Form990-EZ
Click to see list of attachments
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)
bullet 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.
bulletThe organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
2010
Open to Public
Inspection
A
For the 2010 calendar year, or tax year beginning 07-01-2010, and ending 06-30-2011
B
Check if applicable:
C Name of organization
SERVICE ABOVE SELF FOUNDATION OF THE
ROTARY CLUB OF NORTHWEST DES MOINES
Number and street (or P. O. box, if mail is not delivered to street address)PO BOX 3715
  Room/suite
City or town, state or country, and ZIP + 4 URBANDALE, IA503230715
D Employer identification number

75-3131827
E Telephone number

(515) 309-0215
F Group Exemption
Number. . bullet  
G Accounting method: Other (specify) bullet   H Check bulletI Website:bulletHTTP://WWW.CLUBRUNNER.CA/CPRG/HOME/HOMEA.ASP?CID=J Tax-Exempt status(check only one)—Click to see attachment(   ) bullet(insert no.) or
K Check bullet 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 $ 60,466
Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I.) Check if the organization used Schedule O to respond to any question in this Part I . . . . . . . .
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received . . . . . . . . . 1 50,556
2 Program service revenue including government fees and contracts . . . . . . . 2  
3 Membership dues and assessments . . . . . . . . . . . . . . 3  
4 Investment income . . . . . . . . . . . . . . . . . . 4  
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 9,910
b Gross income from fundraising events (not including $   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 200
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c) 6d 9,710
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 60,266
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) . . . . . . . . 10 32,467
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  
14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . 14  
15 Printing, publications, postage, and shipping . . . . . . . . . . . . 15  
16 Other expenses (describe in Schedule O) . . . . . . . . . . 16 17,238
17 Total expenses. Add lines 10 through 16 . . . . . . . . . . . . 17 49,705
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . 18 10,561
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 46,105
20 Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . 20 0
21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . Bullet 21 56,666
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 . . . . . . . . . .
43,030
22
63,555
23Land and buildings . . . . . . . . . . . . .
 
23
 
24Other assets (describe in Schedule O) . . . . . .
6,480
24
820
25Total assets . . . . . . . . . . . . . .
49,510
25
64,375
26
Total liabilities (describe in Schedule O) . . . . .
3,405
26
7,709
27Net assets or fund balances (line 27 of column (B) must agree with line 21) .
46,105
27
56,666
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? SUPPORT THE CHARITABLE AND EDUCATIONAL PURPOSES OF THE ROTARY CLUB OF NORTHWEST DES MOINES BY PROVIDING OPPORTUNITY AND RESOURCES TO SUPPORT COMMUNITY CHARITABLE NEEDS.
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 SUPPORT TO PROJECTS OF THE ROTARY FOUNDATION
(Grants $ 10,783) If this amount includes foreign grants, check here ...MediumBullet		 28a 0
29 SUPPORT TO THE LOCAL COMMUNITY
(Grants $ 19,684) If this amount includes foreign grants, check here ...MediumBullet		 29a 0
30 SCHOLARSHIPS SUPPORT TO AREA STUDENTS TO ATTEND COLLEGE
(Grants $ 2,000) If this amount includes foreign grants, check here ...MediumBullet		 30a 0
31 Other program services (describe in Schedule O) . . . . . . . . . . . .
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a) . . . . . . . . . bullet 32 0
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
ERIC DICKINSON
5822 S WINWOOD DR
JOHNSTON,IA50131
 PRESIDENT0.00 0 0 0
WANDA ARMSTRONG
101 NW 8TH ST 202
GRIMES,IA50111
 PRESIDENT ELECT0.00 0 0 0
BRAD HELGEMO
10986 HICKORY DR
CLIVE,IA50325
 SECRETARY (EX-OFFICIO)0.00 0 0 0
WENDI WILSON
14643 SUMMIT DR
CLIVE,IA50325
 BOARD MEMBER0.00 0 0 0
CAM TORSTENSON
7302 PALM DR
URBANDALE,IA50322
 BOARD MEMBER0.00 0 0 0
MARK MCANDREWS
2601 49TH ST
DES MOINES,IA50310
 BOARD MEMBER0.00 0 0 0
DIANE DOWNING-NELSON
4704 67TH ST
URBANDALE,IA50322
 BOARD MEMBER0.00 0 0 0
JOHN PITTMAN
4622 94TH ST
URBANDALE,IA50322
 BOARD MEMBER0.00 0 0 0
Form 990-EZ (2010)
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 . . . .
33
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 ..............
33
 
No
34
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). ...................
34
 
No
35
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. ........................
a
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
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year? (see instructions) ........
35b
 
 
36
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 .............
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
0
b
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
 
No
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9 ......
39a
 
b
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 bullet0 ; section 4912 bullet0 ; section 4955 bullet0
b
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
 
No
c
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 ..bullet0
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization ...................bullet0
e
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
 
No
41List the states with which a copy of this return is filed. bullet
42aThe organization's books are in care of bulletWILLIAM W CORWIN EXEC TREASURER Telephone no. bullet (515) 309-0215
Located at bullet1055 JORDAN CREEK PKWY SUITE 120
WEST DES MOINES,IA ZIP + 4bullet502665821
b
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
No
42b
 
No
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.
c
At any time during the calendar year, did the organization maintain an office outside of the U.S.?
42c
 
No
If “Yes,” enter the name of the foreign country: bullet  
43.......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year . . . bullet43
 
44a
Did the organization maintain any donor advised funds? If "Yes", Form 990 must be completed instead of
Yes
No
Form 990-EZ.. . . . . . . . . . . . . . . . . . . .
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completed instead of Form990-EZ. . . . . . . . .
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year? . . . . . . .
44c
 
No
d
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
 
 
45
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. . . . . . . . .
45
 
No
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
 
No
46
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. . . . . . . . . .
46
 
No
Form 990-EZ (2010)
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
No
47
Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part II . . . .
47
 
No
48
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E . . .
48
 
No
49a
Did the organization make any transfers to an exempt non-charitable related organization? . . . .
49a
 
No
b
If "Yes," was the related organization a section 527 organization? . . . . . . . . .
49b
 
 
50
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
NONE
50(f)
Total number of other employees paid over $100,000 . . . . . . . . . . . . . bullet  

51
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
NONE
51(d)
Total number of other independent contractors each receiving over $100,000 . . . . . . . bullet  
52
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 ....................
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
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer's Use Only Preparer's
signatureBig Right Arrow 		Date
right pointing bullet image Preparer’s taxpayer identification number
(See instructions)
Firm’s name (or yours
if self-employed),
address, and ZIP + 4Big Right Arrow




 		EIN right pointing bullet image
Phone no. right pointing bullet image
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2010)

Additional Data


Software ID:  
Software Version:  

Form 990-EZ, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2010
Open to Public
Inspection
Name of the organization
SERVICE ABOVE SELF FOUNDATION OF THE
ROTARY CLUB OF NORTHWEST DES MOINES
Employer identification number

75-3131827
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross 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). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .     33,968 47,646 50,556 132,170
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......         9,710 9,710
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.     33,968 47,646 60,266 141,880
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           0
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.           0
c Add lines 7a and 7b..           0
8 Public Support (Subtract line 7c from line 6.)           141,880
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2006 (b) 2007 (c) 2008 (d) 2009 (e) 2010 (f) Total
9 Amounts from line 6...     33,968 47,646 60,266 141,880
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).     33,968 47,646 60,266 141,880
14
Section C. Computation of Public Support Percentage
15
15
100.000 %
16
16
100.000 %
Section D. Computation of Investment Income Percentage
17
17
0 %
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2010

Additional Data


Software ID:  
Software Version:  
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
SERVICE ABOVE SELF FOUNDATION OF THE
ROTARY CLUB OF NORTHWEST DES MOINES
Employer identification number

75-3131827
Identifier Return Reference Explanation
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: CITY OF URBANDALE PARKS & RECREATION. GRANTEE ADDRESS: 3600 86TH ST URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 09/03/10. AMOUNT GIVEN: 4,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: DES MOINES BICYCLE COLLECTIVE. GRANTEE ADDRESS: 617 GRAND AVE DES MOINES, IA 50309. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 09/03/10. AMOUNT GIVEN: 2,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: KAREN ACRES SCHOOL. GRANTEE ADDRESS: 3500 74TH ST URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 09/24/10. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: REACH OUT & READ - IOWA. GRANTEE ADDRESS: PO BOX 1382 JOHNSTON, IA 50131. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 09/03/10. AMOUNT GIVEN: 2,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: READING STATIONS AT MEDICAL CLINICS. GRANTEE ADDRESS: VARIOUS LOCATIONS URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. AMOUNT GIVEN: 2,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: URBANDALE COMMUNITY SCHOOLS. GRANTEE ADDRESS: 11152 AURORA AVENUE URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 06/30/11. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: URBANDALE FOOD PANTRY. GRANTEE ADDRESS: 7611 DOUGLAS AVE, SUITE 31 URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 10/29/10. AMOUNT GIVEN: 4,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: URBANDALE POLICE DEPARTMENT. GRANTEE ADDRESS: 3740 86TH ST URBANDALE, IA 50322. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 09/03/10. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: COMMUNITY DONATION. GRANTEE NAME: VARIOUS. PROPERTY DESCRIPTION: CASH. AMOUNT GIVEN: 1,184.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: ROTARY FOUNDATION. GRANTEE NAME: ROTARY FOUNDATION - GENERAL FUND. GRANTEE ADDRESS: 1560 SHERMAN AVE EVANSTON, IL 60201. PROPERTY DESCRIPTION: CASH. AMOUNT GIVEN: 1,250.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: ROTARY FOUNDATION. GRANTEE NAME: ROTARY FOUNDATION - MATCHING GRANTS. GRANTEE ADDRESS: 1560 SHERMAN AVE EVANSTON, IL 60201. PROPERTY DESCRIPTION: CASH. AMOUNT GIVEN: 6,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: ROTARY FOUNDATION. GRANTEE NAME: ROTARY FOUNDATION - POLIO PLUS. GRANTEE ADDRESS: 1560 SHERMAN AVE EVANSTON, IL 60201. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 05/31/11. AMOUNT GIVEN: 3,533.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: DES MOINES AREA COMMUNITY COLLEGE. GRANTEE ADDRESS: 2006 S ANKENY BLVD ANKENY, IA 50023. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 06/30/11. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: SCHOLARSHIPS. GRANTEE NAME: LUTHER COLLEGE. GRANTEE ADDRESS: 700 COLLEGE DRIVE DECORAH, IA 52101. PROPERTY DESCRIPTION: CASH. DATE OF GIFT: 06/30/11. AMOUNT GIVEN: 1,000. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 32,467.
OTHER EXPENSES FORM 990-EZ, PART I, LINE 16 DESCRIPTION: COSTS - GABUS BIKE RIDE FUND RAISER. AMOUNT: 2,184. DESCRIPTION: COSTS - POLIO PLUS FUND RAISER. AMOUNT: 14,860. DESCRIPTION: BANK CHARGES. AMOUNT: 12. DESCRIPTION: SUPPLIES. AMOUNT: 26. DESCRIPTION: STATE GAMBLING PERMIT. AMOUNT: 156. TOTAL TO FORM 990-EZ, LINE 16: 17,238.
OTHER ASSETS FORM 990-EZ, PART II, LINE 24 DESCRIPTION: ACCOUNTS RECEIVABLE. BEG. OF YEAR AMOUNT: 6,480. END OF YEAR AMOUNT: 820.
OTHER LIABILITIES FORM 990-EZ, PART II, LINE 26 DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 3,305. END OF YEAR AMOUNT: 7,161. DESCRIPTION: PAUL HARRIS ESCROW PAYABLE. BEG. OF YEAR AMOUNT: 100. END OF YEAR AMOUNT: 0. DESCRIPTION: SALES TAX PAYABLE. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 548.
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

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TY 2010 TransferPrsnlBnftContractsDecl
Name:
SERVICE ABOVE SELF FOUNDATION OF THE
ROTARY CLUB OF NORTHWEST DES MOINES
EIN: 75-3131827
Declaration:
THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.