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)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 1,121,099 | 1,121,099 | ||||
| 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 | 1,121,099 | 1,121,099 | ||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | 0 | |||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support. (Subtract line 7c from line 6.) | 1,121,099 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,121,099 | 1,121,099 | ||||
| 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 on 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.).. | 1,121,099 | 1,121,099 | ||||
| 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 0.015 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 0.035 | 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 | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, 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 2021. 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 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| SCHEDULE A, PART III | THE ORGANIZATION WAS FORMED ON APRIL 3, 2020. AS A RESULT, THE SUPPORT TEST CONTAINS AN INITIAL SHORT YEAR (2020). |
| 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, PART VI, SECTION B, LINE 11B | THE FORM 990 WILL BE INITIALLY FILLED OUT BY THE EXECUTIVE DIRECTOR AND COMPLETED BY OUR ACCOUNTING FIRM. A REVIEW WILL TAKE PLACE BY THE FINANCE COMMITTEE AND THEN THE OVERALL BOARD OF DIRECTORS. SOME OF THE STEPS IN THE REVIEW PROCESS ARE: 1. THE INITIAL OVERVIEW: A HIGH-LEVEL OVERVIEW OF THE ENTIRE FORM 990 BY THE FINANCE COMMITTEE 2. PART III, PROGRAMS OVERVIEW: THE NEXT PART OF THE HIGH-LEVEL OVERVIEW WILL BE A LOOK AT THE SECTION ON ACCOMPLISHMENTS. 3. PART IV, REQUIRED SCHEDULES: REVIEW OF THE CHECKLIST OF REQUIRED SCHEDULES 4. PART VII, COMPENSATION: REVIEW OF KEY QUESTIONS. EXAMPLE: ARE ALL THE OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES LISTED IN PART VII? 5. PARTS V AND VI, TAX COMPLIANCE AND GOVERNANCE: READ AND REVIEW ALL THE QUESTIONS AND ANSWERS IN PART V AND VI. 6. FINANCIAL DATA: REVIEW FINANCIALS FOR REASONABLENESS AND ACCURACY. |
| FORM 990, PART VI, SECTION B, LINE 12C | MEMBERS OF THE BOARD AND THE STAFF HAVE A CLEAR OBLIGATION TO CONDUCT ALL AFFAIRS OF THE ORGANIZATION IN AN UPRIGHT AND HONEST MANNER. ALL DECISIONS OF THE ORGANIZATION WILL BE MADE SOLELY ON THE BASIS OF A DESIRE TO PROMOTE THE BEST INTERESTS OF THE ORGANIZATON AND THE INDIVIDUALS, ORGANIZATIONS, AND AGENCIES IT SERVES. MEMBERS OF THE BOARD AND STAFF OF THE ORGANIZATION AGREE TO PLACE THE WELFARE OF THE ORGANIZATION ABOVE PERSONAL INTERESTS, INTERESTS OF FAMILY MEMBERS AND OTHERS WHO MAY BE PERSONALLY INVOLVED IN SUBSTANTIAL AFFAIRS AFFECTING THE ORGANIZATION'S BASIC FUNCTIONS. MEMBERS OF THE BOARD AND STAFF SHALL DISCLOSE FULLY, TO THE SECRETARY OF THE BOARD, THE PRECISE NATURE OF THEIR INTEREST AND INVOLVEMENT WHEN PARTICIPATING IN ANY TRANSACTION FOR THE ORGANIZATION, INCLUDING TRANSACTIONS WITH HIMSELF/HERSELF, A FAMILY MEMBER, AND ANY ORGANIZATION IN WHICH THOSE PERSONS MAY HAVE AN AFFILIATION. MEMBERS OF THE BOARD AND STAFF WHO HAVE A CONFLICT OF INTEREST IN ANY MATTER SHALL REFRAIN FROM PARTICIPATING IN CONSIDERATION OF THE PROPOSED TRANSACTION AND SHALL NOT VOTE ON SUCH MATTERS. THE BOARD MAY REQUEST INFORMATION OR INTERPRETATION FROM THE PERSON OR PERSONS INVOLVED. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ANNUAL PROCESS FOR DETERMINING COMPENSATION IS AS FOLLOWS: THE FINANCE AND EXECUTIVE COMMITTEE SHALL ANNUALLY EVALUATE THE EXECUTIVE DIRECTOR ON HIS/HER PERFORMANCE AND ASK FOR HIS/HER INPUT ON MATTERS OF PERFORMANCE AND COMPENSATION. BOARD APPROVAL THE FINANCE AND EXECUTIVE COMMITTEE WILL OBTAIN RESEARCH AND INFORMATION TO MAKE A RECOMMENDATION TO THE FULL BOARD FOR THE COMPENSATION (SALARY AND BENEFITS) OF THE EXECUTIVE DIRECTOR (AND OTHER HIGHLY COMPENSATED EMPLOYEES OR CONSULTANTS) BASED ON A REVIEW OF COMPARABILITY DATA. FOR EXAMPLE, THE FINANCE AND EXECUTIVE COMMITTEE WILL SECURE DATA THAT DOCUMENTS COMPENSATION LEVELS AND BENEFITS FOR SIMILARLY QUALIFIED INDIVIDUALS IN COMPARABLE POSITIONS AT SIMILAR ORGANIZATIONS. THIS DATA MAY INCLUDE THE FOLLOWING: 1. SALARY AND BENEFIT COMPENSATION STUDIES BY INDEPENDENT SOURCES. 2. WRITTEN JOB OFFERS FOR POSITIONS AT SIMILAR ORGANIZATIONS. 3. DOCUMENTED TELEPHONE CALLS ABOUT SIMILAR POSITIONS AT BOTH NONPROFIT AND FOR-PROFIT ORGANIZATIONS; AND 4. INFORMATION OBTAINED FROM THE IRS FORM 990 FILINGS OF SIMILAR ORGANIZATIONS. CONCURRENT DOCUMENTATION TO APPROVE THE COMPENSATION FOR THE EXECUTIVE DIRECTOR, THE BOARD MUST DOCUMENT HOW IT REACHED ITS DECISIONS, INCLUDING THE DATA ON WHICH IT RELIED, IN MINUTES OF THE MEETING DURING WHICH THE COMPENSATION WAS APPROVED. DOCUMENTATION WILL INCLUDE: 1. A DESCRIPTION OF THE COMPENSATION AND BENEFITS AND THE DATE IT WAS APPROVED. 2. THE MEMBERS OF THE BOARD WHO WERE PRESENT DURING THE DISCUSSION AND THE RESULTS OF THE VOTE. 3. A DESCRIPTION OF THE COMPARABILITY DATA RELIED UPON AND HOW THE DATA WAS OBTAINED; AND 4. ANY ACTIONS TAKEN (SUCH AS ABSTAINING FROM DISCUSSION AND VOTE) WITH RESPECT TO CONSIDERATION OF THE COMPENSATION BY ANYONE WHO IS OTHERWISE A MEMBER OF THE BOARD BUT WHO HAD A CONFLICT OF INTEREST WITH RESPECT TO THE DECISION ON THE COMPENSATION AND BENEFITS. INDEPENDENCE IN SETTING COMPENSATION THE CHAIR OF THE BOARD OF DIRECTORS, WHO IS A VOLUNTEER AND NOT COMPENSATED BY THE ORGANIZATION, WILL OPERATE INDEPENDENTLY WITHOUT UNDUE INFLUENCE FROM THE EXECUTIVE DIRECTOR. NO MEMBER OF THE EXECUTIVE OR FINANCE COMMITTEE WILL BE A STAFF MEMBER, THE RELATIVE OF A STAFF MEMBER, OR HAVE AN RELATIONSHIP WITH STAFF THAT COULD PRESENT A CONFLICT OF INTEREST. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, FINANCIAL STATEMENTS, AND ALL POLICIES AVAILABLE UPON REQUEST. |
| FORM 990, PART VII -- COMPENSATION OF EXECUTIVE DIRECTOR | DURING 2021, PAYMENTS FOR THE SERVICES OF THE EXECUTIVE DIRECTOR, ERIC LEWIS, WERE MADE TO HIS COMPANY, ONE SCSI, ON A FORM 1099-NEC. THAT PAYMENT HAS BEEN REPORTED IN PART VII AS COMPENSATION ATTRIBUTABLE TO HIS SERVICES DURING 2021. |
| FORM 990, PART XI, LINE 9: | INITIAL NET ASSETS 3,974. |
| Software ID: | |
| Software Version: |