Puli Dislosure for Tax-Exempt Organizations Tax-exempt organizations are required to make a opy of their appliation for exemption and Form(s) 99 (and 99-T, if appliale) availale for puli inspetion and to provide opies of suh forms to individuals or organizations that request opies. Alternatively, the nternet may e used to make these douments availale. (See the Using the nternet setion whih follows.) These rules apply to an organization s Form(s) 99 (and 99-T, if appliale) for the last three years and to its appliation for exemption. 1 f the appliation was filed prior to July 15, 1987, dislosure is not required unless the organization had a opy of the appliation on July 15, 1987. An organization may omit names and addresses of ontriutors from its return(s). Failure to omply with dislosure requirements an result in an enforement ation y the RS. While dislosure rules reate an additional urden, they also provide an opportunity for your organization to showase the ommunity enefits that it provides. The rules also heighten the need to arefully review all responses, inluding narrative explanations, ontained on your Form(s) 99/99-T efore filing. Where Must nformation Be Provided? Generally, an organization must make its douments availale for puli inspetion at any loation where it has three or more employees. f the only servies provided at the site are in furtherane of exempt purposes and the site does not serve as an offie for management staff, the douments are not required to e made availale there. How Quikly Must Organizations Reply? Requests for opies an e made in person or in writing. When requests are made in person, the opies must generally e provided on the same usiness day. There are provisions for delays due to unusual irumstanes. However, in no event may the period of delay exeed five usiness days. Unusual irumstanes inlude times when those staff that are apale of fulfilling a request are asent. Written Requests Requested opies generally must e mailed within 3 days from the date of the reeipt of the written request. However, if the organization requires advane payment of a reasonale fee for opying and postage, it may provide the opies within 3 days from the date it reeives payment rather than the date of the original request. What Can an Organization Charge? You are urrently allowed to harge a maximum fee of $. ents per page in addition to atual postage osts. 1 Certain information within an appliation for exemption an e withheld from puli inspetion if puli availaility would adversely affet the organization, e.g., information relating to a trade seret, patent, proess, style of work or apparatus of the organization. BKD TA56 9-11 Puli Dislosure Rules
-- f any organization reeives a written request for opies with no payment enlosed and the organization requires payment in advane, the organization must request payment within seven days from the date it reeived the request. An organization is required to aept a personal hek for written requests if it does not aept payment y redit ard. f an organization does not require prepayment and the requester does not enlose a prepayment with the request, the organization must reeive onsent from a requester efore providing opies for whih the fee harge for opying and postage would e in exess of $. Loal or Suordinate Organizations A loal or suordinate organization that is overed y a group exemption letter is given additional time for responding to some requests. f this type of organization reeives a request made in person for inspetion of its appliation for tax exemption, the loal organization is required to aquire and make availale the appliation for a group exemption letter filed y the entral or parent organization within not more than two weeks. The same general rule would apply with respet to a loal or suordinate organization that does not file its own Form(s) 99/99-T ut is overed under a group return. Again, the loal or suordinate organization must make the group return availale for inspetion within a reasonale period whih is defined as not more than two weeks. f the group return inludes separate shedules with respet to eah loal or suordinate organization, the loal or suordinate organization may exlude or omit any shedules relating only to other organizations whih are inluded in the group return. f a request is made for a personal inspetion to a loal or suordinate organization, it has the option of mailing the return to the requester rather than allowing an inspetion. However, if this is done, the loal or suordinate organization may not harge for the opying of the doument unless the requester onsents to the harge. f a loal or suordinate organization reeives a request for opies, then it must omply with the rules stated previously. Using the nternet As an alternative to providing opies, an organization may provide aess to its exemption appliation and Form(s) 99 (and 99-T, if appliale) through the nternet. The wesite must provide instrutions for downloading the doument(s). The information on the nternet must e in suh a format that it may e aessed, downloaded, viewed or printed in the same format as the atual douments. An organization would need to make the we address availale to the general puli. There is nothing that prevents others from posting your Forms 99, 99-T and exemption appliation on the nternet. Based on this fat and the potential strain on your organization s resoures from providing opies, organizations should onsider posting these douments on the nternet. What if the Requests Are a Form of Harassment? f an organization elieves it is sujet to a harassment ampaign, it an file an appliation for a harassment determination with the nternal Revenue Servie. This would allow the organization to suspend ompliane with these requests. n addition, an organization may disregard requests for opies in exess of two per month or four per year made y a single individual or sent from a single address, without sumitting an appliation for a harassment determination. Please ontat your BKD advisor if you have questions aout these rules. BKD TA56 9-11 Puli Dislosure Rules
Form 99-EZ Short Form Return of Organization Exempt From nome Tax Under setion 51(), 57, or 4947(a)(1) of the nternal Revenue Code (exept private foundations) OMB No. 1545-115 À¾µ Department of the Treasury nternal Revenue Servie Open to Puli Do not enter soial seurity numers on this form as it may e made puli. nspetion nformation aout Form 99-EZ and its instrutions is at www.irs.gov/form99. A For the 14 alendar year, or tax year eginning, 14, and ending, B Chek if appliale: C Name of organization D Employer identifiation numer Address hange Name hange nitial return Final return/terminated Amended return Numer and street (or P.O. ox, if mail is not delivered to street address) Room/suite E Telephone numer City or town, state or provine, ountry, and ZP or foreign postal ode F Group Exemption Appliation pending SPRNGFELD, MO 658 Numer G Aounting Method: Cash Arual Other (speify) H Chek if the organization is not Wesite: required to attah Shedule B J Tax-exempt status (hek only one) - 51()(3) 51() ( ) (insert no.) 4947(a)(1) or 57 (Form 99, 99-EZ, or 99-PF). J K Form of organization: Corporation Trust Assoiation Other L Add lines 5, 6, and 7 to line 9 to determine gross reeipts. f gross reeipts are $, or more, or if total assets m m m m m m m m m m m m m m Revenue, Expenses, and Changes in Net Assets or Fund Balanes (see the instrutions for Part ) Chek if the organization used Shedule O to respond to any question in this Part m m m m m m m m m m m m m m 1 Contriutions, gifts, grants, and similar amounts reeived m m m m m 1 Program servie revenue inluding government fees and ontrats 3 Memership dues and assessments 3 4 nvestment inome m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 4 5 a Gross amount from sale of assets other than inventory 5a Less: ost or other asis and sales expenses m m m m m m m m m m m 5 Gain or (loss) from sale of assets other than inventory (Sutrat line 5 from line 5a) m m m m m m m m m m 5 (Part, olumn (B) elow) are $5, or more, file Form 99 instead of Form 99-EZ $ Part Revenue Expenses Net Assets 6 Gaming and fundraising events a Gross inome from gaming (attah Shedule G if greater than $15,) COH CORPORATON 46-8416 33 S. PATTERSON AVE (417 ) 83-8998 m m m m m m m m m m m m m m m m m m m m m m m m m m m m Gross inome from fundraising events (not inluding $ from fundraising events reported on line 1) (attah Shedule G if the sum of suh gross inome and ontriutions exeeds $15,) m m 6a of ontriutions 6 Less: diret expenses from gaming and fundraising events m m m m 6 d Net inome or (loss) from gaming and fundraising events (add lines 6a and 6 and sutrat line 6) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 7 a Gross sales of inventory, less returns and allowanes m m m m m m m 7a Less: ost of goods sold m m m m m m m m m m m m m m m m m m m m m 7 Gross profit or (loss) from sales of inventory (Sutrat line 7 from line 7a) 8 Other revenue (desrie in Shedule O)m m m m m m m m m m 9 Total revenue. Add lines 1,, 3, 4, 5, 6d, 7, and 8 1 Grants and similar amounts paid (list in Shedule O) 11 Benefits paid to or for memers m m m m m m m m m m 1 Salaries, other ompensation, and employee enefits m m m m m m 13 Professional fees and other payments to independent ontrators 14 Oupany, rent, utilities, and maintenane 15 Printing, puliations, postage, and shipping 16 Other expenses (desrie in Shedule O) m m m m 17 Total expenses. Add lines 1 through 16 m m m m m m m 18 Exess or (defiit) for the year (Sutrat line 17 from line 9) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 19 Net assets or fund alanes at eginning of year (from line 7, olumn (A)) (must agree with end-of-year figure reported on prior year's return) 19 Other hanges in net assets or fund alanes (explain in Shedule O) 1 Net assets or fund alanes at end of year. Comine lines 18 through 1 For Paperwork Redution At Notie, see the separate instrutions. Form 99-EZ (14) 6d 7 8 9 1 11 1 13 14 15 16 17 18 4E18 1. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE
Form 8868 Appliation for Extension of Time To File an (Rev. January 14) Exempt Organization Return OMB No. 1545-179 Department of the Treasury File a separate appliation for eah return. nternal Revenue Servie nformation aout Form 8868 and its instrutions is at www.irs.gov/form8868. m m m m m m m m m m m m m m m m m f you are filing for an Automati 3-Month Extension, omplete only Part and hek this ox f you are filing for an Additional (Not Automati) 3-Month Extension, omplete only Part (on page of this form). Do not omplete Part unless you have already een granted an automati 3-month extension on a previously filed Form 8868. Eletroni filing (e-file). You an eletronially file Form 8868 if you need a 3-month automati extension of time to file (6 months for a orporation required to file Form 99-T), or an additional (not automati) 3-month extension of time. You an eletronially file Form 8868 to request an extension of time to file any of the forms listed in Part or Part with the exeption of Form 887, nformation Return for Transfers Assoiated With Certain Personal Benefit Contrats, whih must e sent to the RS in paper format (see instrutions). For more details on the eletroni filing of this form, visit www.irs.gov/efile and lik on e-file for Charities & Nonprofits. Part Automati 3-Month Extension of Time. Only sumit original (no opies needed). A orporation required to file Form 99-T and requesting an automati 6-month extension - hek this ox and omplete Part only m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m All other orporations (inluding 11-C filers), partnerships, REMCs, and trusts must use Form 74 to request an extension of time to file inome tax returns. Enter filer's identifying numer, see instrutions Type or print File y the due date for filing your return. See instrutions. Name of exempt organization or other filer, see instrutions. Numer, street, and room or suite no. f a P.O. ox, see instrutions. City, town or post offie, state, and ZP ode. For a foreign address, see instrutions. Enter the Return ode for the return that this appliation is for (file a separate appliation for eah return) Appliation s For Form 99 or Form 99-EZ Form 99-BL Form 47 (individual) Form 99-PF Form 99-T (se. 41(a) or 48(a) trust) Form 99-T (trust other than aove) The ooks are in the are of Telephone No. Return Code 1 3 4 5 6 Appliation s For Form 99-T (orporation) Form 141-A Form 47 (other than individual) Form 57 Form 669 Form 887 Employer identifiation numer (EN) or Soial seurity numer (SSN) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Return Code 417 851-4445 FA No. f the organization does not have an offie or plae of usiness in the United States, hek this ox f this is for a Group Return, enter the organization's four digit Group Exemption Numer (GEN). f this is for the whole group, hek this ox. f it is for part of the group, hek this ox and attah a list with the names and ENs of all memers the extension is for. 1 request an automati 3-month (6 months for a orporation required to file Form 99-T) extension of time until 8/15, 15, to file the exempt organization return for the organization named aove. The extension is for the organization's return for: alendar year 14 or tax year eginning,, and ending,. f the tax year entered in line 1 is for less than 1 months, hek reason: nitial return Final return Change in aounting period 3a f this appliation is for Form 99-BL, 99-PF, 99-T, 47, or 669, enter the tentative tax, less any nonrefundale redits. See instrutions. 3a $ f this appliation is for Form 99-PF, 99-T, 47, or 669, enter any refundale redits and estimated tax payments made. nlude any prior year overpayment allowed as a redit. 3 $ Balane due. Sutrat line 3 from line 3a. nlude your payment with this form, if required, y using EFTPS (Eletroni Federal Tax Payment System). See instrutions. 3 $ Caution. f you are going to make an eletroni funds withdrawal (diret deit) with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instrutions. For Privay At and Paperwork Redution At Notie, see instrutions. Form 8868 (Rev. 1-14) COH CORPORATON 46-8416 33 S. PATTERSON AVE SPRNGFELD, MO 658 MARK METZGER, 33 S. PATTERSON AVE SPRNGFELD, MO 658 7 8 9 1 11 1 1 4F854 1. 4/1/15 1:43:16 AM V 14-4.1F 114837 PAGE 1
f you are filing for an Additional (Not Automati) 3-Month Extension, omplete only Part and hek this ox m m m m m m m m Note. Only omplete Part if you have already een granted an automati 3-month extension on a previously filed Form 8868. Form 8868 (Rev. 1-14) Page f you are filing for an Automati 3-Month Extension, omplete only Part (on page 1). Additional (Not Automati) 3-Month Extension of Time. Only file the original (no opies needed). Part Type or print File y the due date for filing your return. See instrutions. Name of exempt organization or other filer, see instrutions. Numer, street, and room or suite no. f a P.O. ox, see instrutions. City, town or post offie, state, and ZP ode. For a foreign address, see instrutions. Enter filer's identifying numer, see instrutions Employer identifiation numer (EN) or Soial seurity numer (SSN) SPRNGFELD, MO 658 Enter the Return ode for the return that this appliation is for (file a separate appliation for eah return) m m m m m m m m m m m m Appliation s For Return Code Appliation s For Form 99 or Form 99-EZ Form 99-BL Form 47 (individual) Form 99-PF Form 99-T (se. 41(a) or 48(a) trust) Form 99-T (trust other than aove) 1 3 4 5 6 Form 141-A Form 47 (other than individual) Form 57 Form 669 Form 887 8 9 1 11 1 STOP! Do not omplete Part if you were not already granted an automati 3-month extension on a previously filed Form 8868. Telephone No. 1 Return Code The ooks are in the are of MARK METZGER, 33 S. PATTERSON AVE SPRNGFELD, MO 658. 417 851-4445. Fax No.. f the organization does not have an offie or plae of usiness in the United States, hek this ox m m m m m m m m m m m m m m m f this is for a Group Return, enter the organization's four digit Group Exemption Numer (GEN). f this is m m m m m m m m m m m m m for the whole group, hek this ox. f it is for part of the group, hek this ox and attah a list with the names and ENs of all memers the extension is for. 4 request an additional 3-month extension of time until 11/15, 15. 5 For alendar year 14, or other tax year eginning,, and ending,. 6 f the tax year entered in line 5 is for less than 1 months, hek reason: nitial return Final return 7 COH CORPORATON 46-8416 33 S. PATTERSON AVE Change in aounting period State in detail why you need the extension ADDTONAL TME S REQURED TO ACCUMULATE THE NFORMATON NECESSARY TO FLE A COMPLETE AND ACCURATE RETURN. 8a f this appliation is for Forms 99-BL, 99-PF, 99-T, 47, or 669, enter the tentative tax, less any nonrefundale redits. See instrutions. 8a $ f this appliation is for Forms 99-PF, 99-T, 47, or 669, enter any refundale redits and estimated tax payments made. nlude any prior year overpayment allowed as a redit and any amount paid previously with Form 8868. 8 $ Balane Due. Sutrat line 8 from line 8a. nlude your payment with this form, if required, y using EFTPS (Eletroni Federal Tax Payment System). See instrutions. Signature and Verifiation must e ompleted for Part only. 8 $ Under penalties of perjury, delare that have examined this form, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is true, orret, and omplete, and that am authorized to prepare this form. Signature Title Date Form 8868 (Rev. 1-14) 4F855 1. 7/3/15 8:58:59 AM V 14-6F 114837 PAGE 1
Form 99-EZ (14) Page Part ll Balane Sheets (see the instrutions for Part ll) Chek if the organization used Shedule O to respond to any question in this Part ll m m m m m m m m m m m m m m m m m m m (A) Beginning of year Cash, savings, and investments Land and uildings m m m m m m m m m Other assets (desrie in Shedule O) Total assets m m m m m m m m m m m m m Total liailities (desrie in Shedule O) m m m m m m m m m m m m m m m m m m 7 Net assets or fund alanes (line 7 of olumn (B) must agree with line 1) m m 7 3 4 5 6 Part Statement of Program Servie Aomplishments (see the instrutions for Part lll) (B) End of year 3 4 5 6 Expenses Chek if the organization used Shedule O to respond to any question in this Part m m m (Required for setion What is the organization's primary exempt purpose? Desrie the organization's program servie aomplishments for eah of its three largest program servies, as measured y expenses. n a lear and onise manner, desrie the servies provided, the numer of persons enefited, and other relevant information for eah program title. 8 NONE 9 COH CORPORATON 46-8416 ATTACHMENT 1 (Grants $ ) f this amount inludes foreign grants, hek here m m m m m m m 8a 51()(3) and 51()(4) organizations; optional for others.) 3 (Grants $ ) f this amount inludes foreign grants, hek here m m m m m m m 9a (Grants $ ) f this amount inludes foreign grants, hek here m m m m m m m 3a 31 Other program servies (desrie in Shedule O) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m (Grants $ ) f this amount inludes foreign grants, hek here m m m m m m m 31a 3 Total program servie expenses (add lines 8a through 31a) m m m m m m m m m m m m m m m m m m m m m m m 3 Part V m m m m m m m m m m m m m m m m m m m m m m m List of Offiers, Diretors, Trustees, and Key Employees (list eah one even if not ompensated - see the instrutions for Part V) Chek if the organization used Shedule O to respond to any question in this Part V (a) Name and title () Average hours per week devoted to position () Reportale ompensation (Forms W-/199-MSC) (if not paid, enter --) (d) Health enefits, ontriutions to employee enefit plans, and deferred ompensation (e) Estimated amount of other ompensation JM BATTEN PRESDENT ENDNG /14 1. MKE KERN SECRETARY 1. HAL DONALDSON VP/PRESDENT BEGNNNG /14 1. 4E19 1. Form 99-EZ (14) 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 3
COH CORPORATON 46-8416 Form 99-EZ (14) Page 3 Part V Other nformation (Note the Shedule A and personal enefit ontrat statement requirements in the instrutions for Part V) Chek if the organization used Shedule O to respond to any question in this Part V Yes No 33 34 35 a 36 37 a 38 a 39 a 4 a d e 41 4 a 43 44 a d 45 a 4E19 1. m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Were any signifiant hanges made to the organizing or governing douments? f "Yes," attah a onformed opy of the amended douments if they reflet a hange to the organization's name. Otherwise, explain the hange on Shedule O (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Did the organization have unrelated usiness gross inome of $1, or more during the year from usiness ativities (suh as those reported on lines, 6a, and 7a, among others)? m m m m m m m m m m m m m m m m m m f "Yes," to line 35a, has the organization filed a Form 99-T for the year? f "No," provide an explanation in Shedule O m m m Was the organization a setion 51()(4), 51()(5), or 51()(6) organization sujet to setion 633(e) notie, Did the organization engage in any signifiant ativity not previously reported to the RS? f "Yes," provide a detailed desription of eah ativity in Shedule O 33 reporting, and proxy tax requirements during the year? f "Yes," omplete Shedule C, Part m m m m m m m m m m Did the organization undergo a liquidation, dissolution, termination, or signifiant disposition of net assets during the year? f "Yes," omplete appliale parts of Shedule N m m m m m m m m m m m m m m m m m m m m m m m m m Enter amount of politial expenditures, diret or indiret, as desried in the instrutions 37a m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m any suh loans made in a prior year and still outstanding at the end of the tax year overed y this return? m m m m m m m m m m m Did the organization file Form 11-POL for this year? Did the organization orrow from, or make any loans to, any offier, diretor, trustee, or key employee or were f "Yes," omplete Shedule L, Part and enter the total amount involved 38 Setion 51()(7) organizations. Enter: nitiation fees and apital ontriutions inluded on line 9 m m m m 39a Gross reeipts, inluded on line 9, for puli use of lu failities m m m m m m m m m m m m 39 Setion 51()(3) organizations. Enter amount of tax imposed on the organization during the year under: setion 4911 ; setion 491 ; setion 4955 Setion 51()(3), 51()(4), and 51()(9) organizations. Did the organization engage in any setion 4958 exess enefit transation during the year, or did it engage in an exess enefit transation in a prior year that has not een reported on any of its prior Forms 99 or 99-EZ? f "Yes," omplete Shedule L, Part m m m Setion 51()(3), 51()(4), and 51()(9) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under setions 491, 4955, and 4958 m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion 51()(3), 51()(4), and 51()(9) organizations. Enter amount of tax on line 4 reimursed y the organization m m m m m m m m m m m m m m m m m m m m m m m transation? f "Yes," omplete Form 8886-T m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter 4e List the states with whih a opy of this return is filed The organization's ooks are in are of MARK METZGER Telephone no. 417-851-4445 Loated at 33 S. PATTERSON AVE SPRNGFELD, MO ZP + 4 658 At any time during the alendar year, did the organization have an interest in or a signature or other authority over Yes a finanial aount in a foreign ountry (suh as a ank aount, seurities aount, or other finanial aount)? 4 f "Yes," enter the name of the foreign ountry: See the instrutions for exeptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Finanial Aounts (FBAR). At any time during the alendar year, did the organization maintain an offie outside the U.S.? m m m m m m m m m m 4 f "Yes," enter the name of the foreign ountry: Setion 4947(a)(1) nonexempt haritale trusts filing Form 99-EZ in lieu of Form 141 - Chek here m m m m m m m m m m m and enter the amount of tax-exempt interest reeived or arued during the tax year 43 m m m m m m m m m Yes No Did the organization maintain any donor advised funds during the year? f "Yes," Form 99 must e ompleted instead of Form 99-EZ m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44a Did the organization operate one or more hospital failities during the year? f "Yes," Form 99 must e ompleted instead of Form 99-EZ m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44 Did the organization reeive any payments for indoor tanning servies during the year? m m m m m m m m m m m m m 44 f "Yes" to line 44, has the organization filed a Form 7 to report these payments? f "No," provide an explanation in Shedule O m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44d Did the organization have a ontrolled entity within the meaning of setion 51()(13)? m m m m m m m m m m m m m 45a Did the organization reeive any payment from or engage in any transation with a ontrolled entity within the meaning of setion 51()(13)? f "Yes," Form 99 and Shedule R may need to e ompleted instead of Form 99-EZ (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 45 34 35a 35 35 36 37 38a 4 No Form 99-EZ (14) 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 4
SCHEDULE A Puli Charity Status and Puli Support OMB No. 1545-47 (Form 99 or 99-EZ) Complete if the organization is a setion 51()(3) organization or a setion 4947(a)(1) nonexempt haritale trust. À¾µ Department of the Treasury Attah to Form 99 or Form 99-EZ. Open to Puli nternal Revenue Servie nformation aout Shedule A (Form 99 or 99-EZ) and its instrutions is at www.irs.gov/form99. nspetion Name of the organization Employer identifiation numer COH CORPORATON 46-8416 Part Reason for Puli Charity Status (All organizations must omplete this part.) See instrutions. The organization is not a private foundation eause it is: (For lines 1 through 11, hek only one ox.) 1 3 4 A hurh, onvention of hurhes, or assoiation of hurhes desried in setion 17()(1)(A)(i). A shool desried in setion 17()(1)(A)(ii). (Attah Shedule E.) A hospital or a ooperative hospital servie organization desried in setion 17()(1)(A)(iii). A medial researh organization operated in onjuntion with a hospital desried in setion 17()(1)(A)(iii). Enter the hospital's name, ity, and state: 5 An organization operated for the enefit of a ollege or university owned or operated y a governmental unit desried in setion 17()(1)(A)(iv). (Complete Part.) 6 7 A federal, state, or loal government or governmental unit desried in setion 17()(1)(A)(v). An organization that normally reeives a sustantial part of its support from a governmental unit or from the general puli desried in setion 17()(1)(A)(vi). (Complete Part.) 8 9 A ommunity trust desried in setion 17()(1)(A)(vi). (Complete Part.) An organization that normally reeives: (1) more than 331/3 of its support from ontriutions, memership fees, and gross reeipts from ativities related to its exempt funtions - sujet to ertain exeptions, and () no more than 331/3 of its support from gross investment inome and unrelated usiness taxale inome (less setion 511 tax) from usinesses aquired y the organization after June 3, 1975. See setion 59(a)(). (Complete Part.) 1 11 An organization organized and operated exlusively to test for puli safety. See setion 59(a)(4). An organization organized and operated exlusively for the enefit of, to perform the funtions of, or to arry out the purposes of one or more pulily supported organizations desried in setion 59(a)(1) or setion 59(a)(). See setion 59(a)(3). Chek the ox in lines 11a through 11d that desries the type of supporting organization and omplete lines 11e, 11f, and 11g. a d e f g Type. A supporting organization operated, supervised, or ontrolled y its supported organization(s), typially y giving the supported organization(s) the power to regularly appoint or elet a majority of the diretors or trustees of the supporting organization. You must omplete Part V, Setions A and B. Type. A supporting organization supervised or ontrolled in onnetion with its supported organization(s), y having ontrol or management of the supporting organization vested in the same persons that ontrol or manage the supported organization(s). You must omplete Part V, Setions A and C. Type funtionally integrated. A supporting organization operated in onnetion with, and funtionally integrated with, its supported organization(s) (see instrutions). You must omplete Part V, Setions A, D, and E. Type non-funtionally integrated. A supporting organization operated in onnetion with its supported organization(s) that is not funtionally integrated. The organization generally must satisfy a distriution requirement and an attentiveness requirement (see instrutions). You must omplete Part V, Setions A and D, and Part V. Chek this ox if the organization reeived a written determination from the RS that it is a Type, Type, Type funtionally integrated, or Type non-funtionally integrated supporting organization. Enter the numer of supported organizations m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1 Provide the following information aout the supported organization(s). (i) Name of supported organization (ii) EN (iii) Type of organization (desried on lines 1-9 aove or RC setion (see instrutions)) (iv) s the organization listed in your governing doument? Yes No (v) Amount of monetary support (see instrutions) (vi) Amount of other support (see instrutions) (A) CONVOY OF HOPE 68-51386 7 (B) (C) (D) (E) Total For Paperwork Redution At Notie, see the nstrutions for Form 99 or 99-EZ. 4E11. Shedule A (Form 99 or 99-EZ) 14 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 6
Shedule A (Form 99 or 99-EZ) 14 Page Part Support Shedule for Organizations Desried in Setions 17()(1)(A)(iv) and 17()(1)(A)(vi) (Complete only if you heked the ox on line 5, 7, or 8 of Part or if the organization failed to qualify under Part. f the organization fails to qualify under the tests listed elow, please omplete Part.) Setion A. Puli Support Calendar year (or fisal year eginning in) 1 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") m m m m m m Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf m m m m m m m 3 The value of servies or failities furnished y a governmental unit to the organization without harge 4 Total. Add lines 1 through 3 m m m m m m m 5 The portion of total ontriutions y eah person (other than a governmental unit or pulily supported organization) inluded on line 1 that exeeds of the amount shown on line 11, olumn (f) m m m m m m m 6 Puli support. Sutrat line 5 from line 4. 7 Amounts from line 4 m m m m m m m m m m 8 Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures m m m m m m m m m m m m m m m m m Setion B. Total Support Calendar year (or fisal year eginning in) 9 Net inome from unrelated usiness ativities, whether or not the usiness is regularly arried on m m m m m m m m m m 1 Other inome. Do not inlude gain or loss from the sale of apital assets (a) 1 () 11 () 1 (d) 13 (e) 14 (f) Total (a) 1 () 11 () 1 (d) 13 (e) 14 (f) Total (Explain in Part V.) m m m m m m m m m 11 Total support. Add lines 7 through 1 m m 1 Gross reeipts from related ativities, et. (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m 1 organization, hek this ox and stop here m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion C. Computation of Puli Support Perentage 15 m m m m m m m m m m m m m m m m m m m 13 First five years. f the Form 99 is for the organization's first, seond, third, fourth, or fifth tax year as a setion 51()(3) 14 Puli support perentage for 14 (line 6, olumn (f) divided y line 11, olumn (f)) Puli support perentage from 13 Shedule A, Part, line 14 14 15 16a 33 1/3 support test - 14. f the organization did not hek the ox on line 13, and line 14 is 331/3 or more, hek this ox and stop here. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m 33 1/3 support test - 13. f the organization did not hek a ox on line 13 or 16a, and line 15 is 331/3 or more, 17a COH CORPORATON 46-8416 hek this ox and stop here. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m 1-fats-and-irumstanes test - 14. f the organization did not hek a ox on line 13, 16a, or 16, and line 14 is 1 or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part V how the organization meets the "fats-and-irumstanes test. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 1-fats-and-irumstanes test - 13. f the organization did not hek a ox on line 13, 16a, 16, or 17a, and line 15 is 1 or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part V how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 18 Private foundation. f the organization did not hek a ox on line 13, 16a, 16, 17a, or 17, hek this ox and see instrutions m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Shedule A (Form 99 or 99-EZ) 14 4E1. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 7
Shedule A (Form 99 or 99-EZ) 14 Page 3 Part Support Shedule for Organizations Desried in Setion 59(a)() (Complete only if you heked the ox on line 9 of Part or if the organization failed to qualify under Part. f the organization fails to qualify under the tests listed elow, please omplete Part.) Setion A. Puli Support Calendar year (or fisal year eginning in) 1 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") Gross reeipts from admissions, merhandise sold or servies performed, or failities furnished in any ativity that is related to the organization's tax-exempt purpose m m m m m m 3 Gross reeipts from ativities that are not an unrelated trade or usiness under setion 513 m 4 Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf m m m m m m m 5 The value of servies or failities COH CORPORATON 46-8416 (a) 1 () 11 () 1 (d) 13 (e) 14 (f) Total furnished y a governmental unit to the organization without harge 6 Total. Add lines 1 through 5 m m m m m m m 7a Amounts inluded on lines 1,, and 3 reeived from disqualified persons m m m m Amounts inluded on lines and 3 reeived from other than disqualified persons that exeed the greater of $5, or 1 of the amount on line 13 for the year Add lines 7a and 7 m m m m m m m m m m m 8 Puli support (Sutrat line 7 from line 6.) m m m m m m m m m m m m m m m m m Setion B. Total Support Calendar year (or fisal year eginning in) 9 Amounts from line 6 m m m m m m m m m m m 1 a Gross inome from interest, dividends, payments reeived on seurities loans, rents, royalties and inome from similar soures m m m m m m m m m m m m m m m m m Unrelated usiness taxale inome (less setion 511 taxes) from usinesses aquired after June 3, 1975 Add lines 1a and 1 m m m m m m m m m 11 Net inome from unrelated usiness ativities not inluded in line 1, whether or not the usiness is regularly arried on m m m m m m m m m m m m m m m 1 Other inome. Do not inlude gain or loss from the sale of apital assets (Explain in Part V.) m m m m m m m m m m m 13 Total support. (Add lines 9, 1, 11, and 1.) m m m m m m m m m m m m m m m m 14 First five years. f the Form 99 is for the organization's first, seond, third, fourth, or fifth tax year as a setion 51()(3) organization, hek this ox and stop here m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion C. Computation of Puli Support Perentage 15 Puli support perentage for 14 (line 8, olumn (f) divided y line 13, olumn (f)) 15 16 Puli support perentage from 13 Shedule A, Part, line 15 m m m m m m m m m m m m m m m m m m m m m m m 16 Setion D. Computation of nvestment nome Perentage 17 nvestment inome perentage for 14 (line 1, olumn (f) divided y line 13, olumn (f)) 17 18 nvestment inome perentage from 13 Shedule A, Part, line 17 m m m m m m m m m m m m m m m m m m m m 18 19 a 33 1/3 support tests - 14. f the organization did not hek the ox on line 14, and line 15 is more than 331/3, and line 17 is not more than 331/3, hek this ox and stop here. The organization qualifies as a pulily supported organization 33 1/3 support tests - 13. f the organization did not hek 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, hek this ox and stop here. The organization qualifies as a pulily supported organization Private foundation. f the organization did not hek a ox on line 14, 19a, or 19, hek this ox and see instrutions (a) 1 () 11 () 1 (d) 13 (e) 14 (f) Total Shedule A (Form 99 or 99-EZ) 14 4E11. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 8
Shedule A (Form 99 or 99-EZ) 14 Page 4 Part V Supporting Organizations (Complete only if you heked a ox on line 11 of Part. f you heked 11a of Part, omplete Setions A and B. f you heked 11 of Part, omplete Setions A and C. f you heked 11 of Part, omplete Setions A, D, and E. f you heked 11d of Part, omplete Setions A and D, and omplete Part V.) Setion A. All Supporting Organizations Yes No 1 3a 4a 5a 6 7 8 9a 1a COH CORPORATON 46-8416 Are all of the organization s supported organizations listed y name in the organization s governing douments? f "No," desrie in Part V how the supported organizations are designated. f designated y lass or purpose, desrie the designation. f histori and ontinuing relationship, explain. 1 Did the organization have any supported organization that does not have an RS determination of status under setion 59(a)(1) or ()? f "Yes," explain in Part V how the organization determined that the supported organization was desried in setion 59(a)(1) or (). Did the organization have a supported organization desried in setion 51()(4), (5), or (6)? f "Yes," answer () and () elow. Did the organization onfirm that eah supported organization qualified under setion 51()(4), (5), or (6) and satisfied the puli support tests under setion 59(a)()? f "Yes," desrie in Part V when and how the organization made the determination. Did the organization ensure that all support to suh organizations was used exlusively for setion 17()() (B) purposes? f "Yes," explain in Part V what ontrols the organization put in plae to ensure suh use. Was any supported organization not organized in the United States ("foreign supported organization")? f "Yes" and if you heked 11a or 11 in Part, answer () and () elow. Did the organization have ultimate ontrol and disretion in deiding whether to make grants to the foreign supported organization? f "Yes," desrie in Part V how the organization had suh ontrol and disretion despite eing ontrolled or supervised y or in onnetion with its supported organizations. Did the organization support any foreign supported organization that does not have an RS determination under setions 51()(3) and 59(a)(1) or ()? f "Yes," explain in Part V what ontrols the organization used to ensure that all support to the foreign supported organization was used exlusively for setion 17()()(B) purposes. Did the organization add, sustitute, or remove any supported organizations during the tax year? f "Yes," answer () and () elow (if appliale). Also, provide detail in Part V, inluding (i) the names and EN numers of the supported organizations added, sustituted, or removed, (ii) the reasons for eah suh ation, (iii) the authority under the organization's organizing doument authorizing suh ation, and (iv) how the ation was aomplished (suh as y amendment to the organizing doument). Type or Type only. Was any added or sustituted supported organization part of a lass already designated in the organization's organizing doument? Sustitutions only. Was the sustitution the result of an event eyond the organization's ontrol? Did the organization provide support (whether in the form of grants or the provision of servies or failities) to anyone other than (a) its supported organizations; () individuals that are part of the haritale lass enefited y one or more of its supported organizations; or () other supporting organizations that also support or enefit one or more of the filing organization s supported organizations? f "Yes," provide detail in Part V. Did the organization provide a grant, loan, ompensation, or other similar payment to a sustantial ontriutor (defined in RC 4958()(3)(C)), a family memer of a sustantial ontriutor, or a 35-perent ontrolled entity with regard to a sustantial ontriutor? f "Yes," omplete Part of Shedule L (Form 99). Did the organization make a loan to a disqualified person (as defined in setion 4958) not desried in line 7? f "Yes," omplete Part of Shedule L (Form 99). Was the organization ontrolled diretly or indiretly at any time during the tax year y one or more disqualified persons as defined in setion 4946 (other than foundation managers and organizations desried in setion 59(a)(1) or ())? f "Yes," provide detail in Part V. Did one or more disqualified persons (as defined in line 9(a)) hold a ontrolling interest in any entity in whih the supporting organization had an interest? f "Yes," provide detail in Part V. Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal enefit from, assets in whih the supporting organization also had an interest? f "Yes," provide detail in Part V. Was the organization sujet to the exess usiness holdings rules of RC 4943 eause of RC 4943(f) (regarding ertain Type supporting organizations, and all Type non-funtionally integrated supporting organizations)? f "Yes," answer () elow. Did the organization have any exess usiness holdings in the tax year? (Use Shedule C, Form 47, to determine whether the organization had exess usiness holdings.) Shedule A (Form 99 or 99-EZ) 14 4E19. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 9 3a 3 3 4a 4 4 5a 5 5 6 7 8 9a 9 9 1a 1
Shedule A (Form 99 or 99-EZ) 14 Page 5 Part V Supporting Organizations (ontinued) 11 Has the organization aepted a gift or ontriution from any of the following persons? a A person who diretly or indiretly ontrols, either alone or together with persons desried in () and () elow, the governing ody of a supported organization? A family memer of a person desried in (a) aove? A 35 ontrolled entity of a person desried in (a) or () aove? f Yes to a,, or, provide detail in Part V. Setion B. Type Supporting Organizations 1 Did the diretors, trustees, or memership of one or more supported organizations have the power to regularly appoint or elet at least a majority of the organization s diretors or trustees at all times during the tax year? f "No," desrie in Part V how the supported organization(s) effetively operated, supervised, or ontrolled the organization s ativities. f the organization had more than one supported organization, desrie how the powers to appoint and/or remove diretors or trustees were alloated among the supported organizations and what onditions or restritions, if any, applied to suh powers during the tax year. Did the organization operate for the enefit of any supported organization other than the supported organization(s) that operated, supervised, or ontrolled the supporting organization? f "Yes," explain in Part V how providing suh enefit arried out the purposes of the supported organization(s) that operated, supervised, or ontrolled the supporting organization. Setion C. Type Supporting Organizations 1 Were a majority of the organization s diretors or trustees during the tax year also a majority of the diretors or trustees of eah of the organization s supported organization(s)? f "No," desrie in Part V how ontrol or management of the supporting organization was vested in the same persons that ontrolled or managed the supported organization(s). Setion D. All Type Supporting Organizations 1 Did the organization provide to eah of its supported organizations, y the last day of the fifth month of the organization s tax year, (1) a written notie desriing the type and amount of support provided during the prior tax year, () a opy of the Form 99 that was most reently filed as of the date of notifiation, and (3) opies of the organization s governing douments in effet on the date of notifiation, to the extent not previously provided? Were any of the organization s offiers, diretors, or trustees either (i) appointed or eleted y the supported organization(s) or (ii) serving on the governing ody of a supported organization? f "No," explain in Part V how the organization maintained a lose and ontinuous working relationship with the supported organization(s). 3 By reason of the relationship desried in (), did the organization s supported organizations have a signifiant voie in the organization s investment poliies and in direting the use of the organization s inome or assets at all times during the tax year? f "Yes," desrie in Part V the role the organization s supported organizations played in this regard. 3 Setion E. Type Funtionally-ntegrated Supporting Organizations 1 Chek the ox next to the method that the organization used to satisfy the ntegral Part Test during the year (see instrutions): The organization satisfied the Ativities Test. Complete line elow. The organization is the parent of eah of its supported organizations. Complete line 3 elow. a 11a 11 11 1 1 1 Yes No Yes No Yes No Yes No The organization supported a governmental entity. Desrie in Part V how you supported a government entity (see instrutions). Ativities Test. Answer (a) and () elow. Yes No a Did sustantially all of the organization s ativities during the tax year diretly further the exempt purposes of the supported organization(s) to whih the organization was responsive? f "Yes," then in Part V identify those supported organizations and explain how these ativities diretly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these ativities onstituted sustantially all of its ativities. Did the ativities desried in (a) onstitute ativities that, ut for the organization s involvement, one or more of the organization s supported organization(s) would have een engaged in? f "Yes," explain in Part V the reasons for the organization s position that its supported organization(s) would have engaged in these ativities ut for the organization s involvement. 3 Parent of Supported Organizations. Answer (a) and () elow. a Did the organization have the power to regularly appoint or elet a majority of the offiers, diretors, or trustees of eah of the supported organizations? Provide details in Part V. COH CORPORATON 46-8416 Did the organization exerise a sustantial degree of diretion over the poliies, programs, and ativities of eah of its supported organizations? f "Yes," desrie in Part V the role played y the organization in this regard. Shedule A (Form 99 or 99-EZ) 14 4E13. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 1 a 3a 3
COH CORPORATON 46-8416 Shedule A (Form 99 or 99-EZ) 14 Page 6 Part V Type Non-Funtionally ntegrated 59(a)(3) Supporting Organizations 1 Chek here if the organization satisfied the ntegral Part Test as a qualifying trust on Nov., 197. See instrutions. All other Type non-funtionally integrated supporting organizations must omplete Setions A through E. Setion A - Adjusted Net nome (A) Prior Year (B) Current Year (optional) 1 Net short-term apital gain 1 Reoveries of prior-year distriutions 3 Other gross inome (see instrutions) 3 4 Add lines 1 through 3 4 5 Depreiation and depletion 5 6 Portion of operating expenses paid or inurred for prodution or olletion of gross inome or for management, onservation, or maintenane of property held for prodution of inome (see instrutions) 6 7 Other expenses (see instrutions) 7 8 Adjusted Net nome (sutrat lines 5, 6 and 7 from line 4) 8 Setion B - Minimum Asset Amount 1 Aggregate fair market value of all non-exempt-use assets (see instrutions for short tax year or assets held for part of year): a Average monthly value of seurities Average monthly ash alanes Fair market value of other non-exempt-use assets d Total (add lines 1a, 1, and 1) e Disount laimed for lokage or other fators (explain in detail in Part V): Aquisition indetedness appliale to non-exempt-use assets 3 Sutrat line from line 1d 3 4 Cash deemed held for exempt use. Enter 1-1/ of line 3 (for greater amount, see instrutions). 5 Net value of non-exempt-use assets (sutrat line 4 from line 3) 6 Multiply line 5 y.35 7 Reoveries of prior-year distriutions 8 Minimum Asset Amount (add line 7 to line 6) Setion C - Distriutale Amount 1 Adjusted net inome for prior year (from Setion A, line 8, Column A) 1 Enter 85 of line 1 3 Minimum asset amount for prior year (from Setion B, line 8, Column A) 3 4 Enter greater of line or line 3 4 5 nome tax imposed in prior year 5 6 Distriutale Amount. Sutrat line 5 from line 4, unless sujet to emergeny temporary redution (see instrutions) 1a 1 1 1d 4 5 6 7 8 6 (A) Prior Year (B) Current Year (optional) Current Year 7 Chek here if the urrent year is the organization's first as a non-funtionally-integrated Type supporting organization (see instrutions). Shedule A (Form 99 or 99-EZ) 14 4E131. 455HC K99 11/1/15 3:3:3 PM V 14-7.6F 114837 PAGE 11