Short Form Return of Organization Exempt From Income Tax

Transcription

1 Form 990-EZ Short Form Return of Organization Exempt From nome Tax Under setion 501(), 57, or 4947(a)(1) of the nternal Revenue Code (exept private foundations) OMB No À¾µ¹ Open to Puli nspetion Do not enter soial seurity numers on this form as it may e made puli. Department of the Treasury nternal Revenue Servie nformation aout Form 990-EZ and its instrutions is at A For the 015 alendar year, or tax year eginning, 015, and ending, 0 B Chek if appliale: C Name of organization D Employer identifiation numer Address hange Name hange nitial return Final return/terminated Numer and street (or P.O. ox, if mail is not delivered to street address) Room/suite E Telephone numer City or town, state or provine, ountry, and ZP or foreign postal ode F Group Exemption Amended return Appliation pending JASPER, OR Numer J m m m m m m m m m m m m m m Revenue, Expenses, and Changes in Net Assets or Fund Balanes (see the instrutions for Part ) Chek if the organization used Shedule O to respond to any question in this Part m m m m m m m m m m m m m m 1 Contriutions, gifts, grants, and similar amounts reeived m m m m m 1 Program servie revenue inluding government fees and ontrats 3 Memership dues and assessments 3 4 nvestment inome m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 4 5 a Gross amount sale of assets other than inventory 5a Less: ost or other asis and sales expenses m m m m m m m m m m m 5 Gain or (loss) sale of assets other than inventory (Sutrat line 5 line 5a) m m m m m m m m m m 5 G Aounting Method: Cash Arual Other (speify) H Chek if the organization is not Wesite: required to attah Shedule B J Tax-exempt status (hek only one) - 501()(3) 501() ( ) (insert no.) 4947(a)(1) or 57 (Form 990, 990-EZ, or 990-PF). K Form of organization: Corporation Trust Assoiation Other L Add lines 5, 6, and 7 to line 9 to determine gross reeipts. f gross reeipts are 00,000 or more, or if total assets (Part, olumn (B) elow) are 500,000 or more, file Form 990 instead of Form 990-EZ Part Revenue Expenses Net Assets 6 Gaming and fundraising events a Gross inome gaming (attah Shedule G if greater than 15,000) VALDATON TRANNG NSTTUTE, NC P.O. BO 43 (541 ) m m m m m m m m m m m m m m m m m m m m m m m m m m m m Gross inome fundraising events (not inluding fundraising events reported on line 1) (attah Shedule G if the sum of suh gross inome and ontriutions exeeds 15,000) m m 6a of ontriutions 6 Less: diret expenses gaming and fundraising events m m m m 6 d Net inome or (loss) gaming and fundraising events (add lines 6a and 6 and sutrat line 6) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 7 a Gross sales of inventory, less returns and allowanes m m m m m m m 7a Less: ost of goods sold m m m m m m m m m m m m m m m m m m m m m 7 Gross profit or (loss) sales of inventory (Sutrat line 7 line 7a) 8 Other revenue (desrie in Shedule O)m m m m m m m m m m 9 Total revenue. Add lines 1,, 3, 4, 5, 6d, 7, and 8 10 Grants and similar amounts paid (list in Shedule O) 11 Benefits paid to or for memers m m m m m m m m m m 1 Salaries, other ompensation, and employee enefits m m m m m m 13 Professional fees and other payments to independent ontrators 14 Oupany, rent, utilities, and maintenane 15 Printing, puliations, postage, and shipping 16 Other expenses (desrie in Shedule O) m m ATCH 1 m m 17 Total expenses. Add lines 10 through 16 m m m m m m m 18 Exess or (defiit) for the year (Sutrat line 17 line 9) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 19 Net assets or fund alanes at eginning of year ( line 7, olumn (A)) (must agree with end-of-year figure reported on prior year's return) 19 0 Other hanges in net assets or fund alanes (explain in Shedule O) 0 1 Net assets or fund alanes at end of year. Comine lines 18 through 0 1 For Paperwork Redution At Notie, see the separate instrutions. Form 990-EZ (015) 6d ,806. 5,30 34, , , , , , ,145. 5E

2 Form 990-EZ (015) Page Part ll Balane Sheets (see the instrutions for Part ll) Chek if the organization used Shedule O to respond to any question in this Part ll m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m (A) Beginning of year m m m m m m m m m m m m m m m m m m m (B) End of year Cash, savings, and investments 3 Land and uildings 3 4 Other assets (desrie in Shedule O) 4 5 Total assets m m m m m m m m m m m m m 136, , Total liailities (desrie in Shedule O) m m m m m m m m m m m m m m m m m m 6 7 Net assets or fund alanes (line 7 of olumn (B) must agree with line 1) m m 136, ,145. Part Statement of Program Servie Aomplishments (see the instrutions for Part lll) Expenses Chek if the organization used Shedule O to respond to any question in this Part m m m (Required for setion What is the organization's primary exempt purpose? Desrie the organization's program servie aomplishments for eah of its three largest program servies, as measured y expenses. n a lear and onise manner, desrie the servies provided, the numer of persons enefited, and other relevant information for eah program title. 8 ATTACHMENT 4 ATTACHMENT 136, ,145. ATTACHMENT 3 501()(3) and 501()(4) organizations; optional for others.) 9 (Grants ) f this amount inludes foreign grants, hek here m m m m m m m 8a 68, (Grants ) f this amount inludes foreign grants, hek here m m m m m m m 9a (Grants ) f this amount inludes foreign grants, hek here m m m m m m m 30a 31 Other program servies (desrie in Shedule O) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m (Grants ) f this amount inludes foreign grants, hek here m m m m m m m 31a 3 Total program servie expenses (add lines 8a through 31a) m m m m m m m m m m m m m m m m m m m m m m m 3 Part V m m m m m m m m m m m m m m m m m m m m m m m List of Offiers, Diretors, Trustees, and Key Employees (list eah one even if not ompensated - see the instrutions for Part V) Chek if the organization used Shedule O to respond to any question in this Part V (a) Name and title () Average hours per week devoted to position () Reportale ompensation (Forms W-/1099-MSC) (if not paid, enter -0-) Health enefits, ontriutions to employee enefit plans, and deferred ompensation 68,758. (e) Estimated amount of other ompensation NAOM FEL DRECTOR 1.00 RTA ALMAN DRECTOR 1.00 FRAN BULLOFF PRESDENT 1.00 KEVN CARLN TREASURER 1.00 ED FEL DRECTOR 1.00 VCK DE KLERK-RUBN SECRETARY 1.00 STEPHEN KLOTZ DRECTOR 1.00 WAYNE OLSON DRECTOR 1.00 HEDWG NEU DRECTOR 1.00 HARVEY STERNS DRECTOR 1.00 CHARLES DE VLMORN DRECTOR 1.00 Form 990-EZ (015) 5E

3 Form 990-EZ (015) Page 3 Part V Other nformation (Note the Shedule A and personal enefit ontrat statement requirements in the instrutions for Part V) Chek if the organization used Shedule O to respond to any question in this Part V Yes No m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 33 Did the organization engage in any signifiant ativity not previously reported to the RS? f "Yes," provide a detailed desription of eah ativity in Shedule O Were any signifiant hanges made to the organizing or governing douments? f "Yes," attah a onformed opy of the amended douments if they reflet a hange to the organization's name. Otherwise, explain the hange on Shedule O (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m a Did the organization have unrelated usiness gross inome of 1,000 or more during the year usiness a 38 a 39 a 40 a d e 41 4 a a d 45 a ativities (suh as those reported on lines, 6a, and 7a, among others)? m m m m m m m m m m m m m m m m m m f "Yes," to line 35a, has the organization filed a Form 990-T for the year? f "No," provide an explanation in Shedule O m m m Was the organization a setion 501()(4), 501()(5), or 501()(6) organization sujet to setion 6033(e) notie, reporting, and proxy tax requirements during the year? f "Yes," omplete Shedule C, Part m m m m m m m m m m Did the organization undergo a liquidation, dissolution, termination, or signifiant disposition of net assets during the year? f "Yes," omplete appliale parts of Shedule N m m m m m m m m m m m m m m m m m m m m m m m m m Enter amount of politial expenditures, diret or indiret, as desried in the instrutions 37a m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m any suh loans made in a prior year and still outstanding at the end of the tax year overed y this return? m m m m m m m m m m m Did the organization file Form 110-POL for this year? Did the organization orrow, or make any loans to, any offier, diretor, trustee, or key employee or were f "Yes," omplete Shedule L, Part and enter the total amount involved 38 Setion 501()(7) organizations. Enter: nitiation fees and apital ontriutions inluded on line 9 m m m m 39a Gross reeipts, inluded on line 9, for puli use of lu failities m m m m m m m m m m m m 39 Setion 501()(3) organizations. Enter amount of tax imposed on the organization during the year under: setion 4911 ; setion 491 ; setion 4955 Setion 501()(3), 501()(4), and 501()(9) organizations. Did the organization engage in any setion 4958 exess enefit transation during the year, or did it engage in an exess enefit transation in a prior year that has not een reported on any of its prior Forms 990 or 990-EZ? f "Yes," omplete Shedule L, Part m m m Setion 501()(3), 501()(4), and 501()(9) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under setions 491, 4955, and 4958 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion 501()(3), 501()(4), and 501()(9) organizations. Enter amount of tax on line 40 reimursed y the organization m m m m m m m m m m m m m m m m m m m m m m m m m transation? f "Yes," omplete Form 8886-T m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter 40e List the states with whih a opy of this return is filed The organization's ooks are in are of VCK DE KLERK-RUBN Telephone no Loated at P.O. BO 43 JASPER, OR ZP At any time during the alendar year, did the organization have an interest in or a signature or other authority over Yes a finanial aount in a foreign ountry (suh as a ank aount, seurities aount, or other finanial aount)? 4 f "Yes," enter the name of the foreign ountry: NETHERLANDS See the instrutions for exeptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Finanial Aounts (FBAR). At any time during the alendar year, did the organization maintain an offie outside the U.S.? m m m m m m m m m m 4 f "Yes," enter the name of the foreign ountry: Setion 4947(a)(1) nonexempt haritale trusts filing Form 990-EZ in lieu of Form Chek here m m m m m m m m m m m and enter the amount of tax-exempt interest reeived or arued during the tax year 43 m m m m m m m m m Yes No Did the organization maintain any donor advised funds during the year? f "Yes," Form 990 must e ompleted instead of Form 990-EZ m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44a Did the organization operate one or more hospital failities during the year? f "Yes," Form 990 must e ompleted instead of Form 990-EZ m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44 Did the organization reeive any payments for indoor tanning servies during the year? m m m m m m m m m m m m m 44 f "Yes" to line 44, has the organization filed a Form 70 to report these payments? f "No," provide an explanation in Shedule O m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 44d Did the organization have a ontrolled entity within the meaning of setion 51()(13)? m m m m m m m m m m m m m 45a Did the organization reeive any payment or engage in any transation with a ontrolled entity within the meaning of setion 51()(13)? f "Yes," Form 990 and Shedule R may need to e ompleted instead of Form 990-EZ (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 45 Form 990-EZ (015) 5E a a 40 No

4 Form 990-EZ (015) Page 4 Yes No 46 Did the organization engage, diretly or indiretly, in politial ampaign ativities on ehalf of or in opposition to andidates for puli offie? f "Yes," omplete Shedule C, Part m m m m m m m m m m m m m m m m m m m m m m m m m 46 Part V Setion 501()(3) organizations only All setion 501()(3) organizations must answer questions and 5, and omplete the tales for lines 50 and 51. Chek if the organization used Shedule O to respond to any question in this Part V m m m m m m m m m m m m m m Yes year? f "Yes," omplete Shedule C, Part m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 47 s the organization a shool as desried in setion 170()(1)(A)(ii)? f "Yes," omplete Shedule E 48 Did the organization make any transfers to an exempt non-haritale related organization? 49a f "Yes," was the related organization a setion 57 organization? m m m m m m m m m m m m m m m m m m m m m m m m m m Did the organization engage in loying ativities or have a setion 501(h) eletion in effet during the tax a 50 Complete this tale for the organization's five highest ompensated employees (other than offiers, diretors, trustees and key employees) who eah reeived more than 100,000 of ompensation the organization. f there is none, enter "None." () Average () Reportale Health enefits, ontriutions to employee (e) Estimated amount of (a) Name and title of eah employee hours per week ompensation enefit plans, and deferred other ompensation devoted to position (Forms W-/1099-MSC) ompensation NONE No 51 Complete this tale for the organization's five highest ompensated independent ontrators who eah reeived more than 100,000 of ompensation the organization. f there is none, enter "None." f Total numer of other employees paid over 100,000 m m m m m m m (a) Name and usiness address of eah independent ontrator () Type of servie () Compensation NONE d Total numer of other independent ontrators eah reeiving over 100,000 m m m ompleted Shedule A m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Yes No 5 Did the organization omplete Shedule A? Note: All setion 501()(3) organizations must attah a Under penalties of perjury, delare that have examined this return, inluding aompanying shedules and statements, and to the est of my knowledge and elief, it is true, orret, and omplete. Delaration of preparer (other than offier) is ased on all information of whih preparer has any knowledge. Sign Here M Signature of offier M Type or print name and title VCK DE KLERK-RUBN SECRETARY Print/Type preparer's name Preparer's signature Date PTN Chek if Paid MARY ELEEN VTALE, CPA self-employed P Preparer Firm's name Use Only HW&CO Firm's EN Firm's address 340 CHAGRN BLVD., SUTE 700 Phone no CLEVELAND, OH May the RS disuss this return with the preparer shown aove? See instrutions Yes No Date m m m m m m m m m m m m m m m m m m m m Form 990-EZ (015) 5E

5 SCHEDULE A Puli Charity Status and Puli Support OMB No (Form 990 or 990-EZ) Complete if the organization is a setion 501()(3) organization or a setion 4947(a)(1) nonexempt haritale trust. À¾µ¹ Department of the Treasury Attah to Form 990 or Form 990-EZ. Open to Puli nternal Revenue Servie nformation aout Shedule A (Form 990 or 990-EZ) and its instrutions is at nspetion Name of the organization Employer identifiation numer VALDATON TRANNG NSTTUTE, NC Part Reason for Puli Charity Status (All organizations must omplete this part.) See instrutions. The organization is not a private foundation eause it is: (For lines 1 through 11, hek only one ox.) A hurh, onvention of hurhes, or assoiation of hurhes desried in setion 170()(1)(A)(i). A shool desried in setion 170()(1)(A)(ii). (Attah Shedule E (Form 990 or 990-EZ).) A hospital or a ooperative hospital servie organization desried in setion 170()(1)(A)(iii). A medial researh organization operated in onjuntion with a hospital desried in setion 170()(1)(A)(iii). Enter the hospital's name, ity, and state: 5 An organization operated for the enefit of a ollege or university owned or operated y a governmental unit desried in setion 170()(1)(A)(iv). (Complete Part.) 6 7 A federal, state, or loal government or governmental unit desried in setion 170()(1)(A)(v). An organization that normally reeives a sustantial part of its support a governmental unit or the general puli desried in setion 170()(1)(A)(vi). (Complete Part.) A ommunity trust desried in setion 170()(1)(A)(vi). (Complete Part.) An organization that normally reeives: (1) more than 331/3 % of its support ontriutions, memership fees, and gross reeipts ativities related to its exempt funtions - sujet to ertain exeptions, and () no more than 331/3 % of its support gross investment inome and unrelated usiness taxale inome (less setion 511 tax) usinesses aquired y the organization after June 30, See setion 509(a)(). (Complete Part.) An organization organized and operated exlusively to test for puli safety. See setion 509(a)(4). An organization organized and operated exlusively for the enefit of, to perform the funtions of, or to arry out the purposes of one or more pulily supported organizations desried in setion 509(a)(1) or setion 509(a)(). See setion 509(a)(3). Chek the ox in lines 11a through 11d that desries the type of supporting organization and omplete lines 11e, 11f, and 11g. a d e f g Type. A supporting organization operated, supervised, or ontrolled y its supported organization(s), typially y giving the supported organization(s) the power to regularly appoint or elet a majority of the diretors or trustees of the supporting organization. You must omplete Part V, Setions A and B. Type. A supporting organization supervised or ontrolled in onnetion with its supported organization(s), y having ontrol or management of the supporting organization vested in the same persons that ontrol or manage the supported organization(s). You must omplete Part V, Setions A and C. Type funtionally integrated. A supporting organization operated in onnetion with, and funtionally integrated with, its supported organization(s) (see instrutions). You must omplete Part V, Setions A, D, and E. Type non-funtionally integrated. A supporting organization operated in onnetion with its supported organization(s) that is not funtionally integrated. The organization generally must satisfy a distriution requirement and an attentiveness requirement (see instrutions). You must omplete Part V, Setions A and D, and Part V. Chek this ox if the organization reeived a written determination the RS that it is a Type, Type, Type funtionally integrated, or Type non-funtionally integrated supporting organization. Enter the numer of supported organizations m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Provide the following information aout the supported organization(s). (i) Name of supported organization (ii) EN (iii) Type of organization (desried on lines 1-9 aove (see instrutions)) (iv) s the organization listed in your governing doument? (v) Amount of monetary support (see instrutions) (vi) Amount of other support (see instrutions) Yes No (A) (B) (C) (D) (E) Total For Paperwork Redution At Notie, see the nstrutions for Form 990 or 990-EZ. 5E Shedule A (Form 990 or 990-EZ) 015

6 Shedule A (Form 990 or 990-EZ) 015 Page Part Support Shedule for Organizations Desried in Setions 170()(1)(A)(iv) and 170()(1)(A)(vi) (Complete only if you heked the ox on line 5, 7, or 8 of Part or if the organization failed to qualify under Part. f the organization fails to qualify under the tests listed elow, please omplete Part.) Setion A. Puli Support Calendar year (or fisal year eginning in) 1 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") m m m m m m Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf m m m m m m m 3 The value of servies or failities furnished y a governmental unit to the organization without harge 4 Total. Add lines 1 through 3 m m m m m m m 5 The portion of total ontriutions y eah person (other than a governmental unit or pulily supported organization) inluded on line 1 that exeeds % of the amount shown on line 11, olumn (f) m m m m m m m 6 Puli support. Sutrat line 5 line 4. 7 Amounts line 4 m m m m m m m m m m 8 Gross inome interest, dividends, payments reeived on seurities loans, rents, royalties and inome similar soures m m m m m m m m m m m m m m m m m Setion B. Total Support Calendar year (or fisal year eginning in) 9 Net inome unrelated usiness ativities, whether or not the usiness is regularly arried on m m m m m m m m m m 10 Other inome. Do not inlude gain or loss the sale of apital assets (Explain in Part V.) m m m m m m m m m m m (a) 011 () 01 () (e) 015 (f) Total (a) 011 () 01 () (e) 015 (f) Total 11 Total support. Add lines 7 through 10 1 Gross reeipts related ativities, et. (see instrutions) m m m m m m m m m m m m m m m m m m m m m m m m m m 1 organization, hek this ox and stop here m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion C. Computation of Puli Support Perentage 15 m m m m m m m m m m m m m m m m m m m 13 First five years. f the Form 990 is for the organization's first, seond, third, fourth, or fifth tax year as a setion 501()(3) 14 Puli support perentage for 015 (line 6, olumn (f) divided y line 11, olumn (f)) Puli support perentage 014 Shedule A, Part, line a 33 1/3 % support test f the organization did not hek the ox on line 13, and line 14 is 331/3 % or more, hek this ox and stop here. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m 33 1/3 % support test f the organization did not hek a ox on line 13 or 16a, and line 15 is 331/3 % or more, 17a hek this ox and stop here. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m 10%-fats-and-irumstanes test f the organization did not hek a ox on line 13, 16a, or 16, and line 14 is 10% or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part V how the organization meets the "fats-and-irumstanes test. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 10%-fats-and-irumstanes test f the organization did not hek a ox on line 13, 16a, 16, or 17a, and line 15 is 10% or more, and if the organization meets the "fats-and-irumstanes" test, hek this ox and stop here. Explain in Part V how the organization meets the "fats-and-irumstanes" test. The organization qualifies as a pulily supported organization m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 18 Private foundation. f the organization did not hek a ox on line 13, 16a, 16, 17a, or 17, hek this ox and see instrutions m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m % % Shedule A (Form 990 or 990-EZ) 015 5E

7 Shedule A (Form 990 or 990-EZ) 015 Page 3 Part Support Shedule for Organizations Desried in Setion 509(a)() (Complete only if you heked the ox on line 9 of Part or if the organization failed to qualify under Part. f the organization fails to qualify under the tests listed elow, please omplete Part.) Setion A. Puli Support Calendar year (or fisal year eginning in) 1 Gifts, grants, ontriutions, and memership fees reeived. (Do not inlude any "unusual grants.") Gross reeipts admissions, merhandise sold or servies performed, or failities furnished in any ativity that is related to the organization's tax-exempt purpose m m m m m m 3 Gross reeipts ativities that are not an unrelated trade or usiness under setion 513 m 4 Tax revenues levied for the organization's enefit and either paid to or expended on its ehalf m m m m m m m 5 The value of servies or failities (a) 011 () 01 () (e) 015 (f) Total furnished y a governmental unit to the organization without harge 6 Total. Add lines 1 through 5 m m m m m m m 7a Amounts inluded on lines 1,, and 3 reeived disqualified persons m m m m Amounts inluded on lines and 3 reeived other than disqualified persons that exeed the greater of 5,000 or 1% of the amount on line 13 for the year Add lines 7a and 7 m m m m m m m m m m m 8 Puli support. (Sutrat line 7 line 6.) m m m m m m m m m m m m m m m m m Setion B. Total Support Calendar year (or fisal year eginning in) 9 Amounts line 6 m m m m m m m m m m m 10 a Gross inome interest, dividends, payments reeived on seurities loans, rents, royalties and inome similar soures m m m m m m m m m m m m m m m m m Unrelated usiness taxale inome (less setion 511 taxes) usinesses aquired after June 30, 1975 Add lines 10a and 10 m m m m m m m m m 11 Net inome unrelated usiness ativities not inluded in line 10, whether or not the usiness is regularly arried on m m m m m m m m m m m m m m m 1 Other inome. Do not inlude gain or loss the sale of apital assets (Explain in Part V.) m m m m m m m m m m m 13 Total support. (Add lines 9, 10, 11, and 1.) m m m m m m m m m m m m m m m m 14 First five years. f the Form 990 is for the organization's first, seond, third, fourth, or fifth tax year as a setion 501()(3) organization, hek this ox and stop here m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Setion C. Computation of Puli Support Perentage 15 Puli support perentage for 015 (line 8, olumn (f) divided y line 13, olumn (f)) Puli support perentage 014 Shedule A, Part, line 15 m m m m m m m m m m m m m m m m m m m m m m m 16 Setion D. Computation of nvestment nome Perentage 17 nvestment inome perentage for 015 (line 10, olumn (f) divided y line 13, olumn (f)) nvestment inome perentage 014 Shedule A, Part, line 17 m m m m m m m m m m m m m m m m m m m m a 33 1/3 % support tests f the organization did not hek the ox on line 14, and line 15 is more than 331/3 %, and line 17 is not more than 331/3 %, hek this ox and stop here. The organization qualifies as a pulily supported organization 33 1/3 % support tests f the organization did not hek a ox on line 14 or line 19a, and line 16 is more than 331/3 %, and line 18 is not more than 331/3 %, hek this ox and stop here. The organization qualifies as a pulily supported organization 0 Private foundation. f the organization did not hek a ox on line 14, 19a, or 19, hek this ox and see instrutions (a) 011 () 01 () (e) 015 (f) Total Shedule A (Form 990 or 990-EZ) 015 5E ,30 5,30 % % % % 34, , , , , , , , ,

8 Shedule A (Form 990 or 990-EZ) 015 Page 4 Part V Supporting Organizations (Complete only if you heked a ox in line 11 of Part. f you heked 11a of Part, omplete Setions A and B. f you heked 11 of Part, omplete Setions A and C. f you heked 11 of Part, omplete Setions A, D, and E. f you heked 11d of Part, omplete Setions A and D, and omplete Part V.) Setion A. All Supporting Organizations Yes No 1 3a 4a 5a 9a Are all of the organization s supported organizations listed y name in the organization s governing douments? f "No," desrie in Part V how the supported organizations are designated. f designated y lass or purpose, desrie the designation. f histori and ontinuing relationship, explain. 1 Did the organization have any supported organization that does not have an RS determination of status under setion 509(a)(1) or ()? f "Yes," explain in Part V how the organization determined that the supported organization was desried in setion 509(a)(1) or (). Did the organization have a supported organization desried in setion 501()(4), (5), or (6)? f "Yes," answer () and () elow. Did the organization onfirm that eah supported organization qualified under setion 501()(4), (5), or (6) and satisfied the puli support tests under setion 509(a)()? f "Yes," desrie in Part V when and how the organization made the determination. Did the organization ensure that all support to suh organizations was used exlusively for setion 170()()(B) purposes? f "Yes," explain in Part V what ontrols the organization put in plae to ensure suh use. Was any supported organization not organized in the United States ("foreign supported organization")? f "Yes," and if you heked 11a or 11 in Part, answer () and () elow. Did the organization have ultimate ontrol and disretion in deiding whether to make grants to the foreign supported organization? f "Yes," desrie in Part V how the organization had suh ontrol and disretion despite eing ontrolled or supervised y or in onnetion with its supported organizations. Did the organization support any foreign supported organization that does not have an RS determination under setions 501()(3) and 509(a)(1) or ()? f "Yes," explain in Part V what ontrols the organization used to ensure that all support to the foreign supported organization was used exlusively for setion 170()()(B) purposes. Did the organization add, sustitute, or remove any supported organizations during the tax year? f "Yes," answer () and () elow (if appliale). Also, provide detail in Part V, inluding (i) the names and EN numers of the supported organizations added, sustituted, or removed; (ii) the reasons for eah suh ation; (iii) the authority under the organization's organizing doument authorizing suh ation; and (iv) how the ation was aomplished (suh as y amendment to the organizing doument). Type or Type only. Was any added or sustituted supported organization part of a lass already designated in the organization's organizing doument? Sustitutions only. Was the sustitution the result of an event eyond the organization's ontrol? 6 Did the organization provide support (whether in the form of grants or the provision of servies or failities) to a anyone other than (i) its supported organizations, (ii) individuals that are part of the haritale lass enefited y one or more of its supported organizations, or (iii) other supporting organizations that also support or enefit one or more of the filing organization s supported organizations? f "Yes," provide detail in Part V. Did the organization provide a grant, loan, ompensation, or other similar payment to a sustantial ontriutor (defined in setion 4958()(3)(C)), a family memer of a sustantial ontriutor, or a 35% ontrolled entity with regard to a sustantial ontriutor? f "Yes," omplete Part of Shedule L (Form 990 or 990-EZ). Did the organization make a loan to a disqualified person (as defined in setion 4958) not desried in line 7? f "Yes," omplete Part of Shedule L (Form 990 or 990-EZ). Was the organization ontrolled diretly or indiretly at any time during the tax year y one or more disqualified persons as defined in setion 4946 (other than foundation managers and organizations desried in setion 509(a)(1) or ())? f "Yes," provide detail in Part V. Did one or more disqualified persons (as defined in line 9a) hold a ontrolling interest in any entity in whih the supporting organization had an interest? f "Yes," provide detail in Part V. Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal enefit, assets in whih the supporting organization also had an interest? f "Yes," provide detail in Part V. Was the organization sujet to the exess usiness holdings rules of setion 4943 eause of setion 4943(f) (regarding ertain Type supporting organizations, and all Type non-funtionally integrated supporting organizations)? f "Yes," answer 10 elow. Did the organization have any exess usiness holdings in the tax year? (Use Shedule C, Form 470, to determine whether the organization had exess usiness holdings.) Shedule A (Form 990 or 990-EZ) 015 3a 3 3 4a 4 4 5a a a 10 5E

9 Shedule A (Form 990 or 990-EZ) 015 Page 5 Part V Supporting Organizations (ontinued) 11 Has the organization aepted a gift or ontriution any of the following persons? a A person who diretly or indiretly ontrols, either alone or together with persons desried in () and () elow, the governing ody of a supported organization? A family memer of a person desried in (a) aove? A 35% ontrolled entity of a person desried in (a) or () aove? f Yes to a,, or, provide detail in Part V. Setion B. Type Supporting Organizations 1 Did the diretors, trustees, or memership of one or more supported organizations have the power to regularly appoint or elet at least a majority of the organization s diretors or trustees at all times during the tax year? f "No," desrie in Part V how the supported organization(s) effetively operated, supervised, or ontrolled the organization s ativities. f the organization had more than one supported organization, desrie how the powers to appoint and/or remove diretors or trustees were alloated among the supported organizations and what onditions or restritions, if any, applied to suh powers during the tax year. Did the organization operate for the enefit of any supported organization other than the supported organization(s) that operated, supervised, or ontrolled the supporting organization? f "Yes," explain in Part V how providing suh enefit arried out the purposes of the supported organization(s) that operated, supervised, or ontrolled the supporting organization. Setion C. Type Supporting Organizations 1 Were a majority of the organization s diretors or trustees during the tax year also a majority of the diretors or trustees of eah of the organization s supported organization(s)? f "No," desrie in Part V how ontrol or management of the supporting organization was vested in the same persons that ontrolled or managed the supported organization(s). Setion D. All Type Supporting Organizations 1 Did the organization provide to eah of its supported organizations, y the last day of the fifth month of the organization s tax year, (i) a written notie desriing the type and amount of support provided during the prior tax year, (ii) a opy of the Form 990 that was most reently filed as of the date of notifiation, and (iii) opies of the organization s governing douments in effet on the date of notifiation, to the extent not previously provided? Were any of the organization s offiers, diretors, or trustees either (i) appointed or eleted y the supported organization(s) or (ii) serving on the governing ody of a supported organization? f "No," explain in Part V how the organization maintained a lose and ontinuous working relationship with the supported organization(s). 11a Yes No Yes No Yes No Yes No 3 By reason of the relationship desried in (), did the organization s supported organizations have a signifiant voie in the organization s investment poliies and in direting the use of the organization s inome or assets at all times during the tax year? f "Yes," desrie in Part V the role the organization s supported organizations played in this regard. 3 Setion E. Type Funtionally-ntegrated Supporting Organizations 1 Chek the ox next to the method that the organization used to satisfy the ntegral Part Test during the year (see instrutions): a The organization satisfied the Ativities Test. Complete line elow. The organization is the parent of eah of its supported organizations. Complete line 3 elow. The organization supported a governmental entity. Desrie in Part V how you supported a government entity (see instrutions). Ativities Test. Answer (a) and () elow. Yes No a Did sustantially all of the organization s ativities during the tax year diretly further the exempt purposes of the supported organization(s) to whih the organization was responsive? f "Yes," then in Part V identify those supported organizations and explain how these ativities diretly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these ativities onstituted sustantially all of its ativities. Did the ativities desried in (a) onstitute ativities that, ut for the organization s involvement, one or more of the organization s supported organization(s) would have een engaged in? f "Yes," explain in Part V the reasons for the organization s position that its supported organization(s) would have engaged in these ativities ut for the organization s involvement. 3 Parent of Supported Organizations. Answer (a) and () elow. a Did the organization have the power to regularly appoint or elet a majority of the offiers, diretors, or trustees of eah of the supported organizations? Provide details in Part V. Did the organization exerise a sustantial degree of diretion over the poliies, programs, and ativities of eah of its supported organizations? f "Yes," desrie in Part V the role played y the organization in this regard. a 3a 3 Shedule A (Form 990 or 990-EZ) 015 5E

10 Shedule A (Form 990 or 990-EZ) 015 Page 6 Part V Type Non-Funtionally ntegrated 509(a)(3) Supporting Organizations 1 Chek here if the organization satisfied the ntegral Part Test as a qualifying trust on Nov. 0, 197 See instrutions. All other Type non-funtionally integrated supporting organizations must omplete Setions A through E. Setion A - Adjusted Net nome (A) Prior Year (B) Current Year (optional) 1 Net short-term apital gain 1 Reoveries of prior-year distriutions 3 Other gross inome (see instrutions) 3 4 Add lines 1 through Depreiation and depletion 5 6 Portion of operating expenses paid or inurred for prodution or olletion of gross inome or for management, onservation, or maintenane of property held for prodution of inome (see instrutions) 6 7 Other expenses (see instrutions) 7 8 Adjusted Net nome (sutrat lines 5, 6 and 7 line 4) 8 Setion B - Minimum Asset Amount 1 Aggregate fair market value of all non-exempt-use assets (see instrutions for short tax year or assets held for part of year): a Average monthly value of seurities Average monthly ash alanes Fair market value of other non-exempt-use assets d Total (add lines 1a, 1, and 1) e Disount laimed for lokage or other fators (explain in detail in Part V): Aquisition indetedness appliale to non-exempt-use assets 3 Sutrat line line 1d 3 4 Cash deemed held for exempt use. Enter 1-1/% of line 3 (for greater amount, see instrutions). 5 Net value of non-exempt-use assets (sutrat line 4 line 3) 6 Multiply line 5 y Reoveries of prior-year distriutions 8 Minimum Asset Amount (add line 7 to line 6) 1a 1 1 1d (A) Prior Year (B) Current Year (optional) Setion C - Distriutale Amount Current Year 1 Adjusted net inome for prior year ( Setion A, line 8, Column A) 1 Enter 85% of line 1 3 Minimum asset amount for prior year ( Setion B, line 8, Column A) 3 4 Enter greater of line or line nome tax imposed in prior year 5 6 Distriutale Amount. Sutrat line 5 line 4, unless sujet to emergeny temporary redution (see instrutions) 7 Chek here if the urrent year is the organization's first as a non-funtionally-integrated Type supporting organization (see instrutions). 6 Shedule A (Form 990 or 990-EZ) 015 5E

11 Shedule A (Form 990 or 990-EZ) 015 Page 7 Part V Type Non-Funtionally ntegrated 509(a)(3) Supporting Organizations (ontinued) Setion D - Distriutions a d e f g h i j a a d e Amounts paid to supported organizations to aomplish exempt purposes Amounts paid to perform ativity that diretly furthers exempt purposes of supported organizations, in exess of inome ativity Administrative expenses paid to aomplish exempt purposes of supported organizations Amounts paid to aquire exempt-use assets Qualified set-aside amounts (prior RS approval required) Other distriutions (desrie in Part V). See instrutions. Total annual distriutions. Add lines 1 through 6. Distriutions to attentive supported organizations to whih the organization is responsive (provide details in Part V). See instrutions. Distriutale amount for 015 Setion C, line 6 Line 8 amount divided y Line 9 amount Setion E - Distriution Alloations (see instrutions) Distriutale amount for 015 Setion C, line 6 Underdistriutions, if any, for years prior to 015 (reasonale ause required-see instrutions) Exess distriutions arryover, if any, to 015: m m m m m m m m From 013 From 014 Total of lines 3a through e Applied to underdistriutions of prior years Applied to 015 distriutale amount Carryover 010 not applied (see instrutions) Remainder. Sutrat lines 3g, 3h, and 3i 3f. Distriutions for 015 Setion D, line 7: Applied to underdistriutions of prior years Applied to 015 distriutale amount Remainder. Sutrat lines 4a and 4 4. Remaining underdistriutions for years prior to 015, if any. Sutrat lines 3g and 4a line (if amount greater than zero, see instrutions). Remaining underdistriutions for 015. Sutrat lines 3h and 4 line 1 (if amount greater than zero, see instrutions). Exess distriutions arryover to 016. Add lines 3j and 4. Breakdown of line 7: Exess 013 Exess 014 Exess 015 m m m m m m m m (i) Exess Distriutions (ii) Underdistriutions Pre-015 Current Year (iii) Distriutale Amount for 015 Shedule A (Form 990 or 990-EZ) 015 5E

12 Shedule B (Form 990, 990-EZ, or 990-PF) Department of the Treasury nternal Revenue Servie Name of the organization Shedule of Contriutors Attah to Form 990, Form 990-EZ, or Form 990-PF. nformation aout Shedule B (Form 990, 990-EZ, or 990-PF) and its instrutions is at VALDATON TRANNG NSTTUTE, NC Organization type (hek one): OMB No À¾µ¹ Employer identifiation numer Filers of: Form 990 or 990-EZ Setion: 501()( 3 ) (enter numer) organization 4947(a)(1) nonexempt haritale trust not treated as a private foundation 57 politial organization Form 990-PF 501()(3) exempt private foundation 4947(a)(1) nonexempt haritale trust treated as a private foundation 501()(3) taxale private foundation Chek if your organization is overed y the General Rule or a Speial Rule. Note. Only a setion 501()(7), (8), or (10) organization an hek oxes for oth the General Rule and a Speial Rule. See instrutions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that reeived, during the year, ontriutions totaling 5,000 or more (in money or property) any one ontriutor. Complete Parts and. See instrutions for determining a ontriutor's total ontriutions. Speial Rules For an organization desried in setion 501()(3) filing Form 990 or 990-EZ that met the 33 1/3 % support test of the regulations under setions 509(a)(1) and 170()(1)(A)(vi), that heked Shedule A (Form 990 or 990-EZ), Part, line 13, 16a, or 16, and that reeived any one ontriutor, during the year, total ontriutions of the greater of (1) 5,000 or () % of the amount on (i) Form 990, Part V, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts and. For an organization desried in setion 501()(7), (8), or (10) filing Form 990 or 990-EZ that reeived any one ontriutor, during the year, total ontriutions of more than 1,000 exlusively for religious, haritale, sientifi, literary, or eduational purposes, or for the prevention of ruelty to hildren or animals. Complete Parts,, and. For an organization desried in setion 501()(7), (8), or (10) filing Form 990 or 990-EZ that reeived any one ontriutor, during the year, ontriutions exlusively for religious, haritale, et., purposes, ut no suh ontriutions totaled more than 1,00 f this ox is heked, enter here the total ontriutions that were reeived during the year for an exlusively religious, haritale, et., purpose. Do not omplete any of the parts unless the General Rule applies to this organization eause it reeived nonexlusively religious, haritale, et., ontriutions totaling 5,000 or more during the year m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Caution. An organization that is not overed y the General Rule and/or the Speial Rules does not file Shedule B (Form 990, 990-EZ, or 990-PF), ut it must answer "No" on Part V, line, of its Form 990; or hek the ox on line H of its Form 990-EZ or on its Form 990-PF, Part, line, to ertify that it does not meet the filing requirements of Shedule B (Form 990, 990-EZ, or 990-PF). For Paperwork Redution At Notie, see the nstrutions for Form 990, 990-EZ, or 990-PF. Shedule B (Form 990, 990-EZ, or 990-PF) (015) 5E

13 Shedule B (Form 990, 990-EZ, or 990-PF) (015) Page Name of organization VALDATON TRANNG NSTTUTE, NC Part Contriutors (see instrutions). Use dupliate opies of Part if additional spae is needed. Employer identifiation numer (a) No. () Name, address, and ZP + 4 () Total ontriutions Type of ontriution (a) No. 1 VCK DE KLERK-RUBN Person Payroll E SWEELNCKSTRAAT 99 5,00 Nonash THE HAUGE NETHERLANDS 517 () Name, address, and ZP + 4 () Total ontriutions (Complete Part for nonash ontriutions.) Type of ontriution Person Payroll Nonash (Complete Part for nonash ontriutions.) (a) No. () Name, address, and ZP + 4 () Total ontriutions Type of ontriution Person Payroll Nonash (Complete Part for nonash ontriutions.) (a) No. () Name, address, and ZP + 4 () Total ontriutions Type of ontriution Person Payroll Nonash (Complete Part for nonash ontriutions.) (a) No. () Name, address, and ZP + 4 () Total ontriutions Type of ontriution Person Payroll Nonash (Complete Part for nonash ontriutions.) (a) No. () Name, address, and ZP + 4 () Total ontriutions Type of ontriution Person Payroll Nonash (Complete Part for nonash ontriutions.) 5E Shedule B (Form 990, 990-EZ, or 990-PF) (015)

14 Shedule B (Form 990, 990-EZ, or 990-PF) (015) Page 3 Name of organization Employer identifiation numer VALDATON TRANNG NSTTUTE, NC Part Nonash Property (see instrutions). Use dupliate opies of Part if additional spae is needed Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived Part () Desription of nonash property given () FMV (or estimate) (see instrutions) Date reeived 5E Shedule B (Form 990, 990-EZ, or 990-PF) (015)

15 Shedule B (Form 990, 990-EZ, or 990-PF) (015) Page 4 Name of organization Employer identifiation numer Part Part VALDATON TRANNG NSTTUTE, NC Exlusively religious, haritale, et., ontriutions to organizations desried in setion 501()(7), (8), or (10) that total more than 1,000 for the year any one ontriutor. Complete olumns (a) through (e) and the following line entry. For organizations ompleting Part, enter the total of exlusively religious, haritale, et., ontriutions of 1,000 or less for the year. (Enter this information one. See instrutions.) Use dupliate opies of Part if additional spae is needed. () Purpose of gift () Use of gift Desription of how gift is held (e) Transfer of gift Transferee's name, address, and ZP + 4 Relationship of transferor to transferee Part () Purpose of gift () Use of gift Desription of how gift is held (e) Transfer of gift Transferee's name, address, and ZP + 4 Relationship of transferor to transferee Part () Purpose of gift () Use of gift Desription of how gift is held (e) Transfer of gift Transferee's name, address, and ZP + 4 Relationship of transferor to transferee Part () Purpose of gift () Use of gift Desription of how gift is held (e) Transfer of gift Transferee's name, address, and ZP + 4 Relationship of transferor to transferee 5E Shedule B (Form 990, 990-EZ, or 990-PF) (015)

16 SCHEDULE O (Form 990 or 990-EZ) Department of the Treasury nternal Revenue Servie Name of the organization Supplemental nformation to Form 990 or 990-EZ Complete to provide information for responses to speifi questions on Form 990 or 990-EZ or to provide any additional information. Attah to Form 990 or 990-EZ. OMB No À¾µ¹ Open to Puli nspetion Employer identifiation numer VALDATON TRANNG NSTTUTE, NC FORM 990EZ, PART - OTHER EPENSES ATTACHMENT 1 ADMNSTRATVE FEES 6,00 BANK CHARGES 74 WEBSTE MANTENANCE 5,99 PROFESSONAL COURSES 1,373. TRANSLATON FEES 14,36. TOTAL 68,339. ATTACHMENT FORM 990EZ, PART - CASH, SAVNGS AND NVESTMENTS BEGNNNG END DESCRPTON OF YEAR OF YEAR CASH 136, ,145. TOTALS 136, ,145. FORM 990EZ, PART - ORGANZATON'S PRMARY EEMPT PURPOSE ATTACHMENT 3 TO ENHANCE RESPECT AND COMMUNCATON BETWEEN PEOPLE LVNG WTH DEMENTA AND THER CARGVERS WHLE BRNGNG THEM TOGETHER THROUGH BETTER COMMUNCATON. FORM 990EZ, PART - STATEMENT OF PROGRAM SERVCE ACCOMPLSHMENTS PROGRAM SERVCE ACCOMPLSHMENT 1 -DEVELOPMENT OF TRANNG CENTERS THAT OFFER VALDATON TRANNG AND ENFORMATON. -DEVELOP AND MANTAN QUALTY STANDARDS FOR CURRCULA, TRANNG MATERALS AND THE SPREADNG OF VALDATON NFORMATON. -DEVELOP CURRCULA AND TRANNG MATERALS ON THE VALDATON ATTACHMENT 4 For Privay At and Paperwork Redution At Notie, see the nstrutions for Form 990 or 990-EZ. Shedule O (Form 990 or 990-EZ) (015) 5E

17 Shedule O (Form 990 or 990-EZ) 015 Page Name of the organization VALDATON TRANNG NSTTUTE, NC FORM 990EZ, PART - STATEMENT OF PROGRAM SERVCE ACCOMPLSHMENTS METHOD. -TRANSLATON OF ALL MATERALS NTO LANGUAGES SERVED BY TRANNG CENTERS. -SUPPORT TRANNG CENTERS AND CERTFED NDVDUALS. -MANTAN NTERNET BASED NFORMATON AND COMMUNCATON AMONG PEOPLE NSTERESTED N VALDATON. Employer identifiation numer ATTACHMENT 4 (CONT'D) 5E Shedule O (Form 990 or 990-EZ) 015