Puli Dislosure for Tx-Exempt Orgniztions Tx-exempt orgniztions re require to mke opy of their pplition for exemption n Form(s) 990 (n 990-T, if pplile) ville for puli inspetion n to provie opies of suh forms to iniviuls or orgniztions tht request opies. Alterntively, the nternet my e use to mke these ouments ville. (See the Using the nternet setion whih follows.) These rules pply to n orgniztion s Form(s) 990 (n 990-T, if pplile) for the lst three yers n to its pplition for exemption. 1 f the pplition ws file prior to July 15, 1987, islosure is not require unless the orgniztion h opy of the pplition on July 15, 1987. An orgniztion my omit nmes n resses of ontriutors from its return(s). Filure to omply with islosure requirements n result in n enforement tion y the RS. While islosure rules rete n itionl uren, they lso provie n opportunity for your orgniztion to showse the ommunity enefits tht it provies. The rules lso heighten the nee to refully review ll responses, inluing nrrtive explntions, ontine on your Form(s) 990/990-T efore filing. Where Must nformtion Be Provie? Generlly, n orgniztion must mke its ouments ville for puli inspetion t ny lotion where it hs three or more employees. f the only servies provie t the site re in furtherne of exempt purposes n the site oes not serve s n offie for mngement stff, the ouments re not require to e me ville there. How Quikly Must Orgniztions Reply? Requests for opies n e me in person or in writing. When requests re me in person, the opies must generlly e provie on the sme usiness y. There re provisions for elys ue to unusul irumstnes. However, in no event my the perio of ely exee five usiness ys. Unusul irumstnes inlue times when those stff tht re ple of fulfilling request re sent. Written Requests Requeste opies generlly must e mile within 30 ys from the te of the reeipt of the written request. However, if the orgniztion requires vne pyment of resonle fee for opying n postge, it my provie the opies within 30 ys from the te it reeives pyment rther thn the te of the originl request. Wht Cn n Orgniztion Chrge? You re urrently llowe to hrge mximum fee of $.20 ents per pge in ition to tul postge osts. 1 Certin informtion within n pplition for exemption n e withhel from puli inspetion if puli vilility woul versely ffet the orgniztion, e.g., informtion relting to tre seret, ptent, proess, style of work or pprtus of the orgniztion. BKD TAX506 9-11 Puli Dislosure Rules
-2- f ny orgniztion reeives written request for opies with no pyment enlose n the orgniztion requires pyment in vne, the orgniztion must request pyment within seven ys from the te it reeive the request. An orgniztion is require to ept personl hek for written requests if it oes not ept pyment y reit r. f n orgniztion oes not require prepyment n the requester oes not enlose prepyment with the request, the orgniztion must reeive onsent from requester efore proviing opies for whih the fee hrge for opying n postge woul e in exess of $20. Lol or Suorinte Orgniztions A lol or suorinte orgniztion tht is overe y group exemption letter is given itionl time for responing to some requests. f this type of orgniztion reeives request me in person for inspetion of its pplition for tx exemption, the lol orgniztion is require to quire n mke ville the pplition for group exemption letter file y the entrl or prent orgniztion within not more thn two weeks. The sme generl rule woul pply with respet to lol or suorinte orgniztion tht oes not file its own Form(s) 990/990-T ut is overe uner group return. Agin, the lol or suorinte orgniztion must mke the group return ville for inspetion within resonle perio whih is efine s not more thn two weeks. f the group return inlues seprte sheules with respet to eh lol or suorinte orgniztion, the lol or suorinte orgniztion my exlue or omit ny sheules relting only to other orgniztions whih re inlue in the group return. f request is me for personl inspetion to lol or suorinte orgniztion, it hs the option of miling the return to the requester rther thn llowing n inspetion. However, if this is one, the lol or suorinte orgniztion my not hrge for the opying of the oument unless the requester onsents to the hrge. f lol or suorinte orgniztion reeives request for opies, then it must omply with the rules stte previously. Using the nternet As n lterntive to proviing opies, n orgniztion my provie ess to its exemption pplition n Form(s) 990 (n 990-T, if pplile) through the nternet. The wesite must provie instrutions for ownloing the oument(s). The informtion on the nternet must e in suh formt tht it my e esse, ownloe, viewe or printe in the sme formt s the tul ouments. An orgniztion woul nee to mke the we ress ville to the generl puli. There is nothing tht prevents others from posting your Forms 990, 990-T n exemption pplition on the nternet. Bse on this ft n the potentil strin on your orgniztion s resoures from proviing opies, orgniztions shoul onsier posting these ouments on the nternet. Wht if the Requests Are Form of Hrssment? f n orgniztion elieves it is sujet to hrssment mpign, it n file n pplition for hrssment etermintion with the nternl Revenue Servie. This woul llow the orgniztion to suspen ompline with these requests. n ition, n orgniztion my isregr requests for opies in exess of two per month or four per yer me y single iniviul or sent from single ress, without sumitting n pplition for hrssment etermintion. Plese ontt your BKD visor if you hve questions out these rules. BKD TAX506 9-11 Puli Dislosure Rules
Exempt Orgniztion Business nome Tx Return OMB No. 1545-0687 Form 990-T (n proxy tx uner setion 6033(e)) For lenr yer 2014 or other tx yer eginning, 2014, n ening, 20. À¾µ Deprtment of the Tresury nformtion out Form 990-T n its instrutions is ville t www.irs.gov/form990t. nternl Revenue Servie Open to Puli nspetion for Do not enter SSN numers on this form s it my e me puli if your orgniztion is 501(). 501() Orgniztions Only Chek ox if Nme of orgniztion ( Chek ox if nme hnge n see instrutions.) D Employer ientifition numer A ress hnge (Employees' trust, see instrutions.) B Exempt uner setion CONVOY OF HOPE X 501( C )( 3 ) Print Numer, street, n room or suite no. f P.O. ox, see instrutions. 68-0051386 or 408(e) 220(e) E Type 408A 530() 330 S. PATTERSON AVE. 529() C Book vlue of ll ssets t en of yer F City or town, stte or provine, ountry, n ZP or foreign postl oe Group exemption numer (See instrutions.) Unrelte usiness tivity oes (See instrutions.) G Chek orgniztion type 501() orportion 501() trust 401() trust Other trust H Desrie the orgniztion's primry unrelte usiness tivity. m m m m m m m During the tx yer, ws the orportion susiiry in n ffilite group or prent-susiiry ontrolle group? Yes No f "Yes," enter the nme n ientifying numer of the prent orportion. J The ooks re in re of Telephone numer Prt Unrelte Tre or Business nome (A) nome (B) Expenses (C) Net 1 Gross reeipts or sles Less returns n llownes Blne 1 2 Cost of goos sol (Sheule A, line 7) 2 3 4 5 6 7 8 9 10 11 12 Gross profit. Sutrt line 2 from line 1 Cpitl gin net inome (tth Sheule D) Net gin (loss) (Form 4797, Prt, line 17) (tth Form 4797) Cpitl loss eution for trusts nome (loss) from prtnerships n S orportions (tth sttement) Rent inome (Sheule C) m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Unrelte et-finne inome (Sheule E) nterest, nnuities, roylties, n rents from ontrolle orgniztions (Sheule F) nvestment inome of setion 501()(7), (9), or (17) orgniztion (Sheule G) Exploite exempt tivity inome (Sheule ) Avertising inome (Sheule J) Other inome (See instrutions; tth sheule) 13 Totl. Comine lines 3 through 12 Prt 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 36,626,954. X SPRNGFELD, MO 65802 531120 m m m m m m m m m m m m m m m m m m m m m RENT OF DEBT-FNANCED REAL ESTATE 3 4 4 4 5 6 7 8 9 10 11 12 MARK METZGER 417-851-4445 13 366,441. 211,603. 154,838. Deutions Not Tken Elsewhere (See instrutions for limittions on eutions.) (Exept for ontriutions, eutions must e iretly onnete with the unrelte usiness inome.) Compenstion of offiers, iretors, n trustees (Sheule K) Slries n wges m m m Repirs n mintenne B ets m m m m m m m nterest (tth sheule) Txes n lienses m m m m m m m m m m m m m m m m m m m m Chritle ontriutions (See instrutions for limittion rules) m m m m m m m m m m m m m m m m Depreition (tth Form 4562) m m m m m m m m m m m m m m m m m 21 Less epreition lime on Sheule A n elsewhere on return 22 Depletion m m m m m m m m m m m m m m m m m m Contriutions to eferre ompenstion plns Employee enefit progrms m m m m m Exess exempt expenses (Sheule ) Exess reership osts (Sheule J) Other eutions (tth sheule) m m m m Totl eutions. A lines 14 through 28 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Unrelte usiness txle inome efore net operting loss eution. Sutrt line 29 from line 13 Net operting loss eution (limite to the mount on line 30) m m m m m m m m m m m m m m Unrelte usiness txle inome efore speifi eution. Sutrt line 31 from line 30 Speifi eution (Generlly $1,000, ut see line 33 instrutions for exeptions) m m m m m m m m m m m m m m m m Unrelte usiness txle inome. Sutrt line 33 from line 32. f line 33 is greter thn line 32, enter the smller of zero or line 32 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 366,441. 211,603. 154,838. For Pperwork Reution At Notie, see instrutions. Form 990-T (2014) 4X2740 2.000 14 15 16 17 18 19 20 22 23 24 25 26 27 28 29 30 31 32 33 34 X 7,621. 14,622. 22,243. 132,595. 132,595. 1,000. 131,595. 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 53
CONVOY OF HOPE EN: 68-0051386 Chritle Contriution Crryover Sheule 12/31/2014 Amount Chritle Contriution Crryover to 2008 - Chritle Contriutions pi uring 2008 277,111 Unrelte Business nome prior to Chritles $ 217,977 eution limittion % 10% 2008 Chritle eution 21,798 Chritle Contriution Crryover to 2009 255,313 Chritle Contriutions pi uring 2009 307,189 Unrelte Business nome prior to Chritles $ 247,629 eution limittion % 10% 2009 Chritle eution 24,763 Chritle Contriution Crryover to 2010 537,739 Chritle Contriutions pi uring 2010 497,796 Unrelte Business nome prior to Chritles 224,795 eution limittion % 10% 2010 Chritle eution 22,479 Chritle Contriution Crryover to 2011 1,013,056 Chritle Contriutions pi uring 2011 735,347 Unrelte Business nome prior to Chritles 206,594 eution limittion % 10% 2011 Chritle eution 20,659 Chritle Contriution Crryover to 2012 1,727,744 Chritle Contriutions pi uring 2012 2,390,102 Unrelte Business nome prior to Chritles 190,493 eution limittion % 10% 2012 Chritle eution 19,049 Chritle Contriution Crryover to 2013 4,098,797 Chritle Contriutions pi uring 2013 2,346,140 Unrelte Business nome prior to Chritles 139,197 eution limittion % 10% 2013 Chritle eution 13,920 Chritle Contriution Crryover to 2014 6,431,017 Chritle Contriutions pi uring 2014 TBD Unrelte Business nome prior to Chritles 146,217 eution limittion % 10% 2014 Chritle eution 14,622 Chritle Contriution Crryover to 2015 6,416,395
CONVOY OF HOPE 68-0051386 Prt Tx Computtion 35 Orgniztions Txle s Corportions. See instrutions for tx omputtion. Controlle group Form 990-T (2014) Pge 2 memers (setions 1561 n 1563) hek here See instrutions n: Enter your shre of the $50,000, $25,000, n $9,925,000 txle inome rkets (in tht orer): $ $ $ Enter orgniztion's shre of: Aitionl 5% tx (not more thn $11,750) m m m m m m m $ $ Aitionl 3% tx (not more thn $100,000) nome tx on the mount on line 34 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 36 Trusts Txle t Trust Rtes. See instrutions for tx omputtion. nome tx on Tx rte sheule or Sheule D (Form 1041) 36 the mount on line 34 from: 37 Proxy tx. See instrutions 37 38 Alterntive minimum tx m m m m m m m m m m m m m m m m m m 38 39 Totl. A lines 37 n 38 to line 35 or 36, whihever pplies m m m m m m m m m m m m m m m m m m m m m m m m m m 39 Prt V Tx n Pyments 40 Foreign tx reit (orportions tth Form 1118; trusts tth Form 1116)m 40 Other reits (see instrutions) m m m m m m m m m m m m m m m 40 Generl usiness reit. Atth Form 3800 (see instrutions) m 40 Creit for prior yer minimum tx (tth Form 8801 or 8827)m 40 e Totl reits. A lines 40 through 40 40e 41 Sutrt line 40e from line 39 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 41 42 Other txes. Chek if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (tth sheule) 42 43 Totl tx. A lines 41 n 42 m m m m m m m m m m m m m m m m m m m m m m m m 43 44 Pyments: A 2013 overpyment reite to 2014 44 19,904. 2014 estimte tx pyments 44 13,000. Tx eposite with Form 8868 m m m m m m m m m m m m m m m m m m m m 44 Foreign orgniztions: Tx pi or withhel t soure (see instrutions) 44 e Bkup withholing (see instrutions) m m m m m m m m m m m m m m m m m 44e f Creit for smll employer helth insurne premiums (Atth Form 8941) m m m m m m 44f g Other reits n pyments: Form 2439 X Other Form 4136 1,711. Totl 44g 1,711. 45 46 47 45 Totl pyments. A lines 44 through 44g m m m m m m m m m m m 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 Estimte tx penlty (see instrutions). Chek if Form 2220 is tthe m m m m m m m m m 47 Tx ue. f line 45 is less thn the totl of lines 43 n 46, enter mount owe 48 Overpyment. f line 45 is lrger thn the totl of lines 43 n 46, m m m m m m m m m m m m enter mount overpi 48 49 Enter the mount of line 48 you wnt: Creite to 2015 estimte tx 43. Refune 49 Prt V Sttements Regring Certin Ativities n Other nformtion (see instrutions) 1 At ny time uring the 2014 lenr yer, i the orgniztion hve n interest in or signture or other uthority over finnil ount (nk, seurities, or other) in foreign ountry? f YES, the orgniztion my hve to file FinCEN Form 114, Report of Foreign Bnk n Finnil Aounts. f YES, enter the nme of the foreign ountry here SV, ET, N X 2 During the tx yer, i the orgniztion reeive istriution from, or ws it the grntor of, or trnsferor to, foreign trust? m m m m X f YES, see instrutions for other forms the orgniztion my hve to file. 3 Enter the mount of tx-exempt interest reeive or rue uring the tx yer $ 1 nventory t eginning of yer 1 6 nventory t en of yer m m m m m m m m m 6 2 Purhses m 2 7 Cost of goos sol. Sutrt line 3 Cost of lor m m m m m m m m m 3 6 from line 5. Enter here n in 4 Aitionl setion 263A osts Prt, line 2 m m m m m m m m m m m m m m m 7 (tth sheule) m m m m m m m 4 8 Do the rules of setion 263A (with respet to Yes No Other osts (tth sheule) 4 property proue or quire for resle) pply 5 Totl. A lines 1 through 4 m to the orgniztion? Sheule A - Cost of Goos Sol. Enter metho of inventory vlution Sign Here M Pi Preprer Use Only 4X2741 2.000 5 m m m m m m m m m m m m m m m m m m m m Uner penlties of perjury, elre tht hve exmine this return, inluing ompnying sheules n sttements, n to the est of my knowlege n elief, it is true, orret, n omplete. Delrtion of preprer (other thn txpyer) is se on ll informtion of whih preprer hs ny knowlege. My the RS isuss this return with the preprer shown elow Signture of offier Dte Title (see instrutions)? Yes No Print/Type preprer's nme Preprer's signture Dte PTN Chek if self-employe M 35 X 34,572. 34,572. 34,572. 34,572. 34,615. BRAN D TODD P00422601 Firm's nme Firm's EN BKD, LLP 44-0160260 Firm's ress 910 E ST LOUS #200/PO BOX 1190 Phone no. 417 865-8701 SPRNGFELD, MO 65806-2523 Yes 43. No Form 990-T (2014) 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 54
CONVOY OF HOPE 68-0051386 Form 990-T (2014) Pge 3 Sheule C - Rent nome (From Rel Property n Personl Property Lese With Rel Property) (see instrutions) 1. Desription of property () From personl property (if the perentge of rent for personl property is more thn 10% ut not more thn 50%) 2. Rent reeive or rue () From rel n personl property (if the perentge of rent for personl property exees 50% or if the rent is se on profit or inome) 3() Deutions iretly onnete with the inome in olumns 2() n 2() (tth sheule) Totl Totl m m m m m () Totl inome. A totls of olumns 2() n 2(). Enter here n on pge 1, Prt, line 6, olumn (A) Sheule E - Unrelte Det-Finne nome (see instrutions) 1. Desription of et-finne property 4. Amount of verge quisition et on or llole to et-finne property (tth sheule) 5. Averge juste sis of or llole to et-finne property (tth sheule) 2. Gross inome from or llole to et-finne property 6. Column 4 ivie y olumn 5 % % % % () Totl eutions. Enter here n on pge 1, Prt, line 6, olumn (B) 3. Deutions iretly onnete with or llole to et-finne property () Stright line epreition (tth sheule) 7. Gross inome reportle (olumn 2 x olumn 6) Enter here n on pge 1, Prt, line 7, olumn (A). Totls m m m m m m m m m m m m m m m m m m m m m m m m m Totl iviens-reeive eutions inlue in olumn 8 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Sheule F - nterest, Annuities, Roylties, n Rents From Controlle Orgniztions (see instrutions) Exempt Controlle Orgniztions 1. Nme of ontrolle orgniztion Nonexempt Controlle Orgniztions 7. Txle nome 2. Employer ientifition numer 8. Net unrelte inome (loss) (see instrutions) 3. Net unrelte inome (loss) (see instrutions) 9. Totl of speifie pyments me Totls m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m ATTACHMENT 1 4X2742 2.000 4. Totl of speifie pyments me 5. Prt of olumn 4 tht is inlue in the ontrolling orgniztion's gross inome 10. Prt of olumn 9 tht is inlue in the ontrolling orgniztion's gross inome A olumns 5 n 10. Enter here n on pge 1, Prt, line 8, olumn (A). () Other eutions (tth sheule) 8. Allole eutions (olumn 6 x totl of olumns 3() n 3()) Enter here n on pge 1, Prt, line 7, olumn (B). 366,441. 211,603. 6. Deutions iretly onnete with inome in olumn 5 11. Deutions iretly onnete with inome in olumn 10 A olumns 6 n 11. Enter here n on pge 1, Prt, line 8, olumn (B). Form 990-T (2014) 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 55
Form 990-T (2014) Pge 4 Sheule G - nvestment nome of Setion 501()(7), (9), or (17) Orgniztion (see instrutions) 3. Deutions 4. Set-sies 5. Totl eutions 1. Desription of inome 2. Amount of inome iretly onnete (tth sheule) n set-sies (ol. 3 (tth sheule) plus ol. 4) Totls m m m m m m m m m m m m Enter here n on pge 1, Prt, line 9, olumn (A). Sheule - Exploite Exempt Ativity nome, Other Thn Avertising nome (see instrutions) 1. Desription of exploite tivity CONVOY OF HOPE 68-0051386 2. Gross unrelte usiness inome from tre or usiness 3. Expenses iretly onnete with proution of unrelte usiness inome 4. Net inome (loss) from unrelte tre or usiness (olumn 2 minus olumn 3). f gin, ompute ols. 5 through 7. 5. Gross inome from tivity tht is not unrelte usiness inome 6. Expenses ttriutle to olumn 5 Enter here n on pge 1, Prt, line 9, olumn (B). 7. Exess exempt expenses (olumn 6 minus olumn 5, ut not more thn olumn 4). Totls m m m m m m m m m m m m Enter here n on pge 1, Prt, line 10, ol. (A). Enter here n on pge 1, Prt, line 10, ol. (B). Sheule J - Avertising nome (see instrutions) nome From Perioils Reporte on Consolite Bsis Prt Enter here n on pge 1, Prt, line 26. 1. Nme of perioil 2. Gross vertising inome 3. Diret vertising osts 4. Avertising gin or (loss) (ol. 2 minus ol. 3). f gin, ompute ols. 5 through 7. 5. Cirultion inome 6. Reership osts 7. Exess reership osts (olumn 6 minus olumn 5, ut not more thn olumn 4). Totls (rry to Prt, line (5)) m m Prt nome From Perioils Reporte on Seprte Bsis (For eh perioil liste in Prt, fill in olumns 2 through 7 on line-y-line sis.) 1. Nme of perioil 2. Gross vertising inome 3. Diret vertising osts 4. Avertising gin or (loss) (ol. 2 minus ol. 3). f gin, ompute ols. 5 through 7. 5. Cirultion inome 6. Reership osts 7. Exess reership osts (olumn 6 minus olumn 5, ut not more thn olumn 4). Totls from Prt m m m m m m m Enter here n on pge 1, Prt, line 11, ol. (A). Totls, Prt (lines 1-5) m m m m Enter here n on pge 1, Prt, line 11, ol. (B). Sheule K - Compenstion of Offiers, Diretors, n Trustees (see instrutions) 1. Nme 2. Title 3. Perent of time evote to usiness % % % % Totl. Enter here n on pge 1, Prt, line 14 m m m m m m m m m m 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 here n on pge 1, Prt, line 27. 4. Compenstion ttriutle to unrelte usiness Form 990-T (2014) 4X2743 2.000 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 56
CONVOY OF HOPE 68-0051386 SCHEDULE E - UNRELATED DEBT-FNANCED NCOME ATTACHMENT 1 4. 5. 7. 8. 3. AVERAGE AVERAGE 6. GROSS NCOME ALLOCABLE 1. 2. DEDUCTONS DRECTLY CONNECTED ACQUSTON ADJUSTED % 4 S REPORTABLE DEDUCTONS DESCRPTON OF DEBT-FNANCED PROPERTY GROSS NCOME (3A) (3B) DEBT BASS OF 5 (2 X 6) 6 * (3A + 3B) WAREHOUSE 485,932. 280,604. 3,116,990. 4,133,376. 75.410 366,441. 211,603. TOTALS 366,441. 211,603. ATTACHMENT 1 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 57
Form 4136 Deprtment of the Tresury nternl Revenue Servie (99) Nme (s shown on your inome tx return) Creit for Feerl Tx Pi on Fuels nformtion out Form 4136 n its seprte instrutions is t www.irs.gov/form4136. CONVOY OF HOPE 68-0051386 Txpyer ientifition numer OMB No. 1545-0162 À¾µ Atthment Sequene No. Cution. Climnt hs the nme n ress of the person who sol the fuel to the limnt n the tes of purhse. For lims on lines 1 n 2 (type of use 13 n 14), 3, 4, n 5, limnt hs not wive the right to mke the lim. For lims on lines 1 n 2 (type of use 13 n 14), limnt ertifies tht ertifite hs not een provie to the reit r issuer. 1 Nontxle Use of Gsoline Note. CRN is reit referene numer. Off-highwy usiness use $.183 7 * 9 8 () Type of use () Rte () Gllons () Amount of reit (e) CRN Use on frm for frming purposes.183 362 Other nontxle use (see Cution ove line 1).183 $ Exporte.184 23 411 2 Nontxle Use of Avition Gsoline () Type of use () Rte () Gllons () Amount of reit (e) CRN Use in ommeril vition (other thn foreign tre) Other nontxle use (see Cution ove line 1) Exporte LUST tx on vition fuels use in foreign tre $.15.193.194.001 $ 354 324 412 433 3 Nontxle Use of Unye Diesel Fuel Climnt ertifies tht the iesel fuel i not ontin visile eviene of ye. Exeption. f ny of the iesel fuel inlue in this lim i ontin visile eviene of ye, tth n explntion n hek here () Type of use () Rte () Gllons () Amount of reit (e) CRN Nontxle use $ e Use on frm for frming purposes Use in trins Use in ertin interity n lol uses (see Cution ove line 1) Exporte.17.244 & $ 360 353 350 413 4 Nontxle Use of Unye Kerosene (Other Thn Kerosene Use in Avition) e f Climnt ertifies tht the kerosene i not ontin visile eviene of ye. Exeption. f ny of the kerosene inlue in this lim i ontin visile eviene of ye, tth n explntion n hek here () Type of use () Rte () Gllons () Amount of reit (e) CRN Nontxle use txe t $.244 $ Use on frm for frming purposes Use in ertin interity n lol uses (see Cution ove line 1) Exporte Nontxle use txe t $.044 Nontxle use txe t $.219 For Pperwork Reution At Notie, see the seprte instrutions..17.244.043.218 & $ 346 347 414 377 369 Form 4136 (2014) 4X2000 2.000 3554DW K929 05/12/2015 13:23:31 V14-4.6F 68-0051386 12
Form 4136 (2014) Pge 2 5 Kerosene Use in Avition (see Cution ove line 1) e () Type of use Kerosene use in ommeril vition (other thn foreign tre) txe t $.244 $.200 Kerosene use in ommeril vition (other thn foreign tre) txe t $.219 Nontxle use (other thn use y stte or lol government) txe t $.244 Nontxle use (other thn use y stte or lol government) txe t $.219 LUST tx on vition fuels use in foreign tre () Rte () Gllons () Amount of reit (e) CRN.175.218.001 $ 417 355 346 369 433 6 Sles y Registere Ultimte Venors of Unye Diesel Fuel Registrtion No. Climnt ertifies tht it sol the iesel fuel t tx-exlue prie, repi the mount of tx to the uyer, or hs otine the written onsent of the uyer to mke the lim. Climnt ertifies tht the iesel fuel i not ontin visile eviene of ye. Exeption. f ny of the iesel fuel inlue in this lim i ontin visile eviene of ye, tth n explntion n hek here m m m () Rte () Gllons () Amount of reit (e) CRN Use y stte or lol government $ $ 360 Use in ertin interity n lol uses.17 350 7 Sles y Registere Ultimte Venors of Unye Kerosene (Other Thn Kerosene For Use in Avition) Registrtion No. Climnt ertifies tht it sol the kerosene t tx-exlue prie, repi the mount of tx to the uyer, or hs otine the written onsent of the uyer to mke the lim. Climnt ertifies tht the kerosene i not ontin visile eviene of ye. Exeption. f ny of the kerosene inlue in this lim i ontin visile eviene of ye, tth n explntion n hek here m m m m Use y stte or lol government 7 Sles from loke pump *8 $ Use in ertin interity n lol uses () Rte () Gllons () Amount of reit (e) CRN.17 $ 346 9 347 8 Sles y Registere Ultimte Venors of Kerosene For Use in Avition Registrtion No. Climnt sol the kerosene for use in vition t tx-exlue prie n hs not ollete the mount of tx from the uyer, repi the mount of tx to the uyer, or hs otine the written onsent of the uyer to mke the lim. See the instrutions for itionl informtion to e sumitte. () Type of use () Rte () Gllons () Amount of reit (e) CRN Use in ommeril vition (other thn foreign tre) txe t $.219 $.175 e f Use in ommeril vition (other thn foreign tre) txe t $.244 Nonexempt use in nonommeril vition Other nontxle uses txe t $.244 Other nontxle uses txe t $.219 LUST tx on vition fuels use in foreign tre.200.025.218.001 $ 355 417 418 346 369 433 Form 4136 (2014) 4X2010 2.000 3554DW K929 05/12/2015 13:23:31 V14-4.6F 68-0051386 13
Form 4136 (2014) Pge 3 9 Reserve Registrtion No. Reserve Reserve () Rte () Gllons of lohol 10 Bioiesel or Renewle Diesel Mixture Creit Registrtion No. () Amount of reit Bioiesel mixtures. Climnt proue mixture y mixing ioiesel with iesel fuel. The ioiesel use to proue the mixture met ASTM D6751 n met EPA's registrtion requirements for fuels n fuel itives. The mixture ws sol y the limnt to ny person for use s fuel or ws use s fuel y the limnt. Climnt hs tthe the Certifite for Bioiesel n, if pplile, the Sttement of Bioiesel Reseller. Renewle iesel mixtures. Climnt proue mixture y mixing renewle iesel with liqui fuel (other thn renewle iesel). The renewle iesel use to proue the renewle iesel mixture ws erive from iomss proess, met EPA's registrtion requirements for fuels n fuel itives, n met ASTM D975, D396, or other equivlent stnr pprove y the RS. The mixture ws sol y the limnt to ny person for use s fuel or ws use s fuel y the limnt. Climnt hs tthe the Certifite for Bioiesel n, if pplile, the Sttement of Bioiesel Reseller, oth of whih hve een eite s isusse in the nstrutions for Form 4136. See the instrutions for line 10 for informtion out renewle iesel use in vition. (e) CRN () Rte () Gllons of ioiesel or renewle iesel () Amount of reit (e) CRN Bioiesel (other thn gri-ioiesel) mixtures Agri-ioiesel mixtures Renewle iesel mixtures $ 1.00 $ 1.00 $ 1.00 $ 388 390 307 11 Nontxle Use of Alterntive Fuel Cution. There is reue reit rte for use in ertin interity n lol uses (type of use 5) (see instrutions). () Type of use () Rte () Gllons () Amount of reit or gsoline gllon equivlents (GGE) (e) CRN e f g h Liquefie petroleum gs (LPG) "P Series" fuels Compresse nturl gs (CNG) (GGE = 126.67 u. ft.) Liquefie hyrogen Fisher-Tropsh proess liqui fuel from ol (inluing pet) Liqui fuel erive from iomss Liquefie nturl gs (LNG) Liquefie gs erive from iomss $.183 12 Alterntive Fuel Creit Registrtion No..183.183.183.183 () Rte () Gllons or gsoline gllon equivlents (GGE) $ 419 2012-001028-AL () Amount of reit 420 421 422 423 424 425 435 (e) CRN e f g h i Liquefie petroleum gs (LPG) "P Series" fuels Compresse nturl gs (CNG) (GGE = 121 u. ft.) Liquefie hyrogen Fisher-Tropsh proess liqui fuel from ol (inluing pet) Liqui fuel erive form iomss Liquefie nturl gs (LNG) Liquefie gs erive from iomss Compresse gs erive from iomss (GGE = 121 u. ft.) $ 3421 $ 1,711. 426 427 428 429 430 431 432 436 437 Form 4136 (2014) 4X2020 2.000 3554DW K929 05/12/2015 13:23:31 V14-4.6F 68-0051386 14
Form 4136 (2014) Pge 4 13 Registere Creit Cr ssuers Registrtion No. () Rte () Gllons () Amount of reit (e) CRN Diesel fuel sol for the exlusive use of stte or lol government Kerosene sol for the exlusive use of stte or lol government Kerosene for use in vition sol for the exlusive use of stte or lol $ $ 360 346 government txe t $.219.218 369 14 Nontxle Use of Diesel-Wter Fuel Emulsion Cution. There is reue reit rte for use in ertin interity n lol uses (type of use 5) (see instrutions). Nontxle use Exporte () Type of use () Rte () Gllons () Amount of reit (e) CRN $.197 $ 309.198 306 15 Diesel-Wter Fuel Emulsion Blening Registrtion No. () Rte () Gllons () Amount of reit (e) CRN Blener reit $.046 $ 310 16 Exporte Dye Fuels n Exporte Gsoline Blenstoks Exporte ye iesel fuel n exporte gsoline lenstoks txe t $.001 Exporte ye kerosene () Rte () Gllons () Amount of reit (e) CRN $.001.001 $ 415 416 17 Totl inome tx reit lime. A lines 1 through 16, olumn (). Enter here n on Form 1040, line 72; Form 1120, Sheule J, line 19; Form 1120S, line 23; Form 1041, line 24g; or the proper line of other returns. 17 $ 1,711. Form 4136 (2014) 4X2030 2.000 3554DW K929 05/12/2015 13:23:31 V14-4.6F 68-0051386 15
Form 2220 Deprtment of the Tresury Unerpyment of Estimte Tx y Corportions Atth to the orportion's tx return. OMB No. 1545-0123 nternl Revenue Servie nformtion out Form 2220 n its seprte instrutions is t www.irs.gov/form2220. À¾µ Nme Employer ientifition numer CONVOY OF HOPE 68-0051386 Note: Generlly, the orportion is not require to file Form 2220 (see Prt elow for exeptions) euse the RS will figure ny penlty owe n ill the orportion. However, the orportion my still use Form 2220 to figure the penlty. f so, enter the mount from pge 2, line 38 on the estimte tx penlty line of the orportion's inome tx return, ut o not tth Form 2220. Require Annul Pyment Prt 1 Totl tx (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 2 Personl holing ompny tx (Sheule PH (Form 1120), line 26) inlue on line 1 m m 2 Look-k interest inlue on line 1 uner setion 460() for omplete long-term ontrts or setion 167(g) for epreition uner the inome forest metho m m m m 2 Creit for feerl tx pi on fuels (see instrutions) 2 Totl. A lines 2 through 2 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m 3 Sutrt line 2 from line 1. f the result is less thn $500, o not omplete or file this form. The orportion oes not owe the penlty m m m m m m m m m m m m m m m m m m m 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 Enter the tx shown on the orportion's 2013 inome tx return (see instrutions). Cution: f the tx is zero or the tx yer ws for less thn 12 months, skip this line n enter the mount from line 3 on line 5 m m m m m 5 Require nnul pyment. Enter the smller of line 3 or line 4. f the orportion is require to skip line 4, enter Prt the mount from line 3 m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m m Resons for Filing - Chek the oxes elow tht pply. f ny oxes re heke, the orportion must file Form 2220 even if it oes not owe penlty (see instrutions). 6 The orportion is using the juste sesonl instllment metho. 7 The orportion is using the nnulize inome instllment metho. 8 The orportion is "lrge orportion" figuring its first require instllment se on the prior yer's tx. Prt Figuring the Unerpyment () () () () 9 nstllment ue tes. Enter in olumns () through () the 15th y of the 4th (Form 990-PF filers: Use 5th month), 6th, 9th, n 12th months of the orportion's tx yer m m m m m m m m m 9 10 Require instllments. f the ox on line 6 11 n/or line 7 ove is heke, enter the mounts from Sheule A, line 38. f the ox on line 8 (ut not 6 or 7) is heke, see instrutions for the mounts to enter. f none of these oxes re heke, enter 25% of line 5 ove in eh olumn m m m m m m m m m m m m m m m m m m Estimte tx pi or reite for eh perio (see instrutions). For olumn () only, enter the mount from line 11 on line 15 m m m m m m m m Complete lines 12 through 18 of one olumn efore going to the next olumn. 12 Enter mount, if ny, from line 18 of the preeing olumn m m m 13 A lines 11 n 12 m m m m m m m m m m m m 15 Sutrt line 14 from line 13. f zero or less, enter -0- m m 16 f the mount on line 15 is zero, sutrt line 13 from line 14. Otherwise, enter -0- m m m m m m m 14 A mounts on lines 16 n 17 of the preeing olumn 14 10 11 12 13 15 16 17 Unerpyment. f line 15 is less thn or equl to line 10, sutrt line 15 from line 10. Then go to line 12 of the next olumn. Otherwise, go to line 18 m m m m m m m m m m m m m m m m m m 17 18 Overpyment. f line 10 is less thn line 15, sutrt line 10 from line 15. Then go to line 12 of the next olumn m m m m m m m m m m m m 18 11,877. 3,850. 8,823. Go to Prt V on pge 2 to figure the penlty. Do not go to Prt V if there re no entries on line 17 - no penlty is owe. For Pperwork Reution At Notie, see seprte instrutions. Form 2220 (2014) 4X8006 2.000 1 2 3 4 5 34,572. 34,572. 32,108. 32,108. 04/15/2014 06/15/2014 09/15/2014 12/15/2014 8,027. 8,027. 8,027. 8,027. 19,904. 13,000. 11,877. 3,850. 8,823. 11,877. 16,850. 8,823. 19,904. 11,877. 16,850. 8,823. 3468DW K929 5/12/2015 4:06:25 PM V 14-4.6F 93933 PAGE 52