Document KEoLzEL7mJwNo4arwgB1a6LK
le file GRAPHIC print - DO NOT PROCESS | As Filed Data - |
D LN :934922480031621
Short Form
OMB No 15 45-115 0
Form990-EZ
Department of the Treasury Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)
Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions)
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form
- The organization may have to use a copy of this return to satisfy state reporting requirements
2011
Open to Public Inspection
A For the 2011 calendar year, or tax year beginning 01-01-2011
B Check if applicable
C Name of organization
I Address change
ASBESTOS INFORMATION ASSOCIATIONNA
, and ending 12-31-2011
I Name change I Initial return
Number and street (or P O box, if mail is not delivered to street address) Room/su ite P O BOX 2227
I Terminated I Amended return I Application pending
City or town, state or country, and ZIP + 4 ARLINGTON, VA 222029227
D Employer identification number
13-2702826 E Telephone number
(703) 560-2980
F Group Exemption Number
I Cash F A c c r u a l Other (specify)
I Website:^ n/a
FJ Tax-Exempt status(check only one) -- 501(c)(3)^l
I I501(c)( ) -^(insert no ) 4947(a)(1) or
527
FH C h e ck s-
if the organization is not
required to attach Schedule B
(Form 9 9 0 , 9 9 0 - E Z , o r 9 9 0 - P F )
K Check -! if the organization is not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally not more than $50,000 A Form 9 9 0-E Z or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions) But if the organization chooses to file a return, be sure to file a complete return__________________________________________
L Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts, If gross receipts are $200,000 or more, or if total assets (Part II, line 25, column (B) below) are $500,000 or
more, file Form 990 instead of Form 990-EZ
$
65,451
Part I
Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions for Part I )
FCheck if the organization used Schedule O to respond to any question in this Part I ................................................
1 Contributions, gifts, grants, and similar amounts received . . . .
2 Program service revenue including government fees and contracts
3 Membership dues and a s s e s s m e n t s .......................................................
65,441
4 Investment i n c o m e ..................................................................................
5a Gross amount from sale of assets other than inventory
5a
O; _,
b Less cost or other basis and sales expenses
5b
qi '! c Gain or(lo ss)from sale of assets other than inventory (Subtract line 5b from line 5a)
Or LC
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000)
ga
b Gross income from fundraising events (not including $ _of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000)
I 6b I
5c
10
c Less direct expenses from gaming and fundraising events
6c
d Net income or (loss) from gaming and fundraising events (Add lines 6a and 6b and subtract line 6c)
6d
7a Gross sales of inventory, less returns and allowances . . . .
7a
b Less cost of goods s o l d ..............................................................
7b
c Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a)
7c
8 Other revenue (descri be in Schedule O ) ................................................
9 Total revenue. Add lines 1 , 2 , 3 , 4 , 5 c , 6d, 7c, and 8 ...........................
6 5,4 51
10 Grants and similar amounts paid (list in Schedule O)
11 Benefits paid to or for m e m b e r s .........................................
12 Salaries, other compensation, and employee benefits
10
11
12 58,193
13 Professional fees and other payments to independent contractors in
14 Occupancy, rent, utilities, and m a i n t e n a n c e ...........................
15 Printing, publications, postage, and shipping . . . .
13 14 15
16 Other expenses (describe in Schedule 0 ) ........................... 17 Total expenses. Add lines 10 through 1 6 ...........................
16 13,254 17 71,447
18 Excess or (deficit) for the year (Subtract line 17 from line 9 ) .........................................
18 -5,996
19 Net assets orfund balances at beginning of year (from line 27, column (A)) (must agree with
< end-of-year figure reported on prior year's r e t u r n ) ....................................................... .
20 Other changes in net assets or fund balances (explain in Schedule 0 ) ...........................
19 24,017 20 0
21 Net assets orfund balances at end of year Combine lines 18 through 20 For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
.... Cat No 106421
21 18,0 21
Form 990-EZ (2010)
Form 990-EZ (2010)
Part II Balance Sheets
Check if the organization used Schedule 0 to respond to any question in this Part II
Page 2
F
(See the instructions for Part II )
(A) Beginning ofy ear
(B) E nd of year
22 Cash, savings, and i n v e s t m e n t s ..............................................................
24,780 22
18,0 21
23 Land and b u i l d i n g s ..................................................................................
23
24 0 ther assets (describe in Schedule 0 ) ..................................
1,500 24
0
25 Total a s s e t s .........................................................................................
26,280 25
18,0 21
26 Total liabilities (describe in Schedule 0 ) ...........................
2,263 26
0
27 Net assets or fund balances (line 27 of column (B) must agree with line 21 )
24,017 27
18,0 21
Part III Statement of Program Service Accomplishments
Check if the organization used Schedule 0 to respond to any question in this Part III
F
What is the organization's primary exempt purpose? PROVIDING INFORMATION ON ASBESTOS-HEALTH RELATIONSHIP AND INDUSTRY EFFORTS TO ELIM INATE PO TE N TIAL PROBLEMS A SSO CIATED WITH ASBESTOS DUST
Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title
Expenses (Required for section 501 (c)(3) and 501(c)(4) organizations and section 4 9 4 7 (a )(l) trusts, optional for others )
28 RE P O R T E D ON G O V E R N M E N T A C T I V I T I E S R E L A T IN G TO TH E A S B E S T O S IN D U S T R Y A P P E A R E D
BEFORE G O V ERN M EN TA L AGENCIES AND PROVIDED WRITTEN C OM M EN TS ON THE RULEMAKING
PROCESS FOR STANDARDS AFFECTING THE INDUSTRY PRODUCED EMPLOYEE PAMPHLETS
(Grants $ 0 )
If this amount includes foreign grants, check here
r
28a
70,824
29
(Grants 30
If this amount includes foreign grants, check here
r
29a
(Grants $ )
If this amount includes foreign grants, check here
r
30a
31 Other program services (describe in Schedule 0 ) ................................................
(Grants $ )
If this amount includes foreign grants, check here
*r
31a
32 Total program service expenses (add lines 28a through 3 1 a ) ...........................
32 70,824
Part IV List of Officers, Directors, Trustees, and Key Employees. List each one even if not compensated (See the instructions for Part IV )
C heck if the organization used Schedule 0 to respond to any q^u^esti1o..n...i.n"thi-s P~art IV
.1
(a) Name and address
(b) Title and average hours per week
devoted to position
(c) Compensation (If not paid, enter -0-.)
(d) Contributions to employee benefit plans 8i
deferred compensation
(e) Expense account and other allowances
BOB J PIGG PO BOX ARLINGTON,VA
22202
P R E S ID E N T 8i T R E A S U R E R 40 00
54,000
00
G BERNARD COULOMBE PO BOX ARLINGTON,VA 22202
D I R E C T O R 1 00
0 00
JEAN-MARC LEBLOND PO BOX ARLINGTON,VA 22202
C H A I R M A N 8i SEC R E T AR Y 1 00
0 00
Form 990-EZ (2011)
Form 990-EZ (2011)
Part V Other Information (Note the statement requirements in the instructions for Part V.)
Check if the organization used Schedule 0 to respond to any question in this Part V . . .
.
33 Did the organization engage in any significant activity not previously reported to the I R S ' If "Yes," provide a detailed description of each activity in Schedule 0 .........................................................................
33
34 Were any significant changes made to the organizing or governing documents'? If "Yes," attach a conformed copy of the amended documents if they reflect a change to the organization's name Otherwise, explain the change on Schedule 0 (see i n s t r u c t i o n s ) .....................................................................................................
34
35 If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 99 0-T, explain in Schedule 0 why the organization did not report the income on Form 9 9 0 - T .................................................................................................................................
Page 3
Yes
No
No No
a Did the organization have unrelated business gross income of $1 ,000 or more during the year from business activities (such as those reported on lines 2, 6a, and 7a, among others)?
35a
b I f 'Y e s 't o line 35a, has the organization filed a Form 990-T for the year? If'No,'provide an explanation in Schedule 0 .......................................
35b
c Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e) notice, reporting, and proxy tax requirements during the year? If'Y e s,'c om ple te Schedule C, Part III
35c
36 Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If "Yes," complete applicable parts of Schedule N ...................................................................
37a Enter amount of political expenditures, direct or indirect, as described in the instructions
| 37a |____________________0
36
No
No No
b Did the organization file Form 1120-POL for this y e a r ? ..............................................................................
37b
38a Did the organization borrow from, orm ake any loans to, any officer, director, trustee, or key employee or were
any such loans made in a prioryearand still outstanding at the end of the tax yearcovered by this return?
38a
No
If "Yes," complete Schedule L, Part II and enter the total amount involved
38b
39 Section 501(c)(7) organizations. Enter
a Initiation fees and capital contributions included on line 9 ............................
39a
b Gross receipts, included on line 9, for public use of club facilities . . . .
39b
40a Section 501(c)(3) organizations. E nter amount of tax imposed on the organization during the year under
section 4911 __________________ 0_ , section 4912 __________________ 0 , section 4955 ________________
0
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 49 58 excess benefit transaction during the y e a ro rd id it engage in an excess benefit transaction in a prioryear that has not been reported on any of its prior Forms 99 0 or 9 90 -E Z? If "Yes," complete Schedule L, Part I . . . .
40b
No
Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 491 2, 49 55, and 4958 . . __________________
Section 501(c)(3) and 501(c)(4) organizations Enter amount of tax on line 40 c reimbursed by the o r g a n i z a t i o n ..................................................................................................... _______________
All organizations. A t any time during the tax year, was the organization a party to a prohibited tax shelter transaction? If "Yes," complete Form 8 8 8 6 - T ....................................................................................
40e
No
41 List the states with which a copy of this return is filed ___________________
42a The organization's books are in care of PHILLIPS & ASSOCIATES LLC 15825 SHADY GROVE ROAD SUITE 40
Located at I ROCKVILLE, MD__________________
.Telephone no (3 01) 5 1 9 -3 2 8 0 Z I P + 4 20850________
b A t 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)?
If "Yes," enter the name of the foreign country _____________________________________________________
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c A t any time during the calendar year, did the organization maintain an office outside ofthe U S ?
42b
Yes
No No
42c No
If "Y es," enter the name ofthe foreign country _____________________________________________________
43 Section 4 9 4 7 (a)(1) nonexempt charitable trusts filing Form 9 9 0 -E Z in lieu of Form 1041--Check here and enter the amount of tax-exempt interest received or accrued during the tax year . . . I 43 I
r
44a Did the organization maintain any donor advised funds? I f "Yes", Form 990 m ust be completed instead of Form 990-EZ.
b Did the organization operate one or more hospital facilities during the year? I f 'Yes,'Form 990 m ust be completed instead of Form990-EZ
c Did the organization receive any payments for indoor tanning services during the year?
d If 'Yes' to line 44c, has the organization filed a Form 7 20 to report these payments? I f 'No,'provide an explanation in Schedule O
45a Did the organization have a controlled entity within the meaning of section 5 1 2 (b)(l 3)?
45b 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'Ye s,'Form 990 and Schedule R may need to be completed instead of Form990-EZ (see instructions)
Form 990-EZ (2011)
Form 990-EZ (2011)
Yes
Page 4 No
46 Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I
46
No
Part VI | Section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only.
All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b and 52.
Check if the organization used Schedule 0 to respond to any question in this Part V I ................................................ I
Yes
No
47 Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year?
If "Yes," complete Schedule C, Part II
47
48 Is the organization a school described in section 170 (b)(l )(A )(ii)? I f "Yes," complete Schedule E
48
49a Did the organization make any transfers to an exempt non-charitable related organization?
49a
b If "Yes," was the related organization a section 527 organization?
49b
No No No
50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $1 00,000 of compensation from the organization If there is none, enter "None "
(a) Name and address of each employee paid more than $100,000
(b) T itie and average hours per week
devoted to position
(c) Compensation
(d) Contributions to employee benefit plans &
deferred compensation
(e )Expense account and other allowances
NONE
f Total number of other employees paid over $ 100,000 .................................................................................. .
51 Complete this table for the organization's five highest compensated independent contractors who each received more than $100,0 00 of compensation from the organization If there is none, enter "None "
(a) Name and address of each independent contractor paid more than $1 00,000
(b) Type of service
(c) Compensation
NONE
d Total number of other independent contractors each receiving over $ 100,000 ......................................... _________________
52 Did the organization complete Schedule A? NOTE: All Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts
must attach a completed Schedule A ..........................................................................................................
F" Yes | No
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
f Signature of officer
L MR BOB] PIGG PRESIDENT &TREASURER
W Type or print name and title
Paid
Preparer's L
signature V ANDREW PHILLIPS CPA
Preparer's Finn's name (or yours L PHILLIPS & ASSOCIATES LLC
Use Only
if self-employed),
P
address, and ZIP +4 * 15825 SHADY GROVE ROAD SUITE 40
Date 2012-08-20
ROCKVILLE, MD 20850 May the IRS discuss this return with the preparer shown above? See instructions
2012-08-20 Date
Check if self-
employed |
Preparer's taxpayer identification number (See instructions) P00839833
EIN 52-2009588
Phone no (301) 519-3280
P"Yes I No
Form 990-EZ (2011)
le file GRAPHIC print - DO NOT PROCESS | As Filed Data - |
DLN: 934922480031*621
SCHEDULE A
(Form990or990EZ)
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
0 M B No 1545-004 7
2011
Department of the Treasury Internal Revenue Service
4947(a)(1) nonexempt charitable trust. Attach to Form 990 or Form 990-EZ. See separate instructions.
Open to Public Inspection
Name ofthe organization
Employer identification number
ASBESTOS INFORMATION ASSOCIATIONNA
_______________________________________________________________________________ 1 3 -2 7 0 2 8 2 6_______
Part I Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is (For lines 1 through 11, check only one box )
1 r A church, convention of churches, or association of churches section 170(b)(l)(A)(i).
32 rr
A school described in section 170(b)(l)(A)(ii). (Attach Schedule E ) A hospital or a cooperative hospital service organization described in section 170(b)(l)(A)(iii).
4 r A medical research organization operated in conjunction with a hospital described in section 170(b)(l)(A)(iii). Enter the
hospital's name, city, and state
sr 7e rr sr
9F
10 r 11 r
er f
g
h
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(l)(A)(iv). (Complete Part II )
A federal, state, or local government or governmental unit described in section 170(b)(l)(A)(v).
An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(l)(A)(vi) (Complete Part II )
A community trust described in section 170(b)(l)(A)(vi) (Complete Part II )
An organization that normally receives (1) more than 33 1/3% of its support from contributions, membership fees, and gross
receipts from activities related to its exempt functions--subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975 See section 509(a)(2). (Complete Part III )
An organization organized and operated exclusively to test for public safety Seesection 509(a)(4).
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of
one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section 509(a)(3). Check
the box that describes the type of supporting organization and complete lines l i e through l l h
a I- Type I
b \~ Type II
c | Type III - Functionally integrated
d | Type III - Other
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons
other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or
section 509(a)(2)
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization,
check this box
r
Since August 17, 20 06, has the organization accepted any gift or contribution from any ofthe
following persons'?
__________
(i) a person who directly or indirectly controls, either alone or together with persons described in (n)
Yes No
and (m) below, the governing body ofthe the supported organization?
(ii) a family member of a person described in (i) above? (iii) a 35% controlled entity of a person described in (i) or (n) above?
Hg(i) iig(ii) iig(iii)
Provide the following information about the supported orgamzation(s)
(i) Name of supported
organization
(iii)
(iv)
Type of
Is the
organization
organization in
()
(described on
col (i) listed in
EIN
lines 1 - 9 above
your governing
or IRC section
document?
(see
instructions))
Yes
No
(v) Did you notify the
organization in col (i) of your
support?
Yes
No
(Vi) Is the organization in col (i) organized in the U S ?
Yes
No
(vii) A mount of support?
Total
F o r P a p e rw o rk R eduction A c tN o tc e , see the In s tru c tio n s fo r F o rm 990
Cat No 1 1 2 8 5 F
S ch e du le A (Form 990 o r 990-EZ) 2011
Schedule A (Form 990 or 9 9 0 - E Z ) 2 0 1 1
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(l)(A)(iv) and 170(b)(l)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify
under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
1 Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants ")
2 Tax revenues levied for the organization's benefit and either paid to orexpended on its behalf
3 The value of services or facilities furnished by a governmental unit to the organization without charge
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2 0 1 1
(f) Total
4 Total. Add lines 1 through 3
5 The portion of total contributions by each person (otherthan a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column
(f) 6 Public Support. Subtract line 5 from
line 4
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2 0 1 1
(f) Total
7 A mounts from line 4
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources
9 Net income from unrelated business activities, whether or not the business is regularly carried on
10 Otherincom e (Explain in Part IV ) Do not include gam or loss from the sale of capital assets
1 1 Total support (Add lines 7 through 10)
12 Gross receipts from related activities, etc (See instructions )
12
13 First Five Years If the Form 99 0 is for the organization's first, second, third, fourth, or fifth tax year as a 501 (c)(3) organization,
check this box and stop here
!
Section C. Computation of Public Support Percentage_________________________ ^__
14 Public Support Percentage f o r2 0 1 1 (line 6 column (f) divided by line 11 column (f))
14
15 Public Support Percentage for 20 10 Schedule A, Part II, line 14
15
16a b
17a
b
18
33 l/3%support test--2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
r
33 l/3%support test--2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
r
10%-facts-and-circumstances test--2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV howthe organization meets the "facts and circumstances" test The organization qualifies as a publicly supported
organization
r
10%-facts-and-circumstances test--2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV howthe organization meets the "facts and circumstances" test The organization qualifies as a publicly
supported organization
r
Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
r
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 9 9 0 - E Z ) 2 0 1 1
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)_____
Section A. Public Support
Calendaryear (or fiscal year beginning in)
1 Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants ")
2 Gross receipts from admissions, merchandise sold orservices performed, or facilities furnished in
( a ) 2007
(b) 2008
(c) 2009
( d ) 2010
( e ) 2011
(f) Total
82,004
70,875
75,693
65,618
65,441
359,631
any activity that is related to the organization's tax-exempt
purpose 3 Gross receipts from activities that
are not an unrelated trade or business under section 513 4 Tax revenues levied for the organization's benefit and either paid to orexpended on its behalf
5 The value ofservices or facilities furnished by a governmental unit to the organization without charge
6 Total. Add lines 1 through 5
82,004
70,875
75,693
65,618
65,441
359,631
7a Amounts included on lines 1, 2, and 3 received from disqualified persons
b Amounts included on lines 2 and 3 received from otherthan disqualified persons that exceed the greater of $ 5,000 or 1% of the amount on line 13 for the year
c Add lines 7a and 7b
0 0 0
8 Public Support (Subtract line 7c from line 6 )
Section B. Total Support
359,631
Calendar year (or fiscal year beginning in)
9 A mounts from line 6
(a) 2007 82,004
(b) 2008 70,875
(c) 2009 75,693
(d) 2010 65,618
(e) 2011 65,441
(f) Total 359,631
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 3 0 ,1 975
c Add lines 10a and 10b
480 122 15 10 10 637 480 122 15 10 10 637
11 Net income from unrelated
business activities not included
in line 10b, whether or not the
business is regularly carried on
12 Otherincom e Do not include
gam or loss from the sale of capital assets (Explain in Part
2,267
2,267
IV )
13 Total support (Add lines 9, 10c, 11 and 12 )
82,484
73,264
75,708
65,628
65,451
362,535
14 First Five Years If the Form 99 0 is for the organization's first, second, third, fourth, or fifth tax year as a 501 (c)(3) organization,
check this box and stop here
!
Section C. Computation of Public Support Percentage
15 Public Support Percentage f o r2 0 1 1 (line 8 column (f) divided by line 13 column (f))
16 Public support percentage from 2010 Schedule A, Part III, line 15
15 99 200 % 16 9 9 120 %
Section D. Computation of Investment Income Percentage
17 Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
17 0 1 8 0 %
18 Investment income percentage from 2010 Schedule A, Part III, line 17
18 0 300 %
19a 33 l/3%support tests--2011. If the organization did not check the box on line 14, and line 15 is more tha i 33 1/3% and line 17 is not
more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organ zatior
p"
b 33 1/3% support tests--2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line
18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly suppor ted orgamzation
!
20 Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see nstru :tions
H
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 9 9 0 - E Z ) 2 0 1 1
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).__________________________________________________
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
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SCHEDULE O
(Form990or990-EZ)
Supplemental Information to Form 990 or 990-EZ
Department of the Treasury Internal Revenue Service
Complete to provide information for responses to specific questions on Form 990 or to provide any additional information. Attach to Form 990 or 990-EZ.
DLN: 934922480031*621 0 M B No 1545-004 7
2011
Open to Public Inspection
Name ofthe organization ASBESTOS INFORMATION ASSOCIATIONNA
Employer identification number 13-2702826
Identifier
Return Reference
Explanation
OTHER INVESTMENT INCOME
FORM 990-EZ, PARTI, LINE4
INTEREST INCOME 10
OTHER EXPENSES
FORM 990-EZ, PARTI, LINE 16
DESCRIPTION OFFICE EXPENSES AM OUNT 4,062 DESCRIPTION TAXES & LICENCES AM OUNT 639 DESCRIPTION T R A V E L AM O U N T 1,851 DESCRIPTION MEETINGS AM O U N T 1,600 DESCRIPTION P A Y R O LL SERVICES AM O U N T 1,160 DESCRIPTION B A N K CHARG ES AM O U N T 4 8 0 DESCRIPTION DUES AM OUNT 75 DESCRIPTION LEG AL AM OUNT 1,887 DESCRIPTION B A D DEBT EXPENSE AMOUNT 1,500 T O TA L TO FORM 990-EZ, LINE 16 13,254
OTHER ASSETS FORM 990-EZ, DESCRIPTION ACCOUNTS RECEIVABLE BEG OF Y E A R AM OUNT 1,500 END OF Y E A R AM OUNT 0 PART II, LINE 24
OTHER LIABILITIES
FORM 990-EZ, DESCRIPTION P AY R O LL TAXES BEG OF Y E A R AM OUNT 2,263 END OF Y E A R AM OUNT 0 PART II, LINE 26
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TY 2011 Transfers Personal Benefits Contracts Declaration
DLN: 934922480031*621
Name: ASBESTOS INFORMATION ASSOCIATIONNA
EIN: 13-2702826
Declaration: 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.
Additional Data
Software ID: Software Version:
EIN: Name:
13-2702826 ASBESTOS INFORMATION ASSOCIATIONNA
Form 990-EZ, Special Condition Description: Special Condition Description