~C-irm 99(f
OMB No 1545-0047
Return of Organization Exempt from Income Tax
.'
2004
Under section 501(c), 527, or 4947(ax1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
Department of the Treasury
Internal Revenue Service
~ The organization m ay have to use a copy of this return to satisfy stat e reporting requirements
A
For the 2004 calendar ear, or tax
B
Check if applicable,
Addresscr,ar,ee
1'RSlebale
°'~Pe
or
see
Name change
Initial return
specucific
instr "
lions.
Final return
ear be g inning
6/01
5/31
, 2004, and endi
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
INC .
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
95-3201899
Telephone number
F
method~y
J
Organization ty E
Check only Of12
K
Check here 01
l
O
charitable trusts must attach a completed Schedule A
(Form 990 or 990-EZ).
H (a) is this a group return for affiliates
H (C)
0.
X
501(c)
3 -4
(insert no)
4947(a)(1) or
527
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, it should file a return without financial data
Some states require a complete return .
Gross receipts Add Itnes 6b, 8b, 9b, and lOb to line 12
~ Yes
N No
~ Yes
F1No
orgarnzalion covered by a group rulings F]Yes
(Xj No
H (b) It 'Yes .' enter number of affiliates 0'
1- 203,447 .
Are all affiliates included
(If 'No,' attach a list See instructions )
H (d) Is this a separate return filed by an
I
Grou p Exem lion Number
Check I~
if the organization is not required
to attach Schedule B (Form 990, 990~EZ, or 990-PF)
Instructio
983 .1 ="
a Direct public support
1a
b Indirect public support
1b
c Government contributions (grants) .
1c
)
65, 983 . noncash $
d is°ti;rougnlicj(cash $
2 Program service revenue including government fees and contracts (from Part VII, line 93)
3 Membership dues and assessments .
4 Interest on savings and temporary cash investments
5 Dividends and interest from securities
6a Gross rents
6a
b Less . rental expenses
6b
R
vE
E
c Net rental income or (loss) (subtract line 6b from line 6a)
1110 .
7 Other investment income (describe
8a Gross amount from sales of assets other
than inventory
(A) Securities
E
XP
E
N
E
S
A
E S
14
15
16
17
18
19
r 7 20
300 .
6t
[CAI
$
8b
8c
of contributions
I 9a
Other revenue (from Part VII, line 103)
Total revenue (add lines 1 d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11
Program services (from line 44, column (B))
' I
8d
11,133 .
3,116 . ;'':
STATEMENT. 1 9c
106, 623 .
STATEMENT 2 10c
8,017 .
106, 623 .
200,331 .
86,000 .
28,757 .
43,433 .
Management and general (from line 44, column (C))
Fundraising (from line 44, column (D))
Payments to affiliates (attach schedule)
Total ex penses add lines 16 and 44, column A)
Excess or (deficit) for the year (subtract line 17 from line 12)
158, 190 .
42,141 .
448,439 .
Net assets or fund balances at beginning of year (from line 7?, column (A))
Other changes in net assets or fund balances (attach explanation)
5 21 Net assets or fund balances at end of ear (combine lines 18, 19, and 20)
BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions .
300 .
Other
Net g~oQl~sjV~e~in e ~ine III 8c, columns (A) and (B))
"
S ecia eventsC
itach schedule) . If any amount is from gaming, check here
~rpsAWapenue (not .i.nclud
65, 983 .
15 , 668 .
3 , 740 .
i
L
n fundraising expenses
~ 9b
Net ~~~~~s~f n spe ial events (subtract line 9b from line 9a)
10a ross
returns and allowances
10a
b Less' cost of goods sold
.
10b
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a)
11
12
13
1d
8a
b Less' cost or other basis and sales expenses
eGa~pnF~locs~.Eatta
9
uAccrual
H and I ate not applicable to section 527 organizations
" Section S01(CX3) organizations and 4947(aXl) nonexempt
Part I~~ - Revenue Ex penses, and Chan ges in Net Assets or Fund Balances s.
1 Contributions, gifts, grants, and similar amounts received
a-U
uCash
Other (specify) 0'
Application pending
Web site: "' I3 /A
, 2005
Employer Identification Number
Amended return
G
Open to Public
Inspection
TEEA0107L
01107/05
490,580 .
Form 990 (2004)
Form 89
Part i1
2004 ~ ASSISTANCE LEAGUE OF CAPISTRANO VALLEY
95-3201899
Statement of Functional Ex enses All organizations must complete column (A). Columns (B), (C), and (D) are
required for section 501(c)(3) and 4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others
Do not include amounts reported on line
6b, 8b, 9b, 10b, or 16 of Part I
22
I'
. 11
23
24
25
26
27
28
Grants and allocations (aft sch)
$
non-cash $
)
Specific assistance to individuals (aft sch)
Benefits paid to or for members (aft sch)
Compensation of officers, directors, etc
Other salaries and wages
Pension plan contributions
Other employee benefits
22
23
24
25
26
27
28
31
32
Accounting fees
Legal fees
31
32
35
36
37
38
39
40
41
42
43
Postage and shipping
Occupancy
Equipment rental and maintenance
Printing and publications
Travel
Conferences, conventions, and meetings
Interest
Depreciation, depletion, etc (attach schedule)
Other expenses not covered above (itemize) :
29
30
Payroll taxes
Professional fundraising fees
33 Supplies
34 Telephone
C-------------------
44
Total functional expenses (add lines 22 ~ 43) .
(A) Total
I
(B) Program
services
I
(C) Management
and general
~D) Fundraising
`(cash
22,889 .
22, 889 .
29
30
1 , 952 .
1 952 .
33
34
74 , 585 .
71 , 535 .
100 .
24 , 530 .
14 , 465 .
35
36
37
38
39
40
41
42
a SEE STATEMENT 3
43a
b------------------43b
d
e
Pa ge 2
6 , 000 .
6 , 000 .
2 , 190 .
860 .
10
6 , 025 .
3 , 089 .
100 .
065 .
2, 936 .
2,318 .
2,318 .
17,478 .
19 , 791 .
2,313 .
43c
43d
43e
Oaganthesetotalsmolimes13115s(B) -(D~'
44
158,190 .
86 , 000 .
28,757 .
43 , 433 .
Joint Costs . Check DOI I if you are following SOP 98 .2 .
Are any joint costs from a combined educational campaign and fundraising solicitation reported m (B) Program services?
~~ Yes X No
If 'Yes,' enter (i) the aggregate amount of these point costs
$
; (ii) the amount allocated to Program services
$
; (iii) the amount allocated to Management and general
$
, and (iv) the amount allocated
to Fundraising $
merits
What is the organization's primary exempt purpose? ~
SERVICES TO THE NEEDY
All organizations must describe their exempt purpose achievements m a clear and concise manner State the number of
clients served publications issued, etc Discuss achievements that are not measurable (Section 501(c)(3) & (4) organizations and 4§47 ( a) ( 1 ) nonexem t charitable trusts must also enter the amount of grants & allocations to others .)
Program Service Expenses
(Required
s~andnd
asa7(a)(1) trusts, but
optional for others >
----------------------------------------------------------------------------------------------------------(Grants and allocations $
)
55 , 110 .
a OPERATION SCHOOL BELL : PROVIDE CLOTHING TO NEEDY CHILDREN
b LINKS TO LEARNING :FUNDS VARIOUS TO MIDDLE SCHOOL PROGRAMS
-----------------------------------------------------------------------------------------------------------
(Grants and allocations $
c HANDS-ON LITERACY : READING ASSISTANCE TO LEARNING AND COMMUNICATION
HANDICAPPED CLASSES
)
19 , 318 .
-----------------------------------------------------(Grants and allocations $
)
2 , 245 .
d VARIOUS OTHER PROGRAMS TO HELP THE NEEDY
-----------------------------------------------------e Other program services
(Grants and allocations $
(Grants and allocations $
------------
f Total of Program Service Expenses (should equal line 44, column (B), Program services)
BAA
TEEA0102L 01/07/05
I
5)
~
9,327 .
86,000 .
Form 990 (2004)
Form S90 (2004) 1 ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
Part IV
Note :
A
s
E
s
Balance Sheets (see Instructions)
Where required, attached schedules and amounts within the description
column should be for end-of-year amounts only
45
46
78,347 .
175,191 .
47a Accounts receivable
b Less . allowance for doubtful accounts
47a
47b
48a Pledges receivable
b Less . allowance for doubtful accounts
49 Grants receivable
48a
48b
Receivables from officers, directors, trustees, and key
employees (attach schedule)
51 a Other notes & loans receivable (attach sch)
51 a
b Less allowance for doubtful accounts
51 b
52 Inventories for sale or use
53 Prepaid expenses and deferred charges
54 Investments - securities (attach schedule)
55a Investments - land, buildings, & equipment basis 55a
234 .
s
~~ Cost[] FMV
57a
74
,
47c
91,891 .
}
. .
~
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)
Total liabilities and net assets/fund balances add lines 66 and 73)
'
51 c
52
53
54
23 , 496 .
-55c
56
280, 649 .
60 Accounts payable and accrued expenses .
61 Grants payable
. . .. .
62 Deferred revenue
63 Loans from officers, directors, trustees, and key employees (attach schedule)
64a Tax-exempt bond liabilities (attach schedule)
..
b Mortgages and other notes payable (attach schedule)
65 Other liabilities (describe ~
66 Total liabilities add lines 60 through 65
73
5,287 .
850 .
55b
Organizations that follow SFAS 117, check here ~ U and complete lines 67
through 69 and lines 73 and 74 .
67 Unrestricted
E
68 Temporarily restricted
69 Permanently restricted
R Organizations that do not follow SFAS 117, check here ~
~ and complete lines
70 through 74 .
N
70 Capital stock, trust principal, or current funds
71 Paid-in or capital surplus, or land, building, and equipment fund
e
72 Retained earnings, endowment, accumulated income, or other funds
N
285, 003 .
50
b Less accumulated depreciation
(attach schedule)
STATEMENT 4 .
57b
58 Other assets (describe 1,
59 Total assets (add lines 45 throug h 58) (must e q ual line 74)
T
45
46
48c
49
50
56 Investments - other (attach schedule)
57a Land, buildings, and equipment basis
(B)
End of year
(A)
Beginning of year
Cash - non-interest-bearing
Savings and temporary cash investments
b Less : accumulated depreciation
(attach schedule)
A
e
Page 3
95-3201899
191, 076 .
450, 985 .
2,546 .
2,546 .
369,812 .
78 , 627 .
=
57c
58
59
60
61
62
63
64a
64b
65
66
67
68
69
,
188
758 .
497 , 257 .
6 677 .
6,677 .
376, 915 .
113 , 665 .
70
71
72
448, 439 .
450,985 .
73
74
490, 580 .
497,257 .
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization How the public perceives an 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
BAA
TEEA0103L
01/07/05
Form X90 (2004) 1 ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
Part IV-A . Reconciliation of Revenue p er Audited
Financial Statements with Revenue
per Return (See instructions .)
a
Total revenue, gams, and other support
per audited financial statements
b
Amounts included on line a but
not on line 12, Form 990 .
(1) Net unrealized
gains on
investments
~
a
200, 331 .
-
Total expenses and losses per audited
financial statements
Do-
b
Amounts included on line a but not
on line 17, Form 990
(1) Donated services and use
of facilities
`
{`"
=
Add amounts on lines (1) through (4)
Line a minus line b
-1,
.
~ ^b
~ c
200, 331 .
Amounts included on line 12,
Form 990 but not on line a :
d
(1) Investment expenses
not included on line
6b, Form 990
$
(2) Other (specify) .
Add amounts on lines (1) and (2)
c
'I J1
~
~ ~~
'
d
Page 4
Reconciliation of Expenses per Audited
Financial Statements with Expenses
per Return
a
-
(3) Recoveries of poor
year grants
(4) Other (specify)
d
;
$
(2) Donated services and use
of faahties
c
Part IV-B
95-3201899
a
$
(3) Losses reported on
line 20, Form 990
(4) Other (speci
$
.,
' '
$
(2) Prior year adjustments reported on
line 20, Form 990
158, 190 .
'
's
'
,
..
Add amounts on lines (1) through (4)
Line a minus line h
.
~
~
b
c
158, 190 .
Amounts included on line 17,
Form 990 but not on line a :
(1 ) Investment expenses
not included on line
6b, Form 990
(2) Other (specify)
$
.
Add amounts on lines (1) and (2) .
~
.
..
d
e
Total revenue per line 12, Form
e
Total expenses per line 17, Form
990 (line c p lus line d
e
200,331 . 1
990 (line c p lus line d)
~ e
158,190 .
O
Part V : List of Officers Directors Trustees and Ke y Em to ees List each one even if not coin ensated, see instructions .
(B) Title and average hours
(C) Compensation
(D) Contributions to
(E) Expense
per week devoted
(if not paid,
employee benefit
account and other
(A) Name and address
to position
enter -0-)
plans and deferred
allowances
compensation
SEE STATEMENT -5
----------------------
0.
0.
0 .
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------75
BAA
Did any officer, director, trustee, or key employee receive aggregate compensation of more
than $100,000 from your organization and all related organizations, of which more than
$10,000 was provided by the related organizations
If 'Yes,' attach schedule - see instructions
.
~ ~ Yes
X--' No
Form 990 (2004)
TEEA0104L
01/07/05
Form 990 (2004)
Part VI
76
ASSISTANCE
LEAGUE
OF
CAPISTRANO VALLEY,
If 'Yes,'
If 'Yes,' attach a conformed copy of the changes
and check whether it is
80a
'
82 a Did the or ganization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental values
b If 'Yes,' you may indicate the value of these items here . Do not include this amount as
revenue in Part I or as an expense in Part II (See instructions in Part III )
81 b
X
82a
X
N/A
82b
83a Did the organization comply with the public inspection requirements for returns and exemption applications
X
83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions?
X
83b
84a Did the organization solicit any contributions or gifts that were not tax deductible?
84a
X
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible
. .
84b
' -=- - -~
N A
85a
N A
b Did the organization make only in-house lobbying expenditures of $2,000 or less?
85b
501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year .
c Dues, assessments, and similar amounts from members
d Section 162(e) lobbying and political expenditures
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices
i Taxable amount of lobbying and political expenditures (line 85d less 85e)
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f?
b Gross income from other sources. (Do not net amounts due or paid to other sources
against amounts due or received from them .)
85
. ,
N/
--
N/A
N/A
;
If 'Yes,' complete Part IX
located at P- 2015 VIA AGUILA,- SAN CLEMENTE, CA
Section 4947(a)(1) nonexempt charitable trusts fling Form 990 in lieu of Form 1041- Check here
and enter the amount of tax-exempt interest received or accrued during the tax year
TEEA0105L
01/07/05
'
88
X
89b
X
0
b 501(c)(3) and 501(c)(4) organizations . Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement
explaining each transaction
b Number of employees employed m the pay period that includes March 12, 2004 (See instructions )
The books are in care of P- CAROLE BARNETT
Telephone number
N IA
N/A
89a 501(c)(3) organizations Enter : Amount of tax imposed on the organization during the year under'
section 4911 1,
0 . ; section 4912 1,
0 . , section 4955 1,
'
;-- ---- .I
N A
85h
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 7701 .3
year under sections 4912, 4955, and 4958 .
d Enter Amount of tax on line 89c, above, reimbursed by the organization
90a List the states with which a copy of this return is filed 0- CALIFORNIA
I
.'
N/A
I 87b1
c Enter : Amount of tax im posed on the or g anization managers or disqualified persons during the
N A
I `
N/A
N/A
N/A
85c
85d
85e
85i
h If section 6033(e)(1 )(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year?
86 501(c)(7) organizations. Enter . a Initiation fees and capital contributions included on
line 12
. .
86a
86b
b Gross receipts, included on line 12, for public use of club facilities
87 501(c)(12) organizations Enter a Gross income from members or shareholders
87a
BAA
X
X exempt
or 11 nonexempt
-81 a
0.
b Did the organization file Form 1120-POL for this years
92
X
LEAGUE
81 a Enter direct and indirect political expenditures . See line 81 instructions
91
X
N A
79
80a Is the organization related (other than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organizations
88
.
78b
Was there a liquidation, dissolution, termination, or substantial contraction during the
years If 'Yes,' attach a statement
85
X
78a
b If 'Yes,' has it filed a tax return on Form 990-T for this years
NATIONAL ASSISTANCE
X
77
78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this returns
b If 'Yes,' enter the name of the organization ~
'--
76
Were any changes made in the organizing or governing documents but not reported to the IRS?
79
No
Yes
Did the organization engage in any activity not previously reported to the IRS
attach a detailed description of each activity
77
Page 5
95-3201899
Other Information (see instructions )
0.
b.
0.
0.
90b
ZIP + 4 1- 92673
~~ 92 I
N/A
0
1
N/A
Form 990 (2004)
Form 990 (2004) ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
Part VII Analysis of Income-Prod ucin Activities (see instructions.)
Note : Enter gross amounts unless
otherwise indicated.
93
Program service revenuea
b
c
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
Unrelated business income
(A)
Business code
(B)
Amount
95-3201899
Excluded b section 512, 513, or 514
(D)
Amount
(C)
Exclusion code
94 Membership dues and assessments
Interest on savings & temporary cash invmnts
Dividends & interest from securities
Net rental income or (loss) from real estate'
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (joss) from saes of inventory
103 Other revenue a
95
96
97
14
3 , 740 .
16
300 .
1
5
8,017 .
106,623 .
b
c
d
e
Page 6
Related or exempt
function income
15, 668 .
118,680 . 1
104 Subtotal (add columns (B), (D), and (E))
15,6
111-
105 Total (add line 104, columns (B), (D), and (E))
Note : Line 105 plus line Id, Part l, should e qual the amount on line 12, Part 1.
134,3
~Pa'rt VIII Relationshi p of Activities to the Accomplishment of Exempt Purposes see instructions .
Line No.
93
Explain how each activity for which income is reported m column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt ourooses (other than 6v Drovidina funds for such ourooses) .
SUPPLEMENTS OTHER REVENUE TO FUND PHILANTHROPIC PROJECTS
. :Part IXk~ Information Re ardin Taxable Subsidiaries and Disreg arded Entities see instructions
(A)
(B)
(C)
(D)
(E)
Name, address, and EIN of corporation,
partnership, or disregarded entity
Percentage of
ownership interest
Nature of activities
Total
income
End-of-year
assets
N/A
a
I Part X Information Re g ardin g Transfers Associated with Personal Benefit Contracts see instructions )
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
b Did the organization, during the year, pay premiums, directly or indir
Note : If 'Yes' to (b), file Form 8870 and Form 4720 see instructions ) ,
Under penalties p f perjury , I declare that I have examined this return, including acc
true, correct, and complete Declaration of preparer (other than officer) is based on
Please
Sign
Here
signature of officer
0' TREASURER
Type or print name and title
Paid
Preparer's
parer's
Firm's name (or "RICHARD K . SCULLY, CPA -
Pre-
Use
Only
BAA
signature
yours d self
1
'
eR, loved) , t 31877 DEL OBISPO, SUITE 211
Zdesns, and
SAN JUAN CAPISTANO, CA 92675
Yes
X No
Organization Exempt Under
Section 501(cx3)
SCHEDULE A
,(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Name oftheorganization
OMB No 1545 0047
(Except Private Foundation) and Section 501(e), 5010, 501(k),
501(n), or Section 4947(aK1) Nonexempt Charitable Trust
Supplementary Information - (See separate instructions .)
200 4
~ MUST be completed by the above organizations and attached to their Form 990 or 990-EZ .
Employer identification number
95-32.01899
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
Tnir
n Officers, Directors, and Trustees
J compensation of the rive hignest raja tmpioyees 1L
(See instructions List each one. If there are none, enter 'None ')
(a) Name and address of each
employee p aid more
than $50,000
(b) Title and average
hours per week
devoted to position
(c) Compensation
(d) Contributions
(e) Expense
to employee benefit I account and other
plans and deferred
allowances
compensation
NONE
-------------------------
Total number of other employees paid
over $50,000
~
0
Part II -' .1' Compensation of the Five Highest Paid Independent Contractors for Professional Services
(See instructions . List each one (whether individuals or firms) . If there are none, enter 'None ')
(a) Name and address of each independent contractor paid more than $50,000
(b) Type of service
(c) Compensation
NONE
Total number of others receiving over
OI
$50,000 for professional services
~I
BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ .
TEEA0401L
07/22/04
f
'
Schedule A (Form 990 or 990-EZ) 2004
Schedule A (Form 990 or 990-EZ) 2004
Part III ~
1
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
95-3201899
Statements About Activities (see instructions )
Yes I No
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 referendums If 'Yes,' enter the total expenses paid
*. $
or incurred in connection with the lobbying activities
N/A
(Must equal amounts on line 38, Part VI-A, or line i of Part VI-B )
Organizations that made an election under section 501 (h) by filing Form 5768 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? (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )
a Sale, exchange, or leasing of property?
X
. 2a ,
b Lending of money or other extension of credits .
I
2bi
I X
c Furnishing of goods, services, or facilities
I
2cl
I X
d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)
1
2 dl
I
e Transfer of any part of its income or assets
.
.
2e
3a Do you make grants for scholarships, fellowships, student loans, etc (If 'Yes,' attach an
explanation of how you determine that recipients qualify to receive payments )
b Do you have a section 403(b) annuity plan for your employees?
4a Did you maintain any separate account for participating donors where donors have the right to provide advice
on the use or distribution of funds?
b Do you provide credit counseling, debt management, credit repair, or debt negotiation services?
3a
3b
X
X
X
4a
4b
X
~
X
X
PartAV7 Reason for Non-Private Foundation Status see instructions)
The organization 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(b)(1)(A)(i)
6
A school . Section 170(b)(1)(A)(n) (Also complete Part V .)
7
A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(in) .
8
A Federal, state, or local government or governmental unit . Section 170(b)(1)(A)(v)
9
10
~ A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ui) . Enter the hospital's name, city,
and state
r] An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(rv)
(Also complete the Support Schedule in Part IV-A )
11a F] An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A )
11 b r] A community trust Section 170(b)(1)(A)(vi) . (Also complete the Support Schedule in Part IV-A .)
12
13
X An organization that normally receives (1) more than 33-1/3% of its support from contributions, membership fees, and gross receipts
from activities related to its charitable, etc, functions - subject to certain exceptions, and (2) no more than 33-113% of its support
from dross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the
organization after June 30, 1975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A )
r] An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in : (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3).)
Provide the following information about the supported
izations (See instructions )
(b) Line number
from above
(a) Name(s) of supported organization(s)
14
BAA
n An organization organized and operated to test for public safety . Section 509(a)(4). (See instructions )
TEEA0402L 07/27/04
Schedule A (Form 990 or Form 990-EZ) 2004
Page 3
Schedule A (Form 990 or 990-EZ 2004 ASSISTANCE LEAGUE OF CAPISTRANO VALLE
95-3201899
art IV-A ' Support Schedule (Complete only if you checked a box on line 10, 11, or 12 ) Use cash method of accounting.
Note : You ma use the worksheet m the Instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year
11~
beginning in)
15 Gifts, grants, and contributions
received (Do not include
unusual grants See line 28.
16 Membership fees received
17
Gross receipts from admissions,
merchandise sold or services performed,
or furnishing of facilities in any activity
that is related to the organization's
charitable, etc, purpose
Gross income from interest, dividends,
amounts received from payments on
securities loans (section 512(a)(5)),
rents, royalties, and unrelated business
taxable income (less section 511 taxes)
from businesses acquired by the organizationafter June 30, 1975
18
19
Net income from unrelated business
activities not included in line 18
Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf
The value of services or
facilities furnished to the
organization by a governmental
unit without charge . Do not
include the value of services or
facilities generally furnished to
the p ublic without char g e
Other income Attach a
schedule Do not include
gain or (loss) from sale of
ca p ital assets. .
20
21
22
23 Total of lines 15 throu gh 22
24 Line 23 minus line 17
25 Enter 1% of line 23
26
(a)
2003
( b)
2002
(c)
2001
(e)
Total
(d)
2000
245, 816 .
69, 505 .
121, 389 .
18, 253 .
41,724 .
13, 065 .
97,462 .
96,524 .
106, 489 .
84,223 .
384, 698 .
1 , 930 .
2 , 445 .
8 , 857 .
1 , 841 .
15,073 .
239,034 .
141,572 .
2 , 390 . 1
153 , 758 .
57, 234 .
1,538 . 1
47,969 .
34,734 .
12, 425 .r20,762 .1
175,740 .
69, 251 .
1,757 . 1
141,560 .
57, 337 . 1
1,416 .
710,092 .
325 C 394 .
N/A
Organizations described on lines 10 or 11 :
a Enter 2% of amount in column (e), line 24
11, 26a
b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly
supported organization) whose total gifts for 2000 through 2003 exceeded the amount shown in line 26a Do not file this list with your
- '---'-°-- --'
return . Enter the total of all these excess amounts
~ 26b
c Total support for section 509(a)(1) test Enter line 24, column (e)
~ 26c
d Add . Amounts from column (e) for fines
18
19
22
26b
26d
e Public support (line 26c minus line 26d total)
~ 26e
f Public support percentage (line 26e (numerator) divided by line 26c (denominator))
$
~ 26f
27 Organizations described on line 12 :
a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the
name of, and total amounts received in each year from, each 'disqualified person ' Do not file this list with your return . Enter the sum of
such amounts for each year'
(2003) _____-__-_ 0_ (2002)---_____--0-(2001)--_---_---0_ (2000)___--__--__0
b For any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to
show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2)
$5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals,) Do not file this list with your return . After
computing the difference between the amount received and the larger amount described m (1) or (2), enter the sum of these differences
(the excess amounts) for each year
(2003) -_--______ 0- (2002)___-----_ _ 0- (2001)_____---_- 0- (2000)-_-__---_~-0 ._
c Add . Amounts from column (e) for lines
15
245,816 .
16
64,505 .
d
e
i
g
h
28
BAA
17
384, 698 . 20
21
27c
Add' Line 27a total
0.
and line 27b total
0.
27d
Public support (line 27c total minus line 27d total)
. .
01 27e
Total support for section 509(a)(2) test . Enter amount from fine 23, column (e)
~ 27f
710 , 092 . , _
Public support percentage (line 27e (numerator) divided by line 27f (denominator))
01 27
Investment income percenta ge line 18, column e numerator divided b line 27f denominator
~ 27h
695
, _
019 .
0.
695 , 019 .
__,
97 . 88 $
2 . 12 0
Unusual Grants : For an organization described in line 10, 11, or 12 that received any unusual grants during 2000 throwg h 2003, prepare a
list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the
nature of the grant Do not file this list with your return . Do not include these grants in line 15 .
7EEA0403L 07/23104
Schedule A (Form 990 or 990-EZ) 2004
Schedule A (Form 990 or 990-E
dart V
Private Schoo
(To be completed
95-3201899
2004 ASSISTANCE LEAGUE OF CAPISTRANO VAL
questionnaire (see instructions )
VLY by schools that checked the box on line 6 in Part IV)
Page 4
N/A
29
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
29
30
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships
30
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast 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 a separate statement .)
31
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------32 Does the organization maintain the following
a Records indicating the racial composition of the student body, faculty, and administrative staff
Yes
No
31
32a
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondiscriminatory basis
32b
c Copies of all catalogues, brochures, announcements, and other 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?
32c
If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement .)-_ _
-------------------------------------------------------Does the organization discriminate by race in any way with respect to
33
-33 a
a Students' rights or privileges?
b Admissions policies?
c Employment of faculty or administrative staff?
... . . .
33c
..
..
d Scholarships or other financial assistance?
33 d
e Educational policies?
33e
f Use of facilities?
33f
g Athletic programs
33
h Other extracurricular activities?
33h
If you answered 'Yes' to any of the above, please explain . (If you need more space, attach a separate statement )
------------------------------------------------------------------------------------------------------------------------------------------------------------------------34a Does the organization receive any financial aid or assistance from a governmental agency
b Has the organization's right to such aid ever been revoked or suspended? .
If you answered 'Yes' to either 34a or b, please explain using an attached statement
35
BAA
Does the organization certify that it has complied with the applicable requirements of
sections 4 .01 through 4 .05 of Rev Proc 75-50, 1975-2 C B . 587, covering racial
nondiscrimination? If 'No,' attach an explanation .
TEEA0404L
07/23/04
34a
34b
35
orm 990 or
-
~ 1
Schedule A (Form 990 or 990-EZ) 2004 ASSISTANCE LEAGUE OF CAPISTRANO VALL
Part WA Lobbying Expenditures by Electing Public Charities (see instructions)
(To be completed ONLY by an eligible organization that filed Form 5768)
Check 0- a
if the organization belongs to an affiliated group
Check 1, b
Limits on Lobbying Expenditures
he term 'expenditures' means amounts paid or incurred )
36
Over $1,000,000 but not over $1,500,000
Over $1,500,000 but not over $17,000,000
totals
$175,000 plus 10% of the excess over $1,000,000
$225,000 plus 5% of the excess over $1,500,000
$1,000,000
Over $17,000,000
Grassroots nontaxable amount (enter 25% of line 41)
Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36
Subtract line 41 from line 38 . Enter -0- if line 41 is more than line 38
Caution : If there is an amount on ether line 43 or line 44, you must file Form 4720 .
42
43
44
N/A
if you checked 'a' and 'limited control' provisions app ly
(a)
(b)
Affiliated group
To be completed
Total lobbying expenditures to influence public opinion (grassroots lobbying)
Total lobbying expenditures to influence a legislative body (direct lobbying)
Total lobbying expenditures (add lines 36 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 If the amount on line 40 is The lobbying nontaxable amount is Not over $500,000
20% of the amount on line 40
Over $500,000 but not over $1,000,000
$100,000 plus 15% of the excess over $500,000
37
38
39
40
41
Page 5
95-3201899
for ALL electing
organizations
36
37
38
39
40
: .
,
' Ip'`
.
~
`,,
41
42
43
44
4 -Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns below
See the instructions for lines 45 through 50 )
Lobbying Expenditures During 4-Year Averaging Period
Calendar year
(or fiscal year
beginning m)
45
Lobbying nontaxable
amount
46
Lobb~mg ceding amount
( 150% of line 45(e))
47
Total lobbying
ex penditures
48
Grassroots nontaxable amount
49
Grassroots ceding amount
(150% of line 48(e))
(a)
2004
'77, T-1
(b)
2003
70.
(c)
2002
(e)
Total
(d)
2001
r
50
Grassroots lobbying
expenditures
Part.Vl-Bj Lobbying Activity by Nonelectin g Public Charities
(For reporting only by organizations that aid not complete Part VI-A) (See instructions )
During the year, did the organization attempt to influence national, state or local legislation, including 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
f
g
h
N/A
Yes
No
Amount
r
.l
Publications, or published or broadcast statements
Grants to other organizations for lobbying purposes
Direct contact with legislators, their staffs, government officials, or a legislative body
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (add lines c through h .)
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA
Schedule A (Form 990 or 990-EZ) 2004
TEEA0405L
07123/04
Schedule A (Form 990 or 990-EZ) 2004 ASSISTANCE LEAGUE OF CAPISTRANO VAL
95-3201899
Part V11, Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Page 6
Exempt Organizations (see instructions)
51
Did the re portmg orgarnzation directly or indirectly engage in 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
(i)Cash
51 a i
X
a ii
X
(ii)Other assets
b Other transactions .
(i)Sales or exchanges of assets with a nonchaniable exempt organization
b i
b ii
(i)Purchases of assets from a nonchantable exempt organization
(M)Rental of facilities, equipment, or other assets
b iii
(iv) Reimbursement arrangements
b iv
(v)Loans or loan guarantees
b v
(vi)Performance of services or membership or fundraising solicitations
b vi
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees
C
~
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 reportin organization If the organization received less than fair market value in
an transaction or sharing arrangement, show in column ~d the value of the goods, other assets, or services received
(a)
Line no .
(b)
Amount involved
(c)
Name of nonchantable exempt organization
X
X
X
X
X
X
X
(d)
Description of transfers, transactions, and sharing arrangements
N/
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501 (c) of the Code (other than section 501(c)(3)) or in section 527
BAA
1- n Yes
Xa
No
Schedule A (Form 990 or 990-EZ) 2004
TEEA0406L
11129/04
PAGE 1
FEDERAL STATEMENTS
2004
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
INC .
CLIENT 1
95-3201899
07 35PM
9/13/05
STATEMENT 1
FORM 990, PART I, LINE 9
NET INCOME (LOSS) FROM SPECIAL EVENTS
SPECIAL EVENTS
BRIDGERS
OTHER EVENTS
LESS
CONTRIBUTIONS
GROSS
RECEIPTS
TOTAL $
8,730 .
2,403 .
11,133 .
0.
0.
0.
$
NET
INCOME
(LOSS)
LESS
DIRECT
EXPENSES
GROSS
REVENUE
8,730 .
2,403 .
11,133 .
3,053 .
63 .
3,116 .
$
5,677 .
2,340 .
8,017 .
STATEMENT 2
FORM 990, PART I, LINE 10
GROSS PROFIT (LOSS) FROM SALES OF INVENTORY
THRIFT SHOP SALES
$
106,623 .
GROSS SALES
LESS RETURNS
NET SALES
LESS COST OF
GROSS PROFIT
$
$
106,623 .
00
106,623 .
$
106,623 .
.
& ALLOWANCES
GOODS SOLD
FROM SALES OF INVENTORY
STATEMENT 3
FORM 990, PART II, LINE 43
OTHER EXPENSES
(A)
TOTAL
ADVERTISING
ASSISTEENS MANAGEMENT
ASSISTEENS MEMBERSHIP
ASSISTEENS RECOGNITION
BANK CHARGES
CONSIGNMENT
INSURANCE
LAS FELICES MANAGEMENT
LAS FELICES MEMBERSHIP
LICENSES AND PERMITS
MEMBERSHIP COMMITTEE
N .A .L . DUES
N .A .L . MEETINGS
PUBLIC RELATIONS
ROSTERS/YEARBOOK
WEBSITE DEVELOPMENT
TOTAL $
218 .
2,522 .
1,868 .
852 .
46 .
657 .
3,096 .
684 .
332 .
42 .
458 .
3,790 .
3,285 .
423 .
668 .
850 .
19,791 .
(B)
PROGRAM
SERVICES
(C)
MANAGEMENT
& GENERAL
2,522 .
1,868 .
852 .
46 .
1,700 .
684 .
332 .
0.
458 .
3,790 .
3,285 .
423 .
668 .
850 .
17,478 .
(D)
FUNDRAISING
218 .
657 .
1,396 .
42 .
2,313 .
2004
FEDERAL STATEMENTS
PAGE 2
INC.
95-3201899
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
CLIENT 1
9/13/05
07 35PM
STATEMENT 4
FORM 990, PART IV, LINE 57
LAND, BUILDINGS, AND EQUIPMENT
CATEGORY
FURNITURE AND FIXTURES
MACHINERY AND EQUIPMENT
BUILDINGS
IMPROVEMENTS
LAND
ACCUM .
DEPREC .
BASIS
$
TOTAL $
9,794
452
66,641
96,132
107,630
280,649
. $
.
.
.
.
.
9,794
452
66,641
15,004
BOOK
VALUE
. $
.
.
.
0
0
0
81,128
107,630
188,758
91,891 . $
.
.
.
.
.
.
STATEMENT 5
FORM 990, PART V
LIST OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES
NAME AND ADDRESS
TITLE AND
AVERAGE HOURS
PER WEEK DEVOTED
BARBARA SURZ
P .O . BOX 133
VICE PRESIDENT
1
SUZANNE GUZZO
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
CONTRIBUTION TO
COMPENSATION
EBP & DC
EXPENSE
ACCOUNT/
OTHER
0. $
0. $
0.
DIRECTOR
1
0.
0.
0.
JOY KEILEY
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
VICE PRESIDENT
1
0.
0.
0 .
DIANE OLSEN
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
SECRETARY
1
0.
0.
0.
SHARON SERRA
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
VICE PRESIDENT
1
0.
0.
0.
CHERYL TYSON
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
PRESIDENT
5
0.
0.
0.
EILEEN MARTIN
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
DIRECTOR
1
0.
0.
0.
KAY ZOLTAN
P .O . BOX 133
SAN JUAN CAPISTRANO,
VICE PRESIDENT
1
0.
0.
0 .
SAN JUAN CAPISTRANO, CA 92693
CA 92693
$
PAGE 3
FEDERAL STATEMENTS
2004
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
INC .
CLIENT 1
9/13/05
95-3201899
07~35PM
STATEMENT 5 (CONTINUED)
FORM 990, PART V
LIST OF OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES
NAME AND ADDRESS
TITLE AND
AVERAGE HOURS
PER WEEK DEVOTED
CONTRIBUTION TO
EBP & DC
COMPENSATION
EXPENSE
ACCOUNT/
OTHER
0. $
0.
DIRECTOR
1
0 .
0.
0.
JOAN NIELSEN
P .O . BOX 133
SECRETARY
1
0.
0.
0.
CAROLE BARNETT
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
TREASURER
5
0 .
0.
0.
LYNN MEINTEL
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
DIRECTOR
1
0 .
0.
0 .
ELYNOR WYLDE
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92677
DIRECTOR
1
0.
0 .
0.
DONNA ECKLES
P .O . BOX 133
SAN JUAN CAPISTRANO, CA 92693
DIRECTOR
1
0.
0.
0.
0 . T-0 -
0.
BETTY LOU LOVEJOY
P .O . BOX 133
SAN JUAN CAPISTRANO,
KAREN SMITH
P .O . BOX 133
SAN JUAN CAPISTRANO,
CA 92693
CA 92693
SAN JUAN CAPISTRANO, CA 92693
DIRECTOR
1
$
TOTAL $
$
0.
5131105
2004 FEDERAL BOOK DEPRECIATION SCHEDULE
PAGE 1 .
ASSISTANCE LEAGUE OF CAPISTRANO VALLEY,
INC .
CLIENT 1
9/13/05
95-3201899
07-35PM
DESCRIPTION
1lQ_
DATE
ACOIIIRFD
DATE
SOL h
CUR
COST/
RASIS
BUS.
179
PCTRONIIS
PRIOR
179/
SPECIAL
DEPR
AI I OW
PRIOR
BONUS/
SPDFPR
DEC BAL
DFPR
SALVAG
/BASIS
RFf111CT
DEPR.
BASIS
PRIOR
DFPR
MFTHOD
I IFE
RATF
CURRENT
FORM 990/990-PF
BUILDINGS
2
BUILDING
8/02/82
TOTAL BUILDINGS
66,641
66,641
0
0
0
0
0
66,641
66,641
66,641
66,641
S/L
15
0
0
FURNITURE AND FIXTURES
5
FURNITURE / FIXTURES
VARIOUS
2,052
7
FURNITURE / FIXTURES
2,052
6/01/86
2,052
S/L
5
0
2,575
8
CLOTHES RACKS
2,575
2,575
S/L
5
0
9/23/87
417
9
SHELVING
417
411
S/L
5
11/11/87
0
144
144
10 CLOTHES RACKS
144
S/L
5
0
12/07/87
471
12 SIGNS
471
411
S/L
5
0
3/30/88
975
975
975
13 CABINETS
S/L
5
0
3/30/88
1,125
14 CABINETS
1,125
1,125
S/L
5
0
4/19/88
200
200
200
S/L
5
0
15
FURNITURE / FIXTURES
11/30/88
788
16
FURNITURE / FIXTURES
788
788
S/L
7
0
11/30/90
1,047
1,047
1,041
S/L
7
0
9,794
9,794
TOTAL FURNITURE AND FIXTURE
9,794
0
0
0
0
0
0
IMPROVEMENTS
3
IMPROVEMENTS
11/30/90
5,732
4
BUILDING ADDITION
5,732
5,732
200DB
7
0
5/31/01
90,400
90,400
6,954
S/L
39
2,318
96,132
12,686
TOTAL IMPROVEMENTS
96,132
0
0
0
0
0
2,318