Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
United Fund Plan of Employees of AMERICAN ORDNANCE LLC
Employer identification number
42-6062997
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)
No
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
No
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
No
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
(1)
National Child Safety Council
386035290
9
No
Yes
Yes
400
(2)
Hope Haven Development Corp
421000580
9
No
No
Yes
1,462
(3)
Miss Valley Boy Scout Council
371318774
9
No
No
Yes
526
(4)
Boy Scout Troop 3
420680479
9
No
No
Yes
357
(5)
Boy Scout Troop 51
000000000
9
No
No
Yes
26
(6)
Boy Scout Troop 71
205223910
9
No
No
Yes
228
(7)
Biggsville Ambulance
000000000
9
No
No
Yes
408
(8)
AMVETS Post 29
030387027
501(c)(19)
No
No
Yes
453
(9)
Biggsville Fire Dept
000000000
9
No
No
Yes
65
(10)
St Vincent Depaul Society
721557396
9
No
No
Yes
383
(11)
Danville Fire and Rescue
562316550
9
No
No
Yes
639
(12)
Great River Hospice
000000000
9
No
No
Yes
511
(13)
West Point Fire
421087241
9
No
No
Yes
497
(14)
Winfield Fire
000000000
9
No
No
Yes
117
(15)
Chicago Shriners Hospital
362193608
9
No
No
Yes
187
(16)
Mediapolis Fire and Ambulance
421192545
9
No
No
Yes
229
(17)
Nauvoo Grade School Basketball
000000000
9
No
No
Yes
176
(18)
Donnellson Volunteer Fire Dept
000000000
9
No
No
Yes
250
(19)
West Burlington Fire
260832805
9
No
No
Yes
156
(20)
Wapello Fire Dept
202146936
9
No
No
Yes
132
(21)
Raritan Fire Dept
000000000
9
No
No
Yes
221
(22)
Oqauwka Fire Dept
000000000
9
No
No
Yes
135
(23)
Oquawka Ambulance
364089806
9
No
No
Yes
25
(24)
Niota Fire Dept
000000000
9
No
No
Yes
33
(25)
New London fire Dept
426005035
9
No
No
Yes
339
(26)
New London Band booster
000000000
9
No
No
Yes
52
(27)
Mt Pleasant Fire Dept
000000000
9
No
No
Yes
130
(28)
Montrose Fire Dept
421464151
9
No
No
Yes
52
(29)
Lee County Hospice
000000000
9
No
No
Yes
133
(30)
American Family Radio KAYP
640607275
9
No
No
Yes
312
(31)
HOPE House Center
421279943
9
No
No
Yes
52
(32)
Henry County Hospice
000000000
9
No
No
Yes
520
(33)
GSA Troop 9249
000000000
9
No
No
Yes
150
(34)
Ft Madison Special Olympics
000000000
9
No
No
Yes
130
(35)
Ft madison Athletic Boosters
000000000
9
No
No
Yes
260
(36)
Food Bank of Southern Iowa
421207197
9
No
No
Yes
164
(37)
Burlington Homeless Shelter
421498646
9
No
No
Yes
189
(38)
Argyle fire Dept
000000000
9
No
No
Yes
78
(39)
Farmington EMS
000000000
9
No
No
Yes
65
(40)
American Lung society
204392201
9
No
No
Yes
52
(41)
Danville United Way
000000000
9
No
No
Yes
119
(42)
Iowa Special Olympics
000000000
9
No
No
Yes
200
(43)
Cub Pack 27
000000000
9
No
No
Yes
50
(44)
Girl Scout Troop 9045
000000000
9
No
No
Yes
50
(45)
Cub Scout Pack 21
000000000
9
No
No
Yes
50
(46)
Amanda the Panda
421166117
9
No
No
Yes
200
(47)
Ronald McDonald House
421189783
9
No
No
Yes
150
(48)
MDA Camp Courageous
237210932
9
No
No
Yes
200
(49)
Burlington Area United Way
420680362
9
Yes
No
Yes
14,793
(50)
Danville United fund
000000000
9
No
Yes
Yes
461
(51)
Mediapolis Community Fund
421195021
9
No
Yes
Yes
635
(52)
Mt Pleasant United Way
420772561
9
No
Yes
Yes
572
(53)
Big River United Way Keokuk
426036779
9
No
Yes
Yes
490
(54)
Ft Madison Area United Way
426067437
9
No
Yes
Yes
1,248
(55)
Wapello United Way
421275624
9
No
Yes
Yes
299
(56)
Wapello Cty United Way
000000000
9
No
Yes
Yes
85
(57)
Warren Cty United Way
370947507
9
No
Yes
Yes
73
(58)
American Cancer Society
420724036
9
Yes
Yes
Yes
3,303
(59)
Gladstone Fire
000000000
9
No
No
Yes
65
(60)
Lomax Fire
370908213
9
No
No
Yes
150
(61)
Easter Seals
420707100
9
No
No
Yes
150
(62)
National Multiple Scleroris
420255544
9
No
No
Yes
23
(63)
Bonaparte Fire
426004286
9
No
Yes
Yes
130
Total
33,790
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
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) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(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 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Specific Org not listed in by-laws but 50% must go to area United Ways, 15% ea. to Cancer Fund and Heart Fund (through the Burlington United Way) and the balance to employee designated charity or 501-c-3 org as decided by the trustees
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
11000129
Software Version:
v1.00
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
United Fund Plan of Employees of AMERICAN ORDNANCE LLC
Employer identification number
42-6062997
Identifier
Return Reference
Explanation
F99Z_P01_S00_L10
Form 990-EZ, Part I, Line 10
9 Area United Way Funds $11,009.96 71 Charities designated by 113 Employees $11,774.42 American heart Fund $3,302.99 American Cancer Society $3,302.99 Distributions to 22 Charities by the Trustees $4,400
F99Z_P03_S00_L28
Form 990-EZ, Part III, Line (28-31)
The total on this line is the amount distributed by the Trustees as required by the by-laws of the plan.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.