EXTENDED TO NOVEMBER 15 2 0 17 OMB No. 1545-0047 990 Return of Organization Exempt From Income Tax Form Under section 501(c), 527. or 4947(a)(1) of the Internal Revenue Code (except private foundations) Treasury Do not enter social security numbers on this form as it may be made public. Open to P_ublic internal Information about Form 990 and its instructions is at A For the 2016 calendar year, or tax year beginning and ending onset it Name of organization Employer identification number applicable: odes CONVENTION 0F STATES ACTION min Doing business as 47*2245708 Number and street [or PD. box it mail is not delivered to street address) Room/suite Telephone number Side 100 CONGRESS AVE 2000 540-441?7227 City or town, state or province, country, and ZIP or foreign postal code 6'$133:de AUSTIN TX 7 8 7 0 1 H(a) Is this a group return Egg?? Name and address of principal officerzM-ARK NECKLER for subordinates? CiYes No SAME AS ABOVE H(b) Are all subordinates inoiuosg7i:iYes Ci No I Tax-exemptitat_us: l_.l 501(c)(3) Lil 501(0) 4 )4 (insert no.) 4947(a)(1) 0r I_l 527 If attach a list. (see instructions) Website: . COSACTION . COM H(c) Group exemption number Form of organization: LXI Corporation Trust Associati?n Other? I Year of formation: 2 0 1 4[ State of legal domicile: TX I?Part- Summary 1 Brie?y describe the organization's mission or most significant activities: TO ADVOCATE FOR A CONSTITUTIONALLY LIMITED GOVERNMENT . 2 Check this box i_i if the organization discontinued its operations or disposed of more than 25% of its net assets. is 3 Number oi voting members oi the governing body (Part VI. iine 1a) a 4 4 Number of independent voting members of the governing body (Part VI. line 1b} 4 3 3 5 Total number of individuals employed in calendar year 201 (Part V, line 23) 5 0 6 Total number of volunteers (estimate if necessaryTotal unrelated business revenue from Part column (0), line 12 7a 0 . Net unrelated business taxable income from Form 990-T. line 34 7b 0 - Prior Year Current Year a 8 Contributions and grants (Part line 1hProgram service revenue (Part iine 29Investment income (Part column (A), lines Other revenue (Part vnl, column (A), lines 5. 6d. ac, 9c. 10c. and 11eTotal revenue - add lines 8 through '11 {must equal Part column (A), line 121 Grants and similar amounts paid (Part IX. column (A), lines 1-3) 0 . 0 . 14 Benefits paid to or for members (Part IX. column (A). line 4) . 0 . 15 Salaries. other compensation. employee benefits (Part IX. column (A), lines 5-1016a Professional fundraising fees (Part ix, column (A), line Total fundraising expenses (Part Ix, column (D). line 25Otherexpenses (Part ix. column (A), linestta-ttci, 11i-24e) 2 301Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25Revenue less expenses. Subtract line 18 from line Beginning of Current Year End of Year 20 Totaiassets(PartX,line16) 532,987. 1,820,586. 21 295 . 587 - 225 .160 - ?5 Net assets or fund balances. Subtract line 21 from line 4?2 ]?art II Signature Block that] have examined Under penalties of periury, I dealer 1? return, including accompanying schedules and statements, and t0 the best of my knowledge and belief, it is an officer) is based on all information of which preparer has any knowledge. 5.9? lg Date Here MECKL CEO Type or print name and title Print/Type preparer's name Preparer's signature Dafe Che? Ll Paid DENNIS K. WEISS CPA Pm WW, 0%09/26/17 Emma,? P01330013 Preparer Firm's name I D. K. WEISS 8c ASSOCIATES PLLC Firm's EIN 30-0022324 Use or?! Firm's address 4 5 6 0 . BRETON COURT SUITE 1 0 2 KENTWOOD, MI 49508 Phoneno.515-87l-1233 May the discuss this return with the preparer shown above? (see instructiorgl DU Yes i_i No 632001 11-11-16 LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2016) CONVENTION OF STATES ACTION 47?2245708 Page2 ement of Program Service Accomplishments if Schedule 0 contains a response or note to any line in this Part ribe the organization?s mission: OCATE FOR A CONSTITUTIONALLY LIMITED GOVERNMENT. 2 Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or : Yes No If "Yes," describe these new services on Schedule O. 3 Did the organization cease conducting, or make significant changes in how it conducts, any program services? : Yes No If "Yes," describe these changes on Schedule O. 4 Describe the organization?s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501 and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. 4a (Code: (Expenses including grants of$ (Revenue COSA ADVOCATES FOR A RETURN TO THE ORIGINAL VI ION OF A LIMITED FEDERAL GOVERNMENT THAT I OF BY AND FOR THE PEOPLE . THI WILL BE ACCOMPLI SHED THROUGH AN ARTICLE CONVENTION OF STATES . 4b (Code: (Expenses including grants of (Revenue 4c (Code: (Expenses including grants of (Revenue 4d Other program services (Describe in Schedule 0.) (Expenses including grants of (Revenue 4e Total program service expenses Form 990 (2016) 632002 11?11?16 3 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l CONVENTION OF STATES ACTION 47?2245708 Page3 cklist of Required Schedules Yes No ization described in section 501 or 4947(a)(1) (other than a private foundation)? plete Schedule A 1 ization required to complete Schedule B, Schedule of ContributorS? 2 .nization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for e? If "Yes, complete Schedule C, Partl 3 4 Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501 election in effect during the tax year? If "Yes, complete Schedule C, Part II 4 5 Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes, complete Schedule C, Part 5 6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes, complete Schedule D, Partl 6 7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes, complete Schedule D, Part II 7 8 Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes, complete Schedule D, Part 3 9 Did the organization report an amount in Part X, line 21, for escrow or custodial account liability, serve as a custodian for amounts not listed in Part or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes, complete Schedule D, Part IV 9 10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes, complete Schedule D, Part 10 1 1 If the organization?s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, IX, or as applicable. a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes, complete Schedule D, Part VI 11a Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes, complete Schedule D, Part VII 1 1b Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes, complete Schedule D, Part 11c Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes, complete Schedule D, Part IX 1 1d Did the organization report an amount for other liabilities in Part X, line 25? If "Yes, complete Schedule D, Part 1 1e Did the organization?s separate or consolidated financial statements for the tax year include a footnote that addresses the organization?s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes, complete Schedule D, Part 1 1f 12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes, complete Schedule D, Parts XI and XII 12a Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes, and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional 12b 13 Is the organization a school described in section If "Yes, complete Schedule 13 14a Did the organization maintain an office, employees, or agents outside of the United States? 14a Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes, complete Schedule F, Parts I and IV 14b 15 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If "Yes, complete Schedule F, Parts II and IV 15 16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If "Yes, complete Schedule F, Parts Ill and IV 16 17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes, complete Schedule G, Part I 17 18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part lines 10 and 8a? If "Yes, complete Schedule G, Part II 18 19 Did the organization report more than $15,000 of gross income from gaming activities on Part line 9a? If "Yes, complete Schedule G, Part 19 Form 990 (2016) 632003 11?11?16 4 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l CONVENTION OF STATES ACTION 47?2245708 Page4 cklist of Required Schedules (continued) Yes No nization operate one or more hospital facilities? If "Yes, complete Schedule 20a ine 20a, did the organization attach a copy of its audited financial statements to this return? 20b .nization report more than $5,000 of grants or other assistance to any domestic organization or overnment on Part IX, column (A), line 1? If "Yes, complete Schedule l, Parts I and ll 21 - oanization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If "Yes, complete Schedule I, Parts I and Ill 22 23 Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization?s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes, complete Schedule 23 24a 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? If "Yes, answer lines 24b through 24d and complete Schedule K. If "No" go to line 25a 24a Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? 24b Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? 24c Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? 24d 25a Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes, complete Schedule L, Part I 25a Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization?s prior Forms 990 or If "Yes, complete Schedule L, Part 25b 26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If "Yes, complete Schedule L, Part II 26 27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes, complete Schedule L, Part 27 28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, or key employee? If "Yes, complete Schedule L, Part I 28a A family member of a current or former officer, director, trustee, or key employee? If "Yes, complete Schedule L, Part IV 28b An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes, complete Schedule L, Part I 28c 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, Part I 31 32 Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets?lf "Yes, complete Schedule N, Part II 32 33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301.7701-3? If "Yes, complete Schedule R, Partl 34 Was the organization related to any tax-exempt or taxable entity? If "Yes, complete Schedule R, Part II, or IV, and Part V, line 1 34 35a Did the organization have a controlled entity within the meaning of section 512(b)(13)? 35a If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes, complete Schedule H, Part V, line 2 35b 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes, complete Schedule R, 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 Fr?, Part VI 37 38 Did the organization complete Schedule 0 and provide explanations in Schedule 0 for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule 0 38 Form 990 (2016) 632004 11?11?16 5 09410927 798302 1381A 2016 . 04020 CONVENTION OF STATES ACTION CONVENTION OF STATES ACTION 47?2245708 Page5 tements Regarding Other IRS Filings and Tax Compliance ck if Schedule 0 contains a response or note to any line in this Part Yes No mber reported in Box 3 of Form 1096. Enter -0- if not applicable 1a 1 2 mber of Forms W-2G included in line 1a. Enter -0- if not applicable 1b 0 .nization comply with backup withholding rules for reportable payments to vendors and reportable gaming innings to prize winners? 10 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return 2a 0 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-fi/e (see instructions) 3a Did the organization have unrelated business gross income of $1,000 or more during the year? 3a If "Yes," has it filed a Form 990-T for this year? If "No, to line 3b, 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)? 4a If "Yes," enter the name of the foreign country: See instructions for filing requirements for Form 114, Report of Foreign Bank and Financial Accounts (FBAR). 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 line 5a or 5b, did the organization file Form 5c 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? 6a If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? 6b 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? 7a If "Yes," did the organization notify the donor of the value of the goods or services provided? 7b Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? 7c If "Yes," indicate the number of Forms 8282 filed during the year I 7d I Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? 7e Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? 7f 9 If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as 79 If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 7h 8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? 8 9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under section 4966? 9a Did the sponsoring 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 10a Gross receipts, included on Form 990, Part line 12, for public use of club facilities 10b 1 1 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholders 1 1a Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) 1 1b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041 12a If "Yes," enter the amount of tax-exempt interest received or accrued during the year I 12b I 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization licensed to issue qualified health plans in more than one state? 13a Note. See the instructions for additional information the organization must report on Schedule 0. Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans 13b Enter the amount of reserves on hand 13c 14a Did the organization receive any payments for indoor tanning services during the tax year? 14a If "Yes," has it filed a Form 720 to report these payments? If "No, provide an explanation in Schedule 0 14b Form 990 (2016) 632005 11?11?16 6 09410927 798302 1381A 2016 . 04020 CONVENTION OF STATES ACTION CONVENTION OF STATES ACTION 47?2245708 Page6 ernance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and fora "No" response - 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule 0. See instructions. if Schedule 0 contains a response or note to any line in this Part VI overning Body and Management Yes No mber of voting members of the governing body at the end of the tax year 1a 4 aterial differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule 0. Enter the number of voting members included in line 1a, above, who are independent 1b 3 2 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? 2 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, or trustees, or key employees to a management company or other person? 3 4 Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? 4 5 Did the organization become aware during the year of a significant diversion of the organization?s assets? 5 6 Did the organization have members or stockholders? 6 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? 7a Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? 7b 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: a The governing body? 8a Each committee with authority to act on behalf of the governing body? 8b 9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization?s mailing address? If "Yes, provide the names and addresses in Schedule 0 9 Section B. Policies (This Section requests information about policies not required by the Internal Revenue Code.) Yes No 10a Did the organization have local chapters, branches, or affiliates? 10a If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization?s exempt purposes? 10b 1 1a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? 1 1a Describe in Schedule 0 the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If "No, go to line 13 12a Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? 12b Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes, describe in Schedule 0 how this was done 12c 13 Did the organization have a written whistleblower policy? 13 14 Did the organization have a written document retention and destruction policy? 14 15 Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? a The organization?s CEO, Executive Director, or top management official 15a Other officers or key employees of the organization 15b If "Yes" to line 15a or 15b, describe the process in Schedule (see instructions). 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? 16a If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization?s exempt status with respect to such arrangements? 16b Section C. Disclosure 17 List the states with which a copy of this Form 990 is required to be filed VAL Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501 only) available for public inspection. Indicate how you made these available. Check all that apply. Own website i:i Another?s website Upon request i:i Other (explain in Schedule 0) 19 Describe in Schedule 0 whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. 20 State the name, address, and telephone number of the person who possesses the organization?s books and records: CLIFTON LARSON ALLEN LP 3 17 574? 9 0 0 9365 COUNSELORS ROW #200 INDIANAPOLIS IN 46240?2045 632006 11?11?16 SEE SCHEDULE 0 FOR FULL LI ST OF STATES Form 990 (2016) 7 09410927 798302 1381A 2016 . 04020 CONVENTION OF STATES ACTION CONVENTION OF STATES ACTION 47?2245708 pensation of Officers, Directors, Trustees, Key Employees, Highest Compensated -loyees, and Independent Contractors if Schedule 0 contains a response or note to any line in this Part Page 7 Part VII ers, Directors, Trustees, Key Employees, and Highest Compensated Employees . table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization?s tax year. organization?s current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. ns (D), (E), and (F) if no compensation was paid. 0 List all of the organization?s current key employees, if any. See instructions for definition of "key employee." 0 List the organization?s five current highest compensated employees (other than an officer, director, trustee, or key employee) who received report- able 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 following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. (A) (B) (C) (D) (E) (F) Name and Title Average (do not one Reportable Reportable Estimated hours per box, unless person is both an compensation compensation amount of week officer and a director/trustee) from from related other (list any the organizations compensation hours for a. 3 organization from the related .. organization organizations and related below 5 organizations line) EE (1) MARK MECKLER 1 . 0 0 CEO 40.00 0. 220,200. 18,452. (2) TIM DUNN 1.00 DIRECTOR 0 . 0 . 0 . (3) ERIC 1.00 DIRECTOR 0 . 0 . 0 . (4) KYLE STALLINGS 1 . 0 0 DIRECTOR 0 . 0 . 0 . (5) MICHAEL RUTHENBERG 1 . 0 0 VICE 40. 00 0. 100 ,400. 23 048. (6) TIMOTHY MURPHY 632007 11?11?16 Form 990 (2016) 8 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A?l 47?2245708 CONVENTION OF STATES ACTION (B) A. and (C) (A) (D) (E) (F) below line) organizations Name and title Average (do not C?gfg'gg?than one Reportable Reportable Estimated hours per box, unless person is both an compensation compensation amount of week officer and a director/trustee) from from related other (list any a the organizations compensation hours for organization from the related organization izations and related Institutional trustee Key employee employee Sub-total Total from continuation sheets to Part VII, Section A Total add lines 1b and 1c 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 0 Yes No 3 Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If "Yes, complete Schedule for such individual 3 4 For any individual listed on line 13, 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 individual 4 5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for 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. Report compensation for the calendar year ending with or within the organization?s tax year. (M (m (Q Name and business address Description of services Compensation INTEGRAM 22695 COMMERCE CENTER CT, DULLES, VA 20166 DIRECT MAIL PRINTING 300 995 . TOM A COBURN MUSKOGEE OK 7 44 0 2 GOVERNMENT RELATIONS THE RICHARD NORMAN COMPANY 3 EAST ESROW ACCOUNT MARKET ST, SUITE 300, LEESBURG VA 20176 SERVICES 136,056. CREATIVE RESPONSE CONCEPTS 2 7 6 0 PUBLIC RELATIONS EISENHOWER AVE FL 4 ALEXANDRIA VA 22 314 SERVICES 13 0 472 . 2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 4 Form 990 (2016) 632008 11?11?16 9 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A?l CONVENTION OF STATES ACTION 47?2245708 Page9 tatement of Revenue heck if Schedule 0 contains a response or note to any line in this Part (A) (B) (C) Total revenue Related or Unrelated exempt function business sections revenue revenue 512 - 514 Part rated campaigns 1a bership dues 1b Fundraising events 1c Related organizations 1d Government grants (contributions) 1e All other contributions, gifts, grants, and similar amounts not included above Noncash contributions included in lines 1a?1f: Total.AddlinesIa-1f 4,903,002. Business Code Contributions, Gifts, and Other Similar Arno Program Service Revenue All other program service revenue Total. Add lines 2a-2f 3 Investment income (including dividends, interest, and other similar amounts) 4 Income from investment of tax-exempt bond proceeds 5 Royalties 26,012- 26,012- Real (ii) Personal 6 a Gross rents Less: rental expenses Rental income or (loss) Net rental income or (loss) 7 a Gross amount from sales of Securities (ii) Other assets other than inventory Less: cost or other basis and sales expenses Gain or (loss) Net gain or (loss) 8 a Gross income from fundraising events (not including of contributions reported on line 10). See Part IV, line 18 a Less: direct expenses Net income or (loss) from fundraising events 9 a Gross income from gaming activities. See Part IV, line 19 a Less: direct expenses Net income or (loss) from gaming activities 10 a Gross sales of inventory, less returns and allowances a Less: cost of goods sold Net income or (loss) from sales of inventory Miscellaneous Revenue Business Code Other Revenue All other revenue Total. Add lines 11a-11d 12 Total revenue. See instructions632009 11?11?16 Form 990 (2016) 0 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l 00.059) CONVENTION OF STATES ACTION 47-2245708 Page10 ement of Functional Expenses and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). heck if Schedule 0 contains a response or note to any line in this Part IX rzgugftsagetp?o/r?ed on lines 6b' Total ??penses Progragaservice Manag?gent and - expenses general expenses expenses ther assistance to domestic organizations governments. See Part IV, line 21 2 Grants and other assistance to domestic individuals. See Part IV, line 22 3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 4 Benefits paid to or for members 5 Compensation of current officers, directors, trustees, and key employees 6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) 7 Othersalariesandwages 590,299. 348,276. 118,060. 123,963. 8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) 9 Other employee benefits 10 Payrolltaxes 50,224. 29,632. 10,045. 10,547. 1 1 Fees for services (non-employees): a Management Legal 50,937. 42,262. 8,675. Accounting 60,113. 60,113. Lobbying 188,215. 188,215. Professional fundraising services. See Part IV, line Investment management fees 9 Other. (If line 11g amount exceeds 10% of line 25, 73,301. 26,846. 9,598. 36,857. 12 Advertisingandpromotion 981,182. 937,535. 27,425. 16,222. 13 Officeexpenses 108,949. 61,753. 25,325. 21,871. 14 Information technology 15 Royalties 16 Occupancy 16,007. 9,444. 3,202. 3,361. 17 Travel 134,879. 104,932. 23,809. 6,138. 18 Payments of travel or entertainment expenses for any federal, state, or local public officials Conferences, conventions, and meetings 20 Interest 8,532. 8,532. 21 Payments to affiliates 22 Depreciation, depletion, and amortization 23 Insurance 59,652. 35,195. 11,930. 12,527. 24 Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule 0.) a DUES SUBSCRIPTIONS 35,293. 12,547. 22,099. 647. EVENTS 31,208. 30,793. 415. POSTAGE MAILING 23,006. 18,173. 4,833. All other expenses 25 3,571,988. 1,852,262. 333,646. 1,386,080. 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here El if following SOP 98?2 (ASC 958?720) 632010 11?11?16 Form 990 (2016) 09410927 798302 1381A 11 2016.04020 CONVENTION OF STATES ACTION CONVENTION OF STATES ACTION 47-2245708 Page11 nce Sheet 632011 11?11?16 09410927 798302 1381A 12 if Schedule 0 contains a response or note to any line in this Part (A) (B) Beginning of year End of year -non-interest-bearing and temporary cash investments 2 - - oes and grants receivable, net 3 4 Accounts receivableLoans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule 5 6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees? beneficiary organizations (see instr). Complete Part II of 6 a 7 Notes and loans receivable, net 7 8 Inventories for sale or use 8 9 Prepaid expenses and deferred charges 10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule 10a Less: accumulated depreciation 10b 10c 1 1 Investments - publicly traded securities 1 1 12 Investments - other securities. See Part IV, line 11 12 13 Investments - program-related. See Part IV, line 11 13 14 Intangible assets 14 15 Other assets. See Part IV, line 11 15 16 Total assets. Add lines 1 through 15 (must equal line 34Accounts payable and accrued expenses Grants payable 18 19 Deferred revenue 19 20 Tax-exempt bond liabilities 20 21 Escrow or custodial account liability. Complete Part IV of Schedule 21 22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule 22 23 Secured mortgages and notes payable to unrelated third parties 23 24 Unsecured notes and loans payable to unrelated third parties 24 25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part of Schedule 25 26 Total liabilities. Add lines 17 through Organizations that follow SFAS 1 17 (A80 958), check here Ill and 3 complete lines 27 through 29, and lines 33 and 34. 27 Unrestricted net assets Temporarily restricted net assets Permanently restricted net assets 29 If Organizations that do not follow SFAS 1 17 (A80 958), check here El 5 and complete lines 30 through 34. *3 30 Capital stock or trust principal, or current funds 30 31 Paid-in or capital surplus, or land, building, or equipment fund 31 *5 32 Retained earnings, endowment, accumulated income, or other funds 32 33 Total net assets or fund balances Total liabilities and net assets/fund balances Form 990 (2016) 2016.04020 CONVENTION OF STATES ACTION 1381A_l CONVENTION OF STATES ACTION 47?224 5708 Page12 onciliation of Net Assets if Schedule 0 contains a response or note to any line in this Part XI ue (must equal Part column (A), line 12) 4,929,014. ses (must equal Part IX, column (A), line 25) 3,571,988. ss expenses. Subtract line 2 from line 1 1,357,026. or fund balances at beginning of year (must equal Part X, line 33, column 237,400. Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments Other changes in net assets or fund balances (explain in Schedule 0) 0. Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column 10 1,594,426. Part Financial Statements and Reporting Check if Schedule 0 contains a response or note to any line in this Part XII 2a 3a Accounting method used to prepare the Form 990: El Cash Accrual Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule 0. Were the organization?s financial statements compiled or reviewed by an independent accountant? If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis Were the organization?s financial statements audited by an independent accountant? If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule 0. 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 If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule 0 and describe any steps taken to undergo such audits Yes No 2a 2bX 20X 3a 3b 632012 11?11?16 09410927 798302 1381A 13 Form 990 (2016) 2016.04020 CONVENTION OF STATES ACTION PUBLIC DISCLOSURE COPY Schedule of Contributors 2? Attach to Form 990, Form 990-EZ, or Form 990-PF. sury Information about Schedule (Form 990, 990-EZ, or 990-PF) and its instructions is at . OMB No. 1545?0047 2016 anization CONVENTION OF STATES ACTION Employer identification number 47?2245708 e(check one): Filers of: Section: Form 990 or 990-EZ 501 4 (enter number) organization 4947(a)(1) nonexempt charitable trust not treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the General Rule or a Special Rule. Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. General Rule For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor?s total contributions. Special Rules For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on Form 990, Part line 1h, or (ii) Form 990-EZ, line 1. Complete Parts and II. For an organization described in section 501(c)(7), (8), or (1 O) filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1 ,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and For an organization described in section 501(c)(7), (8), or (1 O) filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don?t complete any of the parts unless the General Rule applies to this organization because it received nonexclusive/y religious, charitable, etc., contributions totaling $5,000 or more during the year Caution: An organization that isn?t covered by the General Rule and/or the Special Rules doesn?t file Schedule (Form 990, 990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it doesn?t meet the filing requirements of Schedule (Form 990, 990-EZ, or 990-PF). LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule (Form 990, 990-EZ, or 990-PF) (2016) 623451 10?18?16 990, 990-EZ, or 990-PF) (2016) Page 2 on IN OF STATES ACTION Employer identification number 47?2245708 tributors (See instructions). Use duplicate copies of Part I if additional space is needed. Name, address, and ZIP 4 (C) Total contributions Type of contribution 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 10,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 10,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 42,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 10,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 95,000. Person Payroll Noncash (Complete Part II for noncash contributions.) 623452 10?18?16 09410927 798302 1381A 15 Schedule (Form 990, 990-EZ, or 990-PF) (2016) 2016.04020 CONVENTION OF STATES ACTION 990, 990-EZ, or 990-PF) (2016) Page 2 on IN OF STATES ACTION Employer identification number 47?2245708 tributors (See instructions). Use duplicate copies of Part I if additional space is needed. Name, address, and ZIP 4 (C) Total contributions Type of contribution 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 100,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 100,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 10 25,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution ll 100,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 12 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) 623452 10?18?16 09410927 798302 1381A Schedule (Form 990, 990-EZ, or 990-PF) (2016) 2016.04020 CONVENTION OF STATES ACTION 1381A_l 990, 990-EZ, or 990-PF) (2016) Page 2 on IN OF STATES ACTION Employer identification number 47?2245708 tributors (See instructions). Use duplicate copies of Part I if additional space is needed. Name, address, and ZIP 4 (C) Total contributions Type of contribution 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 14 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 15 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 16 10,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 17 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 18 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) 623452 10?18?16 09410927 798302 1381A Schedule (Form 990, 990-EZ, or 990-PF) (2016) 2016.04020 CONVENTION OF STATES ACTION 990, 990-EZ, or 990-PF) (2016) Page 2 on IN OF STATES ACTION Employer identification number 47?2245708 tributors (See instructions). Use duplicate copies of Part I if additional space is needed. Name, address, and ZIP 4 (C) Total contributions Type of contribution 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 20 5,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution 21 1,690,000. Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution Person Payroll Noncash (Complete Part II for noncash contributions.) No. Name, address, and ZIP 4 (C) Total contributions Type of contribution Person Payroll Noncash (Complete Part II for noncash contributions.) 623452 10?18?16 09410927 798302 1381A 18 Schedule (Form 990, 990-EZ, or 990-PF) (2016) 2016.04020 CONVENTION OF STATES ACTION 1381A_l 990, 990-EZ, or 990-PF) (2016) Page 3 lN OF STATES ACTION Employer identification number 47?2245708 cash Property (See instructions). Use duplicate copies of Part II if additional space is needed. (C) . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I No. . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I No. . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I No. . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I No. . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I No. . . FMV (or estimate) from Description of noncash property given . . Date received (See Instructions) Part I 623453 10?18?16 Schedule (Form 990, 990-EZ, or 990-PF) (2016) 19 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l 990, 990-EZ, or 990-PF) (2016) Page 4 on IN OF STATES Employer identification number 47?2245708 a IONS 0 organIza IOIIS uescrIIemore an or - yearfrom any one contributor. Ceomplete columns (a)through andthe following line entry. For organlzatlons pleting Part enter the total of exclusively religious, charitable, etc. contributions of$1, 000 or less for the year. (Enterthisinfocnce) .e duplicate copies of Part if additional space is needed. '3ng Purpose of gift Use of gift Description of how gift is held (6) Transfer of gift Transferee?s name, address, and ZIP 4 Relationship of transferor to transferee No. '3ng Purpose of gift Use of gift Description of how gift is held (6) Transfer of gift Transferee?s name, address, and ZIP 4 Relationship of transferor to transferee No. '3ng Purpose of gift Use of gift Description of how gift is held (6) Transfer of gift Transferee?s name, address, and ZIP 4 Relationship of transferor to transferee No. '3ng Purpose of gift Use of gift Description of how gift is held (6) Transfer of gift Transferee?s name, address, and ZIP 4 Relationship of transferor to transferee 623454 10?18?16 Schedule (Form 990, 990-EZ, or 990-PF) (2016) 2 0 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l . . OMB No. 1545?0047 Supplemental FInanCIal Statements Complete if the organization answered "Yes" on Form 990, 20 16 Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. Attach to Form 990. Open Public Information about Schedule (Form 990) and its instructions is at Employer identification number CONVENTION OF STATES ACTION 47?2245708 anizations Maintaining Donor Advised Punds or Other Similar I_=unds or Accounts.CompIete if the . . .nization answered "Yes" on Form 990, Part IV, line 6. Donor advised funds Funds and other accounts Total number at end of year 1 2 Aggregate value of contributions to (during year) 3 Aggregate value of grants from (during year) 4 5 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 exclusive legal control? Yes No 6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Yes No l?Part II I Conservation Easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 7. 1 Purpose(s of conservation easements held by the organization (check all that apply). Preservation of land for public use recreation or education) Preservation of a historically important land area Protection of natural habitat Preservation of a certified historic structure Preservation of open space 2 Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year. Held at the End of the Tax Year a Total number of conservation easements 2a Total acreage restricted by conservation easements 2b Number of conservation easements on a certified historic structure included in 2c Number of conservation easements included in acquired after 8/17/06, and not on a historic structure listed in the National Register 2d 3 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax 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, handling of violations, and enforcement of the conservation easements it holds? Yes No 6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year 7 Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year 8 Does each conservation easement reported on line 2(d) above satisfy the requirements of section and section Yes No 9 In Part 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?s financial statements that describes the organization?s accounting for conservation easements. Part Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. 1a If the organization elected, as permitted under SFAS 116 (A80 958), 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, provide, in Part the text of the footnote to its financial statements that describes these items. If the organization elected, as permitted under SFAS 116 (A80 958), 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, provide the following amounts relating to these items: Revenue included on Form 990, Part line 1 (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 following amounts required to be reported under SFAS 116 (A80 958) relating to these items: a Revenue included on Form 990, Part line 1 Assets included in Form 990, Part LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule (Form 990) 2016 632051 08?29? 1 6 21 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l 990) 2016 CONVENTION OF STATES ACTION 47?2245708 Page2 anizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets(continued) rganization?s acquisition, accession, and other records, check any of the following that are a significant use of its collection items at apply): exhibition Loan or exchange programs Iarly research Other -rvation for future generations - oescription of the organization?s collections and explain how they further the organization?s exempt purpose in Part 5 During the year, did the organization solicit 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 No I Part IV I Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on 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 and complete the following table: Amount Beginning balance Additions during the year Distributions during the year Ending balance 2a Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? Yes No If "YesLeprain the arrangement in Part Check here if the explanation has been provided on Part I Part I Endowment Funds. Complete if the organization answered "Yes" on Form 990, Part IV, line 10. Current year Prior year Two years back Three years back Four years back 1a Beginning of year balance Contributions Net investment earnings, gains, and losses Grants or scholarships Other expenditures for facilities and programs Administrative expenses 9 End of year balance 2 Provide the estimated percentage of the current year end balance (line Ig, column held as: a Board designated or quasi-endowment Permanent endowment Temporarily restricted endowment The percentages on lines 2a, 2b, and 20 should equal 100%. 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: unrelated organizations (ii) related organizations If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule Describe' In Part the intended us_es of the organization? 3 endowment funds. I Part VI I Land, Buildings, and Equipment. Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10. 00.05 -h Description of property Cost or other Cost or other Accumulated Book value basis (investment) basis (other) depreciation 1a Land Buildings Leasehold improvements Equipment Other Total. Add lines Ia through 1e. (Column (00 must equal Form 990, Part X, column (B), line 100.) 0 . Schedule (Form 990) 2016 632052 08?29? 1 6 22 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l 2016 CONVENTION OF STATES ACTION 47?2245708 if the secu or category (including name of security) ization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Book value Method of valuation: Cost or end-of-year market value Total. Col. must ual Form 990 Part col. Iine12. Investments - Program Related. if the ization answered "Yes" on Form 990 Part IV line 110. See Form 990 Part line 13. Description of investment Book value Method of valuation: Cost or end-of-year market value Total. Col. must ual Form 990 Part col. line 13. if the ization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15. Description Book value Total. mn must Form 990 Part col. Iine15. if the Description of liability ization answered "Yes" on Form 990, Part IV, line He or 11f. See Form 990, Part X, line 25. Book value 1 Federal income taxes Total. Form 990, Part X, col. line 25. 2. Liability for uncertain tax positions. In Part provide the text of the footnote to the organization?s financial statements that reports the organization?s liability for uncertain tax positions under FIN 48 (A80 740). Check here if the text of the footnote has been provided in Part Schedule (Form 990) 2016 mn must 632053 08?29? 1 6 23 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 990) 2016 CONVENTION OF ACTION 47?2245708 Page4 onciliation of Revenue per Audited Financial Statements With Revenue per Return. plete if the organization answered "Yes" on Form 990, Part IV, line 12a. ue, gains, and other support per audited financial statements cluded on Iine1 but not on Form 990, Part line 12: ed gains (losses) on investments 2a rvices and use of facilities 2b of prior year grants 2c Other (Describe in Part 2d Add lines 2a through 2d 2e 0 . 3 Subtract line 2e from line Amounts included on Form 990, Part line 12, but not on line 1: a Investment expenses not included on Form 990, Part line 7b 4a Other (Describe in Part 4b Add lines 4a and 4b 4c 0 . Total revenue. Add lines 3 and :10. (This must equal Form 990_, Part], line 12P5art XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. 1 Total expenses and losses per audited financial statements Amounts included on line 1 but not on Form 990, Part IX, line 25: a Donated services and use of facilities 2a Prior year adjustments 2b Other losses 2c Other (Describe in Part 2d Add lines 2a through 2d 2e 0 . 3 Subtract line 2e from line Amounts included on Form 990, Part IX, line 25, but not on line 1: a Investment expenses not included on Form 990, Part line 7b 4a Other (Describe in Part 4b Add lines Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18Part Supplemental Information. 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 X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. PART X, LINE 2: NO AMOUNTS HAVE BEEN IDENTIFIED, OR RECORDED, AS UNCERTAIN TAX POSITIONS. 632054 08?29?16 Schedule (Form 990) 2016 2 4 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l Supplemental Information Regarding Fundraising or Gaming Activities Complete if the organization answered "Yes" on Form 990, Part IV, line 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Attach to Form 990 or Form 990-EZ. required to complete this part. 1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. Mail solicitations Internet and email solicitations i:i a 0 Phone solicitations ln-person solicitations a CONVENTION OF STATES ACTION draising Activities. Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990-EZ filers are not Information about Schedule Form 990 or 990-EZ and its instructions is at OMB No. 1545?0047 2016 Open to Public Inspection Solicitation of non-government grants Solicitation of government grants 9 El Special fundraising events Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? Yes Employer identification number 47?2245708 i:iNo If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organizationAmount paid . . Name and address of indiVidual .. . . fim raiser (Iv) Gross receipts to (or retained by) Amoqnt paid . . (ll) have custody I I . to (or retamed by) or entity (fundraiser) or control of from actIVIty fundraiser or anization contributions? listed in col_ 9 THE RICHARD NORMAN COMPANY - Yes No 113 MARKET ST SUITE 300, DIRECT MAIL 1,792,048. 1,073,259. 718,789. ACTIVE ENGAGEMENT - ll 3 MARKET ST SUITE 300, INTERNET EMAIL 75,891. 73,273. 2,618. MDS COMMUNICATIONS - 545 JUANITA AVE, MESA, AZ 85210 PHONE 7,000. 7,000. 0. Tota 1,874,939. 1,153,532. 721,407. 3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing. LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. SEE PART IV FOR CONTINUATIONS 632081 09?12?16 09410927 798302 1381A 25 Schedule (Form 990 or 990-EZ) 2016 2016.04020 CONVENTION OF STATES ACTION 1381A_l CONVENTION OF STATES ACTION 47?2245708 Pagez draising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 ndraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. #2 th Event #1 ven 0 er even Total events (add col. through col. (event type) (event type) (total number) 61:) 1 Gross receipts 2 Less: Contributions 3 Gross income (line 1 minus line 2) 4 Cash prizes 5 Noncash prizes 0) ac) 6 Rent/facility costs LIJ E) 7 Food and beverages 5 8 Entertainment 9 Other direct expenses 10 Direct expense summary. Add lines 4 through 9 in column 1 1 Net income summary. Subtract line 10 from line 3, column Part I Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a. Pull tabs/instant . Total gaming (add CD . . . Bingo bingo/progresswe bingo Other gaming col. through col. CD r: 1 Gross revenue a, 2 Cash prizes 3 8 3 Noncash prizes LIJ *6 4 Rent/facility costs 5 Other direct expenses Yes Yes Yes 6 Volunteer labor No No No 7 Direct expense summary. Add lines 2 through 5 in column 8 Net gaming income summary. Subtract line 7 from line 1, column 9 Enter the state(s) in which the organization conducts gaming activities: a Is the organization licensed to conduct gaming activities in each of these states? Yes No If explain: 10a Were any of the organization?s gaming licenses revoked, suspended, or terminated during the tax year? Yes No If "Yes," explain: 632082 09?12?16 Schedule (Form 990 or 990-EZ) 2016 26 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A?l 990 or 990-EZ) 2016 CONVENTION OF STATES ACTION Page 3 anization conduct gaming activities with nonmembers? Yes No zation a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity formed charitable gaming? i:i Yes i:i No percentage of gaming activity conducted in: tion?s facility 13a cility 13b me and address of the person who prepares the organization?s gaming/special events books and records: Name Address 15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? Yes No 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 of the third party: Name Address 16 Gaming manager information: Name Gaming manager compensation Description of services provided i:i Director/officer i:i Employee i:i 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? Yes No Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization?s own exempt activities during the tax year lPal?t Supplemental Information. Provide the explanations required by Part line 2b, columns and and Part lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions SCHEDULE G, PART I, LINE 2B, LIST OF TEN HIGHEST PAID FUNDRAISERS: (I) NAME OF FUNDRAISER: THE RICHARD NORMAN COMPANY (I) ADDRESS OF FUNDRAISER: 113 MARKET ST SUITE 300, LEESBURG, VA 20176 (I) NAME OF FUNDRAISER: ACTIVE ENGAGEMENT (I) ADDRESS OF FUNDRAISER: 113 MARKET ST SUITE 300, LEESBURG, VA 20176 632083 09?12?16 Schedule (Form 990 or 990-EZ) 2016 2 7 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A_l 990 or 990-EZ) CONVENTION OF STATES ACTION 47?2245708 Page4 - plemental Information (continued) Schedule (Form 990 or 990-EZ) 632084 04?01?16 28 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION Compensation Information 0MB No.1s4s-oo47 For certain Officers, Directors, Trustees, Key Employees, and Highest 20 16 Compensated Employees Complete if the organization answered "Yes" on Form 990, Part IV, line 23. sury >Attach to Form 990. Open to P_Ubl'? Information about Schedule (Form 990) and its instructions is at '"5PeCt'0" nization Employer identification number CONVENTION OF STATES ACTION 47?2245708 Part I stions Regarding Compensation Yes No 1a Check the appropriate box(es) if the organization provided any of the following to or for a person listed on Form 990, Part VII, Section A, line 1a. Complete Part to provide any relevant information regarding these items. First-class or charter travel Housing allowance or residence for personal use Travel for companions Payments for business use of personal residence Tax indemnification and gross-up payments Health or social club dues or initiation fees Discretionary spending account Personal services (such as, maid, chauffeur, chef) If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If complete Part to explain 1b 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all directors, trustees, and officers, including the CEO/Executive Director, regarding the items checked on line 1a? 2 3 Indicate which, if any, of the following the filing organization used to establish the compensation of the organization?s CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part Compensation committee Written employment contract Independent compensation consultant Compensation survey or study Form 990 of other organizations Approval by the board or compensation committee 4 During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization: a Receive a severance payment or change-of-control payment? 4a Participate in, or receive payment from, a supplemental nonqualified retirement plan? 4b Participate in, or receive payment from, an equity-based compensation arrangement? 4c If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part Only section 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9. 5 For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the revenues of: a The organization? 5a Any related organization? 5b If "Yes" on line 5a or 5b, describe in Part 6 For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the net earnings of: a The organization? 6a Any related organization? 6b If "Yes" on line 6a or 6b, describe in Part 7 For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed payments not described on lines 5 and 6? If "Yes," describe in Part 7 8 Were any amounts reported on Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regulations section If "Yes," describe in Part 8 9 If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 9 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule (Form 990) 2016 632111 09?09?16 29 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION Schedule (Form 990) 2016 CONVENTION OF STATES ACTION Page 2 I Part II I Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed. For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row and from related organizations, described in the instructions, on row Do not list any individuals that aren?t listed on Form 990, Part VII. Note: The sum of columns for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual. (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and (D) Nontaxable (E) Total of columns (F) Compensation other deferred benefits in column (B) compensation Base (ii) Bonus Other re orted as deferred (A) Name and Trtle compensation incentive reportable :n rior Form 990 compensation compensation (1) MARK MECKLER CEO Schedule (Form 990) 2016 632112 09-09-16 3 0 Schedule (Form 990) 2016 CONVENTION OF STATES ACTION page 3 I Part ISupplemental Information Provide the information, explanation, or descriptions required for Part I, lines 1aand for Part II. Also complete this part for any additional information. Schedule (Form 990) 2016 632113 09?09?16 3 Supplemental Information to Form 990 or 990- E2 Complete to provide information for responses to specific questions on 20 16 Form 990 or 990-EZ or to provide any additional information. Attach to Form 990 or 990-EZ. Open to Public Information about Schedule 0 Form 990 or 990-EZ and its instructions is at Inspection Employer identification number CONVENTION OF STATES ACTION 47?2245708 PART VI, SECTION A, LINE 3: CONTRACT WITH CITIZENS FOR SELF GOVERNANCE FOR PERSONNEL. FORM 990, PART VI, SECTION B, LINE 11B: THE RETURN IS PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C: LEGAL COUNSEL REVIEWS OUTGOING ORGANIZATIONAL PAYMENTS AND ROUTINELY MONITORS FOR POSSIBLE CONFLICTS OF INTEREST. ALL MEMBERS OF THE BOARD OF DIRECTORS ARE REQUIRED TO DISCLOSE ANY POSSIBLE CONFLICTS OF INTEREST AT THE ANNUAL BOARD MEETING. ANY OFFICER OR DIRECTOR WHO FAILS TO PROPERLY REPORT A CONFLICT OF INTEREST IS SUBJECT TO SANCTION BY THE BOARD. FORM 990, PART VI, LINE 17, LIST OF STATES RECEIVING COPY OF FORM 990: FORM 990, PART VI, SECTION C, LINE 19: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC ON REQUEST. FORM 990, PART IX, LINE 18 IDAHO REPRESENTATIVE JAMES $1987.70 IDAHO REPRESENTATIVE THOMAS $1450.20 IDAHO REPRESENTATIVE ERIC REDMAN $2267.20 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule 0 (Form 990 or 990-EZ) (2016) 632211 08?25?16 32 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 990 or 990-EZ) (2016) Page 2 nization Employer identification number CONVENTION OF STATES ACTION 47?2245708 SCHEDULE SCHEDULE R, PART II (A): FULL NAME JOHN HANCOCK COMMITTEE FOR THE STATES (DBA CITIZENS FOR SELF GOVERNANCE) 632212 08?25?16 Schedule 0 (Form 990 or 990-EZ) (2016) 33 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A__l . . . OMB No. 1545-0047 SCHEDULE Related Organizations and Unrelated Partnerships (Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37. 201 6 Attach to Form 990. . Department of the Treasury . Open to PPbl'c Internal Revenue Service Information about Schedule (Form 990) and Its Instructions Is at Inspection Name of the organization Employer identification number CONVENTION OF STATES ACTION 47?2245708 Part I Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33. (C) Name, address, and EIN (if applicable) Primary activity Legal domicile (state or Total income End-of?year assets Direct controlling of disregarded entity foreign country) entity Part II Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year. (0) Name, address, and EIN Primary activity Legal domicile (state or Exempt Code Public charity Direct controlling controlled of related organization foreign country) section status (if section entity entity? 501(c)(3)) Yes No JOHN HANCOCK COMMITTEE FOR THE STATES (SEE SCHEDULE 0) 27?1657203, 106 6TH ST, STE. 900, AUSTIN, TX 78701 CHARITABLE ORGANIZATION TEXAS 501(c)(3) LINE 7 CSG ACTION 27?4648506 106 6TH ST, STE. 900 AUSTIN, TX 78701 ADVOCACY TEXAS 501(c)(4) For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule (Form 990) 2016 632161 09?06?16 LHA 34 Schedule (Form 990) 2016 CONVENTION OF STATES ACTION page 2 Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related Part organizations treated as a partnership during the tax year. (C) (9) Name, address, and EIN Primary activity dtr?ffi?gi'le Direct controlling Predominant income Share of total Share of Disproportionate Code V-UBI General or Percentage of related organization (state or entity (related, unrelated, income end-of?year allocations? amount in box manag'??g ownership foreign excluded from tax under assets - 20 of Schedule partner. country) SECTIONS 512-514) Yes No (Form 1065) Yes No Part IV Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year. (C) (9) Segtion Primary activity Legal domicile Direct controlling Type of entity Share of total Share of 512(b)(13) (stat? or entity (C corp, corp, income end-of?year contFO'lgd ?23233) or trust) assets Name, address, and EIN of related organization Yes No 632162 09?06?16 Schedule (Form 990) 2016 Schedule (Form 990) 2016 CONVENTION OF STATES ACTION page 3 Part Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36. Note: Complete line 1 if any entity is listed in Parts II, or IV of this schedule. Yes No 1 During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts a Receipt of interest, (ii) annuities, royalties, or (W) rent from a controlled entity 1a Gift, grant, or capital contribution to related organization(s) 1'3 Gift, grant, or capital contribution from related organization(s) fc Loans or loan guarantees to or for related organization(s) 1d Loans or loan guarantees by related organization(s) 1e Dividends from related organization(s) 1f 9 Sale of assets to related organization(S) 19 Purchase of assets from related organization(S) 1h i Exchange of assets with related organization(S) 1i i Lease of facilities, equipment, or other assets to related organization(S) 1i Lease of facilities, equipment, or other assets from related organization(s) 1k Performance of services or membership or fundraising solicitations for related organization(s) 1 Performance Of services or membership or fundraising solicitations by related organization(s) 1m Sharing of facilities, equipment, mailing lists, or other assets with related organization(S) 1n 0 Sharing of paid employees with related organization(s) 10 Reimbursement paid to related organization(s) for expenses 1P Reimbursement paid by related organization(s) for expenses 1?1 Other transfer of cash or property to related organization(S) 1r 5 Other transfer of cash or property from related organization(s) 15 2 If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds. (of) Name of related organlzatlon Transaction Amount involved Method of determining amount involved type (a8) (1) CITIZENS FOR SELF GOVERNANCE 3 71 8 65 . ACTUAL AMOUNT INVOICED (2) CITIZENS FOR SELF GOVERNANCE 217 48 3 . ACTUAL AMOUNT INVOICED (3) CITIZENS FOR SELF GOVERNANCE 6 50 0 . ACTUAL AMOUNT INVOICED (4) (5) (6) 632163 09?06?16 3 6 Schedule (Form 990) 2016 Schedule (Form 990) 2016 CONVENTION OF STATES ACTION page 4 Part VI Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37. Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships. (9) Name, address, and EIN Primary activity Legal domicile Predominant income ma Share of Share of Dispropor- of entity (state or foreign uanIated? total end-of-year mate of elgut ??4 ownership rom tax . COUHW) sections 512-514) Income assets (Form 1065) Schedule (Form 990) 2016 632164 09?06?16 3 7 %m2m6 CONVENTION OF STATES ACTION 47?2245708 Pwe5 Part uplemental Information. ide additional information for responses to questions on Schedule R. See instructions. 632165 09?06?16 Schedule (Form 990) 2016 38 09410927 798302 1381A 2016.04020 CONVENTION OF STATES ACTION 1381A__l