Professional Documents
Culture Documents
Return of Organization Exempt From Income Tax: IX) IX)
Return of Organization Exempt From Income Tax: IX) IX)
Return of Organization Exempt From Income Tax: IX) IX)
990
Department
oftheTreasury
1ntema1
Revenue
serv,ce
andending
B Ch~klf
D EmployerIdentificationnumber
%:
2004
D~~~e
OMB No 1545-0047
BASED
52-1759134
IRoom/suiteETelephonenumber
Numberandstreet(or P.O.box1fma1l1snotdelivered
to streetaddress)
D~\t"::, Specific
111 FORBES STREET
lnstruc~r~~
tlons
Cityor town,stateor country,andZIP+ 4
D
D~ru~d~.__-~AN;;;;..;.;;:N~A;;.;;;;;;P~O~L~I~S~,___;M;;.;;;;;;D
__ 2;;;;..;;;1~4~0;;....;;;1
__________
D~g~Jl;,"J10n Section501(c)(3)organizationsand4947(a)(1)nonexemptcharitabletrusts
1200
(410)268-3302
D
Cashrv1
LX.JAccrual
........
D==<.~~~tDh,~=e~=-::M
....
'--------F AccounUng
method
,--_____
_WWW
__ ._AN_N_A_P~O=L=I~S_C_E_N_T_E_R_._O_R_G
__ =~---~~----l
=G_W=eb=s=lte=:.:...
....
J Organization
type (checiconlyone)
.... IX] 501(c)( 3
).....(insert
no>D 4947(a)(1)or
.......
D
M Check....
if the organization
1snot requiredto attach
Sch.8 (Form990,990-EZ,or 990-PF).
665 , 6 79
L Grossrece1ots
Addlines6b,Bb,9b,and1Obto line12 ....
GI
:::,
&.t",
c:=
c:=
2
3
4
5
6a
b
c
7
8a
a:
b
c
d
C',J
C\2
C\2
UJ
Cl
z
z
<(
0
(fl
Ill
GI
Ill
GI
a.
IC
w
b
c
10 a
b
c
11
12
13
14
15
16
17
18
19
20
21
iii
z:a
Contributions,
gifts,grants,andsimilaramountsreceived:
594,000.
Directpublicsupport
1a
1b
Indirectpublicsupport
contributions
(grants)
Government
1c
1d
Total(addlines1athrough1c) (cash$
5 9 4, 0 0 0 noncash$ -------)
2
Programservicerevenue
includinggovernment
feesandcontracts(fromPartVII,line93)
3
Membership
duesandassessments
4
Intereston savingsandtemporarycashinvestments
5
D1v1dends
andinterestfrom securities
17,691.
...
..
SEE
STATEMENT
1
6a
Grossrents
6b
Less:rentalexpenses
..
6c
Netrentalincomeor (loss)(subtractline6b from line6a)
\
7
Otherinvestment
income(describe....
(BlOther
(A) Securities
Grossamountfrom salesof assetsother
thaninventory
..
8a
Less:costor otherbasisandsalesexpenses
8b
Gainor (loss)(attachschedule)
. .
8c
8d
.. ..
.
. .
Netgainor (loss)(combinelineBe,columns(A)and(8))
Specialeventsandactivities(attachschedule)If anyamountis from gaming,checkhere ....
Grossrevenue(notincluding$
0 of contributions
9a
45 , 894
reportedon line1a)
..
Less directexpenses
otherthanfundraisingexpenses
... .
9b
4 0 , 18 8
9c
Netincomeor (loss)fromspecialevents(subtractline9bfrom line9a)
.....
STAT.~MENT . 2
Grosssalesof inventory,lessreturnsandallowances
..
i...;1:..;o=-a-1---------1
._1'-"0-=-b~--------1
Lesscostof goodssold . . .
..... . ...
..
10c
Grossprofitor (loss)from salesof inventory(attachschedule)(subtractline10bfrom line10a)
11
Otherrevenue(fromPartVII,lme103) .. .
12
Total revenue(addlines1d 2 3 4 5 6c 7 Bd 9c 10c and11\
13
Programservices(fromline44,column(8)) .
~-- w r
.
14
Management
andgeneral(fromlme44,column(C))
15
Fundra1smg
(fromline44,column(D))
16
Payments
to affiliates(attachschedule)
... .... ..
17
Total expenses(addImes16and44 columnlA\\
Excessor (def1c1t)
for theyear(subtractline17from line12)
18
Netassetsor fundbalances
at beginningof year(fromlme73,col~~1 (A))
19
Otherchangesin netassetsor fund balances
(attachexplanation)
.... '
.
20
Netassetsor fundbalances
at endof year(combinelines18,19,and20)
21
LHA ForPrivacyActandPaperworkReductionAct Notice,seethe sepate Instructions.
6,125.
14.
17,691.
pl~~.
1
QGOEN-.UT
g~~fj.15
15561121
594,000.
134341
11022
2004.07000
THE ANNAPOLIS
5,706.
1, 955.
625,491.
528,290.
46,325.
77,946.
652,561.
-27,070.
-83,642.
-110,712.
o.
Form990(200~
17
52-1759134
II Stateiy1ent of
I""'Part
"'-"'--"--"'--'~
Functional Expenses
All organizations
mustcompletecolumn(A).Columns(B),(C),and(D)arerequiredfor section501(c)(3)
Page2
and(4) organizations
andsection4947(a)(1)nonexempt
charitable
trustsbut optionalfor others.
, Do not include amounts reported on line
(8) Program
(C) Management
(A)Total
(D) Fundra1sing
6b Bb 9b 10b or 16 of Part/.
services
andoeneral
22 Grantsandallocations(attachschedule)
(cash$
noncash
$
22
23 Specificassistance
to individuals(attachschedule) 23
24 Benefitspaidto or for members(attachschedule) 24
166,635.
149,971.
8,332.
of officers,directors,etc
8,332.
25 Compensation
25
203,604.
145,186.
8,066.
50,352.
26 Othersalariesandwages
26
27 Pensionplancontributions
27
42,829.
38,547.
2,141.
2,141.
28 Otheremployeebenefits
28
23,972.
21,575.
1,199.
1,198.
29 Payrolltaxes
29
fundraisingfees
30 Professional
30
5,387.
5,387.
31
31 Accountingfees
..
32 Legalfees
32
......
33 Supplies
33
.......
16,901.
15,211.
845.
845.
34
34 Telephone
. ....
...
6,328.
5,696.
316.
316.
35 Postageandshipping .. .. . .. ..
35
. .
40,978.
36,880.
2,049.
2,049.
36 Occupancy
...
.. 36
19,117.
17,205.
956.
956.
37 Equipmentrentalandmaintenance
37
38
38 Printingandpubl1cat1ons
54,696.
43,757.
10,939.
39 Travel
39
40 Conferences,
conventions,
andmeetings
40
41
41 Interest
. .
.... ....
...
5,179.
5,179.
42 Deprec1at1on,
depletion,etc.(attachschedule)
42
43 Otherexpenses
notcoveredabove(itemize)
43a
a
43b
b
43c
c
43d
d
66,935.
54,262.
11,855.
818.
43e
e SEE STATEMENT 3
~tal luncl1onal
expenses
(addhnes
22through
43)
652,561.
46,325.
528,290.
77,946.
44 -;1zanons
completing
colurms
(B)-(D).
carry
lhesetolals
toImes13-1544
Joint Costs.Check~
1fyouarefollowingSOP98-2
~
Yes [X] No
Areanyjointcostsfrom a combinededucational
campaignandfundraisingsolicitationreportedin (8) Programservices?
amountof theseJointcosts$
; (ii) the amountallocated
to Programservices$______
_
If 'Yes,'enter(I) theaggregate
the amountallocated
to Manaoement
andoeneral$
andfivl theamountallocated
to Fundraisino
$
rnn
I P~
SEE STATEMENT 4
Pro~m Service
penses
Allorgamzabons
mustdescnbe
theirexempt
purpose
achievements
Inacleerandconcise
manner.
State
thenumber
ofclients
served,
publications
Issued,
etc.Discuss (Required
for501(c)(3)
and
achievements
thatarenotmeasurable
(Section
501(c)(3)
and(4)organizations
and4947(a)(1)
nonexempt
charltable
trustsmustalsoenter
theamount
ofgrants
and
(4)ergs, and4947(a)(1)
allocations
to others
)
forothers
)
trusts,butoptional
a DEVELOPMENT& COMMUNICATIONOF STANDARDS
TO EVALUATE PRODUCT & EVIRONMENTALSTUDIES &
<Grants
andallocations
S
(Grantsandallocations
$
(Grantsandallocations$
528,290.
(Grantsandallocations
$
e Otheroroaramservices(attachschedule)
f Totalof ProgramServiceExpenses(shouldequalline44,column(B),Programservices)
423011
01-13-05
528,290.
Form990(2004)
15561121
134341
11022
2004.07000
Form990(2004)
52-1759134
Page3
(A)
Beginning
of year
45
46
Cash- non-interest-bearing
Savingsandtemporary
cashinvestments
CII
47a
47b
Pledgesreceivable
..
Lessallowance
for doubtfulaccounts
Grantsreceivable
Receivables
fromofficers,directors,trustees,
andkeyemployees
51 a Othernotesandloansreceivable
for doubtfulaccounts
b Lessallowance
for saleor use
52 Inventories
. ...
. ....
anddeferredcharges. .. . ..
53 Prepaidexpenses
54 Investments
- securities .. .... ..... ..
....
- land,buildings,
and
55 a Investments
equipment:
basis .......... .. ...
....
48a
48b
b
56
57 a
b
58
CII
.!!
=
:s
.!!
.J
CII
a>
Ill
ia
m
't,
c::::,
u..
~
CII
1i
CII
:l...
"
. .
47 a Accountsreceivable
for doubtfulaccounts
b Lessallowance
48 a
b
49
50
1i
Lessaccumulated
depreciation
Investments
- other
Land,bu1ldmgs,
andequipmentbasis
Less:accumulated
deprec1at1on STMT
Otherassets(describe~
12,199.
...
..
(B)
Endof year
971.
47c
2,043.
48c
49
..
50
51b
.................
..
..
~ D Cost DFMV
51c
52
53
54
5,013.
2,500.
55a
55c
56
55b
1, 832.
2,043.
I 51a1
....
45
46
I 57a i
57b
.....
50,572.
40,396.
11,618.
57c
58
10,176.
29,801.
61,627.
59
60
61
62
63
64a
64b
65
16,551.
104,610.
66
127,263.
59 Totalassetsladdlines45throuah58\ lmusteaualline74\
andaccruedexpenses
60 Accountspayable
..
61 Grantspayable
.....
revenue
62 Deferred
.. . ...
..........
63 Loansfromofficers,directors,trustees,andkeyemployees. ....
..........
bondl1ab1llt1es
64 a Tax-exempt
b Mortgages
andothernotespayable
. "
65 Otherliabilities(describe~
66 Totalllabllltles{addImes60throuoh65\
Organizations
thatfollowSFAS117,checkhere ~ D andcompletelines67 through
69 andlines73and74
67 Unrestricted
...... ..... . "
........ .....
restricted
68 Temporarily
.. ... ..
. ....
restricted..
69 Permanently
"
.
Organizations
that do notfollowSFAS117,checkhere~ [XJ andcompletelines
70 through74.
or currentfunds
70 Capitalstock,trust pnnc1pal,
. .
.....
Paid-inor capitalsurplus,or land,building,andequipment
fund
71
earnings,
endowment,
accumulated
income,or otherfunds....
72 Retained
73 Totalnet assetsor fundbalances(addlines67through69 or lines70 through72;
column(A)mustequalline19;column(B)mustequallme21)
74 Totalliabilitiesandnetassets/fundbalances(addImes66 and73)
35,000.
16,816.
113,443.
22,653.
67
68
69
o.
o.
-83,642.
o.
o.
70
71
72
-110,712.
-83,642.
29,801.
-110,712.
73
16,551.
74
Form990is available
for publicmspect1on
and,for somepeople,servesasthe primaryor solesourceof information
abouta particularorganization
Howthepublic
perceives
an organization
msuchcasesmaybedetermined
bythemformat1on
presented
onIts return.Therefore,
pleasemakesurethe returnis complete
andaccurate
andfullydescribes,
in PartIll, theorganization's
programsandaccomplishments
423021
01-13-05
15561121
134341
11022
2004.07000
3
THE ANNAPOLIS CENTER FOR SC 11022
Form990 (2004)
'
Totalrevenue,
gains,andothersupport
perauditedfinancialstatements
....a
665,679.
....b
....c
40,188.
625,491.
Totalexpenses
andlossesper
auditedfinancialstatements ...
b Amountsincludedon line a butnoton
line17,Form990
(1) Donated
services
anduseof facilities $
(2) Prioryearadjustments
reportedon line20,
$
Form990 ..
(3) Lossesreportedon
line20, Form990
$
(4) Other(specify):
STMT 7
40,188.
$
Addamountson lines(1) through(4)
c Linea mmusline b
. ...
..
d Amountsincludedon line17,Form
990 butnoton line a:
a
(1) Investment
expenses
(1) Investment
expenses
notincludedon
lme6b,Form990
(2) Other(specify):
notincludedon
lme6b,Form990
(2) Other(specify):
....a
692,749.
....b
40,188.
652,561.
....c
$
Addamountson lines(1) and(2)
d
.......
perline17, Form990
e Totalexpenses
625,491.
(lmec pluslined)
652,561.
e
e
List of Officers, Directors, Trustees, and Key Employees (Listeachoneevenif notcompensated.)
('?In
Contnbubons to
(E)Expense
hours IC)
(B)Titleandaverage
Compensation
plo~ee benefit
accountand
perweekdevotedto
(A)Nameandaddress
If not
enter plans & deferred other
allowances
oosition
comoensatlon
$
Addamountson Imes(1) and(2)
Totalrevenue
perlme12, Form990
(lmec pluslined)
I PartVl
Page4
o.
....d
o.
....
....
....
~8!1
H. RICHARD SEIBERT
ANNAPOLIS, _MD_ 21401 _______________
HAROLD M. KOENIG
SAN DIEGO, _CA_ 92116 _______________
EXECUTIVE VP
40HRS/WK
PRESIDENT
20HRS/WK
137.475.
o.
o.
29,160.
o.
o.
o.
o.
-----------------------------------------------------------------
o.
423031 01-13-05
15561121
134341
11022
2004.07000
4
THE ANNAPOLIS CENTER FOR SC 11022
Form990(2004)
52-1759134
Page5
Yes No
76 '
77
Didtheorganization
engagein anyactivitynotpreviouslyreportedto theIRS?If "Yes,"attacha detaileddescription
of eachactlVlty
or governingdocuments
butnot reportedto the IRS?
Wereanychangesmademtheorganizing
If "Yes,'attacha conformed
copyof thechanges.
78 a Didtheorganization
haveunrelated
businessgrossincomeof $1,000or moreduringtheyearcoveredbythis return?
N/A
b If 'Yes,'hasit fileda tax returnon Form990-Tfor thisyear? ........ . . .
. ..
..
79 Wastherea liquidation,
dissolution,
termination,
or substantial
contraction
dunngtheyear?
..
..
If 'Yes,'attacha statement
80 a Is theorganization
related(otherthanbyassociation
witha statewide
or nationwide
organization)
throughcommonmembership,
governingbodies,trustees,officers,etc.,to anyotherexemptor nonexempt
organization?
x
x
76
77
78a
78b
79
x
x
80a
85
...
N/.~
NI A
x
x
x
_
1-8~5=a-+--+-t-8""5""b..i--+....-
b Didtheorganization
makeonlyin-houselobbyingexpenditures
of $2,000or less?
..
lf "Yes'wasanswered
to either85aor 85b,do notcomplete85cthrough85hbelowunlesstheorganization
received
a waiverfor proxytax
owedfor theprioryear.
c Dues,assessments,
ands1m1lar
amountsfrommembers . .... ...
.. 85c
NI A
d Section162(e)lobbyingandpoliticalexpenditures
. ... . ........
85d
NI A
e Aggregatenondeductible
amountof section6033(e)(1
)(A)duesnotices . ....
85e
NI A
f Taxableamountof lobbyingandpol1t1cal
expenditures
(lme85dless85e) ... ....
. ..
851
NI A
g Doestheorganization
electto paythesection6033(e)taxontheamounton line85f? . ...
...
..... .. . ~ l.:A
1-8~5-io-+---+---h If section6033(e)(1)(A)
duesnoticesweresent,doestheorganization
agreeto addtheamounton line85fto its reasonable
estimateof dues
N/ A
1-8~5~h-+---+-~allocable
to nondeductible
lobbyingandpoliticalexpenditures
for thefollowingtaxyear?
..
..
86 501(c)(7) organizations. Entera Initiationfeesandcapitalcontributions
includedon lme12
86a
NI A
b Grossreceipts,includedon lme12,for publicuseof clubfacilities.
86b
NI A
87 501 (c)(12)organizations. Enter.a Grossincomefrommembersor shareholders
. . 87a
NI A
b Grossincomefromothersources(Donotnetamountsdueor paidto othersources
'---"-87""b'-'____
N.....;../_A
__ _
againstamountsdueor received
fromthem.)
.. . .
. .. .
owna 50%or greaterinterestin a taxablecorporation
or partnership,
88 At anytimeduringtheyear,didtheorganization
or anentitydisregarded
asseparate
fromtheorganization
underRegulations
sections301.77012
and301.7701-3?
x
88
If "Yes,'completePartIX
. ........
.. .. ..
.. ......
........
89 a 501 (c)(3)organizations. Enter:Amountof taximposedontheorganization
duringtheyearunder:
section4911~
0 ; section4912~
0 ; section4955 ~
b 501 (c)(3)and 501(c)(4)organizations.Didthe organization
engagein anysection4958excessbenefit
transaction
duringtheyearor did 1tbecomeawareof anexcessbenefittransaction
froma pnoryear?
x
89b
explaining
eachtransaction
. .. .. .
...... .
If "Yes,'attacha statement
c Enter:Amountof taximposedontheorganization
managers
or disqualified
personsduringtheyearunder
sections4912,4955,and4958
~
0
d EnterAmountof taxon lme89c,above,reimbursed
bytheorganization
~
0
90 a Listthestateswithwhicha copyof this return1sfiled ~ _MAR
__ Y_L_AN
__ D_____________
~----------b Numberof employees
employed
in thepaypenodthatincludesMarch12,2004
90b
9
91 Thebooksaremcareof ~H. RICHARD SEIBERT
Telephoneno.~ 410-268-3302
o.
---------
I I
Locatedat ~
92
ZIP+4 ~
21401
-------
interestreceived
or accruedduringthetaxyear
andentertheamountof tax-exempt
423041
01-13-05
92
Form990(2004)
15561121
134341
11022
2004.07000
Form990 (2004)
! PartVH I
52 - 1759134
Page6
Excluded
bysection
512, 513, or514
(C)
(D)
ExcluAmount
slon
Unrelated
businessincome
(A)
(B)
Business
Amount
code
93 Programservicerevenue.
code
(E)
Related
or exempt
functionincome
a
b
c
d
e
f Med1care/Med1caid
payments....
g Feesandcontractsfromgovernment
agencies
94 Membership
duesandassessments......
95 Interestonsavingsandtemporarycashinvestments..
andinterestfromsecurities
96 Dividends
97 Netrentalincomeor (loss)fromrealestate.
a debt-financed
property
b notdebt-financed
property .. ........
98 Netrentalincomeor (loss)frompersonalproperty ....
income
99 Otherinvestment
......
...
100 Gainor (loss)fromsalesof assets
otherthaninventory
..
101 Netincomeor (loss)fromspecialevents
102 Grossprofitor (loss)fromsalesof inventory
103 Otherrevenue:
6,125.
14.
17,691.
5,706.
a MISCELLANEOUSINCOME
1, 955.
c
d
e
104 Subtotal(addcolumns(B),(D),and(E)) ..
105 Total(addline104,columns(B),(D),and(E))
Not e: L"
l fme 1d Part/ , S h OUId eau a/th e amoun on fme 12 Part/
me 105 pus
'
! PartVIIII
LineNo.
~
'
o.
o.
....____
31,491.
3_1..._,_4_9_1_
importantly
to theaccomplishment
of theorganization's
Explainhoweachactivityfor whichincomeis reportedin column(E)of PartVII contributed
exemptpurposes(otherthanby providingfundsfor suchpurposes).
SEE STATEMENT8
I Part IX I Information Regarding Taxable Subsidiaries and Disregarded Entities (Seepage34 of theinstructions.)
(A}
(B)
(D)
(~) ..
(~-year
Name,address,andEINof corporation,
Percenta11e
of
End-o
Natureo act1v1ties
Totalincome
oartnershio.
or disreaarded
ent1tv
interest
ownershio
assets
N/A
%
%
!PartX
(Seepage34 of theinstructions.)
[Kl No
Dves
[Kl No
Dves
(a) Didtheorganization,
duringtheyear,receiveanyfunds,directlyor indirectly,
to paypremiumsona personalbenefitcontract?
(b) Didtheorganization,
duringtheyear,paypremiums,
directlyor indirectly,ona personalbenefitcontract?
Note:If "Yes" to b , ftle Form 8870 and Form 4720 see instructions.
1
1:'m~iri::i'l:i'tcla~"f.~"nreof't~~~:~(g:<~;~~':I,
~'Ji\'C:J~:."1,:';'l'1:~ga~~=r,i:,ngi5~~~hu~~;~,!!rs~:::'.:";l:'.;o~~~!he
bestofmy knowledge
andbelief,
1t1strue,
Please ~~:~~
Sign
Signature
of officer
=ry_p_e_o_r
p-r.,...in.,...t
n_a_m_e_a-nd.,..,t,..,.1t1=-e.-----------Here
Preparer'sSSN
Paid
423161
01-13-05
Phoneno ....
orPTIN
410 822-4656
Form990 (2004)
15561121
134341
11022
2004.07000
SCHED\,JLEA
(ExceptPrivateFoundation)
andSection501(e),501(1),501(k),
501(n), or Section4947(a)(1)Nonexempt
CharitableTrust
~
PUBLIC
Part I
2004
POLICY,
52. 1759134
INC.
Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
(Seepage1 of the instructions.
Listeachone If therearenone,enter'None.')
(d) Contnbut,ons to
(b) Titleandaveragehours
(e) Expense
(a) Nameandaddressof eachemployee
paid
benefit
(c) Compensationemplo~ee
perweekdevotedto
andother
plans & deferred account
morethan$50,000
oosit1on
compensation
allowances
NONE
----------------------------------
------------------------------------------------------------------------------------------------------------------------------------Totalnumberof otheremployees
paid
over$50,000
IPartHI Compensation
(c) Compensation
NONE
--------------------------------------------
Totalnumberof othersreceivingover
$50,000for professional
services
423101111-24.04
15561121
134341
11022
2004.07000
7
THE ANNAPOLIS
5 2 -1 7 5 913 4
!P@ftIll j Statements
Yes No
includinganyattemptto influence
Dunngtheyear,hastheorganization
attempted
to influencenational,state,or locallegislation,
publicopinionon a legislative
matteror referendum?
If 'Yes,'enterthetotalexpenses
paidor incurredmconnection
withthe
lobbyingactivities..... $
$
(Mustequalamountson line38, PartVI-A,
or linei of PartVI-B.)
Organizations
thatmadeanelectionundersection501(h)byfilingForm5768mustcompletePartVI-A.Otherorganizations
checking
'Yes,'mustcompletePartVI-BANDattacha statement
givinga detaileddescriptionof thelobbyingactivities
Duringtheyear,hasthe organization,
eitherdirectlyor indirectly,engagedin anyof thefollowingactswithanysubstantial
contributors,
trustees,directors,officers,creators,keyemployees,
or membersof theirfam1l1es,
or withanytaxableorganization
withwhichanysuch
personis affiliatedasan officer,director,trustee,majorityowner,or principalbenef1c1ary?
(If the answer to any question is "Yes,"
attach
Page2
a Sale,exchange,
or leasingof property? . ........
2a
2b
c Furnishing
of goods,services,or fac1l1t1es?
2c
d Payment
of compensation
(or paymentor reimbursement
of expenses
if morethan$1,000)?
2d
2e
3a
3b
4a
4b
x
x
x
x
Theorganization
is nota privatefoundationbecause
1t1s(PleasecheckonlyONEapplicable
box.)
5 D
A church,conventionof churches,or association
of churchesSection170(b)(1
)(A)(i).
6 D
A school.Section170(b)(1
)(A)(ii).(AlsocompletePartV.)
7
D A hospitalor a cooperativehospitalserviceorganizationSection170(b)(1)(A)(iil).
8 D
A Federal,
state,or localgovernment
or governmental
unit Section170(b)(1
)(A)(v).
9
D A medicalresearchorganizationoperatedin con1unction
witha hospital.Section170(b)(1)(A)(11i)
Enterthe hospital'sname,city,
andstate .....
An organization
operated
for the benefitof a collegeor universityownedor operated
by a governmental
unit Section170(b)(1)(A)(iv).
10 D
(Alsocompletethe SupportSchedulein PartIV-A.)
unit or fromthegeneralpublic
An organization
thatnormallyreceives
a substantial
partof its supportfroma governmental
11a D
Section170(b)(1
)(A)(vi).(Alsocompletethe SupportSchedulein PartIV-A.)
A communitytrust.Section170(b)(1)(A)(vi).
(Alsocomplete
the SupportSchedulein PartIV-A)
11b D
thatnormallyreceives:(1) morethan331/3%of its supportfromcontributions,
membership
fees,andgross
12 00 An organization
receiptsfromactivitiesrelatedto its charitable,
etc, functions- subjectto certainexceptions,
and(2) no morethan331/3% of
its supportfromgrossinvestment
incomeandunrelated
businesstaxableincome(lesssection511tax)from businesses
acquired
by the organization
afterJune30, 1975. Seesection509(a)(2).(Alsocomplete
the SupportSchedulein PartIV-A.)
13
An organization
that is notcontrolledby anydisqualified
persons(otherthanfoundationmanagers)
andsupportsorganizations
described
in:
(1) lines5 through12above;or (2) section501(c)(4),(5), or (6)1 if theymeetthetestof section509(a)(2).(Seesection509(a)(3))
Providethefollowinginformation
aboutthe supportedorganizations.
(Seepage5 of the instructions.)
(b) Linenumber
fromabove
14
An organization
organized
andoperated
to testfor publicsafetySection509(a)(4).(Seepage5 of theinstructions)
1~~cld-1
4
15561121
134341
11022
2004.07000
19
20
Grossincomefrom interest,
dividends,
amountsreceived
from
payments
on securitiesloans(sect1on512(a)(5)),rents,royalties,
and
unrelated
businesstaxableincome
(lesssection511taxes)from
businesses
acquiredbythe
organization
afterJune30, 1975
Netincomefrom unrelated
business
activitiesnot includedin lme18
Taxrevenues
leviedfor the
organization's
benefitandeither
paidto 1tor expended
on its behalf
12, 251.
13,287.
13,695.
12,044.
51,277.
o.
o.
NONE
423121 12-03-04
15561121
134341
11022
2004.07000
Schedule
A (Form990or 990-EZ)2004 PUBLIC
I.PartVI
29
5 2-1 7 5 913 4
N/A
31
Doestheorganization
maintain
thefollowing:
indicating
theracialcomposition
of thestudentbody,faculty,andadministrative
staff?...
a Records
... ... . .
basis?
documenting
thatscholarships
andotherfinancialassistance
areawarded
ona raciallynondiscriminatory
b Records
brochures,
announcements,
andotherwrittencommunications
to thepublicdealingwithstudent
c Copiesof allcatalogues,
admissions,
programs,
andscholarships?
...
or onits behalfto solicitcontributions?
d Copiesof all materialusedbytheorganization
If youanswered
"No'to anyoftheabove,pleaseexplain(If youneedmorespace,attacha separate
statement)
33
a
b
c
d
e
I
g
h
Doestheorganization
discriminate
by racein anywaywithrespectto:
Students'rightsor privileges? .... .. .. .
. ...
.. .
. ..
Admissions
policies? ....
.....
. ..... ..
..
..
Employment
of facultyor administrative
staff?
. .. .
..
...
assistance?
Scholarships
or otherfinancial
..
. ..... ..
.......
Educational
policies?
..
...
. ....
.....
..
Useoffacilities?
...
....
... .
.....
Athleticprograms?
..
Otherextracurricular
act1v1ties?
.. .
. . . . ..
. ..
..
If youanswered
'Yes'to anyof theabove,pleaseexplain.(If youneedmorespace,attacha separate
statement.)
29
30
31
..........
...
..
.....
..
...
....
receive
anyfinancialaidor assistance
froma governmental
agency?
34 a Doestheorganization
rightto suchaideverbeenrevoked
or suspended?
b Hastheorganization's
.
If youanswered
'Yes'to either34aorb, pleaseexplainusinganattached
statement.
certifythatit hascompliedwiththeapplicable
requirements
of sections4.01through4 05 of Rev.Proc.7550,
35 Doestheorganization
If "No,"attachanexplanation
19752C.B.587,coveringracialnondiscrimination?
..
...
Page4
Yes No
Doestheorganization
havea raciallynondiscriminatory
policytowardstudentsby statement
in its charter,bylaws,othergoverning
instrument.
or in a resolution
of its governingbody?
.....
. ..
Doestheorganization
includea statement
of its raciallynondiscriminatory
policytowardstudentsin allrtsbrochures,
catalogues,
programs,
andscholarships?
andotherwrittencommunications
withthepublicdealingwithstudentadmissions,
rtsraciallynondiscriminatory
policythroughnewspaper
or broadcast
mediaduringtheperiodof
Hastheorganization
publicized
periodif it hasnosolicitation
program,in a waythatmakesthepolicyknown
sol1c1tation
for students,or duringtheregistration
it serves? . .
to allpartsof thegeneralcommunity
. .
.....
..
if 'No,"pleaseexplain.(If youneedmorespace,attacha separate
statement.)
If "Yes,"
pleasedescribe;
30
32
32a
32b
32c
32d
33a
33b
33c
33d
33e
331
330
33h
34a
34b
'
35
Schedule
A (Form990or 990-EZ)2004
423131
11-24-04
15561121
134341 11022
2004.07000
10
THE ANNAPOLIS CENTER FOR SC 11022
Schedule
A (Form990or 990-EZ)2004 PUBLIC
5 2-1 7 5 913 4 Pa e 5
N/A
(Tobecompleted
ONLYbyan eligibleorganization
thatfiledForm5768)
Check
if the oroanization
belonasto anaffiliatedarouo.
Check
aoolv
1fvoucheckeda and"limitedcontrol"orov1sions
(a)
(b)
Affiliatedgroup
To becompleted
for ALL
totals
electingorganizations
N/A
36
37
38
39
40
41
Totallobbyingexpenditures
to influencepublicopinion(grassrootslobbying)
Totallobbyingexpenditures
to influence
a legislative
body(directlobbying)
Totallobbyingexpenditures
(addlines36 and37)
... ..
Otherexemptpurposeexpenditures
.... . . . ...
.....
...
Totalexemptpurposeexpenditures
(addlines38 and39)
......
Lobbyingnontaxable
amountEntertheamountfromthefollowingtable
If the amounton line 40 Is
Thelobbyingnontaxableamountis
36
37
38
39
40
.....
...
"
,0%0<-~-" ............... }
..
"
41
Over$17,000,000
$1,000,000
. . . ....
....
42 Grassroots
nontaxable
amount(enter25%of line41) ....
43 Subtractline42 from line36 EnterOif line42 is morethanline36
44 Subtractline41 fromlme38.EnterO1fllne41 is morethanline38 ....
,,,
"
..
"
..
...
..
..
42
43
44
Caution: If there is an amount on either line 43 or /me 44, you must file Form 4720.
(a)
2004
2003
45 Lobbyingnontaxable
amount
46 Lobbyingceilingamount
1150%of lme451e\\ ...
47 Totallobbying
exoenditu
res
nontaxable
48 Grassroots
amount ...
ceilingamount
49 Grassroots
1150%ofline 481e\l
50 Grassroots
lobbying
exoend1tures
I Part v1..a l
(t)
2002
(b)
"
N/A
(d)
2001
(e)
Total
o.
o.
o.
o.
o.
o.
"
"
"
N/A
(Forreportingonlyby organizations
thatdid notcompletePartVlA)(Seepage11 of the instructions)
Duringtheyear,did the organization
attemptto influencenational,stateor localleg1slat1on,
includinganyattemptto
matteror referendum,
throughtheuseof
influencepublicopinionon a legislative
a Volunteers
..
...
. ..
..
.... .. ....
(Includecompensation
m expenses
reportedon linesc throughh.)
b Paidstaffor management
.....
c Mediaadvertisements
. ..
..
or thepublic .... . ..
d Mailingsto members,legislators,
......
or publishedor broadcast
statements
e Publications,
..
.... . .. .
f Grantsto otherorganizations
for lobbyingpurposes
...
....
theirstaffs,government
off1c1als,
or a legislative
body
g Directcontactwithlegislators,
...
demonstrations,
seminars,
conventions,
speeches,
lectures,or anyothermeans.
h Rallies,
.... ..
I Totallobbyingexpenditures
(Addlinesc throughh.)
. .... ..... .....
. .
.... .....
If 'Yes"to anyof theabove,alsoattacha statement
givinga detaileddescription
of thelobbyingactivities.
423141
11-24-04
15561121
Yes
No
Amount
o.
ScheduleA (Form990or 990-EZ)2004
134341
11022
2004.07000
11
THE ANNAPOLIS CENTER FOR SC 11022
ScheduleAForm990or990-EZ)2004PUBLIC
52-1759134
Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
51
(b)
Lineno.
Amountinvolved
(c)
Nameof noncharitable
exemptorganization
Yes
b(I)
b(ii)
b(III)
b(lv)
b(v)
b(vi)
(b)
Typeof organization
423151
11-24-04
15561121
N/A
(d)
Description
of transfers,transactions,
andsharingarrangements
(a)
No
x
x
x
x
x
x
x
x
x
51a(i)
a(il)
52 a Istheorganization
directlyor indirectlyaffiliatedwith,or relatedto, oneor moretax-exempt
organizations
described
in section501(c) of the
Code(otherthansection501(c)(3))or in section527?
~ D Yes
b If 'Yes' complete
thefollowingschedule
NIA
Nameof organization
Page&
[XJ
No
(c)
Description
of relationship
134341
11022
2004.07000
12
THE ANNAPOLIS CENTER FOR SC 11022
990
428102
Description
Date
Acquired Method
Life
Line
No
Unad1usted
CostOrBasis
Bus%
Exel
Reduction
In
Basis
BasisFor
Depreciation
Accumulated
Depreciation
Current
Sec179
AmountOf
Depreciation
o.
o..
lFAX MACHINE
06 24 93 SL
15.00 16
688.
688.
688.
2 l?AX/TYP.EWRITER
10 13 94 SL
15.00 16
1,150 ...
1,150 ..
1, 15()..
3FILE CABINETS
11 11 94 SL
10.00 16
100.
100.
92.
5:0MPUTERPRINTER
11 14 94 SL
15..oo 16
1,410 ...
l,410ir
1,410.
60FFICE
11 29 94 SL
10.00 16
1,800.
1,800.
1,635.
10 SOFTWARE
01 11 95 SL
3 ..00 16
243 ...
243 ..
2.43.
o..
14 SOFTWARE
08 04 98 SL
3.00
106.
106.
106.
o.
15 CARDSCAN
09 04 9l:lSL
5.00 16
414 ...
414ir
414.
o..
16 PRINTER
05 05 98 SL
3.00
Hl CO.MPtnERS
(}204 9tl SL
19 COMPUTERS
FURNITURE
16
8.
o.
165.
1,400.
1,400.
1,400.
o.
3 ..00 16
7,732.
1-t 732 ..
7-,732w-
o.
04 05 99 SL
3.00
6,794.
6,794.
6,794.
20 ZOMPUTER.
()3OS00 SL
3.00 16
2,449.
2,449 ..
2,449.
21 COMPUTER,
12 05 00 SL
3.00
2,152.
2,152.
2,152.
o.
o..
o.
COMPUTER.
22 ~ATEWAY
02 04 02 SL
3 ..00 16
1,296.
1,296 ..
828.
432 ..
23 GATEWAYCOMPUTER
12 05 02 SL
3.00
16
1,131.
1,131.
408.
377.
COMPUTERS
24 JATEWAY
12 05 02 SL
3 ..00 16
5,748.
5,748 ..
25 POSTAL METER
03 09 03 SL
15.00 16
3,296.
3,296.
549.
659.
26 COMPUTER
b.3l'.>90:3SL
1.00 16
1#303 ..
1;303.
3fJ2.
434 ..
10-08-04
16
16
16
16
2,07=6.
1 ,9lfJ ..
990
Date
Acquired Method
Description
Life
l..Jne
No
UnadJusted
CostOrBasis
3.00
16
933.
5.00
16
1,300.
09 05 03 SL
3.00
16
Otl05 04 SL
COMPUTER.
30 lATEWAY
COMPUTER SERVER/BACKUP
10 05 04 SL
31 UPGRADE
5.00
ls.00
27 COMPUTER
04 05 03 SL
2a PROJECTOR
07
29 COMPUTER
- ~-::-L
~
2 DEPR
Reduction
In
Basis
933.
Accumulated
Depreciation
Current
Sec179
'
AmountOf
Depreciation
311.
1,300.
130
260.
1,152.
1,152.
128.
384.
16
1,36-2.
1~362.
114.
16
2,375.
2,375.
119.
o...
46,334 ..
5.00
BasisFor
Depreciation
233.
Bus%
Exel
16
4,238.
o.
o.
4,238.
50,572.
46,334.
3.0,979.
4,238.
4,238.
4,238.
4,238 ...
50,572.
35,217.
o.
o...
o.
5,179.
o.
o.
5,179.
'
428102
10-08-04
17
52-1759134
RENTAL INCOME
STATEMENT
ACTIVITY
NUMBER
PART I,
FORM 990
ANNUAL DINNER
TICKET PROMOTION
TO FM 990,
PART I,
LINE 9
17,691.
GROSS
RECEIPTS
CONTRIBUT.
INCLUDED
DIRECT
EXPENSES
41,350.
4,544.
37,997.
2,191.
3,353.
2,353.
45,894.
45,894.
40,188.
5,706.
TOTAL
(B)
PROGRAM
SERVICES
DUES AND
SUBSCRIPTIONS
BANK FEES
INSURANCE
REGISRTATION FEES
OFFICE SUPPLIES
INTERNET EXPENSES
COMMUNICATIONS
WORKSHOPS/PROJECTS
1,499.
6,964.
3,404.
225.
11,330.
5,018.
11,325.
27,170.
10,197.
4,516.
11,325.
27,170.
TOTAL TO FM 990,
66,935.
54,262.
134341
11022
2004.07000
1,054.
STATEMENT
(C)
MANAGEMENT
AND GENERAL
445.
6,964.
3,404.
225.
566.
251.
11,855.
NET
INCOME
41,350.
4,544.
(A)
15561121
GROSS
REVENUE
STATEMENT
OTHER EXPENSES
LN 43
17,691.
LINE 6A
FORM 990
DESCRIPTION
GROSS
RENTAL INCOME
DESCRIPTION OF EVENT
(D)
FUNDRAISING
567.
251.
818.
18
STATEMENT(S) 1, 2, 3
THE ANNAPOLIS CENTER FOR SC 11022
l
52-1759134
STATEMENT 4
EXPLANATION
EDUCATIONALORGANIZATIONWHICHASSESSES THE QUALITY OF RESEARCHAND THE
MANNERIN WHICH IT IS APPLIED TO MANAGERISK.
DEPRECIATION OF ASSETS NOT HELD FOR INVESTMENT
FORM 990
COST OR
OTHER BASIS
DESCRIPTION
FAX MACHINE
FAX/TYPEWRITER
FILE CABINETS
COMPUTERPRINTER
OFFICE FURNITURE
SOFTWARE
LEASEHOLDIMPROVEMENT
SOFTWARE
CARD SCAN
PRINTER
COMPUTERS
COMPUTERS
COMPUTER
COMPUTER
GATEWAYCOMPUTER
GATEWAYCOMPUTER
GATEWAYCOMPUTERS
POSTAL METER
COMPUTER
COMPUTER
PROJECTOR
COMPUTER
GATEWAYCOMPUTER
COMPUTERSERVER/BACKUPUPGRADE
TOTAL TO FORM 990,
15561121
134341
PART IV, LN 57
11022
2004.07000
688.
1,150.
100.
1,410.
1,800.
243.
4,238.
106.
414.
1,400.
7,732.
6,794.
2,449.
2,152.
1,296.
1,131.
5,748.
3,296.
1,303.
933.
1,300.
1,152.
1,362.
2,375.
50,572.
ACCUMULATED
DEPRECIATION
688.
1,150.
100.
1,410.
1,800.
243.
4,238.
106.
414.
1,400.
7,732.
6,794.
2,449.
2,152.
1,260.
785.
3,992.
1,208.
796.
544.
390.
512.
114.
119.
40,396.
STATEMENT 5
BOOKVALUE
o.
o.
o.
o.
o.
o.
o.
o.
o.
o.
o.
o.
o.
o.
36.
346.
1,756.
2,088.
507.
389.
910.
640.
1,248.
2,256.
10,176.
STATEMENT(S) 4, 5
19
THE ANNAPOLIS CENTER FOR SC 11022
1
52-1759134
DESCRIPTION
AMOUNT
PART IV-A
FORM 990
40,188.
40,188.
DESCRIPTION
STATEMENT 7
AMOUNT
PART IV-B
40,188.
40,188.
FORM 990
STATEMENT 6
STATEMENT 8
LINE
94
95
97
101
103
15561121
134341
11022
2004.07000
20
STATEMENT(S) 6, 7, 8
THE ANNAPOLIS CENTER FOR SC 11022
1
52-1759134
OTHER INCOME
2003
AMOUNT
DESCRIPTION
STATEMENT
2002
AMOUNT
2001
AMOUNT
2000
AMOUNT
MISCELLANEOUS
630.
1,806.
941.
739.
630.
1,806.
941.
739.
15561121
134341
11022
2004.07000
21
STATEMENT(S) 9
THE ANNAPOLIS CENTER FOR SC 11022
1
Page 2
00
If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box
Note: Only complete Part II if you have already been granted an automatic 3month extension on a previously filed Form 8868.
If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
!Partll
Additional (not automatic) 3-Month Extension of Time - Must file Original and One Copy.
Name of Exempt Organization
Type or
Employer identification
print.
File by the
extended
due date for
fihng the
return See
1nstruct1ons
number
52-1759134
Number, street, and room or suite no. If a P.O. box, see instructions.
ANNAPOLIS, MD 21401
Check type of return to be filed (File a separate application for each return):
00 Form 990
D Form 990BL
D
D
D
D
Form 990EZ
Fonn 990PF
D
D
Form 1041 A
Form5227
Form 4720
Fonn8870
Form6069
STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
~ H. RICHARD SEIBERT
410-268-3302
Thebooksareinthecareof
TelephoneNo.~
FAX No.~-----------If the organization does not have an office or place of business in the United States, check this box .....
If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN)
box
~o
. If this is for the whole group, check this
and attach a list with the names and EINs of all members the extenslOI\ 1sfor.
FEBRUARY 15 , 2 0 0 6 .
-==---------
6
7
Initial return
and ending
Final return
If this application is for Fonn 990BL, 990PF. 990T, 4720, or 6069, enter the tentative tax, Jess any
nonrefundable credits. See instructions
... ~$
________
If this application 1sfor Form 990PF, 990T, 4720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
.. . . .....
previously with Form 8868 .. .
Balance Due. Subtract line Sb from line Sa. Include your payment with this form, or, if required, deposit with FTD
coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions
N/A
'--
vf I
C,Po
Date~
--
We have not approved this application. After considering the reasons stated in item 7, we cannot grant your request for an extension of time to
file. We are not granting a 10-day grace period.
D
D
We cannot consider this application because it was filed after the extended due date of the return for which an extension was requested.
Other
--------------------------------------------By:______________
_
Date
Director
Alternate Mailing Address - Enter the address If you want the copy of this application for an additional 3month extension returned to an address
different than the one entered above.
Name
or print
LLC
Number and street (include suite, room, or apt. no.) or a P.O. box number
8221
City or town, province or state, and country (including postal or ZIP code)
423832
01-10-05
EASTON, MD 21601
Form8868 (Rev.12-2004)
15561121
134341
11022
2004.07000
22
THE ANNAPOLIS CENTER FOR SC 11022
[ -W]
D~ NancyAdams
495 Helena Ct , Apt 204
Aurora, CO 80011-9100
Dr. George K. Anderson
8 Little Harbor Way
Annapolis, MD 21403
Phone: 303-676-3841
Fax: 303-676-3979
Mobile Phone: 303-249-5519
Phone:410-263-4855
Mobile Phone: 703-862-9683
Phone: 301-402-6238
Alt Phone: 301-365-7828
Home Phone: 301-365-0117
Phone: 979-458-7246
Fax:979-458-7202
Phone: 313-665-2948
Fax: 313-665-0746
Home Phone: 248-553-9834
Phone: 360-650-3521
Fax. 360-650-2842
Phone: 202-585-2145
Fax:703-234-4420
Mobile Phone: 301-873-5001
Home Phone: 410-295-7587
Pager: 888-428-6313
Asst. Phone: 703-234-4400
University of Clnnclnnati
M.D. Charles Pierce
5563 Regimental Place
Cinncinnati, OH 45239
University of North Texas Health Sci Ctr
Dr. Ronald R Blanck
President
3500 Camp Bowie Boulevard
Fort Worth, TX 76107-2699
West Virginia University
Paul F. Ziemkiewicz, Ph.D.
PO Box 6064, Room 2020 NRCCE
Morgantown,WV 26506-6064
Phone. 619-281-9377
Fax:603-388-5942
Mobile Phone.
619-855-1181
Home Phone: 619-563-1748
Phone: 505-823-2616
Alt Phone: 608-263-3285
Alt Phone Ext.:Wisc
Fax: 505-823-2617
Home Phone. 505-856-7528
Phone: 817-735-2509
Fax:817-735-2486
Phone:304-293-2867
Phone Ext.:5441
Fax: 304-293-7822
Page2
If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box
'
[Kl
N~t'e: Only complete Part II 1fyou have already been granted an automatic 3month extension on a previously filed Form 8868.
If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
! PartU
Type or
print.
Additional (not automatic) 3-Month Extension of Time - Must file Original and One Copy.
Name of Exempt Organ1zat1on
File by the
extended
due date for
filing the
return See
1nstruct1ons
Employer identification
52-1759134
Number, street, and room or surte no. If a P.0. box, see instructions.
number
NO. 200
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
MNAPOLIS,
MD 21401
Check type of return to be filed (File a separate application for each return):
00 Form 990
Form 990EZ
Form 1041A
Form5227
Form 990PF
Form4720
Form6069
Form 990BL
Form8870
STOP: Do not complete Part II if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
e Thebooksare,nthecareof
~ H. RICHARD
Telephone No.~
410-26 8-3302
SEIBERT
FAX No.~------------If the organization does not have an office or place of business in the United States, check this box
If this is for a Group Return, enter the organ1zat1on'sfour d1g1tGroup Exemption Number (GEN)
box
4
~ D
5
6
7
~D
. If this 1sfor the whole group, check this
and attach a list with the names and EINs of all members the extension 1sfor.
NOVEMBER 15 , 2 0 0 5.
For calendar year 2 001_ , or other tax year beginning -==-----------,==-If this tax year 1sfor less than 12 months, check reason: D
lnrt1alreturn
State in detail why you need the extension
and ending
Final return
If this application 1sfor Form 990BL, 990PF, 990T, 4 720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions
If this application 1sfor Form 990PF, 990T, 4 720, or 6069, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit and any amount paid
previously with Form 8868
Balance Due. Subtract line Sb from line Ba. Include your payment with this form, or, rf required, deposit with FTD
coupon or, rf required, by using EFTPS (Electronic Federal Tax Payment System). See instructions
N/A
Notice t
~Ne
D
c8,,,:
Date
~7/Zfl/os-
ave approved this appiicat1on. Please attach this form to the organ1zat1on'sreturn.
We have not approved this application. However, we have granted a 10day grace period from the later of the date shown below or the due
date of the organization's return (Including any prior extensions). This grace period 1sconsidered to be a valid extension of time for elections
otherwise required to be made on a timely return. Please attach this form to the organ1zat1on'sreturn.
We have not approved this application. After considering the reasons stated in rtem 7, we cannot grant your request for an extension of time to
file. We are not granting a 10day grace period.
D
We cannot consider this application because 1twas filed after the extended due date of the return for which an extension was requested.
________________________________________
D0ther
By _________________
Director
Date
Alternate Mailing Address Enter the address if you want the copy of this application for an add1t1onal3month extension returned to an address
different than the one entered above.
Name
LLC
Number and street (include suite, room, or apt. no.) or a P.O. box number
8221
City or town, province or state, and country (including postal or ZIP code)
423832
01-10-05
EASTON, MD 21601
'
SUBMISSION
PROCESSING,
OGDEN
Form8868 (Rev 122004)
14380728
134341
11022ACE
2004.05060