Form990EZ
Click to see list of attachments
Click to see list of attachments
Click to see list of attachments
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
bullet Do not enter social security numbers on this form as it may be made public.


bullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
A
For the 2021 calendar year, or tax year beginning 10-01-2021, and ending 09-30-2022
B
Check if applicable:
C Name of organization
Optimist International
International City Optimist Club Inc
Number and street (or P. O. box, if mail is not delivered to street address)P O Box 7803
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code Warner Robins, GA31095
D Employer identification number

91-1931701
E Telephone number

(478) 953-0125
F Group Exemption
Numberbullet1334
G Accounting Method: Other (specify) bullet   H Check bulletI Website:bulletwww.icoptimistclub.comJ Tax-exempt status (check only one) - ( 4) bullet (insert no.) or
K Form of organization:  
L Add lines 5b, 6c, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ ...........................bullet $ 83,987
Part Ⅰ
Revenue, Expenses, and Changes in Net Assets or Fund Balances (see the instructions for Part I) Check if the organization used Schedule O to respond to any question in this Part I.....................
VerticalRevenue 1 Contributions, gifts, grants, and similar amounts received .................... 1  
2 Program service revenue including government fees and contracts ................ 2  
3 Membership dues and assessments ............................. 3 5,079
4 Investment income .................................... 4 8
5a Gross amount from sale of assets other than inventory ....... 5a  
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  
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) 6a  
b Gross income from fundraising events (not including $   of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) ..Click to see attachment6b 78,900
c Less: direct expenses from gaming and fundraising events ... 6c 25,023
d Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c) 6d 53,877
7a Gross sales of inventory, less returns and allowances ...... 7a  
b Less: cost of goods sold ............. 7b 0
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) ......... 7c  
8 Other revenue (describe in Schedule O) .................... 8  
9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 .............. Bullet 9 58,964
.
VerticalExpenses 10 Grants and similar amounts paid (list in Schedule O) ................ 10 55,218
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  
16 Other expenses (describe in Schedule O) ................... 16 8,201
17 Total expenses. Add lines 10 through 16 ................. Bullet 17 63,419
VerticalNetAssets 18 Excess or (deficit) for the year (Subtract line 17 from line 9) ............ 18 -4,455
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 44,093
20 Other changes in net assets or fund balances (explain in Schedule O) ........... 20  
21 Net assets or fund balances at end of year. Combine lines 18 through 20 .......... 21 39,638
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I Form 990-EZ (2021)
Form 990-EZ (2021)
Page 2
Part ⅡBalance Sheets (see the instructions for Part II)Check if the organization used Schedule O to respond to any question in this Part II.................

(A) Beginning of year(B) End of year
22Cash, savings, and investments................
44,093
22
39,638
23Land and buildings....................
 
23
 
24Other assets (describe in Schedule O) ..........
 
24
 
25Total assets......................
44,093
25
39,638
26
Total liabilities (describe in Schedule O) .............
 
26
 
27Net assets or fund balances (line 27 of column (B) must agree with line 21)
44,093
27
39,638
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? To support youth of Houston County within the guidelines of Optimist International
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 Museum of Aviation * National STEM Academy support
(Grants $ 10,000) If this amount includes foreign grants, check here ...MediumBullet		 28a  
29 Houston County BOE Social Services Department - 2021 donation to by toys for unerpriveleged children in the Houston County School System
(Grants $ 7,500) If this amount includes foreign grants, check here ...MediumBullet		 29a  
30 Hunt Educational and Cultural Center
(Grants $ 6,500) If this amount includes foreign grants, check here ...MediumBullet		 30a  
Flint River FCA Chapter
(Grants $ 1,500) If this amount includes foreign grants, check here ...MediumBullet		  
Christmas for Kids Charity
(Grants $ 1,000) If this amount includes foreign grants, check here ...MediumBullet		  
Family Promise
(Grants $ 2,500) If this amount includes foreign grants, check here ...MediumBullet		  
Genesis Joy House
(Grants $ 2,000) If this amount includes foreign grants, check here ...MediumBullet		  
H2 Strong
(Grants $ 1,000) If this amount includes foreign grants, check here ...MediumBullet		  
Houston County Habitat For Humanity
(Grants $ 500) If this amount includes foreign grants, check here ...MediumBullet		  
Houston County High School Drama
(Grants $ 1,088) If this amount includes foreign grants, check here ...MediumBullet		  
Legion Football Club
(Grants $ 1,500) If this amount includes foreign grants, check here ...MediumBullet		  
Reach GA Foundation
(Grants $ 3,000) If this amount includes foreign grants, check here ...MediumBullet		  
Reclaiming Ground
(Grants $ 3,000) If this amount includes foreign grants, check here ...MediumBullet		  
Rainbow House Children's Resources assisting in reducing the occurrence of child abuse and assisting the victims
(Grants $ 3,000) If this amount includes foreign grants, check here ...MediumBullet		  
Veteran's High School
(Grants $ 3,500) If this amount includes foreign grants, check here ...MediumBullet		  
K. Milton Youth Cancer Support
(Grants $ 3,000) If this amount includes foreign grants, check here ...MediumBullet		  
Raquaveus Hill Fund
(Grants $ 1,000) If this amount includes foreign grants, check here ...MediumBullet		  
Gus Carter Childhood Cancer Fund
(Grants $ 1,000) If this amount includes foreign grants, check here ...MediumBullet		  
Lacey Boutwell Fund
(Grants $ 2,000) If this amount includes foreign grants, check here ...MediumBullet		  
Flint Energies - Family Donation M Harley
(Grants $ 380) If this amount includes foreign grants, check here ...MediumBullet		  
Barbara Lipsey Fund
(Grants $ 250) If this amount includes foreign grants, check here ...MediumBullet		  
31 Other program services (describe in Schedule O) ................
(Grants $   ) If this amount includes foreign grants, check here...MediumBullet		 31a
32 Total program service expenses (add lines 28a through 31a).......... bullet 32  
Part Ⅳ
List of Officers, Directors, Trustees, and Key Employees (list each one even if not compensated ; see the instructions for Part IV)Check if the organization used Schedule O to respond to any question in this Part IV............
(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
Seeb Lacey  
 
President 		0 0    
Mike Schell  
 
Vice President 		0 0    
Jay Flesher  
 
Secr./Treas 		0 0    
Kent Jordan  
 
Board of Direct 		0 0    
Jack Lester  
 
Board of Direct 		0 0    
Kevin Lipford  
 
Board of Direct 		0 0    
John Luppino  
 
Board of Direct 		0 0    
Randy Meade  
 
Board of Direct 		0 0    
Lee Minor  
 
Board of Direct 		0 0    
Jon Nichols  
 
Board of Direct 		0 0    
Jimmy Walker  
 
Board of Direct 		0 0    
Dale Richmond  
 
Board of Direct 		0 0    
Steve Holcomb  
 
Board of Direct 		0 0    
Form 990-EZ (2021)
Form 990-EZ (2021)
Page 3
Part Ⅴ
Other Information
(Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V.......
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a detailed description of each activity in Schedule O ...................
33
 
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization’s name. Otherwise, explain the changeon Schedule O. See instructions. ..........................
34
 
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)? ............
35a
 
No
b
If "Yes," to line 35a, has the organization filed a Form 990-T for the year? If "No," provide an explanation in Schedule O
35b
 
 
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
 
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If “Yes," complete applicable parts of Schedule N ................
36
 
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions. bullet
37a
 
b
Did the organization file Form 1120-POL for this year?...................
37b
 
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?..
38a
 
No
b
If “Yes," complete Schedule L, Part II and enter the total amount involved .
38b
 
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9.......
39a
 
b
Gross receipts, included on line 9, for public use of club facilities.....
39b
 
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911 bullet0 ; section 4912 bullet0 ; section 4955 bullet0
b
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in any section 4958 excess benefit transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been reported on any of its prior Forms 990 or 990-EZ? If “Yes," complete Schedule L, Part I
40b
 
No
c
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 4912, 4955, and 4958bullet0
d
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Enter amount of tax on line 40c reimbursed by the organizationbullet0
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8886-T ................
40e
 
No
41List the states with which a copy of this return is filed. bullet
42a The organization's books are in care of bulletJay Flesher
 Telephone no.bullet (478) 953-0125


Located at bulletP O Box 7803Warner Robins, GA ZIP + 4 bullet31095
Yes
No
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)? . .
42b
 
No
If “Yes," enter the name of the foreign country: bullet
See the instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
c
At any time during the calendar year, did the organization maintain an office outside the U.S.? . . .
42c
 
No
If “Yes," enter the name of the foreign country: bullet
43...... bullet
and enter the amount of tax-exempt interest received or accrued during the tax year ....bullet43
 
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed insteadof Form 990-EZ.............................
44a
 
No
b
Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be completedinstead of Form 990-EZ.............................
44b
 
No
c
Did the organization receive any payments for indoor tanning services during the year? .........
44c
 
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments? If "No," provide an
explanation in Schedule O ............................
44d
 
 
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?.........
45a
 
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of Form 990-EZ (see instructions)......................
45b
 
No
Form 990-EZ (2021)
Form 990-EZ (2021)
Page 4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for public office? If “Yes," complete Schedule C, Part I. ...........
46
 
No
Part Ⅵ
Section 501(c)(3) Organizations Only All section 501(c)(3) organizations must answer questions 47- 49b and 52, and complete the tables for lines 50 and 51. Check if the organization used Schedule O to respond to any question in this Part VI ..................
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II .......................
47
 
 
48
Is the organization a school as described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ..
48
 
 
49a
Did the organization make any transfers to an exempt non-charitable related organization?......
49a
 
 
b
If "Yes," was the related organization a section 527 organization?................
49b
 
 
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(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
f
Total number of other employees paid over $100,000 .............bullet  

51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a) Name and business address of each independent contractor (b) Type of service (c) Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000..........bullet  


52
Did the organization complete Schedule A? NOTE. All section 501(c)(3) organizations must attach a
completed Schedule A ........................................bullet
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name bullet

Firm's EIN bullet
Firm's address bullet



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
Form 990-EZ (2021)

Additional Data


Software ID: 21013475
Software Version: 2021v4.1

Form 990-EZ, Special Condition Description:
Special Condition Description

SCHEDULE G (Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information Regarding
Fundraising or Gaming Activities
Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrowAttach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
Optimist International
International City Optimist Club Inc
Employer identification number

91-1931701
Part I
Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.
Form 990-EZ filers are not required to complete this part.
1
Indicate whether the organization raised funds through any of the following activities. Check all that apply.
a e
b f
c g
d
2a
Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?
b
If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.


(i) Name and address of individual
or entity (fundraiser) 		(ii) Activity (iii) Did fundraiser have custody or control of contributions? (iv) Gross receipts
from activity 		(v) Amount paid to
(or retained by)
fundraiser listed in
col. (i) 		(vi) Amount paid to
(or retained by)
organization
Yes No
             
             
             
             
             
             
             
             
             
             
Total . . . . . . . . . . . . . . . . . . . . right arrow      
3
List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50083H
Schedule G (Form 990) 2021
Schedule G (Form 990) 2021
Page 2
Part II
Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.









VerticalRevenue
(a) Event #1

Reverse Raffle
(event type) 		(b) Event #2

Golf Tournament
(event type) 		(c) Other events

 
(total number) 		(d) Total events
(add col. (a) through col. (c))

1
Gross receipts . . . . .
49,340
29,560
 
78,900

2
Less: Contributions . . . .
 
 
 
 
3 Gross income (line 1 minus
line 2) . . . . . .
49,340
29,560
 
78,900



VerticalDirectExpenses
4 Cash prizes . . . . . 10,000     10,000
5 Noncash prizes . . . .        
6 Rent/facility costs . . . .        
7 Food and beverages . . .        
8 Entertainment . . . .        
9 Other direct expenses . . . 7,062 7,961   15,023
10 Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . . right arrow 25,023
11 Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . . right arrow 53,877
Part III
Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.
VerticalRevenue
(a) Bingo (b) Pull tabs/Instant
bingo/progressive bingo 		(c) Other gaming (d) Total gaming (add col.(a) through col.(c))

1
Gross revenue . . . . .
 
 
 
 
VerticalDirectExpenses

2
Cash prizes . . . . .
 
 
 
 

3
Noncash prizes . . . .
 
 
 
 

4
Rent/facility costs . . . .
 
 
 
 

5
Other direct expenses . . .
 
 
 
 


6

Volunteer labor . . . .
%
%
%


7
Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow
 

8
Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow
 

9
Enter the state(s) in which the organization conducts gaming activities:
a
Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .
b
If "No," explain:
 
10a
Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .
b
If "Yes," explain:
 
Schedule G (Form 990) 2021
Schedule G (Form 990) 2021
Page 3
11
Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .
12
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming? . . . . . . . . . . . . . . . . .
13
Indicate the percentage of gaming activity conducted in:
a
The organization's facility . . . . . . . . . . . . . . . . . .
13a
%
b
An outside facility . . . . . . . . . . . . . . . . . . . .
13b
%
14
Enter the name and address of the person who prepares the organization's gaming/special events books and records:
Name right arrow
Address right arrow
15a
Does the organization have a contract with a third party from whom the organization receives gaming
revenue? . . . . . . . . . . . . . . . . . . . . . . . .
b
If "Yes," enter the amount of gaming revenue received by the organization right arrow $   and the
amount of gaming revenue retained by the third party right arrow $   .
c
If "Yes," enter name and address of the third party:
Name right arrow
Address right arrow
16
Gaming manager information:
Name right arrow
Gaming manager compensation right arrow $  
Description of services provided right arrow
 
17
Mandatory distributions:
a
Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license? . . . . . . . . . . . . . . . . . . .
b
Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization's own exempt activities during the tax year right arrow$  
Part IV
Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.
Return Reference Explanation
Schedule G (Form 990) 2021
Additional Data


Software ID: 21013475
Software Version: 2021v4.1
SCHEDULE O
(Form 990)

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
2021
Open to Public
Inspection
Name of the organization
Optimist International
International City Optimist Club Inc
Employer identification number

91-1931701
Return Reference Explanation
Grants and Similar Amounts Paid In Excess of $5,000.2 | Donee's Name: Houston County Board of Education | Donee's Address: P.O. Box 1850 Perry GA 31069 | Cash Amount Given: $7500
Grants and Similar Amounts Paid In Excess of $5,000.28 | Donee's Name: Hunt Elementary | Donee's Address: 1750 Hwy 341 North Fort Valley GA 31030 | Cash Amount Given: $6500
Grants and Similar Amounts Paid In Excess of $5,000.46 | Donee's Name: Museum of Aviation | Cash Amount Given: $10000
Other Expenses.1 Meals/Luncheons $4150
Other Expenses.2 Dues & subscriptions $3053
Other Expenses.3 Supplies $847
Other Expenses.4 Flowers $143
Other Expenses.5 Bank Charges $8
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID: 21013475
Software Version: 2021v4.1