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. 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
PILOT CLUB INTERNATIONAL
Employer identification number
62-6047463
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) 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)
(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)
(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
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 2013 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2012 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2013.
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—2012.
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—2013.
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—2012.
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) 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)
(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.") .
105
2,001
3,288
3,256
3,076
11,726
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......
9,330
8,616
6,754
28,007
32,118
84,825
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.
9,435
10,617
10,042
31,263
35,194
96,551
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.)
96,551
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2009
(b) 2010
(c) 2011
(d) 2012
(e) 2013
(f) Total
9
Amounts from line 6...
9,435
10,617
10,042
31,263
35,194
96,551
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
49
45
51
53
54
252
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
49
45
51
53
54
252
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.)..
9,484
10,662
10,093
31,316
35,248
96,803
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 2013 (line 8, column (f) divided by line 13, column (f))
.........
15
99.740 %
16
Public support percentage from 2012 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2013 (line 10c, column (f) divided by line 13, column (f))
......
17
0.260 %
18
Investment income percentage from 2012 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2013.
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—2012.
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) 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:
-
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.
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
PILOT CLUB INTERNATIONAL
Employer identification number
62-6047463
Return Reference
Explanation
Description of other revenue Part I line 8
Description AmountQUARTERS FOR SCHOLARSHIP 150CONV TICKETS 100
List of grants and similar amounts paid Part I line 10
Activity MED.EQUIP FOR ALZHEIMER PATIENTS Grantee PROJECT LIFESAVER C/O LCSD Street 12680 HWY 11W SUITE 1 City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 375Activity PLAYGROUND EQUIPMENT FOR SPECIAL NEEDS CHILDREN Grantee LENOIR CITY PARKS AND REC Street 530 HWY 321 N SUITE 301. City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 1,250Activity SENOIR CITIZEN MED. ASSISTANCE Grantee ALZHEIMERS 5-K C/O LC PARKS Street 119 BROADWAY W City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 350Activity EDUCATIONAL ASSISTANCE Grantee LENOIR CITY HIGH SCHOOL Street 1485 OLD HWY 95 City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 1,000Activity SPECIAL NEEDS CHILDREN ASSISTANCE Grantee SPECIAL OLYMPICS Street 203 KELLEY LANE City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 1,174Activity EDUCATIONAL ASSISTANCE Grantee FRIENDS OF THE LIBRARY Street 100 BROADWAY W City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 25Activity SAFETY AWARENESS FOR CHILDREN Grantee BRAIN MINDERS Street 102 PRESTON COURT City, State, Zip Macon, GA 31208Relationship NONE Amount 220Activity EDUCATIONAL ASSISTANCE Grantee AMERICAN LEG. GIRLS STATE-LCHS Street 1485 OLD HWY 95 City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 350Activity SPECIAL NEEDS CHILDREN ASSISTANCE Grantee LCES-CHILD FIND Street 203 KELLEY LANE City, State, Zip Lenoir City, TN 37771Relationship NONE Amount 412
Description of other expenses Part I line 16
Description AmountPILOT INTERNATIONAL DUES AND CONV. 3,137DISTRICT DUES AND CONNVENTION EXP 3,970THANKSGIVING PARTY 46ANNUAL CORPORATE FILING 42BANK SERVICE CHARGE 9YEARBOOK 118WEBSITE RENEWAL 360ONE PHONE CALL SERVICE 51CHAMBER OF COMMERCE 160ANCHOR CLUB FOOD FOR MEMBERSHIP DRI 70PROJECT GRADUATION 100PRESCHOOL CHRISTMAS PARTY 45HELMETS FOR FARRAGUT ALLIANCE 260
Other changes in net assets or fund balances Part I line 20
Description AmountINTEREST ON CD 54
Description of other assets Part II line 24
Category Beginning of Year End of YearCD 4,101 4,155
Other program services Part III line 31
OTHER PROGRAM SERVICES INCLUDE ALZHEIMERS PATIENTS SUPPORT, ANCHOR CLUB- WHERE YOUNG MEN AND WOMEN HELP OTHERS LESS FORTUNATE IN OUR COMMUNITY, FESTIVAL OF FRIENDS WHICH ALLOWS DISABLED INDIVIDUALS A CHANCE TO WATER SKI AND OTHER ACTIVITES NOT USUALLY AVAILABLE TO THEM, ALSO HELP WITH FUNDING FOR OUR LOCAL LIBRARY AND THE FAMILY RESOURCE CENTER WHICH HELPS STUDENTS AND THEIR FAMILIES IN NEED, THERE ARE SCHOLARSHIPS GIVEN TO ANCHOR CLUB MEMBERS WHO ARE ENTERING THE HEALTH CARE FIELD AND ALSO SUPPORT THE CHAMBER OF COMMERCE IN THEIR QUEST FOR ECONOMIC DEVELOPMENT IN THE COMMUNITY TO AID ALL OF THE RESIDENTS. THE PROGRAM SERVICES ALSO FUND PILOT INTERNATIONAL WHO WORK IN MANY COUNTRIES TO AID ITS CITIZENS. THERE IS A PROGRAM THAT HELPS SEND A YOUNG LADY TO GIRLS STATE EACH YEAR, WHERE THEY HAVE A CHANCE TO SEE HOW GOVT WORKS AND HOW TO HELP IN THEIR LOCAL COMMUNITIES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.