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 private foundation)
bullet Do not enter Social Security numbers on this form as it may be made public. By law, the
IRS generally cannot redact the information on the form.
bullet Information about Form 990-EZ and its instructions is at www.irs.gov/form990.
OMB No. 1545-1150
2013
Open to Public
Inspection
A
For the 2013 calendar year, or tax year beginning 01-01-2013, and ending 12-31-2013
B
Check if applicable:
C Name of organization
PASSAIC COUNTY 200 CLUB
C/O MOUNTAIN DEVELOPMENT CORP
Number and street (or P. O. box, if mail is not delivered to street address)3 GARRET MOUNTAIN PLAZA NO 204
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code WOODLAND PARK, NJ07424
D Employer identification number

22-3342763
E Telephone number

(973) 225-0696
F Group Exemption
Number. . bullet  
G Accounting Method: Other (specify) bullet   H Check bulletI Website:bulletWWW.PC200CLUB.ORGJ Tax-exempt status(check only one)?Click to see attachment(   ) bullet(insert no.) or
K Form of organization:  
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, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . . bullet $ 49,584
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...................
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received............... 1 350
2 Program service revenue including government fees and contracts ............ 2  
3 Membership dues and assessments...................... 3 32,500
4 Investment income........................... 4 12,513
5a Gross amount from sale of assets other than inventory........ 5a 1,362
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 1,362
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 $ 23,471 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 2,859
c Less: direct expenses from gaming and fundraising events....... 6c  
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d 2,859
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.............. Bullet 9 49,584
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................. 10 11,900
11 Benefits paid to or for members........................ 11  
12 Salaries, other compensation, and employee benefits................ 12 18,000
13 Professional fees and other payments to independent contractors............ 13  
14 Occupancy, rent, utilities, and maintenance................... 14 1,562
15 Printing, publications, postage, and shipping................... 15 745
16 Other expenses (describe in Schedule O) .................... 16 12,803
17 Total expenses. Add lines 10 through 16 ................. Bullet 17 45,010
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9)............ 18 4,574
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)................ 19 365,462
20 Other changes in net assets or fund balances (explain in Schedule O) .......... 20 7,179
21 Net assets or fund balances at end of year. Combine lines 18 through 20.........Bullet 21 377,215
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2013)
Form 990-EZ (2013)
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.................

(A) Beginning of year(B) End of year
22Cash, savings, and investments................
356,884
22
371,396
23Land and buildings....................
 
23
 
24Other assets (describe in Schedule O) ..........
8,790
24
6,675
25Total assets......................
365,674
25
378,071
26
Total liabilities (describe in Schedule O) .............
212
26
856
27Net assets or fund balances (line 27 of column (B) must agree with line 21)..
365,462
27
377,215
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? TO RECIEVE FUNDS AND PROPERTY TO INVEST AND REINVEST THE SAME AND TO DISBURSE THE SAME AS VOLUNTARY, GRATUITOUS AND CHARITABLE GIFTS AND CONTRIBUTIONS WITHIN THE MEANING OF SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE FOR THE BENEFIT OF DEPENDENT WIDOW/WIDOWERS, DEPENDENT CHILDREN OR THE NAMED BENEFICIARY OR BENEFICIARIES OF ANY LIFE INSURANCE POLICY PROVIDED BY THE MUNICIPALITY, COUNTY OR STATE OF SALARIED, VOLUNTEER OR SPECIAL LAW ENFORCEMENT OFFICERS INCLUDING STATE POLICE, FBI, DEA, AFT INS, USSS, USCS, USAP, SHEFIFF'S DEPARTMENT, PROSECUTOR'S OFFICE, CORRECTION OFFICERS, PRISON GUARDS, FIREFIGHTERS, EMERGENCY MEDICAL TECHNICIANS AND OTHER PUBLIC SAFETY PERSONNEL WHO, ALTHOUGH NOT SPECIFICALLY LISTED, PERFORM DUTIES OR FUNCTIONS SIMILAR OR RELATED TO THOSE SET FORTH IN THIS SECTION, LIVING OR SERVING IN PASSAIC COUNTY OR ITS MUNICIPALITIES WHO HAVE LOST THEIR LIVES IN THE LINE OF DUTY.TO RECOGNIZE VALOR OR MERITORIUS SERVICE BY ANYONE SET FORTH AS STATED ABOVE.
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 CHARITABLE GIFTS FOR THE BENEFIT OF DEPENDENT WIDOWS AND WIDOWERS, CHILDREN AND BENEFICIARIES OF LAW ENFORCEMENT OFFICERS DESCRIBED IN SECTION #1 OF THE BY-LAWS
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 28a 0
29 SCHOLARSHIPS AWARDED TO CHILDREN OF LAW ENFORCEMENT AS DESCRIBED IN SECTION #1 OF THE BY-LAWS
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 29a 0
30 VARIOIUS AND SUNDRY DONATIONS TO WORTHY CHARITIES
(Grants $ 0) If this amount includes foreign grants, check here ...MediumBullet		 30a 0
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
CHRISTINE E SCHULTZPRESIDENT 0.00 0 0 0
FRANK J LOGIOCOVICE PRESIDENT 0.00 0 0 0
HEIDI SCRIPTUREVICE PRESIDENT 0.00 0 0 0
JAMES R SUESSMANNTREASURER 0.00 0 0 0
RICKY E BAGOLIETRUSTEE 0.00 0 0 0
RICHARD BERDNIKTRUSTEE 0.00 0 0 0
JOSEPH BORELLTRUSTEE 0.00 0 0 0
BARBARA J SCHROEDERTRUSTEE 0.00 0 0 0
DANIEL BRANDMANTRUSTEE 0.00 0 0 0
JEFFREY BUONFORTETRUSTEE 0.00 0 0 0
JOSEPH CANNATELLATRUSTEE 0.00 0 0 0
THEODORE DEMARIATRUSTEE 0.00 0 0 0
Form 990-EZ (2013)
Form 990-EZ (2013)
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 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. bulletNJ
42aThe organization's books are in care of bulletPASSAIC COUNTY 200 CLUB Telephone no. bullet (973) 225-0696
Located at bullet3 GARRET MOUNTAIN PLAZAWOODLAND PARK,NJ ZIP + 4bullet07424
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 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
 
 
Form 990-EZ (2013)
Form 990-EZ (2013)
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 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
 
No
48
Is the organization a school as 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 (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 business address of each independent contractor (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 ...............bullet
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 bullet

Firm's EIN bullet
Firm's address bullet



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2013)


Form 990-EZ, Special Condition Description:
Special Condition Description

Additional Data


Software ID:  
Software Version:  
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.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
PASSAIC COUNTY 200 CLUB
C/O MOUNTAIN DEVELOPMENT CORP
Employer identification number

22-3342763
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 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) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . 39,355 760 3,730 2,420 370 46,635
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...... 34,440 80,088 73,478 23,910 23,471 235,387
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. 73,795 80,848 77,208 26,330 23,841 282,022
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.) 282,022
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (f) Total
9 Amounts from line 6... 73,795 80,848 77,208 26,330 23,841 282,022
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. 6,928 9,738 10,289 10,451 12,513 49,919
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b. 6,928 9,738 10,289 10,451 12,513 49,919
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.).. 80,723 90,586 87,497 36,781 36,354 331,941
14
Section C. Computation of Public Support Percentage
15
15
84.960 %
16
16
87.930 %
Section D. Computation of Investment Income Percentage
17
17
15.040 %
18
18
12.070 %
19a
b
20
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. 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) 2013

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.
right arrowInformation about Schedule G (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
PASSAIC COUNTY 200 CLUB
C/O MOUNTAIN DEVELOPMENT CORP
Employer identification number

22-3342763
Part I
Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
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.
(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 contributions 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) 2013
Schedule G (Form 990 or 990-EZ) 2013
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

BEEFSTEAK
(event type) 		(b) Event #2

VALOR AWARDS
(event type) 		(c) Other events

1
(total number) 		(d) Total events
(add col. (a) through col. (c))
VerticalRevenue 1 Gross receipts . . . 8,970 15,485 1,875 26,330
2 Less: Contributions . . 6,684 15,286 1,501 23,471
3 Gross income (line 1
minus line 2) . . . 		2,286 199 374 2,859
VerticalDirectExpenses 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) ........... right arrow  
11 Net income summary. Subtract line 10 from line 3, column (d)........... right arrow 2,859
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. Subtract line 7 from line 1, 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:
 
Schedule G (Form 990 or 990-EZ) 2013
Schedule G (Form 990 or 990-EZ) 2013
Page 3
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? ..........................
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 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 of the third party:
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
Supplemental Information. 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).
Return Reference Explanation
Schedule G (Form 990 or 990-EZ) 2013
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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
PASSAIC COUNTY 200 CLUB
C/O MOUNTAIN DEVELOPMENT CORP
Employer identification number

22-3342763
Return Reference Explanation
FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME DESCRIPTION: MERRYLL LYNCH. AMOUNT: 8,327. DESCRIPTION: MERRYLL LYNCH. AMOUNT: 4. DESCRIPTION: MERRYLL LYNCH. AMOUNT: 4,182. TOTAL INCLUDED ON FORM 990-EZ, LINE 4: 12,513.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: JAMES BABCOCK. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/06/13. AMOUNT GIVEN: 1,500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: BETHANY DEBLOCK. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/06/13. AMOUNT GIVEN: 1,000.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: VERONICA HILL. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/07/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: SEAN IRELAND. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/07/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: ROBIN JIROUSCHEK. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/07/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: AMANDA MCCARTHY. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 08/07/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: JESSICA O'SHAY. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 09/20/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: RYAN IRELAND. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/06/13. AMOUNT GIVEN: 1,000.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: DOMENIC MATTIA. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/06/13. AMOUNT GIVEN: 1,000.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: KAITLIN REICH. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 05/06/13. AMOUNT GIVEN: 1,000.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: RPMC - NORTH JERSEY CHAPTER. GRANTEE ADDRESS: P.O. BOX 4051 WAYNE, NJ 07474-4051. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 10/28/13. AMOUNT GIVEN: 250.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: PASSAIC COUNTY PIPES & DRUMS. GRANTEE ADDRESS: 9 DWYER ROAD WAYNE, NJ 07470. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/11/13. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: CLIFTON PBA. GRANTEE ADDRESS: P.O. BOX 528 FLORHAM PARK, NJ 07932. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 04/22/13. AMOUNT GIVEN: 100.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: PASSAIC COUNTY POLICE CHIEF'S ASSOCIATION. GRANTEE ADDRESS: 214 OLDHAM ROAD WAYNE, NJ 07470-2205. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 03/11/13. AMOUNT GIVEN: 200.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: NJ FIREMENS' HOME. GRANTEE ADDRESS: 565 LATHROP AVENUE BOONTON, NJ 07005. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 11/19/13. AMOUNT GIVEN: 250.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: DONATION. GRANTEE NAME: FOUNDATION FOR THE HANDICAPPED. GRANTEE ADDRESS: 30 WOODRIDGE TERRACE WAYNE, NJ 07470. GRANTEE RELATIONSHIP: NONE. DATE OF GIFT: 09/27/13. AMOUNT GIVEN: 100.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: JOSEPH DUNCAN. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: MEGAN ROTHLAUF. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: MATTHEW REDA. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: ALLISON SPERANZA. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500.
FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: ENRICO VENDITTE, JR.. GRANTEE RELATIONSHIP: NONE. AMOUNT GIVEN: 500. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 11,900.
FORM 990-EZ, PART I, LINE 14 DESCRIPTION: DEPRECIATION. AMOUNT: 1,562.
FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES DESCRIPTION: AWARDS & PLAQUES. AMOUNT: 2,610. DESCRIPTION: DUES & SUBSCRIPTIONS. AMOUNT: 73. DESCRIPTION: ADDITIONAL EVENTS. AMOUNT: 125. DESCRIPTION: INSURANCE. AMOUNT: 3,267. DESCRIPTION: WEBSITE. AMOUNT: 915. DESCRIPTION: POSTAGE. AMOUNT: 896. DESCRIPTION: CLUB SUNSHINE COMMITTEE. AMOUNT: 187. DESCRIPTION: INVESTMENT FEES. AMOUNT: 150. DESCRIPTION: SUPPLES. AMOUNT: 1,110. DESCRIPTION: TELEPHONE. AMOUNT: 868. DESCRIPTION: PAYROLL TAXES. AMOUNT: 2,070. DESCRIPTION: OTHER TAXES. AMOUNT: 60. DESCRIPTION: PAYROLL FEES. AMOUNT: 472. TOTAL TO FORM 990-EZ, LINE 16: 12,803.
FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS DESCRIPTION: CHANGE IN FMV OF INVESTMENTS. AMOUNT: 7,734. DESCRIPTION: DEPRECIATION (BOOK TO TAX). AMOUNT: -555. TOTAL TO FORM 990-EZ, LINE 20: 7,179.
FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 8,790. END OF YEAR AMOUNT: 6,675.
FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES DESCRIPTION: PAYROLL TAXES PAYABLE. BEG. OF YEAR AMOUNT: 212. END OF YEAR AMOUNT: 856.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  

TY 2013 TransferPrsnlBnftContractsDecl
Name:
PASSAIC COUNTY 200 CLUB
C/O MOUNTAIN DEVELOPMENT CORP
EIN: 22-3342763
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.