a an 9t ?118 10 1% OMB No.1545?0047 Fem 990? Return of Organization Exempt From Income Tax 1 996 Under section 501(c) of the Internal Revenue Code (except black lung benefit I trust or private foundation) or section charitable trust This pm? is of the Treasury Open toPubIl-c [Internal Revenue Service Note: The organization may have: to use a copy of this return to satisfy state reporting requirements. Inspectim A For- the 1996 calendar year, on tax year period beginning 9 1 1995, and endi_ng Check it: Please 0 Name of organization Eniplayeridenti?ra?rmumbcr i] Changeoiarldreas egg: . FREDERIC . CHAMBERLAIN CENTER, Inc . 0 4-25 936:6 6 ?nnmremm p31: or Number and street (or P.0. boxif mail is not delivered to street address) I Roomlsuite Stateth runner a . El Final return See OtiE PLEASANT STREET 0 9 9 0 1 Amandgd return Spml?c City. OffiGB, state. ERUZZIP COUG Check a ?f exemption {mum 3'90 1mm . I a lie iion is endin State reporting) ?m5- MIDDLEBORO Type of organization 5 Exemptunder section 501(c)( 3 4 (insert number) OR section 4947(a)(t) nonexempt charitable trust Note: Section 501(c)(3) exempt organizations and 4947(a)(1) nonexempt charitable trusts MUST attach a completed Schedule A (Form 990). H(a) is this a group return ?led to af??ates"Yes," enter the number of af?liates tor which this return is ?led: . Is this a separate return ?led by an organization covered by a group rulingaccounting method: El Other (specify) iv I if either box in is checked "Yes," en'ter four?digit groUp exemption number (GEN) ll] Cas'h IE Accrual Check here Dr if the organization?s gross receipts are normally not more than $25,000. The organization need not ?le a return with the but-ii it received a Form 990 Package in the mail, it should ?le a return without ?nancial data. Some states require a complete return. Note: Form BBQ-E2 may be used by organizations with gross receipts less than $100,000 and total assets less than $250,000 at end of year. Revenue, Expenses, and Changes in Net Assets or Fund Balances (See Speci?c Instructions on page 1 Contributions, gifts, grants, and similar amounts received: a Direct public support . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . . . . . . . . . . . . . . . . . . . . 1a indirect public support . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . 1b Government contributions (grantsTotal (add lines 1a through to) (attach schedule of contributors) (cash$ 44,992 noncash44,992 2 service revenue including government fees and contracts (from Part Vii, line 93Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3! 4 Interest on savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4: 3 753 5 Dividends and interest from securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5: 6a Gross rents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . as Less: rental expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6b . Net rental income or (loss) (subtract line 6b from line 6aOther investment income (describe (A) Securities (B) Other 3 8a Gross amount from sale of assets other than inventory. . . . 8a Less: cost or other basis and sales expenses . . . . . . . . . . . 8h Gain or (loss) (attach scheduleNet gain or (loss) (combine line Bo, columns (Special events and activities {attach schedule) a Gross revenue (not including of contributions reported on line?laLess: direct expenses other than tundraising expenses . . . . . . . . . . . . . . . . . . .. . . . at) Net income or (loss) from special events (subtract line 9b from line 9a10a Gross sales of inventory, less returns and allowances . . . . . . . . . . . . . . . . . . . . . . . me Less: costof goods sold . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10b Gross pro?t or (loss) from sales of inventory (attach schedule) (subtract line 10b irorn line 10aOther revenue (from Part . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11 I 12 "liotal revenue (add lines 1d8d, ac, iceProgram services (from line 44, column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1'3 2 658 302 it 14 Management and general (from line 44, column . . . . . . . . . . . 1'4 4:25 145 15 Fundraising {from line 44, column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1'5 16 Payments to af?liates (attach scheduleTotal expenses (add lines 16 and 44, column in? .. a? rangExcess or (de?cit) for the year (subtract [line 17 from line 12Flat assets or iund balances at beginning of year (item line 73Other changes in net assets or fund balances (attach explanationNet assets or fund balances at end of year (combine lines 18444.- 182 For Raperw ork Reduction Act Notice, see page 1 of the separate instructions. Form 990 (1993} lul'L?d FREDERIC L. CHAMBERLAIN CENTER INC. 04*2593666 Statement Of All organizations must complete column {at ooiumns to), and to) are required for section 501 mm and (4) organizations and Functional Expenses section 4947(a)(1 non'exompt charitable trusts but optional for others. (See Specific instructions on page i Page 2, . . listenerssass? ii) ?$33322. it Grants and allocations (attach schedule(cash noncash 22 23 S'peci?cassistanco to individuals (attach scheduleBene?ts paid to or tor members {attach scheduleOcmpensation of of?cers, directorsOther salaries and wages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 27 Pension plan contributions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 i 28 Other employee bene?Payroll taxes . . . . . . . . . . . . . . . . Professional tundraising fees . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 81 .A?ccounting tees . . . . . . . . . . . . . . . . . . . . . . . . . . . . Legal tees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 32 i 33 Supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 33 34 Telephone . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 35 Postage and shipping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 i i 36 Occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 36 37 Equipment rental and maintenance . . . . . . . . . . . . . . . . . . . . . . 37 33 Printing and publications . . Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 i 40 Conferences, conventions, and meetings . . . . . . . . . . . . . . . . 40 41 Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 41 42 Depreciation, depletion, etc. (attach scheduleOther expenses (itemize): a SEE ATTACHED 43a 3 083 447' 2 658 302 i 425 145 rmu' 43:: 43d . 433 I 44 Total functional expenses (add lines 22 thru 43) Organizations completing columns carry these totals to lines is 15. 44 3 0 83 4'47 2 658 302 425 145 Reporting of Joint Costs. - Did you report in column (B) (Program services) any joint costs from a combined educational campaign art If "Yes." enter the aggregate amount of these joint costs itindraising solicitation(ii) the amount allocated to Program services and (iv) the amount allocated to Fundralsing the amount allocated to Management and general Statement of Program Service AccOmplishments (See Specific Instructions on page is.) What is the organization?s primary exempt purpose? >Ed/ SOC services to adolescents 5 Program Service All organizations muat describe their exempt purpose achievements. State the number of clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 50l(b)(3) and (4) organizations and 4947(a)(1) and 4)orgs.anci trusts 'must also enter the amount of grants and allocations to others.) tailgalliisi?sl?lfl a Residential education treatment facility for emotionally :disturbed adolescents 180 days/year program. (Grants and allocations 3 35 2 5 2 6 blResidential education treatment facility for emotionally idisturbed adolescents 365 days/year program. (Grants and allocations 2 18 '7 2 70 c'Day educational treatment facility for emotionally disturbed adolescents 180 days/year program. (Grants and allocations 3 1 1 8 4:0 6 {Grants and allocations Other program services (attach schedule) (Grants and allocations 1' Total of Program Service Expenses (should equal line -44, coIUmn (B). Program services302 . Ila. Men Form99011996) FREDERIC . CHAMBERLAIN CENTER, INC . Oil?2593666 Page 3 Balance Sheets (See Speci?c instructions on page 16.) Note: Where required, attached schedules and amounts within the description column should be (A) (B) for 'end?of?year amounts only. Beginning of year End of year 45 Cash non?lnterest?bean?Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47a Accounts receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47a 356 9 6 9 Less: allowance for doubtful accounts . . . . . . . . . . . . . . . . . . . . . . . . Pledges receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48a Less: allowance for doubtful accounts . . . . . . . . . . . . . . . . . . . . . . . . 48b 49 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 50 Receivables from of?cers, directors, truetees, and key employees {attach sch_5ti_ Other notes and loans receivable (attach scheduleLess: allowance for doubtful accounts . . . . . . . . . . . . . . . . . . . . . . . . 51b 510 52 Inventories for sale Prepaid expenses and deferred charges . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 202 50 050 521% investments securities (attach schedule55a investments - land, buildings, and equipment: basis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. I 55a 625 128 Less: accumulated depreciation (attach schedule) See . 3 . 5513 5'6 investments other (attach scheduleLand, buildings, and equipment: basis . . . . . . . . . .. . . . . . . . . . . . . 57's 5 Less: accumulated depreciation (attach scheduleOther assets (describe 59 Total assets (add lines 45 through 58) (must equal line 74Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ll- 5.1 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 A 62 Deferredrevenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 62,3115 62 19,857 5" 63 Loans from of?cers, directors, trustees, and key employees (attach schedule64a Tax?exempt bond liabilities (attach schedule64a and other notes payable (attach scheduleStatementOther liabilities (describe See Statement 5 '7 367' as 23 269 65 Total liabilities (add lines so through 65Organizations that follow SPAS 11?, check here and complete lines 67 through 69 and lines 73 and 74. a 5,7 Unrestricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 242,111 444,182 68 Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Organizations that do not follow SPAS 11?, check here and complete lines 70 through 74. 5 i 70 Capital stock, trust principal, or current funds . . . . .. . . . . . . . . . . .Paid?in or capital surplus, or land, building, and equipment fund . . . . . . . . . . . . . . . . . . . . . . . . . 72 Retained earnings, endowment, accumulated income, or other funds . . . . . . . . . . . . . . . . . . . . . . Total net assets or fund balances - add lines 67 thrcu 69 OR lines 70 throu 72; 73 column (A) must equal line 19 and clolumn (B) must :qual line 2iTotal liabilities and net assetsitund balances (add lines gecaeae FREDERIC L. CHAMBERLAIN CENTER, 1H9 04~2593666 ace Reconciliation of Revenue per Audited Reconciliation of Expenses per Audited Financial Statements with Revenue per Financial Statements with Expenses per Return (See Speci?c Instructions page 18.) Return a Total expenses and losses per audited ?nancial statements . . . . . . . . . . . . . . . . . . .. a 3 083 447 1: Amounts included on line a but not on line 17, Form 990: (1) Donated services and use . .. a Total revenue, gains, and other support per audited ?nancial statements . . . . . . . . . 1) Amounts included on line a but not on line 12, Form 990: (1) Net unrealized gains on investments . . . . . (2) Donated services 2 Prior ear ad'ustments and use of facilities.. a i i 1 reported on line 20, (3) Recoveries of prior Form 990 . . . . . . . . . . . year grants . . . . . . . . (3) Losses reported on (4) Other (specify): line 20, Form 990 .. . . (4) Other (specify) i Add amounts on iines (1) through (it) . . . . . Add amounts on tines (1) through (Lineaminusiineb . . . . . . . . . . . . . . . . . . .. r: 3,285,518 r: Linealminusiineb . . . . . . . . . . . . . . . . . . . .. 3,083,447 Amounts included on line 17, Form 990 but not on iine a: Amounts included on iine 12, Form 990 but not on [line a: (1) Investment expenses not inciuded on line 6b, Form 990 . . . . . . . . . . . (1) investment expenses not included on iihe Sb, Form 990 . . . - . (2) Other (specify): (2) Other (specify) . 3 3 Add amounts on lines (Add amounts on lines (Total revenue per line 12, Form 990 otai expenses per [line 17, Form 990 I (linecpluslined3,285,518 (linecpiusiined3,083,447 List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see Speci?c instructions on page 18.) i to ensc WIELIAM DOHERTY EXEC 3 12a POINT HILL ROAD '40 - WEST BARHSTABLE, HA 96,971 1,849 JEANNE DOHERTY BUS 124 POINT HILL ROAD 40 3 WEST BARNSTABLE, MA 73,629 1,849 0 SARA NORFLEET PROG l4 SUMMER STREET '40 KINGSTOH, MA 70,214 4,068 0 I I i i 75 Did any of?cer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all reiated organizations, of which more than $10,000 was provided by the related organizations"Yes," attach schedule see Speci?c instructions on page 18. i 990 tit-5.5.5) FREDERIC . CHAMBERLAIN CENTER, INC . 0 4-25 9365 5 Page 5 Other Information (See Speci?c Instructions on page 19.) I Yes No 5 76 Did the organization engage in any activity not previously reported to the [If "Yes," attach a detailed description of each activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 76 77 Were any changes made in the organizing or governing documents but not reported to the lFlSltWes,"uattach a conformed copy of the changes. 78 a Did the organization have unrelated business gross income of $i ,000 or more during the year covered by this return"Yes," has it ?led a tax return on Form sec-?r for this year78!) 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? it "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, of?cers, etc., to any other exempt or nonexempt organization"Yes:1 enter the name of the organization and check whether it is exempt OR nonexempt. 81 a Enter the amount of political expenditures, direct or indirect, as described in the instructions for line 81Did the organization ?le Form for this year82.3 Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than fair rental valuemun; :uur - a A. If "Yes," you may indicate the valuo of these items here. Do not include this amount as revenue in Flart or as an expense in Part ll. (See instructions for reporting in Part ill821) I 83a Did the organization comply with the public inspection requirements for returns and exemption applicationsDid the organization comply with the disclosure requirements relating to quid pro quo contributionsDid the organization solicit any contributions or gifts that Were not tax deductible"Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not i taxdeductible34:: 85 501(c)(4), (5), or organizations. - a Were substantially all dues nondeductible by membersDid the organization make only in-house lobbying expenditures of $2,000 or less"Yes" was answered to either 85a or 85b, do not complete 85c through 85h below Unless the organization receivad a waiver for proxy tax owed tor the prior year. Dues, assessments, and similar amounts from members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85:: :1 Section 162(e) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85d 8 Aggregate nondeductibie amount of section 6083(e)(1)(A) dues notices . . . . . . . . . . . . . . . . . . . . . . . . . . . 859 "taxable amount of lobbying and political expenditures (tine 85d less 85eDoes the organization elect to pay the section 6033(e) tax on the amount in 85isection dues notices were sent, does the organization agree to add the amount in 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year501 organizations. - Enter: a Initiation fees and capital contributions included on line Iii/A Gross receipts, included on line 12, for public use of club facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86b 87 501(c)(12) organizations. Enter: a Gross income from members or shareholders . . . . . . . . . . . . . . . . . . 87a Gross income from other sources. (Do not not amounts one or paid to other sources against amounts 5 due or received from them?it any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership? 3 it "Yes," complete Part 89a 501(c)(3) organizations. - Enter: Amount of tax paid during the year under: 3 section ;section 4912 11> ;section 4955 Dr 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess bene?t transaction during the year? it "Yes," attach a statement explaining each transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . it Enter: Amount of tax paid by the organization managers or disquali?ed persons during the year under section 4958 . . . . . . . . . . it Enter: Amount of tax in Site, above, reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 List the states with which a copy of this return is ?led Massachusetts at The books are in care of WILLIAM DOHERTY Telephone noLocated at ONE PLEASANT STREET MIDDLEBORO MA ZIP 4 02346 92 Section 4947(a)(1) trusts ?ling Form 990 in lieu of Form 1041 ?-:Check here . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . El and enter the amount of tax-exempt interest receiVed or accrued during the tax year . . . . . . . . . . . . . . I 92 I emwmuee FREDERIC L. CHAMBERLAIN CENTER, INC . 04?2593666 Analysis of income-Producing Activities (See Specific instructions on page 22.) Page 6 Unrelated business income Excluded by section 512, 513, or'514 Enter gross amounts unless otherwise indicated. (E) 95 (A) (B) (0) Related or exempt 93 Program service revenue: Business code Amount Exclusion code Amount mitotic? income FEES 5 3,236,773 9 Fees and contracts from government agencies . . . . . . . 94 Membership dues and assessments . . . . . . . . . . . . . . . interest on savings and temporary cash investments . . . l4 3 75 3 96 Dividends and interest from securities . . . . . . . . . . . . . . 97 Net rental income or (loss) from real estate: a debt-?nanced property . . . . . . . . . . . . . . . . . . . . . . . . . not debt-?nanced property . . . . . . . . . . . . . . . . . . . . .. 98 Net rental income or (loss) from personal property. . . . . 99 Other investment income . . . . . . . . . . . . . . . . . . . . . . . 100 Gain or (loss) from sales of assets other than inventory . 101 Net income or (loss) from special events . . . . . . . . . . . . 102 Gross pro?t or (loss) from sales of inventory . . . . . . . . . . 103 Other revenue: a runner 1:15 ITotal (add line 104, columns (B), (DNote: ne'105 iinet Parti, should Relational: of Activities to the A Line NO. 93.a related to ex come used for rectl Interest 95 information Ft din axabie Name, address, and employer identification number of corporation or partnership 194 [Subtotal (add (columns is), and .. the amount on tine 1 Pm?. ishment of Exam 1: tax exe SB. 1: Percentage of ownership interest of SES- this Part if the "Yes" box on line 88 is Nature of business activities 3,7753 3,236,773 Il CBS Total income instructions on 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). Fees char ed for serv ces rendered for rov this return, including accompanying schedules and statements. and to the best of my (other than officer) is based on all information of which preparer 23. End?of-year assets 5 SCHEDULE A Organization Exempt Under Section 501(c)(3) OMB No. 154mm . (Except Private. Foundation) and Section 501(e), 50th), 5010:), (Form 990) 50101), or Section 4947(a)(1) Nonexempt Charitable Trust 1: Supplementary Information 1 995 Depanment of me new?, I See separate inshuctions. internal Revenue Service Must be completed by the above organizations and attached to their Form 990 (or soc?E2). Name of the organization i Employer Identification number L. CHAMBERLAIN CENTER, INC. 04-2593'666 . :"Ej .. Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See instructions on page 1. 'List each one. if there are none, enter If ?ne and average hours (?noontributions to Expense Name and address of each employee paid more than $50,000 per week devoted to position I Compensation Eggeggng?grf? accg?gtvimgg?her Richard Frigault Clinical Dir. 1 Pleasant St, Middleboro, MA 40 55,404 Totainumloer of other employees paid over $50,000 . . . . . . Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions on page i. rList each one (whether individuals or ?rms.) if there are none, enter ?None.") Name and address of each independent contractor paid more than $50,000 Type of service p) Compensation Hone Total number of others receiving over $50,000 for i professional services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . For Papenrrork Reduction Act Notice, see page of the Instructions for Form 990 and Form ego-E2. Schedule A (Form 990) 1995 - i-Mmm 1.. m? ?4-14 FREDERIC L. CHAMBERLAIN CENTER, INC. 04?2593666 Schedule A {Form sec) teas Page 2 Statements About Activities Yes I No 1 During the year, has the organization attempted to in?uence national, state, or local legislation, including any attempt to in?uence public opinion on a legislative matter or referendumthe total expenses paid or incurred in connection with the lobbying activities. 11? Organizations that made an election under section 501(h) by ?ling Form 5768 must complete Part vii?A. Other organizations checking "Yes," must complete Part AND attach a statement giving a detailed description of the lobbying activities. 2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any of its trustees, directors, of?cers, creators, key employees, or members of their families, or with any taxable organization with which any such person is af?liated as an of?cer, director, trustee, majority owner, or principal bene?ciary: a Sale, exohange, or leasing of propertyLending of money or other extension of creditFurnishing of goods, services, or facilitiesPayment of compensation (or payment or reimbursement:of expenses if more than 3.012111. .99 0. . .Par.t. .V 2d 6 Transfer of any part of its income or assetsthe answer to any question is "Yes," attach a detailed statement explaining the transactions. 3 Does the organization make grants ior scholarships, fellowships, student loans, etcAttach 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: payments. (See instructions on page 2.) Reason for Non-Private Foundation Status (See instructions on pages 2 through 4.) 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 A school. Section 170(b)(1 )(AXii). (Also complete Part V, page 4.) A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(ili). A Federal, state, or local government or governmental Unit. Section A medical research organization operated in conjunction with a hospital. Section Enter the hospital?s name, city, and state ?to An organization operated for the benefit of a college or university owned or operated by a governmental unit. Section (Also complete the Support Schedule in Part 11a An organization that normally receives a substantial part of its support irom a governmental unit or from the general public. Section (Also complete the Support Schedule in Part 111) El A community trust. Section (Also complete the Support Schedule in Part 12 An organization that normally receives: (1) more than 331l3% of its support from contributions, membership fees, and gross receipts from activities related to its charitable, etc., functions?subject to certain exceptions, and 1(2) no more than 33 113% of its support from :gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after 1975. See section 509(a)(2). (Also complete the Support Schedule in Part Near.) 13 An organization that is not controlled by any disquali?ed persons (other than foundation managers) and supports organizations described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See section Provide the following information about the supported organizations. (See instructions on page 4.) Line number Name(s) of supported organization(s) I from above 14 An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions on page 4.) FREDERIC L. CHAMBERLAIN CENTER, INC. 04-2593666 2 Schedule MForn-i see) 1993 Page 3 3 1 Support Schedule {Complete only if you checked a box on line 10, it, 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 (or ?scal year beginning in) . . . . . 1995 1994 1993 1992 Total 15 Gifts, grants, and contributions received. I '(Do not include unusual grants. See line 28.). . . i 15 Membership fees received . . . . . . . . . . . . . . . . . 1? Gross receipts from admissions, merchandise 3 sold or services performed, or furnishing of facilities in any activity that is not a business unrelated to the organization?s charitable, :eic., purpose . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Grace income from interest, dividends, amounts received from payments on securities loans {section rents, royalties, and Iunrelated business taxable income (less section 511 taxes) from business acquired lby the organization after June 30, 1975 . . . . . . . 19 Net income from unrelated business 4 [activities not included in line 'Tax revenuas levied for the organization?s benefit 3 and either paid to it or expended on its behalf. . 21 The value of services or facilities iurnished to the organization by a governmental unit without charge. no not include the value of services or facilities generally furnished to the public without charge . . . . . . 22 Other income. Attach a sch. Do not include gain (loss) from sale of capital assets . . . . . . . . . . . . 23 Total of lines 15 through Line 23 minus line Enter 1% of line Organizations described in lines 10 or 11: a Enter 2% of amount in column line Fit/11. . . Attach a list {which is not open to public inspection) shouting the name of and amount contributed by each person (other than a government unit or publicly supported organization) whose total gifts tor 1992 through 1995 exceeded the amount shown in line 26a. Enter the sum of all these excess amounts here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Total support for section 509(a)(1) test: Enter ?ne 24, column . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . In it Add: Amounts irom column tor lines: 18 19 22 26b 3 ?Easels a Public support (line 260 minus tine 26d total) . .. . . 5 26s Public support percentage (line 26a (numerator) divided by line 260 (denominatorOrganizations described on line 12: a For amounts included in lines 15, 16, and 17 that were received from a"disqualified person,? attach a list to 'show the name of, and total amounts received in each year from each ?disquali?ed person." Enter the sum of such amounts for each year: Iii/1A (1995) (1994) (1993) (1992) For any amount included in line 17 that was received from a nondisquallfied person, attach a list to show the name of, and amoUnt received for each year, that was more than the larger of the amount on line 25 for the year or (2) $5,000. (include in the list organizations described in lines 5 through 11, as well as individuals.) After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of all these differences (the excess amounts) for each year: (1995) (1994) (1993i (1992) Add: amounts from column for lines: 15 16 17$ 20 21l27c$ Add:Line 27a total .. and line gybtotaPublic support (line 270 total minus line 27d total27a Total support for section 509(a)(2) test: Enter amount on line 23, column . . . . . . . . . . . . . 1$ 9 Public support percentmie (line 27a (numerator) divided byline 271? (denominator"it Investment income percentage (line 18, column to) (numerator) divided byline 27f (denominatorUnusual Grants: For an organization described in line '10, 11, or 12 that received any unusual grants during 1992 through '1999, attach a list (which is not open to public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not include these grants in line 15. (See instructions on page 4.) Mm?? FREDERIC L. CHAMBERLAIN CENTER, INC. 04-2593666 Schedule A (Form sec) 1 see Page 4. Private School Questionnaire (See instructions on page (To be completed ONLY by schools that checked the box on line 6 In Part W) Yes No 29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing bodyDoes the organization include a statement of its racially nondiscri minatcry policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarshipsHas the organization publicized its racially nondiscriminatdry policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes I the policy known to all parts of the general community it servesliWes," please describe; it please explain. (If you need more space, attach a separate statement.) Through Heaps Organization, Policy is published 32 Does the organization maintain the toilowing: 3 a Records indicating the racial composition of the student body, iaculty, and administrative staffRecords documenting that scholarships and other ?nancial assistance are awarded on a racially nondiscriminatory basisGopies of all catalogues, brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships32:: it Copies of all material used by the organization or on its behalf to solicit contributionsyou answered "No" to any of the above, please explain. (it you need more space, attach a separate statement.) 33 Does the organization discriminate by race in any way with respect to: a Students? rightsorprivileges33a Admissions policies33b Employment oiiacully or administrative staffScholarshipsorother ?nancial assistance33d Educational policiesthe of'iacilitiesAthletic programs339' Other extracurricular activitiesyou answered "Yes" to any of the above, please explain. {ll you need more space, attach a separate statement.) 34a iDoes the organization receive any ?nancial aid or assistance from a governmental agencyHas the organization's right to such aid ever been revoked or suspendedyou answered ?Yes? to either 34a or b, please explain Using an attached statement. 35 Does the organization certify that it has complied with applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50, 1975-2 0.3. 58?, covering racial nondiscrimination? it attach an explanation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . FREDERIC L. CHMBERLAIN CENTER, INC . Oil-2593666 Schedule A [Form 990) 1 see Page 5 Lobbying Expenditures by Electing Public Charities (See instructions on page 3/3 {to be completed ONLY by an eligible organization that ?led Form 5768) Check here Ir a El if the organization belongs to an af?liated group. Check here El it you checked above and ?limited control" provisions applyLimits on Lobbying Expenditures Af?liated group To be completed totals for ALL electing he term "expenditures" means amounts paid or incurred.) organiza?ons . as Total lobbying expenditures to influence public opinion {grassroots lobbyingTotal lobbying expenditures to in?uence a legislative body (direct lobbyingTotal lobbying expenditures {add lines Other exempt purpose expenditures . . . . . . . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Total exempt purpose expenditures (add lines Lobbying nontaxable amount. Enter the amount from the following table lf'the amount on line 40 is The lobbying nontaxable amount is th over $500,000 . . . . . . . . . . . . . . . . . . . . . . 20% of the amount on line Otter $500,000 but not over $1,000,000 . . . . . . $100,000 plus 15% of the excess over $500,000. . Otter $1,000,000 but not over $1,500,000 . . . . $175,000 plus 10% of the excess over $1,000,000 Otter $1,500,000 but not over $17,000,000 . . . $225,000 plus 5% of the excess over $1,500,000 . Over $1?,000,000 . . . . . . . . . . . . . . . . . . . . . . . $1,000,000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Grassroots .nontaxable amount (enter 25% of line 41Subtract line 42 from line 86. Enter ii line 42 is more than line Subtract line 41 from line 38. Enter 0 it line 41 is more than line 33$ Caution: if there is an amount on either line 43 or line 44, file Form 4720. 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 45 through 50 on page 8.) Lobbying Expenditures During 4?Year Averaging Period . I lb) Calendar year (or ?scal year beginning in) 1995 1995 1994 1998 Total 45 Lobbying nontaxable amount . . . . . . . . . . . . . . . . 46 Lobbying ceiling amount (150% of line . . . 47 Total lobbying expenditures . . . . . . . . . . . . . . . . . 4B Grassroots nontaxable amount . . . . . . . . . . . . . . . 49 Grassroots ceiling amount (150% of line . . 50 Grassroots lobbying expenditures . . . . . . . . . . . . - Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part (See instructions on page 8.) During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount in?uence public opinion on a legislative matter or referendum, through the use of: Volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Paid staff or management (Include compensation in expenses reported on lines 0 through . . . . . . . . . . . . . . . . . . . . Media advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Mailings to members, legislators, or the public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . . . . . . . . . . . . . . . . . . . . . Publications, or published or broadcast statements . . . . .Grants to other organizations for lobbying purposes . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Direct contact with legislators, their staffs, government officials, or a legislative body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Rallies,:demonstrations, seminars, conventions, speeches, lectures, or any other means . . . . . . . . . . . . . . . . . . . . . . . . Total lobbying expenditures (add lines through it"Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities. FREDERIC L. CHAMBERLAIN CENTER, INC. 04?2593666 Scheddle A {Form 99011998 Page 6 Information Regarding Transfers To: and Transactions and Relationships With Noncharitabie Exempt Organizations 51 Did the reporting organization directly or Indirectly engage in any of the following with any other organization described in section 501(0) 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 nonchan'tatlle attempt organization of: I(i) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. (ii) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Other transactions: 5 qt) Sales of assets to a .noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Rental of facilities or equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 (iv) Reimbursement arrangements . . . . . . . . . . . . . . . . . Loans or loan guarantees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (vi) Performance of services or membership or iundraising solicitations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .- . . . . . . lithe answer to any of the above is "Yes," complete the following schedule. Column should always show the fair market Value Of the goods, other assets, or services given by the reporting organization. it the organization received less than fair market value in any transaction or sharing arrangement, show in column the value of the goods, other assets, or services receIVed. 51 MM (cl Line no. Name of nonohantable exempt organization Description of transfers, transactions. and shanng arrangements NA- 52a is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 5016:) 'of the Code (other than section 50l(c)(3)) or In section 527?Yes,? the schedule. . . . . Name of organization Type of organization Description of relationship d?Lnl- 1996 I Federal Statements Page 1 Client FREDERIC L. CHAMBERLAIN CENTER, INC. 04?2593666 Statement 2 Form 990, Part IV, Line 50 Receivables due from Officers, Directors, Trustees, and Key Employees Balance Due other Receivables Note Receivable from Directors 116,659 Total 116,659 Statement 3 Form 990, Part IV, Line 55 Investments-Land, Buildings, and Equipment Accumulated Book Asset Baels Depreciation Value Automobiles transportation equip. 167,809 82,551 85,258 Furniture and fixtures 127,403 102,794 24,609 Improvements 329,916 105,000 224,916 Total 290,345 334,783 625,128 1996 Federal Statements Page 2 C?ent37 FREDERIC L. CHAMBERLAIN CENTER, INC. 04-2593666 Statement 4 Farm 990, Part IV, Line 64b Mortgages and Other Notes Payable other Notes Payable Lender?s Name: Date of Note: Maturity Date: Interest Rate: Sacurity Provided: Purpose of Loan: Bristol County Savings 8/31/97 1/31/98 10.25% all assets of the organization working capital Balance Due original Amount: 250,000 Balance Due: 208,505 Lender's Name: Vanious maturity Date: 1/31/02 Repayment Terms: installments Security Provided: motor vehicles Purpose of Loan: Purchasae vehicles Balance Due: 61,599 270,104 Total 270,104 Form 990, Part IV, Line 65 Other Liabilities Ending :Capital Lease Obligation 3 23,269 Total 23,269 Contractor FREDERIC CHAMBERLAIN CENTER, INC. Vendor Code: 04-2593666 UFR I SFE Page 1 STATEMENT OF FUNCTIONAL EXPENSES For the Year Ended 08131.97 Fog egg SUPPORTING saches ADMINISTRATION TOTAL OUT OF STATE TOTALS (MNGT. GEN.) FUND RAISING NON-CHARITABLE ALL PROGRAMS NO MA. CLIENTS PROGRAM SERVICES 1. Employee Compensation 8 Related Expenses 2,228,524 341 ,843 1,835,631 2. Occupancy 350,697 7,485 343,212 3. Other Program I Operating Expense 306,582 9,853 296,729 Subcontract Expense 0 a: Administrative Expense 149,179 56,121 93,058 Other Expenses 0 0 7-. Depreciation of Buildings and Equipment 48,465 9,843 38,622 TOTAL EXPENSES 3,083,447 425,145 0 0 2,658,302 0 See Accompanying Notes to Financial Statements Co'ntractdr: FREDERIC CHAMBERLAIN CENTER, INC. STATEMENT OF FUNCTIONAL EXPENSES For the Year Ended 08.3097 Fog 51?? 0, Employee Compensation Related Expenses Occupancy Other Program Operating Expense moist Subcontract Expense 5. Administrative Expense 6. Other Expenses 7. Depreciation of Buildings and Equipment 8. TOTAL EXPENSES See Accompanying Notes to Financial Statements PROGRAM 01 250,881 46,080 38,940 11,820 4.905 352,626 Vendor Code: PROGRAM 02 - 1,556,225 285,809 241,539 73,283 30,414 2,1 37,270 04-2593666 PROGRAM 03 79,5?5 1 1 ,323 1 5,250 7,955 3.303 1 1 8,406 PROGRAM bl" amm- UFR I SFE Page 2 PROGRAM - PROGRAM hush??