TY 2015 Form 990

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(1) MARCY WERNER......................................................................
PRESIDENT

2.00
.................

(2) SALLY SJOBEK......................................................................
VICE PRESIDENT

2.00
.................

(3) KATHY JANDA......................................................................
TREASURER

2.00
.................

(4) MAUREEN MURPHY......................................................................
SECRETARY

2.00
.................

(5) PAM BIARD......................................................................
CONFORMATION REP.

2.00
.................

(6) NANCY EGO......................................................................
FIELD REP.

2.00
.................

(7) FRANCIE PUSATERI......................................................................
OBEDIENCE REP.

2.00
.................

(8) JIM GREGORY......................................................................
AGILITY REP.

2.00
.................

(A)
Name and Title

(B)
Average hours per week (list any hours for related organizations below dotted line)

(D)
Reportable compensation from the organization (W- 2/1099-MISC)

(E)
Reportable compensation from related organizations (W- 2/1099-MISC)

(F)
Estimated amount of other compensation from the organization and related organizations

(A)
Name and business address

(B)
Description of services

Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet

- 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 990-EZ 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

2015

Open to Public
Inspection

Name of the organization

MILE-HI GOLDEN
RETRIEVER CLUB

Employer identification number

84-0953270

Return Reference	Explanation
FORM 990, PART I, LINE 1	AND AGILITY TRIALS UNDER THE RULES OF THE AKC; TO CONDUCT WORKING CERTIFICATE FIELD TESTS APPROVED BY THE GRCA WHICH TEST DOGS' ABILITY TO RETRIEVE GAME BIRDS ON LAND AND WATER; AND TO ENCOURAGE CLUB MEMBERS AND GOLDEN RETRIEVER OWNERS IN GENERAL TO PARTICIPATE IN SANCTIONED AND LICENSED ACTIVITIES AND TO PROVIDE A SOURCE OF INFORMATION AND SUPPORT TO ALL PERSONS INTERESTED IN THE GOLDEN RETRIEVER BREED. WE ARE A LOCAL SPECIALITY CLUB. WE ARE ACTIVE IN COMMUNITY EVENTS IN THE COLORADO AREA. WE HOLD AKC PUBLIC DOG EVENTS WITHIN THAT COMMUNITY. WE HELP EDUCATE THE PUBLIC REGARDING RESPONSIBLE DOG OWNERSHIP, INCLUDING PROPER TRAINING AND HELATH MAINTENANCE. WE OFFER EDUCATIONAL PROGRAMS ON VARIOUS SUBJECTS, PROVIDE BREEDER REFERRAL TO HELP THE PUBLIC FIND SOUND, HEALTHY PETS, AND SUPPORT THE RESCUE AND RE-HOMING OF HOMELESS AND ABANDONED GOLDEN RETRIEVERS. THE CLUB ENCOURAGES DOG OWNERS TO TAKE ADVANTAGE OF OBEDIENCE CLASSES TO HELP THEM TRAIN THEIR DOGS TO BECOME GOOD CANINE CITIZENS, AND REDUCE THE NUMBER OF DOGS THAT ARE ABANDONED DUE TO POOR TRAINING AND RELATED BEHAVIOR PROBLEMS.
FORM 990, PART III, LINE 1	AND AGILITY TRIALS UNDER THE RULES OF THE AKC; TO CONDUCT WORKING CERTIFICATE FIELD TESTS APPROVED BY THE GRCA WHICH TEST DOGS' ABILITY TO RETRIEVE GAME BIRDS ON LAND AND WATER; AND TO ENCOURAGE CLUB MEMBERS AND GOLDEN RETRIEVER OWNERS IN GENERAL TO PARTICIPATE IN SANCTIONED AND LICENSED ACTIVITIES AND TO PROVIDE A SOURCE OF INFORMATION AND SUPPORT TO ALL PERSONS INTERESTED IN THE GOLDEN RETRIEVER BREED. WE ARE A LOCAL SPECIALITY CLUB. WE ARE ACTIVE IN COMMUNITY EVENTS IN THE COLORADO AREA. WE HOLD AKC PUBLIC DOG EVENTS WITHIN THAT COMMUNITY. WE HELP EDUCATE THE PUBLIC REGARDING RESPONSIBLE DOG OWNERSHIP, INCLUDING PROPER TRAINING AND HELATH MAINTENANCE. WE OFFER EDUCATIONAL PROGRAMS ON VARIOUS SUBJECTS, PROVIDE BREEDER REFERRAL TO HELP THE PUBLIC FIND SOUND, HEALTHY PETS, AND SUPPORT THE RESCUE AND RE-HOMING OF HOMELESS AND ABANDONED GOLDEN RETRIEVERS. THE CLUB ENCOURAGES DOG OWNERS TO TAKE ADVANTAGE OF OBEDIENCE CLASSES TO HELP THEM TRAIN THEIR DOGS TO BECOME GOOD CANINE CITIZENS, AND REDUCE THE NUMBER OF DOGS THAT ARE ABANDONED DUE TO POOR TRAINING AND RELATED BEHAVIOR PROBLEMS.
FORM 990, PART VI, SECTION A, LINE 6	GENERAL MEMBERS OF THE ORGANIZATION VOTE FOR THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7A	GENERAL MEMBERS OF THE ORGANIZATION VOTE FOR THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B	GENERAL MEMBERS OF THE ORGANIZATION VOTE FOR THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 11	A DRAFT COPY OF THE FEDERAL FORM 990 IS PROVIDED TO THE GOVERNING BODY FOR REVIEW; UPON APPROVAL OF THE DRAFT FEDERAL FORM 990 THE RETURN IS E-FILED WITH THE IRS.
FORM 990, PART VI, SECTION C, LINE 18	THE ORGANIZATION MAKES ITS FEDERAL FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART IX, LINE 11G	SECRETARY FEES: PROGRAM SERVICE EXPENSES 8,545. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 8,545. JUDGE FEES AND EXPENSES: PROGRAM SERVICE EXPENSES 17,805. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,805.
FORM 990, PART IX, LINE 24E	HOSPITALITY: PROGRAM SERVICE EXPENSES 3,350. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,350. TRAILERS: PROGRAM SERVICE EXPENSES 2,200. MANAGEMENT AND GENERAL EXPENSES 660. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,860. WORKERS FEES: PROGRAM SERVICE EXPENSES 2,858. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,858. RIBBONS: PROGRAM SERVICE EXPENSES 2,541. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,541. DONATIONS: PROGRAM SERVICE EXPENSES 2,361. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,361. BIRDS: PROGRAM SERVICE EXPENSES 2,054. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,054. VOLUNTEERS VOUCHERS: PROGRAM SERVICE EXPENSES 2,050. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,050. MEALS: PROGRAM SERVICE EXPENSES 1,614. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,614. GIFTS: PROGRAM SERVICE EXPENSES 1,431. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,431. AWARD DINNER: PROGRAM SERVICE EXPENSES 1,319. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,319. SWEEPS PAYOUTS: PROGRAM SERVICE EXPENSES 833. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 833. CLEANING: PROGRAM SERVICE EXPENSES 500. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 500. PRINTING AND REPRODUCTION: PROGRAM SERVICE EXPENSES 359. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 359. VENDOR SERVICES: PROGRAM SERVICE EXPENSES 250. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250. POSTAGE AND DELIVERY: PROGRAM SERVICE EXPENSES 140. MANAGEMENT AND GENERAL EXPENSES 49. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 189. LICENSES AND PERMITS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 96. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 96. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 90. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90. EQUIPMENT: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 72. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72. BANK FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 72. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 72. DUES AND SUBCRIPTIONS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 50. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2015

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: MILE-HI GOLDEN RETRIEVER CLUB (MHGRC) IS A MEMBER CLUB OF THE GOLDEN RETRIEVER CLUB OF AMERICA (GRCA) AND IS LICENSED BY THE AMERICAN KENNEL CLUB (AKC). THE CLUB'S PURPOSE IS TO RECOGNIZE THAT THE GOLDEN RETRIEVER IS A GUN DOG AND TO ENCOURAGE AND PROMOTE THE BREEDING OF PUREBRED GOLDEN RETRIEVERS THAT POSSESS THE APPEARANCE, SOUNDNESS, TEMPERAMENT, NATURAL ABILITIES AND PERSONALITY THAT IS REFLECTED IN THE STANDARD OF THE BREED AND TO DO ALL POSSIBLE TO BRING THESE QUALITIES TO PERFECTION; TO URGE MEMBERS AND BREEDERS TO ACCEPT THE STANDARD OF THE BREED AS APPROVED BY THE AKC AS THE ONLY STANDARD OF EXCELLENCE BY WHICH GOLDEN RETRIEVERS SHALL BE JUDGED; TO DO ALL IN ITS POWER TO PROTECT AND ADVANCE THE INTERESTS OF THE BREED BY ENCOURAGING SPORTSMANLIKE COMPETITION AT DOG SHOWS, OBEDIENCE TRIALS, HUNTING TESTS, AND AGILITY TRIALS; TO CONDUCT SANCTIONED AND LICENSED SPECIALITY SHOWS, OBEDIENCE TRIALS, HUNTING TESTING, FIELD TRIALS,
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	8
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	114
5	Total number of individuals employed in calendar year 2015 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	225
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	5,643	6,647
9	Program service revenue (Part VIII, line 2g) .........	100,947	83,321
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	0	0
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	0	0
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	106,590	89,968
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	0	0
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	102,238	93,943
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	102,238	93,943
19	Revenue less expenses. Subtract line 18 from line 12.......	4,352	-3,975
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	29,759	25,204
21	Total liabilities (Part X, line 26).............	2,235	1,655
22	Net assets or fund balances. Subtract line 21 from line 20.....	27,524	23,549

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 79,890 including grants of $ ) (Revenue $ 83,321 )
	AGILITY TRIALS, HUNT TESTS AND SPECIALTIESIN 2015, THE ORGANIZATION HELD TWO AKC AGILITY TRIALS - ONE IN APRIL AND ONE IN JULY. THE ORGANIZATION HELD TWO DAYS OF SANCTIONED SPECIALTY SHOWS IN AUGUST THAT INCLUDED CONFORMATION, AGILITY, OBEDIENCE AND RALLY. THE ORGANIZATION HELD TWO HUNT TESTS - ONE IN JUNE AND ONE IN SEPTEMBER. IN ADDITION, THE ORGANIZATION SPONSORED A GROOMING SEMINAR AND AN AGILITY SEMINAR.IN 2016, THE ORGANIZATION EXPECTS TO OFFER THE SAME TRIALS, TESTS AND SHOWS. IN PLACE OF ONE OF THE DAYS OF SPECIALTY SHOWS, WE WILL BE HOSTING THE WESTERN REGIONAL SPECIALTY FOR GOLDEN RETRIEVER CLUB OF AMERICA, GRCA, (OUR PARENT CLUB).

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












	(Code: ) (Expenses $ 7,576 including grants of $ ) (Revenue $ )
	OTHER PROGRAM SERVICES INCLUDE PROVIDING AWARD BANQUETS, DONATIONS, FUN HUNTS AND MATCHES AND PUPPY/BREEDER REFERRALS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 7,576 including grants of $ ) (Revenue $ )
4e	Total program service expenses87,466

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	0	0	0

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 0

1a	Federated campaigns..		1a
b	Membership dues..		1b	4,817
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e

f	All other contributions, gifts, grants, and similar amounts not included above		1f	1,830

g	Noncash contributions included in lines 1a-1f:$
h Total.Add lines 1a-1f.......		6,647

			Business Code
2a	ENTRY FEES	900099	77,484	77,484
b	SEMINARS	900099	3,235	3,235
c	MERCHANDISE SALES AND	900099	2,602	2,602
d
e
f	All other program service revenue.
g Total.Add lines 2a–2f.....			83,321

3 Investment income (including dividends, interest, and othersimilar amounts) ..........
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss)......
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss).....
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			89,968	83,321	0	0

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........	1,000		1,000
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	26,350	26,350
12	Advertising and promotion ....
13	Office expenses .......	844	508	336
14	Information technology ......	258		258
15	Royalties ..
16	Occupancy ...........	1,400		1,400
17	Travel ............	49	49
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..
23	Insurance ...	2,394		2,394
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	AKC FEES	14,153	14,153
b	GROUNDS	13,620	13,620
c	TROPHIES	4,548	4,548
d	SEMINAR EXPENSES	4,378	4,378
e	All other expenses	24,949	23,860	1,089
25	Total functional expenses. Add lines 1 through 24e	93,943	87,466	6,477	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........		27,999	1	22,679
2	Savings and temporary cash investments .........			2
3	Pledges and grants receivable, net ......			3
4	Accounts receivable, net .............			4	70
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L
				5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
				6
7	Notes and loans receivable, net ....			7
8	Inventories for sale or use ........			8
9	Prepaid expenses and deferred charges ......		1,760	9	1,805
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a
b	Less: accumulated depreciation	10b		10c
11	Investments—publicly traded securities .			11
12	Investments—other securities. See Part IV, line 11 .....			12
13	Investments—program-related. See Part IV, line 11 ..			13
14	Intangible assets ...............			14
15	Other assets. See Part IV, line 11 ...........		0	15	650
16	Total assets. Add lines 1 through 15 (must equal line 34)...		29,759	16	25,204

17	Accounts payable and accrued expenses .....		17
18	Grants payable ...		18
19	Deferred revenue .........	2,235	19	1,655
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..		22
23	Secured mortgages and notes payable to unrelated third parties ..		23
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	2,235	26	1,655

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	27,524	27	23,549
28	Temporarily restricted net assets ...........		28
29	Permanently restricted net assets		29
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund ...		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	27,524	33	23,549
34	Total liabilities and net assets/fund balances ........	29,759	34	25,204

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ...............................................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ...........................................
c	Total lobbying expenditures (add lines 1a and 1b) .......................................................................
d	Other exempt purpose expenditures .........................................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ....................................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) ..........................................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ..........................................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ...........................................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ..............................................................................................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2012	(b) 2013	(c) 2014	(d) 2015	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
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5
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