m 990 re!:,urn o1 organization exempt from income...

F 'm

' 990 Re!:,urn o1 Organization Exempt From Income Tax

0 it or "'lion 501(c), 527, or 4947(a)(1) Of the Internal Revenue Code (except black lung

benefit trust or private foundation) o~rtr~~~~oiuerro~~y ��m��ni s��,« 1 The organization may have to use a copy of this return to satisfy state reporting requirements

41-6027744 RooMsuAe E Telephone number

507-334-0660 f Aa7u^b9mt,TOQ 0 Con a] Accrual

H end I ere not applicable to section 527 organizations H(a) Is this a group return far attiliates7 0 Yes D No H(G) II Yes; enter number of afliliates " H(c) Are allaffiliates included? N/A 0 Yes [::] No

fit no, anach a list ) Hill) Is this a separate return bled by an or-

ganization covered by a nrouo rulina? n Yne FX_1 Nn

J Organization type (~ko+ryoe) " LA 501(c) ( 3 11 nnsennol U 4947(a)l1) or U 52 K Check here " LJ it the organization's gross receipts are normally not more than E25,000 The

organization need net file a return with tie IRS, but i1 the organization received a Farm 990 Package in the mail, It should file a return without financial data Some states require a complete return

M Check " U if the organization is not required to attach SCh B(FOrm 990,990-E2,or990-PF) L Grass receipts Add lines 6b, 8b, 9b and 10b to line 12 57,718

Part 1 Revenue, Ex penses, and Changes in Net Assets or Fund Balances 1 Contributions, gifts, grants, and similar amounts received

a Direct public support to 253,624 . h Indirect public support 1h

O t Government contributions (grants) 1t d iataI (addlines tathrough u)(cashE 253,629 . noncasna 1 is 253 624 .

2 ProAram service revenue including government tees and contracts (from Part VII, line 93) 2 O 3 Membership dues and assessments 3

~W 4 Interest on savings and temporary cash investments 4 3 , 332 . 5 Dividends and interest from securRies 5 6 a Gross rents Be

b Less rental expenses 66 c Net rental income or (loss) (subtract line 6b tram line 6a) 6c

y 7 Other investment income (describe " 7 u B a Gross amount tom sale of assets other A Securities B Other m than inventory Ba CIC 6 Less cost or other basis and sales expenses 8111

c Gain or (loss)(attach schedule) Be E Net gain or (loss) (combine line 8c, columns (A) and (B)) ad

9 Special events and activities (attach schedule) a Gross revenue (not including $ of contributions

reported on line 1a) 9a b Less direct expenses other than fundraising expenses Ab c Nat income or (lass) from special events (subtract line 9b from line 9a) 9c

10 a Gross sales of inventory, less returns and allowances 10a b Less cast of goods sold 10G e Gross profit or (lass) from sales of inventory (attach sc1] fgubtrd~~.9ne~i0b r line 103) tOc

11 Other revenue (from PaRVII,lina103) I ftEtJtivt~~ 1 11 762 . 12 Total revenue add lines td 2 3 4 5 6c 7 ad . 9a 70c~ and 11 ~~~ 12 2-5-7 7718 . 13 Program services (iromline 44,column (B)) ~~ 13 221 990 .

r AUG 2 4 ~g~ ,~ 10 Management and general (from line 44, colum (`~G ~~ 14 19 820 . c x 15 Fundraising(framline 44,column (D)) I 15 22 699 . W 16 Payments to affiliates~attachsc~edule) OGDEfV, UT 7g

17 Total expenses add lines 16 and 44 column A 17 2 6 4 , 509 . 18 Excess or (deficit) for the year (subtract line 17 tram line 12) 18 < 6 791 . >

m N 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 2 2 4 7 92 . 20 Other changes innetassets orfund balances (attacnexplanatian) See Statement 1 20 <81 .>b 21 Net assets or fund balances at end of ear combine lines 18, 19, and 20 21 2 17 , 9 20 .

o?~ai'aa LHA For Paperwork Reduction Act Notice, see the separate Instructions Forth 990 (2002) 1

15580807 766780 F349 2002 .05000 United Way of Faribault Min F349-1~

A For the 2002 calendar year, or tax year pe

B Ch.kd applicable C Name of organization

E Adonis, label or

~Jchan,s P,,,,,United Way of Faribault Minn Inc Name Number and street (or P 0 box A mail is not delivered to street address) chan,is sea

=Initial return specific P0 BMX 644 Rnai inswc

~a�,m �o�, City or town, state arcounlry,andZIP+4 ED awn"e° aribault MN 55021

*Section 501i[s)(3) organizations and 4947(a)(1) nonexempt charitable trusts wolng must attach a completed Schedule A (Form 990 or 990-EZ)

D Employer Identification number

United W< P~ ~~ Statement o nn o0

Functional Expenses and Do not include amounts reported on line

Go, 8b, 9b, 10b, or 16 of Poll 1 22 Grants and allocations (attach schedule)

cash s 174, 875 . ~�,m,ms 23 Specific assistance to individuals (attach schedule) 24 Benefits paid to or for members (attach schedule) 25 Compensation of officers directors elc 26 Other salaries and wages 27 Pension plan contributions 28 Other employee beriefits 29 Payroll axes 30 Professional tundraising teas 31 Accounting fees 32 Legal fees 33 Supplies 33 Telephone 35 Postage and shipping 36 Occupancy 37 Equipment rental and maintenance 38 Pnnhng and publications 39 Travel 40 Conferences, conventions, and meetings 41 Interest 42 Depreciation depletion, etc (attach schedule) 43 Other expenses not covered above (itemize) a 6 c a e See Statement 2

3,900 .

37 77 .

d

8 Other program services (attach schedule) (Grams and allocations E Total of Program Service Expenses (should equal line 44, column (B), Program services) " 22 1 ,990 .

oi3ii ro Form 990 (2002) 2

15580807 766780 F349 2002 .05000 United way of Faribault Min F349 1

of Faribault Minn Inc 41-6 iUons must complete column (A) Columns (B), (C), and (D) are required for sectic anizations and section 4947(a)(1) nonexempt charitable truss but optional for oth

(A) Total (8) Program (C) Management <oviroc end nnnonl

4

5,091

(D) Fundraising

~~ pmae Iw a ee mmu n aq 44 upaNaomscmplnrqcdums(~}(~~wyy~~chmiins1115 1441 264,509 .1 221,990 .1 19,820 . 22,1 Joint Costs Check " LI] d you are following SOP 98-2 Are any point casts from a combined educational campaign and fundraising solicitation reported in (B) Program services 1 ~ Yes ~ Na If Yes,' enter (I) the aggregate amount of these joint costs $ , (II) the amount allocated to Program services $

What is theorgannation'sprimary exempt purpose7 100 See Statement 3 Program Service

Allorpsnl:eGOnamualdaxelDalhelrumnplpurpoaeechlevamenblnecimrsnOCOnfJaemenner State tPenumber ofcllenbserveO,publlwtlonaIssued etc Dlxuea F1p8115Bf

erlilevertwib Nat ere not rtrauMle on 501 (c)P) enC o IxeOOns end 4947(a)(1) nonexempt Uenbble Must, must also enter Ns amount of grants mid pi for 501(c)(J) e (Sect Jon (4) ~ 0 lad orpe , end 49d7(yl

diomuons to others ) trusts butopbonNbrall

a Collect contributions in Faribault area and distribute to non-profit organizations .

b

c

S

175 .409 . Organizations that tallow SFAS 117, cheek here 11111~ U and complete lines 67 through

69 and lines 73 and 74 67 unrestncted 218 942 . 67 212 , 071

m 68 Temporarily restricted 68 m 69 Permanently restricted 5 , 850 . 69 5 851

Organizations that do not follow SFAS 117, check here " E:Dand complete lines u 70 through 74

70 Capital stock, trust principal, or current funds 70 71 Paid-in or capital surplus, or land, building, and equipment fund 71 72 Retained earnings, endowment, accumulated income, or agar funds 72

Z 73 Total net assets or lurid balances (add lines 67 through 69 or lines 70 through 72, column (A)must equal line 79,column (s)must equal line 21) 224 792 . Td 217 921

74 Total liabilities andnatassets /fund balances (ad0lines 66and73) 400 802 . 74 393 32! Forth 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the public

perceives an organization in such cases may be determined by the information presented on it return Therefore . please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments

3 15580807 766780 F349 2002 .05000 United Way of Faribault Min F349 1

Form sso(zooz) United Way of Faribault Minn Inc 41-6027744 Pages

Part IV Balance Sheets

Node Where required, attached schedules and amounts within the descnption column (A) (B) should be for end-of-year amounts onty Beginning at year End of year

45 Cash - non-interest-bearing 45 46 Savings and temporary cash investments 192 481 . 46 195 690 .

47 a Accounts receivable 47a b Less allowance for doubtful accounts 47b 47c

48 a Pledges receivable 48a ~ 207,261 . ,b Less allowance tardoubtful accounts 4Bb 12,500 . 203 391 . 4Bc 199 761 .

49 Grants receivable 49 50 Recervables tram officers, directors, trustees

and key employees 50 N d 51 a Other notes and loans receivable 51a N `~ 6 Less allowance tordoubtful accounts 516 51c

52 Inventories for sale or use 52 53 Prepaid expenses and deferred charges 513 . 53 Sd Investments -securities " 0 Cost E::] FMV Sd SS a Investments - land, buildings, and

equipment basis 55a

6 Less accumulated depreciation 55b SSc 5s Investments -other See Statement 5 422 . 5s 593 . 57 a Land buildings, and equipment basis 57a 14,607 .

h less accumulated depreciation 57e 12,322 . 3 , 995 .. 57c 2 285 . 58 Other assets (describe 111- 58

59 Total assets addlina545throu h5B muste ualline74 400802 . 59 393 329 . 60 Accounts payable and accrued expenses 60 61 Grants payable 175 992 . 61 175 392 . 62 Deferred revenue 62 N

d 63 Loans tram officers directors, trustees, and key employees 63 84 a Tax-exempt bond liabilities 60a

j b Mortgages and other notes payable ~ 64h 65 Other liabilities (describe b Payroll taxes payable ) 18 . 65 17 .

zxavil ai zx-m

4 15580807 766780 F349 2002 .05000 United way of Faribault Min F349 1

Fonnsso 2o02 United Way of Faribault Minn Inc 41-6027744 Page a Part IV-A Reconciliation of Revenue per Audited Part N-B Reconciliation of Expenses per Audited

Financial Statements with Revenue per Financial Statements with Expenses per Return Return

a Total revenue, pains, and other support a Total expenses and losses per - per audited financial statements " a 257,637 . audited financial statements " a 2 64 , 509 .

b Amounts included on line a but not on b Amounts included on line a but not on line 17, Form 990

line 12 Form 990 (1) Donated services (1) Net unrealized gains and use of facilities $

on investments $ (2) Prior year adjustments (2) Donated services reported an line 20

and use of facilities $ Form 990 f (3) Recoveries of prior (3) Lasses reported on

year grants f line 20, Form 990 $ (4) Other (specify) (4) Other (specify)

, , Stmt 6-$ <81 . $ Add amounts on lines (1) through (4) " h <81 . Ado amounts on lines (1) through (4) " b ,0 .

c Line aminus line b " c 257 718 . 9 Line aminus line b " c 264 509 . d Amounts included on line 12, Form d Amounts included on line 17, Form ,

990 but not on line a 990 but not on line a

(1) Investment expenses (1) Investment expenses not included an not included on ' line 6b Form 990 $ line 6b, Form 990 $ ;

(2) Other (specify) (2) Other (specify) s s '

Add amounts on lines (1) and (2) " d 0 . Add amounts on lines (1) and(2) " E 0 . e Total revenue per line 12, Form 990 e Total expenses per line 77, Form 990

(linecplus line d) " e 257 , 718 . (uneeplus uned) " [~72 4 , 509, Part V List of Officers, Dire ctors, Trustees, and Key Employees (gist each one even d not compensated )

(B) Title and average hours yC) Compensation (D~co~we~uo~. m (E) Expense (R) Name and address per week devoted to II not p3I , enter P,~,~ y a ~ account and

position -0- mm ~�~o� other allowances Angela Storch . . .. . . . . . . . . ..... . . . . Executive dir 305 NE 5th St-Faribault MN

32 hrs/wk 30 , 900 . 0 . 0 .

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

--------------------------------- ---------------------------------

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $700,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? It Yes,' attach sc hedule No. Ej Yes M No Form 990 (2002)

223031 01a2 03

511-zz o3 Forth 990 (2002) 5

15580807 766780 F349 2002 .05000 United Way of Faribault Min F349-1

Form 990 (2002) United Way of Faribault Minn Inc 41-6027749 Paces

76 did the organization engage in any activity not previously reported to the IRS II Yes' attach a detailed description al each activity 76 X 77 Were any changes made in the organizing or governing documents but nod reported to the IRS ? 77 X

If 'Yes,' attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of $7,000 or more during the year covered by this return? 78a X

6 If Yes; has it fled a tax return on Form 990-T for this years N/A 78h 79 Was there a liquidation, dissolution termination or substantial contraction during the years 19 X

If 'Yes,' attach a statement BO a Is the organization related (other than by association with a statewide or nationwide organization) through common membership

governing bodies, trustees officers etc , to any other exempt or nonexempt organization? BOa X b If *Yes ' enter the name of the organization 10'

and check whether A i5 = exempt or 0 nonexempt 81 a Enter direct or indirect political expenditures Seeline 8l instructions 81a 0 .

D Did tie organization file Form 1120-POL far this years 81b ' X 82 a did the organization receive donated services or tie use of materials, equipment, or facilities at no charge or at substantially less than

fair rental value? B2a X 6 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 Pall II (See Instructions in Pall III ) B2b 4,962 . 83 a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a V X

h Did the organization comply with the disclosure requirements relating to quid pro quo cantnbuUOns9 83h X 84 a Did the organization solicit any contributions or gifts that were not tax deductible? N/A gqa

D If 'Ves ; did tie organisation include with every solicitation an express statement that such contributions or gifts were not tax deductible? N/A SO

BS 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members NBA BSa h did the organization make only in-house lobbying expenditures of $2 000 or less N/A 85h

It Yes' was answered to either 85a or 85b, do not complete BSc through 85h below unless the organization received a waiver for proxy tax owed for the prior year

c Dues, assessments, and similar amounts from members 85C N/A 0 Section 162(e) lobbying and political expenditures BSd N/A e Aggregate nondeductible amount of section 6033(e)(1 )(A) dues notices BSe N/A I Taxable amount of lobbying and political expenditures (line BSd less BSe) 851 N/A p Does the organization elect to pay the section 6033(e) tax an the amount on line 85r N/A g5 h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following tax years N/A g5p 86 501(c)(7) organizations Enter a Initiation fees and capital contributions included on line 12 B6a N/A

6 Gross receipts, included on line 12 tar public use of club facilities 86b N/A 87 501(c)(12)orgenrzetronsEnter a Gross income from members or shareholders 87a N/A

b Gross income from other sources (DO not net amounts due or paid to other sources against amounts due or received from them ) B7b N/A

BB At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 3017701-2 and 3017701-37 It Yes; complete Part I% 88 X

89 a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under section 4911 . 0 . , section 4912 . 0 .- , section 4955 . 0 .

h 501(c)(3) end 501(c)(4) organrzenons Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year If Yes,' attach a statement explaining each transaction 896 X

e Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . 0 .

d Enter Amount of tax online 89c above, reimbursed by the organization 0 . 90a List thestates with which acopy otthis return isfiled 1 Minnesota

D Number of employees employed in the pay paned that includes March 12, 2002 ~ 906 ~ 2 si rneoooksareincareot 10- Angela Storch reiepnoneno " 507-334-0660

Locaceaatlli~ 303 1st Ave NE, Faribault, MN ziPi4 . 55021

92 Section 4947(a)(i) nonexempt charitable trusts filing Form 990 in Ijeu o/ Form 1041-Check here and enter the amount of tax-exempt interest received or accrued during the tax veer " 1 92 I N/A

41-6027744 Page 9

on 512, 513 (E)

Related arexempt Amount function income

Note Enter prow amounts unless otherwise indicated 93 Program service revenue a D c a e I Medicare/Medicaid payments p Fees and contacts from government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 98 Dividends and interest from securities 97 Net rental Income or (loss) from real estate

a debt-financed property b not debFfinanced 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 profit or (toss) tram sales of Inventory 103 Other revenue

e Misc other 0 a a e

100 Subtotal (add columns (B), (D), and (E)) 105 Total (add line 104, columns (B), (D), and (E))

(B) Amount

1111.

Relationship of Activities to the Accomplishment of Exempt Purposes (See page 32 of the instructions) Line No Explain how each activity for which income is reported In column (E) 01 Pad VII contributed importantly to the accomplishment of the organization's " exempt purposes (other than by providing funds for such purposes)

instructions

of I Nature address,

14000717 766780 F349 2002 .0500

Farm 990 31 of the instructions

(a) Did the organization . during the year, receive any funds, Guectry or indirectly, (b) Did tie organization, during the year, pay premiums, directly or Indirectly, on Note 11 "Yes' to (b) , file Form 8870 and Form 4720 see instructions)

Under paiNCO of pa/u7. I dip that I nave merNned tnh naEim IrrJUEliq ~i P~~iiO ~~p~. ,~f ~(o0i~0unolllm)1s 6ma0on~lllnb Sign V / lA ~ Here

'

31a ureotatticer Date

Paid I Preparers' sianatura

--- - ~ " '^^ " ^~~~ juaa, oszermann s u u=eronry r~�;vi%,m '2209 Bard Avenue 223161 .ea~s . .na n._� m MP ., Faribault . MN 55021

Organization Exempt Under Section 501(c)(3) OMB No 1545-0047

(Except Private Foundation) and Sect Ion 501(e), 501(Q, 501(k), 501(n), or Section 4947(a)(1) Non exempt Ch aritahle Trust ' 0 O

Supplementary Information-See separate instructions.) " MUST be completed by the above organizations and attached to their Farm 990 or 990-EZ

Employer Identillcation number l Way of Faribault Minn Inc 41 6027744

oeperNient of Na Tnmury In~emel Rmanue Service

Compensation of the Five Highest Paid Independent Contractors for Professional Services (See nape 2 of the instructions List each one (whether individuals or firms) It there are none . enter 'None ')

Total number of others receiving aver $50,000 for professional services " I 0 xxaio,Ai xz-m LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ

7 15580807 766780 F349 2002 .05000 United Way of Faribault Min F349 1

SCHEDULE A (Form 990 or 990-EZ)

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one It there are none, enter'NOne') (a) Name and address of each employee paid (6)

Tills and average hours (a) ~ ̂Weu u~~+~o (e) Expense

o ther more than $50,000

per week devoted to (s) Compensation plans d n~ ~^' n

account an0 othat nnsihnn m~.~.. � ., ~n we~~~

None

---------------------------------

---------------------------------

---------------------------------

---------------------------------

Total number of other employees paid

(a) Name and address of each independent contractor paid more than $50,000

None

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(h) Type of service I (c) Compensation

Schedule A (Farm 990 or 990-EZ) 2002

15580807 766780 F349 2002 .05000 United Way of Faribault Min F399

Schedule A(Fortnssoorsso-ez) 2002 United Way of Faribault Minn Inc 41-6027744 raqe2

PBtt 111 Statements About Activities (Seepage 2 of the instructions) Yes No

1 During the year has the organization attempted to influence national, state, or local legislation, including any attempt to influence public opinion on a legislative matter or referendum? If Yes' enter the total expenses paid or incurred in connection with the lobbying activities " E $ (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) 1 X Organizations that made an election under section 501(h) 6y tiling Forth 5768 must complete Part VI-A Other organizations checking Yes; must complete Part VI-B AND attach a statement grvinp a detailed description of the lobbying activities

2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors trustees, directors, officers, creators, key employees, or members of their families or with any taxable organization with which any such person is affiliated as an officer, director, trustee, malonty owner, or principal Deneficiary9 (i! the answer to any question is "Yes,' attach a detaled statement explaining the tinansactions)

a Sale, exchange, or leasing of property 2a X

b Lending of money or other extension of credits 2b I X

c Fumishinpotgoods services, oriacilities9

X d Payment of compensation (or payment or reimbursement of expenses if more than $1,000) 1 2d I I

a Transfer of any part of its income or assels9 2e X

3 Does tea organization make grants for scholarships, fellowships, student loans etc 9 (See Note below ) 3 X 4 Do you have a section 403(b) annuity plan for your employees 4 X Node Attach e statement to explain how the organization determines that indmduels or organizations receiving grants or loans from it in furtherance of its chantable programs "qualify' to receive payments

Part N I Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions The organization is not a private foundation because it is (Please check only ONE applicable box )

5 0 Achurch,convention otchurches,orassociation otchurches Section 170(b)(1)(A)(1) 6 EJ A school section 170(b)(1)(A)(n) (Also complete Part V ) 7 ~ A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(m) B ~ A Federal, slate, or local government or povemmental and Section 170(b)(1)(A)(v) 9 0 A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(n) Enter the hospital's name, city,

and state 10, 10 ~ An organization operated for the benefit 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 part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A ) 116 0 AcommunitytrusiSection170(b)(1)(A)(w)(AlsocomDletetheSupportScheGuleinPaAIV "A) 12 0 An organization that normally receives (1) more than 331/x% of ids support tram contributions, membership fees and gross

receipts from aclrvrties related to it charitable, etc , functions -subject to certain exceptions, and (2) no more than 331/x% of its support from grass investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization otter June 30, 1975 See section 509(a)(2) (Also complete the Support Schedule in Pad IV-A )

13 ~ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations deathbed in 111 lines S through 12 above, or (2) section 501(c)(4) . (5), or (6) . 6 they meet the test of section 509fa1(2) (See section 509(a)(3) )

Provide the following information about the supported organizations (See page 5 of the instructions

(a) Name(s) of supported organization(s) (6) Line hamper

from above

14 0 An organization organized and operated to test for public safety Section 509(a)(4) (See page 5 of the instructions )

Schedule A (Form 990 or 990-E2) 2002

nom ai-zz m

28 Unusual Grants For an organization described in line 70, 11, or 12 that received any unusual gaols during 1998 through 2001, prepare a list for your, records to show, for each year, the name al the contributor, tie date and amount of tie grant, and a brief description of the nature of tie grant no oat file this list with gout return Do not include these prams in line 15

217117 01 22 QA None 9clie0ule A (Form 990 or 990-ES) YOOi

9 15580807 766780 F349 2002 .05000 United Way of Faribault Min F349-1

Schedule n (FOrm ssoor 990-ez) 2002 United Way of Faribault Minn Inc 41-6027744 Page 3 P It IWA Support Schedule (Complete only if you checked a box on line 10, 1 1, or 12) Use cash method of accountu 9 F ~t

Note Youmayuset a worksheet in the instructions for convertin I from the accrual to the cash method of accounting Calendar year (orllscalyear be mnin

in ) 10. 1 (a) 2001 (b) 2000 (c) 1999 (E) 1998 (e) Total

5 Gifts, grants, and contributions received (Do not include unusual grants Seeline 28) 262 .253 . 271,842 . 265, 452 . 237 .950 . 1 .037 .497 .

17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities m any activity that is related to the organization's chaMable etc purpose

18 Gross income tram interest, dividends amounts received from payments on securities loans (section 512(a)(5)) rents, royalties, and unrelated business taxable income (less section 511 lazes) from businesses acquired by the organization after June 30,1975 6 , 629 . 9,119 . 4,593 . 2,395 . 22 , 736 .

19 Net income from unrelated business activities not included in line 18

p Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally famished to the public without charge

zp Other income Attach aschedule See Statement 7 seienicao~eiasseter(loss)from

trom 746 . 517 . 820 . 549 . 2 , 63-2- .

23 Total otlines 75through 22 269 628 . 281 478 . 270 865 . 240 894 . 1 , 06-2 , 86-5 . 24 Line 23minus line n 269 628 . 281 1` 478 . 270 865 . 240 894 . 1 1 062 , 865 . 25 Enter l%ofline 23 2 , 696 . 2 815 . 2 709 . 2 409 . 11 26 Organizations described on lines 10 or 11 a Enter 2% of amount in column (e), line 24 1 26a 2 1 257 . 6 Prepare a list for your records to show the name of and amount cantnbute0 by each person (other than a governmental

unit or publicly supported organization) whose total gifts far 1998 through 2001 exceeded the amount shown in line 26a Do not file this list with your return Enter the sum of all these excess amounts 1 251 ; 0 .

s Total support forsection 509(a)(1) test Enter line 24,column (e) 1 26c 1P062 865 . d add Amounts from column (e)torlines ie 22,736 . is

~ zz 2,632 . 261b 1111- z6a -2-5 , 3-6-8-, e Public support (line 26c minus line 26d foul) " 28e 1 1 037 4, 497 . I-Puhlla support percentage (line 269 (numerator) divided by line 26c denominator)) " 26f 97 . 6132 %

27 Organizations described an line 12 a For amounts included in lines 15, 16, and 17 that were received tram a'disqualdied person,* prepare a list for your records to show the name at, and fatal amounts received in each year from, each 'disqualified person' Do not file this list with your return Enter the sum of such amounts for each year N/A (2001) (2000) (1999) (1998)

h For any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list 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 line 25 tar the year or (2) E5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals ) Do not file this list with your return After computing the difference between the amount received and the larger amount described in (7) or (2), enter the Sum of these differences (the excess amounts) for each year N/A (2001) (2000) (1999) (7998)

e Add Amounts tram column (e) for lines 15 16 17 20 21 " 27s N/A

d Add Lure 27a total one line 27b total " 27U N/A e Public support (line 27c total minus line 270 total) 1 27e N/A 1 Total support for section 509(a)(2) test Enter amount on line 23, column (e) 1 I 27f I N/A p Public support percentage (line 27e (numerator) dinded by line 27f (denominator)) 1 27 NBA %

34 a Does the organization receive any financial aid or assistance tram a governmental agency9 h Has the organization's right to such aid ever been revoked or suspended

It you answered Yes' to either 34a or b, please explain using an attached statement 35 Does the organization ceRAy that d has complied with the applicable requirements of sections 4 01 through 4 05 0l Rev Proc 75 .50,

1975-2 C B 587, coverino racial nondiscnmination9 If'NO .' attach an explanation

Schedule A (Form 990 or 990-EZ) 2002

10

15580807 766780 F349 2002 .05000 United Way of Faribault Min F349 1

Schedule A(FOrmssoorsso-ez) 2002 United Way of Faribault Minn Inc 41-6027744 Pa9ea p~ v Pnvate School Questionnaire (See page 7 of the instructions ) N/A

(To be completed ONLY by schools that checked the box on line 6 in Part IV)

29 Does the organization have a racially nondiscriminatory Yes NO policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body 29

30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all ids brochures, catalogues, and other written communications with the public dealing with student admissions programs, and scholarships 30

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes [he poly known to all pans of the general community it serves 31 It 'Yes,' please describe, if *No,' please explain (If you need more space, attach a separate statement ~

32 Does the organization maintain the following a Records indicating the racial composition of tie student body faculty, and administrative staff b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis c Copies of all catalogues, brochures, announcements, and other written communications is the public dealing with student

admissions, programs, and scholarships? d Copies of all material used 6y tie organization or on its behalf to solicit contnbutions7

If you answered 'NO'to any of the above, please explain (If you need more space, attach a separate statement )

33 Does the organization discriminate by race in any way with respect to a Students' rights or privileges' D Admissions policies? c Employment of faculty or administrative staff? 0 Scholarships or other financial assistance? e Educational policies9 f Use of tacilities9 g Athletic Orograms9 h Other extracurricular activities?

It you answered 'Yes* to any of the above, please explain (If you need more space, attach a separate statement )

]2]131 01-Z2 Q3

scneauieA(Formssoor 990-ez) 2002 United Way of Faribault Minn Inc 41-6027744 page s Pad VI-A Lobbying Expenditures by Electing Public Charities See page 9 of the instructions) N/A

(TO be completed ONLY by an eligible organization that fled Form 5768) Check 1 a n it the omanixahon belonos In an aHduted nmun Check " n n d vnu chnckxd "a" ane'limrtan control' nrnv~annc ~oow

N/A

41

I( there is an amount on either line 43 or line

4-Year Averaging Period Under Section 501 (h) (Some organizations that made a section 501(h) election do oat have to complete all of the five columns

below See the instructions for lines 45 through 50 on page 11 of the instructions )

Lobbying Expenditures During 0-Year Averaging Period

Ibl 1c1 (d) 2001 2000 1999

Calendar year (or (a) fiscal year beginning ln) 1 2002

45 Lobbying nontaxable amount

46 Lobbying ceiling amount 150% of line 45 (e ))

47 Total lobbying expenditures

IB Grassroots nontaxable amount

49 Grassroots ceiling amount 150% of line 48 ( e ))

50 Grassroots lobbying

I Part VI-B I Lobbying Activity by Nonelecting Public Charities (For reporting any by organizations that did oat complete Part VI-A) (See page 71 of the instructions ~ N/A

During the year, did the organization attempt to influence national, state or local legislation, including any attempt to Yes No Amount influence public opinion on a legislative matter or referendum, through the use of

a volunteers h Paid staff or management (Include compensation in expanses reported on lines c through A ~ e Media advertisements d Mailings to members, legislators, or the public e Publications, or published or broadcast statements 1 Grants to other organizations forlobbying purposes g Direct contact with legislators, their stalls, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means

I Total lobbying expenditures (Ad0lines s through h ) ~ - 0 . If Yas'to any of the above, also attach a statement giving a detailed description of the lobbying aclrvrties

i~z ozm Schedule A (Form 990 or B90-EZ) 2002 11


Limits on Lobbying Expenditures term 'exoen0itures' means amounts paid or incurred

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 38 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (ado lines 38 and 39) 47 Lobbying nontaxable amount Enter the amount from the following table -

If the amount on line 40 Is - The lobbying nontaxable amount Is -Not over $500 OOU 70% of Me amount on line 40

Over $500 001D but not mar $1 000 000 $100 COD plus 15% of Me excess me $500 000

Over $1 000,000butnotover f1,500000 $175 000 plus 10% of the moess over $1 000 000

dvfI 50C1 000 but not mar $17,000 000 $225 000 plus 5% of Me "cases over $1 500 000

0va $17 000 000 S1000000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter -0-d line 42 is more than line 36 44 Subtract line 41 from line 38 Enter-0-if line 41 is more than line 38

Is) Affiliated group

totals

(o) To be completed for ALL electing organizations

A (e)

Total

0 .

Schedule n(rormssaorsso-ez) 2002 United Way of Faribault Minn inc 4 1-

(q Cash 51a(i) X (II) Other assets a l it) X

b Other transactions (I) Sales or exchanges of assets with a noncharitable exempt organisation b(l) X (II) Purchases of assets from a nanchanWble exempt organization bill) X (ill) Rental of facilities, equipment, or other assets hiIIQ X (iv) Reimbursement arrangements 6(1v) X (v) Loans or loan guarantees 6(v) X (vi) Performance of services or membership or tundraisinp solicitations h(vl) X

c Sharing of facilities, equipment, mailing lists, older assets, or paid employees c X 0 If the answer to any of the above is 'Yes' complete the following schedule Column (b) should always show the fair market value of the

goods, other assets, or services given by the reporting organization If the organization received less than fair market value in any

52 a Is the organization directly or indirectly affiliated with or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 " 0 Yes XD No

15580807 766780 F349 2002 .05000 United Way of Faribault Min F349

Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructions

51 Did tie reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of tie Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

a Transfers from the reporting organization to a nonchantable exempt organization of Yes No

12

United Way of Faribault Minn Inc 41-6027744

Form 990 Other Changes in Net Assets or Fund Balances Statement 1

Description Amount

UNREALIZED LOSS ON INVESTMENTS <81 .>

Total to Form 990, Part I, line 20 <81 .>

Form 990 Other Expenses Statement 2

Description

Advertising Insurance Dues Repairs Executive Expenses Bad debt expense

Total to Fm 990, In 43

386 . 507 . 108 . 326 .

580 .

22,777 . 1,327 . 580 . 20,870

Form 990 Cash Grants and Allocations Statement 9

15 Statement s) 1, 2, 3, 4 2002 .05000 United Way of Faribault Min F349-1 15580807 766780 F349

(A)

Total

45 . 1,932 . 2,674 .

108 . 326 .

17,692 .

(B) Program Services

45 . 966 .

2,167 .

17,692 .

(C) Management and General

(D)

Fundraising

Form 990 Statement of Organization's Primary Exempt Purpose Statement 3 Part III

Explanation

Collection of contributions and distributions to non-profit organizations .

Classification Donee's Name

AMERICAN RED CROSS-RICE CO

BIG SISTER/BIG BROTHER

BOY SCOUT INDIANHEAD COU

Donee'S Donee's Address Relationship Amount

FARIBAULT MN NONE 23,000 .



Total included on Form 990, Part II, line 22 174,875 .

16 Statement s) 4 15580807 766780 F349 2002 .05000 United Way of Faribault Min F349-1


CATHOLIC CHARITIES FARIBAULT MN NONE 1,500 .

COURAGE CENTER FARIBAULT MN NONE 2,750 .

CROSSROADS OF FARIBAULT MN NONE OWATONNA 2,000 .

ECONOMIC BRIDGING FARIBAULT MN NONE 10,800 .

EXCHANGE CLUB FARIBAULT MN NONE CENTER 5,300 .

FBLT SENIOR FARIBAULT MN NONE CITIZENS 9,000 .

FOSTER GRANDPARENT FARIBAULT MN NONE PROG 5,500 .

FREE POPS FARIBAULT MN NONE 5,000 .

FRIENDSIP VENTURES FARIBAULT MN NONE 2,750 .

GIRL SCOUTS-CANNON FARIHAULT MN NONE VALLEY 7,000 .

INFANTS REMEMBERED FARIBAULT MN NONE 2,000 .

LUTHERAN SOCIAL FARIBAULT MN NONE SERVICES 9,400 .

MEALS ON WHEELS FARIBAULT MN NONE 10,000 .

PROJECT A .B .L .E . FARIBAULT MN NONE 8,000 .

PROJECT SIGHT FARIBAULT MN NONE 8,000 .

SENIOR CAREGIVER FARIBAULT MN NONE RESPITE 4,000 .

SENIOR HOUSING FARIBAULT MN NONE OUTREACH 4,000 .

S MN LEG LEG SERV FARIBAULT MN NONE 3,000 .

WOMAN SAFE CENTER FARIBAULT MN NONE 5,000 .

FARIBAULT AREA FARIBAULT MN NONE CHARITIES 20,000 .

Y .E .S . FARIBAULT MN NONE 4,875 .


Schedule A Other Income Statement 7

1998 Amount

549 .

549 . 746 . 517 . 820 .

17 Statement s) 5, 6, 7 2002 .05000 United Way of Faribault Min F349 1 15580807 766780 F349

Form 990 Other Investments Statement 5

valuation Description Method Amount

26 SHARES AMCAP FUND, INC Market Value 340 . 5 SHARES WALMART STORES INC Cost 253 .

Total to Form 990, Part IV, line 56, Column B 593 .

Form 990 Other Revenue Not included on Form 990 Statement 6

Description Amount

NET UNREALIZED LOSS ON INVESTMENTS <B1 .>

Total to Form 990, Part IV-A <81 .>

Description

Miscellaneous

Total to Schedule A, line 22

2001 2000 Amount Amount

746 . 517

1999 Amount

820

(b) Month and (c) Onis for eeprsietbn ymplaceC (OUfInauAnvntrrcntux in xrvim I ony see lnaWCOOna)

h Residential rental property

f Nonresidential real property

Placed in Service Dunng 2002 Tax Year

S/L e 40~ ear / 40 rs MM S/L

Summary (See instructions ) 21 fisted property Enter amount from line 28 21 22 Total Add amounts from line 12, lines 14 through 17, lines 19 and 20 in column (g), and line 21

Enter here and on the appropriate lines of your return Partnerships and S corporations see instr 22 1 710 . 23 For assets shown above and placed in service during the current year, enter the

portion of the basis attributable to section 263A costs 29 21Q 10-2S02 LHA For Paperwork Reduction Act Notice, see separate instructions Forth 4582 (2002)

Ze


F,nn 462 Depreciation and Amortization 990 DepvirtbntolMeTreuuy (Including Information on Listed Property) interhd R..^u . So, .. " See separate instructions " Attach to your tax return Name(s) sawn on return Business or xWity to which this forth reistes

United Way of Faribault Minn Inc orm 990 Page 2 part 1 ] Election To Expense Certain Tangible Property Under Section 179 Note It you have any listed property, complete Poi 1 Maximum amount See instructions for a higher limn for certain businesses 2 Total cost of section 179 property placed in service (see instructions) 3 Threshold cost of section 179 property before reduction in limitation 4 Reduction in limitation Subtract line 31rom line 2 II zero or less, enter -0

(b)Cost (businosuseony) I I .) Eleccsol cost

7 Listed property Enter amount from line 29 8 Total elected cost of section 179 property Add amounts in column (c), lines 6 and 7 B Tentative deduction Enter the smaller of line 5 or line 8 10 Carryover of disallowed deduction from line 13 of your 2001 Form 4562 11 Business income limitation Enter the smaller o1 business income (not less than zero) or line 5 12 Section 179 expense deduction Add lines 9 and 10, but do not enter more than line 11 13 Carryover of disallowed deduction to 2003 Add lines 9 and 10, less line 12 . 13 Note Do not use Pert 11 or Part III below for listed property Instead, use Part V

14 SpedN Ceprsja0on dlvaanm br queilfieE praqriy (oNC Nen IisteO propvty) PlaceO In servlp during Ne Ina Ym(fib Inelrucuona)

15 Property subject to section 168(0(1) election (see instructions)

17 MACRS deductions for assets placed in service in tax years beginning before 202 1 B If you are electing under section 16801(4) to group any assets placed in service during the tax

202 Aflbchmcnt Sequence No 87

Identifying number

41-602779 fore you complete Part I i 24 , 01C 2 3 E200.000

(e) Clewfcatlon of property R°'°"°q, (e) Canvantbn (A Meno (y Depreciation deduction OMO O I I I

275

I MM I S2 the Alternative Depreciation ;

Form 4562 (2002) Page 2 Part V Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment,

recreation, or amusement) Note For any vehicle for which you ere using the standard mileage rata or deducting lease expense, complete only 24e, 24b, columns (e) thmunh /,I n1 Rnetinn A all n1 Saebnn R anA Rxlrnn C r/ annLrahln

Section A - Depreciation and Other Information (Caution See instructions forlimrts !or

216252/1o-25-a2 Forth 4582 (2002) 19


Ibl 1c1 (d) (e) ~n 191 (h) 19 Type of property Date Business/ Cost or awls bra aro~aoon Recovery

Me thoO/ OeOreciation Elected placed in investment mu"inesft"a~l section 179 (lislvehicles first ) service use percentage other basis u� oniY) period Convention deduction

cost 25 Special depreciation allowance for qualified listed property placed in service during the tax

27

28 Add amounts in column (h), lines 25 through 27 Enter here and on line 21, page 1 29 Add amounts in column Gl . line 26 Enter here and on line 7 . oaae 1

Section B - Information on Use of Vehicles Complete this section for vehicles used by a sole proprietor, partner, or other more than 5% owner,' or related person II you provided vehicles to your employees, first answer the questions in Section C to see if you meet en exception to completing this section for those vehicles

(a) I lbl I let I "dl I let I (Q 30 Total business(nvestmenl miles cloven during the

year (do not include commuting miles) 31 Total commuting miles driven during the year 32 Total other personal (noncommutinq) miles

driven 33 Total miles driven during the year

Add lines 30 through 32 34 Was the vehicle available for personal use

during off-duty hours? 35 Was the vehicle used pnmanly by a more

than 5% owner or related person? 38 Is another vehicle available for personal

use? Section C - questions for Employers Who Provide Vehicles for Use by Then Employees

Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%

37 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your employees?

38 Do you maintain e written policy statement that prohibits personal use of vehicles, except commuting, by your employees? See instructions for vehicles used by corporate officers, directors, or 1 % or more owners

39 Do you treat all use o1 vehicles by employees as personal use? 40 Do you provide more than five vehicles to your employees, obtain information from your employees about

the use of the vehicles, end retain the information received? 41 Do you meet the requirements concerning qualified automobile demonstration use?

Note If your answer to 37, 38, 39, 40, or 47 is 'Yes, " do not complete Section B for the covered vehicles Part VI I Amortization

1c! I till AmoNU01~ Cods nnount eecllon

42

43 Amortization of costs that began before your 2002 lax year 44 Total Add amounts in column (0 See instructions for where to

Treasurer & Past President ' ̀ .. Tim Wayland ABC Financial Services " 333-5200 Work FAX 333-5660

President--Leasing Division twayland@abc-bus corn 25 4th St NW

Allocation Chair Htona Viebahn Wells Fargo-Exec Assist^ 334-5546 General FAX 332.631b

l0-i 5th St NW 332-6353 Direce _ mona viebahn@weilsfargo corn

Cnmpaf¢u Chair Jesse Akemann

Full Board ~j Gary Clark

TcoyDunn

Cate Grinney ``

Patty LaBeau

T J Nomeland

Wai Lm

Allan Shank

1

Met Con-Human Resource 332-2266 Work FAX 332-374? 3107 Industrial Drive - Jesse akemarin@met-cori corn

UPS-Corporate Sales - 334-8697 Home ~ FAX 334-9003 - UPS 7 Aspen Court (6!2)379-6574 x2176 tnclark@ups corn

Rice County Sheriffs Deputy 334-4391 Work FAX 334-0263 1914 Paulis Drive 332-05 19 Homes

FAX 334-6011 I t 77dircccor ¢ hyvee.com

rr_ 1

s

2002 United Way Qf Taribault Board of Directors President '

`~ Gary Weiers R.C . Social Service CJIrector 33.-6206 Work FAX 33?-627 320 3rd St NW - , gwercrs@co rice.mn us

ice President Todd Irtarkman Wells Fargo - VP -334-5546 General FAX 332.6336

104 NW 5th Ave. 333-6335 Direct told markman@wellsftrgo corn

Secretary Irene Paquette blcQuay International -k[.R. 33-4-5594 Work - FAX 334-7810

300 NW 24th St . ~ irenz paquzar@mcquay corn .°`'

Edward Jones - 334-1666 Work Investment Representative 404 Heritage Place

Depot Bar & Grill 332-28?i Work 3l I Heritage Place

Nomeland Dental, LLS 334-7595 Work 1413 Fairway Drive "

10 10 SAY 17th St 334-9147 Home Faribault, Mn 5021

Hy-Vee - Store Manager , 334-2031 Work 1920 Grant Street

FAX 33d-1667 cgrinney(gcharter net

FAX 332-0?60 cheftnc@lakes corn

FAX 33a-4916 tnomeland(.a- charter con

x l

Molted Way of Ferlhsult Inc . ~, Fixed Assets arid Deprecletian -J

De preaiation Report 1/01/02-12/31/02

----------------------------------- -------------------1lsaet Number Description ------------------

-------------------------------------------._____ .___. . ._ Depreciation --------------Prior Current Retirements Aeeuo -------------------------------------------

------------------Date

Acquired Life Method --------------------- Mld Qtr Coat

-----------------------

74607.75 10612 .00 7709.77 .00 12327 .77

c~t: ~~io Date:

Time: 15 :56:09

DPR107-000 Page : 1

1 Office equipment

1 Computer 4/08/94 5.00 11 SL MACH 7153 .00 7753 .00 1753 .00 2 Printer 5/31/94 5.00 11 SL MACH 277.89 277.89 277.89 3 HP Laser)et al. printer 6/07/97 5.00 71 SL MACH 488.84 439 .95 <8.89 488.84 4 Donated IBM PC3-40 r/moot 9/25/97 5.00 71 SL MNCRS 1598.00 148.20 159.80 1598.00 5 R & R software 6/01/97 5 .00 11 SL M0.CRS 160.00 544 .00 16 .00 160.00 6 SCMS softwerd 6/01/97 5 .00 11 SL MNCRS 6235.00 3871 .50 423 .50 4235.00 7 IKON copier 6/07/98 7.00 74 SL MACRS 3355.00 7677.48 479 .29 2156.77 8 Fox 6/01/98 7.00 14 SL MACRS 1000.00 499.99 162 .86 662.85 9 Desk/credenza 6/01/98 7.00 14 SL MACH 500.00 249.99 71 .43 321 .42 10 Computer 6/30/99 5.00 71 SL MACRS 7860.00 920.00 368 .00 7288.00 ----------- ----------- ----------- ----------- -----------

W

STOP Do not complete Pan II if you wen not already granted an automatic 3-month extension on a previously filed Form 8888.

Mo. D 0 H the organization does not have an office or place of business In the United States, check this box

Alternate Marling Address - Enter the address A you want the copy of this application for an additional 3-month extension returned to en address different than the one entered above

Name Judd, Ostermann a

Typo Number and street (include suite, room, a apt no ) Or a P 0 box number orprim I 2209 Hard Avenue

City or town, province or state, end country (Including postal or LP code)

13140811 766780 F349 2002 .06000 United Way of Faribault Min F349-1

0 If you are filing For an Additional (not automatic) 3-Month Extension, complete only Pert II and check this box " FT Note: Only complete Pert li d you have already been granted an automatic 3-month extension on a previously filed Form 8888 . 0 I f you are !ding for an Automatic 3-Month Extension, complete only Pert I (on papa 1) Pert 0 Additional not automatic 3-Month Extension of Time - Must file Ori final and One Co

Name of Exempt Organization Employer identification number Type or print.

United Way of Faribault Minn Inc ° ' 41-6027744 File by me

Number, street, end room or suite no If a P O box, see instructions For IRS use only ~mna.a awa.rof- 0 BOX 644 flllnp tna rewm s.. City, town or post once, state, and LP code For a foreign address, sea instructions Ift"UM.M aribault MN 55021 - - " ' " Check type of slum to be filed (File a separate application for each return) D Forth 990 ~ Forth 990-Q ~ Forth 990~T (sec 40101 or 408/ trust) D Form 1041 ~A 0 Forth 5227 D Form 8870 D Forth 990-BL ~ Forth 990-PF D Forth 99PT (trust other than above) D Forth 4720 D Forth 6069

" Ii this is for a Group Return, enter the organization's four digit Group Exemption Number (CaEN) If this Is for the whole group, check this box " D If it is for part of the group, check this box " = and attach a list with the names and EINs of ell members the extension is for

6 I request an additions] 3-month extension of time until - November 17, 2003 5 For calendar year Z 0 0 2 , or other tax year beginning end ending 8 If this tax year is for less than 12 months, check reason D Initial return D Final return Change in accounting period 7 State in dated why you need the extension

UNABLE TO GATHER NECESSARY INFO FOR TIMELY FILING

8a If flits application is for Forth 99PBL, 990-AF, 890~T . 4720, or 6064, enter the tentative tax, less any nonrefundable credits See instructions

b N this application is for Forth 980-PF, 990.7 . 4720, or 8069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed w a credit and any amount paid previously with Forth 8868 $

c Balance Due. Subtract line 8b horn line 8e Include your payment with this forth, or, A required, deposit with FTD coupon or, A required, by using EFTPS (Electronic Federal Tax Payment System) See Instructions $ NBA

Signature and Verification Under penalties o1 penury, I declare that I have examined this forth . Including accompanying schedules and statements, and to tie heat at my knowledge and belief . R is true, correct, yipcomplete, and Nat I aipaylhonzed to prepare this form

tl /~ ~/~ 3 Signature " title " P& Date r Notice to Applicant - To Be Completed by the IRS

We have approved this application Please attach this form to the organization's return We have not approved this application However, we have granted a 10day grace penod from the later of the date shown below or the due date of the organization's return (including any prior extensions) This grace period is considered to be a valid extension of time for elections

otherwise required to be made on a timely return Please attach this forth to the organization's return We have not approved this application After considenng the reasons stated in item 7, we cannot grant your request for en extension of time to file We era not granting the 10-day grace period

0 We cannot consider this application because it was filed after the due date of the return for which an extension was requested

D Other

By

Form 8888 (12-200"

Im . 99

8868 (December 2000) DmWrwnt of Me unsay Infernal Revenue Servlo

Application for Extension of Time To File an Exempt Organization Return OMB No ,sas~,7os

10, File a each return

Note : Do not complete Part II unless you have already been granted an automatic 3-month extension on a praviousry filed Form 8888 .

Part L Automatic 3-Month Extension of Time - only submit onainal (no copies needed

Note. Form 990-T corporations requesting an automatic 6-month extension - check this box end complete Part I only 10. El All other corporations (including Forth 990-C filers) must use Form 7004 to request en extension of time to file income tar returns Partnerships, REMICs end trusts must use Form 8736 to request an extension of time to file Forth 7065, 1066, or 7041

-6027744 Inc Uni File by Me due cents for filing your return S. InswcCOns

Number, street, and room or suMe no It a P O box, see instructions PO Box 644 City, town or post once, state, and ZIP code For a foreign address, see instructions Faribault, MN 55021

Form 8888 (12.2000) see Instruction

2002 .05000 United Way of Faribault Min F349 08320512 766780 F349

If you are filing for an Automatic 3-Month Extension, complete only Part 1 and check this box " OX

If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this forth)

Type or print

Name of Exempt Organization Employer identification number

Check type of rotum to be filed (file a separate application for each return)

Forth 990 ~ Forth 990~T (corporation) 0 Form 4720

0 Forth 990-BL ~ Forth 990~T (sec 401(a) or 40B(a) trust) ~ Forth 5227

0 Forth 990~EZ D Form 990 T (trust other than above) ~ Forth 6069

D Form 990 PF D Form 1041-A D Form 0870

" If the organization does not have an office or place of business in the United States, check this box " 0

" If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEM If this is for the whole group, check this

box " [:] II R is for part of the group, check this box " = and attach a list with the names and EINs of all members the extension vvill cover

1 I request an automatic 3 month (6-month, for 990-T corporation) extension of time until Augus t 15, 2 00 3

to file the exempt organization return for the organization named above The extension is for the organization's return for

" ~X calendar year z 0 0 2 or " 0 tax year beginning , and ending

2 Ii this tax yeti is for less than 12 months, check reason 0 Initial return ~ Final return D Change in accounting penod

3a If this application is for Form 990-BL, 990~PF, 990 T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b If this application rs for Forth 990~PF or 990-T, enter any refundable credits and estimated tax payments made Include any pnor year overpayment allowed as a credit

e Balance Due Subtract line 3b from line 3a Include your payment with this form, or, A required, deposit with FTD

coupon or, d required, by using EFfPS (Electronic Federal Tax Payment System) See instructions $ NBA

Signature and

Under penalties of penury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, tarred, and complete, and that I am authorized to prepare this faith

LHA For Paperwork Reduction AM

szaeai oso,-ax

m 990 re!:,urn o1 organization exempt from income...

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