TY 2011 Form 990EZ

- TIN:

Form990-EZ
Click to see list of attachments

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

2011

Open to Public
Inspection

For the 2011 calendar year, or tax year beginning 01-01-2011, and ending 12-31-2011

Check if applicable:

Address change

Name change

Initial return

Terminated

Amended return

Application pending

C Name of organization
NEW JERSEY SPECIAL INVESTIGATORS ASSOCI

Number and street (or P. O. box, if mail is not delivered to street address)C/O ED WOOD 840 C INVERNESS COURT
Room/suite

City or town, state or country, and ZIP + 4 LAKEWOOD, NJ08701

D Employer identification number

31-1484308

E Telephone number

(908) 477-9688

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

www.njsia.orgJ Tax-Exempt status(check only one)501(c)(3) 501(c)( 6) bullet

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

K Check

if the organization is not a section 509(a)(3) supporting organization or a section 527 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

$ 24,561


1	Contributions, gifts, grants, and similar amounts received...............			1
2	Program service revenue including government fees and contracts ............			2
3	Membership dues and assessments......................			3	7,801
4	Investment income...........................			4
5a	Gross amount from sale of assets other than inventory........	5a
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
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 $ of contributions from fundraising events reported on line 1) (attach Schedule G if the
	sum of such gross income and contributions exceeds $15,000)	6b	16,760
c	Less: direct expenses from gaming and fundraising events.......	6c	16,004
d	Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)			6d	756
7a	Gross sales of inventory, less returns and allowances........	7a
b	Less: cost of goods sold.................	7b	0
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........			7c
8	Other revenue (describe in Schedule O) .....................			8
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8.................			9	8,557
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
13	Professional fees and other payments to independent contractors............			13
14	Occupancy, rent, utilities, and maintenance...................			14
15	Printing, publications, postage, and shipping...................			15	599
16	Other expenses (describe in Schedule O) ....................			16	6,416
17	Total expenses. Add lines 10 through 16 ....................			17	7,015
18	Excess or (deficit) for the year (Subtract line 17 from line 9)............			18	1,542
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	113
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	1,655

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................

530

1,137

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

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

518

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

530

1,655

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

417

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

113

1,655

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? EDUCATIONAL PURPOSES, INCLUDING BUT NOT LIMITED TO ORGANIZING CONFERENCES AND SEMINARS TO PROVIDE EDUCATION IN THE AREAS OF INSURANCE FRAUD INVESTIGATION.
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 Educational purposes, including but not limited to organizing conferences and seminars to provide education in the area of insurance fraud investigation. (Grants $ ) If this amount includes foreign grants, check here ...		28a
29 (Grants $ ) If this amount includes foreign grants, check here ...		29a
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

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
JACK LUBY 70 HICKORY RD COLONIA,NJ07067	BOARD MEMBER0	0
MARY ANN FABIANO 15 MOUNTAINVIEW RD WARREN,NJ07059	Vice President0	0
CARMEN COPPOLA 40 WANTAGE AVE BRANCHVILLE,NJ07890	BOARD MEMBER0	0
RICHARD DUFFY PO BOX 622 BASKING RIDGE,NJ07920	BOARD MEMBER0	0
SCOTT KEESAL 224 STRAWBRIDGE DRIVE MOORESTOWN,NJ08057	BOARD MEMBER0	0
BARBARA JONES 701 ROUTE 73 SO MARLTON,NJ08053	Secretary0	0
MICHAEL KNOX PO BOX 182 CONCORDVILLE,PA19331	BOARD MEMBER0	0
HOWARD POTTER PO BOX 906 CEDAR KNOLLS,NJ07927	President0	0
RUSSEL HEYMAN PO BOX 581 SUCCASUNNA,NJ07876	BOARD MEMBER0	0
JASON MEROLA 701 RT 73 SOUTH MARLTON,NJ08053	BOARD MEMBER0	0
LONI HAND 301 SULLIVAN WAY WEST TRENTON,NJ08628	BOARD MEMBER0	0
PETE VASQUEZ 210 SILVIA STREET WEST TRENTON,NJ08628	BOARD MEMBER0	0
THOMAS MULVEY 545 WASHINGTON BLVD JERSEY CITY,NJ07310	BOARD MEMBER0	0
EDWARD WOOD 840 C INVERNESS COURT LAKEWOOD,NJ08701	Treasurer0	0
CHRISTOPHER J LOIODICE 331 NEWMAN SPRINGS ROAD RED BANK,NJ07701	BOARD MEMBER0	0

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

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 ...................

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). ..........................

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

Yes

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

Yes

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

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 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. ......

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

ED WOOD Telephone no. bullet

(732) 920-7299

Located at bullet

840 C INVERNESS COURT
LAKEWOOD,NJ ZIP + 4 bullet

08701

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 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

Yes

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

Did the organization operate one or more hospital facilities during the year? If ‘Yes,’ Form 990 must be completedinstead 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 explanationin Schedule O................................

44d

45a

Did the organization have a controlled entity within the meaning of
section 512(b)(13)?............................

45a

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

Form 990-EZ (2011)

Page 4

Yes

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. ..............

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 or have a section 501(h) election in effect during the tax year? 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 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

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
NONE

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 use only

Print/type preparer's name

Preparer's signature

Date

Check if
self-employed

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

YesNo

Form 990-EZ (2011)

Additional Data

Software ID:	11000144
Software Version:	2011v1.2

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

2011

Open to Public Inspection

Name of the organization
NEW JERSEY SPECIAL INVESTIGATORS ASSOCI

Employer identification number

31-1484308

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) 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 GOLF OUTING (event type)	(d) Total Events (Add col. (a) through col. (c))
1	Gross receipts . . .	16,760	16,760
2	Less: Charitable contributions . . .
3	Gross income (line 1 minus line 2) . . .	16,760	16,760
4	Cash prizes . . .
5	Non-cash prizes . .
6	Rent/facility costs . .
7	Food and beverages . .
8	Entertainment . . .
9	Other direct expenses .	16,004	16,004
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........		16,004
11	Net income summary. Combine lines 3 and 10 in column (d)............		756

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) 2011

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) 2011

Additional Data

Software ID:	11000144
Software Version:	2011v1.2

- 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

2011

Open to Public
Inspection

Name of the organization

NEW JERSEY SPECIAL INVESTIGATORS ASSOCI

Employer identification number

31-1484308

Identifier	Return Reference	Explanation
Form 990-EZ, Part II, Line 26.1	Total Liabilities.1	DUE TO NJSIA FOUNDATION - Beginning $417 DUE TO NJSIA FOUNDATION - Ending $0
Form 990-EZ, Part II, Line 24.1	Other Assets.1	DUE FROM NJSIA EDUC FOUNDATION - Beginning $0 DUE FROM NJSIA EDUC FOUNDATION - Ending $518
Form 990-EZ, Part I, Line 16.4	Other Expenses.4	COMPUTER REPAIRS $256
Form 990-EZ, Part I, Line 16.2	Other Expenses.2	COMMITTEE EXPENSES $784
Form 990-EZ, Part I, Line 16.1	Other Expenses.1	SEMINAR/CONFERENCES EXPENSES $4778
Form 990-EZ, Part I, Line 16.1007	Other Expenses.1007	Conferences, Conventions, and Meetings $598
		Client Note 1 - FORM 990-EZ, PART I, LINE 1CONTRIBUTIONS, GIFTS AND GRANTSNOT OPEN TO PUBLIC INSPECTIONNO SINGLE CONTRIBUTOR GAVE $5,000 OR MORE DURING THE YEAR.

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:	11000144
Software Version:	2011v1.2