U.S. TREAS Form treas-irs-990-ez-1992
Form
990EZ
OMB No. 1545-1150
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c) of the Internal Revenue Code (except black lung benefit trust or
private foundation) or section 4947(a)(1) charitable trust
� For organizations with gross receipts less than $100,000 and total assets less
than $250,000 at the end of the year.
Department of the Treasury
The organization may have to use a copy of this return to satisfy state reporting requirements.
Internal Revenue Service
A For the calendar year 1992, or fiscal year beginning
, 1992, and ending
, 19
C
Employer identification number
Number and street (or P.O. box no., if mail is not delivered to street address) Room/suite
D
State registration number
City, town, or post office, state, and ZIP code
E
Enter four-digit group exemption
number (GEN)
B Name of organization
Please
use IRS
label or
print or
type.
See
Specific
Instruc­
tions.
This Form is
Open to Public
Inspection
F Check type of organization—Exempt under section
�
501(c) (
) (insert number),
OR
�
if exemption application pending.
G Check
I Accounting method:
Cash
Accrual
�
section 4947(a)(1) charitable trust
H Check
Other (specify)
�
if address changed.
�
J Check �
if the organization’s gross receipts are normally not more than $25,000. The organization need not file a return with the IRS; but if the organization
received a Form 990 Package in the mail, the organization should file a return without financial data. Some states require a complete return.
� $
K Enter the organization’s 1992 gross receipts (add back lines 5b, 6b, and 7b, to line 9)
If $100,000 or more, the organization must file Form 990 instead of Form 990EZ.
Revenue
Part I
1
2
3
4
5a
b
c
6
a
Statement of Revenue, Expenses, and Changes in Net Assets or Fund Balances
Net Assets
Expenses
b
c
7a
b
c Gross profit or (loss) (line 7a less line 7b)
8 Other revenue (describe �
9 Total revenue (add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8)
10
11
12
13
14
15
16
17
Grants and similar amounts paid (attach schedule)
Benefits paid to or for members
Salaries, other compensation, and employee benefits
Professional fees and other payments to independent contractors
Occupancy, rent, utilities, and maintenance
Printing, publications, postage, and shipping
Other expenses (describe �
Total expenses (add lines 10 through 16)
18
19
Excess or (deficit) for the year (line 9 less line 17)
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)
Other changes in net assets or fund balances (attach explanation)
Net assets or fund balances at end of year (combine lines 18 through 20)
(must agree with line 27, column (B))
20
21
Part II
1
2
3
4
Contributions, gifts, grants, and similar amounts received (attach schedule—see instructions)
Program service revenue
Membership dues and assessments (see instructions)
Investment income
5a
Gross amount from sale of assets other than inventory
5b
Less: cost or other basis and sales expenses
Gain or (loss) (line 5a less line 5b) (attach schedule)
Special events and activities (attach schedule—see instructions):
of contributions
Gross revenue (not including $
6a
reported on line 1)
6b
Less: direct expenses
Net income or (loss) (line 6a less line 6b)
7a
Gross sales less returns and allowances
7b
Less: cost of goods sold
5c
6c
)
�
)
�
7c
8
9
10
11
12
13
14
15
16
17
18
19
20
�
21
Balance Sheets—If Total assets on line 25, column (B) are $250,000 or more, Form 990 must be filed instead of Form 990EZ.
(A) Beginning of year
22 Cash, savings, and investments
23 Land and buildings
24 Other assets (describe �
25 Total assets
26 Total liabilities (describe �
27 Net assets or fund balances (column (B) must agree with line 21)
For Paperwork Reduction Act Notice, see page 1 of the separate instructions.
(B) End of year
22
23
24
25
26
27
)
)
Cat. No. 10642I
Form
990EZ
(1992)
Form 990EZ (1992) Part III
Page
Statement of Program Service Accomplishments—(see instructions)
2
Expenses
(Required for 501(c)(3) and (4)
organizations and 4947(a)(1)
trusts; optional for others.)
Describe what was achieved in carrying out the organization’s exempt purposes. Fully describe the
services provided, the number of persons benefited, or other relevant information for each program title.
28
(Grants $
)
(Grants $
)
(Grants $
(Grants $
)
)
29
30
31 Other program services (attach schedule)
32 Total program service expenses (add lines 28 through 31)
Part IV
List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated. See instructions.)
(A) Name and address
Part V
33
34
35 a
b
36
�
(B) Title and average
hours per week
devoted to position
(C) Compensation
(If not paid,
enter -0-.)
(D) Contributions
to employee
benefit plans
(E) Expense
account and
other allowances
Other Information—Section 501(c)(3) organizations and section 4947(a)(1) charitable trusts must
also complete and attach Schedule A (Form 990). (See General Instruction D1.)
Yes No
Did the organization engage in any activity not previously reported to the Internal Revenue Service?
If “Yes,” attach a detailed description of each activity.
Were any changes made to the organizing or governing documents but not reported to the IRS?
If “Yes,” attach a conformed copy of the changes.
If the organization had income from business activities, such as those reported on lines 2, 6, and 7 (among others), but NOT
reported on Form 990-T, attach a statement explaining your reason for not reporting the income on Form 990-T.
Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return?
If “Yes,” has it filed a tax return on Form 990-T, Exempt Organization Business Income Tax Return, for this year?
Was there a liquidation, dissolution, termination, or substantial contraction during the year? (See instructions.)
If “Yes,” attach a statement as described in the instructions.
Enter amount of political expenditures, direct or indirect, as described in the instructions. � 37a
37a
b Did the organization file Form 1120-POL, U.S. Income Tax Return for Certain Political Organizations, 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 unpaid at the start of the period covered by this return?
38b
b If “Yes,” attach the schedule specified in the instructions and enter the amount involved
39 Section 501(c)(7) organizations.—Enter:
39a
a Initiation fees and capital contributions included on line 9
39b
b Gross receipts, included on line 9, for public use of club facilities (see instructions)
c Does the club’s governing instrument or any written policy statement provide for discrimination against any person
because of race, color, or religion? (If “Yes,” attach statement; see instructions.)
40 List the states with which a copy of this return is filed. �
)
41 The books are in care of �
Telephone no. � (
42
ZIP code �
Located at �
Section 4947(a)(1) charitable trusts filing Form 990EZ in lieu of Form 1041, U.S. Fiduciary Income Tax Return.—Check here
�
and enter the amount of tax-exempt interest received or accrued during the tax year
42
Please
Sign
Here
Paid
Preparer’s
Use Only
�
Under penalties of perjury, 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. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
�
Signature of officer Preparer’s
signature
�
Firm’s name (or
yours if self-employed)
and address
Date
�
Title
Date
�
ZIP code
Check if selfemployed �