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C c_
J

K
990

OMB No 1545-0047

Return of Organization Exempt From I ncome Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation)

Department of the Treasury
lriterna! Revenue Service

-Open to Public
Inspection

B

> The organization may have to use a copy of this return to satisfy state reporting requirements
For the 2011 calendar year, or tax year beginning
OCTOBER 1
.2011. and ending SEPTEMBER 30
.2012
Check ii applicabie 0 Name '9a'ZaI'"BoNNEvILLE CHARITABLE FOUNDATION
D EmP'v"d"3t'" "umber

D
B
[I
D
El

Address change
Name change
Initial return
Terminated
Amended return

A

Cl Application pending

D'9 B5'"55 A5 xsr. QUARTERS 1-on CHRISTMAS, READ TODAY, pnorecr M u s I c
Room/suite
Number and street (or P 0 box if mail is not delivered to street address)

87-0491455
E Telephone number

P.O. BOX 45654
City or town, state or country, and ZIP + 4
SLC,

801-323-4209
G Gross receipts 3
241, 976
H(a) ls thisagroup return for alhates? D Yes E No
H[b) Are all affiliates included? D Yes CI No
lf'No,' attach a list (see instructions)

UT 84145-0654

F Nameand address olprincipalofficer THOMAS KIRBY BROWN JR_
55 NORTH 300 WEST, SUITE 800, SLC, UT
El 501(c)(3)
CI 501(c)<
)4 arisen no) [I 4947(a)(1)or E 527

I
J

Tax-exempt status
Website: V

K

Form of organization E Corporation [:] Trust

H(c) Group exemption number P
[3 Association [I Other P

I L Year olformation 1991

IM State oriegaId'"'"e UT

Summary
1

Briefly describethe organizations mission or most signicant activities

an

To pgovmg CHARITABLE Ass1s'rANcE To mg

?Z9.}.~_:_ _ _':?_.1?__:_ _ .P_1:_3.:3!i1__*:.I__/.I_-_9I3.' _ _1?:3_3.5.9}!-.91 S3_*.~.QU.1?_5. _ 5.5. _ Y"_1:3_1:I~. _ A9. -9_''..*_3P:_ ..3."?_*_P:_I.TP:1.3.1:1f7. - _Q3Si\.._I_ _ .-'.1'.9_1."_-*1 -

E

9.111. _ __NP..\l $.93-IF:-_1:$. _

-'_1_9_ _..P..C.I1C .

_ 93.95111. _Z.EI $91!-S. __C.QN.'!P:1.13 S7_'i."l9.13_5_ - 9?. _ .C}.\.5.1:1_. _ J.-4.*.'_1.5B.IAE.$ .: - _ .C_=.Q.T.tl.1_{<.i . -

_

-951." _

3

2

Z".9_R_1:1_5_ ._!!.9t:1?E1i_I9._?.1RMIT..IH__E9UNP!5Z1ZI9t{.29..i?:Q!lP.E._Ctt6:3I.TA1_i.P:$.$IIEl1Z1_________________________ ._
Check this box D D it the organization discontinued its operations or disposed of more than 25% of its net assets

3
3
E

3
4
5

Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b) I
Total number of individuals employed in calendar year 2011 (Part V, line 2a)
_

':e:

B
7a
b

Total number of volunteers (estimate if necessary)
F
Total unrelated business revenue from Part VIII, column (C .JIne..1
Net unrelated business taxable income from Form 9905, line 34
E

3
4
5
6
7a
J 7b

0
S./2 .
Z 1

Prior Year

3
5
gig 3

8
9
10

Contributions and grants (Part VIII, line/1h)
Program service revenue (Part VIII, line 2g)
Investment income (Part Vlll, column (A), lines 3, 4, and7-d-

'

0:

11
12

Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
Total revenueadd lines 8 through 11 (must equal Part VIII, column (A), line 12)

_| C!

- --- -=-"

1
O
0
30
0
0
Current Year

190, 338 i
0
174

241 , 814
0
162

0 F
190 , 512

O
241 , 976

:

13

Grants and similar amounts paid (Part IX, column (A), lines 1-3)

Z
_',_;-3) 3
E 2

14
15
16a

Benets paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
Professional fundraising fees (Part IX, column (A), line He)

0
0
0

82;

b
17

Total fundraising expenses (Part IX, column (D). line 25) > _____________________ __Q
Other expenses (Part IX, column (A), lines 11a~11d, 11f24e)

1, 22 9

E
(3

18
19

Total expenses Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses Subtract line 18 from Iine12
_

([35
g 20
:<_:. 21
513:. 22

Total assets (Part X, line 16)
Total liabilities (Part x, line 26)
Net assets or fund balances Subtract line 21 from line 20

245, 443

246 , 672
(4, 696)

12, 648
Beginning of Current Year
14, 609 ,
o
14, 609

End of Year
9, 913
o
9, 913

Signature Block
Under penalties of perlury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is
true, correct, and complete DecIarali%n 9 preparer (other than officer) is based on all information of which preparer lias any knowledge
Sign
He"?

D

ffrvme i/WV
Signayre of cfcer '
THOMAS KIRBY BROWN,
Type or print name and title
PrinU Type preparer's naine

JR . ,

i6ll4l7.ias
Date
VICE PRESIDENT AND TREASURER/TRUSTEE

Preparers signature

Preparer
Use

Firm's name
>
Firm's address >
May the IRS discuss this return with the preparer shown above? (see instructions)

Date

check C] If PTIN
self-employed
Firm's EIN >
_ Phone no
1:] yes D No

For Papemlork Reduction Act Notice, see the separate instructions.
ISA

Form 990 (2011)
4
\D

1{

I
Form 990 (2011)
Part,_l||
1

Page 2

Statement of Program Service Accomplishments
Check if Schedule 0 contains a response to any question in this Part III

.

.

.

.

.

.

.

.

U

Briefly describe the organization's mission
C1'_9__?_*3~9...I_P__93l'?E'E.!_$IEE1:S_.I9__TI'!!3_.E993:_.1?Xz__EI'FR*B?_*?~Y.I:1P-.?39:Z$iR9H1?_!:\-Y!_PE_!._9T3i13_-9*3$TA5L
_Q*35E5_1?_I_?3}"_FE9:'.5.
-".1.9-_QP_S3..'- _!Il_3_-B_1"_C_1"_3.I...:3--1_"_*3_3_li'_ ___1?.}_.1?9__\_L__
_ .?*3.<_3:*.1._I_ _Z_"i*_T__?1__~E7-__3.?1.".'F}._%E_'1_".1_?_1i.-913_-E*iv. - _iZ:'".*_Z:1_=5 I
CLOTHING, LABOR, 5. OTHER FORMS OF ASSISTANCE, IN ORDER TO PERMIT THE FOUNDATION TO PROVIDE CHARITABLE ASSISTAN(

2

3

Did the organization undertake any significant program services during the year which were not listed on the
prior Form 990 or 990-EZ? .
.
.
. . . .

[3 Yes

E] No

If "Yes," describe these new services on Schedule 0.
Did the organization cease conducting, or make signicant changes in how it conducts, any program
services? . .
.
. . .

E] yes

[E No

If "Yes," describe these changes on Schedule 0
4

Describe the organization's program service accomplishments for each of its three largest program services, as measured by
expenses Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of
grants and allocations to others, the total expenses, and revenue, if any, for each program service reported

4a

(Code _____________ __)(Expenses$ ______ ___1__9_9_,_9_9_9_inc|uding grants of$ _________ __l__9j9__,__0__0_9_ )(Revenue$ ________________________ )
GRANTS TO PROVIDE SHOES, COATS, AND CLOTHING TO CHILDRE
OF NEEDY FAMILIES AND

4b

(Code.

)(Expenses $

4 1, 671 including grants of $

35 , 478 ) (Revenue $

)

4c

(Code

) (Expenses $

13, 772 including grants of $

13 , 772 ) (Revenue $

)

4d

Other program services (Describe in Schedule 0 )
(Expenses $
including grants of $

4e

Total program service expenses P

)(Revenue $

)

24 5 , 4 4 3
Form 990 (2011)

-I
Form 990 (2011)

Page 3

Checklist of Required Schedules

Yes

No

1

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete Schedule A
.
.
. .
. .

2
3

Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)?
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
candidates for public ofce? If "Yes," complete Schedule C, Part I
.

3

X

4

Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501 (h)
election in effect during the tax year? If Yes, " complete Schedule C, Pan II
. . . .

4

X

5

Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or similar amounts as dened in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III
. .
. . .

5

X

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors
have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If
"Yes," complete Schedule D, Pan I
. .
. .

5

X

Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If " Yes, " complete Schedule D, Part /I

7

x

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III
.
.
.

3

X

Did the organization report an amount in Part X, line 21, serve as a custodian for amounts not listed in Part
X, or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes,"
complete Schedule D, Part IV
.
.

9

X

6

7
8
9

10

Did the organization, directly or through a related organization, hold assets in temporarily restricted
endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V

11

If the organization's answer to any of the following questions is Yes," then complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable

1

X

2

X

a

Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If Yes,
complete Schedule D, Part VI
.
.

113

X

b

Did the organization report an amount for investmentsother securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes, complete Schedule D, Part VII .
. .

11b

X

c

Did the organization report an amount for investmentsprogram related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part V//I
. . .

11

X

d

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If "Yes," complete Schedule D, Pan IX
. .
.

11d

x

11e

X

e Did the organization report an amount for other liabilities in Part X, line 25? If"Yes," complete Schedule D, PartX
f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes, " complete Schedule D, Part X

11f

x

Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI, XII, and XI/I
.
.

123

x

b Was the organization included in consolidated, independent audited nancial statements for the tax year? If "Yes," and if
the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional

12b

X

13
14a

X
X

Did the organization have aggregate revenues or expenses of more than $10.000 from grantmaking,
fundraising, business, investment, and program service activities outside the United States, or aggregate
foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV

1413

X

15

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any
organization or entity located outside the United States? If Yes, " complete Schedule F, Parts II and /V .

15

X

16

Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance
to individuals located outside the United States? If "Yes," complete Schedule F, Parts III and /V

15

X

17

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on
Part IX, column (A), lines 6 and 11e? If Yes, complete Schedule G, Part I (see instructions)

17

X

18

Did the organization report more than $15,000 total of fundraising event gross income and contributions on
Part Vlll, lines 1c and 8a? If"Yes," complete Schedule G, Part II
. .
.

13

X

Did the organization report more than $15,000 of gross income from gaming activities on Part Vlll, line 9a?
If "Yes," complete Schedule G, Part III

19

X

Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H

20a

x

If "Yes" to line 20a, did the organization attach a copy of its audited nancial statements to this return?

20b N
A
Form 990 (2011)

12 a

13
14 a
b

19
20 a
b

Is the organization a school described in section 170(b)(1)(A)Gi)? If "Yes, complete Schedule E
Did the organization maintain an ofce, employees, or agents outside of the United States?
.

.

.

I!

.
Page 4

Form 990 (2011)
Checklist of Required Schedules (continued)

Yes

No

21

Did the organization report more than $5,000 of grants and other assistance to any government or organization
in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule /, Parts land ll
.
. .

21

22

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States
on Part IX, column (A), line 2'? If "Yes," complete Schedule I, Parts land Ill
.

22

X

23

Did the organization answer Yes to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes, complete Schedule J
.
.
.

23

X

24a

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes, answer lines 24b
through 24d and complete Schedule K If No, go to line 25

243

x

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
.

24b

X

24

x

Did the organization act as an on behalf of" issuer for bonds outstanding at any time during the year? .
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benet transaction
with a disqualied person during the year? If "Yes," complete Schedule L, Part /
.

24d

X

253

X

Is the organization aware that it engaged in an excess benet transaction with a disqualied 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
.

25b

x

Was a loan to or by a current or former otcer, director, trustee, key employee, highly compensated employee, or
disqualied person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II

25

X

28b

X

28c
29

X
X

0

25a

26
27

Did the organization provide a grant or other assistance to an ofcer, director, trustee, key employee,
substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity or family member of any of these persons? lf "Yes," complete Schedule L, Part lll
. . .

28

Was the organization a party to a business transaction with one of the following parties (see Schedule L,
Part IV instructions for applicable ling thresholds, conditions, and exceptions)
a
b

A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV
A family member of a current or former officer, director, trustee, or key employee? If "Yes, complete
Schedule L, Part IV
.
.
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an ofcer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV .

X

29
30

Did the organization receive more than $25,000 in non-cash contributions? If "Yes, " complete Schedule M
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualied
conservation contributions? If 'Yes,' complete Schedule M
.

30

X

31

Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part /
.
. .
. . .

31

X

32

Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"
complete Schedule N, Part II
.
. .
. .
.

32

X

33

Did the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301 7701-3? If "Yes," complete Schedule R, Part I
. . .

33

X

34

Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III,
I\/, and V, line 1
.
.

35a

Did the organization have a controlled entity within the meaning of section 512(b)(13)?
.
Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2
.
. . .

35b

X

36

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt noncharitable
related organization? lf "Yes," complete Schedule R, Part V, line 2
.
.
.

36

X

37

Did the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R,
Part l/I .

37

X

38

Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11 and
19? Note. All Form 990 lers are required to complete Schedule 0

38

34
35a

X
X

X

Form 990 (2011)

V.
Form 990 (2011)
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule 0 contains a response to any question in this Part V

.
Yes

D
No

13
b
c

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable
1a
0 "r:}, . 57;
Enter the number of Forms W2G included in line 1a Enter -0- if not applicable
.
1b
0 "
(.3
Did the organization comply with backup withholding rules for reportable payments to vendors and
3,
i ' J
reportable gaming (gambling)winnings to prize winners?
.
1c
N
A

2a

Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, led for the calendar year ending with or within the year covered by this return
2a
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e/e (see instructions)

b

0

Did the organization have unrelated business gross income of $1,000 or more during the year?
if Yes, has it led a Form 990-T for this year? If "No," provide an explanation in Schedule 0

4a

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 nancial
account)?
.

43

X

b

If "Yes," enter the name of the foreign country > N/A
See instructions for filing requirements for Form TD F 9_('):'2'2"1', 'r'<'e';3'<3'ri'6r' i'=''r'.H'iEh'i'}ia"iEi5EiEiiI\E6ii'r3i"""" H

333%,:

,:.,',;/~
.(;~f'/fl

5a
b
C
6a

Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? .
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
If "Yes" to line 5a or 5b, did the organization le Form 8886-T?
.
. . . .
Does the organization have annual gross receipts that are normally greater than $100,000, and did the

5a
5b
5c

X
X
A

organization solicit any contributions that were not tax deductible?
. .
.
. .
If "Yes," did the organization include with every solicitation an express statement that such contributions or

6a

b

gifts were not tax deductible?

6b

2!

.

.

Organizations that may receive deductible contributions under section 170(c).
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods
and services provided to the payor'?

b
c

If Yes," did the organization notify the donor of the value of the goods or services provided?
.
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to le Form 8282'?
.

d
9
f
g
h

If Yes, indicate the number of Forms 8282 filed during the year
I 7d I
N/A
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benet contract?
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benet contract? .
If the organization received a contribution of qualied intellectual property, did the organization le Form 8899 as required?
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization le a Form 1098-0?
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting

8

3a
3b

A
-.: Q? ,l

33
b

7

.
.

~ 43?
' . " l:i
2b
N

N

N

X
A

X
N

eff r
3%?
13
7b

N

A
?::j?I??
x
A

organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring
organization, have excess business holdings at any time during the year?
.
9

Sponsoring organizations maintaining donor advised funds.
a
b

10
a
b
11
a
b

Did the organization make any taxable distributions under section 4966'?
Did the organization make a distribution to a donor, donor advisor, or related person?
Section 501(c)(7) organizations. Enter
Initiation fees and capital contributions included on Part Vlll, line 12
.

10a

_
N/A 1

Gross receipts, included on Form 990, Part Vlll, line 12, for public use of club facilities
Section 501(c)(12) organizations. Enter
Gross income from members or shareholders
.
Gross income from other sources (Do not net amounts due or paid to other sources

10b

N/A 3., f

11a

N/A

against amounts due or received from them )

11b

N/A L

.

_

,, H

12a
b

Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
If "Yes," enter the amount of tax-exempt interest received or accrued during the year
12b
N/A

13
a

Section 501(c)(29) qualied nonprot health insurance issuers.
Is the organization licensed to issue qualied health plans in more than one state?

b

Note. See the instructions for additional information the organization must report on Schedule 0
Enter the amount of reserves the organization is required to maintain by the states in which

c
14a
b

.

X

_
13a

.

X

_
_-

the organization is licensed to issue qualied health plans

13b

N/A

g

Enter the amount of reserves on hand
,
Did the organization receive any payments for indoor tanning services during the tax year? .

13
.

.

N /A I-fi*""
14a

If "Yes," has it led a Form 720 to report these payments? If "No," provide an explanation in Schedule 0

14b

.
T
N

Fonn 990 (2011)

Page6

Form 990 (2011)

Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a "No"
response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions
Check if Schedule 0 contains a response to any question in this Part VI
.
. .
El
Section A. Governing Body and Management
1a

Enter the number of voting members of the governing body at the end of the tax year.
if there are material differences in voting rights among members of the governing body, or
if the governing body delegated broad authority to an executive committee or similar
committee, explain in Schedule O

1a

1

Enterthe number of voting members included in line 1a, above, who are independent
1b
0
Did any ofcer, director, trustee, or key employee have a family relationship or a business relationship with
any other ofcer, director, trustee, or key employee?
00

Did the organization delegate control over management duties customarily performed by or under the direct
supervision of ofcers, directors, or trustees, or key employees to a management company or other person?
Did the organization make any signicant changes to its governing documents since the prior Form 990 was led?
Did the organization become aware during the year of a signicant diversion of the organization's assets?
Did the organization have members or stockholders?
. .
. .
. .
.
Did the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body?
.
.

K1050!-J3

b
9

3
4
5
6
73

X

x

Are any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body?
.
.

x

Did the organization contemporaneously document the meetings held or written actions undertaken during
the year by the following

xx

The governing body?
.
Each committee with authority to act on behalf of the governing body?
.
Is there any ofcer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at
the organization's mailing address? If Yes, provide the names and addresses in Schedule 0
.

A
9

x

Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes No
10a
b

Did the organization have local chapters, branches, or afliates?
.
. .
If Yes, did the organization have written policies and procedures governing the activities of such chapters,
afliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

10a

X

10b

N

11a

Has the organization provided a complete copy of this Form 990 to all members of its governing body before ling the form?

113

x

12a

Describe in Schedule 0 the process, if any, used by the organization to review this Form 990. SE3 SCHEDULE 0 ii-, ' ,*,;t
Did the organization have a written conict of interest policy? lf"No," go to line 13
.
12a X
Were ofcers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conicts?
12b x

A

Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes,"
describe In Schedule C /'l0W this Was done
SEE SCHEDULE 0
.
.
13
14
15

16a

Did the organization have a written whistleblower policy?
.
Did the organization have a written document retention and destruction policy?
.
Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management ofcial
Other ofcers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule 0 (see instructions)
Did the organization invest in, contribute assets to, or participate in a Joint venture or similar arrangement
with a taxable entity during the year?

If Yes, did the organization follow a written policy or procedure requiring the organization to evaluate its
. j
5:
participation in ]Oll'|1 venture arrangements under applicable federal tax law, and take steps to safeguard the A:
.
3.
organization's exempt status with respect to such arrangements?
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be led >
CA, UT
18
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 99of'}iH 990-T (Section 50-1-(_c_)_(3)s only)available for public inspection Indicate how you made these available Check all that apply
19
20

El Own website
D Another's website
El Upon request
Describe in Schedule 0 whether (and if so, how), the organization made its governing documents, conict of interest policy,
and nancial statements available to the public during the tax year SEE SCHEDULE 0
State the name, physical address, and telephone number of the person who possesses the books and records of the
9an|Z-3110 F ANGELA SWALLOW; 801-323-4202; 55 NORTH 300 WEST, SUITE 375 , SLC, UT
Form 990 (2011)

Form 990 (2011)

Page 7
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees,
and Independent Contractors

_,
Check if Schedule 0 contains a response to any question in this Part VII
.
.
.
. . . . U
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed Report compensation for the calendar year ending with or within the
organization's tax year
0 List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of
compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid
0 List all ofthe organization's current key employees, if any See instructions for definition of "key employee.
0 List the organization's ve current highest compensated employees (other than an ofcer, director, trustee, or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations
0 List all of the organization's former officers, key employees, and highest compensated employees who received more than
$100,000 of reportable compensation from the organization and any related organizations
- List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order individual trustees or directors, institutional trustees, officers, key employees; highest
compensated employees, and former such persons
[E Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee
(C)
(A)
Name and Title

(B)
Average
hours per
week
(describe
hours for
related
organizations
in Schedule
0)

_.(.1_)_1_<ITH _E}_-___ll_9_l9ULLIN _________________ __
PRESIDENT (BEGINNING APRIL 2012)

1

-.(.?)_T}?9??.*_.}SE{X__R9J'!};.._9_B_; ________________ _VICE PRESIDENT AND TREASURER/TRUSTEE

1

..()_~.7.-_..RY_}?__E~RE ______________________________ __
VICE PRESIDENT AND SECRETARY/TRUSTEE
-.(.).39.1.i*N._.1?._:_-___1_1_*?*?%\_EZ1S_____________________________ __
TRUSTEE/EXECUTIVE DIRECTOR
-.()_Yl_?}B_.*_*_-__-!!}_P_T:f=3 ________________________________ __
PRESIDENT (PRIOR TO APRIL 2012)

l

(do not chggkslrlngre than one
(D)
(E)
box_ unless person .5 mm an
Reportable
Reportable
omcemndad,,ec(o,/(,u5(ee) compensation compensation from
_ _ O X m: _n
from
related
3% Q 3 53 3.5 9,
the
organizations
$3 5 ,_".: I'D
g
organization
(W-2/1099-MISC)
3.5 2-;
3 Q; " (W-2/1099-MISC)
"E i
5<_
g
g E:
8
g
g 2.
2D)
(D
3
D.

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

X

0

O

0

X

X

0

O

0

1

X

X

0

0

0

l

X

0

0

O

0

0

0

X

-.ll__________________________________________________________ __
-112__________________________________________________________ __
..(l__________________________________________________________ __
..<.9.l__________________________________________________________ -_
.119.)__________________________________________________________ __
.111)__________________________________________________________ __
.112.)__________________________________________________________ __
ll?)__________________________________________________________ __
11.4)__________________________________________________________ __
Form 990 (2011)

I
Page 8

Form 990 (2011)
Part_ VII

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(0)
(A)
Name and title

(3)
Average
hours per
week
(describe
hours for
related
organizations
in Schedule
0)

(do not CheP?ksIrlll(;rlEe than one
(D)
(E)
bx_ uniess person ,5 both an
Reportable
Reportable
omcer and a dlrectomrusyee) compensation compensation from
0 _ _ O X m I _n
from
related
*3 E __ m 3 - Q
the
organizations
3
3
3
organization
(W-2/1099-MISC)
9.5 5
3 8 g " (W-2/1099-MISC)
9
g
g 5
3
3
8 e
'2

(F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations

15)__________________________________________________________ __
_l1)__________________________________________________________ -_
ll?)_________________________________________________________
_i_1_*_3_)__________________________________________________________ __
11.?)__________________________________________________________ __
1.2.9)__________________________________________________________ __
_l?_1)__________________________________________________________ -_
1.2.?)__________________________________________________________ _5.2.?)__________________________________________________________ ..i.2_f~)__________________________________________________________ __
_(?__l__________________________________________________________ __
1b

2

Sub-total

.

.

>

c

Total from continuation sheets to Part VII, Section A

>

d

Total (add lines 1b and 1c)

>

0

0

0

O

O

O

Total number of individuals Gncluding but not limited to those listed above) who received more than $100,000 of
reportable compensation from the organization >
0
Yes

3

Did the organization list any former officer, director, or trustee, key employee, or highest compensated
employee on line 1a7 If "Yes," complete Schedule J for such rndrvrdual
. . .
.
.

4

For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the
organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual .
. .
. .
.
.

4

;-f3l 7
. ,
x

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual
for services rendered to the organization? If Yes, complete Schedule J for such person

if
5

X

5

CZ.
3

No

l*Z"3" ']
x

Section B. Independent Contractors
1
Complete this table for your ve highest compensated independent contractors that received more than $100,000 of
compensation from the organization Report compensation for the calendar year ending with or within the organization's tax
year
Name and business address

(5)
Description of services

(0)
Compensation

NOT APPLICABLE

2

Total number of independent contractors (including but not limited to those listed above) who
received more than $100,000 of compensation from the organization >
0

., .

'-,"'

1

Form 990 (2011)


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