Short Form
Return of Organization Exempt From lncome Tax
,-''990'EZ
)
Deparlment ol the Treasury
lnternal Revenue Servics
A Forthe20ll
calendar
B
Checkifapplicable
I
noar"*"
D
I
I
f]
Nffie chilge
"i,-g,
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or tax
June:i0
,2011, and ending
Jul
,n
12
O Employer identification numb€r
Dcl l"'iar C;ornmunity Conncctions
33 0938895
Number and street (or P.O. box, if mail is not delivered to stre€t address)
E Telephone number
City or town, state or country, and ZIP + 4
F
lnitiatretum
858 792 5947
Tminareo
Amendeo retum
Applicalion pending
M.rr, CA $2$1,t
J Tax-exemptstatus(checkonlyone)-
L
2@11
Under section 501(c), 527, oilt947(axl) of tho lnternal Reyonuo Code
(excopt black lung benent tust or private loundation)
Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facililies,
and certain controlling organizations as defined in section 512(bX13) must fil€ Form 990 (see instructions).
All other organizations wilh gross receipts tess than $200,000 and total assets less than $s00,000
at the end of the year may use this form.
have to
Cash
G Accounting Method:
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K
OMB No. 1545-1 150
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Number
59,17
Accrual
8501(cX3)
Group Exemption
Other (specifu)
)
H Check
)
)
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if the organization is not
required to attach Schedule B
(Form 990, 990-EZ, or 990-PR.
n Sot(c)( ) <
if the organization is not a section 509(a)(3) supporting organization or a section 527 organizalion and its gross receipts are normally
Check
not more than $50,000. A Form 990-EZ or Form 990 return is not reguired though Form 990-N (e-postcard) may be required (see instructions). But if
the organization chooses to file a return, be sure to file a complete return.
Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. lf gross receipts are $200,000 or more, or if total assets (Part ll,
l55tlillj
line 25, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ
Revenue, Expenses, and Changes in Net
used Schedule O to
Check if the
or Fund Balances (see the instructions
ion in this Part
I
78057
442{]4
1527
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o
EC
2097.2
97.3
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8000
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320037
For Paperwork Reduction Act Notice, see the separate instruclions.
187,
Cat. No. 106421
(2011)
Form 990-EZ (2011)
E!@
Page
Balance Sheets. (see the instructions for Part ll.)
Check if the
used Schedule O to
in this Part
ll
.
2
. A
(B) End of year
22
23
24
Cash, savings, and investments
Land and buildings .
Other asseis (describe in Schedule O)
257855
25
Total assets
324A37
26
27
Totalliabilities (describe
621
.
in Schedule O)
Net assets or fund balances (line 27 of column (B) must
with line 21)
31
6618
Statement of Program Seruice Accomplishments (see the instructions for Part lll.)
Check if the orqanization used Schedule O to resoond to anv question in this Part lll
What is the organization's primary exempt
purpose?
To creatc wehi of safety,
se
Expenses
rvice and support for serriors
4947(a)(1)
trusts; optional
for others.)
--o-fl!,S--p1-o-t1ig-qt-tltq-!eligf!'re-!iIt:!9-t-1':,-9il-qP-tt-o-!-l-l9t-:-c-19_i,:-9r!-:{i:9!Lg-.iittfi-u-4y-eL:r------------
lf this amount includes
2g
320037
(Required for section
501(cX3) and s01(cXa)
organizations and section
Describe the organization's program service accomplishments for each of its three largest program services,
as measured by expenses. ln a clear and concise manner, describe the services provided, the number of
persons benefited, and other relevant information for each
e8
Bl
check
here
>n
-!1g:ir-tii:l-o-99-r-t-'111:9-9iil-'"9-LY,-gf:l-:,q91-qg.l]|llll!trg:-t-91-{-ggTp-y-t-q-919:-:t'-:,.!9-c-4i-Tg-q!g-.iL-a-t-q-:9-ii9l
5C!'VlCO5,
lf this amount includes
31
32
check here
here
$
> tr
(Grants
) lf this amount includes foreiqn orants. check
Other program seryices (describe in Schedule O)
lf this amount includes
check here
1E*dltl
Total program service expenses (add lines 28a
31a) .
List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (see the instructions for Part lV.)
used Schedule O to resoond to
in this Part lV
Check if the
!
(b) Title and average
hours per week
{a} Name and address
devoted to position
1!-t
l-1,
-:q::-"-[-
--
Vicc frrcaiCent -" I
Director
-
3l-il Scrilentine DR, Do! mri, i:n-s2-01;
l-,-l g-t:g-1,-t:i v-ll::tl--- --- - -- -107t) Klish llJav, Dr;! tl'la!", Cn 9201d
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-0.
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"0-
Director
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President 16
Dircctor
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0
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8--Dirr:r:tor
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(d) Heallh benefits,
:ontributions to employer (sl Estimaled amount ol
compensation
other compensation
benelii plans, and
Forms W-2l1099-MlSC,
(if not paid, enter -0-)
defer€d compensation
(o) Beporlable
--------------
l,liiilii 6l6i;-
lreasure!'- 18
Director
7
-lt_'_-"-iy,-lta!f:459 Carolina RD
L,: ttlg: I lo-, -l-q l,i:
13781 Roscciott way, sair
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Secretary
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Director
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Dirccior
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Director
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l)ircctor
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rorm
990-EZ
(eott)
Form 990-EZ (201 1)
Other
ule A and
instructions for Pafi V Check if the
3it
u
contract statement
used Schedule O to
tion in this Part V
Did the organization engage in any significant activity not previously reported to the IRS? lf "Yes," provide a
detailed description of each activity in Schedule
O
Were any significant changes made to the organizing or governing documents? lf "Yes," attach a conformed
copy of the amended documents if they reflect a change to the organization's name. Otherwise, explain the
change on Sehedule O (see instructions)
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others)?
b
lf "Yes," to line 35a, has the organization filed a Form 990-T for the year? lf "No," provide an explanation in Schedule O
501 (cX ), 501 (cXs), or 501(c)(6) organization subject to section 6033(e) notice,
reporting, and proxy tax requirements during the year? lf "Yes," complete schedule c, part lll .
c Was the organization a section
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets
during the year? lf "Yes," complete applicable parts of Schedule N
37a Enter amount of political expenditures, direct or indirect, as described in the instructions.
37a
b Did the organization file Form 1120-POL for this year?
38a Did the organization bonow 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 tax year covered by this return?
lf "Yes," complete Schedule L, Part ll and enter the total amount involved
38b
Section 501(cX7) organizations. Enter:
lnitiation fees and capital contributions included on line 9
Gross receipts, included on line 9, for public use of club facilities
4Oa Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
36
)
b
39
a
b
b
{) ; section 4912>
o
t ; section 4955>
section 491 1 >
Section 501(cX3) and 501 (cX4) organizations, Did the organization engage in any section 4958 excess benefit
transaction during the year, or did it engage in an excess benefit transaction in aprioryear that has not been
reported on any of its prior Forms 990 or 990-EZ? lf "Yes," complete Schedule L, Part I .
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
.
(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c
reimbursed by the organization
e All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? lf "Yes," complete Form 8886-T. .
List the states with which a copy of this return is filed. ) Catiiornia
41
42a The organization's books are in care of )
-Katlry_l1nl'lLl__---__-_-__-_ _____-___ Telephone no. >___--_-q?_q_19-?_?l_l!l_-_--9r,(t14
Located at > ',).25 tltir 5T, ilci Mrr, Ci\
ZIP + 4 )
Section
501
b
a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
lf "Yes," enier the name of the foreign country: )
See the instructions for exceptions and filing reguirements for Form TD F 90-22.1, Report of Foreign Bank
and Financial Accounts.
c
43
At any time during the calendar year, did the organization maintain an office outside the U.S.? .
lf "Yes," enter the name of the foreign country; )
Section a9a7@)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041 -Check here
and enter the amount of tax-exempt interest received or accrued during the tax year
!
. > 143
organization maintain any donor advised funds during the year? lf "Yes," Form 990 must be
completed instead of Form 990-EZ
Did the organization operate one or more hospital facilities during the year? lf "Yes," Form 990 must be
completed instead of Form 990-2.
Did the organization receive any payments for indoor tanning services during the year?
lf "Yes" to line 44c, has the organization filed a Form 720 to report these payments? /f "No, " provide an
explanation in Schedule O
Yes No
44a Did the
c
d
Sa
45b
Did the organization have a controlled entity within the meaning of section 512(bX13)?
Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(bX13)? lf "Yes," Form 990 and Schedule R may need to be completed instead of
Form 990-EZ (see instructions) .
44e
/
44b
4c
44d
45a
4.5b
rorm
990-EZ
(eorr)
Form 990-EZ (20'11)
Page
4
No
Did the organization engage, directly or indirecily, in political campaign activities on behalf of or in opposition
candidates for public oflice? lf "Yes," complete Schedule C, part I
46
to
501
organizations and section
nonexempt
trusts only. All section
n 4947(a)(1) nonexempt charitable trusts must answer questions 4749b
501 (cX3) organizations and sectio
and 52, and complete the tables for tines 50 and b1.
Check if the
used Schedule O to
in this Part
Vl
tr
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax
yeafl lt "Yes," complete Schedule C, Part il
#
49a
b
50
ls the organization a school as described in section 170(bX1X4(i)? lf "Yes," complete Schedule E
Did the organization make any transfers to an exempt non-charitable related organization? .
lf "Yes," was the related organization a section 52T organizalion?
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key
employees) who each received more than $100,000 of compensation from the organization. lf there is none, enter "None."
{
(a) Name and address of each employee
paid more than $100,000
i\.lr;
(b) Title and average
hours per we€k
devoted to position
(c) Reportable
compensation
(Forms W-2l1099-MISC)
{d) Health benefits,
contributions to employee
(el Estimated amount ol
other compensation
irr.
f
51
Total number of other employees paid over $100,000
Complete this table for the organization's five highest compensated independent contractors who each received more than
$100,000 of compensation from the organization. lf there is none, enter "None."
(a) Name and address of each independent contractor paid more than $1 00,000
{c} Compensation
dTotalnumberofotherindependentcontractorseachreceivingover$100,000.>
Did the organization complete Schedule A? Note: All seciion 501(c)(Q organizations and 4947(a)(1)
nonexempt charitable trusts must attach a completed Schedule A
52
) E Yes I
No
Under penalties of perjury, I declare that I have examined this return, including ac$ompanying schedules and statements, and to ihe b€st of my knowledge and belief, it is
true, cofiect, and complete. Declaraiion of preparer (olher than otticer) is based on all information of which preparer has any knowledge.
Sign
Here
Paid
Preparer
Use Only
)*#m
i(;tllt*r in:: lrinirlll, I rcasLu'rr
Type or print name and tille
PtintfType preparcr's name
cnecr
fl
it
self^employed
Firm's EIN
>
Phone no.
thelRSdiScussthisreturnwiththepreparershownabove?Seeinstructions>
porm
990-EZ
(zott)
SCHEDULE A
(Form 990 or 990-EZ)
Department of the Treasury
lnlernal Bevenue Service
OMB No. 1il5-0{X7
Public Gharity Status and Public Support
Complete if the organization is a section 501(cX3) organization or a section
49a7@)(1) nonexempt charitable trust.
)
Attach to Form 990 or Form 9S0-EZ.
)
2@11
See separate instructions.
Name of the organization
Employer identif ication number
l-)cl lilar Cenirnunity Connections
33 Cg38S85
instructions.
The organization is not a private toundation because it is; (For lines 1 through 11, check only one box.)
A church, convention of churches, or association of churches described in section 170(bXlXAX0.
A
n school described in section 170(bXlXAXii). (Attach Schedute E.)
A hospital or a cooperative hospitalseruice organization described in section 17O(bXlXAXli|.
l) A medical research organization operated in conjunction with a hospital described in section 170(bXlXAXiii). Enter the
hospital's name, city, and state:
1 !
2
3 fl
4
5[
An organization operated tor ttre ii-endfil oi-e-aoi6blt oii;nliEi-s],it-own;ei
section 170(bXlXAXiv). (Complete Part ll.)
il
oE];iaT bt a !i;i,;iiim6niai-u;it d;$;iGa-in
6 ! A federal, state, or local government or governmental unit described in section 17o(bXlXAXv).
7 @ An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(bXlXAXvi). (Complete Part lt.)
8 fl A community trust described in section 170(bXlXAXvi). (Comptete Part tt.)
9 D Rn organization that normally receives: (1) more than 331/s% 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 33i/g% of its
support from gross investment income and unrelated business taxable income (less section 51 1 tax) from businesses
acquired by the organization after June 30, '1975. See section S0O(aX2). (Complete Part lll.)
10 fl An organization organized and operated exclusively to test for public safety. See section 509(aXa).
11 lAn 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(aX1) or section 509(aX2). See section
509(aX3), Check the box that describes the type of supporting organization and complete lines 1 1e through 1 t h.
b [] TYPe ll
d n Type lll-Other
c n Type lll-Functionally integrated
D Typel
e D gy 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 described in section 509(aX1)
or section 509(a)(2).
f lf the organization received a written determination from the IRS that it is a Type I, Type ll, or Type lll supporting
organization, check this box
D
g 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? .
(iii) A 35% controlled entity of a person described in (i) or (ii) above? .
h Provide the following information about the supported
a
{i} Name of supported
organization
(iiil Type of organization
(vii) Amount ol
(described on lines 1-9
above or IRC section
(see instructons))
support
(A)
(B)
(c)
(D)
(q
For Papenvork Reduction Act Notice, see the lnslructions
Form 99O or 990-EZ.
for
Cat. No. 11285F
Schedulg A (Form 990 or 990-EZl 2011
Version A, cycle
Schedule A (Form 990 or S90-E4 201
Pase2
1
li@llSupportSchedulefororganizationsDescribedinS
(Complete only if you checked the box on line 5,7, or 8 of Part I or if the organization failed to qualify under
Paft lll. lf the organization fails to qualify under the tests listed below, please complete Part lll.)
Section A. Public
)
Galendar year (or fiscal year beginning in)
'l Gifts, grants, contributions,
Total
and
membership fees received. (Do not
include any "unusual grants.")
71!;01
Tax revenues levied for
the
organization's benefit and either paid
to or expended on its behalf
The value of services or
facilities
furnished by a governmental unit to the
organization without charge .
4
Total. Add lines 1 through 3
5
The portion of total contributions by
19000
1 A
.
lita
584822
each person (other than a
governmental unit or publicly
suppofted organization) included on
line 1 that exceeds 2%o of the amount
shown on line 11, column (f)
Public
.
Subtract line 5 from line 4.
B. Total
Galendar year (or fiscal year beginning in)
7
8
58482?.
)
Total
Amounts from line 4
Gross income from interest, dividends,
payments received on securities loans,
rents, royalties and income from similar
584',d22
sources
9
Net income from unrelated
business
activities, whether or not the business
is regularly canied on
10
Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Pad lV.)
11
12
13
16a
b
7
through '1 0
61 7505
Gross receipts from related activities, etc. (see instructions)
First five years. lf the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501
organization, check this box and stop here
E I t {;$:t
of Public
Section C.
14
15
.
Total support. Add lines
94.7 o/o
Public support percentage tor 2011 (line 6, column (0 divided by line '1 1, column (f))
{t?..3 0/o
Public supporl percentage from 2010 Schedule A, Part ll, line 14
filoo/o support test-2011. lf the organization did not check the box on line 13, and line 14 is 331tsyo or more, check this
boxandstophere.Theorganizationqualifiesasapubliclysupportedorganization>
$1rs%o suppon
test-2010. lf the organization did not check a box on line 13 or 16a, and line 15 is 331rsolo or
more,
checkthisboxandstophere.Theorganizationqualifiesasapubliclysupportedorganization>
a
n
17a 107o-facts-and-circumstances test-2011.
lf the organization did not check a box on line 13, 16a, or 16b, and line 14 is
more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in
Part lV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
1oo/o
b
18
1
or
tr
10%-facts-and-circumstances test-2010. lf 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 Pad lV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization
Private foundation. lf the organization did not check a box on line 13, 1 6a, 1 6b, 17a, or 17b, check this box and see
instructions
Schedule A (Form 99O or 99O-EZI2O11
Schedule A (Form 990 or 990-EZ) 201
U!flUl
1
Page
Support Schedule for Organizations Described in Section 5tt9(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part ll.
lf the
fails to
under the tests listed below,
Part I
Section A. Public
Calendar year (or fiscal year beginning in)
1
2
3
)
Gifts, grants, contributions, and membership fees
received. (Do not include any "unusual grants.')
Gross receipts lrom admissions, merchandise
sold or services performed, or facilities
furnished in any activity that is related to the
organization's tax-exempt purpose
Gross receipts from activities that are not an
unrelated trade or business under section
for
Tax revenues levied
51 3
the
organization's benefit and either paid
to or expended on its behalf
The value of services or
6
7a
facilities
furnished by a governmental unit to the
organization without charge .
Total. Add lines 1 through 5 ,
Amounts included on lines 1, 2, and 3
received from disqualified persons
Amounts included on lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1Yo of lhe amount on line 13 for the year
I
c Add lines TaandTb
Public support (Subtract line 7c from
line 6.)
.
B. Total
Galendar year (or fiscal year beginning in)
9
10a
)
Amounts from line 6
Gross income lrom 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
11
.
Add lines 10a and 10b
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
13
Total support. (Add
(Explain in Part lV.)
.
10c, 11,
and 12.)
14
First five years. lf the Form 990 is for the organization's first, second, third, fourth, or
organization, check this box and stop here
15
16
Public support percentage for 201 1 (line 8, column (0 divided by line 13, column (f)
Public support percentage from 2010 Schedule A, Part lll, line 1 5
tax year as a section 501(cX3)
of Public
%
o/o
of lnvestment lncome
17
18
19a
b
ZO
%
lnvestment income percentage for 2011 (line 1 0c, column {0 divided by line 13, column (f))
%
lnvestment income percentage from 2O1O Schedule A, Part lll, line 17 .
331rs7o support tests-2011. lf the organization did not check the box on line 14, and line 15 is more than 331rso/6, and line
17 is not more than 331rso/o, check this box and stop here. The organization qualifies as a publicly supported organization > !
331rso/osupporttests-2010. lftheorganizationdidnotcheckaboxonline14orlinelga,andline16ismorethan33lroo/o,and
line 18 is not more than 331n%, check this box and stop here. The organization qualifies as a publicly supported organization > n
Private foundation. lf the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ) n
Schedule A (Form 99O or 990-EZ) 2011
3
eage4
instructions)'
schedule A (Form
99O or 990-EZ! 201'l
SCHEDULE G
(Form 990 or
Depariment of the Treasury
lnternal Revenue Service
Sqpplqm_eqtal lnformation Regarding
Fdndraising or Gaming ActiVities
-
OMB No. 1545-0047
Complete it th€ organization answered ,Yes( to Form 990, Part lV, lines 17, 18, or 19, or if th€
organization entored more than $15,000 on Form 990-EZ, line 6a.
> Attach to Form gOO or Form 990-eZ > Se€ separato inatuctions.
2@1t
the organization
Del Mar fji)mmunitv Ccnncoliollr;
r@F:#a"r'1??fj,lTi"";3iff,,?.3,j"ff
1
a
b
c
d
2a
"T"?,1'"11?J€nswered"Yes"toForm
lndicate whether the organization raised funds through
any of the following activities. Check all that apply.
uaitsolicitations
Soticitation of non-government grants
Solicitation of government grants
lnternet and email solicitations
Phone solicitations
Specialfundraising events
fl ln-person solicitations
Did the organization have a written or oral agreement with any individual (including otficers, directors, trustees
or key employees listed in Form 990, Part Vll) or entity in connection with professional fundraising services? f] Yes fl tto
lf "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.
en
f n
gI
n
I
f]
(vilAmount paid to
(il Name and address of individual
or entity (fundraise0
(or retained by)
organization
10
List all statei in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from
registration or licensing.
Paperwork Feducton Act Notice, se6 the lnstructions for Form
9{X)
or 99O-EZ.
Cat. No. 50083H
Schedule G (Form 9gO or
990'ul- m1l
Schedule G {Form 990 or 990-E4 201
Ulsll
eage2
1
Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part lV, line 18,
oi
ieported more
than $15,000 of fundraising event contributions and gross income on Form ggO-EZ,lines 1 and 6b. List events with
receipts greater than $5,000.
(b)
Event #2
Gti*:st bar tcnrlor
(cl Otherevents
l.,4omoii;il walk
o)
o)
q)
E
1
2
Gross receipts
Less: Charitable
contributions
3
Gross income (line 1 minus
line 2) .
4
Cash prizes
5
Noncash prizes
0l
o
C
6
RenVfacility costs
o.
7
Food and beverages
8
Entertainment
9
Other direct expenses
o
q)
X
IU
o
c)
.!
o
1O
l1
ii187
3431;
fii,,.
Direct expense summary. Add lines 4 through 9 in column (d)
Net income summary. Combine line 3, column (d), and line 10
answered "Y
orm 990,
,
or reported more
{d) Total gaming (add
col. (a) through col. {c))
I
a
Enter the state(s) in which the organization operates gaming activities: _-__ls the organization licensed to operate gaming activities in each of these states?
b
lf "No," explain:
1Oa
b
Were any of the organization's gaming licenses revoked, suspended or terminated during the
lf "Yes," explain:
- -v;;-n-N;
laxyear?
tr
Yes
n
No
Schedule G {Form 99o or 99O-EiZl2g11
)
Schedule G (Form 990 or 990-FZ) 2011
11
12
eage
ls the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming?
13
lndicate the percentage of gaming activity operated in:
a The organization's facility
b An outside lacility
14 Enter the name and address of the person who prepares the organization's gaming/special events books and
records:
Name
b
c
)
Does the organization have a contract with a third party from whom the organization receives gaming
revenue?
lf "Yes," enter the amount of gaming revenue received by the organization
amount of gaming revenue retained by the third pafty > $
lf "Yes," enter name and address of the third party:
Name
)
tl
$
Yes
n
No
and the
)
Address
16
EYesIHo
)
Address
15a
)
Gaming manager information:
Name
)
Gaming manager compensation
Description of services provided
n
Director/otficer
D
Employee
f]
lndependent contractor
Mandatory distributions:
17
a
ls ihe organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license?
b
[l@|
3
EYesnruo
Does the organization operate gaming activities with nonmembers?
nYesnNo
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
$
>
Supplemental lnformation. Complete this part to provide the explanations required by Part I, line 2b,
columns (iii)and (v), and Part lll, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this
paft to
any additional information (see instructions).
Schedule G {Form glxl or 99O-EZ) 2O1 l
SCHEDULE O
(Form 990 or
OMB No. 1545-0047
Supplemental lnformation to Form 99O or 99O-EZ
Department of the Treasury
lntemal Revanue Service
2@ll
Complete to provide information for respons€s to specific questions on
Form 990 of ggO-EZ or to provlds any addltlonal inforriatlon.
> Attach to Form 990 or 990-EZ.
Name of the organization
Employer identificalion number
Dul Mrr Comnlunity Conrrections
33 09388C5
9g0EZPartl, lineS: Futtdsremovedfromrestriction$187,payroll taxandinstirancercfunds$736
For Paperwork Reduction Act Notice, see the lnslructions for Form 9fl) or 990-EZ.
Cat. No.
51056K
Schedule O (Form
$n
or 990'EZ) (2011)
,.",,''
Application for Extension of Time To Flle an
Exempt Organization Return
8868
(Re,'. Janijary 2012)
)
Depa4n?nl of lhe Treesl'),
Inteintl Rs', Jii,e SslY;c?
O[,iB No. 1545-1709
File a separate application for each return.
rlfyouarefiiingforanAutomatic3.MonthExtension,cornpleteonlyPartlanclcheokthisbox.>
r lf !,ou are filing tor an Additional (Not Automatic) 3-Month Extension, complete only Part ll (on page 2 of this form).
Do not complete Part ll unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.
Electronic filing (e-f,te). You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for
a corporation required to file Form 9S0-T), or an additional (not automatic) 3-rnonth extension of time. You can electronically file Form
8868 to request an extension of time to file any of the forms listed in Part I or Parl ll rvith the exception of Form 8870, lnformation
Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see
instructions). For more details on the electronic filing of this form, visit ututvt.irs.gov/efile and click on e-file for Charities & Nonprofits.
A corporation required to file Form 990-T and requesting an automatic
Part
lonly
-month extension-check this box and complete
> f]
All other corporations (including 1120-C filers), partnetships, RElvllCs, and trusts must use Form 7004 to request an extension of time
to file income tax retums.
Enter tiler's identifying nunrber, see instructions
Type or
Del
print
Fr
e
Cie
Errrployer icientification nunrber (ElN) ot
Na.lte ol exenrpt orgaaizatioir or other {tler, see ir.:str'uclior:s.
Connections
tular
33 0938895
Social security nurlrtrer (SSN)
Nurrrber, street, anci rocnr or suite no. if a P.O. box, see instruclicr.rs.
b),iie
Ciaie iD'
i, lq !|ir
P. O. Box 2947
Ci\r. tot'rrr or post ofiice, state, a'rd ZIP cocie
iLriu, rr. s3E
a loreign aocirsss, see instruciions
Mar, CA 92014
F-l-il
Enter ihe Return code for ihe return that this application is for (file a separate application for each retltrn)
Application
ls For
i
Forrn 990
Form 990-B[.
Form 990-EZ
Form 990-PF
Form 990-T (sec. 40'1 ia) or
Folm 990-T (trust otlter than above)
o
The books are in the care of
)
Return
Code
o2
01
Beturn
Application
ls For
Code
07
Form 990-T
Forrn 1041-A
Form 4724
Form 5227
Form 6069
Form 8870
OB
12
Kathy Finnell
)
- _-__---
No.
FAX
Tereprrone No.
_
_!!!_!91-!3!L.
______-_---- . ---9"!9_-i-911_1_59-_rtot ha'.,e an office or place of business in ihe United Staies, check this box .
does
lf
the
organizaiion
'r
. lf this ls
lf ihis is for a Group Return, enter the organization's four digit Group Exernption Number (GEN)
and
attach
r.,.rhole
group,
group,
this
part
this
box
check
. lf ii is for
check
fJ
of the
for the
a list r';itir the names and ElNs of all members the extension is for.
I request an ar-rtomatic 3-month (6 months for a corp:oration required to file Form 990-T) extension of time
until _ _- - __f9-!-]_!r_-____ - , 2A .11-, to file the exempt organization return for tlre organization named above. The extension is
for the organization's return for:
or
> calendar year
box
. >[
)
> fl
1
I
20
> E tax year beginning
June 30
"-_-."_"..-"-.ty_LIl_-- _ ..--- _ -, , 20 -_-11 _ , and ending ..__-__._____
lnitial return
D Final return
if iire tax year entered in line 1 is for less tl'ran 12 months, checl< reason:
Change in accounting Period
3a lf this application is for Forrn 990-BL, 990-PF, 990-T, 4720, or 6069, enter the teniative tax, less any
nonref undable credits. See instrttctions.
b lf this application is tor Form 990-PF, 590-T, 4720, or 6069, enter any refr-rndable credits and
estimated tax payments made. lnclude any prior year overpayrnent allor,ved as a credit.
3b
ttrrs torm),'tt r-eq*r"d-, bt ,"ins
Balance Aue. Subtracitirre SOfrbm iineTa. trrituae your fiayment
" EFTP$ (Electronic Federal Tax Payment Systenr). See instructions.',vittr
3c l$
Caution. if you are golng to niake arr eleclronic {unci r"iithcirar",,al vJith this Fornr 8868, see Form 8453-EO and Form 8879-EO for payment inslruciions,
Forrn Uts6U (Fte!. 1-2012)
Cat. No.27916D
For Privacy Act and Paperwork Reduction Act Notice, see lnstructions.
2
il
--
n
20t245
c7. 67 20t206 670
086947
3345
92014
29404-287-50873-2
K
:130938895
IITS USF] ONI-Y
A0124r88
]'E
For assistance, call:
ffiql
t-877-829-5s00
f,{ilt+'t;'j;i:Tj':?
Notice Number: CP2l
Date: Novernber
lA
19, 2012
Taxpayer ldentilication Nnmber:
o2t902-!27972.0082.002 1 AT 0.374
373
t,ltlltl,hlt,il11tr1rl111'r1h111t"1111'il'lllrrllt1ll1rl1rrrrl
33-0938f195
Tax Form: 990
I'ax Period: .lune 30, 2012
DEL MAR COMMUNITY CONNECTIONS
Po Bsx ?e47
DEL MAR CA 920L4-5947
P.1::;4
ITI-r+
liEr=
02t902
APPLICATION FOR EXTENSION OF TIME TO FILB AN BXEMPT
ORGANIZATION RETURN . APPROVED
We received and approved your Forrn 8868, Application for Extension of Time to File an Exempt
Organization RetLlrn, tbr tlie return (form) and tax period identified above. Your extetrded due date to file
your retum is February 15, 2013.
When it's time to file your Form 990,990-IF.Z.,990-PF or I 120-POL, you should consicler filing
electronically. Electronic tiling is the fastest, easiest and most accurate way to file your return. For more
infbrmation, visit the Charities and Nonprofit web at www.irs.gov/eo. This site will provide infbrmation
about:
-
The type of retums that can be filed electronically,
approved e-File providers, and
if you are required to file electronically.
If you have any questions, please call us at the number shown above, or you may write us at the address
slrown at the top of this letter.
Page
I
2r
3
lA
TAXABLE YEAJ?
Galifornia Ex
Annual
2Afi
0rganization
r99
Return
01
CalendarYear 201 1 or fiscai year beginning month
year
Corporat,oniorganization Nanre
corporatron number
259686
33093889
Del Mar Communitv Conneclions
Adciress (suile, rcom, or PfuiB no.)
!N
OBox2947
P
Cily
ZIP Code
Del Mar
92014
.......flYes di,ro
A FirstRelurn.
.......O fYes dtuo
B AmendedFelurn..
C lRCSection4947(a)(1)tiust... .......[Yes Mwo
D Final Return
.......[Yes Mitto
.,
lf exempt under B&TC Section 23701 d. has the organizati0n
during the year: (1) participaied in any political campaign,
0r (2) attempted to influence legislation or any hallot l''reasure,
or (3) made an eleciion under R&TC Seciion 23704.5
(relaiing t0 lobbying by public charities)?. .
O DDissolved O[1Sun'enCered (Withdrarvn)
!
a
lv'lerged/Reorganized Enter date:
a
_l _l
ls the organization exempl under R&TC Section 23701g?
Check accounling meihocl:
Federal return liled?
(2)af]9e0(PF) (3)aflsch
ls this a group liling for the subordinates/af{iliates?. . .
H
ls this ofganizati0n in a group exemption?
lf "Yes. ' r,;hat is ihe parent's nanre?
L
qfoE
H (e90)
G
.
.
o [Yes
L
dtuo
If "Yes." atlach a r0ster. See instruclions
I
.. Iyes druo
.
O
[Yes
[diVo
goveining instrilmeni, afiicles 0f incorporation. or bylalis
that have not been repcried r0 ihe Franchise Tax Bcard? .
.l f,Yes
lf organization is exempt under R&TC Section 23701 d and is
exclusively r'eligious, eCucational, or charitable, and is
supp0iied primarily (500./o or more) by pubiic contributions,
checkbox.l,Joiilingfeeisrequired.
H
N
Did the 0rganizaiion ha,ie any changes in iis acrivities,
lf
l-lYes VlNo
lf 'Yes." enier ihe qr0ss receipls frcm nonmember'
ir)ilCash (2)flAccrual (3)n&her
(r).Iee0T
.t
.
lf ''Yes." complete and attach form ffB 3509
dNo
..........atr
lsthe oiganization a Limited Liability Companv? . .
.. ... . O
Did tlte organizallon lile Fotm 100 or Fonn 109 to tepott
llYes
Efttto
laxable income'i
O
[Yes [dNo
ls ihe orqanization under audit by ihe IRS or has lhe
IRS audited in a prior year?
O
L
iYes
l1lNo
Yes." explain, and airach copies of revised documents.
Parl
i
i
I
Receifls
and
I
I
Revenuesl
I
1 Gross sales
or receipts frcm olher sources. From Side 2, Pan ll, line
2 Gross dues anci assessnlents lronr rnernbers and afliliates . . .
a
B
,
,
o
3 Gr0ss c0ntrilruti0ns. gifts, grants, and sinrilar amounis received
4 Total qross receipts for liling requirement test. Add line 1 through line 3.
This line musl be compleled. lf the result is less than $25,000. see General lnst
I
5
Costofgoodssold....
6 Cost oroiherbasis.and salesexpenses
...
0fassetssold
.......... a
....... a
7 Toial costs. Add line 5 and line 6
8
Expenses
9 Total expenses and disbursenrents. Fionr Side
2 Pafi
ll, line i B
s
Flllng
Fee
jrr
Filing fee $i 0 or $25. See General lnstruciion
i't2
Total paynrents
lrs
lra
Use iax. See General
Penalties and lnterest. See General lnsrruction
lnstrucii0n
1
1
linc
F
J . . .. .
.
K
'1
liue, correct, and corp,ete, Declaratlor of preonrer iolher than taxpayef) is based on all informalron of whjch prepnrer has any knowiedge.
Title
Date
,
ll'Teiepno;ie
Sicrature
of-cfirce;
)
Treasurer
i)/is/t?'l
r asa \7s2-rs6s
Preoarer's
onati,te )
Paid
<
Preparer's
Use Only
Firms name (or yoLrrs,
if se,f-employed)
and address
For Privacy Notice, get form FTB 1131,
3651113
Form 199cr 20'11 Side
1
partll
Organizalionswilh0r0ssroceiptsolmorelhan$2S,000andprivrleloundalionsregardlessolamounlolgrossreceiplscomplete Part ll or furnish subslilute inlotmation. See Specilic Line lnshuclions.
1 Grosssalesorreceiptsfrcmallbusinessaclivities.
Seeinstructions
.........O
2 lnterest.
SDividends.
Grossrents...
Grossroyalties.
Reeeipls
trorn
4
5
6
0lher
Sources
......a
..........O
........O
Gross am0unt received from sale of assets (See
lnstructions) . . . .
.
T0therincome.Attachschedule
.....O
I
Tolal gross sales 0r receipls from other sources. Add line 1 through line 7.
g
Contribulions,gifis,grants,andsimilaranrountspaid.Attachschedule
Enler here and on Side 1. Pari l, line
1
,,.
11 Compensation oi oflicers, directors, and trustees. Attach schedule.
12
Other salaries and H'ages. .
Erpenses
and
13 lnierest.
DisbursemBnls
14
.......a
...........O
DisbursementstooIformembers.
'10
.
o
a
Taxes
lSRents
16 Depreciaiionanddepletion(Seeinsti'uctions)......
17 0therExpensesand Disbursements.Altach schedule.
..........a
.....a
...........O
17 Fnter
Schedule
L
Balanse $heels
End ol
ol laxable
larabls
Assels
1 Cash
2 Net accorinis receivable
3 ilet noies receivable
4 lnventories
5 Federal and state government oblioalicns.
6 lnvesimenlsinoiherbonds. ..........
7 lnves:ntents in siock.
I l.,4ortgage loans
I 0thsr in'/eslmenls. Attach scheCxle .
257.855
.
I
.
1
0
a Depreciable assets
.
b Less accuntulaieC depreciirtion . .
11
12
0tlrer assets. Aitach scl'edLlle
13
Toial assets.
.
q2,0e6
.
L-anci
B5
Liahililies and nel worlh
14
15
Accourtts payable
Contfibuii0ns. gifts, or grants pal,/able
Bcnds and r:otes payable..
.
16
17
18
19
|Jo;rgages pa'7able
.
0ther liabililies. Aitach schedule
Capital stock or principle fund. .
20
21
Paid"in or capital surplus. Attach reconciliation
Reiained earnings 0r income
fund . .
.
339,951
.
320.037
liabil ities
per bool(s with income per telurn
D0 n0tcornplete this schedule ifthe amount on Schedule L, line 13, column (d), is less than $25,000
1
2
3
4
lncome recorded on books this year
Net incorne pet books
Fet|eral
incore tar
not included in this return.
Excess of capital losses over capital gairts. .
Attach scl'edule
.
lncome not recorded on bcoks this
Deduciions in ihis return n0t charged
year: Aitach sclreCule
agains: book income this year.
Expenses recorded on books this year noi
deducied in ihis reiurr'r. Attach schedule
6
g
.
10
Total.
Add line 1 through lino
Side
2
Forrn
199ct
5,.
2011
..
.
19,727
3652rL3
Atlach scherlule
Total. Arld line 7 and line
B
Net income per rcturn.
Sublract line 9 irom line 6
ne.727\
DEL MAR COMMUNITY CONNECTIONS
SUPPORTING SCHEDULE FOR FORM 199
30Jun-12
Part l, line 3
Contributions and grants
Program service revenue incl government fees
Fund raising income
78057
44204
20922
143L83
Pe$-l!.&s
7
Payroll tax and worker's comp ins. refunds
Part ll, line 17
Professional fees
Printing and postage
Vehicle maintenance
3378
2956
2042
Senior lunches
L275
Health, legal and social service costs
ln-home service costs
Communications incl internet and phone
2ZA3
1013
Insurance
6233
9198
Storage
1.L76
Other
2795
32269
ANNUAL
REGISTRATION RENEWAL FEE REPORT
TO ATTORNEY GENERAL OF CALIFORNIA
MAIL TO:
Registry of Charitable Trusts
P.O. Box 903447
Sacramento, C A I 420347 0
Telephone: (91 8) 44C2021
Sections 12586 and 125/i7, Calitornia Government Code
11 Cal. Code Regs. sections 301-302,3i1 and 3i2
VVEB SITE ADDRESS:
i,: :.
i.i;.:,,.r
r, {:.,r,/,/t:;liti
;1
Failure to submit thls report annually no later than four months and fifteen days after tha
end ofthe organization's accounung period may result in the loss oftax exemption and
the assessment of a minimum tax of 1800, plus lnterest, and/or fines or filing penalties
as definod ln Govornment Code secuon I 2586.1. IRS extensions will be honored.
il'i;i
State Charlty Registtatlon Number
119626
Check if:
flctrange
Del Mar Community Connections
Name of organlzatlon
EAmended rpport
P O Box2947
AdcF$
(NUmbOr
of address
tnd streetl
Corporate or Organization No.
DelMar, CA92014
Clty or To$m, Stlte end AP Codo
Fede.at Emptoyor l.D.
No.
2259686
J
33 0938895
ANNUAL REGISTRATION RENEWAL FEE SCHEDULE (11 Cal. Code Regs. sections 301-307,311 and 312)
Make Check Payable to Attorney Generat's Rogistry of Charitabte Trusts
Gross Annual
Revenue
$25,000
$1@,000
Less than
Between $25,000 and
Revenue
GrossAnnual
Fee
$250,000
million
Between 100,001 and
Bstween $250,001 and $1
0
$25
Fevenue
Fee
GrossAnnual
$50
$75
Bstween $1,000,00{ and $10
Between $10,000,001 and $50
Greater than $50
million
Fee
mllllon
million
$150
$225
$3(X)
PART A . ACTIVITIES
Foryourmostrecentfullaccountlngporiod(beglnnlng
Gross annual revenue
$
7
145633
t1
t11
Totat assets
ending
$
6
/30 r12
;tist:
320037
PART B . STATEMENTS REGARDING ORGANIZATION DURING THE PERIOD OF THIS REPORT
Note:
lf you answer "yes" to any of the questions below, you must attach a separate sheet providing an explanation and detalls for each "yes"
response, Ploase rsview RRF.I instructions for information required.
Ygs
officer. director or lruslee thereof either directly or with an entity in which any such officer, director or trustee had any financial interest?
2.
3.
4.
During this reporting period, was there any theft, embezzlemenl, diversion or misuse of the organization's charitable property or funds?
During this reporting period, did non-program expenditures exceed 50% ofgross revenues?
During lhis reporting period, were any organization funds used to pay any penalty, fine or judgment? lf you filed a Form 4720 with the
lntemal Revenue Service, attach a copy.
5.
Duringthisreportingperiod,weretheservicesofacommercial
6.
During this reporting period, did the organization receive any governmental functing? lf so, provide an attachment listing the name of
the agency, mailing address, contact person, and telephone number.
7.
During this reporting period, did the organization hold a raffe for charitable purposes? lf "yes," provide an attachment indicating the
number of raffles and the date(s) they occurred.
8.
Does the organization conduct a vehicle donation program? lf "yes," provide an attachment inclicating whether the program is operated
by the charity or whether the organization contracls with a commercial fundraiser for charitable purpoaes.
9.
fundraiserorfundraisingcounsel
provide an attachment listing the name, address, and telephone number of the service provider.
organization's e-mait
(
858
.)-
792
7565
t_l
forcharitablepurposesused? lf"yes,"
Did your organizition have prepared an audited financial statement in accordance wilh generally accepled accounting principles for this
reporting period?
Organizalion's area code and telephone number
n
No
,<
il
xl
x
x
x
tFl
r
r
,C
n tE
email@dmcc'cc
address
I declare under ponalty ol potiury that I have examined thig repoG including accompanying documents, and to the beet of my knowledge and bollef,
It is true, correct and complete.
RRF-i (3-05)
DEL MAR COMMUNIW CONNECTIONS
33 0938895
Supporting Schedule for RRF-I
June 3O 2012
Part B, line 6:
Funding was received from:
The City of Del Mar
Mercedes Martin
1050 Camino del Mar
DelMar, CA920L4
8587552794
The County of San Diego
Mark Olson
L500 Pacific Coast Highway #335
San Diego, CA 92101
619 532 5533
Part B, line 7
A raffle was held on March 19,20L2.