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)
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 07-01-2011, and ending 06-30-2012
B
Check if applicable:
C Name of organization
INNSBROOK ROTARY CHARITABLE FOUNDATION
 
Number and street (or P. O. box, if mail is not delivered to street address)PO BOX 2308
  Room/suite
City or town, state or country, and ZIP + 4 GLEN ALLEN, VA23058
D Employer identification number

54-1771779
E Telephone number

(804) 282-7636
F Group Exemption
Number. . bullet  
G Accounting method: Other (specify) bullet   H Check bulletI Website:bullet   J 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 $ 77,651
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 8,252
2 Program service revenue including government fees and contracts ............ 2  
3 Membership dues and assessments...................... 3  
4 Investment income........................... 4 2
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 $   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 69,397
c Less: direct expenses from gaming and fundraising events....... 6c 36,587
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c) 6d 32,810
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  
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8................. 9 41,064
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 39,095
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  
16 Other expenses (describe in Schedule O) .................... 16 901
17 Total expenses. Add lines 10 through 16 .................... 17 39,996
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 1,068
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 71,019
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 72,087
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................
71,019
22
72,087
23Land and buildings....................
 
23
 
24Other assets (describe in Schedule O) ..........
 
24
 
25Total assets......................
71,019
25
72,087
26
Total liabilities (describe in Schedule O) .............
0
26
0
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
71,019
27
72,087
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? THE MISSION OF THE ROTARY FOUNDATION IS TO ENABLE ROTARIANS TO ADVANCE WORLD UNDERSTANDING, GOODWILL, AND PEACE THROUGH THE IMPROVEMENT OF HEALTH, THE SUPPORT OF EDUCATION, AND THE ALLEVIATION OF POVERTY. THE FOUNDATION IS A NOT-FOR-PROFIT CORPORATION SUPPORTED SOLELY BY VOLUNTARY CONTRIBUTIONS FROM ROTARIANS AND FRIENDS OF THE FOUNDATION WHO SHARE ITS VISION OF A BETTER WORLD.
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 RAISE MONEY IN ORDER TO PROVIDE CONTRIBUTIONS TO ORGANIZATIONS THAT SERVE YOUTH
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 28a 0
29 THE SALE OF ROSES IN ORDER TO RAISE MONEY TO MAKE CONTRIBUTIONS TO CHARITABLE ORGANIZATIONS THAT SERVE THE RICHMOND AREA
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 29a 0
30
(Grants $   ) If this amount includes foreign grants, check here ...MediumBullet 		30a
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 0
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
GERARD SHAIA
P OBOX 2308
GLEN ALLEN,VA23058
 PAST PRESIDENT20.00 0 0 0
KAY KING
P OBOX 2308
GLEN ALLEN,VA23058
 PRESIDENT20.00 0 0 0
ANNE PAYSE
P OBOX 2308
GLEN ALLEN,VA23058
 PRESIDENT ELECT20.00 0 0 0
WES YORK
P OBOX 2308
GLEN ALLEN,VA23058
 TREASURER20.00 0 0 0
JAY STEELE
P OBOX 2308
GLEN ALLEN,VA23058
 SECRETARY20.00 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
 
 
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
 
No
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved .
38b
 
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. ......
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. bullet
42aThe organization's books are in care of bulletINNSBROOK ROTARY CHARITABLE FOUNDAT Telephone no. bullet (804) 474-1238
Located at bulletP O BOX 2308
GLEN ALLEN,VA ZIP + 4bullet23058
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:  
Software Version:  

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
INNSBROOK ROTARY CHARITABLE FOUNDATION
 
Employer identification number

54-1771779
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.") . 6,653 20,418 11,292 10,480 8,252 57,095
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...... 115,329 89,699 90,049 89,699 69,397 454,173
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. 121,982 110,117 101,341 100,179 77,649 511,268
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...           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
c Add lines 7a and 7b..           0
8 Public Support (Subtract line 7c from line 6.)           511,268
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... 121,982 110,117 101,341 100,179 77,649 511,268
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..         2 2
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.         2 2
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.). 121,982 110,117 101,341 100,179 77,651 511,270
14
Section C. Computation of Public Support Percentage
15
15
100.000 %
16
16
100.000 %
Section D. Computation of Investment Income Percentage
17
17
0 %
18
18
 
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:  
Software Version:  
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
INNSBROOK ROTARY CHARITABLE FOUNDATION
 
Employer identification number

54-1771779
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

AUCTION FOR YOUTH
(event type) 		(b) Event #2

ROSE SALE
(event type) 		(c) Other Events

  
(total number) 		(d) Total Events
(Add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 19,526 49,871   69,397
2 Less: Charitable
contributions . . . 		       
3 Gross income (line 1
minus line 2) . . . 		19,526 49,871   69,397
VerticalDirectExpenses 4 Cash prizes . . .        
5 Non-cash prizes . .        
6 Rent/facility costs . .        
7 Food and beverages . .        
8 Entertainment . . .        
9 Other direct expenses . 7,377 29,210   36,587
10 Direct expense summary. Add lines 4 through 9 in column (d) ........... right arrow 36,587
11 Net income summary. Combine lines 3 and 10 in column (d)............ right arrow 32,810
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:  
Software Version:  
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
INNSBROOK ROTARY CHARITABLE FOUNDATION
 
Employer identification number

54-1771779
Identifier Return Reference Explanation
OTHER INVESTMENT INCOME FORM 990-EZ, PART I, LINE 4 INTEREST 2..
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: ALZHEIMER ASSOC. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: BARK. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: CHURCHILL ACTIVITIES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBUTION. GRANTEE NAME: ELDER HOMES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,700.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: FAMILY LIFELINE. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: FEEDMORE. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: EFFECTIVE MINISTRIES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 850.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: GREATER RICHMOND ARC. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: GOODWIN STUDENT ASSISTANCE FUND. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 325.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: IRCF ENDOWMENT. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 3,620.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: JACKSON FIELD HOMES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,250.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: JEWISH FAMILY SERVICES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 750.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: JUNIOR ACHIEVEMENT OF RICHMOND. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: MOTHERS AGAINST DRUCK DRIVERS. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: MS SOCIETY. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: NORTHSTAR ACADEMY. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/01. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: OAK GROVE ELEMENTARY SCHOOL. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 200.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: PRONINO. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,050.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: READ CENTER. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 2,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: RICHMOND AREA PROG FOR MINORITIES. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/31/12. AMOUNT GIVEN: 1,500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: THE ROTARY FOUNDATION. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 300.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: TEE JAY VIKING . GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: VIRGINIA HOME FOR BOYS & GIRLS. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 3,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBUTION. GRANTEE NAME: YMCA. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 5,550.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: MCSHIN FOUNDATION. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: RICHMOND HILL. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: HOSPITATLITY HOUSE. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 1,000.
GRANTS AND SIMILAR AMOUNTS PAID FORM 990-EZ, PART I, LINE 10 ACTIVITY CLASSIFICATION: CASH CONTRIBTION. GRANTEE NAME: COAL PIT LEARNING CENTER. GRANTEE ADDRESS: P O BOX 2308 GLEN ALLEN, VA 23058. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 5,000. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 39,095.
OTHER EXPENSES FORM 990-EZ, PART I, LINE 16 DESCRIPTION: MISC. AMOUNT: 901.
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:  
Software Version:  

TY 2011 TransferPrsnlBnftContractsDecl
Name:
INNSBROOK ROTARY CHARITABLE FOUNDATION
EIN: 54-1771779
Declaration:
THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY,OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT.THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY,OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT.