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.") . | 43,179 | 44,807 | 37,460 | 41,032 | 28,465 | 194,943 |
| 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...... | 21,305 | 32,005 | 61,226 | 43,420 | 52,479 | 210,435 |
| 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. | 64,484 | 76,812 | 98,686 | 84,452 | 80,944 | 405,378 |
| 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.) | 405,378 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 64,484 | 76,812 | 98,686 | 84,452 | 80,944 | 405,378 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 42,761 | 4,511 | 9,236 | 31,999 | 13,249 | 101,756 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 42,761 | 4,511 | 9,236 | 31,999 | 13,249 | 101,756 |
| 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.).. | 107,245 | 81,323 | 107,922 | 116,451 | 94,193 | 507,134 |
| 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: 7. Description: Dividends. Amount: 13242. Total Included on Form 990-EZ, line 4: 13249. |
| Form 990-EZ, Part I, Line 10 - Payments to Affiliates | Affiliate Name: Rotary international. Affiliate Address: 1560 Sherman AVE LI 1 Evanston, IL 60201. Purpose of Payment: Dues. Amount of Payment: 3913. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Education programs. Grantee Name: OSSU Public Schools. Grantee Address: 24 Central St Randolph, VT 05060. Date of Gift: 10/09/14. Amount Given: 1800. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support- Emergency Relief. Grantee Name: Randolph Food Shelf. Grantee Address: PO Box 202 Randolph, VT 05060. Date of Gift: 11/13/14. Amount Given: 1000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Last Mile Ride. Grantee Name: Gifford Medical Center. Grantee Address: Main St Randolph, VT 05060. Date of Gift: 06/13/14. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: David's House. Grantee Address: PO Box 660 Lebanon, NH 03766. Date of Gift: 03/16/15. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Christmas Program. Grantee Name: Safe Haven. Grantee Address: 4 Highland Ave Randolph, VT 05060. Date of Gift: 11/13/14. Amount Given: 350. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Arts Bus. Grantee Name: Chandler Center for the Arts. Grantee Address: Main St Randolph, VT 05060. Date of Gift: 06/13/15. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Literacy Program Support. Grantee Name: Central Vermont Basic Education. Grantee Address: 12 S Main St. Randolph, VT 05060. Date of Gift: 12/13/14. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: White River Craft Center. Grantee Address: 50 Randolph Ave Randolph, VT 05060. Date of Gift: 11/13/14. Amount Given: 1000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: Chandler Center for the Arts. Grantee Address: Main St Randolph, VT 05060. Date of Gift: 03/16/15. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Ballfield sign. Grantee Name: Randolph Youth Baseball. Grantee Address: PO Box 372 Randolph, VT 05060. Date of Gift: 04/24/15. Amount Given: 375. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support- Annual Fund. Grantee Name: White River Valley Ambulance. Grantee Address: 3190 Pleasant Street Bethel, VT 05032. Date of Gift: 06/13/15. Amount Given: 700. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: RACDC. Grantee Address: Main St Randolph, VT 05060. Date of Gift: 11/13/14. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: VNA/VNH. Grantee Address: Main St White River Junction, VT 05001. Date of Gift: 11/13/14. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: College Scholarships. Grantee Name: Randolph Union High School. Grantee Address: Forest St. Randolph, VT 05060. Date of Gift: 05/25/15. Amount Given: 11250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Youth Baseball. Grantee Name: Mid Vermont Sports. Grantee Address: Municipal Bldg Randolph , VT 05060. Date of Gift: 03/16/15. Amount Given: 500. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: Angel flight NE. Grantee Address: 492 Sutton ST North Andover, MA 01845. Date of Gift: 03/16/15. Amount Given: 300. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: Randolph Senior Center. Grantee Address: 6 Hale St Randolph, VT 05060. Date of Gift: 12/13/14. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Operation Christmas. Grantee Name: Samaritan's Purse. Grantee Address: PO Box 3000 Boone, NC 28607. Date of Gift: 11/13/14. Amount Given: 250. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Community Service. Grantee Name: Joslyn House. Grantee Address: Maple Street Randolph, VT 05060. Date of Gift: 03/15/15. Amount Given: 4000. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Program Support. Grantee Name: Safeline. Grantee Address: 348 VT 110 Chelsea, VT 05038. Date of Gift: 11/13/14. Amount Given: 200. |
| Form 990-EZ, Part I, Line 10 - Grants and Similar Amounts Paid | Activity Classification: Christmas. Grantee Name: Randolph Food Shelf. Grantee Address: PO Box 202 Randolph, VT 05060. Date of Gift: 12/13/14. Amount Given: 500. Total included on Form 990-EZ, line 10: 25225. |
| Form 990-EZ, Part I, Line 16 - Other Expenses | Description: Advertising. Amount: 587. Description: Membership Dues and Assessments. Amount: 3212. Description: Treasurer Expense. Amount: 25. Description: Meetings, Conferences and conventions. Amount: 5687. Description: Flowers and Condolences. Amount: 56. Description: Supplies. Amount: 313. Description: Club service expenses. Amount: 1565. Description: Rotary Youth Leadership Awards. Amount: 1500. Description: Rotary Foundation International Service. Amount: 10119. Description: Youth Exchange Program Expense. Amount: 500. Description: Community service expenses. Amount: 15536. Description: Vocational Service Project Expense. Amount: 5711. Description: Club social Events. Amount: 1769. Description: Fund Raising Expenses - Golf tournament. Amount: 3299. Total to Form 990-EZ, line 16: 49879. |
| Form 990-EZ, Part I, Line 20 - Other Changes in Net Assets | Description: Unrealized Losses on investments. Amount: -8688. |
| Form 990-EZ, Part II, Line 24 - Other Assets | Description: Supplies on hand. Beg. of Year Amount: 317. End of Year Amount: 317. |
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