Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 56,897 | 53,905 | 57,524 | 64,743 | 65,548 | 298,617 |
| 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...... | 38,690 | 45,400 | 29,118 | 28,427 | 29,396 | 171,031 |
| 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. | 95,587 | 99,305 | 86,642 | 93,170 | 94,944 | 469,648 |
| 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.) | 469,648 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 95,587 | 99,305 | 86,642 | 93,170 | 94,944 | 469,648 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 91 | 114 | 60 | 41 | 37 | 343 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 91 | 114 | 60 | 41 | 37 | 343 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 95,678 | 99,419 | 86,702 | 93,211 | 94,981 | 469,991 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990-EZ, Part I, Line 4 - Other Investment Income | Description: Interest. Amount: 37. |
| Form 990-EZ, Part I, Line 8 - Other Revenue | Description: Games. Amount: 1,314. Description: Miscellaneous. Amount: 300. Description: Bad debt recovery. Amount: 1,070. Total to Form 990-EZ, line 8: 2,684. |
| Form 990-EZ, Part I, Line 10 - Payments to Affiliates | Affiliate Name: Rotary International. Purpose of Payment: Disrict Dues. Amount of Payment: 3,107. |
| Form 990-EZ, Part I, Line 10 - Payments to Affiliates | Affiliate Name: Rotary International. Purpose of Payment: International Dues. Amount of Payment: 5,629. |
| Form 990-EZ, Part I, Line 10 - Payments to Affiliates | Affiliate Name: Rotary International. Purpose of Payment: Global Grants. Amount of Payment: 3,000. Total included on Form 990-EZ, line 10: 11,736. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Meals for needy and alone. Grantee Name: Banquet of Salem. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Fireworks Sponsorship. Grantee Name: City of Salem. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 100. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Polio eradication. Grantee Name: Rotary International. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Club recognition. Grantee Name: Salem Rotary Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Club recognition. Grantee Name: Rotary International Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 7,925. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Career Day. Grantee Name: Salem Rotary Club KSU Career Day. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Scholarship. Amount Given: 462. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Annual fund drive. Grantee Name: United Way of Northern Columbiana County. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth. Grantee Name: Buckeye Council - Scouts. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth. Grantee Name: Junior Achievement. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Writing Supplies. Grantee Name: Salem City Schools. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 174. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Clothing Drives. Grantee Name: Church Women United. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth Literacy. Grantee Name: Salem Rotary Club Dictionary Project. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Dictionaries. Amount Given: 6,055. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Literacy. Grantee Name: Salem Public Library. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 2,400. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Meals for homebound. Grantee Name: Mobile Meals. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Senior citizen service. Grantee Name: Salem Rotary/Interact Senior Prom. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 831. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Students of the month. Grantee Name: Various. Grantee Relationship: None. Property Description: Scholarship. Amount Given: 1,300. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth exchange program. Grantee Name: Various. Grantee Relationship: None. Property Description: Scholarship. Amount Given: 2,626. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Community Garden. Grantee Name: Kent State University - Salem Branch. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth leadership conference. Grantee Name: Rotary Youth Leadership Assoc.. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 650. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth soccer. Grantee Name: Salem Youth Soccer League, Inc.. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 750. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Cloting Drive. Grantee Name: Operation Warm Inc. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donations. Amount Given: 972. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth Music Groups. Grantee Name: Various. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donations. Amount Given: 600. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Video Cameras. Grantee Name: Salem Police Department. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 10,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Cancer Center. Grantee Name: Salem Regional Medical Center. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 10,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Gingerbread Day. Grantee Name: Salem Community Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 300. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Harville Riding Center. Grantee Name: The Rotary Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth Track and Field. Grantee Name: Salem Xtra Mile Club. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Sponsorship. Amount Given: 100. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Curing Retinal Blindness. Grantee Name: Various. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 100. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Vocational Service Award. Grantee Name: Various. Grantee Relationship: None. Property Description: Scholarship. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Gold Star Project. Grantee Name: Salem Rotary Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 408. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Ugandan Water Project. Grantee Name: Eden Prarie Rotary Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 1,000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Various Projects. Grantee Name: Salem Rotary Foundation. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 2,404. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Boys State/Girls State. Grantee Name: America Legion Post #56. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 600. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Quakertown Super Kids Classic Race. Grantee Name: Quakertown Super Kids Inc. Grantee Address: P.O. Box 1025 Salem, OH 44460. Grantee Relationship: None. Property Description: Donation. Amount Given: 250. Total included on Form 990-EZ, line 10: 58,757. |
| Form 990-EZ, Part I, Line 16 - Other Expenses | Description: Gifts/Memorials. Amount: 335. Description: Internet service. Amount: 658. Description: Meals/Meetings. Amount: 27,227. Description: Newsletter. Amount: 933. Description: Advertising/Club Promotions. Amount: 575. Total to Form 990-EZ, line 16: 29,728. |
| Form 990-EZ, Part II, Line 24 - Other Assets | Description: Receivables. Beg. of Year Amount: 1,922. End of Year Amount: 1,931. |
| Form 990-EZ, Part II, Line 26 - Other Liabilities | Description: Payables. Beg. of Year Amount: 936. End of Year Amount: 991. Description: Other Payables. Beg. of Year Amount: 0. End of Year Amount: 20. |
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