See a Social Security Number? Say Something! Report Privacy Problems to https://public.resource.org/privacy Or call the IRS Identity Theft Hotline at 1-800-908-4490 if I Form 990 I i Department of the Treasury Return of Organization Exempt From Income Tax Under section 501 527, or 4947(a)(1) of the Internal Revenue Code (except black lung bene?t trust or private foundation) I I OMB No 1545-0047 Open to Public imam, Revenue gem? The organization may have to use a copy of this return to satisfy state reporting reqwrements lnspec?on A For the 2008 calendar year, or tax year beginning 7/01 2008, and ending 6I30 20 09 Check .1 Press; 0 Name of organization BASIS SCHOOL, INC. Employer identi?cation number Address change 125;. of 00W Bum? AS 86 0908854 Name change Pm? Nurber and street (or PO box rf mail IS not delivered to street address) Room/suds Telephone number WIDG- See 11440 North 136th Street 430 289-2088 Initial retu If Termination hm: City or town, state or country, and ZIP 4 El Amended return "ans. SCO?Sdale? AZ 82259 Gross receipts 5 3,099,534 Cl Wm pendng Name and address Of pnnCIpal of?cer MiChael H(a) Is this a group retum for at?hates'PDYes ENG same as above ?(bi Are all af?liates included? DYes 501(c)( 3 )4 (insert no) Website: Type of organization Corporation Trust El 4947(a)(1) or 527 If attach a list (see instructions) G'oup exerrptim nurber 1998 State of legal domic?e AZ El Other 1 Year of formation MAR 112111! - Summary 1 Briefly describe the organization's mission or most Significant actiVIties: The {93.5.5199 is! -e?ssdesatlee. missile Itis Beetle. 32 Brands .239. [listens i?iml?? a, 2 Check this box if the organization discontinued its operations or disposed of more than 25% of its assets. .5 3 Number of voting members of the governing body (Part VI, line 1aNumber of independent voting members of the governing body (Part VI, line 1bTotal number of employees (Part V, line 2a). 5 141 2 6 Total number of volunteers (estimate if necessary) 5 0 73 Total gross unrelated busmess revenue from Part line 12, column (C). 7a 0 Net unrelated busmess taxable income from Form 990- T. line 34 7b 0 IV Prior Year Current Year a, 8 Contributions and grants (Part line 1h). .3 . 7.135.252 7.733.224 9 Program serVice revenue (Part line 29) 2 2010' . 250,240 255L540 10 Investment income (Part column (A), lines? 4, a?ggd? .g . 3.212 4.575 11 Other revenue (Part column (A), lines 5, to Sc . 10.877 487 12 Total revenue?add lines 8 through 11 (must eqLal 12) 7,409,581 8,057,927 13 Grants and Similar amounts paid (Part IX, col (A), lines . . . . 0 0 14 Benefits paid to or for members (Part IX, column (A), line Salaries, other compensation, employee benefits (Part IX, column (A) lines 5?10) 4.914399 53023314 3 16a Professional fundraismg fees (Part IX, column (A), line 118) . 17 147 I5 Total fundraismg expenses (Part IX, column (D), line 25) 5.82.5.7? -, 17 Other expenses (Part IX, column (A), lines 11a?11d, 11f?24t) 2,5493% 2 552 112 18 Total expenses. Add lines 13?17 (must equal Part IX, column (A), line 25). 7:481-512 3.375357 19 Revenue less expenses Subtract line 18 from line 12 . (71,931) (317,840) '6 Beginning of Year End of Year 2 a3; 20 Total assets (Part line 13.411.796 221:: 21 Total liabilities (Part X, line 26) 14.497.157 14.209529 2.3 22 Net assets or fund balances. Subtract line 21 from line 20. (479,893) (797,733) Part II Signature Block Under penalties of penury, I declare that I have amined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and com ete iaration oi preparer (other than officer) is based on all information of which preparer has any knowledge Sign "74 0 I Z??v {0 Here gignature of office, Date Type or print name and title Preparer's Date 335* If Preps?r1215 .lfif?lifymg number Paid Signature employed L) Preparer's Firm's name (or yours Use Only if self-employed), . address, and ZIP 4 Phone no May the IRS discuss this return With the preparer shown above? (see instructions) For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. Cat No. 11282Y lI l? I Form 990 (2098) Page 2 Statement of Program Service Accomplishments (see instructions) 1 Briefly describe the organization's missmn: lbs. {assign 15. amiss- 3.7339393 and BASIS Scottsdale 2 Did the organization undertake any Signi?cant program serwces during the year which were not listed on the prior Form 990 "Yes," describe these new sewices on Schedule 0. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program semces? If "Yes,? describe these changes on Schedule 0. 4 Describe the exempt purpose achievements for each of the organization's three largest program serwces by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are reqUIred to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program sewice reported. Yes No 4a (Code: (Expenses 35 including grants of (Revenue 2 52.193") Seiriditiene!Babliessbeele 4b (Code: (Expenses including grants of (Revenue -DUA 4c (Code: (Expenses including grants of (Revenue -lVl/A 4d Other program sewices. (Describe in Schedule 0.) (Expenses including grants of (Revenue 4e Total program service expenses 6,422,276 (Must equal Part IX, Line 25, column Form 990 (2008) Form 990 (2098) Checklist of Required Schedules the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If ?Yes," complete Schedule A . Is the organization reqwred to complete Schedule B, Schedule of Contributors? . . . Did the organization engage in direct or indirect political campaign actiVities on behalf of or in oppoSItion to candidates for public office? If ?Yes,? complete Schedule Part I . . Section 501(c)(3) organizations. Did the organization engage in lobbying actiVIties? If ?Yes," complete Schedule C, Part II Section 501(c)(4), 501(c)(5), and 501(c)(6) organizations. Is the organization subject to the section 6033(e) notice and reporting requirement and proxy tax? If ?Yes, complete Schedule Part . Did the organization maintain any donor advised funds or any accounts where donors have the right to prOVide advrce on the distribution or investment of amounts in such funds or accounts? If "Yes,? complete Schedule Part I . . . . Did the organization receive or hold a conservation easement, including easements to preserve open space, the enwronment, historic land areas or historic structures? If "Yes, complete Schedule D, Part II Did the organization maintain collections of works of art, historical treasures, or other Similar assets? If "Yes, complete Schedule D, Part . . . . Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part or prowde credit counseling, debt management, credit repair, or debt negotiation services? If ?Yes,? complete Schedule D, Part IV Did the organization hold assets in term, permanent, or qua5i- -endowments? If ?Yes," complete Schedule D, Part Did the organization report an amount in Part X, lines 10?Yes,? complete Schedule D, Parts VI, VII, IX, or as applicable . . . . . . . . . . . . . . . . . Did the organization receive an audited financial statement for the year for which it is completing this return that was prepared in accordance With If "Yes," complete Schedule D, Parts XI, XII, and ls the organization a school described in section 170(b) (1 If ?Yes, complete Schedule Did the organization maintain an office, employees, or agents out5ide of the . Did the organization have aggregate revenues or expenses of more than $10, 000 from grantmaking,fundra15i,ng busmess, and program serwce actiwties outSide the If ?Yes, complete Schedule F, Part I . . Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or a35istance to any organization or entity located out5ide the United States? If ?Yes, complete Schedule F, Part II Did the organization report on Part IX, column (A), line 3, more than 000 of aggregate grants or asastance to indiwduals located outSIde the United States? If ?Yes, complete Schedule F, Part Did the organization report more than $15,000 on Part IX, column (A), line 11a? If ?Yes, complete Schedule G, Partl Did the organization report more than $15,000 total on Pait lines lc and 8a? If "Yes," complete Schedule G, Part II Did the organization report more than $15, 000 on Part line 9a? If ?Yes," complete Schedule G, Part Did the organization operate one or more hospitals? If "Yes,? complete Schedule Did the organization report more than 000 on Part IX, column (A), line 1?If ?Yes," complete Schedule I, Parts I and II Did the organization report more than $5,000 on Part IX, column (A), line 2? If "Yes,? complete Schedule I, Parts I and Ill Did the organization answer ?Yes" to Part VII, Section A, questions 3, 4, or 5? If "Yes," complete ScheduIeJ. Did the organization have a tax? exempt bond issue With an outstanding principal amount of more than $100, 000 as of the last day of the year, that was issued after December 31, 2002?lf ?Yes, answer questions 24b?24d and complete Schedule K. If ?No, go to question 25 . . Did the organization invest any proceeds of tax? ?exempt bonds beyond a temporary period exception?. Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax? ?exempt bonds?. Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction With a disqualified person during the year? If ?Yes,? complete Schedule L, Part I . . . . Did the organization become aware that it had engaged in an excess benefit transaction With a disqualified person from a prior year? If ?Yes,? complete Schedule L, Partl . . . . . Was a loan to or by a current or former of?cer, director, trustee, key employee, highly compensated employee, or disquali?ed person outstanding as of the end of the organization' 5 tax year? If "Yes,? complete Schedule L, Part II . Did the organization provide a grant or other a55istance to an officer, director, trustee, key employee, or substantial contributo_r1 or to a person related to such an indiwdual? If ?Yes," complete Schedule L, Part Yes Form 990 (2008) I I 'i .- Form 990 (2093) Page 4 Checklist of Required Schedules (continued) Yes No 28 During the tax year, did any person who is a current or former officer, director, trustee, or key employee: a: a Have a direct busmess relationship With the organization (other than as an officer, director, trustee, or as} employee), or an indirect busmess relationship through ownership of more than 35% in another entity ?ndiwdually or collectively With other person(s) listed in Part VII, Section If ?Yes,? complete Schedule L, . .. Have a family member who had a direct or indirect business relationship With the organization? If ?Yes? complete Schedule L, Part IV . . . . 28b Serve as an officer, director, trustee, key employee partner, or member of an entity (or a shareholder of a professmnal corporation) doing busmess with the organization? If ?Yes, complete Schedule L, Part IV . . 23C 29 Did the organization receive more than $25,000 in non-cash contributions? If "Yes, complete Schedule 29 30 Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If ?Yes," complete Schedule . . . . . . . . . . 30 31 Did the organization liqUIdate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, 31 Part I. . . . . 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?? "Yes,? ?complete Schedule N, Part Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301. 7701 ?2 and 301.7701 If "Yes, complete Schedule Fl, Part I . . . 33 34 Was the organization related to any tax?exempt or taxable entity? If ?Yes,? complete Schedule H, Parts llany related organization a controlled entity Within the meaning of section 512(b)(13)? If ?Yes,? complete ScheduleR,PartV,line2 .. .. 35 36 Section 501(c)(3) organizations. Did the organization make anytransfers to an exempt non- -charitable related organization? If ?Yes,? complete Schedule H, Part V, line 2 36 37 Did the organization conduct more than 5% of its actiVIties through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If ?Yes," complete Schedule Fi, Part Form 990 (2008) Form 990 (2008) MStatements RegardingOther IRS Filings and Tax Compliance Yes No 1a Enter the number reported In Box 3 of Form 1096, Annual Summary and Transmittal of 8. information Returns Enter if not applicable . . . 1a 15 . Enter the number of Forms W- 2G included in line 1a. Enter --0 If not applicable 1b 0 Did the organization comply With backup Withholding rules for reportable payments to vendors and reportable gaming (gambling) Winnings to prize WinnersEnter the number of employees reported on Form W- 3, Transmittal of Wage and Tax 1 Statements, filed for the calendar year ending With or Within the year covered by this return 23 141 - If at least one Is reported on line 2a, did the organization file all required federal employment tax returns? 2b Note. If the sum of lines 1a and 2a Is greater than 250, you may be required to e?fn'e this return. (see i =11 =4 Instructions) - in 33 Did the organization have unrelated busmess gross income of $1,000 or more during the year covered by 3' - this return? . 3a If ?Yes, has It filed a Form 990 for this year? If "No, provide an explanation in Schedule 0 3b 4a At any time during the calendar year, did the organization have an Interest in, or a Signature or other authority over, a finanCIal account in a foreign country (such as a bank account, securities account, or other finanCIal account"Yes, enter the name of the foreign country: . f: See the Instructions for exceptions and filing requirements for Form TD 90- -22.1, Report of Foreign Bank - :1 .- and FinanCIal Accounts. i' sears: 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?. 5a Did any taxable party notify the organization that it was or Is a party to a prohibited tax shelter transaction? 5b If ?Yes, to question 5a or 5b, did the organization file Form 8886-T, Disclosure by Tax-Exempt Entity Regarding Prohibited Tax Shelter Transaction? . 5? 6a the organization soliCIt any contributions that were not tax deductible? . 53 I If ?Yes, did the organization Include with every solICItation an express statement that such contributions or gifts were not tax deductible? 5b ?a 7 Organizations that may receive deductible contributions under section 170(c). . 2 3 Did the organization prowde goods or serVIces in exchange for any quid pro quo contribution of more than 3757 7a If "Yes, did the organization notify the donor of the value of the goods or services prowded? 7b Did the organization sell, exchange, or othenivise dispose of tangible personal property for which It was reqUIred to file Form 8282"Yes, indicate the number of Forms 8282 filed during the year . . . . 7d NM Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal A benefit contract? 7e Did the organization during the year, pay premiums, directly or Indirectly, on a personal benefit contract? 7f 9 For all contributions of qualified Intellectual property, did the organization file Form 8899 as reqUIred? 7 For contributions of cars, boats, airplanes, and other vehicles, did the organization file a Form 1098?0 as reqUIred? 8 Section 501(c)(3) and other sponsoring organizations maintaining donor advised funds and section i 509(a)(3) supporting organizations. Did the supporting organization, or a fund maintained by a sponsoring organization, have excess busmess holdings at any time during the year?. 3 9 Section 501(c)(3) and other sponsoring organizations maintaining donor advised funds. .J 3 Did the organization make any taxable distributions under section 4966? . . 9a the organization make a distribution to a donor, donor advisor, or related person? 9b 10 Section 501(c)(7) organizations. Enter. a Initiation fees and capital contributions Included on Part line 12. . . . 103 ?m Gross receipts, Included on Form 990, Part line 12, for public use of club 10b WA 11 Section 501 organizations. Enter: a Gross income from members or shareholders . . . . . 11a Gross Income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them). . . . . . 11" 123 Section 4947(a)(1) non- exempt charitable trusts. I5 tne organization Form 990 Ill lieu of 1041? 123 if "Yes, enter the amount of tax- -exempt Interest received or accrued during the year. I 12b) MA I Form 990 (2008) I Form 990 (200$) Page 6 Governance, Management, and Disclosure (Sections A, B, and request information about polities not reqwred by the Internal Revenue Code.) Section A. GoverningBody and Management 93 1O 11 For each ?Yes? response to lines 2?7b below, and for a ?No" response to lines 8 or 9b below, describe the 1:31 Circumstances, processes, or changes in Schedule 0. See instructions. . Enter the number of voting members of the governing body . . . . . . . . . 1a 5 Enter the number of voting members that are independent . . . 1b 5 Did any officer, director, trustee or key employee have a family relationship or a business relationship With any other officer director trustee or key employee? Did the organization delegate control over management duties customarily performed by or under the direct supeNiSion of officers, directors or trustees, or key employees to a management company or other person? . Did the organization make any Signi?cant changes to its organizational documents Since the prior Form 990 was ?led? Did the organization become aware during the year of a material diver5ion of the organization's assets? Does the organization have members or stockholders? . Does the organization have members stockholders, or other persons who may elect one or more members of the governing body? Are any deCISlOl'lS of the governing body to approval by members stockholders or other persons? Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the followmg: The governing body? Each committee With authority to act on behalf of the governing body? Does the organization have local chapters branches, or affiliates? if ?Yes" does the organization have written poIICIes and procedures governing the actIVities of such chapters, affiliates, and branches to ensure their operations are consistent With those of the organizationcopy of the Form 990 provided to the organization?s governing body before it was led? All organizations must describe in Schedule 0 the process, if any, the organization uses to reVIew the Form 990 . . . . 10 Is there any officer, director or trustee, or key employee listed in Part Vll, Section A who cannot be reached at the organization? 3 mailing address? if ?Yes,? provide the names and addresses in Schedule Section B. Policies 12a 13 14 15 16a Yes No Does the organization have a written conflict of interest policy? if go to line 13.. . 123 Are officers, directors or trustees, and key employees reqUIred to disclose annually interests that could give rise to conflicts12b Does the organization regularly and conSIStently monitor and enforce compliance With the policy? If ?Yes,? describe in Schedule 0 how this is done . . . . . . . . . . Does the organization have a written whistleblower policy? Does the organization have a written document retention and destruction policy? . . Did the process for determining compensation of the followmg persons include a rewew and approval by :5 ,4 independent persons, comparability data, and contemporaneous substantiation of the deliberation and de0i5ion The organization' 5 CEO, Executive Director, or top management of?Cial? Other officers or key employees of the organization? . . Describe the process in Schedule 0. (see instructions) 3; 341.- . Did the organization invest in, contribute assets to, or partICIpate in a joint venture or similar arrangement ?an" with a taxable entity during the year1631 If ?Yes, has the organization adopted a written policy or procedure requmng the organization to evaluate it? I i if: its partiCIpation in Joint venture arrangements under applicable federal tax law, and taken steps to safeguard . 4? the organization?s exempt status With respect to such arrangements16b Eel tie-lie 5., gill? I 1 A .. - Ji- Section C. Disclosure 17 18 19 20 List the states with which a copy of this Form 990 is reqUired to be filed Section 6104 reqwres an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you make these available. Check all that apply. [3 Own website Ci Another's webSIte Upon request Describe in Schedule 0 whether (and if so, how), the organization makes its governing documents, conflict of interest policy, and Manual statements available to the public. State the name. address, and telephone number of the person who possesses the books and records of the organization; ?nancial documents: Edita Smrcinova, 3434 Broadway Blvd, Tucson, AZ 85716, (520)325-3470 board documents: Mattix, 11485 136th St., Suite 110, Scottsdale, AZ 85259 (480)289-2088 Form 990 (2008) f, I .. Form 990 (2008) Wompensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons reqmred to be listed Use Schedule if additional space is needed. 0 List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation, and current key employees. Enter in columns (D), (E), and (F) if no compensation was paid. 0 List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations. 0 List all of the organization?s former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. 0 List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. List persons in the followung order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this box if the organization did not compensate any officer, director, trustee, or key employee. (A) (B) (C) (D) (E) (F) Name and Title Average Posmon (check all that apply) Reportable Reportable Estimated hours per 0 5 5 7: I .n oorrpeneatim compensation amount of week a 9 3 .52 3:5 2 from from related other 3 ?51 a 5% the organizations compensation 2 a organization from the 9. ii 2' 8 organization 3 and related 57 5 ?3 organizations 0 a U, ?9 21 8 Terry Sarvas, CEO/Chairman Jeff Parker Director 0 -0- -O- -O- resiqned on 3/16/09 since 5/25/09 just a Director 65 156'362 Olga V. Block, CEO 65 197,507 -0- -0- resiqned on 5125/09 Form 990 (2008) I. Form 990 (2008) Page 8 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (A) (B) (C) (D) (E) (F) Name and title Average Posrtion (check all that apply) Reputable Reportable Estimated hours per 0 5 5 7: I .11 oorrpensation compensation amount of week from from related other 0 13organizations compensation 9. a 3 ?5 organization from the 9. r: .9: organization 5 3 .3 and related 5' 5 organizations at 3 u, 21 3 1b Total353,869 0 0 2 Total number of indIVlduaIS (including those in 1a) who received more than $100,000 in reportable compensation from the organization 2 Yes No 3 Did the organization list any former officer, director or trustee, key employee, or highest compensated 1' I 1 employee on line 1a? If ?Yes," complete Schedule for such . . . . . . . 3 4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If ?Yes," complete Schedule for such rndiwdualDid any person listed on line 1a receive or accrue compensation from any unrelated organization for 1 services rendered to the organization? If ?Yes," complete Schedule for such person . . 5 Section B. Independent Contractors 1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Name and busrness address (3) of sewices (Cl Compensation SCORPIUS CORPORATION clo INTERNATIONAL Rental 206,668 DEPT. LA 22643, PASADENA, CA 91185-2643 2 Total number of independent contractors ?ncluding those in 1) who received more than $100,000 in compensation from the organization Form 990 (2008) Form 990 (2098) Page 9 Statement of Revenue . I - (A) (B) (C) (D) Total revenue Related or Unrelated Revenue - 02:17:; 9203231400,?" . revenue revenue 512, 513, or 514 33 1a Federated cam an 0 l' ?2 as 995 3,2 Membership dues . a, to Fundraismg events 10 119.000 5313' Related organizatlons . 1d 0 g-g Government grants (contributions). 1e 7340379 is All other contnbutlons. gifts, grants, . 3'5: "3 and Similar amounts not Included above 1f 5321345 'g Noncash 0 Total. Add lines 1a?1f 7, 788, 224 . 4, Business Code 511000 139 535 139-535 0 0 33 511000 143534 143-534 0 0 3 ?estasatscisaehreverts? 900099 4,343 4.848 0 0 i Beletss!.e99!eaesl9e? 900099 (32.411) (32.411All other program servuce revenue 3,933 3.933 0 0 at Total. Add lines 2a?2f 264,540 3'11} 5:322 3 fa: gr?) 3 Investment income (Including divndends, Interest, and other similar amounts) . . . . 4-575 4576 0 0 4 Income from investment of tax-exempt bond proceeds 0 0 0 0 5 Royalties . . . 0 0 0 0 (I) Real (in) Personal u: I 6a Gross Rents . . 0 0 151' 2' Less: rental expenses 0 0 f" ;j Rental income or (loss) 0 0 Net rental income or (loss) . . 0 0 7a GEES males of Securities Other assetso?terthanlnvemory 0 0 Less cost or other basrs and sales expenses 0 0 Gain or (loss) . . 0 0 a Net gain or (loss) 0 0 3 83 Gross Income from fundrarsmg 7 if?, E, events (not Including - i of contributions reported on line 10). 5 s" See Part IV line 1818,400 i. . Less: direct expenses . 41,507 - - - - Net Income or (loss) from events . (23,207) 0 0 (23,207) 9a Gross income from gaming ?Li?l? - See Part IV line Less: direct expenses . 0 . Net Income or (loss) from gaming 103 Gross sales of inventory, less returns and allowances . . . . a 0 Less: cost of goods sold . . . 0 Net Income or ?oss) from sales of Inventory 0 0 Miscellaneous Revenue Busmess Code I 11a 900099 23,694 23,694 All other revenue . . 0 0 6 Total. Add lines 11a?11d . 23,694 -l 1 12 Total Revenue. Add lines 1h8c, 9c, 10c, and 11e . 8,057,927 292,910 0 @207) Form 990 (2008) Form 990 (2008) Statement of Functional Expenses Page 10 Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D). Do not include amounts reported on lines 6bPart vm. mp 1 Grants and other aSSIstance to governments and 1; organIzatIons In the US. See Part IV, line 21 0 0 2 Grants and other assistance to IndIviduals In 3F: 1,3, the us. See Part 1V, line 22 . 0 f; 3 Grants and other assistance to governments, organIzations, and IndIviduals outside the us. See Part IV, lines egg, 1 4 Bene?ts paid to or for members . 0 0 a 1 5 Compensation of current officers, directors, trustees, and key employees . 414-000 0 414-000 0 6 Compensatlon not Included above, to disqualIf ed persons (as de?ned under section 4958(f)(1)) and persons described In sectIon 4958(c)(3)(B) 0 0 0 0 7 Other salarles and wages . . . 4355-757 4358257 193500 0 8 PenSIon plan Gnclude sectIon 401(k) and sectIon 403(b) employer contributions) 420-436 352505 57331 0 9 Other employee benefits 258-287 237.075 21,211 0 1O payron taxes . 343,284 307,288 35,996 0 11 Fees for SENICBS (non- -emp oyees): a Management 0 0 0 0 Legal 8,801 4,402 4,399 0 LobbyIng . . 0 mg; 0 Professonal fundraISIng services See Part lV, line 17 201341 *?ii i. J: 20.341 Investment management fees . 0 0 0 0 9 Other 255,501 202,598 52,903 0 12 Advertising and promotIon 72333 7.838 0 0 13 Office expenses 276,790 271,920 4,870 0 14 InformatIon technology 45-507 43.501 2,106 0 15 RoyaltIes 0 0 0 0 17 Travel . . 69,930 69,113 817 0 18 Payments of travel or entertaInment expenses for any federal, state, or local public o?iCIals 0 0 0 0 19 Conferences, conventIons, and meetings . 5-732 5-732 0 0 20 interest 988,743 0 988,743 0 21 Payments to affilIates 0 0 0 0 22 DepreCIatIon, depletion, and amortIzatIon 470,294 447,228 23,066 0 23 Insurance 43.112 33.059 7 15,053 0 24 Other expenses. Itemize expenses not L, covered above. (Expenses grouped together . - .1 and labeled mIscellaneous may not exceed 5% of total expenses shown on Me 25 below.) :5 - a Een?rats?ns 37.737 0 0 37.737 Mgsgeuanesw? 137.362 130,962 6,400 All other expenses 0 0 0 0 25 Toiai functional expenses. Add Lines 1 through 24f 3,375,767 6,422,276 1,894,913 58,578 26 Joint Costs. Check here If followmg SOP 98-2 Complete thIs lIne only If the organIzation reported In column (B) 10Int costs from a combIned educatIonal campaIgn and fundralsmg solICItatIon . . . 0 0 0 0 Form 990 (2008) 3 Form 990 (2098) Balance Sheet Page 1 1 (Al (B) Beginning of year End of year 1 Cash?non-interest-bearing . . . . . . . . . . . 209395 1 444515 2 Savmgs and temporary cash investments . . . . . . 300,633 2 239? 3 Pledges and grants receivable156:545 3 118,246 4 Accounts receivable4-130 5 Receivables from current and former officers, directors, trustees, key employees, or other related parties. Complete Part II of Schedule . . 0 5 . 0 6 Receivables from other disqualified persons (as defined under section .. . 1 4958(f)(1)) and persons described in section 4958(0 Complete Part II of Schedule . . +3 7 Notes and loans receivable, net a 8 Inventories for sale or use . 9 Prepaid expenses and deferred charges . . 103 Land, bUIldings, and eqUIpment: cost 103 13.451023 Less: accumulated depreciation. Complete 5" Part VI of Schedule 10b 1,623,647 12,230,811 10c 1,828,376 11 Investments?publicly traded securities . . . . . . . . . 0 11 0 12 Investments-other securities. See Part IV, line See Part IV, line Intangible assets . . . . . . . . . . . . . . . 0 14 0 15 Other assets. See Part IV, line 11 . . . 441:495 15 377:172 16 Total assets. Add lines 1 through 15 (must equal line 34) . . . 14,017,274 16 13,411,796 17 Accounts payable and accrued expenses . . . . . . 165,373 17 332432 18 Grants payable . . . . . . . . . . 0 13 0 19 Deferred revenue . . . . . . . . . . . . . . . . . 11503 19 22:1? 20 Tax- -exempt bond liabilities . 14395300 20 13335300 3 21 Escrow account liability. Complete Part IV of Schedule Wk .. 22 Payables to current and former officers, directors, trustees, key .. 3 employees, highest compensated employees, and disqualified .. persons. Complete Part II of Schedule . 0 23 Secured mortgages and notes payable to unrelated third parties . 0 24 Unsecured notes and loans payable . . . . . . . . 27'0? 24 7'482 25 Other liabilities. Complete Part of Schedule . . . . . . 195 730 25 211 515 26 Total liabilities. Add lines 17 through 25.. . 14, 497, 167 26 14,209 529 Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34. . v; 31 5:315 (1,071,350) 27 Unrestricted net assets . . . . . . . . . . . 1530:1781 27 in 28 Temporarily restricted net assets . . . . . . . . . . . 1501285 28 273,617 2 29 Permanently restricted net assets . . . 0 29_ ,0 LE Organizations that do not follow SFAS 11,7 check here 1?53; 5:51.; 3: a? 3 and complete lines 30 through 34. $34? :4 $131.1? v; 7? 30 Capital stock or trust prinCIpaI, or current funds . . . 30 3 31 Paid- -In or capital surplus, or land, budding, or equipment fund . . 31 32 Retained earnings, endowment, accumulated income, or other funds 32 33 Total net assets or fund balances . . . . . . . . . 33 34 Total liabilities and net assets/fund balances . . . . . 34 Financial Statements and Reporting Yes No 1 Accounting method used to prepare the Form 990: Cash 12 Accrual CI Other . 1 2a Were the organization'SI ?nancial statements compiled or reviewed by an independent accountant? 23 Were the organization? 5 finanCIaI statements audited by an independent accountant? 25 If ?Yes" to lines 2a or 2b, does the organization have a committee that assumes responsibility for oversight of I the audit, revrew, or compilation of Its finanCIal statements and selection of an Independent accountant" to 33 As a result of a federal award, was the organization reqUIred to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A- 133? . 33 If "Yes, did the organization undergo the required audit or audits? 3b Form 990 (2008) Public Charity Status and Public Support To be completed by all section 501(c)(3) organizations and section nonexempt charitable trusts. 5 Attach to Form 990 or Form 990-EZ. See separate instructions. f' OMB No 1545-0047 Open to Public Inspection Name of the organization, Employer identi?cation number BASIS SCHOOL, INC. 86 5 0908854 Reason for Public Charity Status (All organizations must complete this part.) (see instructions) The organization is not a private foundation because it is: (Please check only one organization.) 1 El A church, convention of churches, or of churches described in section Department of the Treasury tntemal Revenue Sewice 2 A school described in section (Attach Schedule E.) 3 A hospital or a cooperative hospital servrce organization described in section (Attach Schedule H.) 4 A medical research organization operated in conjunction With a hOSpital described in section Enter the hospital?s name, City, and state: 5 An organization operated for the benefit of a college or univerSity owned or operated by a governmental unit described in section (Complete Part II.) 6 A federal, state, or local government or governmental unit described in section 7 An organization that normally receives a substantial part of Its support from a governmental unit or from the general public described In section (Complete Part II.) 8 A community trust described in section (Complete Part II.) 9 An organization that normally receives: (1) more than 33% of its support from contributions, membership fees, and gross receipts from actiVities related to its exempt functions?subject to certain exceptions, and (2) no more than 331/: of its support from gross investment income and unrelated business taxable income (less section 511 tax) from busmesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part 10 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). (see instructions) 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h. a Typel Type II Type ill?Functionally integrated Type Ill?Other By checking this box, i certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publiciy supported organizations described in section 509(a)(1) or section 509(a)(2). If the organization received a written determination from the that it is a Type Type II, or Type supporting organization, check this box . 9 Since August 17, 2006, has the organization accepted any gift or contribution from any of the followmg persons? A person who directly or indirectly controls, either alone or together With persons described in (ii) and below, the governing body of the supported organization(ii) A family member of a person described in above35% controlled entity of a person described in (n or (ii) above? Prowde the followmg information about the organizations the organization supports. Name of supported (ii) EIN Type of organization (iv) Is the organization Did you notify (vi) Is the (vii) Amount of organization (described on lines 1?9 in col listed in your the organization in organization in col Support above or IRC section governing document? col of your organized in the (see instructions? supportTotal For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990. Cat No 11285F Schedule A (Form 990 or 990-EZ) 2008 Schedule A (Fprm 990 or 990-EZ) 2008 Page 2 Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I.) Section A. Public Support Calendar year (orfiscal year beginning in) 2004 2005 2006 2007 2008 Total 1 Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants 2 Tax revenues leVIed for the organization's benefit and either paid to or expended on Its behalf 3 The value of sewices or faculties furnished by a governmental unit to the organization Without charge 4 Total. Add lines 1-3 5 The portion of total contributions by each 3, person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column . 6 Public support. Subtract line 5 from line 4. Section B. Total Support Calendar year (or?scal year beginning in) 2004 2005 2006 2007 2008 Total 7 Amounts from line 4 8 Gross income from interest diVIdendS, payments received on securities loans, rents, royalties and income from Similar sources . . . 9 Net income from unrelated busmess actiwties, whether or not the busmess is regularly carried on 10 Other income Do not include gain or loss from the sale of capital assets (Explain in Part IV) 11 Total support. Add lines 7 through 10 . :1 i. )3 12 Gross receipts from related actIVIties, etc. (see instructionsFirst five years. If the Form 990 is for the organization' 5 first, second, third fourth, or fifth tax year as a section organization, check this box and stop here . . . Section C. Computation of Public Support Percentage i ?l i?r? ?i a n. t, 14 Public support percentage for 2008 (line 6, column divided by line 11, column . . . 14 15 Public support percentage from 2007 Schedule A, Part IV- A, line 26f . . . 15 163 331/3 support test? 2008. If the organization did not check the box on line 13, and line 14 is 33?/a% or more, check this box and stop here. The organization qualifies as a publicly supported organization . . . . 331/: support test? 2007. If the organization did not check a box on line 13 or 16a, and line 15 is 33?/a% or more, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . .P 17a 10%-facts- and- circumstances test?2008. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the facts- -and- c-ircumstances" test, check this box ands stop here. Explain' in Part IV hot-??4 organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization . . i 10%-facis-and-circumstances test?2007. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 rs 10% or more, and if the organization meets the ?facts? anci- CIrcumstances" test, check this box and stop here Explain in Part IV how the organization meets the ?facts- and- Circumstances" test. The organization qualifies as a publicly supported organization . . . .P 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions El Schedule A (Form 990 or 2008 Schedule A (Form 990 or 990- EZ) 2003 Page 3 Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I.) Section A. Public Support Calendar year (or fiscal year beginning in) 2004 2005 2006 2007 2008 (1) Total 1 Gifts, grants, contributions, and membership fees received. (Do not include any unusual grants . 2 Gross receipts from merchandise sold or services performed, or faCIlitIes furnished In any activity that :5 related to the organization's tax-exempt purpose . 3 Gross receipts from actIVIties that are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to or expended on Its behalf 5 The value of serVIces or furnished by a governmental unit to the organization Without charge 6 Total. Add lines 1-5 7a Amounts included on lines 1, 2, and 3 received from disqualified persons Amounts Included on lines 2 and 3 received from other than disqualified persons that exceed the greater of 1% of the total of lines 9, 10c, 11, and 12 for the year or 000 Add lines 7a and 7b 8 Public support (Subtract line 7c from .. a?ir a. - rsa to Section B. Total Support Calendaryear(orfiscal year beginning in) 2004 2005 2006 2007 2008 Total 9 Amounts from line 6 103 Gross Income from Interest, dIVIdends, payments received on securities loans, rents. royalties and income from similar sources Unrelated busmess taxable Income (less section 511 taxes) from busmesses achIred after June 30,1975 Add lines 10a and 10b 11 Net Income from unrelated busmess actIVItIes not Included In line 10b, whether or not the busmess Is regularly carried Other income Do not Include gain or loss from the sale of capital assets (Explain In Part IV.) 13 Total support. (Add lines 9, 10c4w, 24.: and 12..) i a 333a; 1.. ff ,3 a, 14 First ?ve years. If the Form 990 IS for the organization? 3 first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here . . . . . . . . . . . . . . . . Section C. Computation of Public Support Percentage 15 Public support percentage for 2008 (line 8, column (1) divided by line 13, column . 15 16 Public S?port percentage from 2007 Schedule A, Part IV-A, line 279 . . . . . . 16 Section D. Computation of Investment Income Percentage 17 Investment income percentage for 2008 (line 10c, column divided by line 13, column 17 18 Investment income percentage from 2007 Schedule A, Part IV-A, Iine 27h . . . . . 13 193 331/: support tests?2008. lithe organization did not cnecx the box on line 14, and iine i5 is more than 337396, and line 17 is not more than 33% check this box and stop here. The organization qualifies as a publicly supported organization 331/: support tests-2007. If the organization did not check a box on line 14 or line 19a, and line 16 Is more than and line 18 IS not more than 33% check this box and stop here. The organization qualifies as a publicly supported organization 20 Private foundation. If the organization did not check a box on line 14, or 19b, check this box and see Instructions Schedule A (Form 990 or 990-EZ) 2008 . I I .n ?l Schedule A (Form 990 or 990- E2) 2008 Page 4 Part IV Supplemental Information. Complete this part to provnde the explanation requnred by Part ll, line 10; Part II, line 17a or 17b; or Part line 12. Provide any other additional Informatlon. (see Instructions) Schedule A (Form 990 or 2008 I I SCHEDULE (Form 990) Supplemental Financial Statements Attach to Form 990. To be completed by organizations that Open to Public answered ?Yes," to Form 99012' Inspection Name of the organization Employer identi?cation number BASIS SCHOOL, INC. 86 5 0908854 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered ?Yes" to Form 990, Part IV, line 6. Donor adVIsed funds Funds and other accounts Total number at end of year . Aggregate contributions to (during year) Aggregate grants from (during year) Aggregate value at end of year Did the organization Inform all donors and donor adVIsors in writing that the assets held In donor adVIsed funds are the organization?s property, subject to the organization?s excluswe legal controlDid the organization inform all grantees, donors, and donor adVIsors In writing that grant funds may be Used only for charitable purposes and not for the benefit of the donor or donor adVIsor or other imlpermISSIble private benefitConservation Easements. Complete If the organization answered ?Yes" to Form 990, Part IV, line 7. Purpose(s of conservation easements held by the organization (check all that apply). Preservation of land for public use recreation or pleasure) El Preservation of an historically Important land area Protection of natural habitat El Preservation of certified historic structure El Preservation of open space 2 Complete lines 2a?2d If the organization held a qualified conservation contribution In the form of a conservation easement on the last day of the tax year. Egg: Held at the End of the Year a Total number of conservation easements Total acreage restricted by conservation easements . . . . Number of conservation easements on a certified historic structure Included in . . 2? Number of conservation easements included In (c achIred after 8/17/Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the taxable year 4 Number of states where property subject to conservation easement IS located 5 Does the organization have a written policy regarding the periodic monitoring, inspection, Violations, and enforcement of the conservation easements It holdsStaff or volunteer hours devoted to monitoring, Inspecting, and enforcmg easements during the year? 7 Amount of expenses incurred In monitoring, InspectIng, and enforcmg easements during the year> 8 Does each conservation easement reported on line 2(d) above satisfy the reqUIrements of section 170(h and section 170(h)(Part XIV, describe how the organization reports conservation easements In Its revenue and expense statement, and balance sheet, and Include, If applicable, the text of the footnote to the organization' 3 finanCIaI statements that describes the organization's accounting for conservation easements. Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Compiete If the organization answered ??i?es"iu Form 990, Part V, has 1a If the organIzatIon elected, as permitted under SFAS 116, not to report In Its revenue statement and balance sheet works of art, historical treasures, or other Similar assets held for public exhibition, education, or research In furtherance of public serVIce, prowde, In Part XIV, the text of the footnote to Its finanCIaI statements that describes these Items. If the organization elected, as permitted under SFAS 116, to report In its revenue statement and balance Sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public serVIce, prowde the followmg amounts relating to these Items: Revenues Included in Form 990, Part line (ii) Assets Included in Form 990, Part . . . . . . . . . . . . 2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the followmg amounts reqwred to be reported under SFAS 116 relating to these items: a Revenues included In Form 990, Part line Assets Included in Form 990, Part . . . . . For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 522830 Schedule (Form 990) 2008 Schedule (Form 990) 2008 Page 2 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continuedL 3 Usmg the organization's acceSSion and other records, check any of the followmg that are a significant use of its collection items (check all that apply): a '3 Public exhibition [1 Loan or exchange programs I: Scholarly research Other Preservation for future generations 4 Prowde a description of the organization?s collections and explain how they further the organization?s exempt purpose in Part XIV. 5 During the year, did the organization what or receive donations of art, historical treasures, or other Similar assets to be sold to raise funds rather than to be maintained as part of the organization?s collection? . Yes El No Trust, Escrow and Custodial Arrangements. Complete if organization answered ?Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. 1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part . . . . Yes No If ?Yes, explain the arrangement in Part XIV and complete the followmg table: Amount Beginning balance . Additions during the year . Distributions during the year . Ending balance . 23 Did the organization include an amount on Form 990, Part X, line 21? If "Yes, explain the arrangement in Part XIV Endowment Funds. Complete if organization answered "Yes" to Form 990, Part IV, line 10. Current year Prior year Two years back to) Three years back Four years back 13 Beginning of year balance . . . 4T - :4 I - - Contributions . . . . -- . - - - I Investment earnings or losses Egg-i? f: . - ~57 Grants or scholarships . . . . Other expenditures for faCIIities j: . and programs . . . . - Administrative expenses . . . - ~53? 9 End of year balance . . . - 2 Prowde the estimated percentage of the year end balance held as a Board des:gnated or quaSi?endowment Permanent endowment Term endowment 3a Are there endowment funds not in the possessmn of the organization that are held and administered for the organization by: Yes No unrelated organizations 330) (ii) related organizations . . . . . . . . 3a(ii) If ?Yes" to 3801) are the related organizations listed as required on Schedule . . . . . . 3b 4 Describe in Part XIV the intended uses of the organization?s endowment funds. Part VI Investments?Land, Buildings, and Equipment. See Form 990, Part X, line 10. Description of investment (3) Cost or other Cost or other DepreCIation Book value (investment) ba5is (other) 1a Land . . . . . . . . . . . . 0 3,368,157 - 3:368:15? . . 0 8,642,855 662,077 7,980,778 Leasehold improvements . . . . . 0 2925'? 292:134 0 Equipment - . - . . 0 1,147,222 669,436 477,786 Other . . 1, 655 0 1,655 Total. Add lines 1a?1e. (Column should equal Form 990, PartX, column (B), line . . . 11,828,376 Schedule (Form 990) 2008 Schedule (Form 990) 2008 Page 3 Pa VII Investments?Other Securities. See Form 990, Part X, line 12. Description of security or category (including name of security) Book value Method of valuation Cost or end?of?year market value FinanCIaI derivatives and other finanCIal products. Closely-held equity interests . . . Other Total. (Column should equal Form 990, Part X, col. (B) line 12 Part Investments?Program Related. See Form 990, Part X, Description of investment type Book value Method of valuation Cost or end-of-year market value Total. (Column should equal Form 990, Part X, col line 13 Other Assets. See Form 990, Part X, line 15. Description Book value Restricted Cash - Reserve Funds - Education Revenue Bonds Series 2006 Restricted Cash - Reserve Funds - Education Revenue Bonds Series 2007 NIA NIA NIA NIA NIA NIA NIA NIA Total. Column should equal Form 990, Part X, col. (8) line 15.) Other Liabilities. See Form 990, Part X, line 25. 236,722 140.450 377.172 Description of liability Amount Federal Income taxes 0 Students Security Deposits 211,515 NIA NIA NIA NIA NIA NIA NIA NIA NIA Total. (Column should equal Form 990, Part X, col (B) line 25 211,515 In Part XIV, prOVide the text of the footnote to the organization's finanCIal statements that reports the organization?s liability for uncertain tax posntions under FIN 48. Schedule (Form 990) 2008 Schedule (Form 990) 2008 Reconciliation of Change in Net Assets from Form 990 to Financial Statements 2 mantra: 3 4 a 5 .Total revenue (Form 990, Part column (A), NM 12) Total expenses (Form 990, Part IX, column (A), ?ne 25) . Excess or (de?CIt) for the year. Subtract lIne 2 from [me 1 Net unrealized gaIns (losses) on Investments Donated serVIces and use of Investment expenses Prior period adjustments Other In Part XIV) Total adjustments (net). Add IInes 4?8 Excess or (defICIt) for the ye ar per financial statements. CombIne lines 3 and 9 8,057,927 8,375,767 (317,840) 0 OODOO (317,840) Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Total revenue, gaIns, and other support per audIted finanCIaI statements . Amounts Included on [me 1 but not on Form 990, Part line 12: Net unreaIIzed game on investments Donated services and use of faCIIities RecoverIes of prior year grants Other (DescrIbe In Part XIV) Add lines 2a through 2d Subtract line 2e from line 1 Amounts Included on Form 990, Part lIne 12, but not on line1: Investment expenses not Included on Form 990, Part lIne 7b Other (DescrIbe In Part XIV) Add lines 4a and 4b . Total revenue. Add Ines 3 and 4c. (ThIs should equal Form 990, Part I, line 12). 2a 8,309,143 2b 2c 2d 251,21 GOOD 4a 251,215 8,057,927 4b 0 8,057,927 Reconciliation of Expenses per Audited Financial Statements With Expenses pe Return Total expenses and losses per audIted fInanCIal statements Amounts Included on Me 1 but not on Form 990, Part IX, line 25: Donated serVIces and use of faCIlitIes . PrIor year adjustments . . . Losses reported on Form 990, Part IX, line 25 . Other In Part XIV) Add IInes 2a through 2d Subtract line 2e from Me 1 . Amounts Included on Form 990, Part IXInvestment expenses not included on Form 990, Part IIne 7b Other (DescrIbe In Part XIV) Add lines 4a and 4b Total expenses. Add lines 3 and 4c. (IhIs should equal Form 990, Part Me 18.) 2a 8,626,983 2b 2c 2d 251,21 4a 251,216 8,375,767 4b 0 8,375,767 Part XIV Supplemental Information Complete this part to provide the descriptions reqUIred for Part II, lines 3, 5, and 9; Part lines 1a and 4, Part IV, lines 1b and 2b; Part V, line 4; Part Part XI, Me 8; Part XII, IInes 2d and 4b; and Part lines 2d and 4b. Part line 2d represents the expenses on lease from 1I1108 to 6/30/09. Gross sublease revenues 5 218,805 were Schedule (Form 990) 2008 1 Schedule (Fprm 99012003 Page 5 Part XIV Supplemental Information (continued) decreased by these expenses 5 251,216 - see 990, Part line 2d. Rentals 206,248 44,580 LeaseneIe-I;;re;emen-t-;oen- Interests 388 - $251,216 Schedule (Form 990) 2008 SCHEDULE Schools (Forrn 990 990-EZ) To be completed by organizations that answer "Yes" to Form 990. Part IV, line 13, or Form BSD-E2, Part VI, line 48. Open to Public Department of the Treasury internal Revenue Semce Attach to Form 990 or Form BSD-EL Inspection Name of the organization Employer identification number BASIS SCHOOL, INC. 86 5 0908854 YES NO 1 Does the organization have a racually 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 nondiscriminatory 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 nondiscriminatory policy through newspaper or broadcast media {3321: 2? during the_per_iqd_o_f or during the registration period if it has no solicitation program, a in a way that makes the policy known to all parts of the general community it serves? If ?Yes," please 1-144 describe. If please explain . . . . . . . . . . . . . . . . . . . . . . . 3 {w assessReassessmentIt! ti,? T: if: :3 [u .9. saris 4 Does the organization maintain the followmg? a Records indicating the raCIal composition of the student body, faculty, and administrative staff? . . . 4a Records documenting that scholarships and other finanCIal are awarded on a racially nondiscriminatory ba5isCopies of all catalogues, brochures, announcements, and other written communications to the public dealing w1th student admissnons, programs, and scholarshipsCopies of all material used by the organization or on its behalf to solicit contributions? . . 4d ?f If you answered ?No" to any of the above, please explain. (If you need more space, attach a separate 99* statement.) sees. separate. statement. 32399. ft? 5 Does the organization discriminate by race in any way With respect to: 3 Students' rights or priwlegespoliCiesEmployment of faculty or administrative staffScholarships or other finanCIal assistanceEducational poliCIesfacilitiesAthletic programsOther extracurricular activitiesyou answered "Yes" to any of the above, please explain (If you need more space attach a separate statement.) Ga Does the organization receive any finanCiaI aid or from a governmental agency? . . . . 53 Has the organization?s right to such aid ever been revoked or suspendedyou answered "Yes" to either line 6a or line 6b, please explain using an attached statement. - - I 7 Does the organization certify that it has complied with the applicable reqwrements of sections 4.01 through 1 4.05 of Rev. Proc. 75?50, 1975?2 08. 58?, covering raCIal nondiscrimination? If attach an explanation. 7 For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 500850 Schedule (Form 990 or 990-EZ) 2008 OMB Nb 1545-0647 SCHEDULE (5 Supplemental Information Regarding (Form 99?0 or 990-EZ) Fundraising or Gaming Activities Department of the Treasury Attach to Form 990 or Form 990-EZ. Must be completed by organizations that answer ?Yes" to Form 990. Part IV. lines 17. Open To Public internal Revenue Service 18, or 19. and by organizations that enter more than $15,000 on Form QED-E2, line Ba. Inspection Employer identification number Name of the organization BASIS SCHOOL, INC. 86 0908854 Fundraising Activities. Complete if the organization answered ?Yes" to Form 990, Part IV, line 17 1 Indicate whether the organization raised funds through any of the followmg actiwties. Check all that apply. a Mail soIICitations SoiICItation of non?government grants Email solicitations SoIICItation of government grants Phone solicnations SpeCial fundraismg events ln-person solicitations 23 Did the organization have a written or oral agreement With any indiwdual (including officers, directors, trustees or key employees listed in Form 990, Part VII) or entity in connection With professmnal fundraismg semces? Yes No If ?Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table Name of IndIVIdual (ii) Actiwty Did fundraiser have (iv) Gross receipts Amount paid to (vi) Amount paid to or entity (fundraiser) custody or control of from actiVity (or retained by) (or retained by) contributions? fundraiser listed in organization col Yes No Dawson, Julee MT Campaign 14?,335 20,841 126,494 Total 5 147,335 20,841 126,494 3 List all states in which the organization is registered or licensed to funds or has been notified it is exempt from registration or licensmg. For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Car No 50033H Schedule (Form 990 or QQD-EZ) 2008 Schedule 6 (Form 990 or 990-EZ) 2003 Fundraising Events. Complete if the organization answered ?Yes? to Form 990, Part IV, line 18, or reported more than $15,000 on Form 990-EZ, line 6a. List events With gross receipts greater than $5,000. a Page 2 9I Event #1 Event #2 {cl Other Events Total Events Dinner (Add col (8) through (total number) M) 1 Gross receipts . . . . . 1371400 137.400 CC 2 Less: Charitable contributions . . . . 119,000 119.000 3 Gross revenue (line 1 minus line 2) . 18,400 13,400 4 Cash prizes U) 3 5 Non-cash prizes 5 0. L33 6 Rent/faculty costs 6 7 Other direct expenses . 41.507 41,507 8 Direct expense summary. Add lines4through 7 in column . . . . . . . . 41, 607) INet income summary. Combine lines 3 and 8 in column . (23, than $15,000 on Form 990- E2, line 6a. Gaming. Complete if the organization answered ?Yes" to Form 990, Part lV, line 19, or reported more Bingo Pull tabs/Instant Other gaming Total gaming (Add 2 bingo/progresswe bingo col (3) through col 9 CD 1 Gross revenue U) . 3 2 Cash prizes (1) 3 Non?cash prizes . ?5 .. 4 Rent/faculty costs a 5 Other direct expenses . Yes El Yes El Yes i 6 Volunteer labor N0 No No i 7 Direct expense summary Add lines 2 through 5 in column . . . . 8 Net gaming income summary. Combine lines 1 and 7 in column . . . . . Yes No i 9 Enter the state(s) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activuies in each of these states? 93 If Explain. I We Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? 103 If "Yes," Explain: 11 Does the organization operate gaming actiVIties With nonmembers? 11 12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming? 12 f) or an-EZ) 2008 I 3 Schedule (Form 990 or 990-EZ) 2008 Page 3 Yes No 13' Indicate the percentage of gaming actIVIty operated in: a The organization?s facility . . . . . . . . . . . 133 An outside facility 13b 14 Prowde the name and address of the person who prepares the organization' 5 gammg/specral events books and records. Name Address 153 Does the organization have a contract with a third party from whom the organization receives gaming revenue? . . 1?a If ?Yes enter the amount of gaming revenue received by the organization and the amount of gaming revenue retained by the third party If "Yes," enter name and address: Name Address 16 Gaming manager information' Name Gaming manager compensation Description of services prowded El Director/of?cer El Employee Independent contractor 17 Mandatory distributions: a Is the organization reqUIred under state law to make charitable distributions from the gaming proceeds to retain the state gaming license? 173 Enter the amount of distributions reqUIred under state law distributed to other exempt organizations or spent 1, in the organization? 5 own exempt actiVIties during the tax year Schedule (Form 990 or 990-EZ) 2008 I I OMB No 1545-00476 SCHEDULE Compensation Information (Form 990) For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Department of the Treasury Attach to Form 990. To be completed by organizations Open to lntemal Revenue Sewice that answered ?Yes" to Form 990, Part IV, line 23. Inspection Name of the organization Employer Identification number BASIS SCHOOL, INC. 86 0908854 Questions Regarding Compensation Yes No 1a Check the appropriate box(es) if the organization prowded any of the followmg to or for a person listed in Form i 990, Part VII, Section A, line 13. Complete Part to prov1de any relevant Information regarding these items. El First-class or charter travel Housmg allowance or reSIdence for personal use 5 Travel for companions Cl Payments for business use of personal reSIdence Cl Tax indemnification and gross-up payments Health or sootal club dues or initiation fees El Discretionary spending account CI Personal serwces maid, chauffeur, chef) If line 1a is checked, did the organization follow a written policy regarding payment or reimbursement or prowsmn of all of the expenses described above? If ?No" complete Part to explain . . . 1b 2 Did the organization reqUIre substantiation prior to retmbursmg or allowing expenses incurred by all officers, directors, trustees. and the CEO/Executive Director, regarding the items checked in line 1a? . 2 3 Indicate which, if any, of the foliowmg the organization uses to establish the compensation of the organization's CEO/Executive Director. Check all that apply. - Compensation committee IZI Written employment contract IZI Independent compensation consultant Compensation survey or study El Form 990 of other organizations El Approval by the board or compensation committee 4 During the year, did any person listed in Form 990, Part VII, Section A, line 1a: 3 3 Receive a severance payment or change of control paymentParticipate in, or receive payment from, a supplemental nonqualified retirement plan? . 4b ?l Partic1pate in, or receive payment from an eqUIty- -based compensation arrangement? . . If ?Yes" to any of lines 4a?c, list the persons and provide the applicable amounts for each item in Part 3 Only 501(c)(3) and 501(c)(4) organizations must complete lines 5?8. i 5 For persons listed in Form 990, Part VII, Section A, line is, did the organization pay or accrue any I compensation contingent on the revenues of: Any related organization?Yes" to line 5a or 5b describe in Part 6 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the net earnings of: 1 a The organizationAny related organization?Yes? to line 6a or 6b, describe in Part z_ ?i 7 For persons listed in Form 990, Part VII Section A, line 1a, did the organization prowde any non-fixed payments not described in lines 5 and 6? If ',Yes describe in Part . . 7 t/ 8 Were any amounts reported in Form 990, Part VII paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regs. section 53. 4958- If "Yes" describe . . . . . .. .. 3 For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 50053T Schedule (Form 990) 2008 Schedule [Form 990) 2008 Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-?l if additional space is I - Page 2 needed. For each ndIVIdual whose compensation must be reported In Schedule J, report compensation from the organization on row (I) and from related organizations. described in-the Instructions, on row 00 not list any indiwduals that are not listed on Form 990, Part VII. Note. The sum of columns must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a. (B) Breakdown of and/0r COITlpel?lSEthl?l Deferred (D) Nonlaxable (E) Total of columns (ilil Other compensation benefits (Bull?(D) (A) Name Ease (ii) Bonus incentive compensation compensation reportable compensation (F) Compensation reported In prior Form 990 or Form 197,507 0 0 19.050 3,905 220,462 i Olga V. Block 195,802 15535200 1.52.259 929.95 17.52%? Michael K. Block (ii) (il (ill Schedule (Form 990) 2008 ?289620396. 5.2338: 003225 95 um: 8 905mm 2.5 53.38.03. o? ammozuzozm 69:.00306.8 35 09.1, 3* m2 maQEosm: 333mg? manage?m 2?qu mac. noom SCHEDULE . (Form 990, Supplemental Information on Tax-Exempt Bonds Attach to Form 990. To be completed by organizations that answered ?Yes" to Form 990, Part IV, Department of Treasurv line 24a. Provide descriptions. explanations. and any additional information on Schedule 0 (Form 990). lniemat Revenue Service Name of the organization OMB No 1545-0047 Open to Public Inspection Employer Identification number BASIS Sc/voa' MC. 367 5 0905554 Bond Issues (Required for 2008) Ial issuer name Issuer EIN (Cl CUSIP Date issued to) Issue price (0 Description of purpose Deteased On behalf oi Issuer :07stst Dram/90mmfarms Yes No Yes No cup-H710 (bums, oppimc-L 7Pia 5; 4?55 000 2004 GCCJUHP {toolbar/Hi1 1/ 722-7 3 GQ7M IndUSTi/?mi D9061 Up?Yi?emT Aggy-f?lrl?) {mane-mg ofrwr?; lo 0,6 4414?6?01417219 af?rm ?33/ 01/0: M7 ?7,000,000 (0., em [?59 arrow/e 72/7 if 1704? I Proceeds (Optional for 2008) Total proceeds of issue Gross oroceeds in reserve funds Proceeds in refunding or defeasance escrows Other unspent proceeds Issuance costs from proceeds Working capital expenditures from proceeds Capital expenditures from proceeds Year 01 substantial completion Yes Were the bonds issued as part of a current refunding issue? 10 Were the bonds issued as part of an advance refunding issue? 11 Has the final allocation of proceeds been made" 12 Does the organization maintain adequate books and records to support the final allocation of proceeds? Part Private Business Use (Optional for 2008) 1 Was the organization a partner in a partnershipmember of an LLC, which owned property financed by tax-exempt bonds." 2 Are there any lease arrangements with respect to the financed property which may result in private busmess use? For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 50i93E Schedule (Form 990) 2008 .f i '1 SCHEDULE Transactions With Interested Persons (Form 990 or 990-E2) Attach to Form 990 or Form To be completed by organizations that answered Dep?artment oi the Treasury ?Yes? on Form 990, Part IV, line 25a, 25b, 26, 27, 283, 28b, or 28c, Internal Revenue Semce or Form 990-EZ, Part V, line 38a or 40b. I OMB No 1545-6047 2008 Open To Public Inspection Name of the organization Employer identification number BASIS SCHOOL, INC. 86 0908854 Excess Benefit Transactions (section 501(c)(3) and section 501(c)(4) organizations only). To be completed by organizations that answered ?Yes? on Form 990, Part IV, line 25a or 25b, or Form QQO-EZ, Part V, line 40b. Corrected? Name of disqualified person Description of transaction 1 Yes No 2 Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958 3 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization >3 Loans to and/or From Interested Persons. To be completed by organizations that answered ?Yes? on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 383. Name of interested person and purpose Loan to or from Origxnal Balance due In default? (I) Approved (9) Written the organization9 prinCipaI amount by board or agreement? committee? To From Yes No Yes No Yes No Total . . . . . . . 1? 35.55: . 5.: Part Grants or Assistance Benefitting Interested Persons. To be completed by organizations that answered ?Yes" on Form 990, Part IV, line 27. Name of interested person Relationship between interested person and the Amount of grant or type of a53istance organization Business Transactions Involving Interested Persons. To be completed by organizatio ns that answered ?Yes? on Form 990, Part IV, line 28a, 28b, or 28?. Name of interested person Relationship between Amount of Description of transaction (8) Sharing ?31 interested person and the transaction organization's organization revenues? Yes No Petra Vyborna Daughter of Olga V. 19,000 Employment Block, CEO Katerina Schmidtova Sister of Olga V.Block 53,047 Accounting Services CEO (performed in Czech Rep.) For anacy Act and Papenivork Reduction Act Notice, see the Instnictions for Form 990. Cal No 50056A Schedule (Form 990 or 2008 i SCHEDULE 0 OMB No 1545-0047 (Form 990) Supplemental Information to Form 990 Attach to Form 990. To be completed by organizations to provide Depanmem o, the Treasury additional Information for responses to SpelelC questions for the Open ?9 Internal Revenue Sen/ice Form 990 or to provide any additional information. Name of the organization Employer Identification number BASIS SCHOOL, INC. 35 5 0908854 -Eert?luine -1. 95- 105?. 9.9.9. will 00-99211519502 599.00-019.002cej9r. [grenades .1) if PEER 89.009. -9.00.t.r.0l?xes..3..0i.t? .1199 Phoenix, AZ 85012-2642 -80 09. .1. 55.0 103210-199- 30.010 51.9 9.0 9.9 {0.0 9.0 0.00.90 9.9.0 0.0 0.0 01.000-94905110 2100.090 9.0 -02 04-211090 00?..003090! .01 3.09-5909. 39. 9.9.09.0 at. $0910.09. teammate 9f. $09-1.3190r91. 0030.09. ?90?isisrss? rssemms090!!9.0? 9t ?00.9901020E03i90 .9.9.r0.r0i.t.t9.9 19 9. .005! 0. .005! gig. 1092001200 9.91 if! 9. 9.99.? ff} -. 9.9? -1. ?9h92 .5199. 9f. 5.5.5. 913. [1?3 9. 31.9.9 as a member. The School Board Members? Assurance reads: ?As a member of the BASIS School Board I will not engage For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat No 51056K Schedule 0 (Form 990) 2008 5/ Schedule 0 (Form 990) 2008 Name of the organizatlon . I Page 2 Employer Identification number Board whenever I, or a relative of mine, haveihas a direct financial interest in a matter before the Board and I will refrain ?9331. 919.99 {9.9 9199.09. 9.9 9. 59.911 .3. 925391333 '15! Y9. 99.9.9- [9.9 PEPE. P9. .519 E929 Ella. 92?: .WP. .?i?jil 9?53 $3.52 .tl? 9.9. it? 9.931935329513335 Rt 191?? 99-5?Eq?i115m9391?5?2 SEES: PE 991']- 9.9! .9 [19.3.92 f! 99195.99? 9.955: 393.94?! i if! Rt. 39. 559.919??! 19995! I255. aetivitm 195-9.r2fit. -92ir31_9_r_9_t_h9_r. 9392 -E?f?l?i written 9999?. .99. $h9?a99nf 12t A??Htanea? -9119. ?15. HEEL Whi?t?. $99919. l9! 39. .9 {5929.5}- 3.5. 91?- [13.9 9.9.53. EYES. returned to BASIS School, Inc. and we were unable to ?le the request in a timely manner. Schedule 0 (Form 990) 2003 2008 FEDERAL STATEMENTS BASIS SCHOOL, INC. 86-0908854 STATEMENT 1 FORM 990, Schedule E, LINE 3 - explanation As a public charter school in the state of Arizona, BASIS School, Inc Is reqUired by law to accept all students regardless of race, color, national and ethnic origin. Our non discrimination policy is printed on all registration documents as well as the Parent-Student Handbook which explains in detail all school poIICies We do not publish our nondiscrimitory policy In the newspaper or media durring the registration period because 1) as a public institution we are reqUIred by law to uphold our nondiscrimination policy and believe our compliance with state law is implied and 2) we are charged by the length of the statement/colum or column inch for each soIiCItation printed in the newspaper or media and are constrained by our limited state resources STATEMENT 2 FORM 990, Schedule E, LINE 4a - explanation We do not maintain records indicating the meal compos:tion of our faculty or administrative staff We collect information on potential employees during the application process and do not believe a staff members race should be taken into conSideration upon the application and hiring process We do keep records for the raCIaI composmon of the student body at BASIS School, Inc As regquired by state law STATEMENT 3 FORM 990, Schedule E, LINE 4b - explanation BASIS School, Inc is a tUItion free school that does not charge tumon As such, we do not award ?nanCIaI assmtance or scholarships and therefore keep no records for documentation purposes. ct Fm?8868 Application for Extension of Time To File an i' - (net Apnl2009) Exempt Organization Return OMB No Department of the Treasury Mama] Revenue Semce File a separate application for each return. If you are ?ling for an Automatic a-Month Extension. complete only Part I and check this box . . . . a if you are ?ling for an Additional (Not Automatic) 3-Month Extension. complete only Part II (on page 2 of this form). Do not com lete Part unless you have already been granted an automatic 3-month extension on a preViously filed Form 8868 WAutomatic 3-Month Extension of Time. Only submit original (no copies needed). A corporation reqmred to file Form QQO-T and requesting an automatic 6-month extenSion?check this box and complete All other corporations (including 1120-0 ?lers), partnerships. REMICs. and trusts must use Form 7004 to request an extensron or? time to file income tax returns. Electronic Filing (e-fite). Generally. you can electronically file Form 8868 it you want a 23-month automatic extenSion of ttme to file one of the returns noted below (6 months for a corporation reqmred to file Form However, you cannot file Form 8868 electronically if (1) you want the additional (not automatic) 13-month extensmn or (2) you file Forms 990-BL. 6069. or 8870. group returns. or a composne or consolidated Form Instead. you must submit the fuiiy completed and Signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form. ViSit and click on e?fiie for Charities Nonprofits. Type or Name of Exempt Organization Employerl identification number print BASIS SCHOOL, INC. 86 0908854 Egg?? Number. street. and room or smte no If a 0 box. see Instructions filing your 11440 North 135th Street City. town or post of?ce, state. and ZIP code. For a foreign address. see instructions. Scottsdale. AZ 85.259 Check type of return to be flied (file a separate application for each return): Form 990 El Form 990-1? (corporation) El Form 4720 El Form 990-BL Form 990-T (sec. 401la) or 408(a) trust) Form 5227 El Form 990-EZ [3 Form 990-T (trust other than above) El Form 6069 El Form sen-PF El Form 1041-A (3 Form 8870 The books are in the care of Ettaamtsi?ttxa. - I7 Telephone No. FAX No. 0 if the organization does not have an office or place of busmess in the United States. check this box . . If this is for a Group Return. enter the organization's four digit Group Exemption Number If this is for the whole group. check this box . . . . If it is for part of the group. check this box . El and attach a list with the names and EINs of all members the exten5ion Will cover. 1 request an automatic 3-month (6 months for a corporation requued to file Form extenSion of time until . 20-19.. to file the exempt organization return for the organization named above. The extenSion is for the organization?s return for: calendar year 20 or Ir tax year beginning 1/91 . 20 . and 20-39-- 2 if this tax year is for less than 12 months. check reason' Initial return Ci Final return CI Change in accounting period 3a If this application is for Form 990-BL. 990-PF, 990-T. 4720. or 6069. enter the tentative tax. less any nonrefundable credits. See instructions. 3a 55 if this application is for Form or enter any retundable credits and estimated tax payments made. Include any prioriear overpayment allowed as a credit. 3b Balance Due. Subtract line so from line 3a. Include your payment with this form. or. it reqUIred. Ag deposn With coupon or. if requtred. by usmg EFTPS (Electronic Federal Tax Payment gm; System). See instructions. 3c 5 Caution. If you are gomg to make an electronic fund Withdrawal With this Form 8868. see Form 8453-EO and Form 8879-EO for payment instructions. For Privacy Act and Paperwork Reduction Act Notice, see Instructions. Cat No 279160 Form 8868 (Rev 4-2009) i' 1' Fem} sees (Flev 4-2009) Page 2 a If you are ?ling for an Additionat (Not Automatic) 3-Month Extension, complete only Part II and check this box . Note. Only complete Part it if you have already been granted an automatic 3-month extensron on a prewously filed Form 8888. if you are filing for an Automatic 3-Month Extension, complete only Part (on page 1). Additional (Not Automatic) 3-Month Extension of Time. Onlyfile the orignaljno cepies needed). Type or Name of Exempt Organization 1' 3.35.1.2: t1}; Employer identification number Print . f: 5 File by the Number, street. and room or surte no. If a PD. box. see instructions 5 'q 2? For lFiS use only extended dlile debt: for rii magn- See City. town or post office. state. and ZIP code For a foreign address. see instructions. . ,r instructions Check type of return to be ?led (File a separate application for each return)- El Form 990 Form 990-PF El Form 1041 -A Form 5059 El Form sec-BL El Form QQO-T (sec. 401(3) or 408(a) trust) El Form 4720 El Form 8870 El Form 990-52 El Form 9904 (trust other than above) Form 5227 Do not complete Part II it you were not already granted an automatic 3-month extension on a previously filed Form 8888. 0 The books are in the care of Telephone No. i. FAX No. a if the organization does not have an of?ce or place of busmess in the Uniteo States, check this box . . Ir 3 0 If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) If this is for the whole group. check this box . . . . . El . If it is for part of the group. check this box. . . . [j and attach a list with the names and Ele of all members the extenSion is for. 4 I requth an additional 3-month extensron of time until . 20 5 For calendar year . or other tax year beginning . 20 . and ending . 2O 6 If this tax year is for less than 12 months. check reason: Cl initial return CI Final return CI Change in accounting period 7 State in detail why you need the extensmn 83 if this application is for Form 990-81.. BSD-PF, 990-T. 4720. or 6069, enter the tentative tax. less any nonrefundable credits. See instructions. Ba If this application is for Form QQO-T. 4720. or 6069. enter any refundable credits and (Ef?e? estimated tax payments made. Include any prior year overpayment allowed as a credit and any e?e?in?ri amount paid previously With Form 8868. 8b 5 Balance Due. Subtract line 8b from line 8a. Include your payment With this form. or. if reqmred. deposn with FTD coupon or. if reqUired, by neigg EFT PS Electronic Federal Tax Payment SystemLSee instructions. 8c 3 Signature and Verification Under penalties of penury. I declare that I have examined this form. including accompanying schedules and statements. and to the best of my knowledge and belief. it is true. correct. and complete. and th I am authorized to prepare this form signature Tine Date #007 Form 3868 [Rev 4-2009)