TY 2015 Form 990EZ

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; optional for others.)
What is the organization's primary exempt purpose? Encourages, Empowers and supports invidual and organizational charitable activities across the globe.
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 Cipanas YUM Village activities are focused on family based services, the providing of assistance for children though families. The CYV aims to provide assistance and support to the wider Cipanas community, offering opportunities for families, mothers and youths to develop and strengthen their skills enabling them to later provide for their families. YUMs ultimate goal is to support and develop families so that they will be able to care for their own children, instead of placing them in institutions. (Grants $ 24,000) If this amount includes foreign grants, check here ...	28a	0
29 Susila Dharma International Association is a global, member based network made up of 23 national Susila Dharma organisations and 47 development projects. (Grants $ 8,750) If this amount includes foreign grants, check here ...	29a	0
30 INTERNATIONAL CHILD DEVELOPMENT PROGRAMMES in South America, Central America, India, Europe, Russia, Israel, and Africa: Working with UNICEF, ICDP provides training to parents and caregivers to help keep children healthy and alive, particularly amidst poverty, migration, war and disease as well as natural disasters. (Grants $ 2,000) If this amount includes foreign grants, check here ...	30a	0
Badger Camp Greater Fresno Area, CA Provides music, art, drama, crafts, writing, and puppetry to low income children to foster self esteem through artistic expression, creativity and self awareness (Grants $ 5,000) If this amount includes foreign grants, check here ...		0
PUEBLO People United for a Better Life in Oakland Urban Youth Harvest is a multi-ethnic, multi-issue community membership organization that uses organizing, direct action, policy research and analysis, leadership development, popular education, and coalition building to confront the issues that affect the lives of its membership. Its mission is to advocate for the needs of low income residents of Oakland, most of them people of color, through grassroots organizing and leadership potential training. At risk youth and low income seniors are the primary beneficiaries of the PUEBLO programs, and many other community members benefit from the project and its activities. (Grants $ 4,000) If this amount includes foreign grants, check here ...		0
QUEST CENTER This Portland, OR program offers holistic care and education to people with critical illnesses, including HIVAIDS and cancer. The emphasis is on healthy meals, alternative therapies, community building, and nutrition education. (Grants $ 5,500) If this amount includes foreign grants, check here ...		0
Bina Cita Utama School The vision of the BCU school is to develop a high quality learning environment and address the need in Central Kalimantan for education. (Grants $ 4,000) If this amount includes foreign grants, check here ...		0
Centre for Culture and Development. Modern forces, industrial and agricultural combine in India to create a huge underclass caught between traditional ways and the global economy, who don't have the skills they need to cope. The Centre for Culture and Development works with disempowered peoples in Southern India, both urban and rural, to help them acquire the skills and rebuild the social structure they need in order to prosper in a changing world. (Grants $ 3,017) If this amount includes foreign grants, check here ...		0
Yayasan Tambuhak Sinta is a development foundation based in the Indonesian provinces of Kalimantan. These provinces have a small population, but are rich in natural resources, and it is inevitable that large scale development will come. The foundation YTS is working to create conditions that will enable this development to be balanced, sustainable, and equitable. To this end YTS is collaborating with local communities and governments to strengthen their capacity to jointly manage the process of development. (Grants $ 5,000) If this amount includes foreign grants, check here ...		0
Anisha is a project begun in 1998 in the slums of Bangalore City, India, by Ms. Valli Rajan and a small group of dedicated humanitarian volunteers. It is a Public Charitable Trust registered with the government of India. The word Anisha means moving from darkness to light, and its work has always embodied that spirit. The original mission of Anisha was to operate a community based preschool in one of Bangalore Citys worst slum districts. It has now shifted its focus to working in rural areas in an effort to slow the flight of families from impoverished areas in the countryside into the hugely overcrowded urban areas. Agricultural practices in much of the countryside have become so dependent on the use of pesticides and artificial fertilizers that the soil is often too depleted to sustain local village life. People are unable to make a living and must abandon their rural way of life for the tragedy of urban slum living. Anishas current rural agricultural project is focused on working with small, marginal farmers and landless families in the Martalli region of the southern Indian state of Karnataka. It is supported by a grant from the German Federal Ministry for Economic Cooperation and Development as well as by grants from our Susila Dharma nationals SDUSA, SD Germany, and in recent years from SD Norway, SD Netherlands, and SD Britain. (Grants $ 4,520) If this amount includes foreign grants, check here ...		0
The Human Force Volunteering for Social Change is a program that was founded and is directed by New York Subud member Alexandra Woodward. In succesive years, starting in 2009, Human Force organized four camps to assist SD projects. In summer 2009, over 20 volunteers came together to rebuild part of a school for children from disadvantaged socioeconomic backgrounds at Fundación Amanecer in Colombia. In 2010, the Human Force worked at SD project Usaha Mulia Abadi in San Miguel Atlautla, Mexico, and in 2011, twelve volunteers assisted the Cipanas YUM Village, a project in Cipanas, Indonesia. Most recently, in July, 2012, a camp of 12 volunteers from around the world was in residence at Anisha, a program designed to assist local farmers in growing organic crops in Karnataka State, India. Among their activities there, they interviewed community members about their farming practices and needs, and also taught English at a local high school. (Grants $ 2,750) If this amount includes foreign grants, check here ...		0
Womens World Wide Institute. This project, founded by New York City Subud member, Uraidah Hassani, has as its goal to inspire and educate young women in low-income communities in NYC and in the developing world. They have initiated an after-school leadership, educational and personal development program called Young Women Rock, for high school girls in local communities. They have also initiated the Notebooks for Peace program which donated inspirational notebooks to young people in conflict zones like the West Bank and Gaza. They have been active in supporting social action campaigns, like Days of Activism Against Gender-based Violence, DENIM Day solidarity with abuse victims, the AIDS walk, and the first ever International Day of the Girl. In 2013, TWWI was granted 2,500 to help in funding the Young Women Rock! program. TWWI also receives financial oversight from the Subud International Cultural Association (Grants $ 3,000) If this amount includes foreign grants, check here ...		0
Usaha Mulia Abadi A.C. is a Subud project located in the rural area of San Miguel Atlautla, Edo. De México, Mexico. Usaha Mulia Abadi has two purposes; First, to be a Subud Centre for all our brothers and sisters from around the world, and second to be a non profit organization that cares about the development of the community. San Miguel Atlautla is a marginalized area with a high index of poverty, 57% of the population is supported by agriculture and 12 per cent is illiterate. Usaha Mulia Abadi has worked in the community since 1997. This organization's main task is to work alongside the local community to build a center with an educational project for children and youth. Our mission is to support through this center, the development of skills, knowledge and comprehension to recognize and manifest the potential of the children and youth in an atmosphere of harmony and respect. (Grants $ 3,000) If this amount includes foreign grants, check here ...		0
The purpose of the Inner City Schools project is to provides art supplies that are not normally available to children in low income schools. Books are also supplied. The project currently supports two schools every month. In addition the project provides clothing for homeless children when requested by social services in the area. The Inner City Schools project is just getting off the ground and has until now been supported only with small donations and grass roots fund raising. It is hoped that with support from SD USA the project can grow, and support more children. (Grants $ 2,450) If this amount includes foreign grants, check here ...		0
Subud Indonesia. Install Clean Water Towers in two villages. Towers are capable of producing 10,000 liters of fresh water per day by removing bacteria without the need for electricity except for the water pump. In addition, provide education concerning water health and hygiene. (Grants $ 5,000) If this amount includes foreign grants, check here ...		0
A Child's Garden of Peace. The garden project (el huerto) in Puebl, Mexico is a collaboration with the Fundacion BP Casa Cuna Palafox y Mendoza, a child care center serving poor families with children ages birth to 5 and Subud Puebla, the Guerrand Hermes Foundation for Peace, SDUSA, Susila Dharma International, and the World Subud Association to establish a garden for education activities and to provide fresh vegetables and fruit to the children. (Grants $ 1,000) If this amount includes foreign grants, check here ...		0
The Lemba-Imbu School was started in 1995 by Santu Ntendi Paul-Gaston and his wife Charlotte Ndona, who is the head teacher. Lemba Imbu School on the outskirts of Kinshasa currently has 450 students and would like to expand that number by building a new high school. Its classrooms are currently packed beyond capacity - school spaces in the area are inadequate to meet the demand. Charlotte and Santu have formed a partnership with World Vision, which has given new desks, school books, and are covering the basic school fees for 150 of the poorest children. During our visit, we met with the World Vision regional representative to explore a possible partnership for the construction of a new school building. Follow-up discussions were held with World Vision Canada upon our return. Lemba Imbu School has been supported by SDIA, SD Norway, SD USA, SD Canada, Oxfam Quebec & Great Britain and DFID. (Grants $ 2,000) If this amount includes foreign grants, check here ...		0
THE ELDERBERRY PROGRAM Founded in 2013, its primary mission is to form a data base of the 'Pioneers' - the elderly Subud members, who may need practical or spiritual assistance. It consists of a Board of Directors from each Subud region and is co-chaired by David McCormak and Mardiyah Tarantino. (Grants $ 550) If this amount includes foreign grants, check here ...		0
GoodLife Mobility ("GLM") utilizes the potential for innovative electric technology to enhance quality of life for those facing physical and emotional challenges--the challenges often associated with life transitions (such as the transition from active duty military to civilian life.) (Grants $ 1,200) If this amount includes foreign grants, check here ...		0
The Q Fund is a US based non-profit, social enterprise founded with the vision of implementing sustainable solutions to eradicate poverty among millions of children left orphaned by the AIDS virus in sub-Saharan Africa. By providing locally-supported, community-based education, today's African children will continue to become tomorrow's teachers, doctors, farmers, artists and leaders. (Grants $ 5,000) If this amount includes foreign grants, check here ...		0
Washington State Smile Partners, or Smile Partners for short, is a long-standing 501 C 3 nonprofit providing preventive dental hygiene services to low-income children and seniors in King and Kitsap counties, Washington state. The organization was founded in 2004 by two dental hygienists who wanted to help roll back the epidemic of tooth decay in area schools. From its humble start at several schools in Bremerton, the project has grown to serve 6,000 students per year in 30 elementary schools and more than 50 preschools in some of the most diverse communities in the country. During the past five years, the program has been able to cut the number of visible cavities among beneficiaries in half from 32% to 16% with the rate of decay continuing to go down at its existing schools (Grants $ 3,000) If this amount includes foreign grants, check here ...		0
Clean Water -1.To provide the public with clean water filtration system unit in order to have access to clean and safe drinking water and to ensure they have the knowledge about water for health and cleanliness and the skill in maintenance of the water purifier equipment / machinery so as to maintain the water quality.2.To improve sanitation facilities where it is needed. This activity supplies clean water towers to Indonesian villages. (Grants $ 5,000) If this amount includes foreign grants, check here ...		0
Brickmakers in Tijuana. Subud San Diego members organized a Day of the Child celebration for a poor community of brickmakers in Mexico south of San Diego. The community has little resources. Subud San Diego provided school supplies, Christmas gifts, and organized group get-togethers to encourage community. (Grants $ 1,000) If this amount includes foreign grants, check here ...		0
Yayasan Permakultur Kalimantan (YPK)Sustainable Land Management Program. This program has been developed in response the environmental and social issues in the region of Central Kalimantan (please refer to the more detailed SD USA Report attached). As part of this program YPK will demonstrate alternative approaches to land management and a numerous strategies will be used in the small scale demonstration site. The availability of a functioning permaculture demonstration site is crucial to the success of this program as it will be the first integrated permaculture demonstration site in the region available to our target group (Grants $ 3,000) If this amount includes foreign grants, check here ...		0
YSS Indonesian Disaster Risk Index released by the National Disaster Management Agency in 2011 stated that the West Java was ranked 2nd among the provinces with a high level of vulnerability. One factor is the number of threats that exist in the province of West Java such as volcanoes, ground movement, flooding, landslides, drought, earthquakes, tsunamis, and tornado like wind disaster.Disaster education in schools becomes the most important program conducted with the aim to help children play an important role in efforts to save lives and protect members of the public at the time of disaster. Education on disaster risk in the school curriculum is very helpful in building awareness of the issue in society.Disaster risk reduction programs in the school do have to be able to push the policy of the school in order to protect children at time of natural disasters event. Education on disasterrisk and safety in the school are two main priorities, as the action of the Hyogo Framework for Action adopted by 168 countries (Grants $ 2,100) If this amount includes foreign grants, check here ...		0
31 Other program services (describe in Schedule O) ................ (Grants $ ) If this amount includes foreign grants, check here...	31a
32 Total program service expenses (add lines 28a through 31a)..........	32	0

(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
Evan Padilla Chair	2	0	0	0
John Schoenthaler Treasurer	2	0	0	0
Michael Shaver Vice Chair	2	0	0	0
Latham Stack Director	2	0	0	0
Alexandra Blonde Director	2	0	0	0
Carol Moncif Director	2	0	0	0
Aminah Ulmer Herman Director	2	0	0	0
Robina Page Director	2	0	0	0
Rachael Knotz Director	2	0	0	0
Hamid Alexander Secretary	2	0	0	0

(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

Evan Padilla

Chair

John Schoenthaler

Treasurer

Michael Shaver

Vice Chair

Latham Stack

Director

Alexandra Blonde

Director

Carol Moncif

Director

Aminah Ulmer Herman

Director

Robina Page

Director

Rachael Knotz

Director

Hamid Alexander

Secretary

(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

(a) Name and business address of each independent contractor

(b) Type of service

(c) Compensation

NONE

- TIN:

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.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (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

SUSILA DHARMA USA INC

Employer identification number

04-2726186

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.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ))

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ..............

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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 ....................... right arrow

33 1/3% support test—2014. 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2015. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .	60,935	113,115	151,630	128,775	110,353	564,808
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......
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.	60,935	113,115	151,630	128,775	110,353	564,808
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.)						564,808

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(f) Total
9	Amounts from line 6...	60,935	113,115	151,630	128,775	110,353	564,808
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..	7,479	10,044	13,491	9,645	3,368	44,027
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.	7,479	10,044	13,491	9,645	3,368	44,027
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.)..	68,414	123,159	165,121	138,420	113,721	608,835

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2015 (line 8, column (f) divided by line 13, column (f)) .........

92.769 %

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

91.581 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

7.231 %

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

8.419 %

19a

331/3% support tests—2015. 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 ....... right arrow

33 1/3% support tests—2014. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2015

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2015

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
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)
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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2015

Additional Data

Software ID:	15000352
Software Version:	v1.00

Return Reference	Explanation
Form 990-EZ, Part I, Line 10	See list in Part III
Form 990-EZ, Part I, Line 16	See list Part 1
Form 990-EZ, Part I, Line 20	Principal loss

Return Reference

Explanation

Form 990-EZ, Part I, Line 10

See list in Part III

Form 990-EZ, Part I, Line 16

See list Part 1

Form 990-EZ, Part I, Line 20

Principal loss

1	Contributions, gifts, grants, and similar amounts received ....................	1	110,352
2	Program service revenue including government fees and contracts ...............	2	0
3	Membership dues and assessments ...........................	3	0
4	Investment income ...........................	4	3,368
5a	Gross amount from sale of assets other than inventory .....	5a	0
b	Less: cost or other basis and sales expenses .......	5b	0
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c	0
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a	0
b	Gross income from fundraising events (not including $ 0 of contributions from fundraising events reported on line 1) (attach Schedule G if the			sum of such gross income and contributions exceeds $15,000) ..	6b	0
c	Less: direct expenses from gaming and fundraising events ...	6c	0
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d	0
7a	Gross sales of inventory, less returns and allowances ......	7a	0
b	Less: cost of goods sold .............	7b	0
c	Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) .........	7c	0
8	Other revenue (describe in Schedule O) ..........	8	0
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ..............	9	113,720

18	Excess or (deficit) for the year (Subtract line 17 from line 9) ............	18	6,411
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	339,333
20	Other changes in net assets or fund balances (explain in Schedule O) ..........	20	-28,657
21	Net assets or fund balances at end of year. Combine lines 18 through 20 .......	21	317,087

Sign Here

	Signature of officer	Date

	Type or print name and title

Name of organization SUSILA DHARMA USA INC

Part I	Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	,	$ RESTRICTED	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

Name of organization SUSILA DHARMA USA INC		Employer identification number 04-2726186

Part II	Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No.from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

10	Grants and similar amounts paid (list in Schedule O) ............	10	100,837
11	Benefits paid to or for members ................	11	0
12	Salaries, other compensation, and employee benefits ................	12	0
13	Professional fees and other payments to independent contractors ............	13	2,880
14	Occupancy, rent, utilities, and maintenance ...................	14	1,100
15	Printing, publications, postage, and shipping ..............	15	2,492
16	Other expenses (describe in Schedule O) ..............	16	0
17	Total expenses. Add lines 10 through 16 ..............	17	107,309


Name of organization SUSILA DHARMA USA INC			Employer identification number 04-2726186
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) $ Use duplicate copies of Part III if additional space is needed.