Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STARFYSH
Employer identification number
27-1976856
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
57,388
113,988
171,376
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
57,388
113,988
171,376
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
171,376
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
7
Amounts from line 4..
57,388
113,988
171,376
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
171,376
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
100.000 %
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
100.000 %
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STARFYSH
Employer identification number
27-1976856
Identifier
Return Reference
Explanation
OTHER EXPENSES
FORM 990-EZ, PART I, LINE 16
EXPENSES DONOR RECORDS SOFTWARE 756 LODGING/TRAVEL FOR PROJECTS 1,388 LIABILITY INSURANCE 98 CLEAN WATER 8,764 HAITI GENERAL EXPENSES 18,491 HOSPITAL PATIENT CARE 15,264 REFUGEE MEDICINE/SUPPLIES 181 SCHOOL CHILDREN FEEDING 15,770 SCHOOL RECREATION EQUIP. 232 LATRINES 9,000 HOSPITAL EQUIPMENT 3,000 AGRICULTURE 4,566 TOTAL 77,510
OTHER ASSETS
FORM 990-EZ, PART II, LINE 24
GUESTHOUSE FURNITURE 0 6,000 LESS ACCUMULATED DEPRECIATION 0 6,000 GUESTHOUSE GENERATOR 0 4,600 LESS ACCUMULATED DEPRECIATION 0 4,600 ATV 0 4,020 LESS ACCUMULATED DEPRECIATION 0 4,020 TRUCK 0 15,084 LESS ACCUMULATED DEPRECIATION 0 11,260 TOTAL 0 3,824
PRIMARY EXEMPT PURPOSE
FORM 990-EZ, PART III
STARFYSH HAS DETERMINED TO FOCUS ON ONE OF THE WORLD'S MOST DESPERATE GEOGRAPHIC LOCALES AND PEOPLE GROUPS: THAT OF THE ISLAND OF LA GONAVE, HAITI. IT IS BOTH OUR PURPOSE AND OUR EXPECTATION THAT WE WILL BE ABLE TO REVERSE THE CYCLE OF POVERTY THERE THROUGH THE ADDRESSING OF ESSENTIAL INFRASTRUCTURAL NEEDS (WATER, AGRICULTURE, HEALTH) WHILE DEVELOPING A MODEL FOR SUSTAINING THOSE IMPROVEMENTS (EDUCATION AND ECONOMIC DEVELOPMENT). WHILE WORKING TOWARD THESE GOALS, WE WILL NOT IGNORE THE OPPORTUNITIES FOR DEMONSTRATING CHRISTIAN COMPASSION IN TIMES OF URGENT, IMMEDIATE, AND DESPERATE NEED.
FIRST ACHIEVEMENT
FORM 990-EZ, PART III, LINE 28
CLEAN WATER - IN A COUNTRY WHERE DIARRHEAL ILLNESS (CONTRACTED FROM TAINTED WATER) KILLS MORE CHILDREN THAN ANY OTHER DISEASE, STARFYSH HAS DETERMINED TO MAKE A DIFFERENCE. PHASE ONE OF OUR WORK WILL BE TO PLACE POINT-OF-USE BIO-SAND FILTRATION UNITS IN THE HOUSEHOLDS OF THOSE WHO FETCH BAD WATER BACK TO THEIR HOMES. 115 COVERS THE COST OF THE PURCHASE, SHIPPING, SET UP OF ONE BIO-SAND FILTER, ALONG WITH EDUCATION AND FOLLOW-UP.
SECOND ACHIEVEMENT
FORM 990-EZ, PART III, LINE 29
AGRICULTURE - YEARS OF DEFORESTATION HAS LEFT LA GONAVE LARGELY BARREN. OUR VISION IS TO SEE LA GONAVE'S COUNTRYSIDE RESTORED WITH THE LUSH VEGEATATION FOR WHICH SHE ONCE WAS KNOWN. WE WILL PLANT TREES - BANANAS, MANGOES, AVOCADOES, PAPAYAS. AND WE WILL SUPPLY PEASANT FAMILIES SEEDS WITH WHICH TO PLANT GARDENS. 3 COVERS THE COST OF PLANTING A BANANA TREE ON LA GONAVE. 5 FOR ALL OTHER TREES. 10 COVERS THE COST OF SEEDS FOR ONE PEASANT FAMILY.
THIRD ACHIEVEMENT
FORM 990-EZ, PART III, LINE 30
CHILD FEEDING: FUNDS RAISED TO FEED 1,000 HUNGRY KIDS. FUNDS COVERED THE COST OF NOT JUST RICE, BEANS, AND DRINK, BUT ALSO PURCHASED THE FUEL, STOVES, COOKWARE, AND TABLEWARE AS WELL AS THE COST OF HIRING LOCAL HAITIAN STAFF (COOKS, SERVING, CLEAN-UP, ETC.).
ALL OTHER ACHIEVEMENTS
FORM 990-EZ, PART III, LINE 31
HOSPITAL PATIENT CARE - COVERED COSTS OF GENERAL OPERATIONAL COSTS (STAFF WAGES, ETC.) OF ISLAND HOSPITAL SCHOOL RECREATION EQUIPMENT - WE WANT TO RESOURCE THIS SCHOOL WITH A MULTI-PURPOSE RECREATION FIELD, COMPLETE WITH SOCCER AND VOLLEYBALL NETS, BASKETBALL HOOPS, PLAYGROUND GAME EQUIPMENT, BALLS, ETC., WHICH THEY CURRENTLY DO NOT HAVE AND ARE UNABLE TO AFFORD. GENERAL FUND/WHERE NEEDED MOST - TO PROVIDE FOR OVERHEAD COSTS TO RUN ORGANIZATION, ALLOW STARFYSH TO DESIGNATE FUNDS TO PROJECTS THAT NEED A BIT OF EXTRA FUNDS. LATRINES - CRITICAL TO BRINGING DEVELOPMENT AND TRANSFORMATION TO LA GONAVE IS SEEING WIDEUSE OF LATRINES. SADLY, LATRINE OWNERSHIP/USE IS WELL BELOW 10% TODAY. WE WILL MAKE LATRINE USE A PRIORITY. 20 COVERS THE COST OF CEMENT FOR A LATRINE BASE/STOOL. HOPSITAL EQUIPMENT - LA GONAVE HAS BUT ONE SMALL MISSION HOSPITAL, AND IT IS IN SEVERE DISREPAIR. STARFYSH RECOGNIZES THE NEED FOR BASIC, YET QUALITY HOSPITAL-LEVEL CARE. THE HOSPITAL'S XRAY EQUIPMENT IS BROKEN AND UNUSABLE, AS IS THE SURGERY ROOM'S ANESTHESIA EQUIPMENT. WE WILL PROVIDE NEW ANESTHESIA AND XRAY EQUIPMENT TO THE HOPSITAL.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.