Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
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)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
1395 DUBLIN ROAD
 
Room/suite
City or town, state or country, and ZIP + 4
COLUMBUS, OH43215
D Employer identification number

55-0603480
E Telephone number

G Gross receipts $ 14,692,125
F Name and address of principal officer:
BECKY WILLIAMS
1395 DUBLIN ROAD
COLUMBUS,OH43215
I
Tax-exempt status: ( 5 ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.SEIU1199.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1984
M State of legal domicile: OH
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: SEIU DISTRICT 1199 SEEKS TO IMPROVE QUALITY OF LIFE FOR ITS MEMBERS AND SOCIETY AS A WHOLE BY IMPROVING THE WORKING CONDITIONS, WAGES AND BENEFITS OF ITS MEMBERS. IT DOES THIS BY REPRESENTING THEM IN COLLECTIVE BARGAINING NEGOTIATIONS WITH THEIR EMPLOYERS, ARBITRATING LABOR DISPUTES AND ORGANIZING NEW BARGAINING UNITS. SEIU DISTRICT 1199 REPRESENTS APPROXIMATELY 25,000 MEMBERS THROUGHOUT WEST VIRGINIA, KENTUCKY AND OHIO.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 232
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 232
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 445
6 Total number of volunteers (estimate if necessary) .... 6  
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 0
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b  
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) .........   0
9 Program service revenue (Part VIII, line 2g) ......... 15,508,020 13,822,855
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 112,206 93,952
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 221,218 266,135
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 15,841,444 14,182,942
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 137,000 70,000
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 6,092,586 5,543,934
16a Professional fundraising fees (Part IX, column (A), line 11e).....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 9,890,406 8,495,224
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 16,119,992 14,109,158
19 Revenue less expenses. Subtract line 18 from line 12....... -278,548 73,784
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 6,656,803 6,394,651
21 Total liabilities (Part X, line 26)............. 1,165,724 887,919
22 Net assets or fund balances. Subtract line 21 from line 20..... 5,491,079 5,506,732
Part II
Signature Block
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 use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: SEIU DISTRICT 1199 SEEKS TO IMPROVE QUALITY OF LIFE FOR ITS MEMBERS AND SOCIETY AS A WHOLE BY IMPROVING THE WORKING CONDITIONS, WAGES AND BENEFITS OF ITS MEMBERS. IT DOES THIS BY REPRESENTING THEM IN COLLECTIVE BARGAINING NEGOTIATIONS WITH THEIR EMPLOYERS, ARBITRATING LABOR DISPUTES AND ORGANIZING NEW BARGAINING UNITS. SEIU DISTRICT 1199 REPRESENTS APPROXIMATELY 25,000 MEMBERS THROUGHOUT WEST VIRGINIA, KENTUCKY AND OHIO.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 14,109,158 including grants of $ 70,000 ) (Revenue $   )
MEMBERS WERE ORGANIZED INTO COLLECTIVE BARGAINING UNITS AND REPRESENTED IN NEGOTIATIONS WITH THEIR EMPLOYERS AS WELL AS JOB ACTIONS. LEADERS WERE TRAINED TO STRENGTHEN THE UNION AND MEMBERS WERE KEPT ABREAST OF EVENTS THAT AFFECT THEM ON A LOCAL AND NATIONAL LEVEL.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 14,109,158
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule A.....................
1
 
No
2
Is the organization required to complete Schedule B, Schedule of Contributors? ........
2
 
No
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
Yes
 
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part II.........................
4
 
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
Yes
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
 
No
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
 
No
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II..
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III..
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H.....
20a
 
No
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements.
20b
 
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................
23
 
No
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I......
25a
 
 
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................
25b
 
 
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
Yes
 
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
 
No
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
 
No
b
If ‘Yes’ to line 35a, 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,” complete Schedule R, Part V, line 2... Click to see attachment
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2...........
36
 
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
 
No
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
119
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
445
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
 
No
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
 
 
4a
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 or securities account)?.......................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
 
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
 
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
 
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
 
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
232
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
232
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
 
No
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
 
No
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
 
No
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
BECKY WILLIAMS
1395 DUBLIN ROAD
COLUMBUS,OH43215
(614) 461-1199
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) JUDY MALDONADO
EXEC BOARD
 1.00 X           3,135 0 0
(2) SHEILA PEACHOCK
EXEC BOARD
 1.00 X           3,112 0 0
(3) PATTIE HUCKABEE
EXEC BOARD
 1.00 X           3,059 0 0
(4) WILLIAM E HARPER III
EXEC BOARD
 1.00 X           2,468 0 0
(5) LARRY DANIELS
EXEC BOARD
 1.00 X           2,280 0 0
(6) CECELIA FLONNOY
EXEC BOARD
 1.00 X           2,224 0 0
(7) LYNN RADCLIFFE
EXEC BOARD
 1.00 X           2,104 0 0
(8) RHONDA CLARK
EXEC BOARD
 1.00 X           1,948 0 0
(9) CONSTANCE DAILEY
EXEC BOARD
 1.00 X           1,306 0 0
(10) CHESTER RICHARDSON
EXEC BOARD
 1.00 X           1,254 0 0
(11) CATHY MOCKUS
EXEC BOARD
 1.00 X           1,206 0 0
(12) PENNY BURCHETT
EXEC BOARD
 1.00 X           1,028 0 0
(13) BARBARA MONTGOMERY
EXEC BOARD
 1.00 X           1,018 0 0
(14) SANDY GORDON
EXEC BOARD
 1.00 X           1,007 0 0
(15) PHYLLIS FORD
EXEC BOARD
 1.00 X           991 0 0
(16) KAY BISHOP
EXEC BOARD
 1.00 X           980 0 0
(17) SHIRLEY LANE
EXEC BOARD
 1.00 X           978 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) DEBORAH HAJZAK
EXEC BOARD
 1.00 X           974 0 0
(19) KATHLEEN COTY
EXEC BOARD
 1.00 X           962 0 0
(20) DORTHY MCLENDON
EXEC BOARD
 1.00 X           959 0 0
(21) AMIYA P HUTSON
EXEC BOARD
 1.00 X           955 0 0
(22) PETER HANLON
EXEC BOARD
 1.00 X           946 0 0
(23) ALICE BICKHART
EXEC BOARD
 1.00 X           931 0 0
(24) LATISHA PRICE
EXEC BOARD
 1.00 X           892 0 0
(25) PATRICIA SHEPHERD
EXEC BOARD
 1.00 X           891 0 0
(26) FRANK WILLIAMS
EXEC BOARD
 1.00 X           888 0 0
(27) BEVERLY OWENS
EXEC BOARD
 1.00 X           883 0 0
(28) EFFIE SCOTT
EXEC BOARD
 1.00 X           875 0 0
(29) MARSHA LIVERPOOL
EXEC BOARD
 1.00 X           871 0 0
(30) KIM MICKLES
EXEC BOARD
 1.00 X           866 0 0
(31) RITA BUTLER
EXEC BOARD
 1.00 X           848 0 0
(32) VALERIE K TAYLOR
EXEC BOARD
 1.00 X           842 0 0
(33) TERRI WALKER
EXEC BOARD
 1.00 X           839 0 0
(34) RUBY FOWLER
EXEC BOARD
 1.00 X           810 0 0
(35) VANESSA D KELLY
EXEC BOARD
 1.00 X           789 0 0
(36) ARLENE WILLIAMS
EXEC BOARD
 1.00 X           785 0 0
(37) EUGENE JORDAN
EXEC BOARD
 1.00 X           783 0 0
(38) JACQUELINE RICHARDSON
EXEC BOARD
 1.00 X           782 0 0
(39) KRISTINA FLOYD
EXEC BOARD
 1.00 X           774 0 0
(40) JOE IMBORDINO
EXEC BOARD
 1.00 X           770 0 0
(41) GLADYS LUMBUS
EXEC BOARD
 1.00 X           764 0 0
(42) MICHELLE JACKSON
EXEC BOARD
 1.00 X           746 0 0
(43) PAMELA MOORE
EXEC BAORD
 1.00 X           745 0 0
(44) LINDA KOWALSKI
EXEC BOARD
 1.00 X           741 0 0
(45) CARMA RICHARDSON
EXEC BOARD
 1.00 X           738 0 0
(46) KAREN DALE
EXEC BOARD
 1.00 X           722 0 0
(47) MAJORIE HYMBAUGH
EXEC BOARD
 1.00 X           720 0 0
(48) CARL BRIDGEFORTH
EXEC BOARD
 1.00 X           700 0 0
(49) DARRELL T PUGH
EXEC BOARD
 1.00 X           694 0 0
(50) CLINT SALMONS
EXEC BOARD
 1.00 X           690 0 0
(51) ANNETTE SWEENEY
EXEC BOARD
 1.00 X           685 0 0
(52) HOLLY QUINN
EXEC BOARD
 1.00 X           684 0 0
(53) BARBARA LEE
EXEC BOARD
 1.00 X           663 0 0
(54) SHEILA GLOWACKI
EXEC BOARD
 1.00 X           662 0 0
(55) EDWARD D'ANGELO
EXEC BOARD
 1.00 X           656 0 0
(56) DANA SAMSON
EXEC BOARD
 1.00 X           654 0 0
(57) MARY JAWORSKI
EXEC BOARD
 1.00 X           649 0 0
(58) SUSAN ELLIOTT
EXEC BOARD
 1.00 X           647 0 0
(59) ROBIN HARRIS
EXEC BOARD
 1.00 X           644 0 0
(60) SAMARA KNIGHT
EXEC BOARD
 1.00 X           643 0 0
(61) DONNA BELLES
EXEC BOARD
 1.00 X           642 0 0
(62) MIKE KENNEDY
EXEC BOARD
 1.00 X           640 0 0
(63) ANNETTE WISNIEWSKI
EXEC BOARD
 1.00 X           640 0 0
(64) DEBRA CROSS
EXEC BOARD
 1.00 X           637 0 0
(65) SHARON BRYANT
EXEC BOARD
 1.00 X           630 0 0
(66) ELEANOR SHAFER
EXEC BOARD
 1.00 X           618 0 0
(67) SONJA COLWELL
EXEC BOARD
 1.00 X           611 0 0
(68) TRACI NASH
EXEC BOARD
 1.00 X           610 0 0
(69) CHRISTIAN NOREK
EXEC BOARD
 1.00 X           600 0 0
(70) PAM BOOTH
EXEC BOARD
 1.00 X           594 0 0
(71) BETTY CANNON
EXEC BOARD
   X           586 0 0
(72) DAMON CORE
EXEC BOARD
 1.00 X           586 0 0
(73) BELINDA PERALES
EXEC BOARD
 1.00 X           579 0 0
(74) JEAN MORAN-HADDEN
EXEC BAORD
 1.00 X           556 0 0
(75) DEBORAH BRODE
EXEC BOARD
 1.00 X           547 0 0
(76) RANDY WARD
EXEC BOARD
 1.00 X           533 0 0
(77) BENJAMIN BLAIR
EXEC BOARD
 1.00 X           531 0 0
(78) LOISSTINE WELLS
EXEC BOARD
 1.00 X           528 0 0
(79) ASHLEY SPENCER-HANLEY
EXEC BOARD
 1.00 X           519 0 0
(80) LILLIAN PAYNE
EXEC BOARD
 1.00 X           516 0 0
(81) PATRICIA SMITH
EXEC BOARD
 1.00 X           514 0 0
(82) MINNIE GILLESPIE
EXEC BOARD
 1.00 X           507 0 0
(83) DONNA EVANS
EXEC BOARD
 1.00 X           497 0 0
(84) RACHELLE CANADY
EXEC BOARD
 1.00 X           493 0 0
(85) CAMILLE GRALEY
EXEC BOARD
 1.00 X           490 0 0
(86) CAROL FORD
EXEC BOARD
 1.00 X           486 0 0
(87) MARTHA MALONEY
EXEC BOARD
 1.00 X           486 0 0
(88) SHAWN GOODE
EXEC BOARD
 1.00 X           484 0 0
(89) BETH MARSHALL
EXEC BOARD
 1.00 X           481 0 0
(90) AMY HOOPS
EXEC BOARD
 1.00 X           477 0 0
(91) BONITA SCYE
EXEC BOARD
 1.00 X           476 0 0
(92) PAULA SEALS
EXEC BOARD
 1.00 X           475 0 0
(93) GAY JONES
EXEC BOARD
 1.00 X           469 0 0
(94) SHAWNITA RIDER
EXEC BOARD`
 1.00 X           461 0 0
(95) LINDA VENDITTI
EXEC BOARD
 2.00 X           460 0 0
(96) FRANCIS ADAMS
EXEC BOARD
 1.00 X           459 0 0
(97) LIO COMICHISTA
EXEC BOARD
 1.00 X           459 0 0
(98) KAREN KIRKWOOD
EXEC BOARD
 1.00 X           459 0 0
(99) HEATHER REBEL
EXEC BOARD
 1.00 X           458 0 0
(100) DENNIS BEAGLE
EXEC BOARD
 1.00 X           457 0 0
(101) PARRIS QUEEN
EXEC BOARD
 1.00 X           455 0 0
(102) SUSAN RASH
EXEC BOARD
 1.00 X           455 0 0
(103) JEREMY GARRETT
EXEC BOARD
 1.00 X           439 0 0
(104) ANGEL HAWKINS
EXEC BOARD
 1.00 X           436 0 0
(105) TRACY ISAAC
EXEC BOARD
 1.00 X           436 0 0
(106) SHARON MCNEAL
EXEC BOARD
 1.00 X           434 0 0
(107) JOHNNY RAINEY
EXEC BOARD
 1.00 X           433 0 0
(108) CHARLOTTE AKERS
EXEC BOARD
 1.00 X           431 0 0
(109) BEVERLY BERRY
EXEC BOARD
 1.00 X           426 0 0
(110) MICHELE WEBB
EXEC BOARD
 1.00 X           420 0 0
(111) ANNITTA BRYANT
EXEC BOARD
 1.00 X           418 0 0
(112) LORRAINE BRADLEY
EXEC BOARD
 1.00 X           415 0 0
(113) PATRICK A POWELL
EXEC BOARD
 1.00 X           413 0 0
(114) JAMES BYRSE
EXEC BOARD
 2.00 X           408 0 0
(115) CINDY SMITH
EXEC BOARD
 1.00 X           405 0 0
(116) DODIE GENNARO
EXEC BOARD
 1.00 X           402 0 0
(117) JENNY VICKERS
EXEC BOARD
 1.00 X           402 0 0
(118) MICHELLE DAVIS
EXEC BOARD
 1.00 X           397 0 0
(119) JACKIE MOORE
EXEC BOARD
 1.00 X           391 0 0
(120) ILEEN KELLY
EXEC BOARD
 1.00 X           390 0 0
(121) SONA MANLEY
EXEC BOARD
 1.00 X           387 0 0
(122) BOWEN AYLSWORTH
EXEC BOARD
 1.00 X           384 0 0
(123) LINDA MAYFIELD
EXEC BOARD
 1.00 X           380 0 0
(124) ANGELA SOTTTLEMIRE
EXEC BOARD
 1.00 X           379 0 0
(125) KIM FRANKLIN
EXEC BOARD
 1.00 X           378 0 0
(126) RICK GARRETT
EXEC BOARD
 1.00 X           375 0 0
(127) DENISE LEPORT
EXEC BOARD
 1.00 X           362 0 0
(128) GRACE SIMS
EXEC BOARD
 1.00 X           362 0 0
(129) DEBORAH MULLEN
EXEC BOARD
 1.00 X           358 0 0
(130) WILL JONES
EXEC BOARD
 1.00 X           356 0 0
(131) FRANCINE TURNER
EXEC BOARD
 1.00 X           355 0 0
(132) BETH ZAWORSKI
EXEC BOARD
 1.00 X           353 0 0
(133) JAMES BROWN
EXEC BOARD
 1.00 X           352 0 0
(134) DWAYNE THORNTON
EXEC BOARD
   X           347 0 0
(135) SALLY KLEPPER
EXEC BOARD
 1.00 X           345 0 0
(136) DONALD COTTINGHAM
EXEC BOARD
 1.00 X           344 0 0
(137) JUANITA DAVIS
EXEC BOARD
 1.00 X           338 0 0
(138) FREIDA JONES
EXEC BOARD
 1.00 X           330 0 0
(139) ELAINE SINGLETON
EXEC BOARD
 1.00 X           316 0 0
(140) CALENA LONG
EXEC BOARD
 1.00 X           312 0 0
(141) ROD KRAUSHER
EXEC BOARD
 1.00 X           308 0 0
(142) DONALD PARTSCH
EXEC BOARD
 1.00 X           299 0 0
(143) VALERIE MCMICHAEL
EXEC BOARD
 1.00 X           291 0 0
(144) GWENDOLYN HINTON
EXEC BOARD
 1.00 X           278 0 0
(145) TINA STOVER
EXEC BOARD
 1.00 X           278 0 0
(146) PEARL BLAIR
EXEC BOARD
 1.00 X           274 0 0
(147) JOANNE BURNS
EXEC BOARD
 1.00 X           272 0 0
(148) ELIZABETH DANDRIDGE
EXEC BOARD
 1.00 X           258 0 0
(149) MASHELL SINGLETON
EXEC BOARD
 1.00 X           252 0 0
(150) MARY KUHENS
EXEC BOARD
 1.00 X           246 0 0
(151) VICKIE KESNER
EXEC BOARD
 1.00 X           245 0 0
(152) MARYANNE LLOYD
EXEC BOARD
 1.00 X           242 0 0
(153) JEAN GROSSHEIM
EXEC BAORD
 1.00 X           238 0 0
(154) CHARLOTTE DOBBINS
EXEC BOARD
 1.00 X           232 0 0
(155) BETTY LEWIS
EXEC BOARD
 1.00 X           229 0 0
(156) WANDA CARPENTER
EXEC BOARD
 1.00 X           227 0 0
(157) DORA-MAE MALARCHICK
EXEC BOARD
 1.00 X           223 0 0
(158) DEB WALKER
EXEC BOARD
 1.00 X           222 0 0
(159) RITA FRISCHKORN
EXEC BOARD
 1.00 X           217 0 0
(160) CARMEN BLAKE
EXEC BOARD
 1.00 X           216 0 0
(161) CHUCK ROBERTS
EXEC BOARD
 1.00 X           216 0 0
(162) LORETTA ROSSI
EXEC BOARD
 1.00 X           214 0 0
(163) MELVIN WHITE
EXEC BOARD
 1.00 X           206 0 0
(164) CHRISTINE SHIREY
EXEC BOARD
 1.00 X           202 0 0
(165) CANDACE NEWSOME
EXEC BOARD
 1.00 X           195 0 0
(166) DONNA PHILLIPS
EXEC BOARD
 1.00 X           192 0 0
(167) PAULA ADAMS
EXEC BOARD
 1.00 X           190 0 0
(168) CATHERINE FERRARI
EXEC BOARD
 1.00 X           190 0 0
(169) ROBERT GASCOIGNE
EXEC BOARD
 1.00 X           190 0 0
(170) LANCE FRANKE
EXEC BOARD
 1.00 X           189 0 0
(171) JAMES BALTZ
EXEC BOARD
 1.00 X           188 0 0
(172) PATRICE MITCHEL
EXEC BOARD
 1.00 X           188 0 0
(173) JENNIFER VAUGHN
EXEC BOARD
 1.00 X           187 0 0
(174) ROXIE GORDON
EXEC BOARD
 1.00 X           185 0 0
(175) ANGELA MEEKS
EXEC BOARD
 1.00 X           183 0 0
(176) KIMBERLY RICE
EXEC BOARD
 1.00 X           182 0 0
(177) KATRINA MORRIS
EXEC BOARD
 1.00 X           178 0 0
(178) PENNY MOORE
EXEC BOARD
 1.00 X           177 0 0
(179) ANGELA GILBERT
EXEC BOARD
 1.00 X           174 0 0
(180) RICKY KENNERLY
EXEC BOARD
 1.00 X           173 0 0
(181) MARGO BACON
EXEC BOARD
 1.00 X           172 0 0
(182) ANDRE BENNETT
EXEC BOARD
 1.00 X           172 0 0
(183) KAREN SCOTT
EXEC BOARD
 1.00 X           172 0 0
(184) MICHELLE AUSTIN
EXEC BOARD
 1.00 X           171 0 0
(185) LINDA HOLMAN
EXEC BOARD
 1.00 X           171 0 0
(186) JACQUE VARTY
EXEC BOARD
 1.00 X           170 0 0
(187) VANESSA HURT
EXEC BOARD
 1.00 X           167 0 0
(188) SHARON GRAY
EXEC BOARD
 1.00 X           166 0 0
(189) KATHY SCHAEFER
EXEC BOARD
 1.00 X           160 0 0
(190) MONTAGO BRADLEY
EXEC BOARD
 1.00 X           158 0 0
(191) LATISHA MOORE
EXEC BOARD
 1.00 X           158 0 0
(192) VIVIAN OWENS
EXEC BOARD
 1.00 X           156 0 0
(193) BARBARA SMITH
EXEC BOARD
 1.00 X           156 0 0
(194) RACKELL ELLIS
EXEC BOARD
 1.00 X           146 0 0
(195) MARIANA DIMITRIU
EXEC BOARD
 1.00 X           143 0 0
(196) M KATHLEEN WETMORE
EXEC BOARD
 1.00 X           143 0 0
(197) BETTY HARRIS
EXEC BOARD
 1.00 X           140 0 0
(198) LILLIAN ROGERS
EXEC BOARD
 1.00 X           140 0 0
(199) MICHELE BURK
EXEC BOARD
 1.00 X           138 0 0
(200) KIANA MILLION
EXEC BOARD
 1.00 X           135 0 0
(201) PATRICIA CARTER
EXEC BOARD
 1.00 X           134 0 0
(202) CASSANDRA KUSH
EXEC BOARD
 1.00 X           133 0 0
(203) LAKEISHIA LAWSON
EXEC BOARD
 1.00 X           131 0 0
(204) KATHY SLONE
EXEC BOARS
 1.00 X           129 0 0
(205) NATHAN RHEA
EXEC BOARD
 1.00 X           128 0 0
(206) GINO BUCURESCU
 
EXEC BOARD
 1.00 X           119 0 0
(207) LOSHA ZIRKL
EXEC BOARD
 1.00 X           118 0 0
(208) CHARLOTTE DAVIS
EXEC BOARD
 1.00 X           116 0 0
(209) SHARON RICHARDSON
EXEC BOARD
 1.00 X           116 0 0
(210) RON WHITE
EXEC BOARD
 1.00 X           113 0 0
(211) HOLLY GIFFORD
EXEC BOARD
 1.00 X           112 0 0
(212) SCHON WRIGHT
EXEC BOARD
 1.00 X           111 0 0
(213) LISA CHURCH
EXEC BOARD
 1.00 X           110 0 0
(214) CATHY A LESTER
EXEC BOARD
 1.00 X           107 0 0
(215) YOLANDA VILLEGAS
EXEC BOARD
 1.00 X           105 0 0
(216) JOYCE LEE
EXEC BOARD
 1.00 X           104 0 0
(217) KATHRYN RAMSEY
EXEC BOARD
 1.00 X           103 0 0
(218) LINDA VAN DYKE
EXEC BOARD
 1.00 X           101 0 0
(219) DAWN GEORGE
EXEC BOARD
 1.00 X           97 0 0
(220) JEANNACE CULPEPPER
EXEC BOARD
 1.00 X           94 0 0
(221) PATRICIA DUNLEVY
EXEC BOARD
 1.00 X           94 0 0
(222) JEANA KAUFMAN
EXEC BOARD
 1.00 X           91 0 0
(223) SUSAN D'AMORE GAWRY
EXEC BOARD
 1.00 X           85 0 0
(224) MICHAEL STEIN
EXEC BOARD
 1.00 X           83 0 0
(225) KATHY DUNLEVY
EXEC BOARD
 1.00 X           75 0 0
(226) LAURA PERRIN
EXEC BOARD
 1.00 X           75 0 0
(227) MARVIN ANDERSON
EXEC BOARD
 1.00 X           73 0 0
(228) DIANA STEPHENSON
EXEC BOARD
 1.00 X           72 0 0
(229) ALEXIS PRESSER
EXEC BOARD
 1.00 X           70 0 0
(230) BEVERLY JONES
EXEC BOARD
 1.00 X           67 0 0
(231) DEBRA WORKMAN
EXEC BOARD
 1.00 X           64 0 0
(232) KATHY HATCHER
EXEC BOARD
 1.00 X           52 0 0
(233) HEATHER WHITMAN
EXEC BOARD
 1.00 X           47 0 0
(234) MARIA CLASS
EXEC BOARD
 1.00 X           41 0 0
(235) DORTHY SANDERSON
EXEC BOARD
 1.00 X           33 0 0
(236) BECKY WILLIAMS
PRESIDENT
 40.00     X       122,112 0 0
(237) ALLEN BACON
VICE PRES
 40.00     X       108,461 0 673
(238) KATHY MCCORMICK
VICE PRES
 40.00     X       105,393 0 761
(239) LISA HETRICK
TREASURER
 40.00     X       100,476 0 523
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 552,355   1,957
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet4
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
 
No
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet  
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d  
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and
similar amounts not included above1f 		 
g Noncash contributions included in lines 1a-1f:$  
h Total. Add lines 1a-1f.......MediumBullet  
Program Service Revenue Business Code
2a MEMBERSHIP DUES   13,822,855 13,822,855    
b
c
d
e
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 13,822,855
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 98,236     98,236
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties............MediumBullet        
(i) Real (ii) Personal
6a Gross rents    
b Less: rental expenses    
c Rental income or (loss)    
d Net rental income or (loss).......MediumBullet        
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 504,899  
b Less: cost or other basis and sales expenses 509,183  
c Gain or (loss) -4,284  
d Net gain or (loss)..........MediumBullet -4,284 -4,284    
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet        
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet        
Miscellaneous Revenue Business Code
11a AFFILIATE SUPPORT   261,305 261,305    
b MISCELLANEOUS   4,830 4,830    
c            
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 266,135
12 Total revenue. See Instructions....MediumBullet 14,182,942 14,084,706   98,236
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 70,000 70,000
2 Grants and other assistance to individuals in the United States. See Part IV, line 22    
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 554,312 554,312    
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 3,321,983 3,321,983    
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 361,154 361,154    
9 Other employee benefits ....... 931,869 931,869    
10 Payroll taxes ........... 374,616 374,616    
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 52,310 52,310    
c Accounting ........... 39,000 39,000    
d Lobbying ........... 500,000 500,000    
e Professional fundraising. See Part IV, line 17..    
f Investment management fees ...... 22,089 22,089    
g Other .......... 193,162 193,162    
12 Advertising and promotion .... 4,300 4,300    
13 Office expenses ....... 511,633 511,633    
14 Information technology ...... 61,578 61,578    
15 Royalties ..        
16 Occupancy ........... 391,312 391,312    
17 Travel ............ 592,862 592,862    
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 283,903 283,903    
20 Interest ...........        
21 Payments to affiliates ....... 3,894,138 3,894,138    
22 Depreciation, depletion, and amortization ..... 80,457 80,457    
23 Insurance .............. 13,335 13,335    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a LOBBYING 991,667 991,667    
b ADMINISTRATIVE 264,702 264,702    
c EDUCATIONAL 228,351 228,351    
d NEGOTIATIONS 141,589 141,589    
e
f All other expenses 228,836 228,836    
25 Total functional expenses. Add lines 1 through 24f 14,109,158 14,109,158 0 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 969,963 1 270,096
2 Savings and temporary cash investments ....... 482,526 2 939,704
3 Pledges and grants receivable, net .........   3  
4 Accounts receivable, net ......... 1,876,637 4 1,813,484
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..........   5 1,500
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L ..........   6  
7 Notes and loans receivable, net .............   7  
8 Inventories for sale or use ..............   8  
9 Prepaid expenses and deferred charges ............   9  
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 842,191
b Less: accumulated depreciation. ..... 10b 665,914 159,597 10c 176,277
11 Investments—publicly traded securities .......... 3,063,321 11 3,111,878
12 Investments—other securities. See Part IV, line 11 ......   12  
13 Investments—program-related. See Part IV, line 11 ..   13  
14 Intangible assets .........   14  
15 Other assets. See Part IV, line 11 ........... 104,759 15 81,712
16 Total assets. Add lines 1 through 15 (must equal line 34)... 6,656,803 16 6,394,651
Liabilities 17 Accounts payable and accrued expenses . 1,165,724 17 887,919
18 Grants payable ..........   18  
19 Deferred revenue ..........   19  
20 Tax-exempt bond liabilities ..........   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....   25  
26 Total liabilities. Add lines 17 through 25..... 1,165,724 26 887,919
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 5,491,079 27 5,506,732
28 Temporarily restricted net assets .....   28  
29 Permanently restricted net assets .....   29  
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 5,491,079 33 5,506,732
34 Total liabilities and net assets/fund balances ..... 6,656,803 34 6,394,651
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
14,182,942
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
14,109,158
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
73,784
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
5,491,079
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-58,131
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
5,506,732
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
 
No
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
 
No
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
 
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number

55-0603480
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$ 41,000
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$ 41,000
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
(1) SEIU DISTRICT 1199 WV PAC
  		1395 DUBLIN ROAD
COLUMBUS,OH43215 		20-4642434   41,000










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

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 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		          
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
 
No
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
 
No
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
No
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
Yes
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
No
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
No
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
  SCHEDULE C, PART I-A, LINE 1 DISTRICT 1199 ALIGNS ITSELF WITH CANDIDATES AND POLITICAL ENTITIES THAT SUPPORT ITS IDEOLOGY. IT MAKES CONTRIBUTIONS DIRECTLY TO THE CANDIDATES CAMPAIGN OR VIA PAC'S OR PCE'S.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number

55-0603480
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance ....        
b Contributions ........        
c Net investment earnings, gains, and losses ...        
d Grants or scholarships .....        
e Other expenditures for facilities
and programs ........ 		       
f Administrative expenses ....        
g End of year balance ......        
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
No
(ii) related organizations ........................
3a(ii)
 
No
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
No
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................      
b Buildings ................        
c Leasehold improvements ............        
d Equipment ................   842,191 665,914 176,277
e Other .................        
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 176,277
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes  








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet  
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 14,182,942
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 14,109,158
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 73,784
4 Net unrealized gains (losses) on investments .......................... 4 -58,131
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8  
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -58,131
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 15,653
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 14,102,722
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -58,131
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d ..................... 2e -58,131
3 Subtract line 2e from line 1..................... 3 14,160,853
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a 22,089
b Other (Describe in Part XIV.) ........... 4b  
c Add lines 4a and 4b....................... 4c 22,089
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 14,182,942
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 14,087,069
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3 14,087,069
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a 22,089
b Other (Describe in Part XIV.) ............ 4b  
c Add lines 4a and 4b....................... 4c 22,089
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 14,109,158
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number
55-0603480
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) WV CENTER FOR BUDGET & POLICY303 WASHINGTON ST W
CHARLESTON,WV253022230 		  20,000       GENERAL SUPPORT
(2) PROGRESS OHIO251 SOUTH 3RD STREET
COLUMBUS,OH43215 		  20,000       GENERAL SUPPORT
(3) POLICY MATTERS3831 PERKINS AVENUE
CLEVELAND,OH44114 		  20,000       GENERAL SUPPORT
(4) INNOVATION OHIO35 EAST GAY STREET
SUITE 260
COLUMBUS,OH43215 		501 10,000       HAITI VICTIMS
















2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
 
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
 
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Schedule I (Form 990) 2011


Additional Data


Software ID:  
Software Version:  


Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number

55-0603480
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
(1) KATHY MCCORMICK
ADVANCE 		  X 2,000 1,200   No   No Yes  
(2) BECKY WILLIAMS
ADVANCE 		  X 2,000 300   No   No Yes  
Total ...............Small Bullet $ 1,500
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
Schedule L (Form 990 or 990-EZ) 2011

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
2011
Open to Public
Inspection
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number

55-0603480
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990 - ORGANIZATION'S MISSION SEIU DISTRICT 1199 SEEKS TO IMPROVE QUALITY OF LIFE FOR ITS MEMBERS AND SOCIETY AS A WHOLE BY IMPROVING THE WORKING CONDITIONS, WAGES AND BENEFITS OF ITS MEMBERS. IT DOES THIS BY REPRESENTING THEM IN COLLECTIVE BARGAINING NEGOTIATIONS WITH THEIR EMPLOYERS, ARBITRATING LABOR DISPUTES AND ORGANIZING NEW BARGAINING UNITS. SEIU DISTRICT 1199 REPRESENTS APPROXIMATELY 25,000 MEMBERS THROUGHOUT WEST VIRGINIA, KENTUCKY AND OHIO.
CLASSES OF MEMBERS OR STOCKHOLDERS FORM 990, PAGE 6, PART VI, LINE 6 INDIVIDUALS WHO ARE EMPLOYED WITHIN THE COLLECTIVE BARGAINING UNITS THE DISTRICT REPRESENTS AND ARE IN GOOD STANDING ARE DEEMED MEMBERS.
ELECTION OF MEMBERS AND THEIR RIGHTS FORM 990, PAGE 6, PART VI, LINE 7A MEMBERS IN GOOD STANDING ARE AFFORDED THE RIGHT TO ELECT THE UNIONS OFFICERS AND A REPRESENTATIVE FROM THEIR AREA TO SERVE ON THE EXECUTIVE BOARD.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS FORM 990, PAGE 6, PART VI, LINE 7B CHANGES TO THE BY-LAWS AND OFFICERS ELECTIONS ARE SUBJECT TO MEMBERSHIP APPROVAL.
POLICIES AND PROCEDURES GOVERNING CHAPTERS FORM 990, PAGE 6, PART VI, LINE 10B YES
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 FORM 990, PAGE 6, PART VI, LINE 11B NO REVIEW WAS OR WILL BE CONDUCTED.
ENFORCEMENT OF CONFLICTS POLICY FORM 990, PAGE 6, PART VI, LINE 12C CONFLICTS OF INTEREST FOR DAY TO DAY OPERATIONS SUCH AS SELECTION OF VENDORS ARE MONITORED BY THE PRESIDENT AND CONTROLLER. ISSUES THAT ARE VOTED ON BY THE EXECUTIVE BOARD ARE DISCUSSED IN SMALL BREAK-OUT SESSIONS BEFORE THE GENERAL SESSION ON WHICH THE ISSUES ARE VOTED. THIS ALLOWS BOARD MEMBERS THE OPPORTUNITY TO COME FORWARD IF THERE IS A CONFLICT OF INTEREST.
COMPENSATION PROCESS FOR TOP OFFICIAL FORM 990, PAGE 6, PART VI, LINE 15A SALARIES FOR THE PRESIDENT AND OTHER OFFICERS OF THE UNION ARE REVIEWED ANNUALLY BY THE STAFF COMPENSATION AND BENEFITS COMMITTEE AND A RATE IS ESTABLISHED FOR THE POSITION. THE RAISES ARE PRESENTED TO AND VOTED ON BY THE EXECUTIVE BOARD.
COMPENSATION PROCESS FOR OFFICERS FORM 990, PAGE 6, PART VI, LINE 15B SALARIES FOR THE UNION'S STAFF ARE REVIEWED ANNUALLY BY THE STAFF COMPENSATION AND BENEFITS COMMITTEE AND A RATE IS ESTABLISHED FOR THE POSITION. THE RAISES ARE PRESENTED TO AND VOTED ON BY THE EXECUTIVE BOARD.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION FORM 990, PAGE 6, PART VI, LINE 19 NO DOCUMENTS AVAIALBLE TO THE PUBLIC.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
SERVICE EMPLOYEES INTERNATIONAL
UNION 1199 W VA & KY HOSPITAL CARE
Employer identification number

55-0603480
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity

















Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) SEIU DISTRICT 1199 PCE

1395 DUBLIN ROAD

COLUMBUS,OH43215
20-4455004 		PAC OH 527   N/A
 
No
(2) SEIU DISTRICT 1199 WV PAC

1395 DUBLIN ROAD

COLUMBUS,OH43215
20-4642434 		PAC WV 527   N/A
 
No
(3) OHIO STATE JOINT COUNCIL

1395 DUBLIN ROAD

COLUMBUS,OH43215
34-0871935 		UNION OH 501   N/A
 
No
(4) HEALTH CARE WORKERS BUILDING CORP

1395 DUBLIN ROAD

COLUMBUS,OH43215
55-0702744 		BLDG CORP OH 501   N/A
 
No
(5) HEALTH CARE & SOCIAL
SERVICE WORKER OHIO PAC
1395 DUBLIN ROAD

COLUMBUS,OH43215
91-2067788 		PAC OH 527   N/A
 
No
(6) SEIU DISTRICT 1199 KY PAC

1395 DUBLIN ROAD

COLUMBUS,OH43215
 PAC KY 527   N/A
 
No


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership












Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
 
No
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
 
No
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
 
No
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1)
(2)
(3)
(4)
(5)
(6)
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


Software ID:  
Software Version: