Return of Organization Exempt From Income Tax
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