Return of Organization Exempt From Income Tax

Commentaires

Transcription

Return of Organization Exempt From Income Tax
Return of Organization Exempt From Income Tax
A,~
Form ~ ~ v
OMB No 1545-0047
2003
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation)
upgfltq Fellc
Department of the Treasury
"
The
organization
may
have
to use a copy of this return to satisfy state reporting requirements
Internal Revenue Service
and ending
JUL 31, 2004
AUG 1
2003
A For the 2003 calendar year, or tax year beginning
D Employer identification number
B Check if
C Name of organization
please
applicable
useIRS
label
Addre
changses
Name
= change
Initial
=return
=
4O &
printoorrCHILD
type
Number
See
sPec1fic45 N .
Fine'
return
Amended
return
In-truc-1
tions
Application
H CHARLES W .
WELFARE
ARDERY MEMORIAL
51-0177489
Room/suite E Telephone number
800-284-4045
11ST FL
F Accountinamethod [K] Cash = Accu.1
D Other
(s peci fy)
H and I are not applicable to section 527 organizations.
H(a) Is this a group return for affiliates
~ Yes OX No
H(b) If "Yes," enter number of affiliates
and street (or P 0 box if mail is not delivered to street address)
PENNSYLVANIA STREET
City or town, state or country, and ZIP + 4
INDIANAPOLIS
IN
4E204
0 Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts
must attach a completed Schedule A (Form 990 or 990-EZ) .
G Website : lo-N/A
J Organization type (checkoniyone) " X 501(c) ( 3
),4 (Insert no ) = 4947(a)(1) or = 527 H(c) Are all affiliates included'?
N/A
0 Yes D No
(If "No ;' attach a list )
K Check here " E=1 if the organization's gross receipts are normally not more than $25,000 The
H(d) Is this a separate return filed by an oramzation covered b a g roup ruling *? X Yes D No
organization need not file a return with the IRS ; but if the organization received a form 990 Package
m the mail, it should file a return without financial data Some states require a complete return .
I
Group Exemption Number
M Check " 0 if the organization is not required to attach
Sch 8 (Form 990, 990-EZ, or 990-PF)
2 94 , 076 . 1
L Gross recei p ts Add lines 6b, 8b, 9b, and 10b to line 12 .
Revenue, Expenses and Chan ges in Net Assets or Fund Balances
1
Z
2
3
4
5
Contributions, gifts, grants, and similar amounts received
a Direct public support
b Indirect public support
c Government contributions (grants)
d Total (add lines 1 a through 1c) (cash $
57,682 . noncash $
Program service revenue including government fees and contracts (from Part VI1, line
Membership dues and assessments
Interest on savings and temporary cash investments
Dividends and interest from securities
6 a Gross rents
d
'e
d
d
b
c
Less rental expenses
Net rental income or (loss) (subtract line 6b from line 6a)
7
Other investment income (describe "
8 a Gross amount from sales of assets other
9
a
~d
N
ZQ
b
c
d
Bb
A Securities
178 , 835 . 8a
162 , 205 . 8b
Less cost or other basis and sales expenses
16 , 630 . 8c
Gain or (loss) (attach schedule)
STMT 1
Net gain or (loss) (combine line 8c, columns (A) and (B))
Special events and activities (attach schedule) If any amount is from gaming, check here 110.
For Paperwork Reduction Act Notice, see the separate instructions .
)
Ba
than inventory
LHA
57,682 .
93)
Gross revenue (not including $
of contributions
reported on line 1a)
ga
b Less direct expenses other than fundraising expenses
9b
from special events (subtract line 9b from line 9a)
10a
of my tory, less returns and allowances
10h
sold
c Gross profit o
) from sales of inventory (attach schedule) (subtract line 10b from line 10a)
1O~er ~e
Part VII, line 103)
lines 1d 2 3 4 5 6c 7 8d 9c 10c and 11
12
ralnllRvices
ran
ices ( om line 44, column (B))
neral (from line 44, column (C))
V Y
15
Fundraising (from line 44, column (D))
16
Payments to affiliates (attach schedule)
17
Total ex p enses add lines 16 and 44 column A
18
Excess or (deficit) for the year (subtract aria i i from aria 12)
Net assets or fund balances at beginning of year (from line 73, column (A))
19
20
Other changes m net assets or fund balances (attach explanation)
21
Net assets or fund balances at end of year (combine lines 18, 19, and 20)
a2aoo ~
a
1a
1b
1c
8 Other
1d
2
3
4
5
60 , 000 .
41 , 586 .
13 , 655 .
6c
7
8d
16 , 630 .
-
9c
10c
11
12
13
14
15
18
17
19
20
21
131 871 .
5 4 ,845 .
2 9 , 184 .
84 , 029 .
47 , 842 .
1,309 , 114 .
1 , 356
0
956 .
Form 990 (2003) V
\~
40 & 8 CHARLES W . ARDERY MEMORIAL
CHILD WELFARE
~
51-0177489
All organizations must complete column (A) Columns (B), (C), and (D) are required for section 501(c)(3)
p
~
Statement of
Functional Expenses
and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others
(C) Management
Do not include amounts reported on line
(B) Program
(D) Fundraising
(A) Total
and g eneral
services
6b 8b 9b lOb or 16 of Part l.
22 Grants and allocations (attach schedule)
54,845 .
5 4 , 8 4 5 . TATEMENT
22
cash $ 54,845 . noncash s
23 Specific assistance to individuals (attach schedule)
24 Benefits paid to or for members (attach schedule)
25 Compensation of officers, directors, etc .
26 Other salaries and wages
27 Pension plan contributions
28 Other employee benefits
29 Payroll taxes
30 Professional fundraising fees
31 Accounting fees
32 Legal fees
33 Supplies
34 Telephone
35 Postage and shipping
36 Occupancy
37 Equipment rental and maintenance
38 Printing and publications
39 Travel
40 Conferences, conventions, and meetings
41 Interest
42 Depreciation, depletion, etc (attach schedule)
43 Other expenses not covered above (itemize)
a CLERICAL ASSISTANCE
b PROMENADE NATIONALE
c ADMINISTR.ATION EXPENSE
d
23
24
25
26
27
28
29
30
31
32
33
34
35
38
87
38
39
40
41
42
6 , 653 .
0 .
6 , 653 .
1,140 .
1 , 140 .
1 , 464 .
1 , 464 .
10 , 000 .
10,000
43a
2 , 514 .
2 , 514
a3b
7 , 413 .
7 r 413
a3c
43d
heel
I
f
o fu nctional expenses
rig
a lines 22 roug 43
44 OrpanizaUOns co
columns ( )-(~, cartylhese
th toTals M lines 13-15 44
84 , ~ 29 .
5 4 ,845 . 1
29 ,18 4
Joint Costs . Check " E::] if you are following SOP 98-2
Are any point costs from a combined educational campaign and fundraising solicitation reported m (B) Program services ?
01If "Yes ;" enter (i) the aggregate amount of these point costs $
, (Ii) the amount allocated to Program services $
Iii the amount allocated to Maria ement and eneral $
' and iv the amount allocated to Fundraisin
1, Par ~ ~ Statement of Program Service Accomplishments
what is the organization's primary exempt purposes " SEE STATEMENT 2
0 .
.
.
.
.1
0 .
Yes EXI No
Program Service
~xDenses
All organizations must describe their exempt purpose achievements in a clear and concise manner State the number of clients served, publications issued, etc Discuss
(Required for 501(c)(3) and
achievements that are not measurable (Section 501(c)(3) and (4) organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of 9rants and
(4) orgs, and 49470(1)
allocations to others )
trusts, but optional for others )
a PAYMENTS TO OR FOR THE BENEFIT OF NEEDY CHILDERN FOR
EMERGENCY FOOD
CLOTHING
MEDICAL SERVICES
ETC .
b
C
d
Grants and allocations
54 , 845 . )
54 , 845 .
"
54,845 .
Form 990 (2003)
Grants and allocations
Grants and allocations $
Grants and allocations $
(Grants and allocations $
e Other p rog ram services attach schedule
f Total of Program Service Expenses (should equal line 44, column (B), Program services)
aZao~ ~
Form 990 (2003)
~V
40 & VCHARLES
CHILD WELFARE
W.
ARDERY
MEMORIAL
29
11
°
m
..
Z
45
46
Cash - non-interest-bearing
Savings and temporary cash investments
47 a
b
Accounts receivable
Less' allowance for doubtful accounts
47a
47b
48 a
b
49
50
Pledges receivable
_
Less allowance for doubtful accounts
48a
48b
Grants receivable
Receivables from officers, directors, trustees,
and key employees
51 a Other notes and loans receivable
b Less allowance for doubtful accounts
52
Inventories for sale or use
53
Prepaid expenses and deferred charges
STMT
54
Investments -securities STMT 4
55 a Investments - land, buildings, and
equipment basis
5
45
46
117,665 .
47c
48c
49
50
51a
51b
" ~X
Cost
0 FMV
1
186
016 .
51C
52
53
54
1 , 236,973 .
55a
Less : accumulated depreciation
Investments - other
Land, buildings, and equipment basis
Less' accumulated depreciation
Other assets (describe "
60
61
82
88
84 a
b
65
Accounts payable and accrued expenses
Grants payable
Deferred revenue
Loans from officers, directors, trustees, and key employees
Tax-exempt bond liabilities
Mortgages and other notes payable
Other liabilities (describe "
55b
57a
57b
55c
58
57c
58
)
1, 309, 114 .1 59 1
80
61
82
63
64a
Bob
65
)
Total liabilities add lines 60 throw h 65
88
Organizations that follow SFAS 117, check here " 0 and complete lines 67 through
69 and lines 73 and 74
Unrestricted
67
Temporarily restricted
88
Permanently restricted
69
Organizations that do not follow SFAS 117, check here 1 D and complete lines
70 through 74
71
72
73
(B)
End of year
(A)
Beginning of year
123 , 098 .
b
56
57 a
b
58
70
Page 3
Balance Sheets
Note : Where required, attached schedules and amounts within the description column
should be for end-of-year amounts only.
N
51-0177489
0.
0 .
67
68
89
Capital stock, trust principal, or current funds
Paid-in or capital surplus, or land, budding, and equipment fund
Retained earnings, endowment, accumulated income, or other funds
Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72 ;
column (A) must equal line 19, column (B) must equal line 21)
Total liabilities and net assets / fund balances (add lines 66 and 73)
gg
... . ..
1, 354, 638 .
1 , 309 , 114 .
0.
0.
70
71
72
1,354,638 .
0 .
0 .
1 , 309 , 114 . 73
1 , 354 , 638 .
1,309,114 . 1 74
1,354,638 .
ut a particu la r o rganiza tion How th e pu bl ic
perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and accurate
and fully describes, m Part III, the organization's programs and accomplishments
74
323021
12-17-0
.3
~
Form 990 (2003)
40 &V CHARLES W . ARDERY MEMORIAL
51-0177489
Page 4
CHILD WELFARE
Reconciliation of Expenses per Audited
Reconciliation of Revenue per Audited
Financial Statements with Revenue per
Financial Statements with Expenses per
~ef ...,
a
Total revenue, gains, and other support
per audited financial statements
b
Amounts included on
line 12, Form 990
(1) Net unrealized gains
on investments
(2) Donated services
and use of facilities
(3) Recoveries of prior
year grants
(4) Other (specify)
c
d
1111.
N/A
line a but not on
(2)
S
$
(3)
$
(4)
S
Add amounts on lines (1) through (4)
Line a minus line b
Amounts included on line 12, Form
990 but not on line a :
"L
" ~c
c
d
Total expenses and losses per
audited financial statements
Amounts included on line a but not on
line 17, Form 990
Donated services
and use of facilities
Prior year adjustments
reported on line 20,
Form 990
;
Losses reported on
line 20, Form 990
$
Other (specify)
S
Add amounts on lines (1) through (4)
Line a minus line b
Amounts included on line 17, Form
990 but not on line a
N/A
" 1 aI
"L
" ~c
(1) Investment expenses
not included on
line 6b, Form 990
$
(2) Other (specify) :
S
Add amounts on lines (1) and (2)
Total revenue per line 12, Form 990
line c plus line d
Pad Y
b
(1)
(1) Investment expenses
not included on
line 6b, Form 990
$
(2) Other (specify)
e
a
List of Officers, Direi
" d
e
., Trustees, and
(A) Name and address
UNION FEDERAL BANK
45 N . PENNSYLVANIA STREET,
INDIANAPOLIS IN 46204
1ST FLOOR
-----------------------------------------------------------------
S
Add amounts on lines (1) and (2)
Total expenses per line 17, Form 990
(tine c plus line d)
T1pl0yeeS (List each one even if not compensated )
(B) Title and average hours C) Compensation (Decor
per week devoted to
~If not p~ I , enter
position
coin
to
a
'RUSTEE
6,653 .
0.
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related
organizations, of which more than $10,000 was provided by the related organizations If "Yes ;" attach schedule " = Yes M No
323031 12-17-03
Form 990 (2003)
40 &'8 CHARLES
Form 990(2003)
CHILD WELFARE
Part Vi Other Information
W.
ARDERY
MEMORIAL
51-0177489
Did the organization engage in any activity not previously reported to the IRS If "Yes," attach a detailed description of each activity
76
77
Were any changes made in the organizing or governing documents but not reported to the IRS
If "Yes," attach a conformed copy of the changes .
78a
78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this returns
NBA
78b
b If "Yes," has it filed a tax return on Form 990-T for this years
79
79
Was there a liquidation, dissolution, termination, or substantial contraction during the years
If "Yes ;" attach a statement
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,
80a
governing bodies, trustees, officers, etc , to any other exempt or nonexempt organizations
"
SEE STATEMENT 6
b If "Yes," enter the name of the organization
and check whether it is 0 exempt or 0 nonexempt
0 .
81 a Enter direct or indirect political expenditures . See line 81 instructions
81a
b Did the organization file Form 1120-POL for this years
81b
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than
82a
fair rental values
b If "Yes," you may indicate the value of these items here Do not include this amount as revenue in Part 1 or as an
N/A
82b
expense in Part II (See instructions in Part III .)
83a
83 a Did the organization comply with the public inspection requirements for returns and exemption applications
83b
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions?
NBA
84 a Did the organization solicit any contributions or gifts that were not tax deductible?
84a
b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not
N/A
tax deductible?
84b
N/A
85
501(c)(4), (5), or (6) organizations. a Were substantially all dues nondeductible by members?
85a
N/A
b Did the organization make only in-house lobbying expenditures of $2,000 or less
85b
If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax
owed for the prior year
N/A
c Dues, assessments, and similar amounts from members
85c
N/A
85d
d Section 162(e) lobbying and political expenditures
N/A
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices
85e
N/A
f Taxable amount of lobbying and political expenditures (line 85d less 85e)
85f
N/A
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f?
85
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues
N/A
allocable to nondeductible lobbying and political expenditures for the following tax years
85h
N/A
86
501(c)(7) organizations . Enter : a Initiation fees and capital contributions included on line 12
86a
N/A
b Gross receipts, included on line 12, for public use of club facilities
86b
N/A
87
501(c)(12) organizations. Enter a Gross income from members or shareholders
87a
b Gross income from other sources (Do not net amounts due or paid to other sources
N/A
against amounts due or received from them )
87b
88
At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301 .7701-37
If "Yes," complete Part IX
88
89 a 501(c)(3) organizations . Enter Amount of tax imposed on the organization during the year under
0 . , section 4912 .
0 . , section 4955 .
0 .
section 4911 .
b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit
transaction during the year or did it become aware of an excess benefit transaction from a prior year
Pages
Yes
76
77
If "Yes ; attach a statement explaining each transaction
Enter Amount of tax imposed on the organization managers or disqualified persons during the year under
sections 4912, 4955, and 4958
d Enter Amount of tax on line 89c, above, reimbursed by the organization
INDIANA
90 a List the states with which a copy of this return is filed DOb Number of employees employed in the pay period that includes March 12, 2003
91
The books are m care of " UNION FEDERAL SAVINGS BANK
Locatedatt 45 N .
92
PENNSYLVANIA ST .,
1ST FL .,
X
X
X
X
X
X
.
"
X
X
0 .
0 .
~90b
Telephone no " 800-284-4045
INDIANAPOLIS
Section 49470(1) nonexempt charitable trusts filing Form 990 m lieu of Farm 1041- Check here
and enter the amount of tax-exempt interest received or accrued dunnQ the tax year
j~30~ ~
X
89b
c
No
0
ZIP+4 .46204
" 1 92 I
10
N/A
Form 990 (2003)
40 &V CHARLES W . ARDERY MEMORIAL
Form 990 (2003)
CHILD WELFARE
OWE Ahalysis of Income-Producing Activities (See page 33 of the instructions)
Unrelated business income
Note : Enter gross amounts unless otherwise
indicated.
(A)
Business
code
93 Program service revenue'
a
b
c
d
e
f Medicare/Medicaid payments
g Fees and contracts from government agencies
94 Membership dues and assessments
(B)
Amount
95 interest on savings and temporary cash investments
96 Dividends and interest from securities
97 Net rental income or (loss) from real estate :
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from personal property
99 Other investment income
100 Gam or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory
109 Other revenue'
a
b
C
d
e
104 Subtotal (add columns (B), (D), and (E))
-105 Total (add line 104, columns (B), (D), and (E))
Note : Line 105 plus line 1d, Part l, should equal the amount on line 12, Part l .
Line No .
51-0177489
Excludad by section 512, sia, or sia
P
(0)
tae
Amount
14
141
41 , 586 .
13,655 .
18
16 , 630 .
0 . __ ._ . .___
71,871 .
"
Page 6
Related or exempt
function income
0.
71,871 .
Relationship of Activities to the Accomplishment of Exempt Purposes (see page 34 of the instructions)
Explain how each activity for which income is reported m column (E) of Part VII contributed importantly to the accomplishment of the organization's
exempt purposes (other than by providing funds for such purposes)
34 of the instructions )
Name, address, and EIN of co
of
I
Nature of activities
N/A
X I Information Regarding Transfers Associated m
(a) Did the organization, during the year, receive any funds, directly or indirectly, ti
(b) Did the organization, during the year, pay premiums, directly or indirectly, on a
Note : If "Yes" to (b), file Form 8870 and Form 4720 (see instructions).
Please
Sign
Here
Signatur of
. ,r, . . .., .
Paid
signature
Preparer's Firm's name for
Use Only yours is
323161
19-17-CII
.S
'~ t, aqd com~le
self-employed),
dress, and
ZIP + 4
Date
L'
' 3333
IND I
A . SPILLMAN &
)UNDERS ROAD
APOLIS, IN 46268
income
r
Organization Exempt Under Section 501(c)(3)
SCHEDULE A
(Form 990 or 990-EZ)
OMB No 1545-0047
(Except Private Foundation) and Section 501(e), 501(f), 501(k),
501(n), or Section 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information-(See separate instructions.)
1 MUST be completed by the above organizations and attached to their Form 990 or 990-E1
Department of the Treasury
Internal Revenue Service
2003
T
Employer identification number
40 & 8 CHARLES W . ARDERY MEMORIAL
51 0177489
CHILD WELFARE
Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
(See page 1 of the instructions List each one If there are none, enter "None ")
the organization
(a) Name and address of each employee
more than $50,000
(b) Title and average hours
per week devoted to
nncdinn
aid
(c) Compensation
(d) Contnbutions co
(e) Expense
pe~'s~ad~Rat account and other
--n-tallnwanras
NONE
---------------------------------
---------------------------------
---------------------------------
--------------------------------Total number of other employees paid
" I
0
Compensation of the Five Highest Paid Independent Contractors for Professional Services
(See page 2 of the instructions List each one (whether individuals or firms) If there are none, enter "None ")
(a) Name and address of each independent contractor paid more than $50,000
(b) Type of service
I (c) Compensation
NONE
--------------------------------------------
--------------------------------------------
--------------------------------------------
-------------------------------------------Total number of others receiving over
$50,000 for professional services
323101/12-05-03
LHA
" I
0
`
For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ .
Schedule A (Form 990 or 990-EZ) 2003
40 ~& 8 CHARLES
Schedule A (Form 990 or 990-EZ)2003 CHILD WELFARE
W.
ARDERY
MEMORIAL
Statements About Activities (See page 2 of the instructions)
1
Yes
During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence
public opinion on a legislative matter or referendum? If "Yes ;" enter the total expenses paid or incurred in connection with the
lobbying activities 1 $
$
(Must equal amounts on line 38, Part VI-A,
or line i of Part VI-B )
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other organizations checking
"Yes," must complete Part VI-B AND attach a statement giving a detailed description of the lobbying activities
During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors,
trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such
person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary (If the answer to any question is "Yes,"
attach a detailed statement explaining the transactions)
2
a Sale, exchange, or leasing of property
X
2a
X
I 2b
c Furnishing of goods, services, or facilities?
I 2c I
SEE
PART
V,
FORM
I X
990
e Transfer of any part of its income or assets?
3 a Do you make grants for scholarships, fellowships, student loans, etc 7 (If "Yes," attach an explanation of how
you determine that recipients qualify to receive payments )
b Do you have a section 403(b) annuity plan for your employees
4
No
1
b Lending of money or other extension of credits
d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)
Page 2
51-0177489
Did you maintain any separate account for participating donors where donors have the right to provide advice
on the use or distribution of funds
Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions )
2e
X
3a
3b
X
X
4
X
The organization is not a private foundation because it is (Please check only ONE applicable box )
5
D A church, convention of churches, or association of churches Section 170(b)(1)(A)(i) .
6
D A school . Section 170(b)(1)(A)(u) . (Also complete Part V .)
7
~ A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(ui)
8
D A Federal, state, or total government or governmental unit. Section 170(b)(1)(A)(v) .
9
10
D A medical research organization operated m conjunction with a hospital . Section 170(b)(1)(A)(uq Enter the hospitals name, city,
and state
D
11a
~
11b
12
0
0
13
D
An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)
(Also complete the Support Schedule in Part IV-A )
An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A )
A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A )
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 charitable, etc ., 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) (Also complete the Support Schedule in Part IV-A )
An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in
(1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See section 509(a)(3) )
Provide the following information about the supported organizations (See page 5 of the instructions )
(a) Name(s) of supported organization(s)
14
323111
12-05-03
U
An organization organized and operated to test for public safety . Section 509(a)(4) (See page 6 of the instructions
(b) Line number
from above
Schedule A (Form 990 or 990-EZ) 2008
40 &~8 CHARLES W . ARDERY MEMORIAL
Schedule A (Form 990 or 990-EZ) 2003 CHILD WELFARE
51-0177489
rt Schedule (Complete only if you checked a box on line 70, 11, or 12 .) Use cash method of accounting .
You may use the worksheet in the Instructions for convertrno from the accrual to the cash method of accou
Calendar year (or fiscal year
heeinnine inl
15
16
17
18
19
yp
21
Gross income from interest,
dividends, amounts received from
payments on securities loans (section 512(a)(5)), rents, royalties, and
unrelated business taxable income
(less section 511 taxes) from
businesses acquired by the
organization after June 30, 1975
Net income from unrelated business
activities not included in line 18
Tax revenues levied for the
organization's benefit and either
paid to it or expended on its behalf
The value of services or facilities
furnished to the organization by a
governmental unit without charge .
Do not include the value of services
or facilities generally furnished to
the public without charge
Other income . Attach a schedule .
Do not include gain or (loss) from
sale of capital assets
22
23
24
25
Gifts, grants, and contributions
received (Do not include unusual
grants See line 28 )
Membership fees received
Gross receipts from admissions,
merchandise sold or services
performed, or furnishing of
facilities in any activity that is
related to the organization's
charitable, etc , purpose
Total oflines t5through 22
Line 23minus line l7
Enter l% otline 23
2002
I
(h) 2001
I
(c) 2000
I
(d) 1999
I
Page 3
(e) Total
38,784 .1
14,613 .1
26,207 .1
46,211 .1
125,815 .
50,875 .1
56,620 .1
69,192 .1
82,636 .
259,323 .
89 , 659 .
89 , 659 .
897 .
71,233 .
71,233 .
712 .
95 , 399 .
95 , 399 .
954 .
128 847 .
128 847 .
1 , 288 .
385,138 .
385,138 .
Organizations described on lines 10 or 11 : a Enter 2% of amount m column (e), line 24
1 28a
7,703 .
b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental
unit or publicly supported organization) whose total gifts for 1999 through 2002 exceeded the amount shown in line 26a .
Do not file this list with your return . Enter the total of all these excess amounts
" 26b
0.
c Total support for section 509(a)(1) test Enter line 24, column (e)
385,138 .
1 26c
d Add Amounts from column (e) for lines
18
259,323 . .
19
22
26b
259 , 323 .
1111" 26a
e Public support (Tine 26c minus line 26d total)
125 , 815 .
1 26e
f Public support percentage (line 28e (numerator) divided by line 26c (denominator))
32 .6675 %
11110- 26f
27
Organizations described on line 12 : a For amounts included m lines 15, 16, and 17 that were received from a "disqualified person," prepare a list for your
records to show the name of, and total amounts received in each year from, each "disqualified person " Do not file this list with your return . Enter the sum of
N/A
such amounts for each year
26
(2002)
(2001)
(2000)
(1999)
b For any amount included in line 17 that was received from each person (other than "disqualified persons'), prepare a list for your records to show the name of,
and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations
described in lines 5 through 11, as well as individuals ) Do not file this list with your return . After computing the difference between the amount received and
the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year
N/A
(2002)
(2001)
(2000)
(1999)
c Add . Amounts from column (e) for lines
15
16
17
20
21
. 27c
N /A
d Add Line 27a total
and line 27b total
1 27d
N/A
e Public support (Tine 27c total minus line 27d total)
N/A
1 27e
9 Public support percentage (line 27e (numerator) divided by line 27f (denominator))
N/A
10-1 27 o
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator))
N/A
1 27h
28 Unusual Grants: For an organization described m line 10, 11, or 12 that received any unusual grants during 1999 through 2002, prepare a list for your records
to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this list wish
your return . Do not include these grants m line 15
323121 12-05-03
NONE
%
Schedule A (Form 990 or 990-EZ) 2003
40 '&' 8 CHARLES W . ARDERY MEMORIAL
Schedule A (Form 990 or 990-EZ)2003 CHILD WELFARE
p~
Private School Questionnaire (see page 7 of the instructions)
(To be completed ONLY by schools that checked the box on line 6 in Part IV)
29
Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing
instrument, or in a resolution of its governing body
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues,
and other written communications with the public dealing with student admissions, programs, and scholarships
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of
solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known
to all parts of the general community it serves
If "Yes," please describe, if "No ;" please explain (If you need more space, attach a separate statement )
30
31
32
33
51-0177489
N/A
Page 4
Yes No
29
30
31
Does the organization maintain the following .
Records indicating the racial composition of the student body, faculty, and administrative staff?
Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis
Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student
admissions, programs, and scholarships
d Copies of all material used by the organization or on its behalf to solicit contributions?
If you answered "No" to any of the above, please explain (If you need more space, attach a separate statement )
a
b
c
a
b
c
d
e
f
g
h
Does the organization discriminate by race m any way with respect to
Students' rights or privileges?
Admissions policies
Employment of faculty or administrative staff
Scholarships or other financial assistance?
Educational policies
Use of facilities?
Athletic programs
Other extracurricular activities
If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement .)
34 a Does the organization receive any financial aid or assistance from a governmental agency
b Has the organization's right to such aid ever been revoked or suspended?
If you answered "Yes" to either 34a or b, please explain using an attached statement
35
Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,
1975-2 C B 587, covering racial nondiscrimination? If "No;" attach an explanation
Schedule A (Form 990 or 990-EZ) 2003
323131
12-05-03
40 '&' 8 CHARLES W . ARDERY MEMORIAL
Schedule A (Form 990 or 990-EZ) 2003 CHILD WELFARE
WA Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions)
Check " a
51-0177489
Pa ge 5
N/A
(To be completed ONLY by an eligible organization that fled Form 5768)
Check " b El if you checked "a" and "limited control" provisions apply
(a)
(b)
Limits on Lobbying Expenditures
Affiliated group
To be completed for ALL
D if the organization belongs to an affiliated arouo
totals
term expenditures" means amounts paid or incurred
36
36 Total lobbying expenditures to influence public opinion (grassroots lobbying)
37 Total lobbying expenditures to influence a legislative body (direct lobbying)
88 Total lobbying expenditures (add lines 36 and 37)
39 Other exempt purpose expenditures
40 Total exempt purpose expenditures (add lines 38 and 39)
41 Lobbying nontaxable amount . Enter the amount from the following table
If the amount on line 40 is -
The lobbying nontaxable amount is
Not over $500,000
20% of the amount on line 40
Over $500,000 but not over $1,000,000
$100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000
$175,000 plus 10% of the excess over $1,000,000
Over $1,500,000 but not over $17,000,000
$225,000 plus 5% of the excess over $1,500,000
Over $17,000,000
$1,000,000
electing organizations
N/A
38
42 Grassroots nontaxable amount (enter 25% of line 41)
43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36
44 Subtract line 41 from line 38 Enter-0- tf line 41 is more than line 38
42
44
Caution : If there is an amount on either line 43 or line 44, you must file Form 4720 .
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns
below . See the instructions for lines 45 through 50 on page 11 of the instructions )
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or
fiscal year beginning In)
45 Lobbying nontaxable
amount
46 Lobbying ceding amount
(150% of line 45(e))
47 Total lobbying
expenditures
48 Grassroots nontaxable
amount
49 Grassroots ceiling amount
(150% of line 48(e))
50 Grassroots lobbying
1
(a)
2003
(b)
2002
(c)
2001
Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI-A) (See page 12 of the instructions )
During the year, did the organization attempt to influence national, state or local legislation, including any attempt to
influence public opinion on a legislative matter or referendum, through the use of,
a Volunteers
b Paid staff or management (Include compensation in expenses reported on lines c through h .)
c Media advertisements
d Mailings to members, legislators, or the public
e Publications, or published or broadcast statements
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (Add lines c through h .)
If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities .
32305-03
(d)
2000
N/A
(e)
Total
0 .
0 .
0 .
0 .
0 .
0 .
N/A
Amount
0 .
Schedule A (Form 990 or 990-EZ) 2003
40 & 8 CHARLES W .
ARDERY MEMORIAL
51-0177489
Schedule A (Form 990 or 990-EZ)2003 CHILD WELFARE
FP ittl Information Regarding Transfers To and Transactions and Relationships With Noncharitable
. .
51
a
Exempt Organizations (Seepage 12 of the instructions)
Did the reporting organization directly or indirectly engage in any of the following with any other organization described m section
501(c) of the Code (other than section 501(c)(3) organizations) or m section 527, relating to political organizations
Transfers from the reporting organization to a nonchantable exempt organization of
(i) Cash
Other transactions
(i) Sales or exchanges of assets with a nonchantable exempt organization
51 a(!)
X
a(ii)
X
b(i)
X
b(ti)
(ii) Purchases of assets from a nonchantable exempt organization
X
b(m)
(Iii) Rental of facilities, equipment, or other assets
X
6(iv)
(iv) Reimbursement arrangements
X
b(v)
(v) Loans or loan guarantees
X
b(vi)
(vi) Performance of services or membership or fundraising solicitations
c
No
Yes
(ii) Other assets
b
Page 6
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
~
C
X
~
~X
d If the answer to any of the above is "Yes ; complete the following schedule Column (b) should always show the fair market value of the
goods, other assets, or services given by the reporting organization . If the organization received less than fair market value in any
transaction or sharing arrangement, show m column (d) the value of the goods, other assets, or services received
la)
Line no .
tbl
Amount involved
(c)
Name of nonchantable exempt organization
52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described m section 501(c) of the
Code (other than section 501(c)(3)) or in section 527?
h If "Yes ;" complete the following schedule
N/A
(a)
Name of organization
(b)
Type of organization
N/A
(d)
Description of transfers, transactions, and sharing arrangements
Yes
EM No
(c)
Description of relationship
Schedule A (Form 990 or 990-EZ) 2003
40 &
8 CHARLES W .
FORM 990
GAIN
(LOSS)
FROM PUBLICLY TRADED SECURITIES
DESCRIPTION
FORM 990
PART I,
LINE
STATEMENT
COST OR
OTHER BASIS
15,000 .
15,024 .
0.
163,835 .
147,181 .
0.
16,654 .
178,835 .
162,205 .
0.
16,630 .
8
EXPENSE
OF SALE
1
GROSS
SALES PRICE
UNION FEDERAL BANK
(A/C 28 01)
UNION FEDERAL BANK
(A/C 28 00)
TO FORM 990,
51-0177489
ARDERY MEMORIAL CHILD
STATEMENT OF ORGANIZATION'S PRIMARY EXEMPT PURPOSE
PART III
NET GAIN
OR (LOSS)
<24 .>
STATEMENT
2
EXPLANATION
PAYMENTS TO OR FOR THE BENEFIT OF NEEDY CHILDREN FOR EMERGENCY FOOD,
CLOTHING, MEDICAL SERVICE, ETC .
FORM 990
CLASSIFICATION
CASH GRANTS AND ALLOCATIONS
STATEMENT
3
DONEE'S NAME
DONEE'S ADDRESS
DONEE'S
RELATIONSHIP
AMOUNT
SEE ATTACHED
VARIOUS
NONE
54,845 .
TOTAL INCLUDED ON FORM 990,
FORM 990
SECURITY DESCRIPTION
PART II,
54,845 .
LINE 22
NON-GOVERNMENT SECURITIES
CORPORATE
STOCKS
CORPORATE STOCKS
CORPORATE BONDS
612,188 .
TO 990, LN 54 COL B
612,188 .
CORPORATE
BONDS
STATEMENT
4
OTHER
PUBLICLY
TOTAL
TRADED
OTHER
NON-GOV'T
SECURITIES SECURITIES SECURITIES
432,391 .
612,188 .
432,391 .
432,391 .
1,044,579 .
STATEMENT S)
1,
2,
3,
4
40 & 8 CHARLES W . ARDERY MEMORIAL CHILD
GOVERNMENT SECURITIES
FORM 990
U .S .
GOVERNMENT
DESCRIPTION
US GOVERNMENT SECURITIES
TOTAL TO FORM 990,
51-0177489
LINE 54,
FORM 990
COL B
STATEMENT
STATE AND
LOCAL GOV T
5
TOTAL GOV T
SECURITIES
192,394 .
192,394 .
192,394 .
192,394 .
IDENTIFICATION OF RELATED ORGANIZATIONS
PART VI, LINE 80B
NAME OF ORGANIZATION
LA SOCIETE NATIONAL DES 40 HOMMES ET 8 CHEVEAUS
STATEMENT
EXEMPT
6
NONEXEMPT
X
STATEMENT S)
5,
6
form 8868 (12-2000)
Page 2
0 If you are fling for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box
Note : Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868 .
0 If you are fling for an Automatic 3-Month Extension, complete only Part I (on page 1) .
Type or
print.
File by
Name of Exempt Organization
40 & 8 CHARLES W .
C HILD WELFARE
ARDERY
D Form 990-EZ
o Form 990-PF
D Form 990-T (sec . 407 (a) or 408(a) trust)
~ Form 990-T (trust other than above)
OX
Employer identification number
MEMORIAL
51-0177489
Number, street, and room or suite no . If a P .O . box, see instructions .
uuedate to.45 N . PENNSYLVANIA STREET
NO . 1ST FL
filing the
return see
City, town or post office, state, and ZIP code . For a foreign address, see instructions .
Instructions
INDIANAPOLIS, IN
46204
Check type of return to be filed (File a separate application for each return) :
D Form 990
D Form 990-BL
"
~ Form 1041-A
0 Form 4720
For IRS use only
D Form 5227
~ Form 6069
~ Form 8870
STOP: Do not co mplete Part II if you were n ot a lready granted an automatic 3-month extension on a previously filed Form 8888.
" If the organization does not have an office or place of business in the United States, check this box
" If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
. If this is for the whole group, check this
box " = . If it is for part of the group, check this box " 0 and attach a list with the names and EINs of all members the extension is for.
4
5
8
7
I request an additional 3-month extension of time until
For calendar year
, or other tax year beginning
If this tax year is for less than 12 months, check reason :
State in detail why you need the extension
JUNE 15, 2005
AUG 1, 2003
D Initial return
, and ending
D Final return
JUL
8a
If this application is for Form 990-BL, 990-PF, 990~T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits . See instructions
b
If this application is for Form 990-PF, 990~T, 4720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
previously with Form 8868
c
Balance Due. Subtract line 8b from line 8a . Include your payment with this form, or, if required, deposit with FTD
coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions .
31,
2004
= Change in accounting period
$
$
N/A
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct, and complete, and1hat I am authorized to prepare this form .
" CPA
re
Notice to Applicant - To Be Completed by the IRS
We have app: d this pplication . Please attach this form to the organization's return .
t
7'
D We have not ap
this application . However, we have granted a 10-day grace period from the later of the date shown below or the due
date of the organization's return (including any prior extensions) . This grace period is considered to be a valid extension of time for elections
otherwise required to be made on a timely return . Please attach this form to the organization's return .
D We have not approved this application . After considering the reasons stated in item 7, we cannot grant your request for an extension of time to
file. We are not granting the 10-day grace period .
We cannot consider this application because it was fled after the due date of the return for which an extension was requested .
0 other
By
Director
Date
Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension returned to an address
different than the one entered above .
Name
Type
or print
Number and street (include suite, room, or apt . no .) Or a P .O. box number
City or town, province or state, and country (including postal or ZIP code)
Form 8868 (12-2000)
CVV ARDERY REF --"",RT FISCAL YEAR 2004
RECORD
040001
040002
GR V#
APPDATE
IN
364
030630
040003
040004
040005
040006
040007
040008
040009
040010
IN
IL
IL
AR
OH
MO
KY
IN
IN
364
594
433
182
021
541
276
364
364
030630
030704
030623
030501
030605
030318
020519
030619
030617
040011
040012
IN
IN
364
364
030521
030506
040013
040014
040015
IN
IN
IN
IN
364
21
364
030421
030708
030630
364
21
21
21
030630
030619
030719
030715
433
364
364
364
64
64
64
64
1 67
31
1 1
030715
030711
030723
030722
030723
030813
030723
030723
030804
030807
040016
040017
040018
040019
040020
040021
040022
040023
040024
040025
040025
040026
040027
040028
040029
040030
040031
040032
IN
IN
IN
IL
IN
IN
IN
IN
IN
IN
IN
SC
WI
MO
IN
IN
IN
040033
040034
040036
040037
040038
IN
IN
IN
IN
IN
040039
040040
040041
040042
040043
IN
IN
IN
IN
IN
040044
IN
07
07
64
64
030318
030725
040818
030813
030814
64
64
64
64
030814
030813
030813
030813
64
64
64
64
030812
030812
030812
030812
030812
164
J64
030826
AMTAPPL FAMILY
131 .55
300.00
268.47
446.71
220.00
175 .39
481 .73
434 .06
280 .41
273 .90
100 .00
50 .00
50 .00
329 .93
437 .99
449.58
186 .64
94.61
331 .03
147.07
FNAME
TITLE
Locale 364
Locale 364
Locale 594
Locale 433
locale 182
Locale 1021
Locale 1541
Locale 1276
Voiture
Voiture
Volture
Volture
Volture
Voiture
Voiture
Voiture
Loacle 364
Locale 364
Locale 364
Voiture
Voiture
Volture
C/O Ronald Monjon
C/O Ronald Monjon
C/O Verlin Funkhous
C/O William Gernant
CIO Gordon C . Murra
C/O Steve Sprague
C/O Leon Hill
CIO Michael Eads
Voiture
Voiture
Voiture
Thompson
Williams
Matheny
Tuthill
Wineburger
Cheech
Sands
1
2
2
3
2
2
1
Shepard
Santos
Bryant
Nelson
3
2
2
2
Linback
Miller
1
3
Locale 364
Locale 364
Griffin
Swanigan
Sneed
David
4
6
3
2
1
Locale
Locale
Locale
Locale
Locale
21
364
364
21
21
5
1
Locale
Locale
Locale
Locale
Locale
Locale
21
433
364
Johnson
King
Roberts
271 .41 Kopf
253 .66 Snapp
37615 Armstrong
278 .91 Page
278 .22 Ortega
275.16 Owens
426.72 Kent
300 .00 Galiebos
429.64 Golomski
481 .73 Sands
375 .03 Snyder
363 .81 Chris Parker
313 .67
142 .82
424 .82
Carmen Romero
Stockton
Stone
269 .78
150 .19
131 .76
144 .09
120 .05
orwick
Thompson
Funk
Harrington
Sadler
Whiotlock
368 .76
129 .74
287 .84
378 .85
CHI LNAME
Bushong
Johnson
Chamberlin
2
2
3
2
3
2
4
2
3
1
2
3
2
1
3
3
1
1
1
1
3
1
2
3
364
36~t
364
Locale 364
Loale 364
Locale 364
Locale 1067
Locale 831
Locale 1541
Locale 107
Locale 107
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Volture
Voiture
Voiture
Volture
Voiture
Voiture
Voiture
AID/R
C/O Ronald Monjon
C/O Ronald Monjon
C/O Ronald Monjon
C/O Ronald Monjon
CIO Ronald Monjon
A
A
A
A
A
A
131 .55
300 .00
268 .47
446 .71
A
A
A
A
481 .73
434 .06
280 .41
273.90
A
A
A
100.00
50.00
C/O James Roberts
C/O Ronald Monjon
C/O Ronald Monjon
C/O James Roberts
C/O James Roberts
A
A
A
A
CIO
C/O
C/O
C/O
C/O
C/O
C/O
C/O
C/O
James Roberts
Rick Steger
A
A
A
Ronald Mojon
Ronald Monjon
Ronald Monjon
A
A
A
Ronald Monj8n
Ronald L . Monjo
Ronald Monjon
Ronald Monjon
C/O Richard Beranrd
C/O David Manske
C/O Leon Hill
GO Wes Lane
C/O Wes Lane
C/O Ronald Morgon
A
A
A
A
A
A
A
A
A
A
Volture
Volture
Voiture
Voiture
Volture
C/O
C/O
C/O
C/O
C/O
Ronald
Ronald
Ronald
Ronald
Ronald
Monjon
Monjon
U Monjo
L . Monjo
L . MonJo
A
A
A
A
A
Volture
Voiture
Voiture
Voiture
Voiture
C/O
C/O
C/O
C/O
C/O
Ronald
Ronald
Ronald
Ronald
Ronald
Monjon
Monjon
Monjon
Monjon
Monjon
A
A
A
A
A
Voiture
C/O Ronald Monjon
A
Volture
Volture
Volture
Volture
Voiture
Volture
Volture
Voiture
Volture
Voiture
Volture
Voiture
AMTPD
220 .00
175 .39
50.00
329.93
437.99
449.58
186.64
94.61
331 .03
147.07
271 .41
253 .66
376.15
278 .91
278 .22
275 .16
426 .72
300 .00
429.64
481 .73
375 .03
363 .81
313 .67
142 .82
424 .82
269 .78
150 .19
131 .76
144 .09
120 .05
368 .76
129 .74
287 .84
378 .85
COMMENTS
CW ARDERY REI'~RT FISCAL YEAR 2004
RECORD
GR ~#
APPDATE
040045
040046
040047
040048
040049
040050
040051
040052
IN
IN
1N
IN
IN
IN
IN
IN
364
364
364
364
364
~364
364
364
030826
030826
030826
030828
030827
030826
030826
030826
040053
040054
040055
IN
IN
IN
364
364
364
030826
030828
030828
040056
040057
IN
IN
IN
~~364
364
030828
030825
364
364
364
999
1277
030829
030829
030811
030902
030830
030827
040058
040059
040060
040061
040062
AR
040063
040064
040065
040066
040067
IN
IN
IN
IN
IN
040066
040068
040069
040070
040071
OH
SC
IN
IN
IN
040072
040073
040074
040075
IN
IN
In
IN
64
64
64
64
030905
030915
030913
030915
040077
In
WI
21
1~23
030829
030926
040078
040079
040080
040082
040083
040084
040085
040086
040087
040088
040089
IN
IN
IL
OH
IN
IN
IN
IN
IN
IN
IN
IN
~364
364
364
364
364
154
~74
64
64
~64
94 `
11
07
07
64
64
64
164
~64
64
030910
030911
030911
030911
030905
031008
030905
030905
030904
030817
030279
041002
040909
030905
030923
030923
040128
030923
030923
AMTAPPL
FAMILY
CHI
187 .23
538 .37
510 .90
Tyner
Huston
Williams
Williams
2
4
5
4
2
2
440 .91
210 .90
223 .30
149 .60
124 .13
486 .02
Moore
Bowman
Senter
Medrano
Crawler
450 .14
296 .52
248 .65
Ogden
Morgan
Kujawa
118 .70
300.00
300 .00
Wallace
Mercado
Rodriguez
Trost
446.28
2500.00
361 .99
100 .00
Voiture Nationals
Bower
Mayorga
53506 Keeves
145 .07 Wooten
44904 Fulford
439.11 Weaver
548.42 Decker
141 .99 White
424 .14 Younker
131 .60 Gayler
294 .64
428.85
150.00
146.79
110.73
199.32
376.37
162.21
293.70
347.75
518.55
50.00
450.00
450.00
150.00
300.00
300.00
Louks
Spencer
Hicks
Me Gfothlen
Jones
Jackson
Krupa
Morgan
Brady
Devine
Warner
Gregory
Wargo
Munson
Shuck
Singh
Gaeta
LNAME
Locale 364
Locale 364
Lcoale 364
Locale 364
Locale 364
1
1
4
3
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
2
2
1
Locale 364
Locale 364
Locale 364
2
2
3
0
3
2
4
1
3
4
4
1
3
1
2
Locale 364
Lcoale 364
Locale 364
Clerical Expense
Locale1277
Locale 364
Locale 364
Locale 364
Locale 364
Locale 364
Locale 154
Locale
Locale
Locale
Locale
974
364
364
364
3
2
1
1
Locale
Locale
Locale
Locale
364
364
364
364
2
Locale 364
4
2
2
2
Locale
Locale
Locale
Locale
2
1
3
3
1
2
2
T
1323
594
11
107
Locale 107
Locale 364
locale 364
Locale 364
Locale 364
Loale 364
Locale 364
FNAME
TITLE
Voiture
C/O Ronald Monjon
C/O Ron aid Monjon
C/O Ronald Monjon
C/O Ronald Monjon
CIO Ronald Monjon
C/O Ronald Monjon
C/O Ronald Monjon
Volture
Voiture
Volture
Votture
Voiture
Volture
Voiture
AID/R
Voiture
Volture
C/O Ronald Monjon
C/O Ronald Monjon
C/O Ronald Monjon
Volture
Volture
Volture
C/O Ronald Monjon
C10 Ronald Monjon
C/O Ronald Monjon
Volture
Voiture
Voiture
Volture
Voiture
Voiture
GO Ronald Monjon
CIO Ronald Monjon
C/O Henry Phillips
Volture
Voiture
Voiture
Voiture
Volture
Voiture
Volture
Volture
Volture
Volture
Volture
Voiture
Voiture
Volture
Volture
Voiture
Voioture
Voiture
Volture
Voiture
Voiture
Voilure
Volture
Voiture
Voiture
C/O Edward Johnson
C10
C/O
C/O
C/O
C/O
CIO
Dennis L . Nunnal
Dennis Nunnally
Dennis Nunnally
Dennis L . Nunnal
Dennis L . Nunnal
Rodger D . Finger
CIO R.E . Wal ;sh
CIO Ronald Monjon
CIO Ronald Monjon
C/O Ronald Monjon
C/O Ronald Monjon
C/O Dennis L . Nunnal
AMTPD
A
A
A
A
A
187 .23
538.37
510 .90
440.91
210.90
A
A
R
A
R
223.30
149.60
94.00
486.02
316.00
A
R
R
D
D
A
A
A
A
D
A
R
R
A
A
R
R
R
R
A
296.52
212.00
95.00
446.28
2500.00
361 .99
100.00
460 .00
145 .07
324 .00
289 .00
548.42
141 .99
200 .00
80.00
250 .00
380.00
150 .00
1467 .89
110 .73
C10 Dennis L . Nunnal
C/O Dennis L . Nunnal
C/O James Roberts
A
A
A
C/O Jim Frisch
C/O Verlin Funkhous
A
199 .32
376.37
A
A
R
R
162 .21
293 .70
300 .00
366.00
A
D
D
D
D
D
50 .00
C/O Wally Ciokajlo
C/O Wes Lane
C/O Wes Lane
C/O Dennis L . Nunnal
C/O
C/O
C/O
C/O
C/O
Dennis
Dennis
Dennis
Dennis
Dennis
L.
L.
L.
L.
L.
Nunnal
Nunnal
Nunnal
Nunnal
Nunnal
COMMENTS
CW ARDERY RET ART FISCAL YEAR 2004
RECORD
GR
APPDATE
" 040090
040091
040092
040093
040094
040095
040096
040097
040098
040099
040100
IN
IN
IN
KY
PA
IN
IN
WI
WI
SD
SC
364
364
364
t276
I 100
310
310
750
750
146
254
040101
040102
040103
SC
SC
OH
040104
040105
040106
040107
WI
PA
IN
IN
~488
11067
10
236
14
040108
040109
040110
040111
040112
040113
040114
040115
IN
WI
IA
PA
KY
IN
IN
KY
040116
040117
040118
SD
IL
KY
040119
040120
040122
040123
II
FL
SD
FL
040123
040124
KY
SD
WI
1 76
58
21
NY
IN
AR
34
1 10
1 J77
75
040125
040126
040127
040128
040129
040129
040130
040131
040132
IN
IN
IN
IN
OH
364
364
364
260
65
846
1~t76
1107
07
1 76
46
94
1 76
94
1 :98
58
1 26
9 99
I
107
I68
030923
030923
030915
031001
030919
031114
031114
031102
031022
031014
030127
031106
031114
031104
031120
031120
031029
030905
031104
040601
031230
031101
031204
041209
031209
031015
031207
031122
031206
031210
031107
031227
031218
031218
031227
040103
040106
031220
030831
040118
040112
031224
031223
040114
AMTAPPL
FAMILY
CHI
450.00
149 .45
614.87
Laborin
Baker
O'Brien
Smith
Lamagro
598 .13
115 .57
352 .33
428 .00
231 .50
125 .26
600 .00
139.77
435 .80
281 .57
100 .00
644 .26
447 .44
50 .00
50 .00
45 .00
544 .94
159 .55
186 .18
427 .77
107 .55
66 .46
149 .12
134 .61
148 .64
449 .97
270 .28
196 .43
112 .77
141 .97
290 .56
151 .10
394 .77
1000.00
297 .64
537 .35
262.83
2500 .00
311 .33
268 .37
36831
Nichols
Ebbert
Butzine
Simon
Atkinson
Hicks
Watkins
Fritz
~
Branville
Drebelis
CrawFord
Lrtiz
Karger
Pozega
Pies
Kondos
Suter
Craig
Catt
Blevins
Darling
Porter
Long
Hayes
Freeman
Schmidt
Angeund
Jones
Muston
Szymanski
Thomas
Sencehdiver
Underdown
Berry
Volture Nationale
Stacy
Schaeffer
Bowen
LNAME
FNAME
TITLE
3
2
4
4
1
7
3
2
1
5
2
3
Locale 364
Locale 364
Locale 364
Locale 1276
Locale 100
Locale 1310
Locale 1310
Locale 750
Locale 750
Locale 146
Locale 1254
Locale 1488
Voiture
Voiture
Voiture
Volture
V oiture
Volture
Voiture
Voiture
C/O Dennis L. Nunnal
C/O Dennis Nunnally
C/O Dennis L. Nunnal
1
5
5
3
Locale 1067
Locale 10
Locale 236
Locale 14
Locale 364
1
1
3
2
2
2
3
2
1
1
1
1
3
2
3
2
1
2
2
3
1
3
4
2
0
5
4
3
Locale 364
Locale 364
Locale 260
Locale 865
Locale 846
Locale 1276
Locale 107
Locale 107
Loacle 1276
Locale 146
Locale 594
Locale 1276
Locale 594
Locale 1598
Locale 558
Locale 1526
Locale 1276
Locale 558
Locale 821
Locale 534
Locale 1310
Locale 1277
Locale 875
Clerical Expense
Locale 1511
Locale 107
Locale 68
Vloiture
Voiture
Volture
Volture
Voiture
Volture
Voiture
Voiture
Volture
Volture
Volture
Volture
Volture
Voiture
Voiture
Voiture
Voiture
Voiture
Volture
Volture
Voiture
Volture
Volture
Voiture
Voiture
Voiture
Voiture
Voiture
Volture
Volture
Voiture
Voiture
Volture
Voiture
Voiture
Voiture
AIDIR
D
D
R
AMTPD
A
A
A
R
A
A
A
50.00
598.13
115.57
352.33
200.00
231 .50
125.26
600.00
A
A
A
A
139.77
435.80
281 .57
100.00
C/O William Janson
C/O Carl Sprankle
C/O Ronald Monjon
C/O Ronald Monjon
C/o Ron Monjon
A
A
A
A
A
644.26
447.44
50.00
50.00
45 .00
C/O Wes Lane
C/O Wes Lane
C/o William Phillips
C/o Terrance C . Mull
C/O Verlin Funkhous
A
A
A
A
C/a Billy Smith
CIO L . Ray Chirdon
C/O Mark Fischer
C/O Bill Cumings
C/O Tom Orval
C/O Thomas J . Onral
CIO Terry Mullner
C/O Robert Gibson
C/O Charles Smith
CIO A. C. Brown
C/O Clair Welters
C/O Herbert Brasda
C10 Cecil Hutton
C/O James Coppage
C/O William Phillips
A
A
A
A
A
CIO William Phillips
C/O Verlin Funkhous
A
A
C/O Joseph Berube
CIO Robert Heesch
GO George Johnston
C/O William H . Phillip
A
A
A
C/O Robert W . Heec
C/O Walter Hoffman
C/o Bernie Sampson
C/o mark Fischer
C/O Edward Johnson
CIO Steve Herring
C/O Fred Zimmer
CIO Edd Moyer
C/O Marvin Everett
544.94
159 .55
186.18
427.77
107 .55
66.46
149 .12
134.61
148 .64
449 .97
270 .28
196 .43
112 .77
141 .97
290 .56
A
A
A
A
151 .10
394 .77
1000 .00
A
A
A
A
A
A
A
297 .64
537 .35
262 .83
2500 .00
311 .33
268 .37
368 .31
COMMENTS
CW ARDERY REI' ~-"IRT FISCAL YEAR 2004
RECORD
GR M
040133
040134
040135
040136
040137
040138
040139
040140
040141
FL
SD
IL
OH
WI
WI
IL
SC
IA
040142
040143
WI
WI
040144
040145
KY
OH
040146
040147
040148
SC
040149
040150
MO
MO
WI
040151
040152
040153
040154
040155
040156
040157
040158
IL
IN
MO
MO
OK
PA
FL
OH
040159
040160
WI
WI
040161
040162
040163
040164
040165
WI
MO
OH
WI
WI
040166
040167
040168
040169
040170
IL
040171
040172
040174
040175
040176
040177
WI
OH
IN
KY
KY
MO
MO
MO
MO
APPDATE
598
146
594
28
856
1372
594
1067
865
904
031223
040111
040119
040124
040120
040122
040201
040126
040210
040203
30
1 76
040210
031118
040218
28
1p67
30
;44
~60
60
56
29
60
60
1 40
03
1 26
10
J31
56
56
30
4 20
31
130
33
9 99
~30
68
21
1 76
1 76
92
92
2
2 2
042203
040222
040216
040130
040107
040110
040228
040107
040130
040214
040303
031223
040315
040419
040225
040225
040402
040403
040419
040310
040422
040315
040522
042004
040421
030723
040524
040105
040303
030409
030824
AMTAPPL
230.00
295.35
137 .39
260.77
103.31
298 .56
28906
300.00
208.53
296.96
108.02
149.97
246.05
115.00
156.33
400.00
FAMILY
George
Coble
Alexander
Coble
Schmidt
Haas
Brown
Buckler
Morgan
Day
Schams
Cox
Hilliard
Hegger
Marriott
Worthy
122.43
129.85
Lane
Cunningham
143 .72
350.00
729.85
122 .43
267 .34
149 .49
158 .62
200 .00
Hartwine
Wolfe
Cunningham
Lane
Welchel
Puino
Allins
Bricker
Sfmonis
431 .24
255 .28
285 .92
499 .93
301 .15
583 .93
108 .46
289 .56
5000 .00
100 .87
275 .48
99 .99
446 .78
448.65
150 .00
150.00
150 .00
150.00
Newcomer
Priest
Phillips
Marsh
Xiong
Schams
Neyert
Voiture Nationale
Zoerb
Dorris
Cuffle
Perkins
Eubanks
Piehl
Valentine
Applebee
Wilson
CHI
3
3
1
2
1
3
2
2
2
2
2
LNAME
FNAME
TITLE
Locale 1598
Locale 146
Locale 594
Locale 28
Locale 856
Locale 1372
Locale 594
Locale 1067
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
C/O Joseph Berube
C/O Terrance Muller
C/O Verlin Funkhous
CIO Paul Sands
C/O Ronald Pfalzgraf
C/O Donald Gibson
C/O Vedin Funkhous
C/O Richard M . Bem
C/O Gene Hutton
CIO Ed Mc Manus~
C/O Allan Johnson
A
'A
A
A
A
A
A
A
A
A
A
230.00
295.35
137.39
260.77
103.31
C/O William Smith
C/O Paul Sands
A
A
149.97
246.05
CIO Richard M . Bem
C/O Dennis Russell
A
A
115.00
156.33
C/O Marvin Harris
C/O Clarence Buckle
A
D
400.00
C/O Clarence Buckle
CIO Ronald Pfalzgraf
D
A
Locale 865
Locale 904
Locale 830
1
2
Locale 1276
Locale 1276
1
1
Locale 1067
Locale 130
Locale 344
3
2
3
1
3
3
2
2
1
4
4
3
2
2
4
2
4
1
2
0
1
4
1
3
3
1
1
1
1
locale 760
Locale 760
Locale 856
Locale 729
Locale 760
Locale 760
Locale 1540
Locale 903
Locale 1526
Locale 10
Locale 831
Locate 856
Locale 856
Locale 130
Locale 442
Locale 831
Locale 830
Locale 433
Clerical Expense
Locale 830
Locale 68
Locale 21
Locale 1276
Locale 1276
Locale 292
Loaie 292
Lcoale 292
Locale 292
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
Voiture
A!D/R
C/o Ben Roui
C/O Clarence Buckle
CIO Clarence Buckle
C/O Aivin P . Konrath
C/O John Cashner
C/O George Johnston
C10 Clair Waiters
C/O David Manske
CIO Ronald Pfalagraf
A
A
A
A
A
C/O Ronald Pfalzgraf
CIO Dennis C . Russe
CIO Theodoer Troski
C/O David Strelke
Cc/O Allan Johnson
A
A
A
D
D
CIO Rick Steger
GO Dale Peterson
CIO Marvin Everette
C/O James Roberts
A
A
A
A
A
C/O
C/O
C/O
C/O
CIO
C/O
A
A
A
A
A
A
Dale Bayan
Dale Bryan
Leslie Davis
Leslie Davis
Leslie Davis
Leslie Davis
A
A
D
A
AMTPD
298.56
289.06
300.00
208.53
296.96
108.02
143.72
350.00
129.85
122.43
267.34
149.49
158 .82
200 .00
255 .28
285 .92
499 .93
301 .15
289 .56
5000 .00
100 .87
275 .49
99 .99
446 .78
448 .65
150 .00
150 .00
150 .00
150 .00
COMMENTS
/
CW ARDERY REF ~RT FISCAL YEAR 2004
,RECORD
GR
040178
MO
MO
MO
MO
MO
WI
040179
040180
040181
040182
040183
TOTALS
I#
292
292
292
292
292
831
APPDATE
AMTAPPL
FAMILY
CHI
030824
031024
150 .00
150 .00
030115
040131
030310
040528
150 .00
450 .00
150 .00
354 .17
Lecoque
Hopper
Clark
Riley
Thointon
Hertrheins
59,536.96
LNAME
FNAME
TITLE
1
1
1
Locale 292
Locale 292
Locale 292
GO Leslie Davis
C/O Leslie Davis
C/o Leslie Davis
1
1
3
Locale 292
Locale 292
Locale 831
Voiture
Voiture
Voiture
Voiture
411
Voiture
Voiture
C/O Leslie Davis
C/O Leslie Davis
C/O David Strelke
AIDIR
A
A
A
A
A
A
AMTPD
COMMENTS
150 .00
150 .00
150 .00
450 .00
300 .00
354 .17
54,845.47
.t
a

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