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)
bullet 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.
bulletThe organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
2011
Open to Public
Inspection
A
For the 2011 calendar year, or tax year beginning 01-01-2011, and ending 12-31-2011
B
Check if applicable:
C Name of organization
RENOVACION CONYUGAL INC
 
Number and street (or P. O. box, if mail is not delivered to street address)PO Box 146
  Room/suite
City or town, state or country, and ZIP + 4 Acworth, GA30101
D Employer identification number

35-2166123
E Telephone number

(678) 363-3079
F Group Exemption
Number. . bullet  
G Accounting method: Other (specify) bullet   H Check bulletI Website:bulletwww.renovacionconyugal.comJ Tax-Exempt status(check only one)—Click to see attachment(   ) bullet(insert no.) or
K Check bullet 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 $ 144,366
Part IRevenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule O to respond to any question in this Part I...........
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 80,680
2 Program service revenue including government fees and contracts ............ 2 48,354
3 Membership dues and assessments...................... 3 0
4 Investment income........................... 4 0
5a Gross amount from sale of assets other than inventory........ 5a 0
b Less: cost or other basis and sales expenses........... 5b 0
c Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ...... 5c 0
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) Click to see attachment. 6a 0
b Gross income from fundraising events (not including $ 8,200 of contributions
from fundraising events reported on line 1) (attach Schedule G if the Click to see attachment
sum of such gross income and contributions exceeds $15,000) 6b 15,332
c Less: direct expenses from gaming and fundraising events....... 6c 14,367
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c) 6d 965
7a Gross sales of inventory, less returns and allowances........ 7a 0
b Less: cost of goods sold................. 7b 0
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ......... 7c 0
8 Other revenue (describe in Schedule O) ..................... 8 0
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8................. 9 129,999
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 1,100
11 Benefits paid to or for members........................ 11 0
12 Salaries, other compensation, and employee benefits................ 12 54,441
13 Professional fees and other payments to independent contractors............ 13 4,152
14 Occupancy, rent, utilities, and maintenance................... 14 8,731
15 Printing, publications, postage, and shipping................... 15 49,226
16 Other expenses (describe in Schedule O) .................... 16 12,629
17 Total expenses. Add lines 10 through 16 .................... 17 130,279
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 -280
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 -2,220
20 Other changes in net assets or fund balances (explain in Schedule O) .......... 20 0
21 Net assets or fund balances at end of year. Combine lines 18 through 20.........Bullet 21 -2,500
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2011)
Form 990-EZ (2011)
Page 2
Part IIBalance Sheets (see the instructions for Part II.)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................
153
22
379
23Land and buildings....................
0
23
0
24Other assets (describe in Schedule O) ..........
8,607
24
10,021
25Total assets......................
8,760
25
10,400
26
Total liabilities (describe in Schedule O) .............
10,980
26
12,900
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
-2,220
27
-2,500
Part IIIStatement of Program Service Accomplishments (see the instructions for Part III.) 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? Our mission is to strengthen, revitalize, and equip Latino couples, parents, youth and families through educational programs that teach life skills, improved communication skills and relationship commitment, empowering participants to thrive and enjoy a healthy family environment.
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28 Couples program - Includes a one day workshop (Taller de Parejas) in Spanish that teaches communication skills and problem solving techniques. Examines the level of commitment of the couple and helps them recognize patterns and traits that they received in their upbringing and how they affect their relationship. Clarifies ideas and misconceptions about their sexuality. Outcomes for this program were 95% reported improved communication skills, 88% reported increased commitment to the relationship, 92% reported improved skills for managing anger and frustration, 87% reported improved understanding of sexuality in the relationship. This outcomes were measured by pre and post evaluations and 3, 6 and 12 month follow-up interviews. On 2011, we prepared 9 of these workshops with a total of 556 participants. After every workshop support groups were established and led by a couple of trained volunteers. We prepared 1 Plenitud Matrimonial workshop for 15 couples that had already attended the "Taller de Parejas" workshop and had completed the support group. This program teaches specific communication techniques, works one-on-one with participants on problem-solving techniques and helps build intimacy. Our couples' program received $1,625 in in-kind use of of facilities and 3,712 donated volunteer hours.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 28a 16,735
29 Our parenting program "Escuela Para Padres" is a series of classes that provide Latino parents with the necessary skills to make their job as parents easiers and give ideas on how to better fulfill their role. The program discusses the role of their native culture and upbringing in how they perceive their kids and their parenting style. Stresses the importance of recognizing kids as people that deserve respect and attention. Program explains ways to help kids to see themselves as valuable, promoting the development of a positive self-image. Establishes the importance of having clearly defined values and the most effective way to implementing discipline and control without verbal or physical violence. Teaches cooperation among family members and promotes the idea of leading kids to eventual self-regulation. A group of volunteer multi-disciplinary professionals present the program and donate 2,428 volunteer in-kind hours to make the program possible. On 2011, 7 parenting workshops were presented in particular through public schools. We also provided 18 individual parenting seminars. These seminar are separate from the regular parenting classes program. The goal is to expand the information provided during the regular curriculum, include additional topics and further parenting education. 514 parents received services through our different parenting efforts. Measured outcomes were 81% of parents were using the "I" message" to communicate with their kids, 87% of parents were showing affection to their kids and giving them unconditional positive strokes, 88% parents could view their kids as an individual person that deserve respect, 79% of parents reported that they were using new techniques to discipline their kids using physical or verbal and to manage anger and frustration when dealing with their kids. We received $1,850 in in-kind use of facilities. Our volunteers donated 922 inkind hours to this program.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 29a 15,545
30 Our teenagers' program (Renovacion Juvenil) is targeted to teens 13 to 18 years of age. The objective of the workshop is to provide them with tools that will prevent in this group drug and alcohol abuse, low self-esteem, participation in gangs, teen pregnancy. The program also helps them adapt to the reality of living in a dual-culture. They receive skills to improve their communication with their parents and develop positive leadership traits. A session is prepared for the teens' parents so that they are prepared to establish a better communication with their teens and they know where to look for help if they need assistance with family relationship issues. All activities are prepared and presented by Latino teens and young adults. Peer mentorship opportunities and counseling referrals are available. On 2011, we prepared 4 workshops with 382 teens in attendance. 576 people participated from the parents' program. A total of 7 support groups were formed, serving 245 teens. We also prepared leadership seminars so that the teens that we interested could gain new skills and leadership abilities. We supported the kids that attended the leadership seminars so that they could start volunteering in our program, their school, church and or community. By making sure that they put to work their newly gain talents, we encourage the formation and development of new positive young leaders for our Latino community. We also offer these teens training on Teen Dating Violence Prevention, Suicide Prevention, Financial, Gang Awareness and "How to Speak in Public". Our measured outcomes were, 78% of teens reported having a better relationship with their parents, 65% were showing new leadership skills by volunteering at their church, school or community, 68% of kids report improved skills for managing anger and frustration and 81% of teens report the ability to better resist peer pressure to use drugs or alcohol. 88% of kids that complete the program are enrolled and attending school. Outcomes were measured by pre and post assessments and 6 and 12 month follow-ups. Volunteers donated 15,206 in-kind hours to make this program possible. We received $5,175 in in-kind use of facilities.
(Grants $ 1,100) If this amount includes foreign grants, check here ...MediumBullet		 30a 43,711
During 2011, Renovacion Conyugal started our "Cultural and Lingusitic Proficiency Education" program. The objective of this effort is to educate other services providers in the community and empower them to better serve Latino couples, parents, youth and families in our community. We use the knowledge that our organization has gained after 10 years of working with Latino families. This work will improve our collective ability to recognize and address gaps in services. We know that by sharing our data and our understanding of Latinos in the region and their reality, we will support the increase of services available and the accessibility of services to Latino families. We will make the existing services more culturally relevant thus more effective. We will support the creation of new partnerships and collaborations among agencies. We will also increase the amount of direct services that we deliver to Latino families. During 2011 we prepared 21 seminars. 917 people participated of these trainings. We received $3,375 in inkind use of facilities. Volunteers donated 314 hours to this program.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 6,648
During 2011 Renovacion Conyugal, Inc. established our "Domestic Violence 101" project as a permanent program of our organization. This program teaches best practices to serve Latino victims of domestic violence. During this year we presented 3 of these seminars. 119 people participated. Volunteers devoted 85 inkind hours to the program. The program received $850 in inkind space donation.
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 4,241
In Partnership with American Cancer Society, Renovacion Conyugal held one session of the program "Con Amor Aprendemos". This project is targeted towards Latino couples of all ages with the goal of teaching them about the Human Papiloma Virus and other sexually transmitted diseases. 22 people participated. Program received $300 in inkind donated facilities. Volunteers donated 54 inkind hours to the program
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 4,591
31 Other program services (describe in Schedule O) ..................
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a)..............bullet 32 91,471
Part IV List 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 title (b) Average
hours per week
devoted to position		 (c)Reportable compensation
(Forms W-2/1099-MISC)
(if not paid, enter -0-) 		(d) Health benefits, contributions to employee benefit plans,
and deferred compensation		 (e) Estimated amount
of other compensation
Dr Jose O Rodriguez MD
3230 Hobson Ridge Trail
Acworth,GA30101
 Chairman of the Board4 0 0 0
Maria Capalleja
135 Jilstone Ct
Johns Creek,GA30097
 Treasurer3 0 0 0
Gisela Cordova MS
4788 Pastry Lane
Acworth,GA30101
 Secretary2 0 0 0
Mariano Maluf
1162 Arborhill Dr
Woodstock,GA30189
 Director3 0 0 0
Sandra Fantauzzi
PO Box 146
Acworth,GA30101
 Chairman Education Committee3.00 0 0 0
Michael C UrbinaPabon
436 Druid Oaks NE
Atlanta,GA30329
 Governance Committee Chairman5.00 0 0 0
Linda Perez
PO Box 146
Acworth,GA30101
 Chairman Marketing Committee3 0 0 0
Alejandro Coss
9155 Nesbit Ferry Rd 76
Alpharetta,GA30022
 Director2 0 0 0
Enrique Garza
4335 Granby Way
Marietta,GA30062
 Director4 0 0 0
Belisa Urbina
54 Mt Vernon Ridge
Dallas,GA30132
 Executive Director40 39,166 0 0
Rosa Gomez
249 Picketts Trace
Acworth,GA30101
 Administrative Assistant20 2,363 0 0
Nicky Lopez
1418 Sisters Ct
Lawrencevile,GA30043
 Development Director8 0 0 0
Adriana Nunez
PO Box 146
Acworth,GA30101
 Outreach Coordinator11 0 0 0
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 3
Part VOther Information(Note the Schedule A and personal benefit contract statement requirements in the instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
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 changeon Schedule O (see instructions). ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If ‘Yes’ to line 35a, has the organization filed a Form 990-T for the year? If ‘No,’ provide an explanation in Schedule O.
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III.
35c
 
No
36
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 ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
0
b
Did the organization file Form 1120-POL for this year?...................
37b
 
No
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
Yes
 
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved Click to see attachment.
38b
8,200
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
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 bullet0 ; section 4912 bullet0 ; section 4955 bullet0
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefittransaction 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. Click to see attachment......
40b
 
No
c
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...bullet0
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization....................bullet0
e
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
 
No
41List the states with which a copy of this return is filed. bulletGA
42aThe organization's books are in care of bulletRenovacion Conyugal - Belisa Urbina Telephone no. bullet (678) 363-3079
Located at bullet4606 Main St Suite C
Acworth,GA ZIP + 4bullet30101
b
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
No
42b
 
No
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.
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
42c
 
No
If “Yes,” enter the name of the foreign country: bullet  
43.......bullet
and enter the amount of tax-exempt interest received or accrued during the tax year....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ.................................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completedinstead of Form990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year?.........
44c
 
No
d
If 'Yes' to line 44c, has the organization filed a Form 720 to report these payments? If ‘No,’ provide an explanationin Schedule O................................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of
section 512(b)(13)?............................
45a
 
No
45b
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 may need to be completed instead of Form990-EZ (see instructions).....................
45b
 
No
Form 990-EZ (2011)
Form 990-EZ (2011)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes,” complete Schedule C, Part I. ..............
46
 
No
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
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
No
48
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ....
48
 
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
No
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
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 title of each employee paid more than $100,000 (b) Average
hours per week
devoted to position		 (c) Reportable compensation
(Forms W-2/1099-MISC) 		(d) Health benefits, contributions to employee benefit plans, and deferred compensation (e) Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000 .................bullet  

51
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
NONE
d
Total number of other independent contractors each receiving over $100,000..........bullet  
52
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 .....................
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
Form 990-EZ (2011)

Additional Data


Software ID: 11000129
Software Version: v1.00

Form 990-EZ, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
RENOVACION CONYUGAL INC
 
Employer identification number

35-2166123
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
f
g
(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
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
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.") . 41,122 65,855 75,909 79,797 80,680 343,363
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...... 36,976 36,802 48,166 61,624 48,354 231,922
3 Gross receipts from activities that are not an unrelated trade or business under section 513.. 0 0 0 0 0 0
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... 0 0 0 0 0 0
5 The value of services or facilities furnished by a governmental unit to the organization without charge.. 0 0 0 1,000 6,275 7,275
6 Total. Add lines 1 through 5. 78,098 102,657 124,075 142,421 135,309 582,560
7a Amounts included on lines 1, 2, and 3 received from disqualified persons... 0 0 0 0 0 0
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. 0 0 0 10,860 5,000 15,860
c Add lines 7a and 7b.. 0 0 0 10,860 5,000 15,860
8 Public Support (Subtract line 7c from line 6.)           566,700
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... 78,098 102,657 124,075 142,421 135,309 582,560
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 0 0 0 0 0 0
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. 0 0 0 0 0 0
c Add lines 10a and 10b. 0 0 0 0 0 0
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. 0 0   0 0 0
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) 0 0 0 0 0 0
13 Total support (Add lines 9, 10c, 11 and 12.). 78,098 102,657 124,075 142,421 135,309 582,560
14
Section C. Computation of Public Support Percentage
15
15
97.278 %
16
16
97.838 %
Section D. Computation of Investment Income Percentage
17
17
0 %
18
18
0 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID: 11000129
Software Version: v1.00
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
RENOVACION CONYUGAL INC
 
Employer identification number

35-2166123
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
RENOVACION CONYUGAL INC
  		Employer identification number

35-2166123
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
RENOVACION CONYUGAL INC
  		Employer identification number

35-2166123
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
RENOVACION CONYUGAL INC
  		Employer identification number

35-2166123
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID: 11000129
Software Version: v1.00
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 arrowAttach to Form 990 or Form 990-EZ. right arrowSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
RENOVACION CONYUGAL INC
 
Employer identification number

35-2166123
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
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?
b
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
Yes No
Total .................right arrow      
3
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) 2011
Schedule G (Form 990 or 990-EZ) 2011
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

Valentines Day Gala
(event type) 		(b) Event #2

 
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 11,695     11,695
2 Less: Charitable
contributions . . . 		5,848     5,848
3 Gross income (line 1
minus line 2) . . . 		5,847     5,847
VerticalDirectExpenses 4 Cash prizes . . . 0     0
5 Non-cash prizes . . 642     642
6 Rent/facility costs . . 10,000     10,000
7 Food and beverages . . 0   0 0
8 Entertainment . . . 0   0 0
9 Other direct expenses . 62     62
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 10,704
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow -4,857
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.
VerticalRevenue (a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (Add col. (a) through col. (c))
1 Gross revenue . . . .        
VerticalDirectExpenses 2 Cash prizes . . . .        
3 Non-cash prizes . . .        
4 Rent/facility costs . . .        
5 Other direct expenses . .        
6 Volunteer labor . . .
 
 
 
7 Direct expense summary. Add lines 2 through 5 in column (d) ........... right arrow  
8 Net gaming income summary. Combine lines 1 and 7 in column (d) .......... right arrow  
9
Enter the state(s) in which the organization operates gaming activities:
a
Is the organization licensed to operate gaming activities in each of these states? ............
b
If "No," Explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? .....
b
If "Yes," Explain:
 
11
Does the organization operate gaming activities with nonmembers? .................
12
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? ..........................
Schedule G (Form 990 or 990-EZ) 2011
Schedule G (Form 990 or 990-EZ) 2011
Page 3
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility ......................
13a
 
b
An outside facility ........................
13b
 
14
Provide the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? ......................................
b
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 $   .
c
If "Yes," enter name and address:
Name right arrow
Address right arrow
 
 
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? ............................
b
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) 2011
Additional Data


Software ID: 11000129
Software Version: v1.00
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
RENOVACION CONYUGAL INC
 
Employer identification number

35-2166123
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) Belisa M Urbina
Cash Flow 		X   10,000 8,200   No Yes   Yes  
Total ...............Small Bullet $ 8,200
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: 11000129
Software Version: v1.00




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
RENOVACION CONYUGAL INC
 
Employer identification number

35-2166123
Identifier Return Reference Explanation
F99Z_P01_S00_L10 Form 990-EZ, Part I, Line 10 22 participants received grants of $50 each to attend organization's "Renovacion Juvenil" program.
F99Z_P01_S00_L16 Form 990-EZ, Part I, Line 16 Meals for program participants, programs' materials other than copies and educational materials
F99Z_P02_S00_L24 Form 990-EZ, Part II, Line 24 Description;EOY Amount^Accounts Receivable;5129|Equipment;5854|Equipment Depreciation;-962^Total;10021^
F99Z_P02_S00_L26 Form 990-EZ, Part II, Line 26 Description;EOY Amount^Loan;8200|Credit Card;1500|Accounts Payable;3200^Total;12900^
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: 11000129
Software Version: v1.00