Document 6426370

Transcription

Document 6426370

- Form oma N6 1545-iiso
Return of -Organization Exempt From income Tax
Form Under section 501(c), 527, or 4947(a)(1) ofthe
Internal
Revenue Code (except blacii lung benelit trust or
private
foundation)
, Sponsoring organizations of donor advised funds and controlling organizations as dehned in section 512(bX13) must file Form 990 All
Depanmem
of me Treasury other organizations with gross receipts less than $500,000 and total assets less than $1,250,000 at the end of the year may use this form Open (0 Public
ln
1 """" R""""e S"*"" b The organization may have to use a oogy of this retum to satisfy state reporting requirements. 10896015011
A For the 2009 calendar year, or tax year beginning and ending
B ,*f,$**cg,f,,,,, p,,,as, c Name oforganlzation DEmployer identification number Y
Ntlldress
use IRS
C anne label
or
miie P""* of EKALB SCHOOL EMPLOYEES FOUNDATION , INC . 2 3 - 7 4 1 2 3 4 8
$21231, gg," Number and street (or P.O. box, if mail is not delivered to street address) Room/suite E Telephone number
5,3532? 1 7 o 1 MOUNTAIN INDUSTRIAL BLVD. 6 7 8 - 6 7 6 - o 1 3 4
galenqded trans City or town, state or country, and ZIP + 4 F Gmup Exempnon
*tiiiFii*5""" TONE MOUNTAIN , GA 3 0 0 8 3 iiumiiei p
Section 501(c)(3) organizations and 49-17(a)(1) nonexempt charitable trusts must attach a completed G Accounting method: LX1 C35" M ACCTUHI
Schedule A (Form 990 or 990-EZ). Other (specify)-)
P NONE H Check P L-X-,I if the organization is not
ax-exempt status (check only one) - E 501(gU 3 ) 4 (insert no.) I I 4947(a)-(1) or I-I 527 required to attach Schedule B iriiiiii 990,990-ez,oi99o-PL
gl , q i L--il-#
1%.*
eck P I-I if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $25,000. A Form 990-EZ or
Form 990 return is not required, but if the organization chooses to tile a return, be sure to tile a complete return.
L Add lines 5b, 6b, and 7b, to line 9 to determine gross receipts: it $500,000 or more, lile Form 990 instead of Form 990-EZ p $ 4 7 7 , 2 1 7 .
I Parr I I Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part l.)
1 Contrmutions, gifts, grants, and similar amounts received A 4 7 1 8 8 0
. . 2 ii , r... - iii 1. - .- nciuding government fees and contracts 2
ast. - Q1 as essments
4 inve
st ntme income
O. .
4 491.
5% Erosls nom -un, i assets other than inventory
f -si -511 . i I T
b Less: cost or other bsis nd sales expenses , ,
- -i. i.: : 2-- .go assets other than inventory (Subtract line 5b lrom line 5a) 5c 3
I .-1 :L -i -i nt . activits (complete applicable parts of Schedule G). ll any amount is from gaming, check here Pl.-I
Gross revenue (not ining $ of contributions
reported on line 1) 6a N
b Less: direct expenses other than fundraising expenses m
c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) , 6c
7a Gross sales of inventory, less returns and allowances , 7a
b Less: cost of goods sold , H
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) , ,
846.
Other revenue (describe P P /Y CHECKS VOIDED & NOT REI S SUED
477,217.
Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8
Grants and similar amounts paid (attach schedule) STMT 1 10 4 7 4 , 4 8 1 .
Benefits paid to or for members , l , 11
12
Salaries, other compensation, and employee benefits
Professional fees and other payments to independent contractors 13 9 , 9 0 0 .
Occupancy, rent, utilities, and maintenance 14 1
Printing, publications, postage, and shipping
Other expenses (describe P FIDELITY BOND & MI SC
) is 1,394.
15
Total expenses. Add lines 10 through 16 P 17 4 8 5 , 7 7 5 .
Excess or (deficit) for the year (Subtract line 17 from line 9) 18 (8 , 5 5 8 . b
Net assets or fund balances at beginning of year (fiom line 27, column (A))
(must agree with end-of-year figure reported on prior year"s return) 19 1 9 0 , 0 5 2 .
20 Other changes in net assets or fund balances (attach explanation) 20
21 7 Net assets or fund balances at end of year. Combine lines 18 through 20 . . P 21 1 8 1 , 4 9 4 .
Part Il 1 Balance Sheets. If Total assets on line 25, column (B) are $1,250,000 or more, file Form 990 instead of Form 990-EZ.
(See the instructions for Part ll.) (A) Beginning nf year
23
Landassets
and buildings
24 Other
(describe) ,) 23
24
22 Cash, savings, and investments , , , l U , 1 9 0 , 0 5 2 . 22
(B) End olyear
181, 494 .
25
Totalassets
190,052.
26 rcuii
iiaiiiiiiiee
(describe25
p )181,494.
0 . ze 0 .
27 Net assets or fund balances (line 27 of column (Q) must agree with line 21) . 1 9 0 , 0 5 2 . 27 1 8 1 , 4 9 4 .
322415-110 Li-lA For Privacy Act and Paperworir Reduction Act Notice, see the separate instructions. Form 990-EZ (2009) W
2
N0
1
i
Form 990-Ez zoos) DEKALB SCHOOL EMPLOYEES FOUNDATION , INC . 2 3 - 7 4 1 2 3 4 8 Pace 2
I Part Ill Estatement of Program Service Accomplishments (See the instructions for Partlll.)
WmHMmmmmmmsmmmwmmmwmwW SEE STATEMENT 3
29 .
Expenses
(Required for section 501(cX3)
and 501(cX4) organizations and
Describe what was achieved in carrying out the organization*s exempt purposes. In a clear and concise manner, descnbe s,,,,,,,,, ,,,,,,aX,),ms,s opnona,
for others )
the services provided, the number of persons benefited, and other relevant information for each program title.
R CHARITABLE CONTRIBUTIONS ON BEHALF OF EMPLOYEES OF THE
DEKALB COUNTY SCHOOL SYSTEM.
(Grants $ ) If this amount includes foreign grants, check here
plQj2n 474,481.
(Grants $ ) lf this amount includes foreign grants, check here
PI-I29a
(Grants $ ) If this amount includes foreign grants, check here
PILJSM
30
31 Other program services (attach schedule) , , , , ,
(Grants $ ) If this amount includes foreign qrants, check here
Pl-WSH
..p n 474,431.
32 Total rogram service expenses (add lines 28a through 31a)
U Part of officers, Directofs, Trustees, and Key Employees- List each one even if not compensated (See the instructions for Part IV)
(d)ConUmuuons
(b) Title and average hours (c) Compensation to employee (e) Expense
(a) Name and address per week devoted to (It not paid, enter bonem plans 3. account and
poddon
deterred other allowances
0. 0. 0.
compensation
LORENZO ALZAGA, 1701 MOUNTAIN
INDUSTRIAL BLVD, STONE MOUNTAIN,
CHERYL WHALEY, 1701 MOUNTAIN
MICHELLE BLUE, 1701 MOUNTAIN
KEITH SHORT, 1701 MOUNTAIN
ERIC CANNADY, 1701 MOUNTAIN
KAREN BARON, 1701 MOUNTAIN
DR. MINDY DISALVO, 1701 MOUNTAIN
URUSTEE
ALEXIS SMITH, 1701 MOUNTAIN
ERUSTEE
TONI FALLON, 1701 MOUNTAIN
MARCUS TURK, 1701 MOUNTAIN
CONCHITA GOMEZ, 1701 MOUNTAIN
HENRIETTA WHITE, 1701 MOUNTAIN
LOLITA MORRISON, 1701 MOUNTAIN
LINDA WOODARD, 1701 MOUNTAIN
LETE PETROS, 1701 MOUNTAIN
LYNDA SCHOFIELD, 1701 MOUNTAIN
CONNIE WALKER, 1701 MOUNTAIN
%gBUSTRIAL
BLVD, STONE MOUNTAIN,
02-DB-10
0.00
WRUSTEE
0.00
URUSTEE
0.00
URUSTEE
0.00
PRESIDE NT
0.00
URUSTEE
0.00
WRUSTEE
0.00
0.00
WRUSTEE
0.00
UREASURER
0.00
WRUSTEE
0.00
URUSTEE
0.00
WRUSTEE
0.00
WRUSTEE
0.00
WRUSTEE
0.00
SECRETARY
0.00
URUSTEE
0.00
of of OO
0. O. 0.
0. 0. 0.
0. 0. 0.
0. 0. 0.
ol 00 OO
of 0. 0.
0. OC of
0. 0. 0.
0. 00 ol
O. 0. 0.
0. 0. 0.
0. 0. 0.
0. 0. 0.
of of ol
0. 0. O.
Form 990-EZ (2009)
FW" 990452 (2009) DEKALB SCHOOL EMPLOYEES FOUNDATION , INC . 2 3 - 7 4 1 2 3 4 8 P809 3
I Part V I Other Information (Note the statement requirements in the instnictions for Part V.)
Yes No
33 Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed description of each activity 33 X
34 Were any changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the changes 34 X
35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not
reported on Form 990-T, attach a statement explaining why the organization did not report the income on Form 990-T.
a Did the organization have unrelated business gross income of $1,000 or more or was it subiect to section 6033(e) notice, reponing,
and proxy tax requirements? A A A 35a X
h If "Yes," has it filed a tax return on Form 990-T for this year? A A 35b N2 E
complete applicable parts of Sch. N . . . . .. 36 X
36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? lf "Yes,"
37a Enter amount of political expenditures, direct or indirect, as described in the instructions. P I 37a I O .
b Did the organization file Form 1120-POL for this year? 37b X
38a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made
in a prior year and still outstanding at the end of the period covered by this return? 38a X
b lf"Yes," complete Schedule L, Part ll and enter the total amount involved 38b N A
39 Section 501(c)(7) organizations. Enter:
a initiation fees and capital contributions included on line 9 A
b Gross receipts, included on line 9, for public use of club facilities
40a Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 P 0 . g section 4912 P 0 . 3 section 4955 L 0 .
b Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the
year or is it aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction
has not been reported on any of the organizations prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part l 40b X
c Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers
or disqualified persons during the year under sections 4912, 4955, and 4958 A P 0 .
organization A A A P 0 .
d Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the
e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? If "Yes," complete Form 8886-T A A A 40e X
41 List the states with which a copy of this return is filed. P GA
42a The organization"s books are in care of P MARCUS TURK Telephone no. P 6 7 8 - 6 7 6 - 0 1 3 4
Located at P 1 7 0 1 MOUNTAIN INDUSTRIAL BLVD . , STONE MOUNTAIN , ZIP + 4 b 3 0 0 8 3
b At any time during the calendar year, did the organization have an interest in or a signature or other authority
over a financial account in a foreign country (such as a bank account, securities account, or other financial
account)? A A A A
If "Yes," enter the name of the foreign country: P
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c At any time during the calendar year, did the organization maintain an office outside of the U.S.?
lf"Yes," enter the name ofthe foreign countryf. P
43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 - Check here .. . P III
and enter the amount of tax-exempt interest received or accrued during the tax year P 43 I NZ A
No
Form
990-EZ
A
A
X
completed instead of Form 990-EZ . 45 X
44 Did the organization maintain any donor advised funds? If "Yes," Form 990 must be completed instead of
45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)( 13)? lf "Yes," Form 990 must be
Form 990-EZ (2009)
932173
02-08-10
F00" 990-EZ (2009) DEKALB SCHOOL EMPLOYEES FOUNDATION , INC . 2 3 - 7 4 1 2 3 4 8 P299 4
Part VI Section 501 (c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. Ari section 5o1(c)(3)
organizations and section 4947(a)(1) nonexempt chantable tnists must answer questions 4649b and complete the tables for lines 50
and 51.
46 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public
office? lf "Yes," complete Schedule C, Part I l N . , . . , , l . ,
47 Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Pan ll , , , ,
48 ls the organization a school as described in section 170(b)(1)(A)(i)? lf "Yes," complete Schedule E ,
49a Did the organization make any transfers to an exempt non-charitable related organization? , , l
b lf "Yes," was the related organization a section 527 organization? , , , , , , , , , ,
50 Complete this table forthe organizations five highest compensated employees (other than officers, directors, trustees and key employees) who each received more
than $100,000 of compensation from the organization. If there is none, enter "None."
(d) Contributions
(b) Title and average hours (c) Compensation to employee (e) Expense
NONE compensation
(a) Name and address of each employee paid more per week devoted to bengm plans & account and
"la" $100,000 position deferred other allowances
f Total number of other employees paid over $100,000 , . . P O
51 Complete this table for the organization"s five highest compensated independent contractors who each received more than $100,000 of compensation from the
organization. If there is none, enter "None."
NONE
(3) Name and address of each independent contractor paid more than $100,000 (b) Type of service (g) Compensation
d Total number of other inde endent contr tors each receiving over $100,000 , H , , , P
SIS"
I June,fofticer
LL,-ZDIO
Hefe Signature
Date
Under pen o eriury, I are at I have e ined this retum, including accompanying schedules and statements, and to the best ol my knowledge and belief, it is true,
correct, lete Dec ion o pr arer (oth than ofllcer) is based on all information of whidi preparer has any knowledge
M L- . " Ii.i.LL,, "Tfjfm surgf
Type or print name en title
Paid Preparer"s signature) Date Check il self- Prepare-5 iaeniiiying number (see mir)
Pfsvafefs MARTHA s . HARTNESS 0 6/1 0/1 o employed p (Il
U" 0"" ,.,,,-,,,,,,,,,,.,.,,, Ross LANE s. COMPANY, LLC an p
lfselffmiilovedl. *7 0 0 0 PEACHTREE DUNWOODY RD , BLDG ONE Phone)
"0""-*""*P**
ATLANTA, GA 30328 "0- (770) 804-8044
May the IRS discuss this return with the preparer shown above? See instructions , . P LXJ Yes I I No
Form 990-EZ (2009)
932174
02-08-10
SCHEDULE A 9 9 , oMa No 1545-0047
(F999 999 or 99992)
Public
Charity
Status
and
Public Support
Complete if the
organization is
a section 501(c)(3)
organization
or a section
oeparimeni or me Treasury 4947(a)(1) nonexempt charitable trust. Open to Public
""9"", Revmue S"*"" P Attach to Form 990 or Form 990-EZ. P See separate instructions. UHSPGCUOFI
Name of tfie organization Employer identification number
DEKALB SCHOOL EMPLOYEES FOUNDATION, INC . 23-7412348
I Part lj ReaSOI1 fOr Public Charity StaiUS (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, dieck only one box.)
1 E A church, convention of churches, or association of churches descnbed in section 170(b)(1)(A)(i).
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)
A hospital or a cooperative hospital service organization descnbed in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital descnbed in section 170(b)(1)(A)(iii). Enter the hospitals name,
city, and state:
5 I3 An organization operated for the benefit of a college or university owned or operated by a govemmental unit described in
section 170(b)(1)(A)(iv). (Complete Part ll.)
E A federal, state, or local govemment or govemmental unit descnbed in section 170(b)(1)(A)(v).
lil An organization that normally receives a substantial part of its support from a govemmental unit or from the general public described in
section 170(b)(1)(A)(vi). (Complete Part ll.)
II A community trust described in section 170(b)(1)(A)(vi). (Complete Part Il.)
E An organization that nomially receives. (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from
activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment
income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975.
See section 509(a)(2). (Complete Part Ill.)
10 II An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
11 CII An organization organized and operated exclusively for the benefit of, to perform the functions of. or to rzrry out the purposes of one or
more publicly supported organizations descnbed in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that
describes the type of supporting organization and complete lines 11e through 11h.
a lj Type I b Cl Type ll c lj Type III - Functionally integrated d I.-ll Type Ill - Other
e E By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than
foundation managers and other than one or more publicly supported organizations descnbed in section 509(a)(1) or section 509(a)(2).
f lf the organization received a written detemiination from the IRS that it is a Type l, Type ll, or Type Ill
supporting organization, check this box , , N , , , , , , , , lj
g Since August 17, 2006, h& the organization accepted any gift or contnbution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons descnbed in (ii) and (iii) below,
the governing body of the supported organization? . . U . , . .
(ii) A family member of a person descnbed in (D above? l .I
(iii) A 35% controlled entity of a person descnbed in 0) or (ID above? ,
h Provide the following information about the supported organization(s).
(i)Name ofsuppmted (ii) EIN giriililmglxiga kiv) lstlie organization (v) Did you notify the orga(lif9)9tlg9tlhIe1 col (vii) Amoumof
organnauon d .bg d I. 19 in (col.(i)
organization
in of
col.
Support
asc" 8listed
0" mesin" your
overnin
document? (i)
our(i)9r99niz9d,nm9
su ort? , .7
above or IRC section g Q y pp U S
(see instructions)) Yes No Yes No Yes No
Total
LHA For Privacy Act and Papenrvork Reduztion Act Notice, see the Instructions for Schedule A (Form 990 or 990-EZ) 2009
Form 990 or 990-EZ.
93202 1 02-08-10
schedule A erm 990 or 990 Ez) 2009 DEKALB SCHOOL EMPLOYEES FOUNDATION , INC 2 3 - 7 4 1 2 3 4 8 Page 2
I Part Il I Support Sch-edule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Pat I.)
Section A. Public Support
Calendar year (ur fiscal year beginning in)) (Q) 2005 (I3) 2006 (9) 2007 (Q) 2008 (Q) 2009 *(9 Total
1 Gifts, grants, contnbutions, and
membership fees received. (Do not
include any "unusual grantsf)
2 Tax revenues levied for the organ
584,643. 490,127. 499,g017. 491,535. 471,880. 2,537,202,
ization*s benelit and either paid to
or expended on its behalf .
3 The value of services or facilities
fumished by a govemmental unit to
the organization without charge
4 Total. Add lines 1 through 3
5 The portion of total contnbutions
by each person (other than a
govemmental unit or publicly
supported organization) included
on line 1 that exceeds 2% of the
amount shown on line 11,
584,643. 490,127. 499,017. 491,535. 471,880. 2,537,202,
column (f) .
2,537,202,
6 PLIbliC SLIQPOFL Subtract line 5 from line 4
Section B. Total Support
Calendar year (or fiscal year beginning in)b (Q) 2005 (I3) 2006 (9) 2007 (g)2008 (e) 2009 (9 Total
7 Amounts from line 4 ,
8 Gross income from interest,
dividends, payments received on
secunties loans, rents, royalties
and income from similar sources
9 Net income from unrelated business
activities, whether or not the
business is regularly camed on
10 Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.)
11 Total support. Add lines 7 through 10
584,643. 490,127. 499,017. 491,535. 471,880. 2,537,202.
3,705. 4,451. 9,107. 7,601. 4,491. 29,355.
4,330. 846. 5,176.
12 Gross receipts from related activities, etc. (see instructions) . , . , 12
2.571.733,
13 First five years. If the Form 990 is for the organization"s first, second, third, fourth, or fifth tax year as a section 501 (c)(3)
oganization check this box and stop here .. . .. . . . . .. . . . . . P I
Section C. Computation of Public Support Percentage
14 Public support percentage for 2009 (line 6, column (f) divided by line 11, column (f)) , N , 14 9 8 . 6 6 %
78
15 Public support percentage from 2008 Schedule A, Part ll, line 14 N , N , , .
15 9 8 . %
16a 33 1/3% support test - 2009.lf the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and
Stop here. The organization qualifies as a publicly supported organization , , , , , , , , , , N , P IE
b 33 1/3% support test - 2008.If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box
and stop here. The organization qualities as a publicly supported organization . . U P lj
17a 10% -facts-and-circumstances test - 2009.lf the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more,
and if the organization meets the "facts-andcircumstances" test, check this box and stop here. Explain in Part IV how the organization
meets the "facts-andcircumstances" test. The organization qualiies as a publicly supported organization . . D CI
b 10% -facts-and-circumstances test - 2008.If the organization did not check a box online 13, 16a, 16b, or 17a, and line 15 is 10% or
more, and if the organization meets the "facts-andcircumstances" test, check this box and stop here. Explain in Part IV how the
organization meets the *facts-andcircumstances" test. The organization qualities as a publicly supported organization , P III
18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions . . PI I
Schedule A (Form 990 or 990-EZ) 2009
932022
02-08- 10
Schedule A orm 990 or 990-EZ) 2009 Page 3
I Part Ill Support Schedule for Organizations Described in Section 509(ajl(2) (Complete only if you checked me box on ,me 9 of pan L)
Section A. Public Support
Calendar year (or fiscal year beginning in)P (a) 2005 (ii) 2006 (9) 2007 (g) 2008 (Q) 2009 (1) Total
1 Gifts, grants, contnbutions, and
membership fees received. (Do not
include any *unusual grants.")
2 Gross receipts from admissions,
merchandise sold or services per
formed, or facilities fumished in
any activity that is related to the
organization"s taxexempt purpose
3 Gross receipts from activities that
are not an unrelated trade or bus
iness under section 513
4 Tax revenues levied for the organ
ization"s benefit and either paid to
or expended on its behalf
5 The value of services or facilities
furnished by a governmental unit to
the organization without charge
6 Total. Add lines 1 through 5 , , ,,
7a Amounts included on lines 1, 2, and
3 received from disqualified persons
b Amounts Included on lines 2 and 3 received
from other than disqualified persons that
exceed the greater of $5,000 or 1% ofthe
amount on line 13 for the year I
c Add lines 7a and 7b , ,
8 Public support (submarine ic from line 6)
Section B. Total Support
Calendar year (or fiscal year beginning in)P (Q) 2005 Q) 2006 (5) 2007 (Q) 2008 (-e) 2009 (g) Total
9 Amounts from line 6 , , , ,
10a Gross income from interest,
dividends, payments received on
securities loans, rents, royalties
and income from similar sources
b Unrelated business taxable income
(less section 511 taxes) from businesses
acquired after June 30, 1975 .
c Add lines 10a and 10b ,
11 Net income from unrelated business
activities not included in line 10b,
whether or not the business is
regularly carried on . . . .
12 Other income. Do not include gain
or loss from the sale of capital
assets (Explain in Part IV.)
13 Total Support (Ada lines 9, ioe, 11, and 12)
14 First five years. lf the Form 990 is for the organization"s first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization,
check this box and stop here . . . . . . . . . . . . . P W
Section C. Computation of Public Support Percentage
15 Public support percentage for 2009 (line 8, column (f) divided by line 13, column (1))
16 Public support percentage from 2008 Schedule A, Part Ill, Hne 15 . .. . . .
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2009 (line 10c, column (f) divided by line 13, column (f)) , , , 17 %
18 Investment income percentage from 2008 Schedule A, Part Ill, line 17 18 %
19a 33 1/3% support tests - 2009. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not
more than 33 1/3%. check this box andstop here. The organization qualifies as a publicly supported organization , P Q
b 33 1/3% support tests - 2008. lf the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, and
line 18 is not more than 33 1/3%, check this box andstop here. The organization qualifies as a publicly supported organization P E
20 Private foundation. If the orqanization did not check a box on line 14, 19a, or 19b, check this box and see instructions .. . . . P FL
Schedule A (Form 990 or 990-EZ) 2009
932023 02-08-10
schedule A erm 990 er 990-Ez) 2009 DEKALB SCHOOL EMPLOYEES FOUNDATION , INC . 2 3 - 7 4 1 2 3 4 8 Page 4
I Part N I Supplemental lnf0rmafi0I1. Complete this part to provide the explanations required by Part II, line 103 Part II, line 17a or 17bp
and Part III, line 12. Provide any other additional infomiation. See instructions.
SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME:
P/Y CHECKS VOIDED & NOT REISSUED
992024 o2-ca-10 Schedule A (Form 990 or 990-EZ) 2009
DEKALB scHoorL EMPLoYEEs FOUNDATION, INC. 23-7412348
FORM 990-EZ CASH GRANTS AND ALLOCATIONS STATEMENT 1
GRANTEE"S
CLASS OF ACTIVITY/GRANTEE"S NAME AND ADDRESS RELATIONSHIP AMOUNT
CHARITABLE
ORGANIZATIONS NONE 474,481.
SEE STATEMENT 4
TOTAL INCLUDED ON FORM 990-EZ, LINE 10 474,481.
STATEMENT ( S) 1
DEKALB SCHOOL EMPLOYEES FOUNDATION, INC.
FORM 990-EZ INFORMATION REGARDING TRANSFERS
ll
23-7412348
STATEMENT 2
ASSOCIATED WITH PERSONAL BENEFIT CONTRACTS
A) DID THE ORGANIZATION, DURING THE YEAR, RECEIVE ANY FUNDS
DIRECTLY OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL
BENEFIT CONTRACT? . . . . . . . . . . . . . . . . . . . . I I YES IXI NO
B) DID THE ORGANIZATION, DURING THE YEAR, PAY PREMIUMS,
DIRECTLY OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT? . . I I YES lX1 NO
STATEMENT(S) 2
23-7412348
STATEMENT 3
990-EZ PG 2
THE FOUNDATION EXISTS FOR THE SOLE PURPOSE OF MAKING CHARITABLE
CONTRIBUTIONS ON BEHALF OF EMPLOYEES OF THE DEKALB COUNTY SCHOOL SYSTEM.
EMPLOYEES VOLUNTARILY ELECT TO MAKE CONTRIBUTIONS VIA PAYROLL DEDUCTIONS:
THE AMOUNTS DEDUCTED ARE FORWARDED TO THE FOUNDATION WHO PROCESSES THE
DISBURSEMENTS TO THE VARIOUS CHARITIES.
Q
STATEMENT(S) 3
EIN 23-7412348
December 31, 2009
CASH DISBURSEMENTS TO CHARITABLE ORGANIZATIONS
Statement #4
Form 990-EZ, Part I, Line 10
100 Black Men of DeKalb County
Alzheimer"s Association, Georgia Chapter
American Cancer Society, Georgia Division
American Heart Association
American Kidney Fund
American Lung Association of Georgia
American Red Cross, Coweta Chapter
American Red Cross, Metropolitan Atlanta Chapter
Angel Flight of Georgia
Arthritis Foundation, Georgia Chapter
Association on Battered Women of Clayton County (Securus House)
Atlanta Alliance on Developmental Disabilities
Atlanta Legal Aid Society
Atlanta Urban League, Inc.
Big Brothers/Big Sisters of Metro Atlanta
Blind & Low-Vision Services of North Georgia
Bobby Dodd Institute
Boy Scouts, Atlanta Council
Boy Scouts, Flint River Council
Boy Scouts, Northeast Georgia Council
Boys & Girls Clubs of Metro Atlanta
Camp Fire USA Georgia Council
Camp Kudzu
Carrie Steele-Pitts Home, Inc.
Catholic Social Services, Inc.
Center for Pan-Asian Community Services
Center for the Visually Impaired
Central Presbyterian Outreach Center
Cherokee Family Violence Center
Children*s Healthcare of Atlanta
CHRIS Kids (Formerly CHRIS Homes)
Clayton County Family Care, Inc.
Communities in Schools of Atlanta, Inc.
Council on Alcohol and Drugs
DeKalb Partners in Education Foundation, lnc.
DeKalb Rape Crisis Center, Inc.
Diabetes Association of Atlanta, Inc.
Easter Seals of North Georgia
Enchanted Closet
Epilepsy Foundation of America, Georgia Chapter
7,315
12,925
42,189
12,750
4,167
1,788
144
16,018
1,965
4,707
937
990
915
1,201
6,637
813
100
1,303
624
492
5,496
324
1,080
4,564
5,296
120
1,194
1,340
206
20,820
2,526
300
784
564
2,651
8,094
21,921
276
5,000
864
61
I
EIN 23-7412348
December 31, 2009
Statement #4
Families First $
Families of Children Under Stress (FOCUS)
Friends of Disabled Adults & Children, Too, Inc.
Gate City Day Nursery Association
Georgia Center for Children
Georgia Lions Lighthouse Foundation, Inc.
Georgia Radio Reading Service, Inc.
Georgia Special Olympics
Girl Scout Council of Northwest Georgia, Inc.
Girls Incorporated of Greater Atlanta
Gladys Cook Scholarship Fund/ PTA Council
Goodwill Industries of North Georgia
Gwinnett Children"s Shelter
Gwinnett Coalition for Health & Human Services
Hearts to Nourish Hope, Inc.
Henry County Council on Aging
Huntington"s Disease Society
It"s All About Education, Inc.
Jewish Family & Career Services
Kidney Foundation of Georgia
Latin American Association
LeKotek of Georgia, Inc.
Leukemia Society
Literacy Action, Inc.
Lupus Foundation of America, Inc.
March of Dimes, Georgia State Chapter
Marcus Jewish Community Center
Metropolitan Atlanta Crime Commission
National Mental Health Association of Georgia
National Multiple Sclerosis Society, Georgia Chapter
Parent to Parent of Georgia
Partnership Against Domestic Violence
PKD Foundation
Planned Parenthood of Georgia, lnc.
Prevent Child Abuse Georgia (Georgia Council on Child Abuse)
Refuge Pregnancy Center
Refugee Family Services
Rockdale Emergency Relief Fund
Scottdale Child Development Center, Inc.
Senior Citizen Services of Metropolitan Atlanta, Inc.
Senior Connections
2of3
2,262
5,665
3,015
101
3,287
674
408
1 1,530
3,156
789
15,000
795
4,338
100
269
167
296
1,640
1,194
4,214
1,716
1,713
6,629
2,617
8,31 1
4,767
495
100
1,258
5,572
413
4,406
787
6,631
100
1,374
1,842
322
4,627
1,173
748
I ol 1,
EIN 23-7412348
December 31, 2009
Statement #4
Sheltering Arms Early Education & Family Centers $ 2,621
23,789
1,000
5,000
2,148
1,404
5,017
599
Sickle Cell Foundation of Georgia, Inc.
Side-by-Side Brain Injury Clubhouse
Sisters By Choice, Inc.
South DeKalb YMCA Academy
Southem Crescent Habitat for Humanity
St. Jude"s Recovery Center, Inc.
The Bridge, Inc.
The Frazer Center
The Link Counseling Center
The Odyssey Family Counseling Center
The Salvation Army
The Sullivan Center
Trave1er"s Aid of Metropolitan Atlanta, Inc.
United Cerebral Palsy of Georgia, Inc.
United Negro College Fund, Inc.
United Way Community Impact Fund
USO Council of Georgia
Visiting Nurse Health System
Wholistic Stress Control Institute, Inc.
YMCA - Butler Street
YMCA of Metropolitan Atlanta
YWCA of Greater Atlanta
761
771
276
6,91 1
100
293
2,088
89,005
12,021
424
344
41 1
2,312
649
636
Total Q 474,481
3of3
ii,
Form 8868 Application for Extension of Time To File an
(Rev-AP"*
2009)
Exempt .Organization Return OMB N0-1545-1709
Department of
the Treasury
iniemei Revenue service V File a separate application for each return.
0 If you are tiling for an Automatic 3-Month Extension, complete only Part I and check this box . . . . P iii
0 If you are hling for an Additional (Not Automatic) 3-Month Extension, complete only Part ll (on page 2 of this form).
Do not complete Part Il unless you have already been granted an automatic 3-month extension on a previously Hled Form 8868.
Panioiiiy.
.PCI
1 Part I I Automatic 3-M0nth Extension Of Time. Only submit onginal (no copies needed)
A corporation required to tile Form 990-T and requesting an automatic 6-month extension - check this box and complete
A/I other corporations Hncluding 1120-C filers), partnerships, REMlCs, and trusts must use Form 7004 to request an extension of time
to file income tax retums.
Electronic Filing (e-file). Generally, you can electronically tile Form 8868 if you want a 3-momh automatic extension of time to tile one of the retums
noted below (6 months for a corporation required to file Form 990-T). However, you cannot tile Form 8868 electronically if (1) you want the additional
(not automatic) 3-month extension or (2) you file Forms 990-BL, 6069, or 8870, group retums, or a composite or consolidated Form 990-T. Instead,
you must submit the fully completed and signed page 2 (Part ll) of Form 8868 For more details on the electronic tiling of this form, visit
www.rs, ov/efile and click on e-fr/e for Charities & Nonprofits.
Type or Name of Exempt Organization Employer identification number
print
DEKALB SCHOOL EMPLOYEES FOUNDATION, INC . 23-7412348
Zllzziisio, Number, street, and room or suite no. If a P.O. box, see instructions
"""9
Yo" 1 7 0 1 MOUNTAIN INDUSTRIAL BLVD
retum See
Instructions City, town or post office, state, and ZIP code. For a foreign address, see instructions.
STONE MOUNTAIN , GA 3 0 0 8 3
Check type of return to be filed (file a separate application for each retum):
CI Form 990 III Form 990-T (corporation) Cl Form 4720
II Form 990-BL III Form 990-T (see. 4o1(a) er 4oe(a) mist) Il Form 5227
I.-it Form 990-EZ ij Form 990-T (trust other than above) ij Form 6069
lil Femi 990-PF II Fom11o41-A CI Form aero
MARCUS TURK - 1 7 O 1 MOUNTAIN INDUSTRIAL BLVD . - STONE
0 The books are in the care of P MOUNTAIN , GA 3 0 0 8 3
Teiephonemb 678-676-0134 FAxNo.b
0 lf the organization does not have an office or place of business in the United States, check this box , , P E
0 If this is for a Group Fletum, enter the organization*s four digit Group Exemption Number (GEN) . if this is for the whole group, check this
box P Zi . If it is for part of the group, check this box P ij and attach a list with the names and EINs of all members the extension will cover.
1 I request an automatic 3-month (6-months for a corporation required to lile Form 990-1) extension of time until
AUGUST 1 5 , 2 0 1 0 , to file the exempt organization retum for the organization named above. The extension
is for the organization*s retum for:
P iii calendar year 2 0 0 9 or
P ij tax year beginning , and ending
2 If this tax year is for less than 12 months, check reason: ij Initial retum ij Final return ij Change in accounting penod
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions. 3a
b lf this application is for Fonn 990-PF or 990-T, eiter any refundable credits and estimated
tax payments made. Include anyLprior year overpayment allowed as a credit. 3b
See instructions. 3c N / A
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required,
deposit with FTD coupon or, it required, by using EFTPS (Electronic Federal Tax Payment System).
Caution. lf you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO aid Form 8879-EO for payment instructions.
LHA For Privacy Act and Paperwork Reduztion Act Notice, see Instructions. Form 8868 (Rev. 4-2009)
923631
05-26-09

Document 6426370

Transcription

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