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Deprtmtrl of thE T8sury

Return of

A I [l n

Forthe20l1 nodr"" Name cnange Initiat return

Under section O0:l(c), , or 4947(aX1) the Intemal of Revenue Code(except blacklung beneflt trustor privato foundation) >The organization may to usea copy thisretuan satisry of to statreporting requirements.

ExemptFrom IncomeTax



B Checkif applicabte: Number and stret(or p.O box mail is not dellverod streetaddress) to

D Employer ldentificallon numbei

E Telphone numbr

Gityor town,stateof I terminateo return n Arnended pendingF Nam6 and address of l-l Application I TaxxemotstiafuE:

G Gross receiots $

Yesl X I No

H(r) ls thls a groupreturnfor affltates? H(b)Are a[ afntiates inctudd? lf "No,''atlacha list.(see instruciions)

vesl-l Ho

50I (cX3)

s01(c) (

K Formoforganizatlon:

L Yearof formation: 1

M State of legal domicit:

Briefly describe organization's the

o 0

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3 4 5 6

ion or mostsignificant activities: G POOR


o o e

o o


Number votingmembers lhe of of Number independent of votingrne Totalnumber individuals of Totalnumber volunteers of

discontinued itsoperations ordisposedmore 2byo itsnelassets, of tiran of ing body(PartVt, tine1a) of the governing body(PartVl, tine1b) . year2011(PartV, line2a) in calendar


7a Total unrelated business revenue

b Net unrelaiedbusi

necessary) Part l, column tine . Vlf (C), 12

from T . l i n e3 4 .


o o E

8 9 10 11 12

a o tl uJ

other 15 Salaries, compensation, employee o

l6a b 17 '18 19

Contributions grants(partVlll, and th). Program service revenue (partVlll, Investment (PartVlll, income (A),lines3, 4, and 7d) . Otherrevenue (PartVlll, column(A) 5 , 6 d , 8 c , 9 c1 0 c a n d1 l e ) . , , :1 Total revenutsadd I throuoh1 ( tines (A), 1 Part column tine Vlll, 13 Grants similar and paid amounts (p lX,column (A),lines 1-3) 14 Benefits paidto or for members (p lX, column(A),line4) . Professional fundraising fees(part column line11e). (A), Totalfundraising (pa( lX, expenses ( D ) ,l i n e2 5 ) > - _ _ _ _ _ _ _ _ - _ - - 7 _ q Otherexpenses (PartlX, column lines11a-11d, 11t-24e,. Totalexpenses. lines13-17 Add it equalParl lX, column (A),line25) . Revenue expenses. less Subtrac
End of Yeat

(Part column lines iX, (A), 5-10)


20 Total (Part tine16). assets X, 21 Total llabilities X, line26) (Part

indudingaccompanying schedutes slalements, to the bestof my knowtedge and and |s oasoon

Underpnaltis perjury, dectare of I thal I have

belief. it is

Sign Here
or pnnt n8meand tiUe


Paid Preparer UseOnly

Maythe IRSdiscuss retumwiththe this

Firm's ) 87 EIN

shownabove?(seeinstructions) .

For Papenrork ReducflonAct Notice, see the


v". porm (zor 990 t)

Form (2011) s90


Check Schedule containsresponse anyquestion thispartill . if O a to in

1 Briefly describe organization's the mission:

Didtheorganization program undertake significant any seryices during yearwhichwerenot listed the on the priorForm990or 990-EZ? Iv"" X"o lf "Yes," describe thesenewservices Schedule on O. Didtheorganization ceaseconducting, makesignificant or changes howit conducts, program in any services? lf "Yes," describe thesechanges Schedule on O Describe organization's program the service accomplishments eachof its threelargest program for services, measured as by expenses Section 501(c)(3) 501(c)(4) and organizations section 7@)(1) and a9 trusts required report amount are to the of grants andallocations others, totalexpenses, revenue, any,for eachprogram to the and if service reported

!v"" E*o

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4 b ( C o d e.:_ - _ _ - _


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1 9 , 5 6 8n c l u d i n g g r a n t$ - -f_ - _ - _ _ - 1 9 , g Q(g _e v e n u e $ _ _ _ _ _ _ _ _ _ ? g p q q - ) i so ) R _

: 4c (Code._-_---

s ) ( E x p e n s e$

4d Otherprogram services(Describe Schedule ) in O 0 includino $ LExpenses orants $ of 4e Total programservice expenses 432.708

0 ) (Revenue $

rorm990 (zot t)

Form990 (201 ) 1


84-14402 Z J


l s t h e o r g a n i z a t i o n d e s c r i b e d i n s e c t i o n 5 0o(rc )9 3 ) ( a ) ( 1 ) ( o t h e r t h a n a p r i v a t e f o u n d at fi " y e s , " l 4 ( 47 on)? completeSchedule A 2 ls the organization required completeSchedule Schedule Contributors to B, (seeinstructions)? of 3 Didtheorganization engage direct indirect in political or campaign activities behalf or in opposition on of to candidates publicoffice?lf "Yes," for completeSchedule paft t C, Section501(cX3) organizations. the organization Did engage lobbying in activities, orhavea section 501(h) election effectduringthe tax year? lf "Yes," in completeSchedute paft tt C, ls the organizationsection a 501(c)(4), 501(c)(5), 501(c)(6) or organization receives that membership dues, assessments, similaramounts definedin Revenue or as Procedure 98-19? lf "yes,"completeschedule c. Part lll . Didthe organization maintain donoradvised any fundsor anysimilar fundsor accounts whichdonors for have the right provide to advice the distribution investment amounts suchfundsor accounts? on or of in /f "Yes," completeScheduleD, Pad I Didthe organization receive holda conservation or easement, including easements preserve to openspace, the environment, historic landareas,or historic structures? "Yes," lf complete ilcheduleD, Pad Il Didtheorganization maintain collections worksof art,historical of treasures, othersimilar or assets?tf "Yes," completeScheduleD, Paft lll Didthe organization report amount PartX, line21; seryeas a custodian amounts listed Part an in for not in X; or provide credit counseling, management, debt repair, debtnegotiation credit or services? "Yes," tf completeScheduleD, Part lV 't0 Didthe organization, directly orthrough related a organization, assets telmporarily hold in restricted permanent endowments, endowments, quasi-endowments? "Yes," or lf complete Schedule Paft V D, 1 1 lf theorganization's answer any of thefollowing questions "Yes," to is thenconrplete D, Schedule Parts Vl, V l l ,V l l l ,l X ,o r X a s a p p l i c a b l e . Didtheorganization report amount land,buildings, equipment PadX, line10? lf "Yes," an for and in comptete Schedule Part Vl. D, Didthe organization report amount investments-other an for securities PartX, line12 thatis 5% or more in of its totalassetsreported PartX, line 16? lf "Yes," in completeSchedule Paft Vll D, Didtheorganization report amount investments-program an for related PartX, line13 thatis 5% or more in of its totalassetsreported PartX, line 16? lf "Yes," in complete Schedule Paft Vlll. . D, Didthe organization reportan amountfor otherassetsin PartX, line '1 that is 5% or moreof its totalassets 5 reported PartX, line 16? lf "Yes," in Schedule Paft lX. complete D, e Didthe organization reportan amountfor otherliabilities PartX, line 25? If "Yes," in complete Schedule PartX. D, f Didtheorganization's separate consolidated or financial statements thetaxyearincrludefootnote addresses for a that 'Yes," theorganization's foruncertain positions liability tax under 48 (ASC FIN 740)? If complete Schedu/e PaftX D, 12a Didthe organization obtainseparate, independent audited financial statements the tax year? lf "Yes," for complete Schedule PaftsXl, Xll, and Xlll D, Wasthe organization included consolidated, in independent audited financial statements the tax year? lf "Yes," for and if the organization answered"No"to line 12a,thencompleting Schedule PaftsXl, Xll, and Xlll is optional D, 1 3 ls the organization schooldescribed section170(bX XAXii)?lf "Yes," a in 1 completeSchedule E 14a Didtheorganization maintain office, an employees, agents or outside the Urrited of States? b Didtheorganization haveaggregate revenues expenses morethan$10,000 or of fromgrantmaking, fundraising, business, investment, program and service activities outside United the States, aggregate or foreign investments valuedat $100,000 more? lf "Yes," or completeSchedule PaftsI and tV F, 1 5 Didtheorganization (A),line3, morethan$5,000 g;rants assistance any report PartlX, column on of or to organization entitylocated or outside UnitedStates?lf "Yes," the completeScltedule Paftsll and lV F, Didtheorganization report PartlX, column (A),line3, morethan95,000 ;aggregate on grants assistance of or to individuals located outside UnitedStates?lf "Yes," the completeSchedule Partslll and lV t:, Didthe organization report totalof morethan$15,000 expenses professional a of for fundraising services on PartlX, column(A), lines6 and 11e? If "Yes," completeSchedule Paft I (see instructions) G, . 1 8 Didthe organization report morethan$15,000 grossincome totalof fundraising event and contributions on PartVlll, lines1c and 8a? lf "Yes," complete Schedu/e Parl ll G, 1 9 Didtheorganization report morethan$15,000 grossincome of fromgaming activities PartVlll, line9a? on lf "Yes,"completeScheduleG, Paft lll Didthe organization operateone or morehospital facilities? "Yes," lf comptete Schedule H lf "Yes" line20a.didthe oroanization to f its audited financial stiatements thisreturn? to



6 7


9 10


11a X 1tb


't1d X

't'te X
11t 12a X X








17 18



X 20a 20b rorm 990 (zotr)

F o r m 9 0( 2 0 1 1 ) 9





21 Didthe organization report morethan$5,000 grants of andotherassistance any government organization to or in the United Stateson PartlX, column(A), line 1? tf "Yes,"comptete Schedule paftsI andtt l, 22 Didtheorganization report morethan$5,000 grants of and otherassistance individuals the to in unitedstateson Part lX, column(A), line2? lf "yes,"compteteschedute parlst and ilt t, 23 Didthe organization answer"Yes"to PartVll, Section line3, 4, or 5 aboutcompensation the A, of organization's current and formerofficers, directors, trustees, employees, highest key and compensated employees? "Yes," lf completeSchedute J 24a Didthe organization a tax-exempt have bondissue withan outstanding principal amount morethan of as $100'000 of the lastday of the year,thatwas issuedafterDecember , 2OO2? "yes," answertines 31 lf 24b through24d and complete Schedute tf ,No,"go to tine 25 K b Didthe organization investany proceeds tax-exempt of bondsbeyonda temporary periodexception? c Didthe organization maintain escrow an account otherthana refunding escrow anytimeduring year at the to defease any tax-exempt bonds? d Didtheorganization as an "on behalf issuer bonds act of for outstanding anytimeduring year? at the 25a Section501(c)(3) 501(cX4) and organizations. the organization Did engage an excess In benefit transaction with a disqualified personduringthe year?lf "yes,"completeschedute paft t L, b ls theorganization aware thatit engaged an excess in benefit transaction a disqualified person a with In praor year, andthatthetransaction notbeenreported anyof the organization's Forms990or has on prior 990-EZ?lf "Yes,"completeScheduteL, part I 26 Was a loanto or by a currentor formerofficer, director, trustee, employee, key highlycompensated employee, or personoutstanding of the end of the organization's year? lf "yes,"completeSchedute paft ll disqualified as tax L, 27 Didtheorganization provide grantor otherassistance an officer, a to director, trustee, employee, key substantial contributor employee or thereof, grantselection a committee member, to a 35%controlled or entityor familymember any of thesepersons?tf "yes,"completeschedute part ttt of L, 28 Was the organization partyto a business a transaction one of the following with parties(seeSchedule L, PartlV instructions applicable for filing thresholds, conditions, exceptions): and a A current formerofficer, or director, trustee, key employee?lf "Yes," or compteteSchedule paft lV L, b A familymember a current formerofficer, of or director, trustee, key employ or ee? lf "yes,"complete ScheduleL, Part lV c An entity whicha current former of or officer, director, trustee, keyemployee a family (or or member thereof) was an officer, director, trustee, director indirect or owner?tf "Yes," completeSchedute partlV L, 29 Didthe organization receive morethan $25,000 non-cash in contributions? "Yes," lf compteteSchedule M 30 Didthe organization receive contributions art,historical of treasures, othersimilar or assets. oualified or conservation contributions? "Yes," lf completeSchedule M 31 Didthe organization liquidate, terminate, dissolve or and ceaseoperations? "Yes," lf complete Schedu/e N, Paft I 32 Didtheorganization exchange, sell, dispose or transfer of, morethan25o/o its net assets? of lf "Yes," completeSchedule Part ll N, 33 Didthe organization 100%of an entity own disregarded separate as fromthe organization underRegulations sections 301.7701-2 30'l.7701-3?lf "yes,"completeSchedule paft t and R, 34 Was the organization related any tax-exempt taxable to or entity?/f "Yes," completeSchedute pafts tt, R, lll, lV, and V, line 1 35a Didthe organization a controlled have entitywithin meaning section the of 512(bX13)? b Didtheorganization receive payment any fromor engage anytransaction a controlled In with entity within the meaning section of 512(b)(13)? "Yes," lf completeSchedute paft V, line 2 R, 36 Section501(cX3) organizations. the organization Did makeanytransfers an exempt to non-charitable related organization? "Yes," lf complete Schedule paft V, tine2 . R, 37 Didtheorganization conduct morethan5% of its activities through entity an thatis nota related organization and that is treated a partnership federalincometax purposes?lf "Yes," as for completeSchedule parl R, VI
38 Did the organization completeScheduleO and provideexplanations ScheduleO for part Vl, lines 11 and in

19?Note.All Form990 filers reouired are to

te Schedule O

1 a tlnterthe number reported Elox of Form1096 Enter if notappricabre in -03 b E n t e t h en u m b eo f F o r m s - 2 G i n c l u d e id l i n e1 a E n t e - 0 -i f n o ta o p l i c a b t e r r w n r c Didtheorganizatron comprly backup with withholding rules reportable for payments vendors to and reportable g a m i n gg a m b l i n g )i n n i n gts p r i z e i n n e r s ? ( w o w 2a E:nter number employees the of reported Formw-3, Transmittal wage andrax on of { i t a t e m e n tfsl,e d o r t h ec a l e n d a r y e a r e n d iw ig ho r w i t h i nh ey e a r c o v e r eb y t h i sr e t u r n i f nt d t lf at least oneis reported line2a,dici organization all required on the file federal employment taxEilrns? trlote' thesumof lines1aancl is greaterthan lf 2a 250,youmay be required e-fite. lo (seeinstructions) 3a D l dt n eo r g a n i z a t i o n v eu n r e l a t eb u s i n e sg r o s s n c o m e f $ 1 , 0 0 0 r m o r ed u r i n gh e y e a r ? ha d s i o o t b lf "Yes,"has it fileda Formggo-Tfor this year? tf "No," providean explanation schedule in o 4 a l \ t a n y t i m e d u r i n gt h e c a l c ' n d ay e a r ,d i d t h e o r g a n i z a t i o h a v e a n i n t e r e s r n ,o r a s i g n a t u r e r n t
o r o t h e ra u t h o r j t y over, a financialaccountin a foreigncountry(such as a bank account,securities account,or other financral

5a b c 6a

provided the payor? andservices to

b c d

Was the organization party to a prohillitedtax sheltertransactron any time duringthe a at tax year? Did any taxableparty notifythe organization that it was or rs a party to a prohibited tax sheltertransaction? ll"'Yes"to line 5a or 5b, di,C organization Form gg86-T? the file D o e s t h e o r g a n i z a t i oh a v e a n n u a lg r o s s r e c e i p t s h a t a r e n o r m a l l y r e a t e rt h a n n t g $ 1 0 0 , 0 0 0a n d d i d t h e , organization solicitany contributions that were not tax deductible? ll'"Yes,"did the organization includewilh every solicitation expressstatementthat such contributions an or giftswere not tax deductible? o r g a n i z a t i o n st h a t m a y r e c e i v e d e d u c t i b l e c o n t r i b u t i o n s u n d e r s e c t i o n 1 7 0 ( c ) . Did the organization receirre payment in excess of $75 made partlyas a contribution a and parly for goods lf "Yes,"did the organization notifythe <lonorof the value of the goods or seryicesprovided? Did the organization sell, erxchange, otheru,uise or dispose of tangiblepersonalpropertyforwhich it was requiredto file Form 8282'7 lf "Yes."indicate the number of Forms t\282 liled duringthe year

account)? llf"Yes," enterthe nameol'theforeign country: > Siee tnstructtons filing for requirements FormTD F gO-22 Report Foreign for 1, of Bankand Financial A;;;;;i;

e f g h

C)id organization the recett'e funds, any directly indirectly, paypremiums a personal or to on benefit contract? crid organization, the during year,paypremiums, the directly indrrecily, a personal or on benefit contract? lf theorganization receivedcontribution a of qualified property theorganrzationForm intellectual did file 889g required? as lf theorganization receivedcontribution a of cars, boats, airplanes,other or vehicles, theorganizationa Form did file 10gg-C?
S p o n s o r i n g o r g a n i z a t i o n sm a i n t a i n i n gd o n o r a d v i s e d f u n d s a n d s e c t i o n 5 0 9 ( a ) ( 3 s u p p o r t i n g ) o r g a n i z a t i o n s . i d t h e s u p p o r t i n g r g a n i z a t i o n ,r a d o n o ra d v i s e df u n d m a i n t a i n e d y a s p o n s o r i n g D o o b o r g a n i z a t i o n ,a v e e x c e s sb u s i n e s s o l d i n g s t a n y t i m e d u r i n gt h e y e a r ? h h a S p o n s o r i n g o r g a n i z a t i o n sm a i n t a i n i n gd o n o r a d v i s e d f u n d s . D t i d h e o r g a n i z a t i om a k e a n y t a x a b l ed i s t r i b u t i o nu n d e rs e c t i o n4 9 6 6 ? t n s Did the organization make a distribution a donor, donor advisor,or relatedperson? to S e c t i o n 5 0 1 ( c ) ( 7 o r g a n i z : a t i o n sE n t e r : ) . I n i t i a t i o fn e s a n d c a p i t a l o n t r i b u t i o nis c l u d e d n p a r t V l l l , I i n e . 1 2 e c n o Girossreceipts, includedon Form 990, partVlll, line 12, for publicuse of club facilities S e c t i o n 5 0 1 ( c X 1 2 ) r g a n i z a t i o n s .E n t e r : o Gross incomefrom membr:rsor shareholders Gross incomefrom other sources (Do not net amountsdue or paid to other sources

9 a b 10 a b 11 a b

agarnst amounts or rer:eived themI due from I t t OI 1 2 a S e c t i o n r a 9 a T ( a ) ( 1 ) n o n - e x e m p t c h a r i t a b lle t r u s t r g a n i z a t i o n f i l i n g F o r m g g 0 i nFio ru o f s heo s. l e m1041?
b lf "Yes,"enter the amount of tax-exemptinterestreceivedor accruedduring the year

13 a b

theorganization is licensed ir;sue quarlified plans to health

S e c t i o n 0 1 ( c ) ( 2 9 ) a l i f i e d o n p r o f i t e a l t hi n s u r a n c es s u e r s . qu 5 n h i ls the organization licensed issuequerlified to plansin morethanonestate? health Note'Seethe instructions additional for information organization report Schedule the must on O Enter amount reserves organization required maintain the states which the of the is to by in


c Enter amount reserves hand the of on 'l4a Didtheorganization receive payments indoor any for tanning services during taxyear? the . b lf "Yes," it fileda Form720to has lf "No "
r o r m9 9 0 ( z o t r )

FOrM (2011) 990




eage 6

respOnse ,la,8b,or 10b toline processes, changes Schedu/e Seeinstructions. below, describe circumstances, the or n 0,
Checkif Schedule contains response anyquestion thisPartVl O a to in . Governinq Bodvand


1a llnterthenumberofvotingmembersofthegoverningbodyattheendofthetaxyear lf therearematerial in diffen:nces voting rights among members thegoverning of body,or if thegoverning bodydelergated broadauthority an executive to committee similar or committee, explain Schedule in O b E n t e r t h e u m b e r ov o t i n g e m b e r is c l u d eid l i n e1 a ,a b o v ew h oa r ei n d e p e n d e n t n f m n n , 2 Didanyofficer, director, trustee, keyemployee or havea family relationship a business or relationship with anyotherofficer, director, trustee, keyemployee? or 3 Didtheorganization delel;ate performed or underthe control overmanagement duties customarily by direct supervision officers, of directors, trustees, keyemployees a management or or to company otherperson? or 4 Didtheorganization anysignificant make changes itsgoverning to documents theprior since Form wasfiled? 990 5 Didtheorganization become awareduring yearof a significant the diversion the organization's of assets? 6 Didtheorganization members stockholders? have or 7a Didtheorganization members, have stockholders, otherpersons or who hadthe powerto elector appoint oneor moremembersof the governing body?
b Are any governancedecisionsof the organization reservedto (or subjectto approvalby) members,

a b

,cther stockholders, persons or thanthegoverning body? Didthe organization contr-.mporaneously document meetings the heldor written actions undertaken during
the year by the following: fhe governingbody? Each committee with authorityto act on behalf of the governingbody?

ls thereanyofficer, director, trustee, keyemployee or listed PartVll, Section who cannot reached in A, be
at the orqanization'smailinq address? lf "Yes." provide the names and addressesin Schedule O

B. Poficies (This Se'ction B

information about policies not

the lnternal Revenue Code

10a Didthe organization localchapters, have branches, affiliates? or b lf "Yes," the organization written policies procedures did have governing activities suchchapters, and the of affiliates, branches ensure and to theiroperations consistent the organization's are with exemplpurposes? providr"'d 11a Has organization the a complete of thisForm to allmembers itsgoverning before copy 990 of body filing form? the b Describe Schedule tlreprocess, any,usedby the organization review in O if to thisForm990 12a Didthe organization a written policy?lf "No," to line 13 have, go conflict interest of b Were officers, directors, ortrustees, keyemployees and required disclose to interests could giveriseto conflicts? annually that c Didtheorganization regularly consistently and monitor enforce and compliance the policy?tf "Yes," with describein ScheduleO how this was done 13 Didtheorganization a written policy? have' whistleblower 'i.4 Didtheorganization a written haver policy? document retention destruction and 15 Didthe process deterrnining for persons compensation the following of include review a and approval by persons, independent cornparability andcontemporaneous data, substantiationthedeliberation decision? of and a Theorganization's CEO,Executive Director, top management or official b Other officers keyemployees the organization or of l f " Y e s " t o i n e1 5 ao r ' 1 b ,d e s c r i b e t hp r o c e s is S c h e d u lO ( s e ei n s t r u c t i o n s ) l 5 e n e 16a Didtheorganization invest contribute in, assets or participate a jointventure similar to, in or arrangemenr
with a taxableentityduring the year?

lf "Yes," the organizalion did policy procedure follow written a or requiring organization evaluate the to its participationjointventure in arrangements underapplicable federal law,andtakestepsto safequard tax thF n's statuswith re to sucha

17ListtheStatesWithwhichacopyofthisForm990isrequiredtobefi|eo> 18 section 6104requires organization makeits Forms'1 (or 1024if applicable) anOOSO-iiSect'o;-sOitcltiji an to 023 990 o'iryf for public insper:tl$ Indicate how youmadetheseavailable. Checkall thatapply |'available | | Anothe/swebsite Uponrequest [__JO*n website f 19 Describe Schedule whether in (andif so, how),the organization O madeitsgoverning documents, conflict interest of policy, financial and statements available the public to 20 State name, physical the address, telephone and number ofthe person who possesses booksand records the ofthe organization: . __T_ug_tvtAg-Q. _r!F_L_E_o_t-!_ ___ _______lgg_3j_41?:gg_O_O_ _ 1 1 2 01 / 2P I N E T R E E TB O U L D E R , O 8 0 3 0 2 S , C rorm 990 izor I I




Employees, and Independent Gontractors checkif schedule contains response anyquestion thispartVll . o a to in
SectionA. Directors 1a Complete tablefor all persons this required be listed Report to compensation the calendar for yearending withor within the organization's year tax ' Listall of theorganization's currentofficers, directors, (whether trustees individuals organizations), or regardless amount of of compensation. -0- in columns Enter (D),(E),and (F) if no compensation paid was ' Listall of the organization's currentkeyemployees, any.See instructions definition ,'key if for of employee.,' o Listthe organization's current highest five compensated (otherthan an officer, employees director, truitee, or key employee; who received reportable (Box5 of Formw-2 and/orBox 7 of Form 1099-Mlsc)of morethan $100,000 compensation fromthe organization any related and organizations ' Listall of the organization's former officers, employees, highest key and compensated employees who received morethan of $100'000 reportable compensation the organization any related from and organizations. ' Listall of the organization's former directors or trustees that received, the capacity a formerdirector trusteeof the in as or organization, than$10,000 reportable more of compensation the organization any related from and organizations Listpersons the following in order:individual trustees directors; or institutional trustees; officers; employees; key highest compensated employees; former and suchpersons Cnecfthisbox if neither organization any related the nor ! organization compensated current any officer, director, trustee. or {c)
(Al Name Title and
(B) Average noursper weeK (describe hours for related organizations in Schedule Position (do not checkmorethan one person bothan box,unless is


(Dl (El (Fl Reportable Reportable Estimated compensatton compensation amount of from from related olher the organizations compensa!on organization (w-2l1099-MtSC) fromthe (w-2/1099-MtSC) organization and related organizations

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Name and title


HOUSE Em (c)



(B) Average noursper weeK (describe hours for related organrzahons in Schedule o)

Position (do notcheckmorethanone box,unless person bothan is

(D) (El Reportable Reportable compensatton compensation from from related tne organizations organization (w-zl10ee-Mtsc) (w-2l10ee-Mtsc)

(F) Estimated amount ot otner compensalion fromthe organizatron and related organtzattons

11_51 -(1-6).

.11_81 _0_sJ

_t?I_ _t??)_

1b c d 2 Sub-totarl Totalfrom continuation s,heets part Vll. SectionA to T o t a l( a c l di n e s1 b a n d 1 c _ l Totalnurnber individuals of (including notlimited thoselisted brit to above) who received morethan$100,000 of reportable compensation the orqan from ization Didtheorganization any former officer, list director, trustee, employee, highest or key or compensated employer-. line 1a? lf "yt>s," on compteteSchedute for suchindividuat J Foranyindividual listed line1a,is ther on sum of reportable compensation othercompensation and from t h e o r g a n i z a t i o n a n d r e l a t e d o r g a n i z a t i o n s g r e a t e r t h a n $l1 5y e 0 0"0 ? m p t e t e s c h e d u t e J f o r s u c h f " 0, s, co individual Didanyperson listed line1a recelve accrue on or compensation any unretated from organization individual or Or_:g*fg99j9nderedto tnspfggllzgllg!? tf ',yes,', comptete Schedute for such Derson J

Section B. lndependent Contractors

1comp|etethistab|eforyourfivehighestcompensatedinoeoen compensation the orgianization from Report compensation the calend year for ar ending withor within organization,s the tax year _
(A) Nameand businerss address


Totalnuntber inOepenOeirt-ontrlcto-E ot morethan9100,000 compensation the orqanization of from rorm 990 1zol1

Form 9C 2011) 9 (

B R I D G E O I J S EF R M L y l ] J EC A R R T A G EO U S E O M M U N T T 'A B L E H H C Ty

(D) Revenue excluded from tax under sections

o (9

1a b c d e I

o o o o @

Federated campaigns M e m b e r s hdp e s iu Fundrarsing events Related organizatiors Government grants (contributions;) A l lo t h e r o n t r i b u t i o n sf,t s g r a n t sa n d gi , c , s i m i l aa m o u n t n o ti n c l u d ea b o v e r s d Noncash contribution$ included lirres in 1a-1f
'Iotal. A d d l i n e s1 a - 1 f

1 2 . 5 1 3o t 5 1 4


F o r m 9 0( 2 0 1 1 ) 9

B R I D G EI 1 O U S E R M L Y H EC A R R I A G H O U S E O M M U N I TT A B L E [ F, T E C Y



o n a lE

Sectlon 501(c)(3) and 501(c)(4) organizations mustcomplete columnsAII other organizationsmustcomptetecolumn(A) but are all not reauiredto columns Check Schedule contains response anyquestion thispart lX if O a to in Do not include amounts reportedon tines 6b, 7b,8b,9b,and 10bof PartVtrll. 1 Grants andotherassistance governments to and organizationsthe United in StatesSee PartlV, line21 2 Grants andotherassistarrce individuals the to in Unitecl States See PartlY. line22 3 Grantrs otherassistance governments, and to organizations, individuals and outside the Unitecl StatesSee PartlV, lines15 and 16 paid 4 Benefits to or for members 5 Compensation current of officers, directors, trustees, keyemployees and 6 Compensation included not above, disqualified to persons defined (as under section 4958(f)(1)) and persons described section in a958(c)(3)(B) 7 Other salaries wages and planaccruals contributions 8 Pension (include and section 401(k) and403(b) employer contributions) 9 Other employee benefits 10 Payroll taxes '11 Feesfor services (non-employees): a Management b Legal c Accounting d Lobbying e Professional fundraising services. Part line17 See lV, f Investment management fees s Other 1 2 Advertising promotion and 1 3 Officeexpenses . 1 4 Inforrnation technology 1 5 Royalties 1 6 Occupancy 1 7 Travel 1 8 Payments travel entertainment of or expenses for anyfederal, state, localpublic or officials 1 9 Conferences, conventions, meetings and 20 Interest 2 1 Payments affiliates to 2 2 Depreciation, depletion, amortization and 2 3 Insurance 24 Other expenses ltemize expenses covered not above(Listmiscellaneous expenses line24e lf in line24eamount exceeds 10%of line25, column (A)amount, line24eexpenses Schedule ) list on O a B O U L E RC H A N G E O U C H E R S D V
b c d _v_ELlQ_r=E. P_AE_(ry-G_,_[4tl_E_49_E, _E_IQ. __ _ _ e All other expenses 25 26 Joint costs.Complete lineonlyif the this
(D) Fundraising




0 2.309 3.670

787 691

organization (B) reported column jointcosts in froma combined educational camoaion -t and fundraising solicitation, Checkhere 't I



rorm990 lzorr 1

Form902011) 9 (







Savings temporary and cashinvestments Pledges grants and receivable, net Accounts receivable, , net Receivables current from and former officers, directors, trustees, key part ll of employees, highr:st and compensated employees. Complete Receivables otherdisqualified from persons defined (as under section persons 4958(0(1)), described section in 4958(c)(3)(B), contributing and employers sponsioring and organizations section of 501(c)(9) voluntary employees' beneficiary organizat (seeinstructions) ions
Notesand loans receivable, net


o o o o

Inventories saleor use for

Prepaidexpensesand deferredcharges

Land, buildings, r:quipment: or and cost otherbasis Complete PartVl of Schedule | 10a D
Less: accumulated depreciation



Investments-publicl,y securities traded Investments-other securities See PartlV, line11 Investments-program-related PartlV, line11 See Other assetsSee Perrt line11 lV, Totalassets.Add lines1 payable accrued Accounts and expenses payable Grants . Deferred revenue Tax-exemot bondliabilities Escrow custodial or erccount liability Complete PartlV of Schedule D Payables current former to aLnd officers, directors, trustees, key employees, highest crompensated employees, disqualified and personsComplete Partll of Schedule L Secured mortgages notespayable unrelated and to thirdparties Unsecured notesancl loanspayable unrelated to thirdparties Otherliabilities (including federal income tax,payables related to third parties, otherliabilities included lines17-24)Complete and not on PartX of Schedule D Totalliabilities. Add lines17

.= = .s J

o G)

17 18 19 20 21 22

23 24 25

zJ.o I I zJ.6 t I

o o o


o o o, o o


Organizations I'ollowSFAS117,check here > |T] anO that c o m p l e t ei n e s2 7 t h r o u g h2 9 ,a n d l i n e s3 3 a n d 3 4 . l 27 Unrestricted assets net 21, Temporarily restricted assets net 21, Permanently restricterd assets net Organizations do not follow SFAS117,check here )l-l that and completelines 30 through34. 30 Capital stockor trustprincipal, current or funds, 3 1 P a i d - i o r c a p i t as u r p l u s ,r l a n d , u i l d i n g ,r e q u i p m e nu n d n l o b o ft 3i2 Retained earnings, endowment, accumulated income, olherfunds or 33 Totalnetassets fundbalances or
liabilities and net

rorm 990 (zor rt



84-1440292 eaoe 12

Checkif Schedu|: contains response anyquestion thisPartXl . O a to in

1 2 3 4 5 6 (must Totalrevenue (A),line12) equalPartVlll, column (must Total (A),line25) expenses equalPartlX, column Revenue expenses. less Subtract 2 fromline1 . line Netassets fundbalancs beginning year(must (A)) or at of equalPartX, line33,column (explain Schedule in Otherchanges netassets fundbalances or in O) Netassets fundbalances end of year.Combine or at lines3, 4, and 5 (must equalPartX, line33, ( c o l u m nB

o v v ./ c v

497 115


Financial Statements and Reporting if Check Schedule contains response anyquestion thisPartXll O a to in
Accounting method usedto prepare Form990: ! Other the Casn lTlAccrual "Other," lf the organization its from explain in changed method accounting a prioryearor checked of Schedule O Weretheorganization's financial statements compiled reviewed an independent accountant? or by Weretheorganization's financial statements audited an independent by accountant? lf "Yes" line2a or 2b,doesthe organization a committee assumes to have responsibility oversight for of that the audit, review, compilation its financial statements selection an independent accountant? . or of and of process selection process in lf the organization during tax year,explain the changed eitherits oversight or Schedule O for lf "Yes" line2a or 2b,checka box belowto indicate whether financial the statements the yearwere to issued a separate consolidated basis. both: or on basis. and basis basis eotn consolidated separate basis [Tl Consolioated [-l Separate ! required undergo auditor audits setforthin to an as As a result a federal of award, was the organization A-133?. theSingle AuditAct andOMBCircular lf did the auditor audits? the organization not undergo lf "Yes," the organization did undergo required the
audit or audi in ScheduleO and describeanv steps taken to such audits

2a b c


Business Income Tax ,"'" s)90-T ExemptOrganization section6033(e)) Return 2 @ 1 1 (and proxy tax under
O M BN o 1 5 4 5 - 0 6 8 7 of Department the Treasury lnternal Revenue Service
^ A B l-l l-J Checkbor rl addresscha

yeat 2011or othertax year beginning _- ___- - ______, and For cafendar . instructions. ) See ending
Name of organization( [ Check box if name changed and see instructions)

number identification
(Employees trusl. seeinslructions)

Exernpt under seclion

Number, streel, and room or suite no lf a P O box, see instructions

, l T l u o( . l r 3 I +oet"l l-l tzo(") l-l ! +oan ! sso1"1

C Bool( value of all assets al end of year //VJ Y/O

E Unrelated businessactivitycodes (See inslructions )

andZIP code Cityor town.state,

DER CO instructions t i o nn u m b e r SOt corporation type I I G Checkorganization 1c)

80306 (c) 501 trust 4 0 1 ( at)r u s t Other trust

primary business acttvity.) H Describel organization's the unrelated |Duringthetaxyear,wasthecorporationasubsidiaryinanaffi|iatedgrouporaparent-subsidiarycontro||ed ) corporation number theparent of lf '-YegJ:nter name identifvinq the and
The books in careof ) are 1a b 2 3 4a b c 5 6 7 8 9 10 11 12 13 THOMAS NELSON C Telephone number ) (303) 442-8300
(c) Net

Income Tradeor Business Ulnrelated

Gross receipts sales or --Tl l-ess returns allowances and A, sold(Schedule line7) Costof goods {3ross profitSubtract 2 fromline1c line (attach {Japital netincome gain D) Schedule ) c Balance

(loss) (Form ll, 17) Form l\etgain 4797,Panline (attach 4797) tlaoital deduction trusts loss for
(attach (loss) partnershipsS corporations statement) Income from and (Schedule lRent rncome C) (Schedule E) income Unrelated debt-financed royalties, rentsfromcontrolled and Interes;t, annuities, ,crganizations (Schedule F) n 5 I n v e s t m ein tc o m e f a s e c t i o n 0 1 ( c ) ( 7()9 ) ,o r ( 1 7 ) o (Schedule G) organization (Schedule l) income exempt activity Exploited (Schedule J) income Advertising (Seeinstructions; schedule attach Otherincome )

(Except contributions, (Seeinstructions limitations deductions.) for on for Not TakenElsewhere Deductions
14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 must be connectedwith the unrelatedbusinessincome. cleductions (Schedule K) directors, trustees and of Compensation officers, and Salarir:s wages Repairs maintenance and Baddebts (attach Interest schedule) 'laxes andlicenses
rules ) (See instructions limitation for Charitable contributions (attachForm 4562) Depreciation claimedon ScheduleA and elsewhereon return Less <ieoreciation Deoletion Contributions deferredcomoensationolans to


programs benefit Employee (Schedule l) expenses Excesis exempt J) readership costs(Schedule Exces;s (attach schedule) Other deductions 2 A T o t a ld e d u c t i o n s . d dl i n e s1 4t h r o u q h 8 line loss Subtract 29 fromline13 net income before operating deduction business taxable Unreliated (limited the amount line30) on to loss Netoperating deduction line Subtract 31 fromline30 specific deduction income before business taxable Unrelated for (Generally but Specific deduction $1,000, see line33 instructions exceptions.) thanline line Unrelated businesstaxableincome.Subtract 33 fromline32. lf line33 is greater of zeroor line32 9 r o r m 9 0 - Tr z o t r t

ReductionAct Notice,see instructions. For Paroerwork

36 37 38 39

40a b c d e 41 42 43 44a b c d e l

4,s1-ro- a'oriiiorm [ ro*eaoi omriattao*in.o,r.; e6g7 ?HJil:: ! ::TllJ:?F":U

Othprt:rvoc l^hanr' rr, *.f--'l E^-/^F^'-

Totaf credits. Add lines40a through40d Subtriact 4Oe line fromline39

General business credit. Attach Form (see 3g00 instructions) Creditfor year prior minimum (attach tax FoimSeOi gg27) -. or '
. .

Foreign credit(.orpo tax Othercredits(see instruclions) .


r 'rvq l


Payments: 2010overpayment A credited 2011 to

45 46 47 48


-l - | 44s I 0l Totat payments. rines Add 44a,f,drg'i';g _ Estimertedlaxpenalty(seeinstruclionil.Ctrecf .':o: fiForm222Oisattached. .. .>n rhe.torai,of 43 ano+6,enter tines amount :. owed l?:,*.*:." fl:',"::]11" israrser rhev r q | v rinesl iandr | o . + o | e n l e r a ouerpaii r p a i d . > I than torarof| | | +3+ J a46, ! || g m - oun|ove 3"yljl311l1']lil"i: "nt", "roui'r l'-'-n"funded

other) for"iJ;'";ffi"ot'tu in lf YES, organization have fireForm the may " to TD F 90-22.1, nepoi ot i"iiig" Bank and Financial Accounts.yES,enter name theforeign lf the of country here) During taxvear, the the did organizatlon . ii.irilrti.i t r, .i '"rJit gianior - -- - . re.eiu" rn" df b?ii;i;6il 6,-; 6rds; fdt? , . lf YES, instructronsother see for forms organization have fire. the may to

rhe orsanizationaninterest a sienarure have inor 3::[::fi*Jy"li:overa financiar or otherr authority irjjflglt"::,oid (bank, account securities, or

Costol labor ,Additional section263A costs (attachschedule) b Other costs(aftach schedule) 'Iotal. 5 /\dd lines1
Unds pffitties ot prjury,

1 2 3 4a

Inventorybeginning year. at of Purchases

6 Inventory endofyear at 7 Costof goodssold.Subtract line6 from b. Enter line here andin Part line2 . l, 8 Dotherules sestion of (witn@A to ZOSA property produced acquired resale) or for

Sign Here


May the IRSdisoss lhrsretumwith Sillnature of ofiicef

Paid Preparrer Use ()nly

Frrm's EIN )

porm 990-T (eorrl

rjrTgg9-rjzol]) BRIP9E HOUSE, FRMLY CARRIAGE THE HOUSE COMMUNTTY TABLE 8+-ra+OZgZ ScheduleG-Rent Income (From Real Property and PersonalProperty LeasedWitn neai property) _Ggg1nstructions)
L (1) (2) (3) 2, Rent received oraccrued (al Frompersonal property the percentage rent (if of properlyis morethan 10% but not for personal morethan50%) (b) From real and personal property(if the percentage rentfor personal property of exceeds 50% or if the rentis basedon orofitor income) Description properly of

pan" 3

3(a) Deductions dtrectlyconnected with the income in columns 2(a)and 2(b)(attach schedule)


Total (c) Tolal income.Add totalsof columns 2(a)and 2(b).Enter hereand on page1, Partl, line6, c;olumn

(b) Total deductions. Enter hereandon page1,

I line6 column (B) > 3. Ooductions drrectly connected with or allocable to deblfinancedproperty (bl Otherdeductions (aitachschedule)

Scherdule E:-Unrelated Debt-Financed lncome see instructions

property 1. Description debt-financed of 2, Grossincomefrom or allocable deb!fi nanced to propeny


4, Amouniof average acquisition debl on or allocable debt-financed to property (attachschedule)

7. Grossincomereportable (column2xcolumnO)

8. Allocble deductions (column x tolalof columns 6 3(a)and 3(b))

Enterhereand on page 1, Partl, line7, column(A). Total:; Total dividends-received deductionsincluded in

Enterhereand on page 1, Partl, line7, column(B)



and RentsFrom Controlled

3, Netunrelated income (loss)(see inslructions)

4 5. Partof column thatis included the conlrolling in

(1) (2)


7. Taxable Income

8. Net unielated income (loss)(seje instruclions)

10.Partof column thatis 9 11. Deduclions directly included the conirolling connecied in with incomein column10


Add columns and 10 5 Enterhereand on page1 (A) Partl, lineE, column

Add cllumns6 and 1'l Enterhereandon page1, Partl, line8, mlumn(B)

rorm990-T rzottt

FOTM (201I) 990-T



1 Desrcription income of


5. Totaldeductions andselasides(col 3

Enterhereand on page1 Partl, line9, column (B)

4. Netincome (loss) from unrelated lrade or business (colum2 minus n column lf a 3) gain,compute cols 5 through 7
5. Gross income from activity that is not unrelated business income

1. Description exploited of activity

7, Excess exempl expenses (column minus 6 column but not 5, morethan 4 column )

Enterhereand on p a g e1 , P a r tI , h n e1 0 ,c o l ( A )

Enter here and on page 1, Partl, line 10,col (B)



Income (seeinstructions From Perriodica o n a C o n s o l i d a t e dB a s i s

7. Exess readershrp costs(column 6 minuscolumn 5, butnot morelhan column 4)

1. l,lame of periodical

to Partll, line

IncomeFrom Perriodicals Reported a Separate on Basis(Foreachperiodical listed part ll, in -line oolumns 2 basis
1 llame of periodical

4 Advertising gainor (loss)(col 2 mrnus 3) lf col , a g a r nc o m p u t e cols 5 through 7

7. Ex@ss readershrp costs(column 6 minuscolumn 5 but notmorelhan column 4)

(3) (4)

Totals from Part I

Enterhereand on pagel,Partl, l i n e1 1 ,c o l ( A )
Enter here and on page 1, PartI, line 11,col (B) Enter here and Parl ll, line27


S c h e d u l eK
1. Namr:

3. Percent of timedevoted to ousrness 4 Compensation attribulable to unrelated business

(2\ (3)

Total.E:nter hereand on

1 , P a r tl l , l i n e1 4

Form fiISG)z
Department lhe Treasury of Internal Revenue Seruice (gg)

Depreciation Amortization and (lncluding Information Listed on Property)

) See

OMB No 1545-0172


> Attach to

tax return.
ldentifying number

:ihowncrnreturn Name(s)

B R I D G E O U S i E ,R M L Y H EC A R R I A G E H F T H

Paft V before

ElectionTo ExpenseCertainPropertyUnderSection179
Note: /f you have any listed

1 2 3 4 5

(seeinstructions) Maximum amount placed service (seeinstructions) Totalcostof section prop,erly 179 in (see Threshold 179 reduction limitation instructions) in , costofsection property before Reduction limitation, in line Subtract 3 fromline2 lf zeroor less,enter-0for filing Dollerr limitation tax year Siubtract 4 fromline1 lf zeroor less,enter-0- lf married line
(al Description property of (b) Cosl(business only) use

property 7 Listed Enter amount fromline29 the (c), 8 Totalelected 179property Add amounts column lines6and7 in costofsection 9 Tentative dc.duction Enter smallerof line5 or line8 thel 1 0 Carnyover disallowed of deduction fromline13 of your2010Form4562 1 1 B u s i n e s s n c o m el i m i t a t i o nE r r t e r t h e m a l l e r o fb u s i n e s s n c o m e( n o t l e s s t h a nz e r o )o r l i n e 5 ( s e e i n s t r u c t i o n s ) i i s 1 2 S e c t i o n l T 9 lx p e n s e d e d u c t i A n d l i n e s 9 a n d l 0 , b u t d o n o t e n t e r m o r e t h a n l i n e l l e od 13 ofd uctionto 2012 Add lines 9 and 1 l i n e1 2

Special iationAllowanceand Other iation (Do not include listed property (otherthan property) placed service 14 Special forqualified listed in depreciation allowance year(seeinstructions) during tiax the 15 Property 168(0(1) subject section to election (includinq 16 Otherr depreciation ACRS)



(Do not include iartion listed


See instructions

placed in servicein tax years beginningbefore201 1 1 7 MACRS deductions assets; for placed service 1 8 lf you areelecting grouparryassets to in during tax yearintoone or more the genelral here ass,et accounts, checl< SectionB - Assets Placedin Service 20'l'l Tax Year Us the General
(a) Classiification property of

(9)Depreciation deduclion

(c) Basis depreciation for (business/investment use only-see instructions)

19 a

b 5 c 7

h Fiesidential rental i Nlonresrrjential real

SectionG - Assets Placedin Service

20 a Class life

2 0 1 1T a x Y e a rU s i

the Alternative De


propertyEnter 21 List<;d amount fromline28 2 2 T o t a t A d da m o u n t s f r o mn e1 2 ,l i n e sl 4 t h r o u g h1 7 ,l i n e s 9 a n d2 0 i n c o l u m ng ) ,a n dl i n e2 1 l. li ( 1 - see instructions Enterr hereandon the approprriate of yourreturnPartnerships S corporations lines and 23 Forassets shown aboveand placed service year,enterthe portion in during current the of the basrsi attributable ser:tion to 263Acosts ForPaperuvork Reduction Notice, separate Act see instructions.

(201 Form 4562 1)



, ,


page 2


entertainment, recreation, amusement.) or

Note; For any veh,icle for which you are using the standard mileage rate or deducting lease expense, complete onlv 24a, 24b, columns (a) throuqh (c) of SectionA, ail of SectionB, and Section C if app.licabte

Section i a t i o na n d tion (Caution:Seelhe instructions automobiles 24a Doyou have evidence tosupport business/investment the "Yes," theevidence use claimed? 24b lf is written? !V." !v.r !No
{a} TyF,eof proFrerty (list vehicles first)


Elected section 179 cost

25 Special depreciation property allowance qualified for placed service listed in during thetax yerar usedmorethan50% in a oualified and business instructions useo business se: u 2OO4 CHE\A/ VAN OVEN TOR used50%or lessin a b u s r n e su s e s

2 8 Add amounts column lines25 through Enterhereand on line21, page1 (h), in 27 ( 29 i n c o l u m n i ) ,l i n e2 6 E n t e r e r ea n do n l i n e7 h 1

Section B-lnformation on Use of Vehicles Complete sectlon vehicles this for partner, other"morethan5% owner," related usedby a soleproprietor, or person lf you provided or vehicles to youremployees, answer questions Section to seeif you meetan exception lirst the in C to this sectionfor thosevehicles

31 32 33 34 35

Totalbusiness/investment driven miles during year(clonot include ther commuting miles) Totalcomrnuting milesdrivencluring year the Totalotherpersonal (noncomnruttng) miles driven Totalmiles; drivenduringthe year Add lines:]0 through 32 Was the vehicle available personal for use duringoff-duty hours? Was the vr:hicle usedprimarily a morethan by 50^owor'or relaledoerson? ls ianolher vehicle available for

SectionC-Questions for Employers Who ProvideVehicles Use by Their Employees for questions deterrnine you meetan exception completing Answer these to if to B Section for vehicles usedby employees who
are not more than 57oowners or related see Inslructrons youmtinlainwritten 37 Dc, policy a statement prohibits personal of vehicles, that all use including commuling, by yourenrployees? 3 8 Do you maintain written policy a personal of vehicles, statement prohibits that use except commuting, youremployees? by Seethe instructions vehicles for usedby corporate officers, directors, 1!o or moreowners or 3 9 Dc,you treatall use of vehicles employees personal by as use? 40 Dc,you provide morethanfive vehicles youremployees, to obtaininformation fromyouremployees about the use of the vehicles, relainthe information and received? 41 Do you melet requirements the qualified concerning automobile demonstration use?(Seeinstructions ) Nctte:lf ycturanswerto 37, 38, 39,40, or 41 is "Yes,"do not SectionB for the covered vehicles

(a) Descflptionof costs

Amortizalion thisyear for

Arnortization of

2011 tax

see Instructrons

4 3 Arnortizationcosts of thatbeganbefore your2011taxyear 44 Totql.Add amounts column Seethe instructions (f). in for
F o r m 4 5 6 2 ( 2 0 11 )

SCHEDULE: A (Form on990-EZ) 990

Department the Treasury of lnternal Revenue Nameof the organization

PublicCharityStatusand PublicSupport
Completeif the organizationis a section 501(cX3) organizationor a section 4947(aX1) nonexemptcharitabletrust. >Attach to Form 990 or Form 990-EZ. >See instructions.
Employeridentification number


'1 Theorsgnization nota private is foundation because is: (Forlines1 through 1, checkonlyone box.) it 1 [-J A ohurch, convention churches, association churches of or in of described section170(b)(lXAX|). (Attach 2 [] A r;chool irr described section 170(bxlXAXii). Schedule ) E 3 [ ]

Reason PublicC for


izations must


A ltospital coopelrative hospital ora service organization described section170(bxlXAXiii). in 4 [ ] A m e d i c arl e s e a r c h o r g a n i z a t i o n o p e r a t e d i n c o n j u n c t i o n w i t h a h o s piiba ld i n e c t i o n l T O ( b X l X A X i i i ) . E n t e r t h e descr t e s hospital's name, city.and state 5 [ ] An organization for operated the benefit a college university of or ownedor operated a governmental described by unit (Complete ll ) in section170(bxlXAXiv). Part 6 [ ] A tederal, state, localgovernment governmental described section170(bXlXA)(v). or or in unit part public ? l E An organization normally that receives substantial of itssupport a froma governmental or fromthegeneral unit (Complete ll ) described sectionr in 170(b)(1)(A)(vi). Part (Complete ll ) 8 l l A r:ommunity described section170(b)(1)(A)(vi). trust in Part (1) e l f Arrorganization normally that receives: morethan33 113% its support fromcontributions, of membership fees,andgross rer:eipts activities from related itsexempt functions-subject certain to to exceptions, (2) no morethan33 1/3%of its and (lesssection tax)frombusinesses support fromgrossinvestment income and unrelated income business taxable 511 (Complete lll ) acquired the organization by afterJune 1975 See section509(a)(2). 30, Part 10 An organization orgernized operated and exclusrvely testfor public to safetySee section509(aX4). 11 Arrorganization orgernized operated and exclusively the benefit to perform functions or to carryoutthe for of, the of, p u r p o s e s o fn e o r n n o r e p u b l i c l y s u p p o r t e d o r g a n i z a t i o n s d e s c r i b e d i n s e c t i o n 5 0 9 ( a ) ( 1 ) o r s e c t ie e s e c t(i a ) ( 2 ) o S on509 on 509(aX3). Check boxthatdescribes typeof supporting ther the organization complete and lines11e through t h 1 a! rypet b ! Type ll fyp" lll-Functionally integrated c ! O I fype lll-Other gV checking box,I certify this thatthe organization notcontrolled is directly indirectly one or moredisqualified or by l] " persons managers otherthanoneor morepublicly otherthanfrrundation and supported organizations described section in 5 0 9 ( a X 1 )r s e c t i o n 0 9 ( a ) ( 2 ) o 5 lf the organization rerceivedwritten a determination the IRSthatit is a Typel, Typell, orType lll supporting from or'3anization, checkthis box L__l Since August17,2006,hasthe organization accepted giftor contribution any of the any from


followingpersons? (i) A personwho directlyor indirectly controls,either alone or togetherwith personsdescribedin (ii)

and (iii)below, governing the bodyof the supported organization? (ii) A family memller a person of described (i) above? in (iii) A 35%controlled entity a person of described (i) or (ii)above? in Provide followinq information the aboutthe
(i) llame of siupported organizalion

(iii) Typeof organization (described lines1-9 on aboveor IRCsection (seeinstructions))





For Papenvonk ReductionAct Nrotice, the Instructionsfor see Form 990 or 990-EZ.

ScheduleA (Form990 or 990-EZ) 2011


2 84-14402,

page 2



under failed qualify to (Complete if you checke<j box on line5, 7, or 8 of PartI or if the organization the only please qualifu Pad lll.) complete below, under testslisted the fails lll. P,art lf t[e olgrnization to A. F,ublic

year(or fiscalyear breginning in) Calenclar and contributions;, 1 Gifts grants, (Do not fees rnembership receiverl " g i n c l u d a n y" u n u s u a lr a n t s ) e -lax levied the organtzation's for 2 revenues patdto or expended on benefit either and its behalf 'fhe valueof services f,acilities or unit 1'urnishr,'d governmental to ther by a without charl3e organization 'Iotal. l\dd lines1 through 3 'The portion totalcontrillutions each by of person (other unill thana goverrnmental ' r r p u b l i c ls u p p o ( e d r g a n i z a t i o n ) y o 2% included line1 thatexr:eeds on st o o ft h ee r m o u n h o w n n l i n e11 , ( c o l u m nf )
6 Public

0 348708

2.348,7 Total

B Sectircn .'Iotal Ca|endaryear(orfisca|yearlreginninginl1> fromline4 7 Amounts income fromintererst, dividends, Gross 8 payments loans, received securities on fromsimilar royaltles inconre rents, and sources business from 9 Netinc;ome unrelaterd is whether notthe business or activitir-'s, regularly carried on gainor 10 Otherincome Do notinr:lude lossfromthe saleof cac,ital assets ( E x p l a iin P a r tl V ) n 1Ct Add lines, through 7 11 Total$upport. ,etc receipts fromrelated activities, (seeinstructions) 12 Gross

71 4 , 1 3 1


2 471

first,second,th ird, fourth,or fifth tax year as a section501(c)(3) First fiiveyears. lf the Form 990 is for the organization's organi:zation, check this trox and stop here

> Ll 98 42%

SectionG. Com
14 15

ion olfPublicSu


8335% th or did 1 16a 33 113% supporttest-;201 . lf the organization notcheckthe boxon line13, and line14 is 33 113"k more,check is box a n d s t o p h e r e . T h e o r g e r n i z a t i o n q u a | i f i e s a s a p u b | i c l y s u p p o r t e d o r g a n i z a t i o , t o a l di s b 3 3 1 / 3 % u p p o r t t e s t - t 2 0 1 0f.t h e o r g a n i z a t i o ndn o tc h e c k b o xo n l i n e1 3 o r 1 6 a ,a n dl i n e1 5 i s 3 3 1 1 3 % r m o r e c h e c k h i qualifies a publicly organization as supported stop here.The organization boxarrd t__J '14 lf did test--2O11. the organization notchecka box on line13, 16a,or 16b,and line 17a 10%-fiacts-and-circums'tances seckt e e.o pl d i s l 0 o 4 o r m o r e , a n d i f t h e o r g a n i z a t i o n m e e t s t h e " f a c t s - a n d - c i r c u m s t a n c e s " t e s t , c h t o p h h irs b E x a na i n i n qualifies a publicly supported as test meetsthe "facts-and-circumstances"The organization Partl\/ howthe organizartion organization did b 10%-facts-and-circumsitances test--2010.lf the organization notchecka boxon line13, 16a,16b,or 17a,and line 1 5 i s 1 0 % o r m o r e , a n d i f t h e o r g a n i z a t i o n m e e t s t h e " f a c t s - a n d - c i r c u m s t a n c e s " t e s t , c s te cp h h i s bE x p ln dn t n h o ktere. oxa ai qualifies a publicly Partl\/ howthe organizertion meets "facts-and-circumstances"The organization as the test supported organization 1 8 Private foundation. f t h eo r q a n i z a t i c r n n o tc h e c k b o xo n l i n e1 3 ,1 6 a ,1 6 b ,1 7 a , r 1 7 b , h e c k h i sb o xa n ds e e l o c t did a instrur;tions

Publicsupportpercentagefor 2011 (lrrre column (f) dividedby line 11, column (f)) 6, p f A P u b l i c u p p o r t e r c e n t a g er o m 2 0 1 0 S c h e d u l e , P a r t l l , l i n e 1 4 s




A ) S c h e d u l e ( F o r m9 9 0o r 9 9 0 - E Z2 0 1 1

s c h e d u l e A ( F o n n e e o o r e2 0 1 1 z ) B R I D G EH O U S E ,F R M L Y T H E C A R R I A G EH T f , U S E O M M U N I T Y T A B L E eo-E C



bf o-.o-rgarffi @[-Supportsch-A;f (Oomplete if youcheckeclthe on line of PartI or if tlreorganization to qualify only box 9 failed under ll. Parl please orqanization to quaiifu fails listed under tests the below, complete ll.) Part ___llthe
A. F'ublic year yearbeginning Calendlar (orfiscal in) 1


grants, Gifts, contributions, and membership fees

(Do grants") rerceived not include any "unusual receipts Gross fromadmissions, merchandise performed, facilities furnished soldor srrvices or in any acl.ivity is related the that to purpose organization's tax-exempt

from activities are not an Grossreceipls thal unrelated trade business or under section 513 . Tax revenues levied the organization's for br-.nefit eitherpaidto or expended and on itsbehalf The valueof services facililies 5 or furnished a governmental to the by unit organization without charge Total.Add lines1 through 5 7a Amounts included lines1. 2. and 3 on persons received fromdisqualified b Amounts included lines2 and 3 recerved on pL.rsons fronrotherthandisqualified that exceed greater $5,000or 1% of the lhe of amount lrne13for theyear on 8 c Add lines7a andTb Putrlic support(Subtract 7c from line line6 )

Section B.ll'otalSu
y C a l e n d a n e ar ( o r f i s c a l y e a r b e g i n n i n g i n ) I A,mounts fromline6 frominterest. 10a Grossirlcome clividends. payments received securilies loans, on rents, ro)falties income fromsimilar and sources (less income Llnrelated business taxable section 11 taxes)frombusinesses 5 acquired after June30. 1975 Adcl lines10aand 10b 11 fromunrelated flet income business not in whether activities included line 10b, is or notthe business regularly carried on garnor 1 2 Other incomeDo notinclude lossfromthe saleof caoital assets (Explain PartlV ) in 1 3 l'otal support.(Addlines9, 10c,11, encl12)
'14 F : i r s tf i v e y e a r s . l f t h e F o r m 9 9 0 i s f o r t h e o r g a n i z a t i o n ' sl r s t ,s e c o n d ,t h i r d ,f o u r t h ,o r f i f t h t a x y e a r a s a s e c t i o n5 0 1 ( c ) ( 3 ) t o r g a n i z a t i o nc h e c k t h i s b o x a n d s t o p h e r e ,

0 00%
0 00% 0 00% 0.00%

15 'l6

of Public

percentage 2011(line8, 0olumn divided line Public (f) support Iot by Putrlic from2010Schedule Partlll. line15 A.

Sectircnr l3om D.

of lnvestmen't lncome Percen

percentage 2011(line10c,column divided line13,column 17 Investnrent income (f) (f1) for by 18 lnvestment income from oercentaoe 20{0 S;chedule Partlll. line17 A, '14, 19a il3 113% supporttests-2011. lf the organization notcheck boxon line did the andline15 is morethan33 1/3%, and line17 is 'l13%, qualifies a publicly notmorr than33 check thisboxand stop here.The organization as supported organization b 3 3 1 / 3 % s u p p o r t t e s t s - 2 0 1f0h e o r g a n i z a t i o n d i d n o l c h e c k a b o x o n l i n e l 4 o r l i n e l 9 a , a n d l i n e l 6 i s m o 1e 3h a o ,3 3 d | t . r / t 0/ n an qualifies a publicly line'18 nol morethan33 1/3%, isi checkthisboxand stop here.The organization as supported organization tloundation. the orqanization notcheck boxon line14,19a,or 19b,check 20 Private lf did a thisbox andsee instructions



201 ScheduleA (Form990 or 990-EZ) 1

A 2011 Schedule (Form990or 990-EZ)



TABLE 84-1440292

Partll, line17aor 17b,

required Partll, line1 the by Complete partto provide explanations this

(See information. Partlll, line12.Alsocomplete partfor any additional this

Schedule A (Form 990 or 990'Ezl2011

D SCHEDULE (Form990)
Department the Treasury of IntemalRevmue Servic

sup ementalFinancialStatements
Part lV, if the organizationanswered"Yes," to Form 990, 6 , 7 , 8 , 9 , 1 0 ,1 1 a ,1 1 b ,1 ' l c ,1 1 d ,1 l e , 1 1 1 , 1 2 a , o r ' 1 2 b . to Form 990. ) See separateinstructions.

OMB No 1545-0047



Employer identifi cation numbel



ning Organizations answered the

1 2 3 4 5
Total numberat end of year . Aggregate contributionsto (during

AdvisedFundsor Other milar lV. line6.

if or Accounts.Complete
Fundsand otheraccounis

grantsfrom(during year) Aggregate value end of year. at Aggregate heldin donoradvised in that donoradvisors writing the assets inform donors all Didtheorganization legalcontrol? property, exclusive to the organization's fundsarethe organization's in thatgrantfundscan be and donors, donoradvisors writing inform all Didthe organization or purposes for the benefit thedonoror donoradvisor, for anyother of for charitable and usedonly purpose . impermissible benefit? conferring

vesE ruo

if the
easem( Purpose(s) conservation of for use of land public I I Preservation habitat of l--l Protection natural l-l Pr"r"*ation of openspace 2d lines2a through if the Complete on easement the lastday of the tax a b

7 "Yes"to Form990.PartlV l i n e .

(check thatapply). a]l heldby the organization landarea important of or | | Preservation an historically , recreation education) historic structure Pr"s"r"tion of a certified l-l in contribution the formof a conservation helda qualified conservation anization
Held at the End of the Tax Yoal

of Totalnumber conservation 'r easements Total acreagerestrictedby in included (a) . historic structure easements a certified Number conservation of and after8/17106, noton a in (c) acquired easements Number conservation of
historic structure listed in the National

by or released, extinguished, terminated the organization transferred, easements ified, Number conservation of during tax year the 4 5

property where Number states of

havea written Doesthe organization of violations, enforcement the and hoursdevotedto Staffand volunteer incurred in Amount expenses of > $

is easement located to conservation handling of inspection, monitoring, regarding periodic the it easements holds?



during year the easements conservation and , inspecting, enforcing

ooe. idnii*iiion easemenl ""in 1 170(hX4XBXi) section70(hX4X and

howthe In PartXlV,describe if and include, balance sheet, ization's Maintaining Organizations
if the elected,as 1 a lf the organization

that financial statements describes to , the text of the footnote the organization's or Treasures, Other SimilarAssets. of Art, Historical to Form990.PartlV
under sFAS 116 (ASC 958), not to reportin its revenuestatementand balancesheel

in education, research furtherance or exhibition, heldfor public similar assets or treasures, worksof art.historical theseitems that statements describes provide, PartXIV the text of the footnote its financial to in service, of public sheet and in statement balance underSFAS116(ASC958),to report its revenue as elected, lf the organization in education, research furtherance or exhibition, heldfor public similar assets treasures, or worksof art, historical provide followi amounts relating theseitems: to the of publicservice, > $ (i) Revenues V l l l ,l i n e1 in Form990, included
(ii)Assetsincludedin Form 990, Part

a b

lf the organization received held or following amounts required be to in Revenues included Form990, Assets included Form990,PartX in

for similar assets ti^"n"]arl;i;,;.il;th-; oi treasrr"", other s of art,historical items: relating these to 116 958) under SFAS (ASC
ll, line1 .
> q

For PaperworkReductionAct Notice,see the {HTt,)

for Form 990.

ScheduleD {Form990}2011

C Y E T H . B R I D G E O U S EF R M L Y H EC A R R I A G H O U S E O M M U N I TT A B L E8 4 - 1 4 4 0 2 9 2
D Schedule (Form990)201'1

Collections Art, Historic of ns Maintaining

3 that checkanyof the following are a significant and accession, otherrecords, acquisition, LJsing organization's the all items(check thatapply): of urser itscollection programs Loanor exchange d Public exhibition []


" Other e research Scholany b [] for Preservation futuregenerations . [] purpose In exempt provide description the organization's organization's howtheyfurtherthe and collections explain of a PartXIV or treasures, othersimilar of donations art,historical solicit receive or During year,didthe organization the . V"" I colle<lion? as thanto be maintained partof the organization's assets, be soldto raisefundsrather to !



b c d e f 2a b

990' YesaoForm Parl

on an line9, or reported amount Form990,PartX' line2'1 -

not or for or custodian otherintermediary contributions otherassets trustee, an ls the organization agent,
includedon Form 990, Part X? lf "Yes;," explainthe arrangementin Part XIV and completethe followingtable: l S e g i n n i nb a l a n c e g



during year the ,Additi,cns during year the Distributions balance Errding X a t i n D i r lt h eo r g a n i z a t i on c l u d e n a m o u no n F o r m9 9 0 ,P a r t , l i n e2 1 ?
lf "Yes."explainthe arra in Part XIV

Funds.Com Endowment
1a b c
d e

if the

"Yes"to Form990 PartlV l i n e1 0 nization answered

(e) Four years back

g a b c

of Berginningyearbalance Contributions gatns Nt.'t investment earntngs, andlosses or Grants scholarships for expenditures facilities Oither arlop,rograms expenses Admi istrative n Errd yearbalance of
providethe estimatedpercentageof the currentyear end balance (line 19, column (a)) held as: % or Boanjdesignated quasi-endowment oh > endowment Prgrmanent % endowment restricted Tr-.mporarily

1 e p 2 i s T l ' r e e r c e n t a g en l i n e s a , 2 b ,a n d2 c s h o u l d q u a l 0 0 % for possession the organization are heldand administered the that of fundsnot in the 3a Aretnereendowment by: organization (i) unrelatedorganizations (ii) relatedorganizations R? on as listed required Schedule organizations aretherelated 3a(ii), b lf ',Yes"to f ndowmentunds usesof the o in Describe PartXIVthe '10. SeeForm990,PartX, line uipment. and Build
of Description properly ( b )C o s to r o l h e r (other) basrs
(d) Book valu

'la b c

Lancl Builclings Leaseholdimorovements

d E,quipment e Otherr Total./\dd lines1a throu

20.747 Part X column

, line 1

D S c h e d u l e ( F o r m9 9 0 )2 0 1 1

D Schedule (Form990)2011


See Form990,PartX, line12. lnvestments-OtherSecurities.

(a) Description securityor category of (including nameof security) (cl Method valuation: of market value Costor end-of-year

(1) Financial derivatives

(2)Closely-held interests equity (3)Other


SeeForm990.PartX, line13. ram Related.

(al Description investment type of
(cl Method of valuation: Cost or end-of-vear market value

1 To|a|.(co|umn(b)nus!equalFom99o,Pa|1x'col(B)line13)>

OtherAssets.See Form990,PartX. line15.

(a) Description Bookvalue


92.894 0


0 Total. Form ParI X. col line 1 4

S OtherLiabilities. ee Form990,PartX, line25

(a| Descriptionof liability 1. income taxes 1) Federal PA PAYABLE ACCRUED & PAYABLE VOUCHERS

1 |ota|.(cotumn(b)nusteaualFom99o,PadX,co|(B)]ine25)>

the financial that statements reports to In the 2. FIN48 (ASC740)Footnote PartXlV, provide textof thefootnote the organization's liabilitv uncertain positions for underFIN48 (ASC740) orqanization's tax
D S c h e d u l e ( F o r m9 9 0 )2 0 1 1

H , B R I D G E O U S EF R M L Y
D Schedule (Form990)2011



Net Assets from Form

1 2 3 4 5 6 7 8 9 10 1 2 (Form990,PartVlll, Totalrevenue (Form990,PartlX, Totalexpenses for Excess (deficit) the year.Subtr or gains(losses) on Netunrealized services and use of facilities Donated Investment expenses . Priorperiodadjustments in Other(Describe PartXlV.). (net) Add lines4 Totaladlustments for Excess (deficit) or

699,759 133.497

462 462 133,959

With Revenue Statements AuditedFinancial

gains, financial statements oeraudited Totalrevenue, andother V 9 9 0 .P a r t l l l ,l i n e1 2 : Amounts included line1 but noton on gainson investments . a Netunrealized and use of facilities Donated services b of c Recoveries prioryeargrants. in d Other(Describe PartXIV ) 2d e Add lines2a through . line Subtract 2e from line 1 . 3 included Form990,Part , l i n e1 2 ,b u tn o to n l i n e 1 on 4 Amounts 990.PartVlll. line7b . not on expenses included a Investment (Describe PartXIV ) . in b Other c Add lines4a and4b Form 990,Paft l, line 12. Add lines3 and4c. Totalrevenue


699 759 585

1 2
a b c d e

per and Total expenses losses audited

With Statements AuditedFinancial statements

3 4
a b c

on Amounts included line1 but not on rm 990,PartlX, line25: . and use of facilities Donated services yearadjustments Prior Otherlosses. in Other(Describe PartXlV.) 2d Add lines2a through line Subtract 2e fromline 1 . Amounts included Form990,PartI , l i n e2 5 ,b u tn o to n l i n e 1 : on 990.PartVlll. line7b on not Investment expenses included (Describe PartXIV ) . in Other Add lines4a and4b Paft l, Iine 18 Form must Add lines3 and4c. Total

for reouired Partll, lines3, 5, and 9; Partlll, lines1a and4; PartlV, lines1b the this Complete partto provide 8: PartXll, lines2d and4b; and PartXlll, lines2d and4b.Alsocomplete and2b: PartV, line4: PartX, line2; PartXl, informa any thispartto provide additional


2011 ScheduleD (Form9901

Department the Treasury of lnlernal Revenue Service Name(s) shown return on

Premiums Insurance Health Creditfor SmallEmployer

to > Attach yourtax return. H O U S E O M M U N I TT A B L E C Y

OMB No 1545-2198




6 7

I 9 10 11 12 13

14 15 16

you Enter number individuals employed of during tax yearwho areconsidered the the (seeinstructions) for of employees purposes thiscredit you lf Enter number full{imeequivalent of employees hadfor thetax year(seeinstructions) the youentered or more,skiplines3 through 1 andenter-0- on line12 1 25 or lf Average annual wagesyou paidfor thetax year(seeinstructions) you entered $50,000 11 more, skiplines4 through and enter-0- on line12 insurance you included line1 for health on Premiums paidduring tax yearfor employees the (see coverage under qualifying a arrangement instructions) the you for equaled on Premiums wouldhaveentered line4 if thetotalpremium eachemployee youoffered insurance coverage premium the smallgroupmarket whrch health in for average (seeinstructions) Enter smallerof line4 or line5 the percentage: Multiply 6 by the applicable line . Tax-exempt multiply 6 by 25%(25) line smallemployers, . All othersmallemployers, multiply 6 by 35%( 35) line fromline7 Otherwise, instructions see lf line2 is'10or less,enterthe amount see fromlineI Otherwise, instructions lf line3 is $25,000 less,enterthe amount or paid available of subsidies andanystatetax credits Enter totalamount any statepremium the included line4 (seeinstructtons) to youfor premiums on line Subtract 10 fromline4 lf zeroor less,enter-0o E n t e t h es m a l l e r f l i n e9 o r l i n e1 1 r O 5 l f l i n e l 2 i s z e r o , s k i p l i n e s l 3 a n d l 4 a n d g o t o l i n et lh e r w i s e , e n t e r t h e n u m b e r o f the during tax yearfor health included line1 for whomyou paidpremiums on employees (see a arrangement instructions) insurance coverage under qualifying you on employees wouldhaveentered line2 if you only of Enter number full{imeequivalent the
rncluded employeesincludedon line 13


18 19


premiums S frompartnerships,corporations, insurance health for Credit smallemployer and cooperatives, estates, trusts(seeinstructions) go small estates, trusts, to line17 Tax-exempt and Add lines12 and 15 Cooperatives, stop go to line19,Partnerships S corporations, here and skip employers, lines17 and 18 and on this hereand report amount Form K. stop on andreport amount Schedule All others, this 3800,line4h or of or of Amount allocated patrons the cooperative beneficiaries theestate trust(see to instructions) line and subtract 17 fromline16 Stophereand reportthis Cooperatives, estates, trusts, amount Form3800,line4h on payroll of you taxesfor purposes thiscredit Enter amount paidin 2011for taxesconsidered the (seeinstructions) pt enterthe smallerof line16 or line19 hereand on Form990-T, Tax-exem smallemployers, line44f rorm 8941 tzorrl

For PaperworkReductionAct Notice,see separateinstructions.


SCHEDULE G (Form or 990-EZ) 990

Oepanment the Treasury of IntemalRevonue Service

ementalInformation Regarding draisingor GamingActivities

Complete if the answered"Yes' to Form 990,Part lV, lines 17, 18, or 19, or if the entered more than $15,000on Form 990-EZ,line 6a.

OMBNo 1545-0047




Fundraising Activities.
1 a b c d 2a Indicate whether oroanization the u"it solicitations I

"Yes" 990,PartlV,line17. if theorganization answered to Form

fundsthroughg;r of the following activities. Checkall that apply grants of e I X I Solicitation non-government grants t I soticitation government of and solicitations [Tl Internet email g I fundraising enone Special events solicitations I

solicitations lTl ln-p"rron

(including officers, directors, trusteeg iI Didthe organization havea writtenor 'al agreement with any individual with professional fundraising services? [| V"s f] Ho key employees listedin Form990, P Vll) or entityin connection paid (fundraisers) pursuant agreements is whichthe fundraiser lf "Yes," the ten highest list ls or entities to under organization. to be compensated least$5,000by at
(iiil Didfundraiser have custodyor controlof contributions? paidto (vil Amount (or retainedby) organizaiion

(il Nameandaddress individual of or entily(fundraise0




Total 3 Listall statesin whichthe registration licensing. or

it or to is registered licensed solicitcontributions has beennotified is exemptfrom or

Schedule G (Form 990 or 990-EZ) 201 1

S c h e d u lG ( F , e

"Yes"to Form990,PartlV, line18,or reported Fundraising Events.Complete the organization if answered m o r e t h a n $ l 5 , 0 0 0 o f f u n d r a i s i n g e v e n t c o n t r i b u t i o n s a n d g r o s s i n c o m e o n F i n eml9 9 0 -6 bZ ,i s t l:or s and E L with iptsqreater events than$5,000
( a )E v e n # 1 t (b) Event #2 (c) Otherevents



(d) Totalevents (addcol (a)through col (c))

0.) 0) E.

1 2 3

Grossreceipts Less: Charitable contributions . (line1 income Gross


4 5
o 0) a c c) X LU o

Cashprizes prizes Noncash RenUfacility costs Foodandbeverages Entertainment Other direct expenses 18,349

6 7 8 9

(d) 10 Direct expense summaryAdd lines4 through in column 9

1 1 N e t i n c o m es u m m a r v C o m b i n el i n e 3 c o l u m n( d ) .a n d l i n e 1 0

"Yes" Form990,PartlV, line19,or reported more if answered to Gaming.Complete the organization 15000on Form990-EZ. 6a line
o) 0) o) E
( b ) P u l lt a b s / i n s t a n l bingo/progressivebingo (d) Total gaming (add col (a) through col (c))

1 2

revenue Gross Cashprizes prizes Noncash RenVfacility costs

tU o)

3 4

7 8

(d) Direct 5 expense summaryAdd lines2 through in column li d N e to a m i n on c o m e u m m a r v , o m b i n e n e1 . c o l u m n . a n dl i n e7 . i s C

gaming activities in operates 9 Enterr state(s) whichthe organization the gaming in licensed operate to activities eachof thesestates? a ls the organization
b l f " N o , "e x p l a i n



1 0 a W e r e a n y o f t h e o r g a n i z a t i o n ' s g a m i n g l i c e n s e s r e v o k e d , s u s p e n d e d o r t e r m i n a t e d d u r i n g t[h eea x y eE r ? v t s ato " b l f " Y e s .e x o l a i n :

G ) S c h e d u l e ( F o r m9 9 0o r 9 9 0 - E Z2 0 1 1

eeo 2011 TABLE schedule c (Form oreeo-Ez) BRIDGE HOUSE COMMUNITY FRMLY THECARRIAGE HOUSE, '11 Doestheorganization gaming withnonmembers? operate activities or of of beneficiary trustee a trustor a member a partnership otherentity or 12 ls the organizationgrantor, a
formedto administer charitablegaming?

3 84-1440292 Pase I Yes n Ho

13 a b 14

in: operated of activity Indicate percentage gaming the . facility The organization's An outside facility . gaming/special books events the who prepares organization's of Enterthe nameand address the person and records: N a m e> Address )

gaming receives with a thirdpartyfromwhomthe organization havea contract 1 5 a Doesthe organization revenue? 0 and the ) revenue received the organization $ by of b lf "Yes," enterthe amount gaming retained the thirdparty > $ - - - - - - - - - - - - - -0-. by of amount gamingrevenue of enternameandaddress thethirdparty: c lf "Yes," N a m e) Address ) 16 manager information Gaming N a m e) manager compensation > $ Gaming provided Description services of



l-l Director/officer

l-l emptoyee


contractor tnoepenoent

17 Mandatorydistributions: proceeds to from distributions the gaming required understatelawto makecharitable a ls the organization gaminglicense? retainthe state fves Eto organizations to required understatelawto be distributed otherexempt of the b Enter amount distributions 0 $ during tax vear ) the activities own in or gpent the orqanization's exempt Xp|anationsrequiredbyPart|,|ine2b,co|umns t . ( i i i )a n d ( v ) ,a n d P a r t l l l , l i n e s9 , 9 b , 1 0 b , 1 5 b , 1 5 c , 1 6 , a n d 1 7 b ,a s a p p l i c a b l eA l s o c o m p l e t e h i s p a r t t o

(see information instructions). orovide additional anv

201 ScheduleG (Form990 or 990-EZ) I

:'^ O ; i o

o N o v o o o q o L o E o

o o



E o

6 . 9 6 o


: q ) E @ O r

o o ,6 o c

b G
3 !

(6 o

P oe o
'N . > F(D t o

c E

o o


o 3

o o

o - o


E il E o
o q )

5'oL ( J

O'E 6ol


g c )

$5 F

-o o) o o o o (t' L o)

O ; uix 0ro E-o y O O,E
E 0) f 0) J ( J E o) c o C. c o o c, o o E, o

5 e


trE . - o

T( ; E J
0) (E

o (o .9,
o o o o o

- c )o c !
a O .- rf) an@


c) c
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to Information Form 990 or 990-EZ Supplemental

Completeto provide informatlonlor responsesto specific questions on Form 990 or 990-EZor to provldeany additionalinformation. > Attach to Form 990 or 990-EZ.

OMBNo 1545-0047


Departmenl the Treasury of lntemalRevenue Seryic Name of the organization

H O U S EF R M L Y .



FormeeoPartVl Section Lin-e Q 19-A-L-L-REqU!B-E-g-9-q9-tl[4EN-T$,F--o-L-19-l-E-9,IAX-B-E-TV-BN-q'-F:r-q.{ts-ETO UPONREQUEST THE PUBLIC AVAILABLE



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ScheduleO (Form990or 990'EZ)(2011)