TY 2010 Form 990EZ

- TIN:

Form990-EZ
Click to see attachment

Department of the Treasury
Internal Revenue Service

Short Form
Return of Organization Exempt From Income Tax

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

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

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

OMB No. 1545-1150

2010

Open to Public
Inspection

For the 2010 calendar year, or tax year beginning 12-01-2010, and ending 11-30-2011

Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization
ROCKFORD COMMUNITY FIRE COMPANY INC

Number and street (or P. O. box, if mail is not delivered to street address)201 N MAIN STREET
Room/suite

City or town, state or country, and ZIP + 4 ROCKFORD, OH45882

D Employer identification number

34-1412518

E Telephone number

(419) 363-3611

F Group Exemption
Number. . bullet

G Accounting method: CashAccrualOther (specify) bullet

H Check bullet

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

N/AJ Tax-Exempt status(check only one)501(c)(3) 501(c)( 4) bullet

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

K Check

if the organization is not a section 509(a)(3) supporting organization and its gross receipts are normally not more than $50,000. A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.

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

$ 143,052


1	Contributions, gifts, grants, and similar amounts received . . . . . . . . .			1	66,484
2	Program service revenue including government fees and contracts . . . . . . .			2	52,721
3	Membership dues and assessments . . . . . . . . . . . . . .			3
4	Investment income . . . . . . . . . . . . . . . . . .			4	13
5a	Gross amount from sale of assets other than inventory . . . .	5a
b	Less: cost or other basis and sales expenses . .	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) . .			5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a
b	Gross income from fundraising events (not including $ 17,784 of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceed $15,000) . . . . . . .
c	Less: direct expenses from gaming and fundraising events . . .	6c	5,996
d	Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)			6d	11,788
7a	Gross sales of inventory, less returns and allowances . . . .	7a
b	Less: cost of goods sold . . . . . . . . . .	7b
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) . . . . . .			7c
8	Other revenue (describe in Schedule O) . . . . . . . . .			8	6,050
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . . . . .			9	137,056
10	Grants and similar amounts paid (list in Schedule O) . . . . . . . .			10
11	Benefits paid to or for members . . . . . . . . . . . . . . .			11
12	Salaries, other compensation, and employee benefits . . . . . . . . . . .			12	7,131
13	Professional fees and other payments to independent contractors . . . . . . . .			13	1,000
14	Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . .			14	19,161
15	Printing, publications, postage, and shipping . . . . . . . . . . . .			15
16	Other expenses (describe in Schedule O) . . . . . . . . . .			16	26,223
17	Total expenses. Add lines 10 through 16 . . . . . . . . . . . .			17	53,515
18	Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . .			18	83,541
19	Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
	end-of-year figure reported on prior year’s return) . . . . . . . . . . .			19	86,265
20	Other changes in net assets or fund balances (explain in Schedule O) . . . . . . .			20
21	Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . .			21	169,806

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

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

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

29,903

42,641

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

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

56,362

127,165

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

86,265

169,806

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

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

86,265

169,806

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

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

Form 990-EZ (2010)

Page 2

Part IIIStatement of Program Service Accomplishments Check if the organization used Schedule O to respond to any question in this Part III .	Expenses (Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose? THE ORGANIZATION PROTECTS THE COMMUNITY AND SURROUNDING AREA FROM HARM AND/OR DAMAGE AS RESULT OF FIRE.
Describe what was achieved in carrying out the organization's exempt purposes. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 FIRE PROTECTION FOR THE COMMUNITY AND SURROUNDING AREA. (Grants $ ) If this amount includes foreign grants, check here ...			28a	18,203
29 FIRE PROTECTION FOR THE COMMUNITY AND SURROUNDING AREA. (Grants $ ) If this amount includes foreign grants, check here ...			29a	11,831
30 (Grants $ ) If this amount includes foreign grants, check here ...			30a
31 Other program services (describe in Schedule O) . . . . . . . . . . . . (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a) . . . . . . . . .	32	30,034

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

(a) Name and address	(b) Title and average hours per week devoted to position	(c) Compensation (If not paid, enter -0-.)
ROB BELNA 11446 ST RTE 118 ROCKFORD,OH45882	CHIEF10.00	200
CHAD RANSBOTTOM 10487 NOW RD ROCKFORD,OH45882	ASSISTANT CH10.00	100
TODD WILLIAMS 302 W SOUTH ST ROCKFORD,OH45882	CAPTAIN5.00	0
DICK PONTIUS 157 E WALNUT ROCKFORD,OH45882	1ST LIEUTENA5.00	0
JORDAN BELNA 11446 ST RTE 118 ROCKFORD,OH45882	2ND LIEUTENA5.00	0
LUCAS MINNICH 2875 TAMA RD ROCKFORD,OH45882	PRESIDENT1.00	0
BRENT VOGEL 109 N FRANKLIN ROCKFORD,OH45882	VICE PRESIDE1.00	0
TODD MCKEE 103 WAYNE ST ROCKFORD,OH45882	SECRETARY/TR1.00	0
AARON SUTTER 209 S FRANKLIN ROCKFORD,OH45882	1 YEAR TRUST1.00	0
BRIAN BRUNS 11301 ST RTE 118 ROCKFORD,OH45882	2 YEAR TRUST1.00	0
JOE FELVER 203 N JAY ROCKFORD,OH45882	3 YEAR TRUST1.00	0

Form 990-EZ (2010)

Page 3

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

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

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

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

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

35a

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

35b

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

37a

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

37a

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

37b

38a

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

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

38a

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

38b

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

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

39a

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

39b

40a

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

section 4911 bullet

; section 4912 bullet

; section 4955 bullet

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I. ....

40b

Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 .. bullet

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

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

40e

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

42aThe organization's books are in care of bullet

ROB BELNA Telephone no. bullet

(419) 363-3633

Located at bullet

11446 ST RTE 118
11446 ST RTE 118
ROCKFORD,OH ZIP + 4 bullet

45882

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

Yes

42b

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

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

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

42c

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

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

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

44a

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

Yes

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

44a

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

44b

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

44c

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

44d

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

45a

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

45a

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

Form 990-EZ (2010)

Page 4

Part VI

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

Yes

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

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

49a

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

49a

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

49b

Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."

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

50(f)

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

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

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

51(d)

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

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

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

Sign Here

	Signature of officer	Date

	Type or print name and title

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

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

YesNo

Form 990-EZ (2010)

Additional Data

Software ID:
Software Version:

Form 990-EZ, Special Condition Description:

Special Condition Description

- TIN:

SCHEDULE G
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19,
or if the organization entered more than $15,000 on Form 990-EZ, line 6a.
right arrow

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization
ROCKFORD COMMUNITY FIRE COMPANY INC

Employer identification number

34-1412518

Part I

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and e-mail solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

Yes

If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.

(i) Name and address of individual or entity (fundraiser)	(ii) Activity	(iii) Did fundraiser have custody or control of contributions?		(iv) Gross receipts from activity	(v) Amount paid to (or retained by) fundraiser listed in col. (i)	(vi) Amount paid to (or retained by) organization
	(ii) Activity	Yes	No	(iv) Gross receipts from activity		(vi) Amount paid to (or retained by) organization
Total .................

List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from registration or licensing.

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2010

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.

		(a) Event #1 9/11 FUNDRAISER (event type)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	17,784	17,784
2	Less: Charitable contributions . . .
3	Gross income (line 1 minus line 2) . . .	17,784	17,784
4	Cash prizes . . .
5	Non-cash prizes . .
6	Rent/facility costs . .
7	Food and beverages . .	5,996	5,996
8	Entertainment . . .
9	Other direct expenses .
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........		5,996
11	Net income summary. Combine lines 3 and 10 in column (d)............		11,788

Part III

Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

(d) Total gaming (Add col. (a) through col. (c))

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes
	No

	Yes
	No

	Yes
	No

Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow

Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow

Enter the state(s) in which the organization operates gaming activities:

Is the organization licensed to operate gaming activities in each of these states? ............

YesNo

If "No," Explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....

YesNo

If "Yes," Explain:

Does the organization operate gaming activities with nonmembers? .................

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? ...........................

YesNo

Schedule G (Form 990 or 990-EZ) 2010

Page 3

Indicate the percentage of gaming activity operated in:

The organization's facility ......................

13a

An outside facility ........................

13b

Provide the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? ......................................

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? ............................

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Complete this part to provide additional information for responses to quuestion on Schedule G (see instructions.)

Identifier	ReturnReference	Explanation

Schedule G (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.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

ROCKFORD COMMUNITY FIRE COMPANY INC

Employer identification number

34-1412518

Identifier	Return Reference	Explanation
OTHER REVENUE	FORM 990-EZ, PART I, LINE 8	AMBULANCE RENT 6,050 TOTAL 6,050
OTHER EXPENSES	FORM 990-EZ, PART I, LINE 16	9/11 FUNDRAISER 9/11 CONTRIB TO LOCAL FDS 5,759 EXPENSES DUES & SUBSCRIPTIONS 336 LIABILITY INSURANCE 7,784 MEETING EXPENSE 304 TRUCK GASOLINE 1,029 LICENSES AND PERMITS 519 POSTAGE AND FREIGHT 62 EQUIPMENT REPAIRS 5,782 FIRE SUPPLIES 1,975 OFFICE SUPPLIES 521 SHOP SUPPLIES 271 UNIFORMS 449 TRAINING 180 ADVERTISING AND PUBLIC RE 284 TELEPHONE EXPENSE 968 TOTAL 26,223
OTHER ASSETS	FORM 990-EZ, PART II, LINE 24	EQUIPMENT 435,846 518,478 LESS ACCUMULATED DEPRECIATION 379,484 391,313 TOTAL 56,362 127,165
PRIMARY EXEMPT PURPOSE	FORM 990-EZ, PART III	THE ORGANIZATION PROTECTS THE COMMUNITY AND SURROUNDING AREA FROM HARM AND/OR DAMAGE AS RESULT OF FIRE.
ALL OTHER ACHIEVEMENTS	FORM 990-EZ, PART III, LINE 31	FIRE PROTECTION FOR THE COMMUNITY AND SURROUNDING AREA.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

TY 2010 CompensationExplanation

Name:

ROCKFORD COMMUNITY FIRE COMPANY INC

EIN: 34-1412518

Person Name	Explanation
ROB BELNA
CHAD RANSBOTTOM
TODD WILLIAMS
DICK PONTIUS
JORDAN BELNA
LUCAS MINNICH
BRENT VOGEL
TODD MCKEE
AARON SUTTER
BRIAN BRUNS
JOE FELVER