Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | 169,778 | 245,367 | 208,836 | 137,783 | 43,303 | 805,067 |
| 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 | 169,778 | 245,367 | 208,836 | 137,783 | 43,303 | 805,067 |
| 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).. | 227,216 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 577,851 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 169,778 | 245,367 | 208,836 | 137,783 | 43,303 | 805,067 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 63 | 186 | 320 | 682 | 749 | 2,000 |
| 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.).. | 6,075 | 24,452 | 259 | 30,786 | ||
| 11 | Total support. Add lines 7 through 10 | 837,853 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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 | ||||||
| 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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2015 | (b) 2016 | (c) 2017 | (d) 2018 | (e) 2019 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 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.).. | ||||||
| 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): |
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| 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 | ||||
| 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 2019 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-2019 |
(iii) Distributable Amount for 2019 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2019 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2019: | ||||
| a From 2014....... | ||||
| b From 2015....... | ||||
| c From 2016....... | ||||
| d From 2017....... | ||||
| e From 2018....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2019 distributable amount | ||||
|
i
Carryover from 2014 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2019 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2019 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2020. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2015..... | ||||
| b Excess from 2016..... | ||||
| c Excess from 2017..... | ||||
| d Excess from 2018..... | ||||
| e Excess from 2019..... | ||||
| 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.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990-EZ, PART I, LINE 4 - OTHER INVESTMENT INCOME | DESCRIPTION: INTEREST. AMOUNT: 749. |
| FORM 990-EZ, PART I, LINE 8 - OTHER REVENUE | DESCRIPTION: OTHER REVENUE. AMOUNT: 259. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: PROGRAM SUPPLIES. AMOUNT: 1,235. DESCRIPTION: PHONE CARD. AMOUNT: 350. DESCRIPTION: SECURITY SYSTEM. AMOUNT: 579. DESCRIPTION: TELEPHONE EXPENSE. AMOUNT: 1,924. DESCRIPTION: INTERNET EXPENSE. AMOUNT: 2,516. DESCRIPTION: OFFICE SUPPLIES/EXPENSES. AMOUNT: 1,606. DESCRIPTION: INSURANCE. AMOUNT: 1,312. DESCRIPTION: DUES & SUBSCRIPTIONS. AMOUNT: 2,386. DESCRIPTION: BANK FEES/SERVICE CHARGES. AMOUNT: 196. DESCRIPTION: PAYROLL PROCESSING. AMOUNT: 290. DESCRIPTION: DEPRECIATION EXPENSE. AMOUNT: 2,433. DESCRIPTION: TRAVEL & MEALS. AMOUNT: 12,398. DESCRIPTION: MERCHANT FEES/PROCESSING. AMOUNT: 3,423. DESCRIPTION: DRILL. AMOUNT: 466. DESCRIPTION: OPERATIONS. AMOUNT: 7,343. TOTAL TO FORM 990-EZ, LINE 16: 38,457. |
| FORM 990-EZ, PART I, LINE 20 - OTHER CHANGES IN NET ASSETS | DESCRIPTION: UNREALIZED GAIN. AMOUNT: -1,345. DESCRIPTION: PRIOR PERIOD ADJUSTMENT. AMOUNT: -500. TOTAL TO FORM 990-EZ, LINE 20: -1,845. |
| FORM 990-EZ, PART II, LINE 24 - OTHER ASSETS | DESCRIPTION: PREPAID EXPENSES. BEG. OF YEAR AMOUNT: 1,811. END OF YEAR AMOUNT: 1,263. DESCRIPTION: TRAVEL ADVANCE. BEG. OF YEAR AMOUNT: -50. END OF YEAR AMOUNT: 10,896. DESCRIPTION: ACCOUNTS RECEIVABLE. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 5,259. DESCRIPTION: OTHER DEPRECIABLE ASSETS. BEG. OF YEAR AMOUNT: 33,567. END OF YEAR AMOUNT: 31,133. |
| FORM 990-EZ, PART II, LINE 26 - OTHER LIABILITIES | DESCRIPTION: LOAN PAYABLE. BEG. OF YEAR AMOUNT: 10,000. END OF YEAR AMOUNT: 10,000. DESCRIPTION: DEFERRED REVENUE. BEG. OF YEAR AMOUNT: 20,145. END OF YEAR AMOUNT: 15,109. DESCRIPTION: ACCOUNTS PAYABLE. BEG. OF YEAR AMOUNT: 0. END OF YEAR AMOUNT: 2,828. |
| FORM 990-EZ, PART III, LINE 28, PROGRAM SERVICE ACCOMPLISHMENTS: | INTERNATIONAL ACTION CONTINUED TO SUPPORT & GROW ITS WATER INITIATIVE IN HAITI IN 2018. WITH THE HUMAN POWERED DRILL, THE INTERNATIONAL ACTION TEAM BEGAN TO PUT THEIR TRAINING INTO PRACTICE IN THE GONAIVES AREA. THE NEW DRILL GIVES THE INTERNATIONAL ACTION TEAM THE CAPACITY TO DIG WELLS DOWN TO 120FT. FOR THIS AREA IN HAITI, THAT MEANS THAT BENEFICIARIES OF THE WELLS WILL HAVE ACCESS TO WATER MOST OF THE YEAR, IF NOT FOR THE FULL 12 MONTHS. THE INTERNATIONAL ACTION TEAM SUCCESSFULLY COMPLETED TWO WELLS IN THE ZONE OF MORNE BLANCHE IN GONAIVES, WHICH IS THE FUTURE SITE OF AN EXPANDED UNIVERSITY. UPON COMPLETION, THESE WELLS WERE CLEANED & THEN CAPPED, SO THAT THE UNIVERSITY CAN DETERMINE HOW THEY WANT TO INCORPORATE THEM INTO THE FUTURE WATER SYSTEM AT A LATER DATE. THE INTERNATIONAL ACTION TEAM SPENT TIME IN THE NORTHERN ARTIBONITE TO DRILL A NEW DEEPER WELL FOR A HEN HOUSE INITIATIVE IN THE COMMUNE OF GROS MORNE. THIS DEEPER WELL, WHICH WAS OUTFITTED WITH A SUBMERSIBLE SOLAR POWERED PUMP UPON COMPLETION, WILL ENABLE THE HEN HOUSE TO MEET ITS DAILY WATER NEEDS OF 1,500 LITERS PER DAY. DOWN THE ROAD FROM THE HEN HOUSE, THE INTERNATIONAL ACTION TEAM DUG A WELL FOR THE COMMUNITY OF CAMPECHE. COMMUNITY MEMBERS USE THIS NEW CLOSER WATER SOURCE WITH A HAND POWERED PUMP ATTACHED TO IT TO WASH DISHES, WASH CLOTHES, & PUMP WATER TO TAKE BACK FOR THEIR LIVESTOCK TO DRINK. INTERNATIONAL ACTION ALSO DRILLED A WELL IN KAYIMIT, ANOTHER NORTHERN VILLAGE IN THE ARTIBONITE DEPARTMENT. AFTER A HAND POWERED PUMP WAS INSTALLED, PEOPLE IN KAYIMIT BEGAN TO USE THE WATER TO IRRIGATE THEIR GARDENS, WASH THEIR CLOTHES, CLEAN THEIR HOUSES, & BATHE. BENEFICIARIES AT EACH SITE ENJOY ACCESS TO A MORE REGULAR WATER SOURCE, & ARE ABLE TO BETTER MANAGE THEIR TIME & RESOURCES BY HAVING WELLS NEARBY. AT EACH DRILL SITE, THE INTERNATIONAL ACTION TEAM EMPLOYED AT LEAST TWO LOCAL LABORERS SO THAT THEY COULD LEARN & PARTICIPATE IN THE WELL DIGGING PROCESS. THIS ALSO IMPROVED THE KNOWLEDGE OF THE CORE WELL DIGGING TEAM, SINCE THEY HAD TO BE KNOWLEDGEABLE ENOUGH ABOUT THE WELL DIGGING PROCESS TO EFFECTIVELY COMMUNICATE & SHARE THIS WITH THE LOCAL TEAM MEMBERS. EACH DRILL SITE INVOLVED A TEAM LEADER TO GIVE DIRECTION, PLUS AT LEAST 6 MEN TO WORK THE DRILL. WHILE THE DRILL TEAM WAS KEPT BUSY WITH THESE VARIOUS DIG SITES, OTHER INTERNATIONAL ACTION TEAM MEMBERS COMPLETED WATER ASSESSMENTS FOR POTENTIAL FUTURE DRILL SITES. THIS INVOLVED MAKING A SITE VISIT & DETERMINING WHAT WATER RESOURCES ALREADY EXIST IN THE COMMUNITY, WHAT THE WATER NEEDS ARE, & HOW INTERNATIONAL ACTION COULD IMPROVE ACCESS TO WATER FOR THE BENEFICIARY COMMUNITY VIA DIGGING WELLS, CREATING A WATER SYSTEM, OR NETWORKING WITH OTHER GROUPS INVOLVED IN THE DOMAIN OF PROVIDING ACCESS TO WATER IN HAITI. THESE FUTURE BENEFICIARIES INCLUDE A HOSPITAL, SCHOOLS, HEALTH CLINIC, & COMMUNITIES WHERE WATER IS SCARCE. INTERNATIONAL ACTION CONTINUED ITS PARTNERSHIP WITH MARCHAND DESSALINES BY WORKING WITH THE LOCAL REPRESENTATIVES OF THE AREA TO DETERMINE WHAT NEEDED TO HAPPEN IN ORDER TO PROMOTE ACCESS TO WATER IN THE COMMUNE. INTERNATIONAL ACTION ALSO CONTRACTS WITH WELL TECHNICIANS, WHO WERE ABLE TO SERVICE TWO EXISTING WELLS IN GONAIVES, ONE WITH A HAND PUMP & THE OTHER WITH A SUBMERSIBLE PUMP, TO PROVIDE WATER FOR THE NEIGHBORHOOD OF KA SOLEIL & A LARGE PRIMARY SCHOOL OF 750 STUDENTS. 2018 WAS A YEAR OF EXPANSION & A YEAR OF CONTINUED DEVELOPMENT FOR THE INTERNATIONAL ACTION TEAM, AS THEY WORKED TO UTILIZE THE NEW DRILL TO ITS FULL CAPACITY FOR THE BENEFIT OF THE COMMUNITY. INTERNATIONAL ACTION CREATED BEST PRACTICES FOR DRILLING & FOR MANAGING THIS EXPANDING ENDEAVOR TO CREATE ACCESS TO WATER. |
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