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Le Train Bleu restaurant gourmet belle époque Le Train Bleu, c’est un dîner en partance pour l’Italie et ses multiples saveurs ensoleillées : ambiance Belle Époque et cuisine gourmet se mêlent avec élégance dans un décor unique, à l’intérieur même du Casino de Monte-Carlo... Peintures, couleurs, boiseries : tout ici rappelle les fastes d’un train de voyageurs, début du XX ème siècle, avec pour paysage la Place du Casino. Ouvert pour le dîner, le Train Bleu veille et accueille les convives tant que vit le Casino de Monte-Carlo. Si les joueurs apprécient de s’y relaxer le temps d’une parenthèse gourmande, le Train Bleu reçoit tous les visiteurs qui souhaitent agrémenter leur soirée d’un dîner savoureux et élégant. nos suggestions automne & hiver Caviar de l’Amour servi à la cuillère, blinis, crème citronnée «Caviar de l’Amour» servito al cucchiaio, blinis, crema al limone 150€ Amur caviar served with a spoon, blinis, lemon cream Икра амурского осетра на ложечке, оладьи, лимонный крем Les 6 huitres « Gillardeau », pain noir au beurre demi-sel, vinaigre à l’échalote Sei ostriche « Gillardeau », pane nero al burro mezzo sale, aceto allo scalogno 36€ 6 Gillardeau oysters, black bread with semi-salted butter, shallot vinegar Устрицы Жилардо (6 шт.), черный хлеб со слабосоленым сливочным маслом, уксус с луком-шалот Marmite de crustacés et coquillages, haricot blanc, bouillon réduit Pentola di crostacei e frutti di mare, fagioli bianchi, brodo ristretto 46€ Shellfish casserole, white beans, broth reduction Ракообразные и моллюски на сковороде, белая фасоль, крепкий бульон quelques informations OUVERT TOUTE L’ANNÉE Tous les jours, de 19 heures à la fermeture du Casino de Monte-Carlo. RÉSERVATIONS +377 98 06 24 24 [email protected] LE CHEF THIERRY SAEZ-MANZANARES Amoureux du produit de saison, le chef Thierry Saez- Manzanares dirige les cuisines du Train Bleu, accompagné de son 1 er sous chef Eric Rouvidant. Il y décline une carte qui conjugue les multiples saveurs de la Méditerranée.

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Page 1: PREGN R990s.foundationcenter.org/990_pdf_archive/237/237418649/237418… · 6b, 8b, 9b, 10b, or 16 of Part l. w~ T°~~ services and genera N1 Fundraising 22 Grants and allocations

OMB No 7545-0047 990 ~ Return of Organization Exempt From Income Tax ~00

Department

Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung beneTrt trust or private foundation) ~ ~ ~

d the Treasury The organization may have to use a copy of this return to satisfy state reporting requirements ~ Internal Revenue Service

~

A For the 2002 calendar ear, or tax ear beginning IA L , 2002, and ending 0 E' 30 . 200 3 B Check d applicable PhmC Name of organization D Employer identification number

D Address change use IRS 'PREGN ff~. R l~ C ¬IJ~ s I ~ . Z3 : 14 k 19 b`7

Name change Prl °r dumber and street (a P O box if mail is not de erect to street address) Room/suite E Telephone number

g0 REE4q.T 044 ( '~0 1) `t41- '(%5I D Initial return city or town, state coon and ZIP + 4 Final return i~+c- h ~'' ZD .~ F AccuetrnJ rrelhod. ~ Cash ~Acaual

Amended return lions. 0 P AA L~

O D Other (specify)

Application pending 0 Section 501(cH3) organizations and 4947(a)(1) nonexempt charitable H and I are not applicable to section 521 or,~,an¢a~~odns, trusts must attach a completed Schedule A (Form 890 or 99QEZ). H(a) Is this a group return (or affiliates? LJ Yes 1'l No

G Web site: " 110 (`0(Q~'S H(b) If "Yes," enter number of affiliates ii, - ._ ._____ . .____. V H(c) Are all affiliates included? Yes 0 No

J Organization e check only one) " 501(c) ( 3 ) .4 (insert no ) 0 4941(a)(1 or [1527 (If "No," attach a list See instructions.)

K Check here " El if the organization's gross receipts are normally not more than E25.000. The H(d) IS this 2 Separate return filed by an

organization need not file a return with the IRS, but d the organization received a Form 990 Package organization covered by a group ruling) D Yes No

in the mail, it should file a return without financial data Sane states require a complete return . I Enter 4-dig it GEN t

M Check lio- C] if the organization is riot required L Gross receipts Add lines lib, Bb, 9b, and 1Qb to line 12 " to attach Sch B (Form 990, 990-EZ, or 990-PF) " Revenue Expenses, and Changes in Net Assets or Fund Balances See a e 1'

1 Contributions, gifts, grants, and similar amounts received a Direct public support . . . . . . . . . . , , . 1a b Indirect public support . c Government contributions (grants) d Total (add lines la through 1c) (cash $ ~3- noncash S 0 ) 11

2 Program service revenue including government fees and contracts (from Part VII, line 93) 3 Membership dues and assessments . . . . . . . 4 Interest on savings and temporary cash investments 5 Dividends and interest from securities . . .

~ 6a Gross rents . . . . . . . . . . . . , , , , 6a b Less. rental expenses . . . . . . . . . , . , , lib , c Net rental income or (loss) (subtract line lib from line 6a)

~ 7 Other investment income (describe " Uti1REA-Lt G&-1-4 ) 7

d 8a Gross amount from sales of assets other (A) Securities (B) Other

than inventory b Less. cost or other basis and sales expenses . 8b c Gain a (loss) (attach schedule) d Net gain or (loss) (combine line 8c, columns (A) and (B)) , . . . ~n, y . .~ . 9 Special event and activities (attach schedule) a Gross revenue (not including $ of ~f

contributions reported on line 1a) 1961 nn b Less : direct expenses other than fundraising expenses c Net income or (loss) from special events (subtract line 9b from line 9a

10a Gross sales of inventory, less returns and allowances 110a I

b Less : cost of goods sold . c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) .

10

11 Other revenue (from Part VII, line 103) . . . . . . . , . . . . . . . 1' 12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) . . 1 ; 13 Program services (from line 44, column (B)) , . . . 14 Management and general (from line 44, column (C)) . . 15 Fundraising (from line 44, column (D)) . . , . . .

u+ 16 Payments to affiliates (attach schedule) . . . . . 17 Total expenses (add lines 16 and 44, column (A)) 1 . 18 Excess or (deficit) for the year (subtract line 17 from line 12)

Q 19 Net assets or fund balances at beginning of year (from line 73, column (A' ) , 20 Other changes m net assets or fund balances (attach explanation) , 21 Net assets or fund balances at end of ear (combine lines 18, 19, and 20) 2'

For Paperwork Reduction Act Notice, see the separate instructions. Cat No ii28zr

132.643

0 0 N

W

G

Form 990 (2002)

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v W vE vvv a r0 v'%~ a

Form 990 (2002) ~ ~ Page

Statement of All organizations must complete column (A) Columns (8), (C), and (D) are required for section 501(c)(3) and (4) organizations Functional Expenses aid section 4941(aM1) nonexempt charitable vests but optional for others see page 21 of the instructions)

Do not include amounts reported on line (s) Program (C) Management 6b, 8b, 9b, 10b, or 16 of Part l. w~ T°~~ services and genera N1 Fundraising

22 Grants and allocations (attach schedule) . (cash 8 - rancash $

eulE ) 22

23 Specific assistance to individuals (att c lule 23 160 3 24 Benefits paid to or for members (atta~ch E~ u) . 24 25 Compensation of officers, directors, etc. 25 00 4,19 ZO ( 51A 26 Other salaries and wages . . . . . . 26 ZX 1. Alibi - 27 Pension plan contributions . . . . . . 27 3 2 28 Other employee benefits . . . . . . 28 5 l 2L 29 Payroll taxes . . . . . . . . . . . 29 U117- 0 S 30 Professional fundraising fees . . . . , . 30 31 Accounting fees 32 Legal fee's . 32 33 Supplies . . . . . . . . . , . 33 0$~ -A39 13 11 34 Telephone , . . . . . . . , , , , 34 '{ Z l-1 35 Postage .end shipping . . . . . . , 35 36 Occupancy . . . . . . . . . . . 36 `1 3'l 4314 ?22 L 37 Equipment rental and maintenance . 38 Printing rind publications . . . . , , 38 39 Travel . . . . . . . . . , , , 39 40 Conferences, conventions, and meetings , . 40 X3q 9~4 41 Interest . . . 42 Depreciation, depletion, etc . (attach schedule) 42 1-3 O1 19 S~

43 0,~er~ ~experues not covered above (itemize) : akAs!ArdMU- 43a Mil 0 33 2'Z1 S

b !! .l YC1W \Y_ ~S ---~4SV:tCZs ------------------- 43b 2-1 .91 Z

-M~G~I~-- S -- - ~i ------------ 43c B d _~ft 1a0~~~- _. .---------------- asd 31 31 e _ca Aaa ----~!1P-i ; --------------- . . . . 43e I lit Lh 00

44 Total fimcuonal elip enses (add fines 21 through 43) Organizations cmip+etin9 columns (sHQ, carry these totals to lines 13-15 44 `A bb 462. ~ 24 9-1 2S 16-1 R4 LO

Joint Costs. Check " -0 If you are following SOP 98-2 Are any joint costs from a combined educational campaign and fundring solicitation reported m (B) Program services? " D Yes )(No If "Yes," enter () the aggregate amount of thesejoint costs $-6. r~- , (~ the amount allocated to Program services $ o (iii) the amoun t allocated to Management and general $ v ; and (v) the amount allocated to Fundraising $ 'Statement of Pro ram Service Accomplishments See page 24 of the instructions . What is the organization's primary exempt purpose? ------------ --------------------------- ---------------------------- Program Service

Expenses All organizations must describe their exempt purpose achievements m a clear and concise manner. State the number (Required for soi(c)(3) and of clients served, publications issued, etc . Discuss achievements that are not measurable . (Section 501(c)(3) and (4) (4) orys,aro+s+7(a)(i) organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) trusts . b'" optional for

others)

a ._ Gsdr! .̀At-Jon . roll. -- e!~ - -- - P~4~~1_ .._ SSIC`~t~l't..--- ~+nr'"1 LS6 -- -!`-~'n----~ehct~~. m --f~A 5---fre~°YAnW S-----~-rav~j e---fir2l!A

1C--5 ----- ECU---cb2r#--------.. . .-------- ) - _ ~ ~ (Grants and allocations $ n 53 LIAS

b MKic..__D~40. _ ._tr_n't :!~---t/.~lu'_tetns_. .------------------~'a_s~st(~ cJ~------ 2Sz,~ ------ ---------Ct tQrt7 -..---------------------------------------------------------------------------------------------------------------------------------------------------------------

(Granu and allocations $ Q ) 7 ;49-t

.. c . . . MQ eSC- .---~ -----------------

-- - --- - -- -------- ---- (Grants and allocations $ )

---------------- ---------------- Mist I

d . .---------------------------------------------- . . . . .-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------

(Grants and allocations $ e Other program services (attach schedule) (Grants and allocations $ ) f Total of Program Service Expenses (should equal line 44, column (B), Program services) .

Form 9`J0 (zoo2)

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48a Pledges receivable . . . . . . . . 45a //// b Less: allowance for doubtful accounts 48b 48c

49 Grants receivable . . . . . . . . . . . . . . . . . . 49

50 Receivables from officers, directors, trustees, and key employees (attach schedule) . . . . . . . . . . . . . . . . . . 50

51a Other notes and loans receivable (attach 51 a schedule)

y b Less : allowance for doubtful accounts . . 51b 51c a 52 Inventories for sale or use . . . .

53 Prepaid expenses and deferred charges . . . . 53 97101 54 Investments-securities (attach schedule) . . . " El Cost~FMV 4_1 4~ 21 Lo 54 0

55a Investments-land, buildings, and equipment : basis .

b Less .: accumulated depreciation (attach schedule) . . . . , . . . . , . . 55b 55c

56 Investments-other (attach schedule) , . ~ .

56 57a Land, buildings, and equipment: basis 57a Z

b Less : accumulated depreciation (attach G1 schedule) . . . . , . . . . , , . 57b l ~ 4 3 ~~ 57c ~ S 1 ~CI

58 Other assets (describe " ) 58

59 Total assets (add lines 45 through 58) (must equal line 74) 327-1g 59 So 60 Accounts payable and accrued expenses . . . . . . . . . . g` 60 V 140 61 Grants payable . . . . . . . . . , . . . . . . . . 61 62 Deferred revenue . . . . . . . . . . . . . . . . , 62

2 63 Looms from officers, directors, trustees, and key employees (attach WIN - 63 schedule) . . . . . . . . . . .

20 . . . . . . , 64a 64a Tax-exempt bond liabilities (attach schedule) "j b Mortgages and other notes payable (attach schedule) . . . . 64b

65 Other liabilities (describe " ) 65

66 Total liabilities (add lines 60 through 65) . 66

Organizations that follow SFAS 117, check here t and complete lines 67 through 69 and lines 73 and 74 . 2 ////

67 Unrestricted . . . . . . . . . . . . . . . . . - - - 712~ 67 3 68 Temporarily restricted . . . . .

m 69 Permanently iestncted . . . . . . . . . . . . . . . . 69

Organizations that do not follow SFAS 117, check here " ~ and complete lines 70 through 74 .

0 70 Capital stock, trust principal, or current funds 71 71 Paid-in or capital surplus, or land, building, and equipment fund

72 Retained earnings, endowment, accumulated income, or other funds 72

73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72 ;

3t3 to i3" 341y4W column (A) must equal line 19 ; column (B) must equal line 21) . 74 Total liabilities and net assets / fund balances (add lines 66 and 73) Z Z ~ 74

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization . How the public 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, in Part III, the organization's programs and accomplishments .

Form 990 (2002) ' Page

Balance Sheets (See page 24 of the instructions .)

Note: Where required, attached schedules and amounts within the description (A) (B) column should 6e for end-of-year amounts only Beginning of year End of year

45 Cash--non-interest-bearing . . . . . . . . . . . . . 45 $

46 Savings and temporary cash investments . . . . . . . . . . 46

47a Accounts receivable . . . . . . . . aia b Less: allowance for doubtful accounts 47b - - 0 - b8,~13 ~7c~ 5~,$Q

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Form 990 (2002) Page

Fame 990 (2002)

Reconciliation of Revenue per Audited ~ = Reconciliation of Expenses per Audited Financial Statements with Revenue per Financial Statements with Expenses per Return (See page 26 of the instructions .) Return

a Total revenue, gains, and other support a Total expenses and losses per per audited financial statements . . " a q audited financial statements . . " a SO

b Amounts included on line a but not on b Amounts included on line a but not line 12, Form 990: ~ on line 17, Form 990:

(1) Net unrealized gains (1) Donated seances on investments . . 5 and use of facilities ~a

(2) Donated services (2) Prior year adjustments and use of facilities E $ ~°3~ reported on line 20,

(3) Recoveries of prior Form 990 . . . $ year granM . . $ (3) Losses reported on

(4) Other (specify). line 20, Form 990 , ---------------------- 5 b /~ (4) Other (specify)-----

Add amounts on lines ( 1) through (4) " . . . . . . . . . . . . . . . . . . . . . . `{' /

c s~o' S~ Add amounts on lines (1) through (4~ c

c Line a minus line b. . . . . . " t~ ~Q c Line a minus line b d Amounts included on line 12, d Amounts included on line 17,

Form 990 but not on line a : Form 990 but not on line a :

(1) Investment expenses (1) Investment expenses not included on line not included on line 6b, Form 990 . . . $ 6b, Form 990,

(2) Other (specify): (2) Other (specify) : ---------------------- ----------------------

Add amounts on lines (1) and (2) " d Add amounts on lines (1) and (2) " d 0 e Total revenue per line 12, Form 990 ~~' e Total expenses per line 17, Form 990

line c plus line . " e 5~ ~' ~ line c plus line .

. . " e List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated ; see page 26 of the instructions )

(lU Name and address (9) Tide and average hours per A~ dm ~ enter emu eContributions to e benlans 8 account and other week devoted to position

-0- . deferred coin nsatron allowances

--------------- . ..In. ------~ - N W ECK, 1 800 ~E I b O o

s~u ma ~ ~ T rQC 0

. _ [~S~ ~.y~---~~ ~ al'~t,r,-----------------------~-E~r la o LA V ----- rr 6J cac_ D 4 O ,---------- ---~ ..~_ __ SECe --- ~ !=A ._ . Y:M1e. w Hz C oS a M~ ~ ~ O ~ O C( 7- klzg=

----------- ----- --- 7'-'~_ D t ---lhS 6~.

--- ~~---- ~ - N c-w D O O

._I .̀nat+`~-a~`~"~.-----S.~ar_ ~ .~ . . ..~ .-~--~---- D t p O O -~a~ne__ .1 ~~r .----- ---- ---- -- . . . .-------- ~ a1P`~ o 11 --o 1 ww ont- c:)

-- -- a~ - - - ---~na~.~K-- -------- tz.oo y br ~~-------- o o a

o La~ ~a -----P~; - I o o 1o 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 " El Yes 110 If "Yes," attach schedule-see page 26 of the instructions.

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88 At any torte 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 .7701-3? If "Yes," complete Part IX . . . . . . . . . . . . . . . . . $8

89a 501(c)(3) organizations. Enter : Amount of tax imposed on the organization during the year under : section 4911 " n ; section 4912 " ; section 4955 "

b 501(c)(3) and 501(c)(4) orgs. 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? If "Yes," attach a statement explaining each transaction . . . . . . . . . . . . . . . . . . . . . . . 89b

c Enter: Mount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . , . . , . . . . . . , . . . . . . " C

d Enter : Amount of tax on line 89c, above, reimbursed by the org ~nizati , .

. . . . . . :- . " -_ -_

.d 90a List the states with which a copy of this return is filed " . . . . . . . . . - . . . . . ._ . . . . . ._ .__ .__ ._

--

b Number of employees employed i the- pa ` period that in lodes March 12, 2002 (See instructions .) 190b I ~ ~ 91 The books are in pre of " ! Y __-s(1J l .___ ____________~__ ._ ~_Telephone no.

Located at " . .:1!?~r1'~. --~~~. . . . . . - . . . . . _ C_in!~9~. BLIP + 4 " . . .--- ..----------------

92 Section 4947(a)(1) nonexempt charitable trusts riling Form 990 in lieu of Form 1041--Check here and enter the amount of tax-exempt interest received or accrued during the tax year " 1 92 I O

Form 990 (2002)

Form 990 (2002) 1 Page

" Other Information (See gape 27 of the instructions .) Yes No 76 Did the organization engage in any activity not previously reported W the IRS? If "Yes," attach a detailed description of each activity . 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 Did the organization have unrelated business gross income of 81,000 or more during the year covered by this return? . b If "Yes," has it filed a tax return on Form 990-T for this year? . . . . . . . . . t~ ~A . . . .

79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement 80a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies, trustees, officers, etc , to any other exempt or nonex mpt organization? b If "Yes," enter the name of the organization " ._ . . . .____ . . . ._____________ . . . .____!~.A_____ .___ .___ .____ . . ._ ._ . . .

----------------------------------------------------- and check whether it is 0 exempt a 0 non,~ex,~mpt . 81a Enter direct or indirect political expenditures. See line 81 instructions , , . . 1818 ~ ~~'"c- b Did the organization file Form 1120-POL for this year? . . . . . . .

82a Did the organization receive donated services w the use of materials, equipment, or facilities at no charge or at substantially less than fair rental value? . . . . . . . . . . .

b If "Yes, " you may indicate the value of these items here. Do not include this amount 3 ~ ( as revenue in Part I or as an expense in Part II . (See instructions m Part III .) . . 182b ~ 3~O

83a Did the organization comply with the public inspection requirements for returns and exemption applications? b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? .

84a Did the organization solicit any contributions or gifts that were not tax deductible? b If "Yes," did the organization include with every solicitation an express statement that such conViquUOns

or gifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . ~,P . . 85 501(c)(4), (.5), or (6) organizations a Were substantially all dues nondeductible by members? b Did the organization make only in-house lobbying expenditures of $2,000 or less? . . . . (J lP .

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. _ ,

c Dues, assessments, and similar amounts from members . . . . . , . 3x u

d Section 162(e) lobbying and political expenditures e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices f Taxable amount of lobbying and political expenditures (line 85d less 85e) , , 85f tj /A' g Does the organization elect to pay the section 6033(e) tax on the amount on tine 85f? . . . . . A . h If section Ii033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its

reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the followi g tax years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~l~A

86 501(c)(7) args . Enter : a Initiation fees and capital contnbuUOns included on line 12 . 86a NI 1X b Gross receipts, included on line 12, for public use of club facilities . . . . , 86b

87 501(c)(12) orgs. Enter . a Gross income from members or shareholders . b Gross income from other sources. (Do not net amounts due or paid to other

sources against amounts due or received from them .)

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Form 990(2002) Page 6

" Analysis of Income-Producing Activities See page 31 of the instructions .

Note: Entel9rOSS amounts uNess OthenMSe Unrelated business income Excluded by section 512, 513, or 574 Related or

indicated (A) (B) (C) (D) exempt function

93 Pro am service revenue: ~ Business code Amount Exclusion code Amount income

a ~1Qdl~ . Q~r5~5'Fd.hCt~ ntn~C7 ~ Z

b c _ d e _

Medicare/Medicaid payments . g Fees and contracts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments SO 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 Gain or (lass) from sales of assets other than inventory 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory . 103 Other revenue: a

b _ c _ d _

S 104 Subtotal (add columns (B), (D), and (E)) `t1ll l . . 3` 105 Total (add line 104, columns (B), (D), and (E)) . . . . . Note: Line 105 plus line 70, Part l, should equal the amount on line 12, Part I " Relationship of Activities to the Accomplishment of Exempt Purposes (See page 32 of the instructions .)

Line No . Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes).

WEh. Y r xe riled Ent' ies ( e~

(C) Nature of activities Name, address, and EIN of

oartnershin. a disreaarc of Total income

-Information Regarding Transfers Associated with Personal Benefit Contracts (See page 33 of the r

(a) Did the organization, during the year, raceme any funds, directly or indirectly, to pay premiums on a personal benefit contract? (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? Note: If " Yes" to (b), file Form 8870 and Form 4 720 (see instructions).

Yes El No Yes O No ,ijP

Please Sign Here

Paid Preparer's Use Onh

Taxable Subsidiaries and 32 of the

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SCHEDULE A ' Organization Exempt Under Section 501(c)(3) OMB No 1545-0047

(Form 990 Of 990-EZ) (Except Private Foundation) and Section 501(e), 5010, 501(1c), 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust

Supplementary Information~See separate instructions.) ~~~L Department of the Trrasi:ry

q

Internal Revenue seance " MUST be completed by the above organizations and attached to their Forth 990 or 990-EZ Name of the organization Emplqer identification member

pPIEGNj~t,J~t,Ja« ccij, ~Kc- I Z- 3; ,41 g6qCoQnpen lion 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.'

(a) Name and address of each employee paid more (b) Title and average hours (~ Conaibutrons to (e) Expense

than $50,000 r week devoted to pos ition ~c) Compensation mployee benefit plans account and other

Aafartwl rnmnancatum all-n-

i S2

---------------------------------------------------------

umber of other employees paid over $50,000

I

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.

Total number of others receiving over E50,000 for professional services

For Paperwork Reduction Act Notice, see the Instructions for Forth 990 and Form 990-EZ. Cat No. 11285E Schedule A (Forth 990 a 990-EZ) 2002

Licr _ Cy ~r~~ D

]~~p, no c~� Lt/ ~ "~ L Nou ~J37~G~L~

----------------- ---------------------------------------

------------------------------ ------ -------------------

(a) Name and address of each independent contractor paid more than $50,000

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

--------------------------------------------------------- ------------------------------

--------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------

(b) Type of service I (c) Compensation

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990 or 990-EZ) 2002 2 Schedule A

Statements About Activities (See page 2 of the instructions .) Yes I No

3 Does the organization make grants for scholarships, fellowships, student loans, etc .? (See Note below) . . . 3 1_1 X_ 4 Do you have a section 403(b) annuity plan for your employees? . . , . . Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans from it in furtherance of its charitable programs "qualify" to receive merits rmm

Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions .)

The organization is not a private foundation because it is (Please check only ONE applicable box .) 5 ~ A church, convention of churches, or association of churches Section 170(b)(1)(A)() . 6 D A school . Section 170(b)(1)(A)() . (Also complete Part V ) 7 0 A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(n) 8 El A Federal, state, or local government or governmental unit . Section 170(b)(1)(A)(v). 9 El A medical research organization operated in conjunction with a hospital . Section 170(b)(1)(A)(u) . Enter the hospital's name, city,

and state " ------------------------------------------------------------------------------------------------------------------------------10 D An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 1170(b)(1)(A)(m)

(Also complete the Support Schedule m Part IV-A) 11a X An organization that normally receives a substantial part of it support from a governmental unit or from the general public

Section 170(b)(1)(C)(vi]i (Also complete the Support Schedule m Part IV-A .) 11b 0 A community trust Section 170(b)(1)(A)(v). (Also complete the Support Schedule in Part IV-A .) 12 El An organization that normally receives (1) more than 331h% 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 33'h% 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)

13 D An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described m : (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 we instructions (b) Line number

from above (a) Name(s) of supported organization(s)

14 [] An organization organized and operated to test for public safety Section 509(a)(4) (See page 5 of the instructions .) Schedule A (Form 990 a 990-En 2002

1 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 referendyqi? If "Yes," enter the total expenses paid or incurred in connection with the lobbying activities " $ ~J (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 .

2 During the year, has the organization, either directly or indirectly, engaged m 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 .)

a Sale, exchange, or leasing of property? , . . , . . . . . . . . .

b Lending of money or other extension of credit? . . . . . . . . . . . . . . . , . , , , , 2b

c Furnishing of goods, services, or facilities? , . . . . . . . . . . . . . . sauw~s a~~ . ,

d Payment o1` compensation (or payment or reimbursement of expenses if more than $1,000)? P~ v . . , 2d

e Transfer of any part of it income or assets? . , . . , . . . , , . . . , . . . . . . . . 2e

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Schedule A (Form 990 or 990-EZ) 2002 Page 3

Support Schedule (Complete only if you checked a box on line 10, 11, or 12 .) Use cash method of accounting. Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting Calendar year (ot fiscal year beginning in) . " (a) 2001 (b) 2000 (c) 1999 (t) 1998 (e) Total 15 Gifts, grants, and contributions received (Do

not include unusual grants See line 28) . . ~ 3~ ~t78 ~ 14 'S3 Z$ ~'rl $~ 105 o 16 Membership fees received 17 Gross receipts from admissions, merchandise

sold or senFices performed, or furnishing of facilities in any activity that is related to the 2~-13~~ ~~ gc+~ 16S 2 l organization 's charitable, etc ., purpose .

18 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 ~ 1

CS~~b !Z-~2 3,,~ J by the orga nization after June 30, 1975 . ~. / (p 19 Net incorne from unrelated business

activities not included m line 18

20 Tax revenues levied for the organization's benefit and either paid to it or expended on it behalf . ,

21 The value of services or facilities furnished to the organisation by a governmental unit without charge Do not include the value of services or facilities generally furnished to the public without charge .

22 Other income. Attach a schedule . Do not include gam or (loss) from sale of capital assets

23 Total of lines 15 through 22 24 Line 23 minus line 17 . 25 Enter 1% of line 23

26 Organizations described on lines 10 or 11 : a Enter 29'0 of amount in column (e), line 24 , . , . " Ma IITWrrv

b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental and or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 2.6a Do not file this list with your return. Enter the total of all these excess amounts " 26b

c Total support for section 509(a)(1) test Enter lin Z6 n (e) . . , . . . . . , , , , 26c -70 3 0141 d Add . Amounts from column (e) for lines 18 19 .~ "

22 0 26b I~ . . . . . " 26d 3.4 e Public support (line 26c minus line 26d total) . . . , . , . . , . , , . , . . . . " 26e ~~ . Z4 f Public support percentage pine 26e (numerator) divided by tine 26c (denominator)) , . , , . " 26t 7:3, S i-71

27 Organizations described on line 12 : a For amounts included in lines 15, 16, and 17 that were received from a "disqualified person," prepare a list for your records to show we 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 such amounts for each year

(2001) . . . . . . . . . . . . . . . . . . . . . . . . . . . (2000) .. . . . . . . . . . . . . . . . . . . . . . . . . . . (1999) .. . . . . . . . . . . . . . . . . . . . . . . . . . . (1998) --------------------------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 ale this list with your retain . 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

~J (2001) --------------------------- (2000) --------------------------- (1999) (1998)

c Add' Amounts from column (e) for lines : 15 16 17 20 21 , , , . , , " 27c

d Add . Line 27a total , and line 27b total . op. 27d e Public support (line 27c total minus line 27d total) . , , . . , . . 27 f Total support for section 509(a)(2) test Enter amount from line 23, column (e) . . " .2 g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) . . , . . . " 27 h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)). " 27h

' 28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 1998 through 2001, ', 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 `V~ A descnpuon of the nature of the grant. Do not file this list with you return . Do not include these grants m line 15 .

Schedule A (Forth 990 or 990-EZ) 2002

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35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev. Pros 73-50, 1 975-2 C.B . 587, covering racial nondiscrimination? If "No," attach an explanation . I 35

scneauae a dorm 990 or 9W-En 2002

Schedule A (Form 990 o, 990-E~ 2002 Page

" Private School Questionnaire (See page 7 of the instructions .) .1 (To be completed ONLY b schools that checked the box on line 6 in Part 11)

29 Does the organization have a racially nondiscriminatory policy toward students by statement in it charter, bylaws, Yes No

other governing instrument, or in a resolution of its governing bodes . . ,

30 Does we 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? , . . . . , . , . , . . . . . . . . . . . . . , , , , 30

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media dunng 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 we general community it serves . If "Yes," please describe ; if "No," please explain. (If you need more space, attach a separate statement)

---------------------------------------------------------------------------------------------------------------------------- ------------- -------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------

32 Does the organization maintain the following

a Records indicating the racial composition of the student body, faculty, and administrative staffs , , , , , 32a

b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32b

c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships . . . . . . , . . . . . . . , , , , , 32c

d Copies of all material used by the organization or on its behalf to solicit contributions? . . . , , , , , 32d

If you answered "No" to any of the above, please explain . (If you need more space, attach a separate statement) ------------- --------------------------------------------------------------------------------------------------------------

33 Does the organization discriminate by race m any way with respect to .

a Students' rights or privileges? , . . . . . . . . . . . . . , . .

b Admission; policies? . . . . . . . . . . . . . . . . . . .

c Employment of faculty or administrative staffs . . . . . . . . . . .

d Scholarships or other financial assistance? . . . . , . . , . , . .

e Educational policies? . . , . , , , , , , , , , , , . , , ,

f Use of facilities? . . . . . , . . . . . . . . . . . . , , ,

g Athletic programs? . . , . , . . . . . . . . . . . . . . . , . ,

h Other extracurricular activities? . . . . , . . , , . . . , . , , . ,

If you answered "Yes" to any of the above, please explain (If you need more space, attach a separate statement.) ------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

34a Does the organization receive any financial aid or assistance from a governmental agency .

b Has the aiganization'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.

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5

(b) To be completed for ALL electing organizations (The term "expenditures" means amounts paid or incurred

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) . 38 Total lobbying expenditures (add lines 36 and 37) . . . 39 Other exempt purpose expenditures . . . . . . 40 Total exempt purpose expenditures (add fines 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 1596 of the excess over $500,000 Over $1,000,1)00 but not over E1,500,000 . $175,000 plus 1096 of the excess over $1,000,000 Over $1,500,000 but not over 817,000,000 , $225,000 plus 5S'o of the excess over $1,500,000 Over $17,000,000 . . . . . . . . $1,000,000 .

42 Grassroots nontaxable amount (enter 25% of line 41) , , 43 Subtract tine 42 from line 36 . Enter -0- if line 42 is more than line 36 . 44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38 .

50 Grassroots lobbying expenditures -Lobbying Activity by Nonelecting Public Charities

(For reporting only by organizations that did not complete Part VI-A) (See page 11 of the instructions .)

During the year, did the organization attempt to influence national, state or local legislation, including any Yes No Amount 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 . . . , . . f Grants to other organizations for lobbying purposes . . . . . . g Deed 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" Go an of the above, also attach a statement giving a detailed descnption of the~lobbylng actrvrties . JIA SchedWe A (Form 990 990-En 2002

Schedule A (Form 990 a 990-EA 2002

Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions .) (To be completed ONLY by an eligible organization that filed Form 5768)

Check " a if the organization belongs to an affiliated group. Check " b 0 if you checked "a" and "limited control"

(a) Limits on Lobbying Expenditures Affiliated group

totals

N

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 tines 45 through 50 on page 11 of the instructions .)

Lobbying Expenditures During 4-Year Averaging Period

Calendar gear (or (a) (b) (c) (d) (e) fiscal year beqinninq 6n) " 2002 2001 2000 1999 Total

45 Lobbying nontaxable amount,

46 Lobbying ceiling amount (150°i6 of line 45(e)) .

47 Total lobbing expenditures

48 Grassroot~~ nontaxable amount

49 Grassroots ceding amount (150`3'0 of line 48(e))

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Schedule A (Form 990 'or 990-EZj 2002 Page

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructions .)

51 Did the reporting organization directly or indirectly engage m any of the following with any other organization described in section 501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations

a Transfers from the reporting organization to a nonchantable exempt organization of. Yes No

f1 Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51a 0i

(i) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a ii b Other transactions

(i) Sales or exchanges of assets with a nonchantable exempt organization , () Purchases of assets from a nonchantable exempt organization . . . . . . . . . . , . , b (ii) Rental of facilities, equipment, or other assets . . . , . . . . . (H Reimbursement arrangements . . . . . . . . . . . . . . (v) Loans or loan guarantees . . . . . . , . . . . . . . . . . . . . . . . . , , b(v) (vi) Performance of services or membership or fundraising solicitations . ,

c Sharing of facilities, equipment, marling lists, other assets, or paid employees . . . . . . . . . . . nc I I( 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 in column (d) the value of the goods, other assets, or services received .

52a Is the onoanization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 . . . . . . " 0 Yes )~ No

u

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PREGNANCY AID CENTERS, INC. 4809 GREENBELT ROAD COLLEGE PARK, MD 20740

23-7418649 FORM 990 FYE 06130/03

298,098 1 130,131 1 13,048 1 143,179

AMY PISANI 666 11TH ST, NW #202, WASHINGTON, DC ROSEMARY GOODWIN 5712 WARWICK PL, CHEVY CHASE, MD

PRIMUS COMMON STOCK INTEL COMMON STOCK I_EGG MASON CASH TOTAL

LAND & BUILDING & EQUIPMENT

DIRECTOR 1 HR/WEEK 0 0 0 DIRECTOR 1 HR/WEEK 0 0 0

1,542

067

Page 14: PREGN R990s.foundationcenter.org/990_pdf_archive/237/237418649/237418… · 6b, 8b, 9b, 10b, or 16 of Part l. w~ T°~~ services and genera N1 Fundraising 22 Grants and allocations

,~�� tqt kau x9p .m-atinn far Extension of time Ta File an Exempt Orl;anization Return OMQ No 1545-1709

'5W Ii- FIJI) J '<"y7alYt! 7!(t(AIGJf1011 /O( Ca1C11 (,.turn ^-

i " 1( Wl ;Iin filing firm) A(t(pql .:iil : 3-M11iI1 . CyG:ILI:RII, ca14pletc only Ratt 1 and ChCCI( this box p 11 y(q1 ,sic 111:4,g 6'm ilin QdtT, ;iP#),j! (not autn,i> >tb".) 3 "Melnlll 6xtpnsiun, complete only Part 11 (on page 2 of thus form) . iK w ; IN wit Yam l+ ;.vr, nl~ ~e~ly bet~~~ prantrQ as Jutomdlic 3-month Cxlencfrnn on a previausly filed -in dnR

P~I;~L'T.~, :1k; 3-a°with fxlarsirri of 7iMc--Only :uhmtl or{ninal (no copu~s neCCJcd) . N3Va 1'(vnl +W " ( cc.rpnrri,~urr; n:qu : slrr?q on sutcrnn(ir, fi-ma01li r".riCnsluri .-chock this box and cornnlrtc Pail 10111Y . . , ` (] All 'j ;I)v r.roy~.ra;+n ;,ti (uacirnq Fortrf 9-Al C 17 .usl if:.a Farm T(bf [a lrrpac ;r nn ca7ot Sinn of fitnP f0 6lc incnr»c fax r .~1idH ; I-:ht~r4~hriS~ r1;,A~~1f :~ r:n.l trri: r, mu;f u "~^ 1 nrn, 8/36 (v r,quC51 An CXIcnS iOn or tune ui Id4 fiY111 7065. 1066, or 1041

1 ~ ~~J :Ir~p`N~Yr'1i'E4Ulthhi, ,PMm - "-- Employer iOcnllficalionnumber C. .t~nlr~;n.5,_)+`t . Z3 '7119 L49

1 ~yr~ .p ~ ~ ~ t~ .d:yxK~ v~i "vA . .an~) ~n~kn~ ~~,au io . 1fd, E .c) 1.ix sCC ul~diU~~lon;, . r r~ LS l_(

1.b', ur ~AY~I Oih :P. NI .A^, 8f x1 llfn)i1o (ev11n :01gi1 admi4 . . . 5CC bl,ffuCllOn.

~{u' ~~` ti 1+''" ()1 ti1wn t .5 L¢ tilt :! (iitr .I .1r applwali'xi fir C .ir.il r( .,bjrn) ,F.'~tr~ka I I a 4:fa C~ F of n, 090 - T (i. at pot at ;nu) [1 Form 4720

i am 0011,1 (<<N:. .701(a) or 40"fj1 t1w,i) (~ Form 5227 . ; . ~ '0 F'A,n : 4VA' C1 L 1 Forin 3n0-1 (mist nihcr thjan about) ~] farm 6069

Fn,mRA)0 4r-+ k 11 1; ; : (lit . IWA hwr fill r4!4< <" CI ~,i::rr. V I in the uniied Srwcs. check this boa . . . . . . . r I,

ft ,t,i: v~ !m .s k,,L-ira, tact! Iho ar,~,~sv,~~t+c�rs Saar ci-cpi ( ;ranP fxempticxn NnmUrr (i3FN) , .. . I( this, Is t.ii lid,f,h,tf ; sy%Iw, dw; fin,c 1s- L-1 If It il . fro part cf the group chcclc INS biz " rj and attach ,1 Gsl w+rh the

nor. I .,, llw rxto.n_w,n VAN ctier 1 ',I rh,pas :l (.,'{ .1ulaiw, :o : 7-r.,iaoih (6-nonth, fur ')1h3..7 +_orporition) extonaon of Umr, un~l 20V.T,

I< : fitr )U(: f(W the w(J.u .wziluii 11nmed ahovi, . lho extrns(on is for the Organization's !Clam for : R i ~.~' ~~ :rl,-rirlru r~t.r 7u . . or A ff£+~trix .pr, ;~ tx:y~ .~r~,n.~ . . . . .~. 20~~-~~ncl endinij . . . . . . . . .uf,!!~C.~3,-- . . . . . . . 20V~

.2 I( uus sax y0i i :" ::A IC',!. 117,111 -t1 n-.clrnlr., CItM('Ji fh3tiLNi 11 Initial r(,wrn C] rlna1 rewin 0 Change hi accounting period

3:3 Ii I :sl, ;IPjdh : :I0k: i; :r%r r(xm .9,M-BL, 9')0-PF, 9Jfl-( 4720, or F,Qfi9, cntpr the IcimAile tax, less any la : t+t;t :lt+ . Mitt` tn :g11(f:f1"W1 . . . . . . . . . , . . . . . . . .

U if i . :i:v .lPfYAy1If,.t 1 " .1,'~; 1 rnin !)')0 PF 00 90 T, e,uCi any tclixict;.b1o trcdn ; and cstun31('1t tax papncnls 7~'.It :t ; I11411kj; 1141ir fif)rx j'l'nf ~~1rC~(1:lyliiCfll AtlnW'd ,1S d Gff'JII . , , , _ . . . , . . . _

kill, It, Gwnl fu71 : 2.1 . hltJudh+yau peyincm will ibis form, or, if rcquircJ, dcFos.t 4:r ;y rIF) w(qrft +v i! a.ipdM :f, ny u".ing Cfil' ; ; (C.A:tvavc Fc-lanl lax Haymcsit SyatnniI . Scr.

. . . . , .,. . . . .. ., w ~ .._.r- .. __ ., .r. .. ~ _.~ ._ ._-. .,...- ~Siqraturir- and UcNdiaadon

1~1i~~~ yti: K1Kk'~s pft]-C~, 1 AY.! -'v 111,11 I n'.'Yt f"4;oNpdd 1111" (tdnl Itll hrt1eq :C:i)(i pprtytnj ,".rllCduk! arno s1ilqr.riPt, and to t11C bcit ill ffl Il 1, y1~. " . ah ::Cl. .4n $ttrt.RIP' .*Ail If.~~ 17~q atil "r~~ .'.vl ~0 fv_~1fS ~Ih GA1n

1 ~n AI& fl;+' k,.;~rna~ty 1".,1dacu,ns < ~t r, crs hr,tn~U4n Cm No »Otrn

S -_

t

S

Y it ~111

Mid,

-D~ Form 8160 (u . :nno)

L I-CUUJ nun 1 l ;Uy fin HUU5INU GUUNStL 1IVU StKy1

VAX (VU. [UC4bL5JU5 r, U

4~