Form 990-Ez - Short Form Return Of Organization Exempt From Income Tax - 2017
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Short Form
OMB No. 1545-1150
990-EZ
Return of Organization Exempt From Income Tax
2017
Form
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Open to Public
Do not enter social security numbers on this form as it may be made public.
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Inspection
Department of the Treasury
Go to for instructions and the latest information.
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Internal Revenue Service
A For the 2017 calendar year, or tax year beginning
, 2017, and ending
, 20
B
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C Name of organization
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Employer identification number
Check if applicable:
Address change
Room/suite
Name change
Number and street (or P.O. box, if mail is not delivered to street address)
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E Telephone number
Initial return
Final return/terminated
City or town, state or province, country, and ZIP or foreign postal code
F Group Exemption
Amended return
Number
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Application pending
Other (specify)
Cash
Accrual
G Accounting Method:
H Check
if the organization is not
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I Website:
required to attach Schedule B
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(Form 990, 990-EZ, or 990-PF).
J Tax-exempt status (check only one) —
501(c)(3)
501(c) (
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(insert no.)
4947(a)(1) or
527
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K Form of organization:
Corporation
Trust
Association
Other
L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets
(Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ
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$
Part I
Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I)
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Check if the organization used Schedule O to respond to any question in this Part I . . . . . . . . . .
1
Contributions, gifts, grants, and similar amounts received .
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1
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2
Program service revenue including government fees and contracts
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2
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3
Membership dues and assessments .
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3
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4
Investment income
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4
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5 a Gross amount from sale of assets other than inventory
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5a
b Less: cost or other basis and sales expenses .
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5b
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) .
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5c
Gaming and fundraising events
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a Gross income from gaming (attach Schedule G if greater than
$15,000) .
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6a
b Gross income from fundraising events (not including $
of contributions
from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000) .
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6b
c Less: direct expenses from gaming and fundraising events
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6c
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract
line 6c)
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6d
7 a Gross sales of inventory, less returns and allowances .
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7a
b Less: cost of goods sold
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7b
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .
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7c
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Other revenue (describe in Schedule O) .
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Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8
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9
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Grants and similar amounts paid (list in Schedule O)
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Benefits paid to or for members .
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Salaries, other compensation, and employee benefits .
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12
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13
Professional fees and other payments to independent contractors .
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13
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14
Occupancy, rent, utilities, and maintenance
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Printing, publications, postage, and shipping .
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Other expenses (describe in Schedule O) .
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16
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17
Total expenses. Add lines 10 through 16 .
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18
Excess or (deficit) for the year (Subtract line 17 from line 9)
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18
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Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior year’s return)
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19
20
Other changes in net assets or fund balances (explain in Schedule O) .
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Net assets or fund balances at end of year. Combine lines 18 through 20
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990-EZ
For Paperwork Reduction Act Notice, see the separate instructions.
Form
(2017)
Cat. No. 10642I
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