Form EXTENDED TO NOVEMBER 16, 2015 Short Form Do not enter social security numbers on this form as it may be made public. Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the lntemal Revenue Code (except private foundations) OMB No. 1545-1150 2014 Department of the Treasury open 10 A For the 2014 calendar year, or tax year beginning and endIng 353$, Name of organIzatIon Employer identi?cation number [:lAddnass change Clowns", CONVENTION OF STATES ACTIONEmma, "mm mimber and street (or PO. box, It marl is not delivered to street address) Room/smte Telephone number 31:13:32? 800 BRAZOS ST 300 540?441?7227 DAmanded rem," CIty or town, state or province, county, and ZIP or foreIgn postal code Group Exemption Easement. AUSTIN, Tx 78701 Number Accounbng Method: Cash Accrual Other (specrty)> it Check bl I Ifthe organIzatIon Is Website: . COSACTION . COM not requIred to attach Schedule Form 01 organization: Corporation Trust AssomatIon Other I Tax-exempt status (check only one) I_l 501(c)(3)lLI 501(c)( 4 Hansen no.) Ll 4947(a)(1) or 527 (Form 990, goo-?2, or 990-PF). Add lInes 5bdetermIne gross receipts. It gross receIpts are $200,000 or more, or if total assets (Part II, column (3) below) are $500, 000 or more, ?le Form 990 instead of Form 990-Part I Revenue, Expenses, and Changes In Net Assets or Fund Balances (see the Instructions Ior Part 1) Check If the organIzatIon used Schedule 0 to respond to any women In this Part I . IXI 1 Conb'IbutIons, gifts, grants. and SImIlar amounts recered Program serVIce revenue IncludIng government fees and contracts 2 3 Membership dues and assessments 3 4 lnvestrnent Income .. . . . . .. . 4 5a Gross amount from sale of assets other than Inventory . .. 5a Less: costor other baSlS and sales expenses_ 5b GaIn or (loss) from sale of assets other than Inventory (Subtract line 5b from line 5a) 5c 6 GamIng and fundraising events a, a Gross income from gaming (attach Schedule it greater than a $15,000)? leal 0 Gross Income from fundralsing events (not Including of contnbuttons from fundraismg events reported on Me 1) (attach Schedule If the sum of such gross Income and contnbutions exceeds $15, 000) 6b Less: dIrect expenses from gamIng and fundraISIng events Be It Net Income or (loss) from gaming and fundraIsmg events (add lines 6a and 6b and subtract line 6c) 6d 7a Gross sales of Inventory, less returns and allowances . . 7a Less: cost of goods sold 7b Gross pro?t or (loss) from sales of InventOry (Subtract lIne 7b trornliiOther revenue (descrIbe In Schedule 0) __tu a; 8 9 Total revenue. Add lines Grants and swim amounts paId (lIst in Schedule 0) 18 NOV 1L 2015 10 11 Bene?ts paid to or for members . 11 (-3: 12 Salanes, other compensatlon and employee bene?ts QGDEN Professronal fees and other payments to independent contractors . Occupancy, rent, and maIntenance 14 15 publlcatrons, postage, and shIppIng . Other expenses (descnbe In Schedule 0) .. SEE SCHEDULE Total expenses. Add lInes 10 through @7131, 18 Excess or (deficit) for the year (Subtract line 17 from Net assets or fund balances at begInnIng of year (from 1m 27, column 2 (must agree end-of-year lIgure reported on poor year's return) . 19 0 . 20 Other changes In net assets or fund balances (explaIn In Schedule 0) 20 0 . 21 Net assets or tund balances at end of year. CombIne lines 18 through 20 . 21 ?2 455 . LHA For Paperwork Reduction Act Notice, see the separate instructions. 432171 12-15-14 14101110 798302 1381 1 Form 990-EZ (2014) (SW 2014.05000 CONVENTION OF STATES ACTION 1381 1 Mmsme??M) EONVENTION OF STATES ACTION, INC 47?2245708 Pwe2 Part II I Balance Sheets (see the instructions for Part II) - Check if the organization used Schedule 0 to respond to amamestion in this Part II . . . El (A) Beginning at year (B) End of year 22 Cash and investments .. . Land and burldIngs . .. 23 24 Other assets (descnbe In Schedule 0) . .. . 24 25 Totalassets . 0. 25 54,104. 26 SEE SCHEDULE 0.26 56,560. 27 Net assets or tund balances (um 27 of column (8) must agree line 21Part Statement of Program Service Accomplishments (see the instructions for Part Ill) Expenses Check if the organization used Schedule 0 to respond to any question in this Part (Requ'red for 59m? 501 3 a d501c 4 What Is the organization's primary exempt purpose?SEE SCHEDULE 0 mgg?gago?s; ophgn?l Desmbe the organization's program service accomplishments for each of its three largest program services. as measured by expenses In a clear and comes Others') manner. desa-Ibo the savrces provided. the number of persons bene?ted. and other relevant Information for each program htle 2a SEE SCHEDULE 0 (Grants If this amount includes foreign_grants. check here 283 (Grants If this amount includes foreig?rants, check here . 29m 30 (Grants If this amount includes foreign grants. check here . 30m 31 Other program servrces (describe In Schedule 0) . . . . (Grants$ )lfthIs amount Includes foreign_grants, check here. I: 3181 32 Total am servicee :enses add lines 28a throu- 31aand Key Employees first each one even If not oompensated- see the Instructions for Part IV) Check if the organization used Schedule 0 to respond to any question in this Part IV . .. (b)Average hours (0) Reportable (?Health bene?ts. (e)EstImated Name and the per week devoted to wwg?fgg?ggs $133333; amount of other posmon (.1 nomad, em. .0.) compensatIon MARK MECKLER CEO TIM DUNN BOARD MEMBER 1.00 0. 0. 0. ERIC 0 KEEFE BOARD MEMBER 1.00 0. 0. 0. MARK ROLLINS BOARD MEMBER 1.00 0. 0. 0. MICHAEL FARRIS BOARD MEMBER 1.00 0. 0. 0. MICHAEL RUTHENBERG VICE PRESIDENT AND SECRETARY TIMOTHY MURPHY CFO 432172 12?15?14 Form 990-EZ (2014) 2 14101110 798302 1381 2014.05000 CONVENTION OF STATES ACTION 1381 1 Form 990-52 (2014) CONVENTION OF STATES ACTION, INC 4'7? 2245708 Page3 Part Other Information (Note the Schedule A and personal bene?t contract statement requirements in the . instructions for Part V) Check if the organization used Sch. 0 to respond to any question in this Part 33 34 35a the organrzatIon engage In any sIgnI?cant not prevrously reported to the If 'Yes,? provrde a detarled of each actiwty In Schedule 0 Were any sIgnIfIcant changes made to the or documents? If 'Yes," attach a conformed copy of the amended documents If they re?ect a change to the orgamzatron 5 name. Otherwrse, explain the change on Schedule 0 (see InstructIons) the organIzahon have unrelated busrness gross income 01 $1,000 or more durrng the year from busrness (such as those reported on 2, 6a, and 7a, among others)? If 'Yes' to lIne 35a, has the organrzatron filed a Form 990-1 for the year? If proVIde an explanatron In Schedule 44a 45a Was the organlzahon a sectron 501(c)(4), 501(c)(5), or 501(c)(6) organIzatIon subject to sectron 6033(e) notIce, and proxy tax requrrements durrng the year? If 'Yes," complete Schedule 0, Part the organizatIon undergo a IIqurdatIon. dIssolutIon, termination, or SIgnI?cant disposrtron ot net assets durrng the year? If 'Yes,? complete applIcable parts of Schedule . . . . Enter amount of poIItIcal expendrtures, dIrect or indIrect; as In the instructions the organIzatIon ?le Form 1120- POL for thIs year? . the organizatron borrow from, or make any loans to, any of?cer, drrector, trustee, or key employee or were any such loans made in a prror year and outstandmg at the end of the tax year covered by return'Yes,? complete Schedule L, Part II and enter the total amount Involved 38b A 37!) 38a >4 Sectron 501(c)(7) orgamzations. Enter: tees and caprtal on lIne9 39a A Gross receipts, Included on line 9, for publrc use of club tacIlItIes 39!: A Sectron 501(c)(3) orgamzatrons. Enter amount of tax Imposed on the organIzatIon durrng the year under. sectron 4911 A sectron 4912 A sectron 4955 A Sectron 501(c)(3), 501(c)(4), and 501(c)(29) orgamzatrons. Did the organrzatron engage In any sectron 4958 excess benetlt transactIon durrng the year, or am It engage In an excess benetrt transactlon In a prror year that has not been reported on any of Its prror Forms 990 or 990- lf'Yes," complete Schedule L, Part I . Sectron 501(c)(3), 501(c)(4), and 501(c)(29) orgamzatrons. Enter amount oftax Imposed on organIzation managers or drsqualr?ed persons durrng the year under sectrons 4912, 4955, and 4958 0 . Sechon 501(c)(3), 501(c)(4), and 501(c)(29) organizatlons. Enter amount oftax on trne 40c rermbursed by the organIzatIon 0 . All organIzatJons. At any tIme durrng the tax year was the organrzatron a party to a tax shetter transactIon? If 'Yes," complete Form 8886-T mm the states a copy ot the return Is frled SEE SCHEDULE 0 40b 40c The organrzatron' 5 books are In care 01 CLIFTON LARSON ALLEN LP Telephone noLocated at 9 3 5 5 COUNSELORS ROW 1? 20 0 INDIANAPOLIS IN At any trme durrng the calendar year, old the organrzahon have an Interest In or a signature or other authorrty over a ?nanCIal account In a torergn country (such as a bank account, securrties account, or other frnancral account)? enter the name of the foreign country: 5 See the Instructrons tor exceptrons and ?ling reqUIrements tor Form 114, Report of Forum Bank and ?nanced Accounts (FBAR). At any hme dunng the calendar year, dId the organrzatron marntarn an ottrce outsrde of the If 'Yes,? enter the name of the foreign country: 5 Sectron 4947(a)(1) nonexempt charrtable trusts fIlIng Form In Ireu of Form 1041 -Check here . and enter the amount of tax-exempt Interest recered or accrued durrng the tax year I 43 er+4 46240?2045 Yes No 42!) 42c the organrzatron marntain any donor advrsed funds durrng the year? It 'Yes," Form 990 must be completed Instead of Form 990- E2 the organrzatron operate one or more hospttal taCIlitIes durrng the year? If 'Yes," Form 990 must be completed instead of Form 990-EZ the organtzatron recerve any payments for Indoor servrces during the year? If 'Yes' to 1m 44c, has the organIzatIonI ?led a Form 720 to report these payments? If provrde an explanation In Schedule 0 the organIzatIon have a controlled the meanrng of sectron 512(b)(13)? the organizatron recerve any payment from or engage In any transactron a controlled withrn the meanrng of sectron 512(b)(13)? If 'Yes,? Form 990 and Schedule may need to be completed Instead 01 Form 990- E2 (see Instructrons44d 45a 45b 432173 12?15-14 14101110 798302 1381 3 Form 9 90-EZ (2014) 2014.05000 CONVENTION OF STATES ACTION 1381 1 Form 990-52 (2014) CONVENTION OF STATES ACTION INC Page ?have, 46 Did the- organrzatron engage, directly or Indirectly, In political campaign activities on behalf of or an opposition to candidates for public of?ce? i a: :32} -. It'Yes' complete Schedule C, PartSection 501(c)(3) organizations only All section 501(c)(3) organizations must answer questions 47-49b and 52. and complete the tables for lines 50 and 51. Check if the organrzatron used Schedule 0 to respond to any question in this Part the organization engage in lobbying actIVIties or have a section 501(h) election in effect during the tax year? If 'Yes,? complete Sch. C, Part II 47 48 Is the organization a school as described In section If 'Yes,? complete Schedule . 48 49a Did the organization make any transfers to an exempt non-charitable related organization? . . 49a It 'Yes.? was the related organrzation a section 527 organization? 49b 50 Complete thIs table for the organizatron' 3 two highest compensated employees (other than officers. directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there Is none. enter ?None.? Name and title 01 each employee Average hours Reportable Hgla?h?benemi (8) Estimated per week devoted to ?meg/?gguggs amount of other A posrtron 33:13:? compensation Total number 01 other employees pard over $100 000 . 51 Complete this table for the organizatron? 5 five highest compensated independent contractors who each received more than $100,000 of compensation from the If there Is enter ?None.? A a Name and business address of each In dent contractor of service Com Total number of other independent contractors each receiving over $100,000 . 52 the organization complete Schedule Note. All section 501(c)(3) organizations must attach a completed Schedule A .. . . Yes No Under penalties of periury. I declare that have examined this return Includlng accompanying schedules and statements. and to the best of my knowledge and belief, it Is true, correct. and complete. De 0 ct preparer (other than officer) IS based on all Information of which preparer has any knowledge. low Sign Here MARK ECKLER, CEO ype or name an Punt/Type preparer's name Preparer's signature Date Check L__j If PTIN . . If employed Pard ll se Preparer DENNIS K. WEISS, Kit/u? (M 5 901330013 Use Only ?am - - WEISS ASSOCIATES. PLLC Frrm324 Flfm'S address 4 6 6 0 . BRETON COURT SUITE 1 0 2 Phone noKENTWOOD MI 4 9 5 0 8 May the IRS discuss this return with the preparer shown above? See Instructions . . . . Yes LJ No Form 990-EZ (2014) 432174 12-15-14 4 14101110 798302 1381 2014.05000 CONVENTION OF STATES ACTION 1381 1 SCHEDULE 0 (Form 990 or Department ol the Treasury Internal Revenue SaVIce Name of the organization 0MB N2 15450047 Open to Public . ., Inspection Employer identi?cation number Supplemental Informatlon to Form 990 or 990- E2 Complete to provide information for responses to Speci?c questions on Form 990 or 990-EZ or to provide any additional information. Attach to Form 990 or I - I IL u? CONVENTION OF STATES ACTION, INC 47?2245708 FORM 990-EZ, PART I, LINE 16, OTHER EXPENSES: DESCRIPTION OF OTHER EXPENSES: AMOUNT: ADVERTISING MARKETING 100,655. BANK FEES 16. CONFERENCES MEETINGS 290. INSURANCE 358. MISCELLANEOUS 1,530. PAYROLL TAXES 180. TOTAL TO FORM LINE 16 103,029. FORM PART II, LINE 26, OTHER LIABILITIES: DESCRIPTION BEG. OF YEAR END OF YEAR ACCOUNTS PAYABLE 0. 56,560. FORM 990-EZ, PART CONSTITUTIONALLY LIMITED GOVERNMENT. PRIMARY EXEMPT PURPOSE TO ADVOCATE FOR A FORM PART COSA ADVOCATES FOR A RETURN TO THE ORIGINAL VISION OF A LINE 28, PROGRAM SERVICE ACCOMPLISHMENTS: LIMITED FEDERAL GOVERNMENT THAT IS OF, BY AND FOR THE PEOPLE. THIS WILL BE ACCOMPLISHED THROUGH AN ARTICLE CONSTITUTIONAL CONVENTION OF STATES. FORM 990-EZ PART V, LINE 41, LIST OF STATES RECEIVING COPY OF FORM 990-EZ: LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 43221 1 08-27-14 9 14101110 798302 1381 Schedule 0 (Form 990 or 990-EZ) (2014) 2014.05000 CONVENTION OF STATES ACTION 1381 1 SCHEDULE 0 Supplemental Information to Form 990 or 990-EZ 1545,0047 (Form 990 or 990.52) Complete to provide information for responses to speci?c questions on 20 1 4 Form 990 or or to provide any additional information. Department of the Treasury Attach to Form 990 or 990-EZ. Open to Public Internal Revenue Samoa Inspection Name of the organization Employer identi?cation number CONVENTION OF STATES ACTION, INC 47*2245708 FORM PART V, INFORMATION REGARDING PERSONAL BENEFIT CONTRACTS: THE ORGANIZATION DID NOT, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY, OR INDIRECTLY, TO PAY PREMIUMS ON A PERSONAL BENEFIT CONTRACT. THE ORGANIZATION, DID NOT, DURING THE YEAR, PAY ANY PREMIUMS, DIRECTLY, OR INDIRECTLY, ON A PERSONAL BENEFIT CONTRACT. LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Schedule 0 (Form 990 or 990-EZ) (2014) 432211 08?27-14 10 14101110 798302 1381 2014.05000 CONVENTION OF STATES ACTION 1381 1