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 53400 031132002 1 43 PM umnEP 0 5 2002 Form 990 OMB No 1545-0047 . Return of Organization Exempt From Income Tax 2001 . Under section 501(c). 527. or 4947(a)(1) of the Internal Revenue Code (except black lung Department of the Treasury bene?t trust or prlvate foundation) 0 ?3 Public Internal Revenue Service 2 The organlzetlon may have to use a copy of We return to state reqytrements ?Foam" A For the 2001 calendar year? or tax year begtn?g and Check .1 Name of organtzatlon Employer ID number Address change Name change print or DAYSTAR RESIDENTIAL INC . Telephone number Inrual return type Number and street (or 0 00K 11' mall 13 not dellvered to street address) RoomI'SUIte Frnal return . . Box 307 Accounttn method Cash Mendel: return 31:3? Ctty or town. state or country. and ZIP 4 Accrual Other (speaty) LAKE JACKSON TX 77566 .Sectton 501(c)(3) orgenlzetlone and 4947(a)(1) nonexempt charlteblet-I and are not to secuon 527 organtzatlons trusts must attach a completed Schedule A (Form 990 or 990-EZ) H(a) Is thus a group return for af?liates? Yes No Web 8110 H(b) It ?(as enter no of af?llates MIA Organtzatton type H(c) Are all Induded? MIA Yes No (check only one) 5 a 501(c) 3 (Insert no 4947(a)(1) or 527 (If No art. a Inst. See Check here ll the organtzatlon's gross recalpts are normally not more than H(d) Is Ihls a separate return ?led by an NIA 525.000 The organrzatlon need not ?le a return truth the IRS, but If the organization organizetton covered by a group rulrng? Yes No recetved a Form 990 Package 1n the marl. It should ?le a return without ?nanclal data I Enter GEN Some states requrre a complete return Check If the organlzatlon l5 not requrred Gross receipts Add Imes 6b 8b 9b, and 10b to lune attach (Form 990 or 990-PF) I Partl 1 Revenue. Expenses. and Changes In Net Assets or Fund Balances (See SpeCI?c Instructtons on page 16 1 Contnbutlons. gifts. grants. and almrlar amounts recmved a Dtrect publlc support 1a 2 6 0 Indtrect publtc support 1b Government contnbutrons (grants) 1c Total (add Ilnes 1a through 10) (cash 5 2 680 noncash 1d 2 680 2 Program servrce revenue Including government fees and contracts (from Part VII. [the 93dues and assessments 3 4 Interest on savmgs and temporary cash Investments 4 5 Dtv1dends and Interest from secunttes 5 6a Gross rents Ba Less rental expenses 6b Net rental Income or (loss) (subtract ltne 6b from line 6a) 5c 7 Other Investment Income (descnbe A .. . 3 8a Gross amount from sales of assets other (A) Secuntles (B) Other 3 than Inventory Ba Less cost or other has and sales expenses 8b Galn or (loss) (attach schedule) 9c cl Net gain or (loss) (combrne lune 8c columns (A) and Bd 9 Spectal events and (attach schedule) a Gross revenue (not Includlng of contnbutlons reported on lune 1a) 9a Less direct expenses other than expenses 9b Net Income or (loss) from speclal events (subtract llne so from Itne 9a) 9c 10a Gross sales of Inventory less returns and allowances 10a I Less cost of goods sold 10b Gross pro?t or (loss) from sales of Inventory (att (subtract Ime 10b from Ime 10a) 10c 11 Other revenue (from Part VII, Ilne 103Total 1d .. 12 7,797,271 13 Program serwces (from Ilne 44. column 13 5 882 990 14 Management and general (from Itne 44. column Fundratsmg (from Itne 44 column 1 5 9 4 0 16 Payments to af?liates (attach schedule) 16 17 Total expenses (add Ilnes 16 and 44, column 17 7 425 5 91 A 113 Excess or (de?at) for the year (subtract Ime 17 from Ilne 12) 1a 371 680 It: 19 Net assets or fund balances at beginning of year (from lune 73. column 19 625 553 20 Other changes net assets or fund balances (attach explanation) 20 9 21 Net assets or fund balances at end of year (combine ltnes 18, 19. and 20) 21 997 233 For Paperwork Reductlon Act Notice. see the separate Instructions Form 990 (2001) DM n?l-q 53400 03? 312002 1 43 PM Form 990 (2001) DAYSTAR RESIDENTIAL, Partll~ I Statement of - Functional Expenses INC. 76-0336160 and section 494?(a Page 2 All organizations must complete column (A) Columns (8) (C) and (D) are required for section 501(c)(3) and (4) organizations (1) nonexempt charitable trusts but optional for others (See Specific Instructions on page 21 Do not include amounts reported on line Program Management 6b, 8b. 9b, 10b, Ol' 16 of Part I (A) Total services and general Fundraiaing 22 Grants and allocations (attach schedule) non- (cash 5 cash 5 22 23 Speci?c assistance to individuals 23 24 Benefits paid to or for members 24 25 Compensation of of?cers. directorsOther salaries and wages 26 27 Penston plan contributions 27 28 Other employee bene?Payrolltaxes 29 199,759 190,326 9,433 3D Professmnal fundraismg fees 30 31 Accountingfees 31 72B, 724 728,724 32 Legalfees 32 29,557 29,557 33 Supplies 33 52 305 52 305 34 Telephone 34 67,131 34 635 496 35 Postage and shipping 35 36 Occupancy 36 37 Equment rental and maintenance 37 38 Pnnting and publications 38 39 Travel expenses as 89,613 86,304 3,209 40 Conferences. conventions and meetings 40 41 Interest 41 16, 626 16, 626 42 Depreciation depletion. etc (an schOther expenses not covered above (itemize) a 43a 6 SEE 1 43b 3,856,709 3,246,728 609,041 940 43c 43d 0 43a 44 Total functional expensee (add lines 22 - 43) Organlzatlons completing columns (BHD). to llnes 13-15 44 7, 425,591 5, 382 990 1 ,541, 661 940 Jomt Costs Check it you are following SOP 98-2 Are any Icint costs from a combined educational campaign and fundraising solicmltion reported in (B) Program semioes? If 'Yes enter (I) the aggregate amount of these pint costs 5 (iti) ttie amount allocated to Management and general I Part I What is the organization's primary exempt purpose? SEE STATEMENT 2 All organizations must descnbe their exem purpose achievements in a clear and whose manner State the number of clients served, publications issued etc iscuss achievements that are not measurable (Section 501(c)(3) and (4 organizations and nonexempt charitable trusts must also enter the amount of grants and allocations to at (It) the amount allocated to Program services and (Iv) the amount allocated to Fundraising Statement of Program Serwce Accomplishments (See SpeCI?c Instructions on page 24 DUYesgNo 5 Program Sewice Expenses (Required for 501(c)(3) and (4) orgs and 4947mm trusts. but optional for rs others a SEE STATEMENT 3 (Grants and allocations 5 382 990 (Grants and allocations 5 (Grants and allocations (Grants and allocations 5 Other program sewices (attach schedule) (Grants and allocations 1' Total of Program Semce Expenses (should equal line 44, column (B), Program sewices) 5 882 990 UM Form 990 l2001) 53400 0811322002 1 43 PM Form 990 (2001) DAYSTAR RESIDENTIAL . INC . '7 6?033 61 60 Page 3 Balance Sheets (See SpeCl?c Instructlons on page 24 Note Where requred. attached schedules and amounts the (A) (8) column Should be for end-of?year amounts only of year End of year 45 Cash-non?lnterest-beanng Saulngs and temporary cash Investments 46 47a Acmunts recelyable 47a 1 135 665 A Less allowance for doubtful accounts 47b 665 43a Pledges recelvable 433 Less allowance for doubtful accounts 48b 48c 49 Grants recelvable 49 50 Recelvables from of?cers dlrectors. trustees and key employees A (attach schedule) 50 51a Other notes and loans recelvable (attach schedule) SEE WORKSHEET 51a 1 1 '7 9 0 4 Less allowance for doubtful accounts 51b Inventorles for sale or use 52 53 Prepald expenses and deferred charges 53 54 Investments-secuntles Cost FMV 54 55a Investments-land and equment basls 55a 1 3J 3 1 9 Less accumulated depreClatlon (attach schedule) 55b 11 .505 2. 9'77 55o 1,814 56 Investments-other (attach schedule) 56 57a Land. and eqUtpment ba5ls 57a Less accumulated depreclatlon (attach schedule) 57b 57c 58 Other assets (descnbe SEE Total assets (add llnes 45 through 58) (must equal llne 74Accounts payable and accrued expenses Grants payable 61 a 62 Deferred revenue 62 63 Loans from of?cers. dlrectors trustees. and key employees (attach 1 schedule) 53 64a Tax-exempt bond (attach schedule) 64a Mortgages and other notes payable (attach schedule) SEE WORKS HEET Other (descnbe SEE Total (add llnes so through 65Organlzations that follow SFAS 11?. check here and complete llnes 67 through 69 and llnes Temporarlly 53 69 Permanently 69 A Organlzatlons that do not follow SPAS 11?. check here and 8 complete llnes 70 through 74 5 a 70 Capltal stock. trust pnnCIpal. or current funds 70 71 Pald-ln or capltal surplus. or land and eqmpment fund 71 3 72 Retalned endowment, accumulated Income. or other funds Total net assets or fund balances (add llnes 67 through 69 OR llnes 2 70 through 72, column (A) must equal Ilne 19. column (B) must equal llne 21Total and net assets l' fund balances (add llnes 445 484 Form 990 IS ayallable for publlc lnspectlon and for some people serves as the pnmary or sole source of lnformatlon about a partlcular organlzatlon How the publlc percewes an organlzatlon tn such cases may be detennlned by the tnfon'natlon presented on us return Therefore. please make sure the return ls complete and accurate and fully descnbes ln Part the organlzatlon's programs and 0AA 63400 0811321302 1 43 PM Form 990 (2001) DAYSTAR RESIDENTIAL 7 6? 033 5150 page 4 I Part i Reconctliatton of Revenue per Audtted Part of Expenses per AudIted FInanCIal Statements w1th Revenue per FInanCIal Statements w1th Expenses per Return (See Specu?c InstructIons, page 26 Return a Total revenue. gaIns. and other support . ANM a Total expenses and losses per 1 per audIted ?nanc1al statements a 7 813 933 audIted ?nanCIal statements a 7 4 42 253 Amounts Included on Me a but not on Amounts Included on lIne a but not Me 12. Form 990 on ?no 17. Form 990 (1) Net unrealtzed gatns on (1) Donated serwoes and use Investments 5 of (2) Donated serVIces and use (2) Pnor year adjustments of 3 reported on ltne 20. (3) Recovertes of pnor Fom) 990 year grants 5 (3) Losses reported on Me 20. (4) Other (specIfy) Form 990 5 SEE 6 (4) Other (speedyAdd amounts on [Ines (1) through (Add amounts on lines (1) through (4) 16 662 LIneamInusllneb LIneamInuslIneb 7L4251591 Amounts Included on [me 12. Amounts Included on Me 17. Form 990 but not on km a Form 990 but not on lIne a (1) Investment expenses (1) Investment expenses not Included on me 60, not Included on lIne 6b Form 990 5 Form 990 (2) Other (speedy) (2) Other (spectfy) 8 Add amounts on (1) and (2) 11 Add amounts on lInes (1) and (2) 9 Total revenue per km 12, Form 990 0 Total expenses per km 17. Form 990 (lInecplusIIned) 7,7971271 _(lI_negpluslIned) 0 7,425,591 Part1!) Instructtons on page 26) of Of?cers, DIrectors, Trustees, and Key Employees (LIst each one even If not compensated. see SpecI?c ontnb (A) Name and address e?rlg?lg?yieed??wig 8:551:31: TERRI HILL SUGARLAND, Tx 77469 40 34,491 0 CAL SALLS AUSTIN, Tx 25 *113,039 0 EVERET E. KENNEMER, LAKE JACKSON, TX 77566 16 53,313 0 1 THIS COMPENSATION IS FOR OTHER SERVICES PROVIDED BY THE DIRECTOR AND NOT FOR THE btRVILtb OF THE LISTED IN COL MN B. 75 any of?cer dIrector. trustee. or key employee recetve aggregate compensatIon Of more than $100,000 from your organtzatton and all related orgamzatlons. of mm more than 510.000 was provtded by the related organtzatIons'? If "Yes attach schedule?see Specmc InstructIons on page 27 SEE STMT DAA Form 990 (2001) 53400 08f13l2002 1 43 PM Form 990(2001) DAYSTAR RESIDENTIAL, INC. 76-0336160 Page5 Part Other Information (See SpeCI?c Instructions on page 27 Yes No 76 Did the organization engage in any activlty not previously reported to the If "Yes." attach a detailed of each activity 76 77 Were any changes made in the organizmg or governing documents but not reported to the 77 If "Yes." attach a conformed copy of the changes 78a Did the organization have unrelated busrness gross inc of $1.000 or more dunng the year covered by this return? 78a If "Yes 'has it ?led a tax return on Form 990-1 for this year? 78b 79 Was there a liqmdation. dissolution teririination or substantial contraction dunng the year? lf "Yes." attach a statement 79 80a ts the organization related (other than by assOCiation with a statewide or nationwide organization) through common . membership. governing bodtes. trustees of?cers. etc . to any other exempt or nonexempt organization? 80a If "Yes." enter the name of the organization >494 and check whether it is exempt OR nonexempt 81a Enter direct or indirect politrcal expenditures See line 81 instr 31a Did the organization ?le Form 1120-POL for this year? 81b 82a Did the organization receive donated services or the use of materials. equment. or facmties at no charge or at substantially less than fair rental value? 82a If "Yes you may indicate the value of these items here Do not include this amount as revenue in Part I or as an expense in Part It (See instructions in Part Ill) 83a Did the organization comply With the public inspection reqUIrements for returns and exemption applications? 83a Did the organization comply With the disclosure requrrements relating to qUId pro quo contnbutions'? 83b 84a Did the organization solicit any contributions or gifts that were not tax deductible? 34a If "Yes.? did the organization include With every solicrtation an express statement that such contributions 1 or gifts were not tax deductible? A 84b 85 501(c)(4) (5). or (6) organizations a Were substantially all dues nondeductible by members? A 85a Did the organization make Only in-house lobbying expenditures of $2.000 or less? 85b If "Yes" was answered to either 85a or 85b. do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the pnor year Dues. assessments. and Similar amounts from members 35c Section 162(e) lobbying and polittcal expenditures 85d Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 850 Taxable amount of lobbying and political expenditures (line 85d less 85e) 851' Does the organtzation elect to pay the section 6033(e) tax on the amount in 85f? 859 If section 6033(e)(1)(A) dues notices were sent. does the organization agree to add the amount in 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the followtng tax year? A 85h 86 501(c)(7) orgs Enter a Initiation fees and capital contnbutions included on line 12 85a Gross receipts. included on line 12. for public use of club faCIlities 86b 87 501(c)(12) orgs Enter a Gross income from members or shareholders 87a Gross Income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them 87b 88 At any time dunng the year. did the organization own a 50% or greater interest in a taxable corporation or or an entity disregarded as separate from the organization under Regulations sections 301 7701-2 and 301 7701-3? If "Yes." complete Part IX 88 39a 501(c)(3) organizattons Enter Amount of tax imposed on the organization dunng the year under section 4911 0 . section 4912 . section 4955 0 501(c)(3) and 501(c)(4) orgs Did the organization engage in any section 4958 excess bene?t transaction during the year or did it become aware of an excess bene?t transaction from a prior year? If "Yes attach a statement explaining each transaction 39b Enter Amount of tax imposed on the organization managers or disquali?ed persons dunng the year under sections 4912. 4955. and 4953 0 Enter Amount of tax on line 89c above. reimbursed by the organization 0 90a List the states with which a copy of this return is filed TX Number of employees employed in the pay period that includes March 12 2001 (See instructions 90b I 95 91 The books are in care of EVERET . KENNEMER I I I Telephone no 97 9?2 97 ?-4075 Located at 8 WEST WAY COURT . LAKE JACKSON ZIP 4 TX 7'75 66 92 Section 4947(a)(1) nonexempt chantable trusts ?ling Form 990 in lieu of Form 1041- Check here and enter the amount of tax-exempt interest received or accrued dunng the tax year 5] 92 I N99 39-0-an Form 990 (2001) 63400 031132002 1 43 PM Form 990 (2001) Part VII 1 DAYSTAR RESIDENTIAL, INC. 76-0336160 AnalySIs of lncome-Producmg Activities (See SpeCI?c Instructions on page 32 Page 6 Note Enter gross amounts unless otherwise Unrelated business income Exduded by sec 512 513 or 514 Indicated 93 Program semice revenue RESI incom Related or A Busln?eal code Angiosint Ex?lulion Arr?ioilnt exempt ?"6110" code 0 DENTIAL EDUCATIONAL 7 689 .833 SERVICES INVESTMENT INCOME 9 ,272 Q?u'?l MEDI CAID REVENUE 90 .289 MedicareIMedicaid payments 9 Fees and contracts from government agenaes 94 Membership dues and assessments 95 Interest on savings and temporary cash investments 96 Dividends and Interest from securities 97 Net rental Income or (loss) from real estate j? km a debt-?nanced property not debt-?nanced property 98 Net rental income or (loss) from personal property 99 Other investment income 100 Gain or (loss) from sales of assets other than inventory 101 Net income or (loss) from special events 102 Gross pro?t or (loss) from sales of inventory 103 Other revenue a MISCELLANEOUS INCOME 5 ,010 LOAN DISCOUNT INCOME 187 104 Subtotal (add columns (B). (D105 Total (add line 104. columns (B). (D), and '7 I 7 94 Note Line 105 plus line 1d1 Part I. should equal the amount on line 12, Part I rPart vm I Line No 0 93A Part ix! .591 Relationship of Activities to the Accomplishment of Exempt Purposes LSee Speci?c Instructions on page 32 I Explain how eadi for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by prowdmg funds for such purposes; THE EDUCATIONAL AND RESIDENTIAL SERVICES ARE ESSENTIAL TO THE BEHAVIORAL AND EMOTIONAL DEVELOPMENT OF THE PHYSICALLY AND MENTALLY HANDICAPPED INDIVIDUALS SO THEY MAY BE ABLE SEE STATEMENT 9 Information Regarding Taxable SubSIdiaries and Disregarded Entities (See Speci?c Instructions on page 33) ,591 (A) (B) (C) I I Name. address. and EIN of corporation. Percentage of Nature of activmes Total(income End-of?ye partnership, or disregarded entity ownership interest assets ar [PartX?I Infon'nation Regarding Transfers Associated with Personal Bene?t Contracts (See Speci?c Instructions on pg Did the organization durlng the year receive any funds. dlrectIy or indirectty to pay premiums on a personal bene?t contract? Yes Did the organization. during the year, pay premiums. directly or indirecIIy. on a personal bene?t contract? Yes Note If "Yes" to ?le Form 8870 and Form 4720 (see instructions) Please Sign Here Under penalties of perjury I declare that have examlned this retum Including accompanying schedules and statements and to the best of my knowledge and b?j?f. it Is true. correct andemplete Dedaraticn of preparer (other than of?cer) is based on an infom'iaticn of which preparer has any knowtedge Quand? Signature of o?'icer Date 1;er .IZL Type or print name and ri?e 33) 11-: No 41 No Paid Preparer's Date Chhecti if Preparer's SSN or PTIN (See Gen signature 8/13/02 them Instr W) Preparer's Use Only rI eel-employed) address and ZIP 4 Phone Firms name (or yours EIN m, . 0M Form 990 (2001) 53400 081132002 3 57 PM SCHEDULE A (Form 990 or De rtment of the TreaSury Revenue Semce Organization Exempt Under Section 501(c)(3) (Except Private Foundation) and Section 501(e). 5010'). 501(k), 501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Supplementary Information-(See separate Instructions MUST be completed by the above organizations and attached to their Form 990 or 990-EZ OMB No 1545-0047 2001 Name of the organizatmn DAYSTAR RESIDENTIAL, INC. IPartI I Employer Identi?cation number 76?0336160 Compensation of the Five Highest Paid Employees Other Than Officers. Directors. and Trustees (See page 1 of the instructions List each one lfthere are none. enter "None "l Name and address of each employee paid more (D) Title and average hours It!) Contributions ?3 Expense than $50 000 per week devoted to posmon (cl deeTepgfobn?go?m? ?mg?gzggeimer JAVIER RUIZ-NWIO ST 17915 RIDGETOP DR, HOUSTON, TX 7 4 81 646 ANTONIO BRINKLEY DC SUPERVSOR 5216 GIBSON, HOUSTON. TX 77007 120 51,976 0 0 VALDA MCNE IL RN P.0.BOX 354, ROSHARON, TX 77583 40 51,101 0 0 Total number of other employees paid over . .. 0 [Partll 1 Compensation Of theFive Highest Paid Independent Contractors for Professional Serwces (See paqe 2 of the instr List each one (whether indiwduals or ?rms) If there are none, enter "None Name and address of each independent contractor paid more than 50 000 Type of service to) Compensation NONE Total number of others receivmg over $50,000 for professmnal semces .. .. .4 0 For Paperwork Reduction Act Notice, see the Instructions tor Form 990 and Form 990-57. DAA Schedule A (Form 990 or 990-EZ) 2001 53400 0W13i'2002 1 43 PM Schedule A (Form 990 or QQD-EZ) 2001 DAYSTAR RES IDENTIAL INC . Page 2 Statements About Activrties (See page 2 of the instructions Yes No 1 During the year has the organization attempted to in?uence national. state. or local legislation. including any attempt to in?uence public opinion on a legislative matter or referendum?? If "Yes enter the total expenses paid 1 or incurred in connection the lobbying activities ?5 (Must equal amount on line 38. Pan or line I of Pan Organrzations that made an electron under section 501(h) by filing Form 5768 must complete Part Other organizations checking "Yes." must complete Part VI-B AND attach a statement givmg a detailed description of the lobbying actiwties 2 During the year. has the organization. either directly or indirectly. engaged in any of the follovving acts with any substantial contributors trustees. directors. of?cers. creators. key employees. or members of their families or with any taxable organization with which any such person is affiliated as an of?cer. director. trustee. majority owner. or principal bene?ciary? (If the answer to any question is "Yes." attach a detailed statement explaining the transactions a Sale exchange. or leasing of property? SEE STMT 10 2a Lending of money or other extenSion of credit? SEE 1 1 2b Furnishing of goods. sewices or facrlities" SEE STMT 12 2c Payment of compensation (or payment or reimbursement of exp if more than :1 000)? 2d SEE STMT 1 3 0 Transfer of any pan of its income or assets? 2e 3 Does the organization make grants for scholarships fellowships student loans. etc (See Note below) 3 4 Do you have a section 403(b) annuny plan for your employees? 4 Note Attach a statement to explain how the organization determrnes that individuals or organizations receiving grants or loans from it in furtherance of its charitable programs "quality" to receive payments Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions The or anization is not a private foundation because it is (Please check only ONE applicable box) 5 A church convention of churches or association of churches Section A school Section 170(b)(1)(A)(ii) (Also complete Pan V) A hospital or a cooperative hospital service organization Section A Federal. state. or local government or governmental unit Section A medical research organization operated in conjunction with a hospital Section Enter the hospital's name. city. and state 10 An organization operated for the bene?t of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv) (Also complete the Support Schedule in Part IV-A 11a An organization that normally receives a substantial pan of its suppon from a governmental unit or from the general public Section 170(b)(1)(A)(vr) (Also complete the Support Schedule in Part IV-A) 11b I A community trust Section 170(b)(1)(A)(vr) (Also complete the Support Schedule in Part IV-A 12 5: An organization that normally receives (1) more than 33 of its suppon from contributions. membership fees. and gross receipts from related to its charitable. etc . functions-subject to certain exceptions. and (2) no more than 33 of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquwed by the organization after June 30. 1975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A) 13 An organization that is not controlled by any disquali?ed persons (other than foundation managers) and suppons organizations descnbed in (1) lines 5 through 12 above. or (2) section 501(c)(4). (5). or (6). if they meet the test of section 509(c)(2) (See section 509(a)(3) Provide the following information about the supponed organizations (See page 5 of the instructions) Line number from above Name(s) of supported organization(s) 14 An organization organized and operated to test for public safety Section 5096:1161 (See page 6 of the instnic-tions DM Schedule A (Form 990 or BBO-EZ) 2001 53400 0311312002 1 43 PM Schedule A (Form 990 or 990-EZ) 2001 DAYSTAR RES IDENTIAL INC . Page 3 I: Part Support Schedule (Complete onty r1 you checked a box on line 10. 11 or 12 Use cash method of accounting Note You may use the worksheet 1n the instruchons for convening from the accrual t0 the cash method of accountln Catendaryear {or ?scal year beginning In) 2000 1999 1998 1997 Total 15 Gifts grants. and contnbutlons received (Do not Include unusual grants 896 line 28 16 Membership fees received 17 Gross receipts from admissions merchandise sold or eerylces performed or furnishing of tealtues In any acuvlty that ts related to theorgenlzauon'schentable etc purpose 6,360,593 5,593,949 5,281,177 4,021,255 21,256,974 18 Gross Inc from Int duvldends amounts received from on secunttes toans(sectton 512(a)(5)) rents royalties 8. unrelated busn taxable Inc (less sec 511 taxes) from businesses acquired by the organization after June 30 1975 19 Net Income from unrelated bustness activities not Included In line 18 20 Tax revn levied for the organizatton ben 3. either pa1d to 11 or expended on Its behatl 21 The value of new or fact tumrshed to the 0119 by a governmental umt without charge Do not Ind the value of serv or fee gen- eralty_i'um1shed to the pubic without charge 22 Other 1ncome Attach a schedule Do not Include gain or (loss) trorn sale of cap assets 23 Total ofllnes 15mmth 256, 974 24 Line 23 mrnus Ime 17 25 Enter1%ofllne23 63,606 55,939 52,812 40,213 26 Organizattons descnbed on itnes 10 or 11 a Enter 2% ct amount In column Ime 24 26a Prepare a lust for your records to show the name of and amount contnbuted by each person (other than a governmental unit or publicly supported organization) whose total 9111s for 1997 through 2000 exceeded the amount shown In ltne 26a Do not ?le this list with your return Enter the total of all these excess amounts 26b Total support for section 509(a)(1) test Enter lune 24. column (9) 26c Add Amounts from column for lines Public support (line 26c minus line 26d total) 26a 1 Public support perce?ge (line 26e (numerator) dwlded by Ime 26c (denominator)) I 261' 27 Orgamzattons descnbed on Ime 12 a For amounts Included In lines 15. 16 and 17 that were received from a ?disquali?ed person." prepare a list for your records to show the name of. and total amounts received In each year from. each "disquali?ed person Do not ?le this list with your return Enter the sum of such amounts for each year (2000) (1999) (1998) (1997) For any amount Included In line 17 that was received from each person (other than "disquali?ed persons"), prepare a Itst for your records to show the name of. and amount received for each year that was more than the larger of (1) the amount on ltne 25 for the year or (2) 55.000 (Include In the list organizations descnbed tn lines 5 through 11. as well as Individuals Do not ?le this list with your return Alter computing the difference between the amount received and the larger amount descnbed In (1) or (2). enter the sum of these dl?erences (the excess amounts) for each year (2000) 5,662,390 (1999) 5,054,481 (1998) 4,893,537 (1997) 3,815,598 Add Amounts from column for ltnes 15 16 17 21,256,974 20 21 27: 21,256,974 (1 Add Llne27a total and line 27btota 19,426,006 27d 19,426,006 Publlc support (line 27c total minus Ime 27d total) 278 1 830 968 1 Total support for section 509(a)(2) test Enter amount on Ime 23. column I 271Public support percentage (llne 27a (numerator) divided by late 271' (denominator)) _21g_ 8 . 6135 Investment income percentage (line 18, column (9) (numeratorj?vlded by line 271? (denominator)) 27h 28 Unusual Grants For an organtzatlon descnbed In into 10 11 or 12 that any unusual grants dunng 1997 through 2000. prepare a Itst for your records to show. for each year. the name of the contnbutor. the date and amount of the grant and a bnef of the nature of the grant Do not ?le Itst your return Do not Include these grants In llne 15 0M Schedule A (Form 990 or 990-EZ) 2001 53400 03t13!2002 1 43 PM Schedule A (Form 990 or QQO-EZ) 2001 DAY STAR RESIDENT IAL1 INC . '7 6-03361 60 Page 4 Part ?i PrIvate School QuestIonnaIre (See page 7 of the Instructions (To be completed ONLY by schools that checked the box on Me 6 In Part IV) 29 Does the organIzatIon have a poIIcy toward students by statement In Its charter bylaws. Yes No other governIng Instrument. or In a resolutlon of Its body? 29 30 Does the organIzatIon Include a statement of Its nondIscnmInatory polIcy toward students In all Its brochures. catalogues. and other wntten communIcatIons mm the publtc dealtng wIth student programs. and 3o 31 Has the organIzatIon publIched Its ractally nondIscrImInatOty poIIcy through newspaper or broadcast medIa dunng the penod of solICItatIon for students. or dunng the regIstratIon penod If It has no soIICItatIon program. In a way that makes the whey known to all parts of the general communIty It serves? 31 If "Yes please descrIbe If No." please epraIn (If you need more space. attach a separate statement) 32 Does the organlzatlon maIntaIn the followtng a Records IndIcatIng the moat composItIon of the student body. faculty. and admInIstratIve staff?? 32a Records documentIng that and other ?nanaal assIstance are awarded an a racIaIly nondIscnmInatory basrs" 32b Coptes of all catalogues. brochures announcements and other wntten communIcatIons to the publIc dealIng wIth student programs. and scholarshIps?? 32c It Games of all matenal used by the organIzatIon or on Its behalf to what contnbutIons? 32d lf you answered "No" to any of the above please epraIn (If you need more space attach a separate statement 33 Does the organtzatron by race In any way respect to Students' or pnvIIeges?? 33a polIaes'o? 33b Employment of faculty or admInIstratIve staff? 33:: or other ?nancIal assIstance? 33d Educattonal polIcIes7 33o 1' Use of features? 331' Athlettc programs? ?5 Other extracumcular actIvItIes? 33h If you answered "Yes" to any of the above. please explaIn (If you need more space attach a separate statement 34a Does the organIzatIon recere any ?nanaal am or assIstance from a governmental agency? 34a Has the organIzatIon's to such aId ever been revoked or suspended? 34b It you answered "Yes" to eIther 34a or please explatn usmg an attached statement 35 Does the organtzatlon oertIfy that It has oomptIed mm the appIIcable requu'ements of sectIons 4 01 through 4 05 of Rev Proc 75-50. 1975-2 587, covenng racIal nondIscnmInatIon'? If attach an explanation . 35 Schedule A (Form 990 or 900-EZ) 2001 63-400 OBHSI2002 1 43 PM Schedule A (Form 990 or 990452) 2001 RESIDENTIAL .. INC . '7 6-03361 60 Page 5 Part VI-A Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions (To be completed ONLY by an eligible organization that ?led Form 5768) Check a I I if the organization belongs to an af?liated group Check if you checked and 'Iimited control" provrsrons apply Limits on Lobbying Expenditures Ammogzgoup totals To M?szleted for ALL electing (The term ?expenditures" means amounts paid or incurred Oma?mvons 36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36 37 Total lobbying expenditures to in?uence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) 3a 39 Other exempt purpose expenditures 39 40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount Enter the amount from the following table- If the amount on line 40 is- The lobbying nontaxable amount is- . Not over 5500.000 20% of the amount on line 40 . i Over $500,000 but not over 31.000.000 3100.000 plus 15% of the excess over $500,000 Over $1 000 000 but not over $1,500.000 $175 000 plus 10% of the excess over $1.000 000 41 i Over 31.500.000 but not over $17 000 000 $225 000 plus 5% of the excess over 31.500.000 Over 517.000.000 $1.000 000 2 42 Grassroots nontaxable amount (enter 25% of line 41) 42 43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 43 44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38 44 Caution If there is an amount on either line 43 or line 44. you must ?le Form 4720 4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the ?ve columns below See the instructions for lines 45 through 50 on page 11 of the instructions Lobbying Expenditures During 4-Year Averaging Period Calendar year (or ?scal year in) 2001 2000 1999 1990 Total 45 Lobbying nontaxable amount 46 Lobbying ceiling amount (150% of line 45(e)) 1 . 47 Total lobbying expenditures 48 Grassroots nontaxable amount 49 Grassroots ceiling amount (150% of line 48(e)) 50 Grassroots lobbying expenditures I Part I Lobbying Activrty by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See page 12 of the instr) Dunng the year. did the organization attempt to in?uence national. state or local legislation including any attempt to in?uence public opinion on a legislative matter or referendum. through the use of a Volunteers Paid staff or management (include compensation in expenses reported on lines is through Media advertisements Mailings to members. legislators. or the public Publications. or published or broadcast statements Grants to other organizations for lobbying purposes Direct contact with legislators. their staffs. government of?cials. or a legislative body Rallies. demonstrations. seminars. conventions speeches. lectures. or any other means Total lobbying expenditures (add lines through If "Yes" to any of the above. also attach a statement giving a detailed description of the lobbying activities Yes No Amount Schedule A (Form 990 or QED-E2) 2001 DM 63400 08? 312002 1 43 PM Schedule A (Form 990 or 990-EZ) 2001 DAYSTAR RESIDENTIAL INC . '7 6-03361 60 Page 6 Part VII I ?lnformatton Regarding Transfers To and Transactlons and Relationships Noncharltable Exempt Omamzatlons (See page 12 of the Instructions 51 the reponmg organizatlon dlrectly or Indirectly engage 1n any of the followlng any other organlzatlon descnbed In section 501(c) of the Code (other than 501(c)(3) organizattons) or In SECIIOD 527. relatlng to political organizauons? a Transfers from the reporting to a nonchantable exempt organizatton of Yes No (I) Cash 51am (It) Other assets at") Other transactions (I) Sales or exchanges of assets With a n0nchantable exempt organizatmn btl) (It) Purchases of assets from a nonchantable exempt organization hm) (at) Rental of equnpment or other assets bun} (Iv) Retmbursement arrangements btlv) Loans or loan guarantees b(v) Performance of SEWICBS or or b(vt) Sharing of equnpment. Itsts other assets. or paid employees If the answer to any of the above Is "Yes." complete the followtng schedule Column should always show the fair market value of the goods. other assets or SBWIOBS given by the reporting orgamzatlon If the organizatron received less than fair market value In any transaction or show In column the value of the other assets or SENIGBS received {at (bl (Cl Ltne no Amount Involved Name of nonchantable of transfers transactions and A 52a Is the orgamzatlon dlrectly or Indirectly af?liated or related to. one or more tax-exempt organizations descnbed In section 501(0) of the Code (other than sectton 501(c)(3)) or In 527'? Yes No If "Yes the schedule In) Name of of of A 0M Schedule A (Form 990 or 990-EZ) 2001 63400 0N13a'2002 1 43 PM Form Other Notes and Loans Receivable For calendar year 20011 or tax year 2001 and ending Name DAYSTAR RESIDENTIAL, INC. Name of borrower DAISTAR PHARMACY INC. Onglnal amount borrowed Date of loan 171 648 12 31 00 Secunly prowded by borrower Consuderatlon by lender 9 1 0 Totals FORM 990 PART IV LINE 51A - ADDITIONAL INFORMATION Malunty date 12 31 03 Employer Identi?cation Number 76-0336160 Relationship to dlsqualu?ed person COMMON OFFICERS Interest Repayment terms rate 3 YEARS 6.150 Purpose of loan EXTENSION OF CREDIT Balance due at Balance due at Farr market value of year end of year (QQO-PF only) 171 648 117 904 171 648 117 904 53400 08i13l2002 1 43 PM Form 9901990-PF For calendar year 2001. or tax year Mortgages and Other Notes Payable and ending 2001 Name DAYSTAR RESIDENTIAL, INC. Name of lender COMERICA BANK-TEXAS Ongmal amount borrowed Date of loan 30 814 10 28 01 Secunty provnded by borrower ACCOUNTS RECEIVABLES Consuderatlon fumlshed by lender 10 Totals FORM 990 PART IV LINE 643 - ADDITIONAL INFORMATION Matunty date 10 28 02 Employer Identi?cation Number 76-0336160 Relationship to dusquah?ed person Interest Repayment terms rate INT 5 PAID 5.750 Purpose of loan EXTENSION OF CREDIT Balance due at Balance due at beginning of year end of year 30 814 15 000 63400 DAYSTAR RESIDENTIAL, INC 76-03361-60 Federal Statements FYE 12/31/2001 811 312002 1 43 PM Statement 1 - Form 990, Part II, Line 43 - Other Functional Expenses Total Program 8. Fund- Expenses Servrce General Ralsmg EXPENSES CONTRACTED PROFESSIONALS 130,201 130,201 CONTRACTED SERVICES PROFESSIONAL MEDICAL 155,653 37,614 118,039 DIRECT CARE 1,664,269 1,664,269 ADMIN, CLERICAL MAINT 410,426 409,486 940 MEDICAL EXPENSE 28,059 28,059 FOOD 529,814 529,814 PERSONAL CARE SUPPLIES 69,288 69,288 CLOTHES 14,681 14,681 STAFF DEVELOPMENT 3,460 3,460 CLIENT EXP ENTERTAINMT 50,899 50,899 RENT EXPENSES 457,852 447,244 10,608 MAINTENANCE REPAIRS 151,220 141,139 10,081 UTILITIES 105,316 96,127 9,189 LICENSES AND FEES 1,414 1,414 OTHER INSURANCE 105 105 OTHER EXPENSES 8,789 8,789 CLAIMS EXPENSES 7,000 7,000 OFFICE EXPENSE 40,092 40,092 SCHOOL SUPPLIES 1,623 1,623 INSURANCE 24,535 23,692 843 MEMBERSHIP DUES 452 452 MEALS ENTERTAINMENT 1,357 1,357 INSTRUCTIONAL MATERIAL 204 204 TOTAL 3,856,709 3,246,728 609,041 940 Statement 2 - Form 990. Part - Organization's Primary Exempt Purpose TO PROVIDE EDUCATIONAL AND RESIDENTIAL SERVICES TO PHYSICALLY AND MENTALLY HANDICAPPED INDIVIDUALS. Statement 3 - Form 990. Part Line a - Statement of Program Service Accomplishments THE ORGANIZATION WAS ABLE TO PROVIDE RESIDENTIAL AND EDUCATIONAL SEERVICES, BEHAVIORAL, AND SPEECH THERAPY DEPENDING ON INDIVIDUAL NEEDS TO 100-200 MENTALLY AND EMOTIONALLY HANDICAPPED PERSONS. L3 63400 DAYSTAR RESIDENTIAL, INC 8/13/2002 1 43 PM 76-0335150 Federal Statements FYE 12/31/2001 Statement 4 - Form 990. Part IV. Line 58 - Other Assets Beginning End of Description of Year Year ACCTS REC ALVIN ISD 46,420 63,461 ACCTS REC RELATED COMPANIES 208,236 102,465 ACCTS REC EMPLOYEES 1,736 1,289 PREPAID EXPENSES 990 TOTAL 256,392 5 168,205 Statement 5 - Form 990, Part IV, Line 65 - Other Liabilities Beginning End of onear Year ACCTS PAYABLE RELATED 207,920 66,186 CLIENT TRUST FUND LIABILITY 1,019 678 ACCTS PAYABLE OTHER 345 342 ACCTS PAYABLE LIFE INS WITHHELD 142 ACCTS PAYABLE OTHER DEDUCT 374 TOTAL 209,284 67,722 63400 DAYSTAR RESIDENTIAL, INC 8/13/2002 2 03 PM 76-0336160 Federal Statements FYE 12/31/2001 Statement 6 - Form 990, Part - Other Revenue Included In Financial Statements DescrIptIon Amount NETTED EXPENSE REIMBURSEMENT INCOME AGAINST THE RELATED 5 16,662 EXPENSE TOTAL 16,662 Statement 7 - Form 990. Part - Other Expenses Included in Financial Statements DescrIptIon Amount NETTED EXPENSE REIMBURSEMENT INCOME AGAINST THE RELATED 16,662 EXPENSE TOTAL 16,662 Statement 8 - Form 990. Part V. Line 75 - Schedule of Compensation in Excess of $100,000 Name Related Ogganlzatlon CompensatIon Bene?ts Expenses EVERET E. KENNEMER, INVESTMENTS, INC. 157,919 CLAY D. HILL INVESTMENTS, INC. 1,155,958 CAL SALLS INVESTMENTS, INC. 155,827 63400 DAYSTAR RESIDENTIAL, INC 8/13/2002 143 PM 76-0336160 Federal Statements FYE 12/31/2001 Statement 9 - Form 990. Part - RelatIonshIQ of Activitles LIne No DescrIptIon TO FUNCTION MORE INDEPENDENTLY AND DEAL WITH THEIR HANDICAPPING CONDITIONS 93C THE INVESTMENT INCOME EARNED IS A RESULT OF LOANS TO ORGANIZATIONS WHICH PROVIDE MANY SERVICES WHICH ENABLE US TO PROVIDE THE RESIDENTAL EDUCATIONAL SERVICES TO OUR CLIENTS 63400 DAYSTAR RESIDENTIAL. INC 8/13/2002 1 43 pM 76-0336160 Federal Statements FYE 12/31/2001 Statement 10 - Schedule A. Part Question 2a - Sale, Exchanqe, or Lease of Property DAYSTAR RESIDENTIAL, INC LEASES FACILITIES FROM BEHAVIOR TRAINING, RESEARCH, INC. AN OWNER OF BEHAVIOR TRAINING RESEARCH, INC. IS THE SPOUSE OF AN OF DAYSTAR RESIDENTIAL, INC. THE LEASING OF THE FACILITY IS AT COST Statement 11 - Schedule A. Part Question 2b - Lendingof Money DAYSTAR RESIDENTIAL, INC. EXTENDED CREDIT, PROVIDED SERVICES PAID COMPENSATION TO SEVERAL RELATED CORPORATIONS DURING THE YEAR. THE CORPORATIONS ARE RELATED BY COMMON OFFICERS DIRECTORS IN ADDITION, DAYSTAR RESIDENTIAL, INC. RECEIVED EXTENSION OF CREDIT, RECEIVED SERVICES RECEIVED COMPENSATION FROM SEVERAL RELATED CORPORATIONS ALL OF THE TRANSACTIONS ARE PROVIDED RECEIVED AT COST. ALL OF THE EXTENSIONS OF CREDIT TO FROM DAYSTAR RESIDENTIAL, INC. WILL BE PAID. Statement 12 - Schedule A. Part Question 2c - Furnishing of Goods DAYSTAR RESIDENTIAL, INC EXTENDED CREDIT, PROVIDED SERVICES PAID COMPENSATION TO SEVERAL RELATED CORPORATIONS DURING THE YEAR THE CORPORATIONS ARE RELATED BY COMMON OFFICES DIRECTORS. IN ADDITION, DAYSTAR RESIDENTIAL, INC. RECEIVED EXTENSION OF CREDIT, RECEIVED SERVICES RECEIVED COMPENSATION FROM SEVERAL RELATED CORPORTIONS ALL OF THE TRANSACTIONS ARE PROVIDED RECEIVED AT COST. ALL OF THE EXTENSIONS OF CREDIT TO FROM DAYSTAR RESIDENTIAL, INC. WILL BE PAID. Statement 13 - Schedule A. Part Question 2d - Payment of Compensation DAYSTAR RESIDENTIAL, INC. EXTENDED CREDIT, PROVIDED SERVICES PAID COMPENSATION TO SEVERAL RELATED CORPORATIONS DURING THE YEAR. THE CORPORATIONS ARE RELATED BY COMMON OFFICERS DIRECTORS. IN ADDITION, DAYSTAR RESIDENTIAL, INC. RECEIVED EXTENSION OF CREDIT, RECEIVED SERVICES RECEIVED COMPENSATION FROM SEVERAL RELATED CORPORATIONS. ALL OF THE TRANSACTIONS ARE PROVIDED RECEIVED AT COST. ALL OF THE EXTENSIONS OF CREDIT TO FROM DAYSTAR RESIDENTIAL, INC. WILL BE PAID. 10-13 63400 DAYSTAR RESIDENTIAL, INC 08/13/2002 143 PM 76-0336160 Federal Asset Report FYE 12/31/2001 Indirect Depreciation Date Bus Sec Sec Asset In Serwce Cost jig 168(k) P_erConv Meth Prlor Current Prior MACRS FURNITURE 12/011'9] 6,244 FURNITURE 3f3lf92 522 2 $320 00 l0f 7f94 320 VCR l0f 7i94 230 ZENITH 25" COLOR TV - BICKERSTAFF $29296 379 CBS COMPUTER SOFTWARE ll3lf92 350 CBS COMPU I ER SOFTWARE (NR PKG) 10106292 225 4X4X6 RIC GRINDER 4H U95 5,000 HY 20000 6,244 0 HY 20003 522 0 HY 20000 353 HY 20003 220 l0 HY 200013 294 34 HY 200013 350 0 HY 20008 225 0 5,000 HY 20000 4.33l 446 5 979 12.539 50? XX 370 230 379 Grand Totals 3,320 5 979 I2 539 503' Less. Disposmons 0 0 0 0 Net Grand Totals 3.320 0 5.979 l2,539 507 CO 63400 DAYSTAR RESIDENTIAL, INC 03/130002 143 PM 76-0336160 Federal Asset Report FYE 12131/2001 Date Bus Sec Sec Asset Description In Semce Cost 115} 168(k) E_e_rConv Meth Pnor Current Prlor MACRS: FURNITURE l2f0U9 6,244 FURNITURE 3:"10!] "#94 330 VCR IOHW94 230 ZENITH 25" COLOR TV - BICKERSTAFF I 81'29s?96 379 CBS COMPUTER SOFTWARE ?3 H92 350 CBS COMPUTER SOFTWARE (AIR PKG) 0f06f92 225 4X4X6 ELECTRIC GRINDER 4H ?95 5,000 I3 320 HY 20008 6,244 0 HY 20003 522 0 HY 200DB 353 HY ZOODB 220 10 HY ZOODB 294 34 HY 200DB 350 HY ZOODB 225 0 5.000 HY 200DB 4 33] 446 5,939 12,539 50? 370 230 329 :3 Grand Totals 13,320 5,979 2,539 507 Less: Disposmons 0 0 0 Net Grand Totals 13,320 0 5 979 2,539 50? CD CD 3400 051152002 8 41 AM arm 8868 - Application for Extension of Time To File an lecember 2000)? Exempt organization Return OMB No 1545-1709 apartment ol' the Treasury temai Revenue Service File a separate application for each return If you are ?ling for an Automatic 3-Month Extension. complete only Part and check this box If you are ?ling for an Additional (not automatic) 3-Month Extension. complete only Part ll (on page 2 of this form) ote Do not complete Part ll unless you have already been granted an automatic 3-month extension on a prewously ?led 3868 Part I Automatic S-Month Extensmn of Time- Only submit original (no copies needed) ote Form 990-T corporations requesting an automatic 6-month extensmn-check this box and complete Part I only other corporations (including Form 990-0 ?lers) must use Form 7004 to request an extension of time to ?le income tax gums Partnerships. and trusts must use Form to request an extension of time to ?le Form 1065. too?mr 1041 9P0 0' Name Of Exempt Organization Employer identification number [la bythe DAYSTAR RESIDENTIAL, INC . 76?0336160 ?3 ?3?3 Number. street. and room or su?e no If a 0 box. see Instructions '"gmr P.O. BOX 307 ~tum See City. town or post of?ce. state. and code For a foreign address. see instructions LAKE JACKSON TX 77566 :heck type of return to be ?led (?le a separate application for each return) Form 990 Form 990-T (corporation) Form 4720 Form Form QQO-T (sec 401(a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 Form BSD-PF Form 1041 -A Form 8370 If the organization does not have an of?ce or place of business in the Unrted States. check this box If this IS for a Group Return, enter the or anization's four digit Group Exemption Number (GEN) If this is or the whole group. check this box If it is for part at the group check this box 5 and attach a list the ames and Eth of all members the extensmn will cover 1 request an automatic 3-month (6-month. for 990-T corporation) extenSion of time until g/iSLog . to ?le the exempt organization return for the organization named above The extension is for the organization's return for calendar year 2 0 0 or tax year beginning . and ending 2 If this tax year is for less than 12 months. check reason Initial return Final return Change in accounting period So If this application is for Form BSD-BL. BSD-PF. ego?T. 4720 or 6069. enter the tentative tax. less any nonrefundable credits See instructions 5 If this application is for Form QQO-PF or 990-T. enter any refundable credits and estimated tax payments made lnclude any prior year overpayment allowed as a credit 5 Balance Due Subtract line 3b from line 3a Include your payment With this form. or. if reqwred. deposit with FTD coupon or. if requtred. by using EFTPS (Electronic Federal Tax Payment System) See instructions .. .. . . .. . 5 Signature and Veri?cation Jnder penalties of perjury. I declare that I have examined this form. including accompanying schedules and statements. and to the best of my nowtedge and belief. it is true. correct. and complete. and that am authonzed to prepare this form .gnmumsh Kt 4- am 5/15/02 or Paperwork Reduction Actuatice. see Instructlon Form 3333 (12-2000)