TY 2010 Form 990EZ

- TIN:

Form990-EZ
Click to see attachment

Department of the Treasury
Internal Revenue Service

Short Form
Return of Organization Exempt From Income Tax

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)

Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.

The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-1150

2010

Open to Public
Inspection

For the 2010 calendar year, or tax year beginning 01-01-2010, and ending 12-31-2010

Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization
INTERNATIONAL CONCRETE REPAIR
INSTITUTE CAROLINAS CHAPTER

Number and street (or P. O. box, if mail is not delivered to street address)8608 TIMBERWIND DRIVE
Room/suite

City or town, state or country, and ZIP + 4 RALEIGH, NC27615

D Employer identification number

56-1856532

E Telephone number

F Group Exemption
Number. . bullet

G Accounting method: CashAccrualOther (specify) bullet

H Check bullet

required to attach Schedule B
(Form 990, 990-EZ, or 990-PF).I Website: bullet

WWW.ICRICAROLINAS.ORGJ Tax-Exempt status(check only one)501(c)(3) 501(c)( 6) bullet

(insert no.) 4947(a)(1) or 527

K Check

if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required 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.

L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts; If gross receipts are $200,000 or more, or if total assets (Part II, line 25, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ.. . bullet

$ 52,289


1	Contributions, gifts, grants, and similar amounts received . . . . . . . . .			1
2	Program service revenue including government fees and contracts . . . . . . .			2	39,775
3	Membership dues and assessments . . . . . . . . . . . . . .			3	5,175
4	Investment income . . . . . . . . . . . . . . . . . .			4	170
5a	Gross amount from sale of assets other than inventory . . . .	5a
b	Less: cost or other basis and sales expenses . .	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . .			5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a
b	Gross income from fundraising events (not including $ 7,169 of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceed $15,000) . . . . . . .
c	Less: direct expenses from gaming and fundraising events . . .	6c	5,106
d	Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)			6d	2,063
7a	Gross sales of inventory, less returns and allowances . . . .	7a
b	Less: cost of goods sold . . . . . . . . . .	7b
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . .			7c
8	Other revenue (describe in Schedule O) . . . . . . . . .			8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . .			9	47,183
10	Grants and similar amounts paid (list in Schedule O) . . . . . . . .			10	1,500
11	Benefits paid to or for members . . . . . . . . . . . . . . .			11
12	Salaries, other compensation, and employee benefits . . . . . . . . . . .			12
13	Professional fees and other payments to independent contractors . . . . . . . .			13	20,974
14	Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . .			14
15	Printing, publications, postage, and shipping . . . . . . . . . . . .			15	1,668
16	Other expenses (describe in Schedule O) . . . . . . . . . .			16	42,815
17	Total expenses. Add lines 10 through 16 . . . . . . . . . . . .			17	66,957
18	Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . .			18	-19,774
19	Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
	end-of-year figure reported on prior year’s return) . . . . . . . . . . .			19	53,502
20	Other changes in net assets or fund balances (explain in Schedule O) . . . . . . .			20
21	Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . .			21	33,728

Part IIBalance Sheets Check if the organization used Schedule O to respond to any question in this Part II. . . . . . . . .

(See the instructions for Part II.)(A) Beginning of year(B) End of year

22Cash, savings, and investments . . . . . . . . . .

53,502

33,728

23Land and buildings . . . . . . . . . . . . .

24Other assets (describe in Schedule O) . . . . . .

25Total assets . . . . . . . . . . . . . .

53,502

33,728

Total liabilities (describe in Schedule O) . . . . .

27Net assets or fund balances (line 27 of column (B) must agree with line 21) .

53,502

33,728

For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.

Cat. No. 10642I Form 990-EZ (2010)

Form 990-EZ (2010)

Page 2

Part IIIStatement of Program Service Accomplishments Check if the organization used Schedule O to respond to any question in this Part III .	Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? EDUCATION ON CONCRETE MAINTENANCE
Describe what was achieved in carrying out the organization's exempt purposes. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 HOLD MEETINGS TO PROMOTE EDUCATION ON IMPROVING THE QUALITY OF REPAIR, RESTORATION, AND PROTECTION OF CONCRETE. (Grants $ ) If this amount includes foreign grants, check here ...		28a
29 MAINTAIN WEBSITE WITH MEMBERSHIP DIRECTORY, ANNOUNCEMENTS, AND TECHNICAL ARTICLES FOR THE CONCRETE TRADE. (Grants $ ) If this amount includes foreign grants, check here ...		29a
30 PUBLISH QUARTERLY NEWSLETTER OF CURRENT ACTIVITIES OF THE CHAPTER AND THE BOARD OF DIRECTORS. (Grants $ ) If this amount includes foreign grants, check here ...		30a
31 Other program services (describe in Schedule O) . . . . . . . . . . . . (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a) . . . . . . . . .	32

Part IVList of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated. (See the instructions for Part IV.) Check if the organization used Schedule O to respond to any question in this Part IV . . . . . . . .

(a) Name and address	(b) Title and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-.)	(d) Contributions to employee benefit plans & deferred compensation	(e) Expense account and other allowances
KEITH HARRISON 2630 ROWLAND ROAD SUITE 100 RALEIGH,NC27615	PRESIDENT1.00	0
JOHN MCDOUGALL 1401-A DIGGS DRIVE RALEIGH,NC27603	VICE PRESIDE1.00	0
JEFFREY MOLBY 4651 CHARLOTTE PARK DRIVE 150 CHARLOTTE,NC28217	SECRETARY1.00	0
JAMES F HADLEY 8909 SUTHERLAND DRIVE HUNTERSVILLE,NC28078	PAST PRESIDE1.00	0
DANIEL L BUEKER 5029 OLD FOX TRAIL CHARLOTTE,NC28269	DIRECTOR1.00	0
TARA CAVALLINE 9201 UNIV CITY BLVD SMITH BLDG 245 CHARLOTTE,NC28223	DIRECTOR1.00	0
TED L BARTELT 4911 GREEN ROAD SUITE 107 RALEIGH,NC27616	DIRECTOR1.00	0
DOUG SAUNDERS 4210 PEBBLE STREET CHARLOTTE,NC28206	TREASURER1.00	0
PAUL FARRELL PO BOX 1007 CREEDMOOR,NC27522	DIRECTOR1.00	0
KENT YARBOROUGH 6726 NETHERLANDS DRIVE SUITE 1100 WILMINGTON,NC28405	DIRECTOR1.00	0
HAYES THOMPSON 114 FAIRWOOD AVENUE CHARLOTTE,NC28203	DIRECTOR1.00	0

Form 990-EZ (2010)

Page 3

Part VOther Information(Note the statement requirements in the instructions for Part V.)YesNo Check if the organization used Schedule O to respond to any question in this Part V . . . .

Did the organization engage in any activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ..............

Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the change on Schedule O (see instructions). ...................

If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990-T, explain in Schedule O why the organization did not report the income on Form 990-T. ........................

Did the organization have unrelated business gross income of $1,000 or more or was it a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements?

35a

If "Yes," has it filed a tax return on Form 990-T for this year? (see instructions) ........

35b

Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes,” complete applicable parts of Schedule N .............

37a

Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet

37a

Did the organization file Form 1120-POL for this year? ...............

37b

38a

Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were

any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?

38a

If “Yes,” complete Schedule L, Part II and enter the total amount involved .

38b

Section 501(c)(7) organizations. Enter:

Initiation fees and capital contributions included on line 9 ......

39a

Gross receipts, included on line 9, for public use of club facilities ....

39b

40a

Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:

section 4911 bullet

; section 4912 bullet

; section 4955 bullet

Section 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 engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I. ....

40b

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 .. bullet

Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization ................... bullet

All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T. .................

40e

41List the states with which a copy of this return is filed. bullet

42aThe organization's books are in care of bullet

KELLY ANDREWS Telephone no. bullet

(919) 870-0315

Located at bullet

8608 TIMBERWIND DRIVE
RALEIGH,NC ZIP + 4 bullet

27615

At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?

Yes

42b

If “Yes,” enter the name of the foreign country: bullet

See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.

At any time during the calendar year, did the organization maintain an office outside of the U.S.?

42c

If “Yes,” enter the name of the foreign country: bullet

43 Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of Form 1041Check here ....... bullet

and enter the amount of tax-exempt interest received or accrued during the tax year . . . bullet

44a

Did the organization maintain any donor advised funds? If "Yes", Form 990 must be completed instead of

Yes

Form 990-EZ.. . . . . . . . . . . . . . . . . . . .

44a

Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completed instead of Form990-EZ. . . . . . . . .

44b

Did the organization receive any payments for indoor tanning services during the year? . . . . . . .

44c

If 'Yes' to line 44c, has the organization filed a Form 720 to report these payments? If ‘No,’ provide an explanation in Schedule O. . . . . . . . .

44d

Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If ‘Yes,’ Form 990 and Schedule R must be completed instead of Form990-EZ. . . . . . . . .

45a

Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If ‘Yes,’ Form 990 and Schedule R must be completed instead of Form990-EZ. .

45a

Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I. . . . . . . . . .

Form 990-EZ (2010)

Page 4

Part VI

Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52. Check if the organization used Schedule O to respond to any question in this Part VI . . . . . . . .

Yes

Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part II . . . .

Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . . .

49a

Did the organization make any transfers to an exempt non-charitable related organization? . . . .

49a

If "Yes," was the related organization a section 527 organization? . . . . . . . . .

49b

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. If there is none, enter "None."

(a) Name and address of each employee paid more than $100,000	(b) Title and average hours per week devoted to position	(c) Compensation	(d) Contributions to employee benefit plans & deferred compensation	(e) Expense account and other allowances

50(f)

Total number of other employees paid over $100,000 . . . . . . . . . . . . . bullet

Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

(a) Name and address of each independent contractor paid more than $100,000	(b) Type of service	(c) Compensation

51(d)

Total number of other independent contractors each receiving over $100,000 . . . . . . . bullet

Did the organization complete Schedule A? NOTE: All Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A .................... Yes No

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

	Signature of officer	Date

	Type or print name and title

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (See instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.

May the IRS discuss this return with the preparer shown above? See instructions ......... bullet

YesNo

Form 990-EZ (2010)

Additional Data

Software ID:
Software Version:

Form 990-EZ, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

INTERNATIONAL CONCRETE REPAIR
INSTITUTE CAROLINAS CHAPTER

Employer identification number

56-1856532

Identifier	Return Reference	Explanation
OTHER EXPENSES	FORM 990-EZ, PART I, LINE 16	EXPENSES ADVERTISING & PROMOTION 3,000 OFFICE 161 TRAVEL 1,869 CONFERENCES & MEETINGS 36,198 AWARDS & CERTIFICATES 687 TELEPHONE 900 TOTAL 42,815

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

TY 2010 CompensationExplanation

Name:

INTERNATIONAL CONCRETE REPAIR

INSTITUTE CAROLINAS CHAPTER

EIN: 56-1856532

Person Name	Explanation
KEITH HARRISON
JOHN MCDOUGALL
JEFFREY MOLBY
JAMES F HADLEY
DANIEL L BUEKER
TARA CAVALLINE
TED L BARTELT
DOUG SAUNDERS
PAUL FARRELL
KENT YARBOROUGH
HAYES THOMPSON