, 99f~
i ~
Return of Organization Exempt From Income Tax
'
Under section 601(c), 527, a 4947(a)(1) of the Internal Revenue Code (except black lung
Interned R^b""° Service
W
A For the 2002 calendar y ear.
B Check d applicable
PU~
F jAddreas change
Name cha nge
an
SpKft
c~
cy) O Final return
0
- IRS
1"
~ or
~
print
D initial return
Application pending
The organization may have M use a copy of this return to satisfy staff reporting requirements
tax year beginnin g
C Name of organ'aUon
DUNSEITH COMMUNITY BETTERMENT CLUB
°r
M^^~ °b ~ (a P O Em M r~ull h not dell weE b meat address
p0 BOX 238
City a twvn
State or camtry
DUNSEITH
ZIP " 4
ssaze
ND
t
ORGANIZATION TYPE (croctonpone)III
cnscJc hens
P. E] if the org.[.twn~
apantratbn need not Ills a return with the I
mall, M should file a return wilhoul financial
sir
m receipts are normally ml more than $25.0W The
tart U the ppanmatlan received a Form ON Paclops In the
SOME STATES REQUIRE ACOMPLETE RETURN
111.
H(e)
bt~hapmupreWmbralRllabsl
!yD)
M'Yee; errtm number d efllllalas
N(c)
Are dl effiIMw Included?
X(E)
h this a ssparab reNm filed by en
M
18
19
20
Excess or (defiat) for the year (subtract line 17 from line 12)
Net asset or fund balances at beginning of year (from tine 73, column (A))
Other changes m net assets or fund balances (attach explanation)
For Paperwork Reduction Act Notice. am the separate Instructions.
imtbn
Yes E No
Check W UH the organization Is NOT required
b etch Seh B (Form 990. 980
.Q . w 990-PF)
Program services (from tine 44, column (B))
Management and general (from 6ne 44, column (C))
Fundratsing (from tine 44, column (D))
Payments to affiliates (attach schedule)
a
Yes ~ NO
D Yes ~ No
covered M e pinup Willis?
13
14
15
18
9
b
c
d
L-J
m moo: mmdh a [W See Instructions)
b
c
10 a
b
c
1'1
a
b
c
d
2
3
4
5
8a
b
c
7
8a
O8
(Krp
I D Other c.pecitn .
and Changes in Net Assets or Fund Balances (Seepage 17 of the instructions )
Contributions, gifts, grants, and similar amounts received
A
1a
Direct public support
1b
Indeed public support
Government confibubons (grants)
1c
TOTAL (add lines 1 e through 1 c) (cash i
nonpsh
$
)
Program service revenue including government fees and contracts (from Pert VII, line 93)
Membership dues and assessments
Interest on sarongs and temporary cash investments
Dividends and interest from securroes
Ba
Gross rents
77,68
Less rental
Ms
~~Ep
Bb
83,61
Net rental into a or I
e8bj~ One 6a)
Other mvestrne
come (describe
Gross amount
sa~~{ ~s~s a~
y
A Secunhes
B
~
8a
than inventory r
8b
Less cost or o r
ryes
tan or (lose) (
ch
'
Bc
Net gain or (loss comane tine Bc, columns (A) and (B))
Special event end achwbea (attach schedule)
Gross revenue (not Including
of
$
contributions reported on line Is)
1 9a l
Less direct expenses other than fundraising expenses
9b
NM income or (lose) from special every (subtract fine 9b from line 9a)
Gross sales of inventory, less returns and allowances
7oa
Less cost of goods sold
tOb
Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a)
Other revenue (from Pert VII, line 103)
1
o g
F IYZOUmInp erowa
Hand I ass nal applicable b saclbn 527000~~~~iii niaibns
- 9ecnon6of(cx3) organizations uWaw7(aM7)raneaemptcherhabla
Wets must attach a completed Schedule A (Form 880 or 880+Z/.
so
JIG Web site:
2
benefit trust a private foundation)
Department d the Treasury
U~
OMB No 154SOD47
7
I
319 ,024
Form 880 (2002)
CI
/
~J
V
.~ end (e) apantrntbm
Statement of
al «penlmtnm must compble column (P) columns (M, (G), and (~ are reqw'ee for aecuon 501(c)(
Functional Expenses and section aen(e)(1) nonmamq charitable trusts do optimal r« anus sae pop si arms Instructions)
Program
DO not include amounts reported on One
~p~ Total
(B)
~~ ~`~°"°a°oral
"""~ (D) Fundrefalnp
services
°"d o°^
8b, 8b, 9b, 10b, w 18 0/ PER /
Grants and allocations (attach schedule)
31 , 021
31021
(cash
$
31,021 noncash $
) 22
23
Specific assistance to individuals (attach schedule)
21
Benefits paid to or for members (attach schedule)
25
Compensation of officers, directors, etc
28
16,732,i
18 732
Other salaries and wages
27
Pension plan contributions
28
Other employee benefits
4 004
29
4 . 0134
Payroll taxes
30
fundraising
fees
Professional
37
Accounting fees
32
Legal fees
33
9 , 987
9 . 987
Supplies
34
784
784
Telephone
57
35
57
Postage and shipping
38
7,
800
7
,
800
Occupancy
37
Equipment rental and maintenance
38
Printing and publications
39
Travel
40
Conferences, conventions, and meetings
41
Interest
457
42
457
Depreciation, depletion, etc (attach schedule)
a
43a
Other expenses not covered above (demlze)
41 504
43b
41 , 504
b SEE STATEMENT
c
43d
d
iiw
e
43f
f
'
22
23
24
25
28
27
28
28
30
31
32
33
34
35
38
37
38
39
40
41
42
43
44
-
TOTAu FurrcnKNOu owv+ses (.ad aw n muwan u) onwN¢Anars
COMMETvicoo1-uhvas(BI-R,CARRY THESE TOTALS roLn+esiais
q,y
112,348
31,021
81,325
JOINT COSTS Check w[-]if you are following SOP 9&2
t E]Yes E:]No
Are any Joint costs hen a combined educa6anal campaign and fundralsinp edr.Aahon reported In (B) Program services?
, (I1) the amount allocated m Program servk:es
E
If 'Yes,' enter (I) the aggregate amount of these joint caste
$
S
III MIB 81IIWf1I2110C8SEd W Mananement and general
and
the amount allocated to FUI1dI8
p
Statement of Program Service Aeeompliehmertls (Seepage 24 of the instructions )
Expenses
What is the organization's primary exempt purpose7l~
RFWnd for 501(c)C3) and
All organizitlons must describe their attempt purpose achievements m a clear end taxies manner Slate the number
(4) orp arid 4947(d)(1)
win, eon opeonm for
a clients served, publications Issued, eEe Discuss achievements that era not measurable (Section 507 (e)(3) end (4)
organizations and 4947(a)(1) nonexempt charitable trusts must also inter the amount of grants and allocations to others )
a THE CHARITABLE EXEMPT PURPOSE OF THE ORGANIZATION IS ACHIEVED BY PROVIDING FUNDING
A WIDE VARIETY OF PROGRAMS THROUGHOUT THE COMMUNITY INCLUDING DONATIONS TO
VARIOUS YOUTH ORGANIZATIONS . SENIOR CITIZENS AND PEOPLE OF LOW INCOME AND OTHER
SERVICE
Form 990 (2002)
Form 890(2002)
DUNSEITH COMMUNITY BETTERMENT C45-0348714
Page 3
Balance Sheet (See page 24 of the instructions )
Note :
Where required, attached schedules end amounts within the description
column should be for end-of-year amounts only
45
48
40 , 632
61 , 094
Cash - non-interest-bearing
Sarongs and temporary cash investments
47 a Accounts receivable
b Less allowance for doubtful accounts
47a
47b
m
p
52
53
54
55
58
57
58
Pledges receivable
48a
Less allowance for doubtful accounts
48b
Grants receivable
Recervables from officers, directors, trustees, and key employees
(attach schedule)
a Other notes and loans receivable (attach
57a
schedule)
57b
b Less allowance for doubtful accounts
Inventories for sale or use
Prepaid expenses and deferred charges
" C]Cost
E]FMV
Investments -securities (attech schedule)
a Investments-land, buildings, end
equipment basis
55a
493 , 981
b Less accumulated depreciation (attach
schedule)
55b
122 , 453
Investments - other (attach schedule)
57a
a Land, buildings, and equipment basis
b Less accumulated deprecation (attach
schedule)
57b
)
Other assets (describe "
TOTAL ASSETS add lines 45 throug h 58 must equal line 74
Accounts payable and accrued expenses
Grants payable
Deferred revenue
Loans from officers, directors, trustees, and key employees (attach
schedule)
64 a Tax-exempt bond liabilities (attach schedule)
b Mortgages and other notes payable (attach schedule)
85
Other liabilities (describe "
50
7 , 500
1*
~t
51c
52
53
54
389 .425 55e
56
7 , 500
371 , 528
57c
58
498 . 651
59
80
81
82
83
84a
178 , 569 84b
85
)
TOTAL LIABILITIES add lines 80 throu g h 85
Organizations that follow SFAS 117, check here "
and complete lines
87 through 89 and lines 73 and 74
67
Unrestricted
88
Temporarily restricted
89
Permanently restricted
Organizations that do not follow SFAS 117, check her" XOand
complete lines 70 through 74
70
Capital stock, trust principal . or current funds
77
Paid-in or capital surplus, or land, budding, end equipment fund
72
Retained earnings, endowment, accumulated income, or other funds
73
TOTAL NET ASSETS OR FUND BALANCES (add lines 67 through 69 OR
lines 70 through 72,
column (A) MUST equal line 19, column (B) MUST equal line 21)
44 , 144
62 , 858
48c
49
59
80
81
82
83
88
45
48
47c
48 a
b
49
50
51
(g)
End a year
(A)
Beginning of year
178.569
88
486 , 030
4 , 142
162 . 864
167.006
67
88
89
70
71
72
319 , 02i
320,0823
319,024
320 .082
I
L
Forth 980 is available for public inspection end, for some people, serves as the primary or sole source of information about a
particular organization How the public perceives en organization in such cases may be determined by the information presented
on its return Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's
programs and accomplishments
Reconciliation of Revenue per Audited
Financial Statements with Revenue per
e
Total revenue, gains, and other support
per audaed financial statements
"
Amounts included on line a but not
b
on line 12, Form 890
(1) Net unrealized gains
on investments
$
(2) Donated services and
use of facilities
(3) Recoveries of prior
year grants
(4) Other (specify)
a
a
NA
/
b
~
(1)
(2)
$
/
(3)
i
S
Add amounts an lbws (1) through (4)
c
d
Reconciliation of Expenses per Audited
Financial Statements with Expenses per
Line a minus line b
Amounts included on line 12,
Form 990 but not on line a
(1) Investment expenses
not included on line
6b, Forth 990
(2) Other (specify)
(4)
"
b
"
c
Total expenses and losses per
audited financial statements
Amounts included on line a but not
on line 17, Forth 990
Donated sernces
and use of facilities
Prior year adjustments
reported on line 20,
Forth 990
$
Losses reported on
line 20, Form 990
$
Other (specify)
~
,(/,((~(/
S
Add amounts on [fries (1) through (4)
c
Lane a minus line b
/
d
Amounts included on line 17,
Forth 990 but not on line a
(1) Investment expenses
not included on line
Bb, Forth 980
$
,,~
(2) Other (specify)
1111.
Add amounts on lines (1) and (2)
Add amounts on lines (1) and (2)
" d
" d
a
Total
per
line
17,
Form
e
Total revenue per line 12, Form 990
expenses
990
line c plus line d
" e
line c plus line d
" e
and
Key
each
one
even
if
not
compensated,
see
'art. r=
List of Officers, Directors, Trustees,
Employees (List
pace 26 of the instructions )
(A) Name and address
ND
average
hours per I
I (B) TIUe
~end
~~
~ ~~
(C) Compensatbn I
(D) Contributions W
I
(E) Expense
pF NOT PAID,
employee benefit plans 8
account and other
ENTER ~ )
deferred compensation
allowances
PRESIDENT
ND
7$
Did any officer, director, trustee, or key employee receive aggregate compensation of mae than 5100,00D from your organization
and all related organizations, of which more than $10,000 was provided by the related organizations?
yes
lr-ves : attach schedule-see page 2e a u, . Instructions
NO
porn 990 (20p2)
Other Information
78
77
CLUB
(Seepage 27 of the instructions )
Yes
DM LM organization erpape In any ectlvXy not previously 'sported W the IRS? 7 Yse ; attach a Aeroibd dncAptlon U each Both*
Were any changes made in the organizing or governing documents but not reported to the IRS
78
77
If "Yes," attach a conformed copy of the changes
78 a Did the organtratbn have u nrelated badness prose income of $1,000 a more during the year wveled by this return?
78a
79
Was there a liquidation . dissolution, termination, a substantial contraction during the year? If 'Yes." attach a statement
80 a Is the organization related (ether than by association with a statewide a natlomNds organization) through common
membership . 8ovemlnp bodies, trus0eesaMcere, e0e , W any other exempt a none xempt argentratbn9
b If Was,' enter the name of the organ¢etior~-
79
b If "Yes," has d filed a tax return on FORM 890-T for this year
78b
end check whether it Is
Uexempt OR
nonexempt
81 a Enter direct or indirect political expenditures See line 81 instructions
81a
b Did the organization file FORM 112aPOL for this year?
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge
or at substantially less than fair rental value?
b If "Yes," you may indicate the value of these items here Do not include this amount
as revenue m Part I or as an expense in Pert II (See instructions in Part III )
1 8211;
83 a Did the organiza4on comply with the public inspection requirements for returns and exemption applications?
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions?
84 a Did the organization solicit any contributions or gifts that were not tax deductible?
b If 'Yes," did the organization include with every solicitation an express statement that such contributions
or gifts were not tax deductible?
85
501(c)(4), (5), or (8) orgen¢ations a Were substantially all dues nondeductible by members?
b Did the organization make only in-house lobbying expenditures of $2,000 or less?
If "Yes" was answered to either 85a or 85b, DO NOT complete BSc through 85h below unless
o
the
organization received a waiver for proxy tax owed for the prior year
c Dues, assessments, end similar amounts from members
85e
d Section 182(e) lobbying and political expenditures
Aggregate nondeductible amount of section 8033(e)(1)(A) dues notices
85e
f Taxable amount of lobbying and political expenditures (line B5d less BSe)
85f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f1
h If section 8033(ex1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to
it reasonable estimate of dues allocable to nondeductible lobbying end polRical expenditures for the
following tax year?
88
501(c)(7) orgs Enter
a Initiation foes and capital contnbutions included on line 12
18681
b Gross receipts, inducted on line 12, for public use of club facilities
88b
87
501(c)(12) orgs Enter a Gross income horn members or shareholders
87a
b Gross income from other sources (Do not net amounts due or paid to other
sources against amounts due or received horn them )
87b
88
At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or
partnership, or an entity disregarded as separate from the organization under Regulations sections
301 7701-2 and 301 77017 If 'Yes," complete Part IX
89 a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under
section 4911 "
, section 4812 "
, section 4955
b 501(c)(3) and 501(c)(4) orgs Did the organization engage in any section 4958 excess benefit transaction
dunng the year or did R become aware of an excess benefit transaction from a pnor year? If "Yes," attach
a statement explaining each transaction
c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4855, and 4958
d Enter Amount of tax on line 89c, above, reimbursed by the organization
"1 92
X
X
FAI
X
X
gyp
X
83E
83!
841
gqt
858
get
a
BSh
Section 4947(a)(1) nonexempt chantsble trusts filing Forth 990 m lieu of FORM 1041 - Check here
and enter the amount of tax-exempt interest received or accrued dunn9 the tax year
X
X
80a
80 a List the states with which a copy of this return is flied " NONE
b Number of employees employed in the pay period that includes March 12, 2002 (See instructions )
I 90b
91
The books are in care of " KIM BOGUSLAWSKI
Telephone no " 701 244-5491
Located at " DUNSEITH, ND
ZIP + 4
92
No
Form 990
X
Analysis of Income-Produclng Activities (Seer
Unrelated Ix
Note' inter gross amounts unless otherwise
(A)
indicated
Business code
93
Program service revenue
a GAMING
b
e
d
e
1 MedscareNtedicaid payments
g Fees and contracts from OovernmmM apendes
94
Membership dues and assessments
95
himnao~ ...+w" .~ae .~w .+~vmne
96
Dividends mid Into
from securities
97
Net rental Income or (loss) from real estate
531110
a debt-financed property
b riot debt-financed property
88
rot Mw i~ a ro.U ft. ~i cmosnr
99
Other Investment income
531310
100
Gal . ap,o) ,ms,a n 9m,b s,m,r
101
Net income « (loss) from special events
453220
102
Gross profit a (it=) from miss of i nventory
a
103
Other revenue
31 of the instructions
(B)
Amount
I
8
section
(C)
Excluslan code
513,x514
Amount
(D)
(E)
Related or exempt
function income
b
c
d
e
104
Subtotal (add columns (B) . (D), and (E))
105
TOTAL (add line 104, columns (B), (D), and (E))
Note : Line 105 plus line 1 d, Part l, should equal the amount on firm
Relationship of Activities to the Accomplishment of Exempt Purposes (See page 32 of the instructions )
LLro No
E~laln how each ecWlty, far which inoane to reported M column (E) of Part VII contributed Importantly to the accorriplishment
01 the aaanlraUOn's exempt purposes (olMr than by providing funds for such purposes)
Information Regarding Taxable Subsidiaries and Dian
wi
Name, address, and EIN of corporation,
partnership, w disregarded mitHY
Information Reg
Lei
Percentage Of
ownership i
d Entitles (Seepage 32 of the instructions )
(C)
Nature of activities
(D)
Total Income
Transfers Associated vnth Personal Benefit Contacts (See page 33 of the instructions
(a) Did the organization, during the year, too" em funds, directly or Indirectly, to pay premiums on a personal benefit contract?
(b) Did the organization, during the year, pay premiums, directly or i
Vote: h' Yes' to (b) file Form 8870 AND Form 4720 (see ins
Under penalties d perjury, I Eeclere that I have mmmined
.ad caoD~ela. DeeFa'atlon dthi. 10
and LdfftN Is true . cured
Please
Sign
Here
SpM
' Tw`P ~
1;
Pant
,q awro
Preperers I----Use Only ~ gyp,
(E)
End-of-year
assets
SCHEDULER
(Fotm 9Q0 or 990-EZ)
o"~man»r~un
hftroi aewnue seines
Name of the organization
Organization Exempt Under Section 501(c)(3)
(Except Private Foundation) and Section 501(e), 507(f), 501(k),
o,,8 No ,
501(n), or Section 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information -(See separate instructions .)
200
MUST be completed by the above organizations and attached to their Form 890 w 990-EZ
-
DUNSEITH COMMUNITY BETTERMENT CLUB
2
Employer iaenNecauon number
4x0348714
Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
(See page 1 of the instructions List each one If there are none, enter "None ")
(a) Name and address of each
employee pant more than $50,000
(b) Title and everape
hour per week
deviled to positbn
(d) Contributions W
(c) Compensation
employee benefit plans 8
deterred compensation
(e) Expense account
and other
allowances
number of other employees paid
Compensation of the Five Highest Paid Independent Contractors for Professional Services
(See page 2 of the instructions List each one (whether individuals or firms) If there are none, enter "None ")
(a) Name and address of each Independent contractor paid mom than $50,000
(b) Type of service
(o) Compensation
Total number of others receiving over
(FrrA)
For Paperwork Reduction Ad Notice, seethe Instructions for Form 990 end Form B80fZ.
Schedule A (Form 090 or 880-EZ) 2002
Schedule A Forth 890ar990
.E2 2002
DUNSEITH COMMUNITY BETTERMENT CLUB
Statements About Activities
45-0348714
p as 2
(See page 2 of the instructions )
During the year, has the organization attempted to influence national, state, or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid
or Incurred in connection with the lobbying activities
$
(Must equal amounts on line 38,
Part VI-l, or line i of Part VI-B )
Organizations that made an election under section 501(h) by filing Form 5788 must complete Part VI-A Other
organizations checking "Yes.' must complete Part VI-B AND attach a statement giving a detailed description of
the lobbying activities
2
During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or
with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority
owner, or principal beneficiary? (K the answer to any question s "Yes," attach a detailed statement explaining the
transactions
a Sale, exchange, or leasing of property!
Yes
No
T ~
X
7
b Lending of money or other extension of credit?
2a
2b
c Furnishing of goods, services, or facilities?
I 2c I
X
I
X
d Payment of compensation (or payment or reimbursement of expenses d more than $1,000)9
2d
X
e Transfer of any part of its income or assets?
2e
X
3
4
X
X
3
Does the organization make grand for scholarships, fellowships, student loans, etc 7 (See NOTE below )
4
Do you have a section 403(b) annuity plan for your employees?
Note: Attach a statement to explain how the organization determines that individuals or organizations receiving grants
or loans hom d m furtherance of its charitable programs 'qualify' to receive payments
Reason for Non-Private Foundation Status
(See pages 3 through 5 of the instructions )
The or an¢ahon is not a private foundation because it is (Please check only ONE applicable box)
5
]A church, convention of churches, or association of churches Section 170(bx1)(A)(p
8
7
8
9
F ]A school Section 170(b)(1)(A)(n) (Also complete Part V )
DA hospital or e cooperative hospital saints organization Section 170(b)(1)(A)(ni)
RA Federal, state, or local government or governmental unR Section 170(bu1)(A)(v)
F-1A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(m) ENTER THE HOSPITAL'S
NAME, CITY, AND STATE
10 [-]An organization operated for the benefit of a college or unnersdy owned or operated by a governmental unit Section
170(b)(1)(A)(rv) (Also complete we SUPPORT SCHEDULE m Pert IV-A)
11 a[--] An organization that normally receives a substantial part of it support from a governmental unit or from the general
public Section 170(b)('I)(A)(h) (Also complete the SUPPORT SCHEDULE in Part IV-A)
11 b DA community trust Section 170(b)(1)(A)(w) (Also complete the SUPPORT SCHEDULE m Part IV-A)
12
13
ZM organization that normally receives (7) MORE THAN 33 7/396 of ft support from eaAribuhons, menbnship fees, end prose recapb from
activities related to Its charitable, etc , functions -subbed to certain mxeptbm, end (2) NO MORE THAN 331/3% W Ns support horn gross
Investment Income and unrelated buslnasa taxable Income (less section 571 fix) horn businesses acquired by the organization after June 30,
1975 See section 509(a)(2) (Also complete the SUPPORT SCHEDULE In Pert IV-A )
DAn organization that is not controlled by any disqualfied persons (other than foundation managers) and supports
organ¢eGons deathbed in (1) fines 5 through 12 above, or (2) section 501(c)(4), (5), or (8), d they meet the test of section
(a) Name(s) of supported organization(s)
14
(b) Line number
from above
UAn organization organized end operated W test far public safety Section 509(a)(4) (See page 5 of the instructions )
Schedule A (Forth 990 or 880£2) 2002
~o-vatio~Y
rage
UUrvati i n L.UmmUm i r OM i i CrtmCn i ~wo
arm 990 a 890
.EZ) 2002
Support Schedule (Complete only A you checked a box online 10, 11, or 12 ) USE CASH METHOD OF ACCOUNTING
NOEe : You may use the worksheet m the insduclions for converting from the accrual to the cash method
Gifts, grams, and contributions received (Do
Gross receipts from admissions, merchandise
sold or services performed, or furnishing of
fealnles In any eUlvlly that Is related to the
18
Groan Income from Interest, dividends,
amounts received from payments on securities
bans (section 572(a)(5)), rents, royalties, and
unrelated business taxable income (less
section 517 taxes) from businesses acquired
19
Net Income from unrelated business
Tax revenues levied for the organization's
benefit and either paid to d w offended on
21
me value of services a facilities famished w
the organization try a governmental unit
without charge Do not include the value of
services or facilities generally furnished to the
22
Other Income Attach a schedule Do riot
ORGANIZATIONS DESCRIBED ON LINES 10 OR 11 a Enter 2% 01 amount In cdumn (e), Ime 24
b Prepare a list far your recalls to show the name of and amount contributed by each person loth" than a governmental
unit or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount sham In line 26a
DO NOT FILE THIS LIST WITH YOUR RETURN Enter the Mtal a( ail these mess amounts
c Total support for section 509(P)(1) M& Enter line 24, column (a)
19
d Add Amounts from column (a) for lines
is
26b
22
e Public support (fine 26e minus line 2Bd flog
ORGANIZATIONS DESCRIBED ON LINE 12 a For amounts Included in lines 15, 78, and 77 that were received from a"disqualified
pawn," prepare s IM for your records b show the name of, end total amounts received In each year from, each 'disqualified person
DO NOT FILE THIS LIST WITH YOUR RETURN Enter we sum of each amounts for each year
(2000)
(1998)
(2001)
(19M)
b For any amount included In line 17 Nat was received from each person (other than "disqualified persons'), prepare a list for your records to
show the name of, end amount received for each yew . that was more than the LARGER of (1) the amount on line 25 (or the year w (2) E5,000
(Irroiude In the list organl¢atlons described In lines S through 11, as well as individuals ) DO NOT FILE THIS LIST WITH YOUR RETURN After
computing the difference between the amount received arid the larger amount dacrlbad In (1) a (2), enter the sum of these differences (the
excess amounts) for each year
(2000
(2000)
(1999)
(1998)
75
16
C Add Amounts from column (e) for lines
27c
2 , 436 , 544
21
77
2 , 436,544 20
27d
27b
total
d Add LJne 27a trial
and line
27e
24 38 544
e Public support pine 27c total minus line 27d total)
27f
2 , 45
2290
Trial support for section 509(a)(2) test Enter amount from line 23, column (e)
~
27
99 36%
9 PUBLIC SUPPORT PERCENTAGE (LINE 27E (NUMERATOR) DMDED BY LINE Z'7F (DENOMINATOR))
0 84°i6
h INVESTMENT INCOME PERCENTAGE LINE 18 COLUMN E NUMERATOR DIVIDED BY LINE 27F DENOMINATOR 27h
arty
unusual
grants
during
1998
through
2001,
prepare
a
28
UNUSUAL GRANTS For an organization described In line 10, 71, a 12 that received
list for your racade to show, for each year, the name o1 the contributor, the date and amount of the grant, and a brief description of to
nature of the grant DO NOT FILE THIS LIST WITH YOUR RETURN Do not include these arents in line 15
Schedule A (Form 990 or BOO-EZ) 2002
ROOM
29
30
31
32
Private School Questionnaire (Seepage 7 of the instructions )
(To be completed ONLY by schools that checked the box on line 6 in Part IV)
Does the organization have a racially nondiscriminatory policy toward students by statement in its
charter, bylaws, other governing instrument, or in a resolution of its governing body?
Does the organization include a statement of its racially nondiscriminatory policy toward students m all
its brochures, catalogues, and other written communications with the public dealing with student
admissions, programs, and scholarships?
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadest
media during the period of solicitation for students, or during the registration period if it has no solicitation
program, in a way that makes the policy known to all parts of the general community it serves?
If "Yes," please describe. if "No," please explain (If you need more space, attach e separate statement )
Does the organization maintain the following
a Records indicating the racial composition of the student body, faculty, end administrative staff?
b Records documenting that scholarships and other financial assistance ere awarded on a racially
nondiscriminatory basis?
c Copies of all catalogues, brochures, announcements, and abler written communications to the public
dealing with student admissions, programs, and scholarships?
d Copies of all material used by the organization or on its behalf to solicit contributions?
If you answered 'No' W airy of the above, please explain (If you raced more space, attach a separate staberrent
33
Does the organization discriminate by race in any way with respect to
a Students' rights or privileges?
b Admissions policies?
c Employment of faculty or administrative staff?
d Scholarships or other financial assistance?
a Educational policies?
f Use of facilities?
g Athletic programs?
h Other extracurricular activities?
If you arrwered'Yes' to any M the above, please epWln (if you need more span, attach a separate statement
34 a Does the organization receive any financial aid or assistance horn a governmental agency?
b Has the organization's right to such aid ever been revoked or suspended?
H you answered "Yes" to either 34a or b, please explain using en attached statement
35
Does the organization certify that it has complied with the applicable requirements of sections 4 01 through
4 OS of Rev Proc 7550 . 1975-2 C B 587. covering racial nondiscrimination? If "No," attach an exolanatioi
Schedule A (Forth 990 or 990 .EZ) 2002
Lobbying Expenditures by Electing Public Charities (see page 9 of the instructions )
(To be completed ONLY by an eligible organization that filed Form 5788)
"
Check
a[:]if the organization belongs to en affiliated group Check b[ :]ii you checked "a" and "limited control" provisions apply
Limits; on Lobbying Expenditures
Affiliated group
totals
term "expenditures' means amounts paid a Intuited )
38
37
38
39
40
41
42
43
44
Total lobbying expenditures to influence public opinion (grassroMs lobbying)
Total lobbying expenditures to influence a legislative body (direct lobbying)
Total lobbying expenditures (add lines 38 and 37)
Other exempt purpose expenditures
Total exempt purpose expenditures (add lines 38 and 39)
Lobbying nontaxable amount Enter the amount from the following table The lobbying nontaxable amount is If the amount on line 40 Is Not over SSOO,ODO
20% of the amount on line 40
over $5W 000 nun not war $1,000,000
$100,000 qua Is% or the excess over
$175,000 plus 10% of the excess over $511.)0=0,
Over $7,000,000 bid not over $1,500,000
$225,000 plus 5% of the excess over $1,500,000
Over $1,500,000 but not over 517,OOD,OOD
$7,000,000
Over S17,OOO,ODO
Grassroots nontaxable amount (enter 25% of line 41)
Subtract line 42 from line 38 Enter- if line 42 is more than line 38
Subtract line 41 from line 38 Enter-0- if line 47 is more than line 38
To be oompietee
for ALL electing
.. . .._
38
on either Gne 43 or line 44. you must h1e Form
4-Year Averaging Period Under Section 507(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns below
Lobbying Expenditures During 4-Year Averaging Period
(d)
999
Calendar year (or
I
(e)
Total
of line
48
Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI-A) (See page 11 of the instructions )
the year, did the organization attempt to
state or local
any
attempt to influence public opinion on a legislative matter or referendum, through the use of
a Volunteers
b Paid staff or management (Include compensation in expenses reported on lines c through h )
c Media advertisements
d Mailings to members, legislators, or the public
e Publications, or published or broadcast statements
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
I Total lobbying expenditures (Add hoes c through h )
If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities
Schedule A (Forth 990 or B90-EZ) 2002
51
Information Regarding Transfers To and Transactions and Relationships With Noncharitable
(See pegs 12 of the instructions )
Exempt Organizations
Did the reporting organization directly or indirectly engage m any of the following with any other organization described in section
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a nonchantable exempt organization of
Yes No
(1) Cash
Other assets
570(i1) a II
v
b Other transactions
(I) Sales or exchanges of assets with a noncharitable exempt organization
V,
b( i)
(u) Purchases of assets from a noncharttable exempt organization
L~'
b( il )
(III) Rental of facilities, equipment, or other assets
b( ill)
(iv) Reimbursement arrangements
b(Iv)
(v) Loans or loan guarantees
bv
r
(vi) Performance of services or membership or fundraising solicitations
-vi
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees
d If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting organization If the organization received less than fair market value
Lineeno
I
Amount
I
Name
(d)
transitions, and sharing arningemente
a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described m section 501(c) of the Code (other than section 501(c)(3)) or in section 5277
(a)
Name of oigenIzaUon
[] Yes
~ No
k1
Description of relatimship
Schedule A (Form 990 a 880fZ) 2002
DUNSEITH COMMUNITY BETTERMENT
EIN 45-0348714
FORM 990
LINE 43
GAMING TAXES
LICENSES
COMMISSIONS
ADVERTISING
INSURANCE
REPAIRS
TAXES
UTILITIES
29,833
150
8,387
882
500
1,504
781
1,487
41,504