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.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
TRANQUILLITY CAMP INC
Employer identification number
13-5634525
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
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
Provide the following information about the supported organization(s).
(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) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
624,479
203,309
195,667
215,567
430,403
1,669,425
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......
637,125
782,445
792,819
795,870
807,816
3,816,075
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.
1,261,604
985,754
988,486
1,011,437
1,238,219
5,485,500
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
75,000
20,000
18,000
34,000
13,000
160,000
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.
c
Add lines 7a and 7b..
75,000
20,000
18,000
34,000
13,000
160,000
8
Public Support (Subtract line 7c from line 6.)
5,325,500
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
1,261,604
985,754
988,486
1,011,437
1,238,219
5,485,500
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
35,509
27,821
23,827
23,544
22,973
133,674
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
35,509
27,821
23,827
23,544
22,973
133,674
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.).
1,297,113
1,013,575
1,012,313
1,034,981
1,261,192
5,619,174
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
94.774 %
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
93.007 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
2.379 %
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
3.191 %
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
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) 2011
Additional Data
Software ID:
Software Version:
-
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.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
TRANQUILLITY CAMP INC
Employer identification number
13-5634525
Identifier
Return Reference
Explanation
DIRECTORS WHO CANNOT BE REACHED AT ORGANIZATION'S ADDRESS
SECTION A QUESTION #11
RICHARD LAWRENCE, PRESIDENT & DIRECTOR 260 UMPAWAUG ROAD, REDDING CT 06896-1826 MARC S. COHN, VICE PRESIDENT, SECRETARY & DIRECTOR 53 NORTH PARK AVENUE SUITE 302, ROCKVILLE CENTRE, NY 11570 MAURICE SCHLANG, VICE PRESIDENT & DIRECTOR 2580 SOUTH OCEAN BLVD, PALM BEACH, FL 33480 ROBIN CAINE DIAMANT, ASSISTANT TREASURER & DIRECTOR 20791 EAGLE CREEK COURT, BOCA RATON, FL 33498 DANIEL COHN, DIRECTOR 246 HIGHWOOD AVE., TENAFLY, NJ 07670 CRAIG SNOW, VICE PRESIDENT & DIRECTOR 11 HUNTER'S LANE ITHACA, NY 14850 CHERYL JANER, TREASURER & DIRECTOR 4132 CEDAR CREEK ROAD, BOCA RATON, FL 33487 SARAH LAWRENCE, DIRECTOR 260 UMPAWAUG ROAD, REDDING, CT 6896 CARY SPIEGEL, DIRECTOR 3 SHERMAN COURT, PLAINSBORO, NJ 08536 ADRIENNE GARNETT, DIRECTOR 48 HILLSIDE AVENUE, NEW ROCHELLE, NY 10801 IRA ALTMAN, DIRECTOR 74 PROSPECT STREET, HUNTINGTON, NY 11743
GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS
PART VI, SECTION C QUESTION #19
THE ORGANIZATION GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE ON ANOTHERS WEBSITE - WWW.GUIDESTAR.COM. THESE DOCUMENTS CAN ALSO BE MADE AVAILABLE AT ITS LOCATION DURING CAMP HOURS WHEN THE REQUEST IS MADE WITH ADVANCE NOTICE.
COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD REVIEWS AND AUTHORIZES COMPENSATION FOR EXECUTIVE OFFICERS AND KEY EMPLOYEES.
AUDIT COMMITTEE
FORM 990, PART XI, LINE 2
THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT AND REVIEW OF AUDITS, REVIEWS AND COMPILATIONS PERFORMED BY INDEPENDENT ACCOUNTANTS.
NET ASSET RECONCILIATION
FORM 990, PART XI, LINE 5
THE OTHER CHANGES IN THE NET ASSET RECONCILIATIOPN OF $75,289 REPRESENTS THE UNREALIZED GAIN FOR THE YEAR.
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:REPAIRS & MAINTENANCE TOTAL EXPENSES:63099 PROGRAM SERVICES:63099
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:GARBAGE REMOVAL TOTAL EXPENSES:7398 PROGRAM SERVICES:7398
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LAUNDRY & LINEN TOTAL EXPENSES:3472 PROGRAM SERVICES:3472
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PERMITS & DUES TOTAL EXPENSES:3854 PROGRAM SERVICES:3854
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:OBITUARY TOTAL EXPENSES:882 MANAGEMENT AND GENERAL:882
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LANDSCAPING TOTAL EXPENSES:9206 PROGRAM SERVICES:9206
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CAMPER TRANSPORTATION TOTAL EXPENSES:13724 PROGRAM SERVICES:13724
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:POSTAGE TOTAL EXPENSES:6006 PROGRAM SERVICES:6006
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:SUPPLIES TOTAL EXPENSES:45761 PROGRAM SERVICES:45761
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:AMORTTIZATION TOTAL EXPENSES:253 PROGRAM SERVICES:253
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PCM MEMORIAL WALKWAY TOTAL EXPENSES:471 PROGRAM SERVICES:471
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TELEPHONE TOTAL EXPENSES:6942 PROGRAM SERVICES:3471 MANAGEMENT AND GENERAL:3471
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:MISCELLANEOUS TOTAL EXPENSES:5833 PROGRAM SERVICES:5710 MANAGEMENT AND GENERAL:123
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:SCHOLARSHIPS TOTAL EXPENSES:4725 PROGRAM SERVICES:4725
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EQUIPMENT LEASE TOTAL EXPENSES:6485 PROGRAM SERVICES:6485
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EDUCATION TOTAL EXPENSES:610 MANAGEMENT AND GENERAL:610
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CONTRIBUTION TOTAL EXPENSES:1500 MANAGEMENT AND GENERAL:1500
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:INTERVIEWS & ADVERTISEMENT TOTAL EXPENSES:355 PROGRAM SERVICES:355
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CREDIT CARD FEES TOTAL EXPENSES:2116 MANAGEMENT AND GENERAL:2116
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.