TY 2019 Form 990EZ

(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
Nicole Owens Board Member	8	0	0	0
Jen Yorko Board Member	5	0	0	0
Peter Carfagna Director	3	0	0	0
Rita Carfagna Director	2	0	0	0
Ray Murphy Director	2	0	0	0
Katie Murphy Director	2	0	0	0
Amy Gyetko Board Member	3	0	0	0

- 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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CAPTAINS CHARITIES INC

Employer identification number

35-2197135

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 12, 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 agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

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 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

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) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

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.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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—2018. 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—2019. 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—2018. 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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 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.") .	0	0	0	0	1,000	1,000
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	0	0	0	0	1,000	1,000
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.)						1,000

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
9	Amounts from line 6...	0	0	0	0	1,000	1,000
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.)..	0	0	0	0	1,000	1,000

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 2019 (line 8, column (f) divided by line 13, column (f)) .........

100 %

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

100 %

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

0 %

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

0 %

19a

331/3% support tests—2019. 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—2018. 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) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d 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 12a or 12b 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) 2019

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) 2019

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 (explain in Part VI). 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) 2019

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 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.
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)
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.
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.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
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.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

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) 2019

Additional Data

Software ID:
Software Version:

- 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

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

CAPTAINS CHARITIES INC

Employer identification number

35-2197135

Return Reference	Explanation
Part I, line 10	\| Activity:, Grantee Name:, Grantee Address:, Amount:, Relationship:\| Donation, Hospice of the Western Reserve, "17876 St Clair Ave Cleveland, Oh 44110", $100.00, None\| Donation, Mentor Area Chamber of Commerce, "6972 Spinach Dr Mentor, Oh 44060", $30.00, None\| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $1000.00, None\| Donation, Willoughby Western Lake County, "28 Public Square Willoughby, Oh 44094", $270.00, None\| Little League Sponsorship, Willoughby Wildcats Travel Baseball, "38101 Strumbly Place Willoughby, Oh 44094", $300.00, None\| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $400.00, None\| Donation, Mentor Area Chamber of Commerce, "6972 Spinach Dr Mentor, Oh 44060", $300.00, None\| Donation, Crestwood All Sports Boosters, "PO Box 411 Mantua Oh 44255", $507.00, None\| Donation, Friends of Lake ADAMHS, "PO Box 696 Painesville, Oh 44077", $210.00, None\| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $60.00, None\| Donation, EPAL, "35150 Lakeshore Blvd Eastlake Oh 44095", $1000.00, None\| Donation, Movers for Meals, "1420 Lloyd Rd, Wickliffe, OH 44092", $157.00, None\| Donation, Madison Softball Association MSA, "PO Box 595 Madison, Oh 44057", $250.00, None\| Donation, Lake Health Foundation, "7590 Auburn Rd Concord Twp, Oh 44077", $750.00, None\| Donation, Tim Groves Memorial Golf Outing, "7473 Center St., Mentor, Oh 44060", $300.00, None\| Donation, American Legion Post 214, "4304 Center St Willoughby, Oh 44094", $532.00, None\| Donation, Crohn's & Colitis Foundation, "4700 Rockside Rd Ste 425 Independence, Oh 44131", $602.00, None\| Donation, Painesville City Local Schools, "58 Jefferson St. Painesville, Oh 44077", $630.00, None\| Donation, American Heart Assocation, "1375 E. 9th St., Suite 600, Cleveland, Oh 44114", $2500.00, None\| Donation, HOLA, "3311 Perkins Ave Suite 200 Cleveland, Oh 44114", $179.00, None\| Donation, American Legion Post 214, "4304 Center Street Willoughby, Ohio 44094", $1037.00, None\| Donation, Phillip DeVito Foundation, "6491 Derby Dr., Mayfield Village, OH 44143", $50.00, None\| Donation, Dayton Dragon's Foundation, "Fifth Third Field PO Box 2107 Dayton, Oh 45401", $100.00, None\| Donation/Sponsorship, Hola Ohio, "PO Box 3066 Ashtabula Oh 44005-3066", $500.00, None\| Donation, Miracle League of Lake County, "35150 Lakeshore Blvd Eastlake, Ohio 44095", $500.00, None\| Donation, CHD Coalition, "75 Fifth Floor New York, New York", $100.00, None\| Donation, Willoughby Western Lake County Turk, "28 Public Square, Willoughby, Oh 44094", $150.00, None\| Donation, Jefferson Community Center, "11 E Jefferson St, Jefferson, OH 44047", $134.00, None\| Donation, American Red Cross, "431 18th Street NW Washington, DC 20006", $213.00, None\| Donation, Chardon Wrestling, "PO Box 282 Chardon, Oh 44024", $1295.00, None\| Donation, Ohio Schools Boards Association, "8050 N. Hight St., Suite 100 Columbus, Oh 43235", $610.00, None\| Donation, XCEL Athletics, "8505 Mulberry Rd., Chesterland, Oh 44026", $594.00, None\| Donation, Metzenbaum Sheltered Industries, "8090 Cedar Rd., Chesterland, Oh 44026", $334.00, None\| Donation, Miracle League of Lake County, "35150 Lakeshore Blvd., Eastlake, OH 44095", $345.00, None\| Donation, Saint Justin Martyr, "35781 Stevens Blvd., Eastlake, Oh 44095", $388.00, None\| Donation, Pancreatic Cancer Awareness Network, "1500 Rosecrans Ave., Ste 200 Manhattan Beach, CA 90266", $573.00, None\| Donation, Leadership Lake County, "8804 Mentor Ave Mentor, Oh 44060", $1190.00, None\| Donation, United Way Lake County, "9285 Progress Parkway Mentor, Oh 44060", $1154.00, None\| Donation, American Legion Post 214, "4304 Center St., Willoughby, OH 44094", $718.00, None\| Donation, Eastlake North Volleyball, "34041 Stevens Blvd., Eastlake, Oh 44095", $1579.00, None\| Donation, Lake Erie College, "391 W Washington St, Painesville, OH 44077", $200.00, None\| Donation, Team Cribbs Foundation, "17400 Flamingo Ave, Cleveland, OH 44135", $1000.00, None\| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $550.00, None\| Donation, Lake Health Foundation, "7590 Auburn Rd Concord Twp, Oh 44077", $3000.00, None\| Donation, Make a Wish Foundation, "2545 Farmers Dr., Suite 300, Columbus, OH 43235", $500.00, None\| Donation, Lake Health Foundation, "7590 Auburn Rd., Concord Twp., OH 44077", $12343.00, None\| Donation, Lake Health Foundation, "7590 Auburn Rd., Concord Twp., OH 44077", $4000.00, None\| Donation, Movers for Meals, "1420 Lloyd Rd Wickliffe, Oh", $161.00, None\| Donation, Habitat for Humanity, "100 Parker Ct #6, Chardon, OH 44024", $2234.00, None\| Donation, Matt Pruzinsky Memorial Outing, "Mentor, Oh", $250.00, None\|
Part I, line 16	\| Other Expenses:, Amount:\| Bank Fees, $69.00\| Insurance, $1355.00\| Legal Expenses, $203.00\|

Return Reference

Explanation

Part I, line 10

| Activity:, Grantee Name:, Grantee Address:, Amount:, Relationship:| Donation, Hospice of the Western Reserve, "17876 St Clair Ave Cleveland, Oh 44110", $100.00, None| Donation, Mentor Area Chamber of Commerce, "6972 Spinach Dr Mentor, Oh 44060", $30.00, None| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $1000.00, None| Donation, Willoughby Western Lake County, "28 Public Square Willoughby, Oh 44094", $270.00, None| Little League Sponsorship, Willoughby Wildcats Travel Baseball, "38101 Strumbly Place Willoughby, Oh 44094", $300.00, None| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $400.00, None| Donation, Mentor Area Chamber of Commerce, "6972 Spinach Dr Mentor, Oh 44060", $300.00, None| Donation, Crestwood All Sports Boosters, "PO Box 411 Mantua Oh 44255", $507.00, None| Donation, Friends of Lake ADAMHS, "PO Box 696 Painesville, Oh 44077", $210.00, None| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $60.00, None| Donation, EPAL, "35150 Lakeshore Blvd Eastlake Oh 44095", $1000.00, None| Donation, Movers for Meals, "1420 Lloyd Rd, Wickliffe, OH 44092", $157.00, None| Donation, Madison Softball Association MSA, "PO Box 595 Madison, Oh 44057", $250.00, None| Donation, Lake Health Foundation, "7590 Auburn Rd Concord Twp, Oh 44077", $750.00, None| Donation, Tim Groves Memorial Golf Outing, "7473 Center St., Mentor, Oh 44060", $300.00, None| Donation, American Legion Post 214, "4304 Center St Willoughby, Oh 44094", $532.00, None| Donation, Crohn's & Colitis Foundation, "4700 Rockside Rd Ste 425 Independence, Oh 44131", $602.00, None| Donation, Painesville City Local Schools, "58 Jefferson St. Painesville, Oh 44077", $630.00, None| Donation, American Heart Assocation, "1375 E. 9th St., Suite 600, Cleveland, Oh 44114", $2500.00, None| Donation, HOLA, "3311 Perkins Ave Suite 200 Cleveland, Oh 44114", $179.00, None| Donation, American Legion Post 214, "4304 Center Street Willoughby, Ohio 44094", $1037.00, None| Donation, Phillip DeVito Foundation, "6491 Derby Dr., Mayfield Village, OH 44143", $50.00, None| Donation, Dayton Dragon's Foundation, "Fifth Third Field PO Box 2107 Dayton, Oh 45401", $100.00, None| Donation/Sponsorship, Hola Ohio, "PO Box 3066 Ashtabula Oh 44005-3066", $500.00, None| Donation, Miracle League of Lake County, "35150 Lakeshore Blvd Eastlake, Ohio 44095", $500.00, None| Donation, CHD Coalition, "75 Fifth Floor New York, New York", $100.00, None| Donation, Willoughby Western Lake County Turk, "28 Public Square, Willoughby, Oh 44094", $150.00, None| Donation, Jefferson Community Center, "11 E Jefferson St, Jefferson, OH 44047", $134.00, None| Donation, American Red Cross, "431 18th Street NW Washington, DC 20006", $213.00, None| Donation, Chardon Wrestling, "PO Box 282 Chardon, Oh 44024", $1295.00, None| Donation, Ohio Schools Boards Association, "8050 N. Hight St., Suite 100 Columbus, Oh 43235", $610.00, None| Donation, XCEL Athletics, "8505 Mulberry Rd., Chesterland, Oh 44026", $594.00, None| Donation, Metzenbaum Sheltered Industries, "8090 Cedar Rd., Chesterland, Oh 44026", $334.00, None| Donation, Miracle League of Lake County, "35150 Lakeshore Blvd., Eastlake, OH 44095", $345.00, None| Donation, Saint Justin Martyr, "35781 Stevens Blvd., Eastlake, Oh 44095", $388.00, None| Donation, Pancreatic Cancer Awareness Network, "1500 Rosecrans Ave., Ste 200 Manhattan Beach, CA 90266", $573.00, None| Donation, Leadership Lake County, "8804 Mentor Ave Mentor, Oh 44060", $1190.00, None| Donation, United Way Lake County, "9285 Progress Parkway Mentor, Oh 44060", $1154.00, None| Donation, American Legion Post 214, "4304 Center St., Willoughby, OH 44094", $718.00, None| Donation, Eastlake North Volleyball, "34041 Stevens Blvd., Eastlake, Oh 44095", $1579.00, None| Donation, Lake Erie College, "391 W Washington St, Painesville, OH 44077", $200.00, None| Donation, Team Cribbs Foundation, "17400 Flamingo Ave, Cleveland, OH 44135", $1000.00, None| Donation, United Way of Lake County, "9285 Progress Parkway Mentor, Oh 44060", $550.00, None| Donation, Lake Health Foundation, "7590 Auburn Rd Concord Twp, Oh 44077", $3000.00, None| Donation, Make a Wish Foundation, "2545 Farmers Dr., Suite 300, Columbus, OH 43235", $500.00, None| Donation, Lake Health Foundation, "7590 Auburn Rd., Concord Twp., OH 44077", $12343.00, None| Donation, Lake Health Foundation, "7590 Auburn Rd., Concord Twp., OH 44077", $4000.00, None| Donation, Movers for Meals, "1420 Lloyd Rd Wickliffe, Oh", $161.00, None| Donation, Habitat for Humanity, "100 Parker Ct #6, Chardon, OH 44024", $2234.00, None| Donation, Matt Pruzinsky Memorial Outing, "Mentor, Oh", $250.00, None|

Part I, line 16

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

1	Contributions, gifts, grants, and similar amounts received ....................	1	1,000
2	Program service revenue including government fees and contracts ................	2
3	Membership dues and assessments .............................	3
4	Investment income ....................................	4
5a	Gross amount from sale of assets other than inventory .......	5a
b	Less: cost or other basis and sales expenses ............	5b
c	Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a) ......	5c
6	Gaming and fundraising events
a	Gross income from gaming (attach Schedule G if greater than $15,000)	6a	51,280
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	28,437
c	Less: direct expenses from gaming and fundraising events ...	6c	40,776
d	Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)	6d	38,941
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
9	Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 ..............	9	39,941

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? The mission of Captains Charities, Inc. is to provide charitable support to our community organizations that reflect the values and vision of Captains Charities, Inc.. Captains Charities, Inc., will lead, organize, operate fundraising and development initiatives to generate financial support to realize its charitable community mission.
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 Grant given to Lake Health Foundation as part of a 5 year plan for the construction of Phase 2 of the Wellness Walk. The Wellness Walk is located on the Concord Township property of Lake Health Hospitals. (Grants $ 12,343) If this amount includes foreign grants, check here ...		28a	0
29 (Grants $ ) If this amount includes foreign grants, check here ...		29a
30 (Grants $ ) If this amount includes foreign grants, check here ...		30a
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

(a) Name and business address of each independent contractor	(b) Type of service	(c) Compensation
NONE

Sign Here

	Signature of officer	Date

	Type or print name and title

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

10	Grants and similar amounts paid (list in Schedule O) ................	10	45,879
11	Benefits paid to or for members ......................	11
12	Salaries, other compensation, and employee benefits ................	12
13	Professional fees and other payments to independent contractors ............	13
14	Occupancy, rent, utilities, and maintenance ...................	14
15	Printing, publications, postage, and shipping ...................	15	638
16	Other expenses (describe in Schedule O) ...................	16	1,627
17	Total expenses. Add lines 10 through 16 .................	17	48,144

18	Excess or (deficit) for the year (Subtract line 17 from line 9) ............	18	-8,203
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	14,558
20	Other changes in net assets or fund balances (explain in Schedule O) ...........	20	0
21	Net assets or fund balances at end of year. Combine lines 18 through 20 ..........	21	6,355