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
SOUTH LAMAR COUNTY RESCUE SQUAD INC
Employer identification number
63-0793461
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.") ....
15,668
18,879
71,821
16,133
20,598
143,099
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
5,005
4,677
4,955
4,526
5,030
24,193
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
20,673
23,556
76,776
20,659
25,628
167,292
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.
167,292
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..
20,673
23,556
76,776
20,659
25,628
167,292
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
2,822
593
1,822
1,872
993
8,102
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.)..
19,162
8,332
7,332
34,826
11
Total support (Add lines 7 through 10).
210,220
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
79.580 %
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
72.300 %
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.") .
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......
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.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
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.
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
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...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
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.)..
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
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
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
THE RESCUE SQUAD IS ENTIRELY A VOLUNTEER ORGANIZATION. IN ADDITION TO RECEIVING DONATIONS FROM THE GENERAL PUBLIC (BOTH INDIVIDUALS AND BUSINESSES) AS WELL AS TOBACCO TAX PROCEEDS COLLECTED BY AND FORWARDED FROM THE LOCAL COUNTY GOVERNMENT, AS FUNDRAISERS THE SQUAD USUALLY HOSTS 4 FISH FRIES PER YEAR FOR THE GENERAL PUBLIC TO ATTEND. AS WITH ALL OTHER SERVICES PERFORMED BY THE RESCUE SQUAD, ALL EFFORTS TO HOST THE EVENTS ARE PUT FORTH ENTIRELY BY VOLUNTEERS. NOT ONLY DO THE VOLUNTEERS INCLUDE MEMBERS OF THE SQUAD, BUT ALSO OFTENTIMES VOLUNTEERS FROM THE COMMUNITY AT LARGE. ALL OF THE NET PROCEEDS FROM THE EVENTS ARE UTILIZED ENTIRELY FOR THE PURPOSE OF ASSISTING IN FUNDING THE EMERGENCY SERVICES OPERATIONS PERFORMED BY THE ORGANIZATION THROUGHOUT THE YEAR.
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
SOUTH LAMAR COUNTY RESCUE SQUAD INC
Employer identification number
63-0793461
Identifier
Return Reference
Explanation
RELATED PARTY INFORMATION AMONG OFFICERS
FORM 990, PAGE 6, PART VI, LINE 2
FRED RAY SAVAGE LARRY SAVAGE PRESIDENT TRUSTEE FAMILY RELATIONSHIP GLADYS FAULKNER BANKS FAULKNER TREASURER TRUSTEE FAMILY RELATIONSHIP JACK HOMAN JANICE HOMAN TRUSTEE GEN MEMBER FAMILY RELATIONSHIP JACK HOMAN MARY HOMAN TRUSTEE GEN MEMBER FAMILY RELATIONSHIP
ELECTION OF MEMBERS AND THEIR RIGHTS
FORM 990, PAGE 6, PART VI, LINE 7A
THE VOLUNTEER MEMBERS DO SELECT FROM AMONG THEMSELVES INDIVIDUALS WILLING TO SERVE IN LEADERSHIP CAPACITIES. THERE IS NO COMPENSATION FOR THOSE SERVING IN LEADERSHIP ROLES, NOR IS THERE COMPENSATION FOR THE MEMBERSHIP AT LARGE.
DECISIONS SUBJECT TO APPROVAL OF MEMBERS
FORM 990, PAGE 6, PART VI, LINE 7B
THE GENERAL MEMBERSHIP OF THE RESCUE SQUAD ELECT FROM AMONG THEMSELVES INDIVIDUALS TO SERVE AS OFFICERS AND TRUSTEES/DIRECTORS. THE MEMBERSHIP MEETS REGULARLY. ISSUES REQUIRING DECISIONS ARE INITIALLY CONSIDERED BY THE TRUSTEES/DIRECTORS WHICH IS COMPOSED OF THE SQUAD'S PRESIDENT PLUS AN ADDITIONAL FOUR MEMBERS KNOWN AS TRUSTEES. AFTER CONSIDERATION BY THE TRUSTEES/DIRECTORS, ISSUES ARE THEN BROUGHT BEFORE THE SQUAD'S GENERAL MEMBERSHIP FOR CONSIDERATION AND FINAL DECISION-MAKING. IN THE EVENT CIRCUMSTANCES DICTATE, THE GROUP OF FIVE (COMPOSED OF THE PRESIDENT AND THE FOUR TRUSTEES) ARE AUTHORIZED TO MAKE DECISIONS ON BEHALF OF THE MEMBERSHIP AS A WHOLE. THOSE DECISIONS ARE THEN REPORTED TO THE MEMBERSHIP AT LARGE.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990
FORM 990, PAGE 6, PART VI, LINE 11B
SOUTH LAMAR RESCUE SQUAD, A RESCUE SERVICE ORGANIZATION COMPOSED ENTIRELY OF A GROUP OF VOLUNTEERS. THE MEMBERS DO HAVE REGULAR PERIODIC MEETINGS. THE FORM 990 IS ENTIRELY OPEN TO BOTH THE GROUP OF VOLUNTEERS THAT SERVE IN THE ORGANIZATION, AS WELL AS THE GENERAL PUBLIC. THE RETURNS ARE REVIEWED BY THE OFFICERS OF THE ORGANIZATION, AND WELL AS AS MANY OF THE VOLUNTEERS READILY AVAILABLE AT THE MEETING HELD JUST PRIOR TO SUBMISSION. VOLUNTEERS ARE KEPT ABREAST OF THE FINANCIAL POSITION OF THE ORGANIZATION ON A REGULAR BASIS THROUGHOUT THE COURSE EACH YEAR.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION
FORM 990, PAGE 6, PART VI, LINE 19
THE GOVERNING DOCUMENTS OF THE SOUTH LAMAR RESCUE SQUAD ARE FULLY AVAILABLE TO THE PUBLIC UPON REQUEST.
OTHER CHANGES IN NET ASSETS EXPLANATION
FORM 990, PART XI, LINE 9
CORRECT ROUNDING DIFFERENCE, PRIOR YEAR 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.