Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
TRANQUILLITY CAMP INC
Employer identification number
13-5634525
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the 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
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 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) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
203,309
195,667
215,567
430,403
297,898
1,342,844
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......
782,445
792,819
795,870
807,816
757,135
3,936,085
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
985,754
988,486
1,011,437
1,238,219
1,055,033
5,278,929
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
20,000
18,000
34,000
13,000
16,180
101,180
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..
20,000
18,000
34,000
13,000
16,180
101,180
8
Public support (Subtract line 7c from line 6.)
5,177,749
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
985,754
988,486
1,011,437
1,238,219
1,055,033
5,278,929
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
27,821
23,827
23,544
22,973
31,815
129,980
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
27,821
23,827
23,544
22,973
31,815
129,980
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
0
13
Total support. (Add lines 9, 10c, 11, and 12.)..
1,013,575
1,012,313
1,034,981
1,261,192
1,086,848
5,408,909
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
95.726 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
94.774 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
2.403 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
2.379 %
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2012
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
TRANQUILLITY CAMP INC
Employer identification number
13-5634525
Identifier
Return Reference
Explanation
DIRECTORS WHO CANNOT BE REACHED AT ORGANIZATION'S ADDRESS
SECTION A QUESTION #11
RICHARD LAWRENCE, PRESIDENT & DIRECTOR 260 UMPAWAUG ROAD, REDDING CT 06896-1826 MARC S. COHN, VICE PRESIDENT, SECRETARY & DIRECTOR 53 NORTH PARK AVENUE SUITE 302, ROCKVILLE CENTRE, NY 11570 MAURICE SCHLANG, VICE PRESIDENT & DIRECTOR 2580 SOUTH OCEAN BLVD, PALM BEACH, FL 33480 ROBIN CAINE DIAMANT, ASSISTANT TREASURER & DIRECTOR 20791 EAGLE CREEK COURT, BOCA RATON, FL 33498 DANIEL COHN, DIRECTOR 246 HIGHWOOD AVE., TENAFLY, NJ 07670 CRAIG SNOW, VICE PRESIDENT & DIRECTOR 11 HUNTER'S LANE ITHACA, NY 14850 CHERYL JANER, TREASURER & DIRECTOR 4132 CEDAR CREEK ROAD, BOCA RATON, FL 33487 SARAH LAWRENCE, DIRECTOR 260 UMPAWAUG ROAD, REDDING, CT 6896 CARY SPIEGEL, DIRECTOR 3 SHERMAN COURT, PLAINSBORO, NJ 08536 ADRIENNE GARNETT, DIRECTOR 48 HILLSIDE AVENUE, NEW ROCHELLE, NY 10801 IRA ALTMAN, DIRECTOR 74 PROSPECT STREET, HUNTINGTON, NY 11743
GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS
PART VI, SECTION C QUESTION #19
THE ORGANIZATION GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE ON ANOTHERS WEBSITE - WWW.GUIDESTAR.COM. THESE DOCUMENTS CAN ALSO BE MADE AVAILABLE AT ITS LOCATION DURING CAMP HOURS WHEN THE REQUEST IS MADE WITH ADVANCE NOTICE.
COMPENSATION
FORM 990, PART VI, SECTION B, LINE 15
THE BOARD REVIEWS AND AUTHORIZES COMPENSATION FOR EXECUTIVE OFFICERS AND KEY EMPLOYEES.
AUDIT COMMITTEE
FORM 990, PART XI, LINE 2
THE AUDIT COMMITTEE IS RESPONSIBLE FOR THE OVERSIGHT AND REVIEW OF AUDITS, REVIEWS AND COMPILATIONS PERFORMED BY INDEPENDENT ACCOUNTANTS.
NET ASSET RECONCILIATION
FORM 990, PART XI, LINE 5
THE OTHER CHANGES IN THE NET ASSET RECONCILIATION OF $14,699 REPRESENTS THE UNREALIZED GAIN FOR THE YEAR.
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:REPAIRS & MAINTENANCE TOTAL EXPENSES:50046 PROGRAM SERVICES:50046
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:GARBAGE REMOVAL TOTAL EXPENSES:12376 PROGRAM SERVICES:12376
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LAUNDRY & LINEN TOTAL EXPENSES:1731 PROGRAM SERVICES:1731
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PERMITS & DUES TOTAL EXPENSES:2740 PROGRAM SERVICES:2740
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:OBITUARY TOTAL EXPENSES:1719 MANAGEMENT AND GENERAL:1719
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:LANDSCAPING TOTAL EXPENSES:2904 PROGRAM SERVICES:2904
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CAMPER TRANSPORTATION TOTAL EXPENSES:8998 PROGRAM SERVICES:8998
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:POSTAGE TOTAL EXPENSES:4642 PROGRAM SERVICES:4642
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:SUPPLIES TOTAL EXPENSES:53955 PROGRAM SERVICES:53955
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:AMORTIZATION TOTAL EXPENSES:253 PROGRAM SERVICES:253
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:PCM MEMORIAL WALKWAY TOTAL EXPENSES:714 PROGRAM SERVICES:714
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:TELEPHONE TOTAL EXPENSES:7364 PROGRAM SERVICES:3682 MANAGEMENT AND GENERAL:3682
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:MISCELLANEOUS TOTAL EXPENSES:7268 PROGRAM SERVICES:6464 MANAGEMENT AND GENERAL:804
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:CREDIT CARD FEES TOTAL EXPENSES:895 MANAGEMENT AND GENERAL:895
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EQUIPMENT LEASE TOTAL EXPENSES:10360 PROGRAM SERVICES:10360
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:EDUCATION TOTAL EXPENSES:2444 MANAGEMENT AND GENERAL:2444
OTHER EXPENSES
FORM 990 PART IX
DESCRIPTION:INTERVIEWS & ADVERTISEMENT TOTAL EXPENSES:4285 PROGRAM SERVICES:4285
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.