk all that apply. Own wsit Anothr's wsit Upon rqust Dsri in Shdul O whthr (and if so, how), th organization maks its govrning doumnts, onflit of intrst poliy, and finanial statmnts availal to th puli during th tax yar. Stat th nam, physial addrss, and tlphon numr of th prson who posssss th ooks and rords of th organization: Valri Johnson (3) Harling Lan Annandal, VA a 8 8a 8 9 1a 1 11a 12a 12 15a 15 16a 16 Ys Ys

7 KEYS for th Homlss Foundation In Pag Part VII Compnsation of Offirs, Dirtors, Trusts, Ky Employs, Highst Compnsatd Employs, and Indpndnt Contrators Chk if Shdul O ontains a rspons to any qustion in this Part VII... Stion A. Offirs, Dirtors, Trusts, Ky Employs, and Highst Compnsatd Employs 1a Complt this tal for all prsons rquird to listd. Rport ompnsation for th alndar yar nding with or within th organization's tax yar. List all of th organization's urrnt offirs, dirtors, trusts (whthr individuals or organizations), rgardlss of amount of ompnsation. Entr -- in olumns (D), (E), and (F) if no ompnsation was paid. (1) (2) (3) (4) (5) (6) () Valri Johnson Exutiv Dirtor 6. 1,16 (8) List all of th organization's urrnt ky mploys, if any. S instrutions for dfinition of "ky mploy." List th organization's fiv urrnt highst ompnsatd mploys (othr than an offir, dirtor, trust, or ky mploy) who rivd rportal ompnsation (Box 5 of Form W-2 and/or Box of Form 199-MISC) of mor than $1, from th organization and any rlatd organizations. List all of th organization's formr offirs, ky mploys, and highst ompnsatd mploys who rivd mor than $1, of rportal ompnsation from th organization and any rlatd organizations. List all of th organization's formr dirtors or trusts that rivd, in th apaity as a formr dirtor or trust of th organization, mor than $1, of rportal ompnsation from th organization and any rlatd organizations. List prsons in th following ordr: individual trusts or dirtors; institutional trusts; offirs; ky mploys; highst ompnsatd mploys; and formr suh prsons. Chk this ox if nithr th organization nor any rlatd organization ompnsatd any urrnt offir, dirtor, or trust. C Marquz (A) (B) (C) (D) (E) (F) organizations Nam and Titl Avrag Position Rportal Rportal Estimatd hours pr ompnsation ompnsation from amount of (do not hk mor than on wk from rlatd othr (dsri ox, unlss prson is oth an th organizations ompnsation hours for offir and a dirtor/trust) organization (W-2/199-MISC) from th rlatd (W-2/199-MISC) organization I n t d r i I n t r O f K H i o m F o and rlatd in Shdul d u r s u f y g m p r organizations O) i s t s i h p l m v t i t o i t t m s n y r d o u r p t s u r t l a a o i o t l r o y n d a l Dirtor 2. E Durso Dirtor 2. J Gargiulo Jr Dirtor 2. J Oaks VP/Srtary 2. Matthw Burk Trasurr 2. O L Gwaltny Dirtor 2. (9) (1) (11) (12) (13) (14)

8 KEYS for th Homlss Foundation In Pag 8 Part VII Stion A. Offirs, Dirtors, Trusts, Ky Employs, and Highst Compnsatd Employs (ontinud) (15) (A) (B) (C) (D) (E) (F) Nam and Titl Avrag Position Rportal Rportal Estimatd hours pr (do not hk mor than on ompnsation ompnsation from amount of wk ox, unlss prson is oth an from rlatd othr (dsri offir and dirtor/trust) th organizations ompnsation hours for I t d I t O K H F organization (W-2/199-MISC) from th rlatd n r i n r f i o m o (W-2/199-MISC) organization d u r s u f y g mp r organizations and rlatd i s t s i h p l m in Shdul v t i t o organizations i t t m O) s n y r d o u r p t s iu r t l a a o i o t r o y l n d a l (16) (1) (18) (19) (2) (21) (22) (23) (24) (25) 1 Su-total... Total from ontinuation shts to Part VII, Stion A... d Total (add lins 1 and 1)... 1,16 2 Total numr of individuals (inluding ut not limitd to thos listd aov) who rivd mor than $1, in rportal ompnsation from th organization Ys 3 Did th organization list any formr offir, dirtor or trust, ky mploy, or highst ompnsatd mploy on lin 1a? If "Ys," omplt Shdul J for suh individual For any individual listd on lin 1a, is th sum of rportal ompnsation and othr ompnsation from th organization and rlatd organizations gratr than $15,? If "Ys," omplt Shdul J for suh individual Did any prson listd on lin 1a riv or aru ompnsation from any unrlatd organization or individual for srvis rndrd to th organization? If "Ys," omplt Shdul J for suh prson... 5 Stion B. Indpndnt Contrators 1 Complt this tal for your fiv highst ompnsatd indpndnt ontrators that rivd mor than $1, of ompnsation from th organization. Rport ompnsation for th alndar yar nding with or within th organization's tax yar. (A) (B) (C) Nam and usinss addrss Dsription of srvis Compnsation 2 Total numr of indpndnt ontrators (inluding ut not limitd to thos listd aov) who rivd mor than $1, of ompnsation from th organization

9 KEYS for th Homlss Foundation In Pag 9 Part VIII Statmnt of Rvnu Contriutions, Gifts, Grants and Othr Similar Amounts Program Srvi Rvnu 1a d f g h 2a d (i) Ral (ii) Prsonal 6a Gross rnts... Lss: rntal xpnss Rntal inom or (loss) d Nt rntal inom or (loss)... a Lss: ost or othr asis and sals xpnss... O t Gain or (loss)... h d Nt gain or (loss)... r 8a Gross inom from fundraising vnts (not inluding $ R of ontriutions rportd on lin 1). v S Part IV, lin a Lss: dirt xpnss... n u Nt inom or (loss) from fundraising vnts... 9a Gross inom from gaming ativitis. S Part IV, lin a Lss: dirt xpnss... Nt inom or (loss) from gaming ativitis... 1a Gross sals of invntory, lss rturns and allowans... a Lss: ost of goods sold... Nt inom or (loss) from sals of invntory... 11a Fdratd ampaigns... Mmrship dus Fundraising vnts Rlatd organizations... Govrnmnt grants (ontriutions).. All othr ontriutions, gifts, grants, and similar amounts not inludd aov nash ontriutions inludd in lins 1a-1f: $ 22,623 Total. Add lins 1a-1f... f All othr program srvi rvnu... g Total. Add lins 2a-2f... Invstmnt inom (inluding dividnds, intrst, and othr similar amounts)... Inom from invstmnt of tax-xmpt ond prods... Royaltis... Gross amount from sals of assts othr than invntory Misllanous Rvnu (i) Suritis d All othr rvnu... Total. Add lins 11a-11d Total rvnu. S instrutions... 1a 1 1 1d 1 1f Businss Cod (ii) Othr Businss Cod 265,415 (A) (B) (C) (D) Total rvnu Rlatd or Unrlatd Rvnu xmpt usinss xludd from tax funtion rvnu undr stions rvnu 512, 513, or , ,415

10 KEYS for th Homlss Foundation In Pag 1 Part I Statmnt of Funtional Expnss Stion 51()(3) and 51()(4) organizations must omplt all olumns. All othr organizations must omplt olumn (A) ut ar not rquird to omplt olumns (B), (C), and (D). Do not inlud amounts rportd on lins 6,, 8, 9, and 1 of Part VIII a d f g a d Chk if Shdul O ontains a rspons to any qustion in this Part I Grants and othr assistan to govrnmnts and organizations in th Unitd Stats. S Part IV, lin 21. Grants and othr assistan to individuals in th Unitd Stats. S Part IV, lin Grants and othr assistan to govrnmnts, organizations, and individuals outsid th Unitd Stats S Part IV, lins 15 and Bnfits paid to or for mmrs... Compnsation of urrnt offirs, dirtors, trusts, and ky mploys... Compnsation not inludd aov, to disqualifid prsons (as dfind undr stion 4958(f)(1)) and prsons dsrid in stion 4958()(3)(B)... Othr salaris and wags... Pnsion plan aruals and ontriutions (inlud stion 41(k) and 43() mployr ontriutions).. Othr mploy nfits... Payroll taxs... Fs for srvis (non-mploys): Managmnt... Lgal... Aounting... Loying... Profssional fundraising srvis. S Part IV, lin 1. Invstmnt managmnt fs... Othr... Advrtising and promotion... Offi xpnss... Information thnology... Royaltis... Oupany... Travl... Paymnts of travl or ntrtainmnt xpnss for any fdral, stat, or loal puli offiials... Confrns, onvntions, and mtings... Intrst... Paymnts to affiliats... Dpriation, dpltion, and amortization... Insuran... Othr xpnss. Itmiz xpnss not ovrd aov (List misllanous xpnss in lin 24. If lin 24 amount xds 1% of lin 25, olumn... (A) (B) (C) (D) Total xpnss Program srvi Managmnt and Fundraising xpnss gnral xpnss xpnss 11,54 11,54 5,22 5, ,39 3,39 8,669 6,411 2,58 2 4,99 4,99 1, ,363 1, ,99 3,99 (A) amount, list lin 24 xpnss on Shdul O.) Fundraising Dus and Susriptions 2,568 1, Goods rdistriutd in kind 29,326 29,326 Equiptmnt Rntal 2,66 2,66 All othr xpnss... 4,89 4,89 Total funtional xpnss. Add lins 1 through 24 Joint osts. Complt this lin only if th organization rportd in olumn (B) joint osts from a omind duational ampaign and. 261, ,382 15,15 2,356 fundraising soliitation. Chk hr if following SOP 98-2 (ASC 958-2)...

11 KEYS for th Homlss Foundation In Pag 11 Part Balan Sht (A) (B) Bginning of yar End of yar 1 Cash - non-intrst-aring... 5,9 1 14,216 2 Savings and tmporary ash invstmnts Pldgs and grants rival, nt Aounts rival, nt Rivals from urrnt and formr offirs, dirtors, trusts, ky 6 mploys, and highst ompnsatd mploys. Complt Part II of Shdul L... Rivals from othr disqualifid prsons (as dfind undr stion 4958(f)(1)), prsons dsrid in stion 4958()(3)(B), and ontriuting A s mployrs and sponsoring organizations of stion 51()(9) voluntary s mploys' nfiiary organizations (s instrutions)... 6 t ts and loans rival, nt... s 8 Invntoris for sal or us... 6,3 8 9 Prpaid xpnss and dfrrd hargs a Land, uildings, and quipmnt: ost or othr asis. Complt Part VI of Shdul D... 1a 11,85 Lss: aumulatd dpriation ,496 3,1 1 2, Invstmnts - pulily tradd suritis Invstmnts - othr suritis. S Part IV, lin Invstmnts - program-rlatd. S Part IV, lin Intangil assts Othr assts. S Part IV, lin Total assts. Add lins 1 through 15 (must qual lin 34)... 15, ,5 1 Aounts payal and arud xpnss Grants payal L 19 Dfrrd rvnu i 2 Tax-xmpt ond liailitis... 2 a 21 Esrow or ustodial aount liaility. Complt Part IV of Shdul D i 22 Payals to urrnt and formr offirs, dirtors, trusts, ky l mploys, highst ompnsatd mploys, and disqualifid prsons. i t Complt Part II of Shdul L i 23 Surd mortgags and nots payal to unrlatd third partis s 24 Unsurd nots and loans payal to unrlatd third partis... 5, , Othr liailitis (inluding fdral inom tax, payals to rlatd third partis, and othr liailitis not inludd on lins 1-24). Complt Part of Shdul D Total liailitis. Add lins 1 through ,2 26 2,863 Organizations that follow SFAS 11, hk hr and omplt N F lins 2 through 29, and lins 33 and 34. u t n 2 Unrstritd nt assts... 9,45 2 d 28 Tmporarily rstritd nt assts , A 29 Prmanntly rstritd nt assts s B s a Organizations that do not follow SFAS 11, hk hr and l omplt lins 3 through 34. t a s n 3 Capital stok or trust prinipal, or urrnt funds Paid-in or apital surplus, or land, uilding, or quipmnt fund o r s 32 Rtaind arnings, ndowmnt, aumulatd inom, or othr funds Total nt assts or fund alans... 9, , 34 Total liailitis and nt assts/fund alans... 15, ,5 5

12 KEYS for th Homlss Foundation In Pag 12 Part I Roniliation of Nt Assts Chk if Shdul O ontains a rspons to any qustion in this Part I... 1 Total rvnu (must qual Part VIII, olumn (A), lin 12) ,415 2 Total xpnss (must qual Part I, olumn (A), lin 25) ,453 3 Rvnu lss xpnss. Sutrat lin 2 from lin ,962 4 Nt assts or fund alans at ginning of yar (must qual Part, lin 33, olumn (A)) ,45 5 Othr hangs in nt assts or fund alans (xplain in Shdul O) Nt assts or fund alans at nd of yar. Comin lins 3, 4, and 5 (must qual Part, lin 33, olumn (B)) , Part II Finanial Statmnts and Rporting Chk if Shdul O ontains a rspons to any qustion in this Part II a d 3a Aounting mthod usd to prpar th Form 99: Cash Arual Othr If th organization hangd its mthod of aounting from a prior yar or hkd "Othr," xplain in Shdul O. Wr th organization's finanial statmnts ompild or rviwd y an indpndnt aountant?... Wr th organization's finanial statmnts auditd y an indpndnt aountant?... If "Ys" to lin 2a or 2, dos th organization hav a ommitt that assums rsponsiility for ovrsight of th audit, rviw, or ompilation of its finanial statmnts and sltion of an indpndnt aountant?... If th organization hangd ithr its ovrsight pross or sltion pross during th tax yar, xplain in Shdul O. If "Ys" to lin 2a or 2, hk a ox low to indiat whthr th finanial statmnts for th yar wr issud on a sparat asis, onsolidatd asis, or oth: Sparat asis Consolidatd asis Both onsolidatd and sparat asis As a rsult of a fdral award, was th organization rquird to undrgo an audit or audits as st forth in th Singl Audit At and OMB Cirular A-133?... If "Ys," did th organization undrgo th rquird audit or audits? If th organization did not undrgo th rquird audit or audits, xplain why in Shdul O and dsri any stps takn to undrgo suh audits... 2a 2 2 3a 3 Ys