-
TIN:
Form
990-EZ
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
20
12
Open to Public
Inspection
A
For the 2012 calendar year, or tax year beginning
01-01-2012
, and ending
12-31-2012
B
Check if applicable:
Address change
Name change
Initial return
Terminated
Amended return
Application pending
C
Name of organization
CLEAR LAKE GOLF CLUB ASSOCIATION
Number and street (or P. O. box, if mail is not delivered to street address)
PO BOX 491
Room/suite
City or town, state or country, and ZIP + 4
CLEAR LAKE
,
SD
572260491
D Employer identification number
46-6017080
E
Telephone number
(605) 874-8311
F
Group Exemption
Number.
.
G
Accounting Method:
Cash
Accrual
Other (specify)
H
Check
required to attach Schedule B
(Form 990, 990-EZ, or 990-PF).
I Website:
N/A
J Tax-exempt status
(check only one)
501(c)(3)
501(c)
(
7
)
(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
.
.
.
.
.
.
.
$
187,572
Part I
Revenue, 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
...................
1
Contributions, gifts, grants, and similar amounts received
...............
1
1,957
2
Program service revenue including government fees and contracts
............
2
33,170
3
Membership dues and assessments
......................
3
39,891
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
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
4,811
c
Less: direct expenses from gaming and fundraising events
.......
6c
3,360
d
Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)
6d
1,451
7a
Gross sales of inventory, less returns and allowances
........
7a
106,725
b
Less: cost of goods sold
.................
7b
57,312
c
Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a)
.........
7c
49,413
8
Other revenue (describe in Schedule O)
.....................
8
1,018
9
Total revenue.
Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8
..............
9
126,900
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
55,082
13
Professional fees and other payments to independent contractors
............
13
14
Occupancy, rent, utilities, and maintenance
...................
14
13,497
15
Printing, publications, postage, and shipping
...................
15
16
Other expenses (describe in Schedule O)
....................
16
47,733
17
Total expenses.
Add lines 10 through 16
.................
17
116,312
18
Excess or (deficit) for the year (Subtract line 17 from line 9)
............
18
10,588
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
-33,954
20
Other changes in net assets or fund balances (explain in Schedule O)
..........
20
-2,156
21
Net assets or fund balances at end of year. Combine lines 18 through 20
.........
21
-25,522
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
2
Part II
Balance Sheets
(see the instructions for Part II)
Check if the organization used Schedule O to respond to any question in this Part II
.................
(A)
Beginning of year
(B)
End of year
22
Cash, savings, and investments
................
1,638
22
11,992
23
Land and buildings
....................
77,743
23
68,614
24
Other assets (describe in Schedule O)
..........
4,038
24
4,000
25
Total assets
......................
83,419
25
84,606
26
Total liabilities
(describe in Schedule O)
.............
117,373
26
110,128
27
Net assets or fund balances
(line 27 of column (B)
must
agree with line 21)
..
-33,954
27
-25,522
Part III
Statement 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?
Providing members recreation and place to socialize
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
NUMBER OF ROUND OF GOLF PLAYED DURING OPEN GOLF- 5512 SUMMER PROGRAM OF GOLF INSTRUCTION FOR STUDENTS- 24 PARTICIPANTS
(Grants $
)
If this amount includes foreign grants, check here
...
28a
29
MENS GOLF LEAGUES- 88 MEN PLAYED FOR 16 WEEKS, INFORMAL COUPLES GOLF ON MONDAY NIGHTS 36 participants, SEPTEMBER LEAGUE, 36 MEN FOR 6 WEEKS
(Grants $
)
If this amount includes foreign grants, check here
...
29a
30
NON-PROFIT EVENTS ARE HELD MONTHLY DURING THE GOLF SEASON. THESE EVENTS BENEFIT THE LOCAL COMMUNITY.
(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
Ren Preheim
President
002.00
0
Hans Sacrison
Secretary
001.00
0
Barry Koenecke
Director
001.00
0
Paul Hansen
Treasurer
002.00
0
Mike Kellen
Director
001.00
0
Eric Kriz
Director
001.00
0
Tom Lundberg
Vice President
001.00
0
Mike Dahl
Director
001.00
0
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
3
Part V
Other 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 change
on 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
Yes
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
Yes
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.
37a
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
Yes
b
If “Yes,” complete Schedule L, Part II and enter the total amount involved
.
38b
100,000
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9
.......
39a
0
b
Gross receipts, included on line 9, for public use of club facilities
.....
39b
45,019
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911
; section 4912
; section 4955
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit
transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been
reported on any of its prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I
......
40b
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
...
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization
...........................
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
41
List the states with which a copy of this return is filed.
SD
42a
The organization's books are in care of
LISA LUNDBERG
Telephone no.
(605) 874-8280
Located at
410 3RD AVE S PO BOX 319
CLEAR LAKE
,
SD
ZIP + 4
57226
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:
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:
43
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of
Form 1041
Check here
.......
and enter the amount of tax-exempt interest received or accrued during the tax year
....
43
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 completed
instead of Form 990-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
explanation in 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
Form 990-EZ (see instructions)
......................
45b
No
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to
candidates for public office? If “Yes,” complete Schedule C, Part I.
..............
46
No
Part VI
Section 501(c)(3) organizations only
All section 501(c)(3) organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51
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
48
Is the organization a school as described in section 170(b)(1)(A)(ii)?
If "Yes," complete Schedule E
..
48
49a
Did the organization make any transfers to an exempt non-charitable related organization?
......
49a
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
.................
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
..........
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
...............
Yes
No
Sign Here
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.
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
Firm's EIN
Firm's address
Phone no.
May the IRS discuss this return with the preparer shown above? See instructions
.........
Yes
No
Form
990-EZ
(2012)
Form 990-EZ, Special Condition Description:
Special Condition Description
Additional Data
Software ID:
12000057
Software Version:
12.15.422.1
-
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. Form 990-EZ filers are not required to complete this part.
Attach to Form 990 or Form 990-EZ.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public
Inspection
Name of the organization
CLEAR LAKE GOLF CLUB ASSOCIATION
Employer identification number
46-6017080
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
Mail solicitations
e
Solicitation of non-government grants
b
Internet and email solicitations
f
Solicitation of government grants
c
Phone solicitations
g
Special fundraising events
d
In-person solicitations
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?
Yes
No
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.
(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
.................
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 Paperwork Reduction Act Notice, see the Instructions for Form 990or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
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 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a)
Event #1
(event type)
(b)
Event #2
(event type)
(c)
Other events
(total number)
(d)
Total events
(add col.
(a)
through col.
(c)
)
1
Gross receipts
.
.
.
2
Less: Contributions
.
.
3
Gross income (line 1
minus line 2)
.
.
.
4
Cash prizes
.
.
.
5
Noncash prizes
.
.
6
Rent/facility costs
.
.
7
Food and beverages
.
8
Entertainment
.
.
.
9
Other direct expenses
.
10
Direct expense summary. Add lines 4 through 9 in column (d)
...........
11
Net income summary. Combine line 3, column (d), and line 10.
..........
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)
)
1
Gross revenue
.
.
.
.
2
Cash prizes
.
.
.
.
3
Non-cash prizes
.
.
.
4
Rent/facility costs
.
.
.
5
Other direct expenses
.
.
6
Volunteer labor
.
.
.
Yes
No
Yes
No
Yes
No
7
Direct expense summary. Add lines 2 through 5 in column (d)
...........
8
Net gaming income summary. Combine lines 1 and 7 in column (d)
..........
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?
............
Yes
No
b
If "No," explain:
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year?
.....
Yes
No
b
If "Yes," explain:
Schedule G (Form 990 or 990-EZ) 2012
Schedule G (Form 990 or 990-EZ) 2012
Page
3
11
Does the organization operate gaming activities with nonmembers?
.................
Yes
No
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?
..........................
Yes
No
13
Indicate the percentage of gaming activity operated in:
a
The organization's facility
......................
13a
b
An outside facility
........................
13b
14
Enter 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?
......................................
Yes
No
b
If "Yes," enter the amount of gaming revenue received by the organization
$
and the
amount of gaming revenue retained by the third party
$
.
c
If "Yes," enter name and address of the third party:
Name
Address
16
Gaming manager information:
Name
Gaming manager compensation
$
Description of services provided
Director/officer
Employee
Independent contractor
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?
............................
Yes
No
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
$
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).
Identifier
Return Reference
Explanation
Schedule G (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000057
Software Version:
12.15.422.1
-
TIN:
Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
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, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
See separate instructions.
OMB No. 1545-0047
20
12
Open to Public Inspection
Name of the organization
CLEAR LAKE GOLF CLUB ASSOCIATION
Employer identification number
46-6017080
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)
Relationship between disqualified person and organization
(c)
Description of transaction
(d)
Corrected?
Yes
No
2
Enter the amount of tax incurred by organization managers or disqualified persons during the year under section 4958.
...........................
$
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization
.......
$
Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a)
Name of interested person
(b)
Relationship with organization
(c)
Purpose of loan
(d)
Loan to or from the organization?
(e)
Original principal amount
(f)
Balance due
(g)
In default?
(h)
Approved by board or committee?
(i)
Written agreement?
To
From
Yes
No
Yes
No
Yes
No
(1)
PAUL HANSEN
CLUB MEMBER
OPERATIONS
X
105,000
100,000
No
Yes
Yes
Total
......
$
100,000
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 assistance
(d)
Type of assistance
(e)
Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2012
Schedule L (Form 990 or 990-EZ) 2012
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) 2012
Additional Data
Software ID:
12000057
Software Version:
12.15.422.1
-
TIN:
TY 2012 CompensationExplanation
Name:
CLEAR LAKE GOLF CLUB ASSOCIATION
EIN:
46-6017080
Software ID:
12000057
Software Version:
12.15.422.1
Person Name
Explanation