A, i l, i l 1 OMB No 1545-1150 Returnsection of Organization Exempt From of Income Tax Revenue Code , form Under 501(c), 527, or 4947(a)(1) the Internal (except black lung benetit trust or private foundation) P Sponsoring organizations of donor advised funds and controlling organizations as defined in section . 512(b)(13) must tile Form 990 All other organizations with gross receipts less than $500,000 and total Open to Public Depanmeni ol the Treasury assets less than $1 ,250.000 at the end of the year may use this form Ins ection iniernai Revenue service P The organization may have to use a copy of this retum to satisfy state reporting requirements p For the 2009 calen Check if applicable Address change ame change itial return erminated mended return dar ear, or tax year beginning - - and ending Please C Name ol organization D Employer identification number use IRS label or print or CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Number and street (or P O box, il mail is not delivered to street address) Room/suite E Telephone number WPS See Specific Instruc O Application pending tions PO BOX 136 (937) 378-6853 Cliy, (Own, Of C0uI1ify Si6iE ZIP + 4 F Group Exemption 45121 Number GEORGETOWN P Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach G Accounting Method iii Cash L-I Accrual a completed Schedule A (Form 990 or 990-EZ). Other (specify) P H Check P if the organization is not I Website: P N/A required to attach Schedule B (Form 990, art I " J Tax-exemptstatus(checkonlyone)- 501(c)( 3 )4(inserin0)i:l 4947(a)(1) or E527 990-52-of 990"PF) K Check P ij 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 hte a return, be sure to tile a complete return L Add lines 5b, 6b, and 7b. to line 9 to determine gross receipts, if $500,000 or more, file Form 990 instead of Form 990-EZ P $ 65,079 ...2 Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I ) Contributions, gifts, grants, and similaramounts received. . . . . . . . . 1 4,200 2 Program service revenue including government fees and contracts . . . Investment income . . . . . . . . . . . , 3 Membership dues and assessments . . . . . . . . . 4 2015 b Less or other basis sales . . . . .. .. ., m 5a Grosscost amount from sale of and assets otherexpenses than inventory 5a 0 c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . . . 5c 0 6 Special events and activities (complete applicable parts of Schedule G) If any amount is from gaming, check here P Li a Gross revenue (not including $ of contributions reported on line 1) . . 6a 25,346 6c , . . ). 7c 0 8 . 0 1110 12 , b Less direct expenses other than fundraising expenses . H 3,235 c Net income or (loss) from special events and activities (Subtract line 6b from line 6a) . . . bc Gross Less cost of goods sold . . . . . . . profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . 7a Gross sales of inventory, less returns and allowances , 7a , 8 Other revenue (describe b See Attached Statement .. 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 . . P 9 10 Grants and similar amounts paid (attach schedule) . . 11 Benefits paid to or for members . . . . 12 Salaries, other compensation, and employee benefits . . . . 22111 33 518 61,844 31 134 13 Professional fees and other payments to independent contractors . . 13 2,598 14 Occupancy, rent, utilities, and maintenance . . . . . . . 14 17,769 15 Printinqd-publications, postage, and shipping . . . 15 7,927 REGEiP ses(E,escribe P See Attached. .Statement ) 1665,838 6,410 aT -"* : dd lines10through16. . . . . . P 17 26 ) ao igclissgipgije forthe (Subtract line 17agree from line 9) . . . . 18 -3,994 Q t sMQW s r -i balances at beginning E* of year (fromyear line 27, column (A)) (must with . end-of-year fig reported on prior year"s return) . . . . . . . . . . . . . . . . 19 69,349 . i 6"*-lit: .Wbalances s"lTi net balances (attach explanation) . 20 0 ez E-i-gk): :- - --i at assets end of orfund year. Combine lines 18 through 20 . . . .. .. .. 5. .21. .65,355 Part II 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 Il ) (A) Beginning Of year 22 16,807 7,251 Cash, savings, and investments . .. .. .16,807 . . 13,397 23 Land and buildings . . 40,000 24 42,001 24 Other assets (describe * INVESTMENTS ) 25 25 66,059 Total liabilities (describe P AQCCOUNTS PAYABLE 855 26 704 Net assets or fund balances (line 27 of column (Q) must agree with line 21) . 69,349 27 65,355 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions 22 23 (B) End of year Total assets . . . . . . . 70,204 27 (HTA) Form 990-EZ (zoos) ,1 I D Form 990-EZ (2009) CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 2 I M Statement of Program Service Accomplishments (See the instructions for Part III.) What is the organizations primary exempt purpose? ASSIST WOMEN,MEN AND FAMILIES IN CRISIS PREG Describe what was achieved in carrying out the organizations exempt purposes. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) tnists. optional for others ) 28 ----------------------------------------------------------------------- - (Grants $ 0 ) If this amount includes foreign grants, check here . . -i""lI"I 283 0 29 I - - - - - - . - - . - - . - - . - . - - - - - - - - - . - - - - - - - - - - - - - - - - - - - . - - - . . - - - - - . - U - - . - . - - - -U (Grants $ 0 ) If this amount includes foreign grants, check here . . *lj 29a O 30 - - - - . - - U . - - - - - - - - - - - - - - . - - - - - - - - . - - - - - - - - - . - - . - - - - - - - - - - . - - - - . . - - - U . - - . - - - -- (Grants $ 0 ) If this amount includes foreign grants, check here . . "fi :wa 31 Otherprogram services (attach schedule) . . . . . . . . (Grants $ 0 ) If this amount includes foreign grants, check here . . . .fl-:I 31a 0 32 32 Total rogram service expenses (add lines 28a through 31a) mp List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See th e instructions for Part IV ) 0 0 (b) Title and average (c) Compensation (d) Contributions to (e) Expense (a) Name and address hours per week (lf not paid, employee benetit plans & account and other allowances Tiiie CHAIR 100 O 0 0 100 O 0 0 100 0 0 0 1.00 0 0 0 1.00 0 0 0 Hr/wx 1 OO 0 0 O 11,774 O 0 15 O0 16,275 0 0 I-ir/wx .OO 0 0 0 0 0 0 0 0 0 0 0 O 0 0 0 0 0 0 Hr/vvx .OO 0 0 0 Hr/wx .O0 0 0 O O 0 O 0 0 I-if/wx BAN DX [email protected]. ........................... . Tiiie V CHAIR i-if/wx .SEBI Q/IH./5LL ................................... - . Tiiie SEC Hr/wx .BI.L.U.E. .BURTQN ................................. - Title TREAS Hr/vi/K .DAVID .SHARE .................................. - . Title BOARD MEM Hr/WK D QI?QTI."I.Y .VI/.Il-.3.Q.N ............................. - B 5.55996. -l./I.QI3.QB.EB.T.S. ........................ - .T./.XII/.III/I.P.I ELYM 5.55.53 ............................ . deferred compensation enter -0-.) devoted to position .J.QHN-5E.N DEB .................................. - me BOARD MEM Tiiie CLIENT SERV DIR i-if/vi/K 12 O0 Tiiie DIRECTOR I-if/wx Title i-ir/wif .00 Hr/vvx .00 Title Title I-ir/wx 00 Title I-if/wx .00 I-ir/wx .00 Title I Title Title Title Title Hr/WK .O0 I-ir/WK .00 Title 0 Form 990-EZ (2009) u 1 Poms-Ez izoogi cRisis PREGNANCY CENTER oF BROWN couNW 31-1348780 page 3 Other Information (Note the statement requirements in the instructions for Part V.) thechanges..... 33 Did the organization engage in any activity not previously reported to the IRS? lf "Yes," attach a detailed description of each activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Were any changes made to the organizing or governing documents? If "Yes," attach a conformed copy of 35 If the organization had income from business activities, such as those reported on lines 2, Sa, 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 subject to section 6033(e) notice, reporting, and proxy tax requirements? . . . . . . . . . . . . . b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . . . . . . . 36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If "Yes," complete applicable parts of Schedule N . . . . . . . . . . . 37 a Enter amount of political expenditures, direct or indirect, as described in the instructions P 37a I b Did the organization file Form 1120-POL for this year? . . . . . . . . . . 38 a 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? b If "Yes," complete Schedule L, Part ll and enter the total amount involved 39 Section 501(c)(7) organizations Enter* a Initiation fees and capital contributions included on line 9 . . . . . . . . b Gross receipts, included on line 9, for public use of club facilities . . . . . . aab 0 @ S-.S0 Yes N 33 X 34 X *DX il 35a 35b 36 X 37b X 38a 40 a Section 501(c)(3) organizations Enter amount of tax imposed on the organization during the year under" section 4911 P 5 section 4912 P , section 4955 P 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 organization"s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I . . . . . . . . . . . . . 4Ob 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,and4958 . .. .. .... .. .... P d Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax on line 40c reimbursed by the organization . . . . . . . . . . .P 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 . . . . . . . . . . . . . . 40e X 41 List the states with which a copy of this return is filed. P account)? .. 42 H The 0f9ef"ZeU0f1"S DOOKS ere in Cafe Of * TM/IMA. *SP1-.YM6$.S.EB. ............... .- Telephone U0- * .--.(9?.7).3?f3:@3f3.5.9: LOC-Bled el * ,$914. .S.C,Q.FflE.L.D. BD ,,,,,,,, -,QiIy,Bll?,L,EY ............. ..$T.,.Q,H-- ZIP + 4 * 453.51 .............. -. 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 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.? . . If "Yes," enter the name of the foreign country. * 43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041-Check here . . . . i i and enterthe amountoftax-exempt interest received oraccrued during thetaxyear. . . . . .bl 43 IN/A 44 Did the organization maintain any donor advised funds? lf "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . 45 Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If "Yes," Form 990 must be completed instead of Form 990-EZ . . . . . . . . . . . . N0 B- X 45 x Form 990-EZ (2009) t 1 F0fm 990-EZ (2009) CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 4 Part VI Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section n 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 46-49b and complete the tables for lines 50 and 51 Yes Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to 46 candidates for public office? lf "Yes," complete Schedule C, Part I Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part ll 48 ls the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . . 49 a Did the organization make any transfers to an exempt non-charitable related organization?. . . I 47 47 48 49a 49b Complete this table for the organizations five highest compensated employees (other than officers, directors, truste es and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter " None? b lf "Yes," was the related organization a section 527 organization? . 50 (b) Title and average (c) Compensation (d) Contributions to (e) Expense (a) Name and address ol each employee paid more hours per week employee benefit plans & account and than $100,000 devoted to position deterred compensation other allowances N90? .............. - ,sir ,,,,,,,,,,,,,,,,,,,,, ,, T-iie City ST ZIP Hr/WK ST ZIP Hr/WK - - . - - - . - - . - - - - - - - - -"Str-U--no-"U"---H--N Title ST ZIP Hr/WK - - . - - . - - . - - - - - - - - - ---Str--U-U"---U"-----up Title ST ZIP Hr/WK - - - - . - . . - - - - - - . . . - ---Str---H-nn"-U"--"U Title ST ZIP Hr/WK f Total number of other employees paid over $100,000 . . .N.3."J@ City . .N.@."J@ City . .N.3."3@ City . .NPFJQ City - .Na."J% 00 0 O .O0 O 0 OO 0 0 00 0 0 O0 O O . - - - - - - - - - - - - - - - - . ---Str"nn--"nu"-"nn Title P 51 Complete this table for the organizations five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None." (a) Name and address of each independent contractor paid more than $100,000 (b) Type of service (c) Compensation . .N.3."J@ City . .N.a."3@ City . .N.a."?Q City . .Na."J*2 City sr zip .................................. ST zip .................................. sr zip .................................. sr zip N90? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- 59* . . . . . . . . . . . . . . . . .- sr zip .Str ................. . . .N.a."3@ City d Total number of other independent contractors each receiving over $100,000 P pt Inf"/zyazo//J Under penalties of perjury. l declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and beli f, it is true, corre - - plete Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge Sign Here P. , Type or pnnt name and tide Paid prepafer-S , Date gg?-Ck 4/22/2010 If Preparefs identifying number , signature , *-/-N-/ employed s (See instruciiorisi EIN P Ureparer S Firm S flame (Or y0Uf$ JI ge Only if self-employed), Y address, and zip + 4 1627 Grunwald CV, Fayetteville , OH 45118 Phone "0 P (513) 875-2299 May the IRS discuss this return with the preparer shown above? See instructions . . . . . . . . PIZI Yes CI No Form 990-EZ (2009) SCHEDULE A . . . OMB N0 1545-0047 (Fomfsso or 990-Ez) Public Charity Status and Public Support Complete if the organization is a section 501(c)(3) organization or a section Depanmem of the Treasury 4947(a)(1) nonexempt charitable trust. Qpen tg Public imemei Revenue Semee b Attach to Form 990 or Form 990-EZ. P See separate instructions. Inspection Name of the organization Employer identification number 31 1348780 CRl SIS PREGNANCY CENTER OF BROWN COUNTY Reason for Public Charity Status (All organizations must complete this part.) See instructions. The org-a-nization is not a private foundation because it is: (For lines 1 through 11, check only one box.) 1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E ) A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospitals name, city, and state: --------------------------------------------------------------- U 5 6 7 8 9 .L 10 III F11 E An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part ll ) A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part ll ) A community trust described in section 170(b)(1)(A)(vi). (Complete Part ll.) An organization that normally 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.) An organization organized and operated exclusively to test for public safety. See section 509(a)(4). An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described 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. . e E a E Typel b lj Typell c E Type Ill-Functionally integrated d lj Type lll-Other lf 9 By checking this box, l 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 described in section 509(a)(1) or section 509(a)(2). organization, checkthis box . . . . from . . .the. .IRS . .that . . it. is. a. Type . I, Type ll, or Type Ill supporting lj If the organization received a written determination Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below, the governing body of the supported organization? . . . (ii) A family member of a person described in (i) above? . . . . . . 11 ii (iii) A 35% controlled entity of a person described in (i) or (ii) above?. . . . . . . . . 11 iii h Provide the following information about the supported organization(-sl). or amzanon the organization in 9 above or IRC section goveming document? col (I) of your (iii) Type of organization (iv Is the organization v Did ou noti Y (I) Name of supponed (H) EIN (described on lines 1-9 in col (i) listed in your (see instructions)) support? Yes No Yes No (vi) Is the organization in col (I) organized in the US? (vii) Amount of suppon Yes No 0 0 0 0 0 Total For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ (HTA) O Schedule A (Form 990 or 990-EZ) 2009 Scheduie A (Form 990 N990-Ez) 2009 CRisis PREGNANCY CENTER oF eRowN CouNTY 31-1348780 Page 2 E suppen seheeiuie for organizations Described in seeiions11o(b)(1)(A)(iv)and 11o(b)(1)(A)(vi) - (Complete only if you checked the box on line 5, 7, or 8 of Part I.) Section A. Public Support Calendar year (or fiscal year beginning in) P (5) 2005 (Q) 2006 (E) 2007 (dj 2008 (5) 2009 (f) Total 1 Gifts, grants, contributions, and include any "unusual grants ") 0 membership fees received. (Do not its behalf . . . . . . . . . . 0 2 Tax revenues levied for the organization"s benefit and either paid to or expended on 3 The value of services or facilities organization without Charge . . . 0 4 Total. Add lines 1 through 3 . . 0 0 0 0 0 O furnished by a governmental unit to the 5 The portion of total contributions by each person (other than a governmental unit 6Public 7 . support m Subtract line 5 fro line 4. 0 or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, Column (f) . Section B. Total Support 7 AmountsfromIine4. . . . . . 0 O O O 0 0 Calendar year (or fiscal year beginning in) P (Q) 2005 (p) 2006 (Q) 2007 (Q) 2008 (E) 2009 (f) Total sources . . . . O regularly carried on . . . . . 0 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar 9 Net income from unrelated business activities, whether or not the business is inAdd Part . . . .10O0 11(Explain Total support. linesIV) 7 through 10 Other income Do not include gain or loss from the sale of capital assets 12 Gross receipts from related activities, etc (see instructions) . . . . . . . . . . . . . . 12 I 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) organization,checkthisboxandstophere. . . . . . . . . . . . . . . . . . . . . . . . . . .PD Section C. Computation of Public Support Percentage 14 Public support percentage for 2009 (line 6, column (f) divided byline 11, column (f)) . . . . 14 0.00% 15 Public support percentage from 2008 Schedule A, Part ll, line 14 . . . . . . . * I 0 00% 16a 33 1/3% support test-2009. If 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 . . . . . . . . . . . . . . . .P 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 qualifies as a publicly supported organization . . . . . . . . . . . . . . . . b 17a 10%-facts-and-circumstances test-2009. If 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-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization. . D * b 10%-facts-and-circumstances test-2008. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-Circumstances" test, check this box and stop here. Explain in Part IV how-p the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly supported organization . .D 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 . . . . P -s Schedule A (Form 990 or 990-EZ) 2009 Schedule A (F0fm 990 Of 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Page 3 Part Ill Support Schedule for Organizations Described in Section 509(a)(2) - (Complete only if you checked the box on line 9 of Part I.) Section A. Public Sup-port Calendar year (or fiscal year beginning in) P (3) 2005 (p) 2006 (Q 2007 (Q) 2008 (g) 2009 (f) Total 1 Gifts, grants, contributions, and include any "unusual grants.") . . . . O organizations tax-exempt purpose O membership fees received. (Do not 2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the its behalf . . . . O organization without charge . . . 0 unrelated trade or business under section 513 0 3 Gross receipts from activities that are not an 4 Tax revenues levied for the organization"s benefit and either paid to or expended on 5 The value of services or facilities furnished by a governmental unit to the 6 Total. Add lines 1 through 5 0 0 0 O 0 0 received from disqualified persons 0 amount 13. .for 0 N c Add lineson 7a line and 7b . . .the . . Oyear 0 0 O. .O. O 7a Amounts included on lines 1, 2, and 3 b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the line 6 ) . . . . . . 0 9 Amounts from line 6 . . . . 0 0 0 0 0 0 8 Public support (Subtract line 7c from Section B. Total Support Calendar year (or fiscal year beginning in) P (E) 2005 (Q) 2006 (S) 2007 (Q) 2008 (5) 2009 (f) Total sources. . . . . . . . . 0 10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar b Unrelated business taxable income (less section 511 taxes) from businesses June cacquired Add lines after 10a and 10b30, . . 01975 0 0 0. 0. 0 0 carried on . 0 (Explain in Part IV.). . . . . 0 11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly 12 13 14 Other income Do not include gain or loss from the sale of capital assets and12) 0 0 0 O 0 0 Total support. (Add lines 9, 10c, 11, First five years. If the Form 990 is for the organizations first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,checkthisboxandstophere. . . .. ...... ... . ..............bl:-I Section C. Computation of Public Support Percentage 15 Public support percentage for 2009 (line 8, column (f) divided byline 13, column (f)) . . . 15 0.00% S " D. C " f I I P 16 Public support percentage from 2008 Schedule A, Part lll, line 15 . . . , 16 , O 00% ection omputation o nvestment ncome ercentage 17 Investment income percentage for 2009 (line 10c, column (f) divided by line 13, column (f)) . . 17 0 00% 18 Investment income percentage from 2008 Schedule A, Part Ill, line 17 . . . . . . . . . . . E 0.00% 19a 33 1/3% support tests-2009. lf 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 and stop here. The organization qualities as a publicly supported organization . . . .P lj b 33 1/3% support tests-2008. If 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 and stop here. The organization qualities as a publicly supported organization . . . . . P E 20 Private foundation. lf the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions . . . P Schedule A (Form 990 or 990-EZ) 2009 Sflhedule A (F0ffT1 990 Of 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31 -1 348780 Page 4 Part IV Supplemental Information. Complete this part to provide the explanations required by Part II, line 103 Part Il, line 17a or 17bg and Part III, line 12. Provide any other additional information. See instructions. Schedule A (Form 990 or 990-EZ) 2009 SCHEDULE (Form 990 or 990-EZ) G Supplemental Information Regarding OMBN" 154500" Fundraising or Gaming Activities Department ol the Treasury . . , Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the Open T0 Public Internal Revenue Semce organization entered more than $15,000 on Form 990-EZ, line 6a. lnspectlon Name of the organization Employer identification number CRISIS PREGNANCYP Attach CENTER BROWN COUNTY 31-1348780 to Form 990 orOF Form 990-EZ P See separate Instructions. 4 Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are not required to complete this part. 1, 8 Indicate whether the organization raised funds through any of the following activities. Check all that apply lj Mail solicitations e lj Solicitation of non-government grants b lj Internet and email solicitations f lj Solicitation of governmentgrants C D Phone solicitations g Special fundraising events d EI In-person solicitations 2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees b or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes El No If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. (i) Name ol individual (ii) Activity (iii) Did fundraiser have (iv) Gross receipts (V) Amour" pald to (vl) Amount paid to or entity (fundraiser) custody or control of from activity (or retamed by) (or retained by) co i In organization contributions? fu"dra"sTr(")Sted Yes No l l i 0O O 0 O0 FUND RAisERs X 25,346 ALL 0 25,346 O 0 0 0 0 O O 0 O O 0 0 0 O 0 0O 00 00 Total . . . . . P 25,346 0 25,346 3 List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule G (Form 990 or 990-EZ) 2009 (HTA) CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 schedule G (Form 990 of 990-Ez) zoos Page 2 Part Il Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000. (a) Event #1 (b) Event #2 (c) Other events (d) Total events O 0 00 (add col (a) through (event type) (total number) Gross receipts Less Charitable contributions Gross income (line 1 minus line 2) Cash prizes wi (Cl) 00 O O 0 0 Noncash prizes O Rent/facility costs . 0 Food and beverages . 0 Entertainment . . 0 + .Pt 0) 0 Other direct expenses . 11 Elm Directexpense summary. Add lines4through9in column (d). . . . . . . . . . Net income summary. Combine line 3, column (Q), and line 10. . . . . . . . . . . . . P (a) Bingo (b) Pull tabs/instant (c) Other gaming bingo/progressive bingo -. 0 Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or rep orted more than $15,000 on Form 990-EZ, line 6a. (d) Total gaming (add col (a) through col (c)) Gross revenue . 0 Cash prizes O Noncash prizes . O Rent/facility costs O Other direct expenses . 0 Yes ------ H"/0 ljYes ------ no/0 EYes ------ U"/0 Volunteer labor E No lj No E No Direct expense summary Add lines 2 through 5 in column (d) . . . . . P g O) Net gaming income summary Combine line 1, column d, and line 7 . . P 0 Yes No 9 Enter the state(s) in which the organization operates gaming activities: ---------------------------- U ls the organization licensed to operate gaming activities in each of these states? . . . 9a If "No," explain. 10a Were any of the organization"s gaming licenses revoked, suspended or terminated during the tax year? 10a If "Yes," explain. 11 Does the organization operate gaming activities with nonmembers"7 . . . . . . . . . . . . . . . . 12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming? . . . . . . . . . . . . . . . . . . . . 11 12 Schedule G (Form 990 or 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 Schedule G (Form 990 or 990-EZ) 2009 Page 3 Yes No 13 Indicate the percentage of gaming activity operated in. 3 b 14 The organization"s facility . . . . . . . . . . . . . 13a % An outside facility . . . . . . . . . . . . . . . . . m % Enter the name and address of the person who prepares the organization"s gaming/special events books and records revenue? .. Name P ----------------------------------------------------------------------------------------- - Address P -------------------------------------------------------------------------------------- - 15a Does the organization have a contract with a third party from whom the organization receives gaming b WC . 15a If "Yes," enter the amount of gaming revenue received by the organization P $ ------------ U and the amount of gaming revenue retained by the third party P $ ------------ If "Yes," enter name and address of the third party Name P Address P -------------------------------------------------------------------------------------- - 16 Gaming manager information Name P Gaming manager compensation P $ ------------------ --Q Description of services provided P --------------------------------------------------------------- U E Director/officer E Employee lj Independent contractor 17 Mandatory distributions a is the organization required under state law to make charitable distributions from the gaming proceeds to N g - M Y retainthestategamingIicense"7. . . . . . . . . . . . . . . . . . . . . . . . . . 17a b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization"s own exempt activities during the tax year P $ Schedule G (Form 990 or 990-EZ) 2009 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 P.art I, Line 8 (990-EZ) - Other Revenue donation Income 33,518 Amount Descriptuon 32,404 1,114 on-IERINCOME v- -W * 4 W -9-W --- , l3. C .. ,..M...*-.-* 11 .EL -.M -.., -,W,.--MC -,--.--* 1.4.---.-----------.-- .12 T " - *"""*"" 16 18 19 20 flfm" "fff ij, C --- 9 10 11 12 13 14 15 16 17 18 19 20 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 o 1 Travel . . . . . . Par1 L Line 16 (990-EZ) - Other Expenses 1 -2 Meals and entertainment 4 Fundraising. ..... .. .. . Amortization 5 Conferences, conventions, and meetings . . 3 6 1 6,410 0 Depreciation Depletion . . . .. .. ,. .. Interest . .. . . . Supplies Telephone . . 0 a Equipment rental and maintenance 9 10 11 12 Unrelated business 13 CENTER EXPENSES 14 15 income taxes . ADVERTISTNG " T- " T- "fu -"M , --fu" -,MM wwf.-" QHARILQLETBQQITAX. ------ 2 1s PRIOGRAM ExPENsEs 11 18 19 20 ARCH-GRANT.EXEEf*EE-Qfafflf-fi"--"H-- "Q7-QQ." *. 9 10 11 12 13 14 15 16 17 18 19 20 21 21 22 23 so 22 23 24 25 26 27 28 29 30 31 31 32 32 24 2s 26 21 28 29 0 1,619 304 50 237 4,200 CRISIS PREGNANCY CENTER OF BROWN COUNTY 31-1348780 IY i Part II, Line 24 (990-EZ) - Other Assets 40,000 End 42,001 Description Beginning INVESTMENTS 40,000 42,001 T . -.-.-- .- .-.. --. .Q . .---.-. ,. - L --.-.s-.-.-- - 12 13 L -.--.-..-A ,LL - - ------..-.- - .LL - , --------E 15 11 19 3.0. -V M- CRISIS PREGNANCY CENTER OF BROWN COUNTY 31 1348780 1Q s ,U s .Part Il, Line 26 (990-EZ) - Liabilities AQCCOUNTSPAYABLE 855 704 855 704 Descnpuon Bemnnmg En
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