mid valley mentors 2012 charity report

8/11/2019 Mid Valley Mentors 2012 Charity Report

1/21

F orm

CT-12

F o r

O r e g o n C h a r i t i e s

Charitable

Activit ies Section

Oregon Department of Just ice

1515 SW 5 th Avenue , Su i te 410

P or t l and , OR 9 7201 -545 1

Em a i l : cha r i tab l e . ac t i v i t i e s@d o j . s ta te . o r . us

Webs i te : h t tp : / / vww. d o j . s ta te . o r . us

VOICE ( 9 7 1 ) 6 7 3 - 1 8 8 0

TT Y

( 800 ) 735 -29 00

FAX

( 9 7 1 ) 6 7 3 - 1 8 8 2

F or Accou n t i ng P e r i od s Beg inn in

2012

Section I. Gene ralInformation

1.

#38039

iVIlDV A L L E Y M E N T O R S

3030 C E N T E R S T R E E T N E

S A L E M , O R 9 7 3 0 1

(503)409-6533

07/01/12 6 /30/13

C r o s sThro ugh Incorrect I tems and C orrect Here:

(See instruct ions for change of name or account ing per iod . )

Registration # :

Organization N a m e :

A d d r e s s :

Ci ty, S ta te , Z ip :

P hone :

Em a i l :

Period Beg inn ing :

Fax:

Period End ing :

' ^ ^ O ^ ^ ^ ' Q S m e n d e

^ Repor t

/ _

Did

a cer t i f ied publ ic accountant aud i t your f inancia l records? - I f yes, a t tach a copy of the aud i tor ' s repor t , f inancia i s ta tements,

accompanying no tes , sched u les , o r o the r d ocum en ts supp lem en t i ng the repo r t o r f i nanc ia l s ta tem en ts .

Is the o rgan i za t i on a pa r ty to a con t rac t i n vo l v i ng pe rson - to -pe rso n , ad ve r t i s i ng , vend ing m a ch ine o r te l ephone fund - ra i s i ng In

Oregon?

I f yes , w r i te the nam e o f the fund - ra i s i ng f i rm (s ) who cond uc ts the cam pa lgn (s ) :

H as the o rgan i za t i on o r any o f i t s o f f i ce rs , d i r ec to rs , tr us tees , o r key em p loy ees eve r s i gned a vo l un ta ry ag reem en t w i th a ny

govemment

agency, such as a sta te a t torney genera l , secre tary of s ta te , or loca l d is t r ic t a t torney, or been a par ty to lega l act ion

in any cou r t r ega rd ing cha r i tab l e so l i c i ta t ion , ad m in i s t ra t i on , m ana gem e n t , o r f i d uc ia ry p rac t i ces ? I f yes , a t tach exp lana t i on o f

each such ag reem en t o r ac t i on . See Ins t ruc t i ons .

During th is repor t ing per iod , d id the organ iza t ion amend i ts ar t ic les of incorpora t ion , bylaws, or t rust documents, OR d id the

organization rece ive a deter minat ion le t te r f rom the In terna l Reven ue Serv ice re la t ing to Its tax-e xem pt sta tus? I f yes, a t tach a

copy o f the am e nd ed d ocum en t o r l e t te r.

Is the organ iz a t ion c easing o pera t io ns an d is th is the f ina l repor t? ( I f yes , see instruc t ions on how to c lose your reg istra t ion . )

Provide

contact in format ion for the person responsib le for re ta in ing the organ iza t ion 's records.

ZlYes

m

Yes

Zl

2

Y e s 0

m Yes

Yes

Zl

Z

Name

Position

Phone

Mailing Ad d ress & Em a i l Ad d ress

SARAH C A V A Z O S

EXECUTIVE

DIRECTOR

503-409-6533

SAME A S A B O V E

List

o f Off ice rs, Di rectors, Trus tees an d Key Em ploy ees - L is t each pe rson wh o he ld one of thes e posi t ions a t any t ime dur ing the year eve n i f they

not r ece i ve com pens a t i on . A t tach ad d i t i ona l shee ts if necessa ry . I f an a t tached IRS fo rm i nc l ud es subs tan t ia l l y the sam e com p ensa t i on i n fo rm a t i o

the ph rase "Se e IRS F o rm " m ay be en te red i n li eu o f com p le t i ng tha t sec t i on . (O regon l aw requ i res a m in im um o f th ree d i rec to rs .)

(A )

Nam e , m a i l i ng ad d ress , d ay t im e phone num be r

and em a i l ad d ress

(B) Tit le &

average week l y

hou rs d evo ted to

position

(C)

Compensation

(enter $0 i f

position unpa id )

N a m e :

A d d r e s s :

P hone :

Em a i l :

SE E A T T A C H M E N T

L )

Nam e :

A d d r e s s :

P hone :

Emai l :

( )

Nam e :

A d d r e s s :

P hone :

Emai l :

( J

F o r m C o n t i n u e d o n

R e v e r s e S i d e


2/21

Section II. F ee Ca lculation

10.

11.

12.

13.

14.

15.

16.

17.

Total R e v e n u e

( F r o m

L i ne

12 (cun-ent yea r ) on Form 990;

L i ne

9 on Form 990-EZ; Par t I ,

L i ne

1 2 a o n F o r m 9 9 0 - P F ;

L i ne

9 on Forni 1041

o r F o r m

1041-A;

or see page 3 o f

ttie

ins t ruc t ions If no federa l tax re turn was pre pared . A t tac h exp lana t ion i f To ta l

R e v e n u e

Is $0 . )

$240,530.00

Revenue Fee

( S e e

char t

below. Minimum

fee is

$10,

even i f

total

revenue is a nega t ive amount )

$7

Amount

o n L i n e 9

R e v e n u e

F e e

$0

$24,999 $10

$25,000 $49,999

$25

$50,000 $99,999

$45

$100,000

$249,999

$75

$250,000 $499,999

$100

$500,000 $749,999

$135

$750,000 $999,999

$170

$1,000,000 or

more

$200

Net Asse ts o r F und Ba lances a t End o f the Repor t i ng P e r i od . . . .

( F r o m L i n e 22 (end o f yea r ) on Form 990, L i ne 21 on

F o m i

990-EZ, o r Pa r t I I I , Line

6 on F orm 99 0-P F; o r see page 3 o f CT-1 2 ins t ruc tions to ca lcu la te . )

Net F i xed Asse ts Used to Cond uc t Cha r i tab l e Ac t i v i t i e s

(Genera l ly ,

from Part X,

L i ne 10c

o n F o r m 9 9 0 ,

L i ne

2 3 B o n

F o m i

990-EZ or Par t

II,

L i ne 14b on Form 9 90-P F; o r se e page 4 o f CT-1 2 ins tn jc t ions to ca lcu la te . S ee

i nst ruct i ons

i f o rganiza t ion ow ns income-produc ing. )

Amount Sub jec t to Ne t Asse ts o r F und Ba lances F ee

( L i ne

11

m i n u s

L i ne

12. If

L i ne

11

m i n u s

L i n e

12 is

l es s

than $50,000,

write

$0.)

11.

12.

$43,232.00

13.

$0.00

Net Asse ts o r F und Ba lances F ee

( L i ne

13 mult iplied by

0001,

If the fee isl es s than $5, enter 3

Not

t o e x c e e d $ 1 ,0 0 0 . R o u n d

c e n t s

to the neares t whole do l la r . )

Ar e you f i l ing th is repor t la te? Yes No . ,

(If

yes , the la te fee is a min imum of $20, You may ow e more depen ding on how la te the repor t

is.

Se e Ins t ruc t ion

15

for addit ional information or contact the

C h a r i t a b l e

Ac t iv i t ies Sec t ion a t (971) 673-1880 to obtain late fee amount . )

Total A m o u n t D u e

(Add L i n e s

10,14, an d

15 .

Make

c h e c k

payable to the Oregon Depar tment o f

Jus t ic e . )

14.

$

15.

$2

16.

$9

Attach a copy of the organ iza t ion 's federa l 990 or o ther re turn and a l l suppor t ing schedu les and a t tachments tha t were f i led wi th the IRS wi th the

exception tha t Form 990 & 990 EZ f i le rs do not need to a t tach a copy of the i r Sched u le B. A lso , if the organ iz a t ion d id not

file

wi th the IRS or f i led a

990 -N , bu t had To ta l R evenue o f $25 ,000 o r m ore , o r Ne t Asse ts o r F und Ba lances o f $50 ,000 o r m ore , see the ins t ruc t i ons as the o rgan i za t i on m a

be

r equ i red to com p le te ce r ta i n IRS F o rm s fo r O rego n pu rpose s on l y . I f the a t tached re tu m was no t f i l ed w i th the IRS , then m a rk any such re tu rn a

"For Orego n Purp ose s Only. " I f your organ iz a t ion f i les IRS Form 990-N (e-Pos tcard) p lea se a t tach a copy or conf i rm at ion of i ts f i l ing

Please

Sign

Here

Und e r pe na l t i e s o f pe r ju r y , I d ec l a re tha t I have exam ined th i s re tu rn , in c l ud ing a il a ccom pa ny ing fo rm s , sched u les , and a t tachm en ts , an

to

t he^es t p f my know ledge and be l ie f , i t i s t rue , correct , and co mp le te .

D at l

T

Title

Paid

Preparer's

UseOnly

.F>f iepaf^s s ignature

P repa re r ' s nam e

Date

Phone

A d d r e s s


3/21

F orm 990

Departmentofthe Treas ury

Internal R e v e n u e S e r v i c e

Return

of Organization Exempt Fro m Incom e Tax

U n d e r

s e c t i o n

501 (c ) , 527 , o r4947(a)(1) of

tfie

I nt e r n a l R e v e n u e

C o d e

(except b lac i t lung

benefit t r us t o r pr iv a t e foundat ion)

The o rgan i za t i on m ay have to useacopy o f th i s r e tu rn to sa t i s fy s ta te repo r t i ng requ i rem en ts .

C M S N o . 1545-0047

2012

O p e n t o Pub l i c

I n s p e c t i o n

A

F o r t h e 2 0 1 2 c a l e n d a r y e a r , o r t a x y e a r b e g i n n i n g JUL 1. 2012 a n d e n d i n g JUN 30, 2013

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

1

lated

j

l A m e n d e d

1

1

return

1

l A p p f i c a -

1

Ition

pending

0 Nam e o f o rgan i za t i on

MID

V A L L E Y MENTORS

D E m p l o y e r i d e n t if i c a ti o n n u m b e r

2 0 - 5 5 3 1 2 3 7

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

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lated

j

l A m e n d e d

1

1

return

1

l A p p f i c a -

1

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pending

Doing

Bus iness As

D E m p l o y e r i d e n t if i c a ti o n n u m b e r

2 0 - 5 5 3 1 2 3 7

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

1

lated

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l A m e n d e d

1

1

return

1

l A p p f i c a -

1

Ition

pending

Nu mb er an d stree t (or P.O. box

if

mail is not delivered to street address) Room /suite

3 0 3 0

CENTER S T R E E T

NE

E

T e l e p h o n e n u m b e r

5 0 3 - 4 0 9 - 6 5 3 3

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

1

lated

j

l A m e n d e d

1

1

return

1

l A p p f i c a -

1

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pending

Ci ty , town , o r pos t o f f i ce , s ta te , and Z IP cod e

SALEM.OR 9 7 3 0 1

G

G r o s s r e c e i p t s

2 4 3 f 7 4 3 >

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

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j

l A m e n d e d

1

1

return

1

l A p p f i c a -

1

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pending

Ci ty , town , o r pos t o f f i ce , s ta te , and Z IP cod e

SALEM.OR 9 7 3 0 1

H(a)

Is th isag roup re tu rn

for a f f i l ia tes?

L J Y e s L X I N O

H(b)Are all affil iates include d? v e s N o

I f "No , " a t tachal i s t , (see in struc t ions )

H(c) G r o u p e x e m p t i o n n u m b e r

B C h e c kif

appl i cable ;

1

l A d d r e s s

1

I c h a n g e

1

[Name

1

I c h a n g e

I {Initial

1

Iretum

1 iTernrifn-

1

lated

j

l A m e n d e d

1

1

return

1

l A p p f i c a -

1

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pending

F Nam e and ad d ress o f p r i nc i pa l o f f i ce r :SARAH CAVAZOS

SAMEAS CABOVE

H(a)

Is th isag roup re tu rn

for a f f i l ia tes?

L J Y e s L X I N O

H(b)Are all affil iates include d? v e s N o

I f "No , " a t tachal i s t , (see in struc t ions )

H(c) G r o u p e x e m p t i o n n u m b e r

1 T a x - e x e m p t s t a t u s : L X l 501(c)(3) 1 1 501(c) ) -


4/21

For m990( 2012) MID VA L LE Y

MENTORS

2 0 - 5 5 3 1 2 3 7 Paae2

P a r t

illIStatement of ProgramS e r v i c e A c c o m p l i s h m e n t s

Che ck if Sche dule 0 conta ins a respo nse to any ques tion in this Part III I I

1 Briefly describe the organization's mission:

TO

P ROVIDE QUA LITYMENTORING FOR A T - R I S K

YOUTH

AND F A M I L I E S THAT

O F F E R S NEW

P E R S P E C T I V E S

ON L I F AND LEADS TO BRIG HTER FUTURES.

2

Did the organ izatio n unde rtake any signifi cant prog ram services during the year whic h were not listed on

th e

prior Form 990 or 990-E2?

CZjYes

C x ] N O

If Yes, describ e these new services on Schedule 0 .

3

Did the organization cease conductin g, or make significant changes In how It cond ucts , any program services? [ZHves IXINo

If Yes, describ e these changes on Schedule O.

4 Describe the organization's program service accompl ishmen ts for each of its three largest program sen/Ices, as measured by expenses.

Sect ion

501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and

revenue, if any, for each program service reported.

4a ( C o d 6 :

)

( E x p e n s e s

7 0 , 6 3 6 .

i nc ludi ng grants o f

)

( R e v e n u e

1 9 , 9 8 4 .

)

THE J U V E N I L E ENRICHMENT

THROUGHMENTORING (JEM)PROGRAM PROV IDES

EVIDENCE-BASED

VOLUNTEER-DRIVEN

MENTORING

FOR

A T - R I S K YOUTH

I N

S A L E M - K E I Z E R

OREGON

WHO

HAVE

A

PARENT

I N PRISON, ARE

UNDER S U P E R V I S I O N

OF THE

J U V E N I L E

DEPARTMENT OR WHO HAVEMUL TIP LE FACTORS ASSOCIA TED

WITH

R I S K

FOR

SCHOOL

F A I L U R E .

DURING

THE

2 0 1 2 - 1 3

F I S C A L

YEAR THE

PROGRAM

PROVIDING

ONE-TO-ONE

MENTORING RELA TIONSH IP S FOR THIRTY-FOUR YOUTH.

4 b ( C o d e :

)

( E x p e n s e s

1 9 3 , 0 9 9 .

i n c l u d i n g g r a n t s o f 8 , 0 0 0 . ) ( R e v e n u e

1 7 0 , 2 0 3 .

)

THE

REENTRY SOLUTIONPROGRAM ( RSP ) PROVIDE PRE- AND POST- REL EASE

T R A N S I T I O N

AND SUPPORT

S E R V I C E S

FOR INCARC ERATED PARENTS

R E L E A S I N G

TO

MARION

COUNTY.

DURING

THE

2 0 1 2 - 1 3 F I S C A L

YEAR THE

PROGRAM

CONDUCTED

F O R T Y - S I X

C L I E N T

ASSESSMENTS. PROVIDED 64

C L I E N T S WITH

PREAND/OR POST

R E L E A S E

MENTORING

AND

F A C I L I T A T E D

F IFTY- TWO TRA NSITI ON

EDUCATION/SUPPORT

GROUPS.

4c

( c o d e :

)

( E x p e n s e s

$ including grants of $ )

( R e v e n u e

$

4d Other pro gra m servic es (Describe in Sche dule O.)

( E x p a n s e s

$

i n c l u d i n a

grants of $ )

( R e v e n u e

$

4e

T o t a l

program

s e r v i c ee xp e n s e s

2 6 3 , 7 3 5 .

Form99 (2012

232002

12-10-12


5/21

Part IV

C h e c k l i s t

o f Re q u i re d

S c h e d u l e s

Y e s No

1

I s the o rg an iza t io n de sc r ib e d in sec t io n 501(c ) (3) o r 4947(a ) (1 ) (o t her t han a p r i va te f o und a t io n )?

If Yes, complete Schedule A

1

X

2

I s t he o rgan iza t io n requ i red t o co m p le te Schedule B, Schedule of Contributors

2

X

3

D id t he o rgan iza t io n engag e in d i rec t o r ind i rec t po l it i ca l cam pa ign ac t i v i t i es o n b eha l f o f o r in o ppo s i t i o n t o cand ida tes f o r

pub l i c o f f i ce? If Y es, compiete Schedule C, Part

1

3

X

4 S e c t i o n

5 0 1 ( c X 3 ) o r g a n i z a t i o n s .D id t he o rgan iza t io n engag e in l o b b y ing ac t i v i t i es , o r have a sec t io n 5 01 (h ) e lec t io n i n e f f ec t

dur ing t he t ax year?

If Yes, complete Schedule C, Part li

4

X

5 I s t he o rgan iza t io n a sec t io n 501 (c)(4),5 0 1(c)(5),o r 501 (c )(6 ) o rgan iza t io n t ha t rece ives m emb ersh ip due s , assessm ents , o r

s i m il a r a m o u n t s a s d e f i n e d i n R e v e n u e P r o c e d u r e 9 8 - 1 9 ? T e s , " c o m p / e fe S c h e d u / e C , P a r t / / /

5

X

6

D id t he o rgan iza t io n ma in ta in any do no r adv i sed f unds o r any s im i l a r f und s o r acc o un t s f o r wh ic h do no rs have t he r i gh t t o

p ro v ide adv ice o n t he d i s t r i b u t io n o r i nves tment o f amo unt s i n such f unds o r acco un t s?

If Yes, compiete Schedule D, Part1

7

D id t he o rgan iza t io n rece ive o r ho ld a co nsen /a t i o n easem ent , i nc lud ing easeme nts t o p reserve o pen space ,

t he env i ro nme nt , h i s t o r ic l and a reas , o r h i s t o r i c s t n j c t u res ? If Yes, compie te Schedu le D, Part II . .

6

X

6

D id t he o rgan iza t io n ma in ta in any do no r adv i sed f unds o r any s im i l a r f und s o r acc o un t s f o r wh ic h do no rs have t he r i gh t t o

p ro v ide adv ice o n t he d i s t r i b u t io n o r i nves tment o f amo unt s i n such f unds o r acco un t s?

If Yes, compiete Schedule D, Part1

7

D id t he o rgan iza t io n rece ive o r ho ld a co nsen /a t i o n easem ent , i nc lud ing easeme nts t o p reserve o pen space ,

t he env i ro nme nt , h i s t o r ic l and a reas , o r h i s t o r i c s t n j c t u res ? If Yes, compie te Schedu le D, Part II . .

7

X

8

D id t he o rgan iza t io n ma in ta in co l l ec t i o ns o f wo rks o f a r t , h i s t o r i ca l t reasures , o r o t her s im i l a r asse t s?

If Yes, compiete

Scheduie D, Part iii

8

X

9

D id the orga niza t ion rep ort an am oun t in Part X, l ine 2 1 , f o r esc ro w o r cus to d ia l acco u n t l i ab i l it y ; se rve as a cus to d ia n f o r

am o un t s no t l i s t ed i n Par t X ; o r p ro v ide c red i t co unse l i ng , deb t man age men t , c red i t repa i r , o r deb t neg o t ia t i o n se rv i ces?

If

Yes, compiete Schedule D, Part IV

9

X

10

D id t he o rgan iza t io n , d i rec t l y or t h ro u gh a re la t ed o rgan iza t io n , ho ld asse t s i n t empo rar i l y res t r i c t ed en do w me nts , pe rman ent

e n d o w m e n t s , o r q u a s i - e n d o w m e n t s ?

If Yes,' complete Schedule D, Part V

10

X

11 I f t he o rgan iza t io n ' s answer t o any o f t he f o ll o w ing ques t io ns i s "Yes , " t hen co m p le te Sch edu le D, Par t s VI ,V I I ,

V l l l ,

IX, or X

as app l i cab le .

a

D id t he o rgan iza t io n repo r t an amo u nt f o r

l and ,

b u i l d ings , and equ ipm ent i n Par t X , l i ne 10? If

Yes,

compiete Scheduie D,

Part

VI

11a

X

b

D id the organ izat ion re port an amo un t fo r investm en ts o ther sec ur i t ies in Part X, l ine 12 that is 5% or more o f it s to ta l

assets reported in Part X, l ine 16? If

Yes,

complete Schedule D, Part Vll

l ib

X

c D id the organiza t ion repor t an am oun t fo r invest me nts - pro gra m related in Part X, l ine 13 that is 5% or more o f i t s to ta l

asse t s rep o r t ed i n Par t X , l ine 16?

If Yes, compiete Schedule D, Part Vlii

11c

X

d

D id the organ izat ion rep ort an amo unt fo r o the r ass ets In Part X, l ine 15 tha t is 5% or more o f Its to ta l asse ts reporte d in

Part X, l ine 16? if Yes, compiete Schedule D, Part IX

l id

X

e

D id the orga niza t ion repor t an amo un t fo r o the r l iab i l i ties in Part X, l ine 25 ?

If Yes, complete Scheduie D, Part X

l i e

X

f

D id t he o rgan iza t io n ' s separa te o r co nso l i da ted f i nanc ia l s t a t em ent s f o r t he t ax year inc lude a f o o tno te t ha t add resses

the o rga n iza t io n ' s l i ab il i ty f o r uncer t a in t ax po s i t i o ns und er F IN 48 (ASC 740)? If Yes, complete Scheduie D, Part X

l i t

X

1 2a D id t he o rgan iza t io n o b ta in separa te , i nde pen den t aud i t ed fi nanc ia l s t a t em ent s f o r t he t ax year? if Yes, complete

Schedule

D, Parts Xi and XII

12a

X

b

Was t he o rgan iza t io n i nc luded in co nso l i d a ted , i ndep ende n t aud i t ed fi nanciad s t a t em ent s f o r t he t ax year?

If

"Ves, "and if the organization answered No to line 12a, then completing Schedule D, Parts Xi and Xii is optional 12b

X

13

I s the orga niza t ion a sch oo l des cr ib ed in sec t ion 170(b)(1)(A)( ii )? If Yes, com plete Schedule E

13

X

1 4a

D id t he o rgan iza t io n ma in ta in an o f f ice , emp lo yees , o r agen t s o u t s ide o f t he Un i t ed S ta tes?

14a

X

b

D id t he o rgan iza t io n have aggrega te revenues o r expen ses o f mo re t han $10 ,00 0 f ro m gran tmak ing , f und ra i s ing , b us ine ss ,

i nves tment , and p ro gram serv i ce ac t i v i t i es o u t s ide t he Un i t ed S ta tes , o r aggrega te f o re ign i nves tment s va lued a t $100 ,000

o r mo re?

If Yes, complete Scheduie F, Parts

1

and IV

14b

X

15 D id t he o rgan iza t io n repo r t o n Par t IX , co lum n (A), l i ne 3 , mo re t han $5 ,000 o f g ran t s o r ass i s t anc e t o any o rgan iza t io n

or

en t i t y l o ca ted o u t s ide t he Un i t ed S ta tes?

If Yes,' complete Schedule F, Parts II and IV 15

X

16

D id t he o rgan iza t io n repo r t o n Par t IX , co lum n (A), l i ne 3 , mo re t han $5 ,000 o f aggrega te g ran t s o r ass i s t an ce t o i nd i v idua l s

lo ca ted o u t s ide t he Un i t ed S ta tes? if

Yes,

complete Schedule F, Parts

iii

and IV

16

X

17

D id t he o rgan iza t io n repo r t a t o t a l of mo re t han $15 ,000 o f expe nses f o r p ro fess io na l f und ra i s ing se rv i ces o n Par t IX ,

c o l u m n

(A) , l ines 6 and

l i e ? / r ' / e s , c o m p / e f e S c h e c f u t e

G , P a r t /

17

X

18

D id t he o rgan iza t io n repo r t mo re t han $15 ,000 t o t a l o f f und ra i s in g even t g ro ss i nco me and co n t r i b u t io ns o n Par t

V l l l ,

l ines

1 c and 8a? If 'Yes, comple te Schedu le G, Part li

18

X

19

D id t he o rgan iza t io n repo r t mo re t han $15 ,0 00 o f g ro ss i nco me f ro m gam ing ac t iv i t i es o n Par t

V l l l ,

l ine 9a?

If Yes,

complete

Schedu le G, Part III

19

X

2 0 a

D id t he o rgan iza t io n o pera te o ne o r mo re ho sp i t a l f ac i l i ti es?

If Yes, complete Schedule hi

2 0 a

X

b

If "Yes " t o li ne 20a , d id t he o rqan iza t io n a t t ach a co py o f it s aud i t e d fi nanc ia l s t a t em ent s t o t h i s re t u rn?

20b

Fo rm

99

(2012

232003

12-10-12


6/21

Part IV

C h e c k l i s t

o f R e q u i r e d

S c h e d u l e s

(continued)

Y e s

No

21

D id the o rgan i za t i on repo r t m ore than $5 ,000 o f g ran ts and o the r ass i s tance to any gove rnm en t o r o rgan i za t i on i n the

United S ta tes on Par t IX , co lumn (A) , l ine 1 ?

If Yes, complete Sctiedule

1,

Parts

1

and II

21

X

22

D id the o rgan i za t i on repo r t m ore than $5 ,000 o f g ran ts and o the r ass i s tanc e to ind i v i d ua l s In the Un i ted S ta tes on P a r t IX ,

column (A), l ine 2? If Yes, complete Scheduie 1, Parts 1and Ili

22

X

23 D id the o rgan i za t i on answ e r "Yes" to P a r t V l l , Sec t i on A , line 3 ,4 , o r 5 abou t com pensa t i on o f the o rgan i za t i on ' s cu r ren t

an d fo rm e r o f f i ce rs , d i r ec to rs , t r us tees , key em p loyees , and h i ghes t com pensa ted em p loyees?

If Yes, complete

Scheduie J

23 X

2 4 a D id the o rgan i za t i on have a tax -exem p t b ond i ssue w i th an ou ts tand ing p r i nc i pa l am o un t o f m ore than $100,000 as of the

last d ay o f the yea r , tha t was i ssued a f te r Decem ber 3 1 , 2 0 0 2 ? If Yes, answer lines 24b through 24 d and complete

Scheduie K. If No , go to line 25

2 4 a

X

b D id the o rgan i za t i on i nves t any p roce ed s o f tax -exem p t bond s bey ond a tem p ora ry pe r i od ex cep t i on ?

24b

c

D id the o rgan i za t i on m a in ta i n an esc row acc oun t o the r than a re fund ing esc row a t any t im e d u r i ng the yea r to d e fease

any

t a x -e x e m p t b o n d s ?

2 4 c

d

D id the o rgan i za t i on ac t as an "on beha l f o f " i ssue r fo r bond s ou ts tan d ing a t any t im e d u r i ng the yea r?

24d

2 5 a S e c t i o n501(c)(3) a n d501(c)(4) o r g a n i z a t i o n s . D id the o rgan i za t i on engage i n an excess bene f i t t r ansac t i on w i th a

disqualified pe rson d u r i ng the yea r? If Yes, complete Scheduie L, Part1

2 5 a

X

b I s the o rgan i za t i on aw a re tha t i t engag ed i n an excess b ene f i t t r ansac t i on w i th a d i squa l i f i ed pe rson i n a p r i o r yea r , and

that

t he t r ansac t i on has no t been repo r ted on any o f the o rgan i za t i on ' s p r i o r F o rm s 990 o r 990 -EZ?

If Yes, complete

Schedule L, Part 1

25b

X

26

Wa s a l oan to o r by a cu r ren t o r fonne r o f f i ce r , d i r ec to r , tm s tee , key em p loyee , h i ghes t com p ens a ted em p loyee , o r d i squa l i f i ed

person ou ts tand ing as o f the end o f the o rgan i za t i on ' s tax yea r?

If Ye s, complete Schedule L, Part II

26

X

27 D id the o rgan i za t i on p rov i d e a g ran t o r o the r ass i s tance to an o f f i ce r , d i r ec to r , tm s tee , key em p loy ee , sub s tan t i a l

con t r i bu to r o r em p loyee the reo f , a g ran t se l ec t i on com m i t tee m em ber , o r to a 35% con t ro l l ed en t i t y o r fam i l y m em ber

o f any o f these pe rsons? If Y es, complete Scheduie L, Part III

27 X

28

Was the o rgan i za t i on a pa r ty to a bus iness t r ansac t i on w i th one o f the fo l l ow ing pa r t i e s ( see Sche d u le L , P a r t IV

i ns tm c t i ons fo r app l i cab le f i l i ng th resho ld s , cond i t i ons , and excep t i ons ) :

a A cu r ren t o r fonne r o f f ice r , d i rec to r , tm s te e , o r key em p loyee? if Yes, compiete Scheduie L, Part IV

2 8 a

X

b A fam i l y m em ber o f a cu r ren t o r fo rm e r o f f i ce r , d i r ec to r , tm s tee , o r key em p loyee ? if Yes, compiete Schedule L, Part IV

28b

X

c An en t i t y o f wh i ch a cun -ent o r fo rm e r o f f i ce r , d i r ec to r , tm s te e , o r key em p loye e (o r a fam i l y m em ber the reo f ) was an o f f i ce r ,

director, tm s tee , o r d i r ec t o r i nd i rec t owne r?

If Yes, compiete Schedule L, Part IV

2 8 c

X

29 D id the o rgan i za t i on rece i ve m ore than $25 ,000 in non -cash con t r i bu t i on s? if Yes, complete Schedule M 29

X

30 Did t he o rgan i za t i on rece i ve con t r i bu t i ons o f a r t , h i s to r i ca l t r easu res , o r o the r s im i l a r asse ts , o r qua l if i ed conse rva t i on

contributions? If Yes, compiete Scheduie M

30

X

31 D id the o rgan i za t i on l i qu i d a te , te rm ina te , o r d i sso l ve and cease ope ra t i ons?

if Yes,' complete Schedule N, Part1

31

X

32 D id the o rgan i za t i on se l l , e xchange , d i spose o f , o r t r ans fe r m ore than 25% o f i t s ne t asse ts? / f Yes, compiete

Scheduie N, Part II

32 X

33 D id the o rgan i za t i on ow n

1 0 0 %

o f an en t i t y d i s rega rd ed as sepa ra te f r om the o rgan i za t i on und e r Regu la t i ons

s e c t i o n s301.7701-2 an d 301.77 01 -3?

If Yes, compiete Schedule

R,

Part

1

33

X

34 Was the o rgan i za t i on re l a ted to any tax -exem p t o r taxab le en t i t y? If 'Yes, compiete Schedule R, Part II, ill, or IV, and

PartV, iine 1

34 X

3 5 a D id the o rgan i za t i on have a con t ro l l ed en t i t y w i th i n the m ean ing o f sec t i on 512(b)(13)? 3 5 a

X

b

I f "Yes" to l ine 35a , d i d the o rgan i za t i on rece i ve any paym en t f r om o r engag e i n any t r ansac t i on

with

a con t ro l l ed en t i t y

within

t he m ean ing o f sec t i on

512(b)(13)?

If 'Yes, complete Schedule R, Part V, line 2

35b

36

S e c t i o n

501(c)(3)

o r g a n i z a t i o n s .Did t he o rgan i za t i on m a ke any t r ans fe rs to an exem p t non -cha r i tab l e re l a ted o rgan i za t i on?

If

Yes, compiete Schedule R, Part V, line 2

36

X

37 D id the o rgan i za t i on con d u c t m ore than 5% o f it s ac t i v i t i e s th rou gh an en t i t y tha t is no t a re l a ted o rgan i za t i on

and t ha t i s t r ea ted as a pa r tne rsh ip fo r fed e ra l i n com e tax pu rpose s? If Yes, compiete Schedule R, Part VI

37 X

38

Did t he o rgan i za t i on com p le te Sched u le 0 a nd p rov i d e exp lan a t i ons i n Sche d u le 0 fo r P a r t V I , l i nes l i b a n d 19?

Note.

A l l F o rm 990 f i l e rs a re requ i red to com p le te Sc hed u le 0

38

X

F o r m

99 0

(2012

232004

12-10-12


7/21

F orm

990 (2012)

MID

V A L L E Y MENTORS 2 0 - 5 5 3 1 2 3 7

PaaeS

P a r t V

S t a t e m e n t s R e g a r d i n g O t h e r I R S

F i l ings

a n d T a x C o m p l i a n c e

Check i f Sche d u le O con ta i ns a respons e to any ques t i on i n th i s P a r t V

Y e s No

l a En te r the num b e r repo r ted i n Box 3 o f F o rm 1096 . En te r

-0-

i f not app l icable

l a 0

I c

b

En te r the num be r o f F o rm s W-2G i nc l ud ed i n l ine

l a .

En te r -O- I f not app l icable

l b 0

I c

0 D id the o rgan i za t i on com p l y w i th bac kup w i thho ld i ng ru les fo r r epo r tab l e paym en ts to vend o rs and repo r tab l e gam ing

(gam b l i ng ) w inn ings to p r i ze w inne rs?

I c

2 a

En te r the num b e r o f em p loyee s repo r ted on F o rm W-3 , T ransm i t ta l o f Wa ge and Tax S ta tem e n ts ,

filed

fo r the ca l end a r yea r end ing w i th o r w i th i n the yea r cove red by th i s re tu rn 2 a

1 3

2b

X

I f a t least one is repor ted on l ine 2a, d id the organ iza t ion f i le a l l requ i red federa l employment tax re tur

Note. I f the sum of l ines 1 a and 2a Is g rea te r than 250 , you m ay be requ i red to e-file ( see i ns tm c t i ons

3 a D id the o rgan i za t i on have un re l a ted bus iness g ross i ncom e o f $1,000 o r m ore d u r i ng the yea r?

ns?

2b

X

I f a t least one is repor ted on l ine 2a, d id the organ iza t ion f i le a l l requ i red federa l employment tax re tur

Note. I f the sum of l ines 1 a and 2a Is g rea te r than 250 , you m ay be requ i red to e-file ( see i ns tm c t i ons

3 a D id the o rgan i za t i on have un re l a ted bus iness g ross i ncom e o f $1,000 o r m ore d u r i ng the yea r?

)

3 a

X

b I f "Ye s," has i t f i led a Form 990-T for th is year? If No, provide an expianation in Scheduie 0

3b

4 a

A t any t im e d u r i ng the ca l end a r yea r , d i d the o rgan i za t i on have an i n te res t i n , o r a s i gna tu re o r o the r au tho r

financial a cco un t i n a fo re i gn coun t r y ( such as a bank acc oun t , secu r i t i e s acc oun t , o r o the r f i nanc ia l acco u

b

I f "Yes , " en te r the nam e o f the fo re i gn cou n t r y :

ty over , a

nt)?

4 a X

4 a

A t any t im e d u r i ng the ca l end a r yea r , d i d the o rgan i za t i on have an i n te res t i n , o r a s i gna tu re o r o the r au tho r

financial a cco un t i n a fo re i gn coun t r y ( such as a bank acc oun t , secu r i t i e s acc oun t , o r o the r f i nanc ia l acco u

b

I f "Yes , " en te r the nam e o f the fo re i gn cou n t r y :

5 a

X

See

i n s tm c t i ons fo r f i l i ng requ i rem en ts fo r F o rm TD F 9 0 - 2 2 . 1 , Repo r t o f F o re ign Bank and F inanc ia l /

5 a Wa s the o rgan i za t i on a pa r ty to a p roh ib i ted tax she l te r t r ansac t i on a t any t im e d u r i ng the tax yea r?

b D id any taxab le pa r ty no t i f y the o rgan i za t i on tha t i t was o r I s a pa r ty to a p roh ib i ted ta x she l te r t r ansa

Accoun ts .

5 a

X

See

i n s tm c t i ons fo r f i l i ng requ i rem en ts fo r F o rm TD F 9 0 - 2 2 . 1 , Repo r t o f F o re ign Bank and F inanc ia l /

5 a Wa s the o rgan i za t i on a pa r ty to a p roh ib i ted tax she l te r t r ansac t i on a t any t im e d u r i ng the tax yea r?

b D id any taxab le pa r ty no t i f y the o rgan i za t i on tha t i t was o r I s a pa r ty to a p roh ib i ted ta x she l te r t r ansa

ction?

5b

X

c I f "Yes ," to l ine 5a or 5b , d id the organ iz a t ion f i le Form 888 6-T?

5 c

6 a Does the o rgan i za t i on have annua l g ross rece ip ts tha t a re no rm a l ly g rea te r than $10 0 ,00 0 , and d i d the o rgan i za t i on so l i c i t

any

con t r i bu t i ons tha t we re no t tax d ed uc t i b l e as cha r i tab l e con t r i bu t i ons?

6 a

X

b

I f "Yes , " d i d the o rgan i za t i on i nc l ud e w i th eve ry so l i c ita t i on an exp ress s ta te m en t tha t such con t r i bu t i ons o r g i f t s

were no t tax d ed uc t i b l e?

6b

7 O r g a n i z a t i o n sthat m a y r e c e i v e d e d u c t i b l e c o n t r ib u t i o n s u n d e r s e c t i o n 170(c) .

a Did the organization receive a paymen t in excess of $75 made partly as a contr ibution and partly for good s and sen/Ices provided to the payor?

b

I f "Yes , " d i d the o rgan i za t i on no t i f y the d ono r o f the va l ue o f the good s o r sen / i ces p rov i d ed ?

7 a

X

7 O r g a n i z a t i o n sthat m a y r e c e i v e d e d u c t i b l e c o n t r ib u t i o n s u n d e r s e c t i o n 170(c) .

a Did the organization receive a paymen t in excess of $75 made partly as a contr ibution and partly for good s and sen/Ices provided to the payor?

b

I f "Yes , " d i d the o rgan i za t i on no t i f y the d ono r o f the va l ue o f the good s o r sen / i ces p rov i d ed ?

7b

c

D id the o rgan i za t i on se l l , e xchange , o r o the rw i se d i spose o f tang ib l e pe rsona l p rope r ty fo r wh i ch i t was requ i red

to

f i l e F o rm 8282?

7 c

X

d

I f "Yes , " i nd i ca te the num be r o f

Fomns

8282 f i led dur ing the year 7 d

7e

X

Did the o rgan i za t i on rece i ve any fu nd s , d i r ec t l y o r Ind i rec tl y , to pay p rem ium s o n a pe rsona l bene f i t con t rac

f Did t he o rgan i za t i on , d u r i ng the yea r , pay p rem ium s, d i r ec t l y o r i nd i rec t l y , on a pe rsona l bene f i t con t rac t?

g I f t he o rgan i za t i on rece i ved a con t r i bu t i on o f qua l i f i ed i n te l le c tua l p rope r ty , d i d the o rgan i za t i on f il e F o rm88

;t?

7e

X

Did the o rgan i za t i on rece i ve any fu nd s , d i r ec t l y o r Ind i rec tl y , to pay p rem ium s o n a pe rsona l bene f i t con t rac



7f

X

e D id the o rgan i za t i on rece i ve any fund s , d i r ec t l y o r Ind i rec t ly , to pay p rem ium s o n a pe rson a l bene f i t con t rac



99 a s requ i red ?

79

X

h

I f t he o rgan i za t i on rece i ved a con t r i bu t i on o f ca rs , boa t s , a i r p lanes , o r o the r veh i c l es , d i d the o rgan i za t i on f il e a F o rm

1098-C?

8 Sponsoring

organizations maintaining donor

advised

funds and

section

509(a)(3) supporting organizations.

Did the supporting

organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any

time

during the year?

9 S p o n s o r i n g o r g a n i z a t i o n s m a i n t a i n i n g d o n o r a d v i s e df u n d s .

a

D id the o rgan i za t i on m ake any taxab le d i s t r i bu t i ons und e r sec t i on 49 66?

7h

X

I f t he o rgan i za t i on rece i ved a con t r i bu t i on o f ca rs , boa ts , a i r p lanes , o r o the r veh i c l es , d i d the o rgan i za t i on f i le a F o rm

1098-C?

8 Sponsoring


advised

funds and

section


Did the supporting


time

during the year?


a


8

X

h

I f t he o rgan i za t i on rece i ved a con t r i bu t i on o f ca rs , boa t s , a i r p lanes , o r o the r veh i c l es , d i d the o rgan i za t i on f il e a F o rm

1098-C?

8 Sponsoring


advised

funds and

section


Did the supporting


time

during the year?


a


9 a X

b D id the o rgan i za t i on m ake a d i s t r i bu t i on to a d ono r , d on o r ad v i so r , o r r e l a ted pe rs on?

9b

X

10 S e c t i o n 5 0 1 ( c K 7 ) o r g a n i z a t i o n s . Enter :

a I n i t i a ti on fees and cap r ta l con t r i b u t i ons i nc l ud ed on P a rt V l l l , l ine 12

10a

12a

b G ross rece ip ts , i n c l ud e d on F o rm 990 , P a rt V l l l , l ine 1 2 , for publ ic use of c lub fac i l i t ies

10b

12a

11 S e c t i o n

501(c)(12)o r g a n i z a t i o n s .

Enter :

a

G ross i ncom e f rom m em bers o r sha reho ld e rs

11a

12a

b G ross i ncom e f rom o the r sou rces (Do no t ne t am o un ts d ue o r pa id to o the r sou rc es aga ins t

am oun ts d ue o r r ece i ved f rom them . )

l ib

12a

2a S e c t i o n 4947(a)(1)n o n - e x e m p t c h a r i t a b l e t r u s t s . Is the organ iza t ion f il ing Fo rm 990 in

lieu

of Fomn

1041?

b I f "Yes ,"enter the am oun t o f tax -exem p t i n te res t r ece i ved o r accm ed d u r i ng the yea r 12b |

12a

2a S e c t i o n 4947(a)(1)n o n - e x e m p t c h a r i t a b l e t r u s t s . Is the organ iza t ion f il ing Fo rm 990 in

lieu

of Fomn

1041?

b I f "Yes ,"enter the am oun t o f tax -exem p t i n te res t r ece i ved o r accm ed d u r i ng the yea r 12b |

13 S e c t i o n

501(c)(29)

qua l i f i ed nonpr o f i t h ea l t h i n s u r a n c e i s s u e r s .

a

I s the o rgan i za t i on l i censed to I ssue qua l i f i ed hea l th p l ans in m ore than one s ta te?

13 S e c t i o n

501(c)(29)

qua l i f i ed nonpr o f i t h ea l t h i n s u r a n c e i s s u e r s .

a

I s the o rgan i za t i on l i censed to I ssue qua l i f i ed hea l th p l ans in m ore than one s ta te?

13a

Note. See the i ns tm c t i ons fo r ad d i t i ona l i n fo rm a t i on the o rgan i za t i on m us t r epo r t on Sched u le 0 .

b En te r the am o un t o f r ese rves the o rgan i za t i on I s requ i red to m a in ta i n by the s ta tes i n wh i ch th e

organization Is l i censed to issue qua l i f ied hea l th p lans

13b

c

En te r the am oun t o f r ese rves on hand

13c

14a D id the o rgan i za t i on rece i ve any paym en ts fo r ind oo r tann ing se rv i ces d u r i ng the tcix yea r?

14a

X

b I f "Yes ," has it f iled a Form 720 to repo r t the se oavments? If No, provide an explanation in Scheduie O

14b

Form

9 90

(2012

232005

12-10-12


8/21

F o r m99 0 (2012)

MID

V A L L E Y MENTORS

2 0 - 5 5 3 1 2 3 7 PaoeS

Part V I

I G o v e r n a n c e ,

M a n a g e m e n t , a n d

D is c l o s ur e Foreach T e s " response to lines 2 through 7b beiow, and for a No response

to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.

Check i f Sched u le O con ta i ns a response to any ques t i on i n th i s P a r t V I LXj

S e c t i o n A . G o v e m i n g B o d y a n d M a n a g e m e n t

Y e s No

l a En te r the num b e r o f vo t i ng m em bers o f the gove rn ing bod y a t the end o f the tax yea r l a

7

2

X

If there are material differences in voting rights among members of the governing body, or if the governing

bodydelegated broad authority to an executive committee or similar committee, explain in Schedule 0.

b

En te r the num be r o f vo t i ng m em bers i nc l ud ed i n l ine 1 a , above , wh o a re i nd epe nd en t

lb

7

2

X

2 D id any o f f i ce r , d i r ec to r , tm s tee , or key em p loyee have a fam i l y r e l a t i onsh ip o r a bus iness re l a t i onsh ip w i th any o the r

officer, d i r ec to r , tm s tee , o r key em p loyee? 2

X

3 D id the o rgan i za t i on d e l ega te con t ro l ove r m ana gem e n t d u t i es cus tom ar i l y pe r fo rm ed by o r und e r the d i r ec t supe rv i s i on

o f

o f f i ce rs , d i r ec to rs , o r tm s tees , o r key em p loyees to a m anagem en t com pany o r o the r pe rson?

3

X

4 D id the o rgan i za t i on m ake any s i gn i f i can t chan ges to i t s gove rn ing d ocu m en ts s i nce the p r i or F o rm 990 wa

5 D id the o rgan i za t i on beco m e awa re d u r i ng the yea r o f a s i gn i f i can t d i ve rs i on o f the o rgan i za t i on ' s asse ts ?

6 D id the o rqan i za t i on have m em b ers o r s tock ho ld e rs ?

s f i led?

4 XDid the o rgan i za t i on m ake any s i gn i f i can t changes to i t s gove rn ing d ocum en ts s i nce the p r i o r F o rm 990 wa


6 D id the o rqan i za t i on have m em b ers o r s tock ho ld e rs ?

5 X

4 D id the o rgan i za t i on m ake any s i gn i f i can t chan ges to i t s gove rn ing d ocu m en ts s i nce the p r i or F o rm 990 wa


6 D id the o rqan i za t i on have m em b ers o r s tock ho ld e rs ? 6 X

7 a

D id the o rgan i za t i on have m em bers , s tockho ld e rs , o r o the r pe rsons wh o had the pow e r to e l ec t o r appo in t one o r

more m em bers o f the gove rn ing bod y?

7 a X

b

A re any gove rnanc e d ec i s i ons o f the o rgan i za t i on rese rved to ( or sub jec t to app rova l by ) m em ber s , s tockho ld e rs , o r

p e r s o n s o t h e r t h a n t h e g o v e m i n g b o d y ? 7b

X

8

Did the organization contemp oraneous ly docum ent the meetings held or written actions undertaken during the year by the follow ing:

a T h e g o v e m i n g b o d y ?

8 a X

b

Each com m i t tee w i th au tho r i t y to ac t on beha l f o f the govem in g b od y?

8b

X

9 I s the re any o f f ice r , d i r ec to r , tm s tee , o r key em p loyee l i s ted in P a r t V l l , Sec t i on A , wh o canno t be reached a t the

o raan i za t i on ' s m a i l i nq ad d ress? If 'Yes, provide the names and addresses in Schedule 0

9 X

S e c t i o n

B .

P o l i c i es (This Section

S

requests information about policies not required by the intemal Revenue Code.)

Y e s No

1 0a

D id the o rgan i za t i on have l oca l chap te rs , b ranc hes , o r a ff i l ia tes?

10a

X

b

I f "Yes , " d i d the o rgan i za t i on have wr i t ten po li c i es and p roced u re s gove rn ing the ac t i v i t i e s o f suc h chap te rs , a f f il i a tes ,

and b ranches to ensu re the i r ope ra t i ons a re cons i s ten t w i th the o rgan i za t i on ' s exem p t pu rposes? 10b

1

l a H as the o rgan i za t i on p rov i d ed a com p le te co py o f th i s F o rm 990 to a l l m em bers o f i t s gove rn ing bod y be fo re fi l ing the fo rm ?

b

Desc r i be i n Sch ed u le 0 the p roces s , if any , used by the o rgan i za t i on to rev i ew th i s F o rm 990 .

1 2 a D id the o rqan i za t i on have a wr i t ten con f l i c t o f i n te res t po l i cy? If No, go to line 13

11a

X

l a H as the o rgan i za t i on p rov i d ed a com p le te co py o f th i s F o rm 990 to a l l m em bers o f i t s gove rn ing bod y be fo re fi l ing the fo rm ?

b

Desc r i be i n Sch ed u le 0 the p roces s , if any , used by the o rgan i za t i on to rev i ew th i s F o rm 990 .

1 2 a D id the o rqan i za t i on have a wr i t ten con f l i c t o f i n te res t po l i cy? If No, go to line 13 12a

X

b

Were officers , directors, or trustees, and key employees required to disclose annually interests that could give rise to cor

c D id the o rgan i za t i on regu la r i y and cons i s ten t l y m on i to r and en fo rce com p l i anc e w i th the po l i cy?

If Yes, d

in

Schedule 0 how this was d one

flicts?

12b

Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to cor

c D id the o rgan i za t i on regu la r i y and cons i s ten t l y m on i to r and en fo rce com p l i anc e w i th the po l i cy?

If Yes, d

in

Schedule 0 how this was d one

escribe

12c

13 D id the o rgan i za t i on have a wr i t ten wh i s t l eb l owe r po l i cy? 13

X

14

Did

t he o rgan i za t i on have a wr i t ten d ocum en t re ten t i on and d es tm c t i on po l i cy? 14 X

15 D id the p roces s fo r d e te rm in ing com pen sa t i on o f the fo l l ow ing pe rsons i nc l ud e a rev i ew and app rova l by i nd epe nd en t

pe rson s , com p a rab i l i t y d a ta , and con tem poran eous su bs tan t i a t i on o f the d e l ibe ra t i on and d ec i s i on?

a Tbe o rgan i za t i on ' s CEO, Execu t i ve D i rec to r , o r top m anagem en t o f f i c i a l 15a

X

b O the r o f f i ce rs o r key em p loyee s o f the o rgan i za t i on

15b

X

I f "Yes" to l i ne 15a o r 15b , d esc r i be the p roces s i n Sche d u le 0 ( see i ns tm c t i o ns ) .

16 a D id the o rgan i za t i on i nves t i n , con t r i bu te asse ts to , o r pa r t i c i pa te i n a j o i n t ven tu re o r s im i l a r a r rangem en t w i th a

taxable

en t i t y d u r i ng the yea r? 16a

X

b

I f "Yes , " d i d the o rgan i za t i on fo l low a wr i t ten po l i cy o r p roced u re requ i r i ng the o rgan i za t i on to eva lua te i ts pa r t i c i pa t i on

in jo i n t ven tu re a r rangem en ts un d e r app l i cab le fed e ra l tax l aw , and take s te ps to sa fegua rd the o rgan i za t i on ' s

exemot

s ta tus w i th respec t to such an-anqements?

16b

S e c t i o n

C .

D is c l o s ur e

17

18

List t he s ta tes w i th w h i ch a co py o f th i s F o rm 990 i s r equ i red to be f i led

O R

Section 6104 r equ i res an o rgan i za t i on to m ake i t s F o rm s 1023 (o r1024 i f app l icab le) , 990, and 990-T (Sect ion 501(c) (3)s on ly) ava i lab le

fo r pub l i c i n spec t i on . Ind i ca te how you m a d e these ava i l ab l e . Che ck a l l t ha t app l y .

I

I Ow n web s i te I

I

Ano th e r ' s webs i te I

X

I Up on reques t I I O the r

(explain in Scheduie O)

Describe

i n Sch ed u le 0 whe the r ( and i f so , how) , the o rgan i za t i on m a d e i t s gove rn ing d ocu m e n ts , con f l i c t o f i n te res t po l i cy , and f i nanc ia l

s ta te m en ts ava i l ab le to the pub l i c d u r i ng the tax yea r .

State t he nam e , phys i ca l ad d ress , and te l ephon e num b e r o f the pe rson w ho poss esse s the books and rec o rd s o f the o rgan i za t i on :

SARAH S P I N K S - 5 0 3 - 5 8 4 - 4 8 6 5

3 0 3 0 CENTER S T R E E T N E . SALEM. O R 9 7 3 0 1

12-10-12

19

20

Form

9 9 0

(201


9/21

F o r m9 90 (2012)

MID

V A L L E Y MENTORS

2 0 -5531237 P a g e ?

C o m p e n s a t i o n of

O f f i c e r s ,

D i r e c t o r s ,

T r u s t e e s ,

K e y

E m p l o y e e s ,

H i g h es t C o m p e n s a t e d

E m p l o y e e s ,

a n d In d e p e n d en t C o n t r a c t o r s

Check i f Sch ed u le 0 con ta i ns a response to any que s t i on i n th i s P a r t V l l

S e c t i o n

A .

O f f i c e r s ,

D i r e c t o r s .T r u s t e e s , K e y E m p l o y e e s , a n d H i g h e s t C o m p e n s a t e d E m p l o y e e s

l a Complete this table for all person s required to be listed. Report compe nsation for the calendar year ending with or within the organization's tax year.

L i s t a ll o f the o rgan i za t i on ' s

c u r r e n t

o f f i ce rs , d i r ec to rs , t r us tees (whe the r i nd i v i d ua l s o r o rgan i za t i ons ) , r ega rd l ess o f am oun t o f com pensa t i on .

E n t e r -0- I n co l um n s (D) , (E ), and (F) if no com pens a t i on was

pa id .

Lista l l o f the o rga n i za t i on ' s c u r r e n t key em p loye es , i f any . See i ns t ruc t i ons fo r d e f i n i t ion o f " key e m p loye e . "

List the organization 's five

current

highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable

compensation

(Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.

Us t a ll o f the o rgan i za t i on ' s

f o r m e r

o f f i c e rs , k e y e m p l o y e e s , a n d h i g h e s t c o m p e n s a t e d e m p l o y e e s w h o r e c e i v e d m o r e t h a n $100,000 o f

reportable com pensa t i on f r om the o rgan i za t i on and any re l a ted o rgan i za t i ons .

Us t a l l o f the o rgan i za t i on ' s

f o r m e r d i r e c t o r s o r t r u s t e e s

t ha t r ece i ved , i n the cap ac i t y as a fo rm e r d i r ec to r o r t r us tee o f the o rgan i za t i on ,

more t h a n $10,000 o f r epo r tab l e com pensa t i on f r om the o rgan i za t i on and any re l a ted o rgan i za t i ons .

List pe rson s i n the fo l l ow ing o rd e r : i nd i v i d ua l t r us tee s o r d i r ec to rs ; i n s t i tu t i ona l t r us tee s ; o f f i ce rs ; key em p loye es ; h i ghes t com p ens a ted em p loyees ;

an d fom ne r such pe rsons .

I I Che ck th i s box if ne i the r the o rgan i za t i on no r any re l a ted o rgan i za t i on com pen sa te d any cu ne n t o f f i ce r , d i r ec to r , o r t r us tee .

(A)

Name

and Ti t le

(B)

Average

hou rs pe r

week

(list any

hou rs fo r

related

organ i za t i ons

below

l ine)

(C)

Position

(do no t

c h e c k

more than one

box, un l es s

p e r s o n i sboth an

officer

and a

d l rec tor / tn js tee)

(D)

Reportable

compensation

f r o m

the

organization

(W-2 /1099 -MISC)

(E)

Reportable

compensation

f r om re l a ted

o rgan i za t i ons

(W-2 /1099 -MISC)

(F)

Estimated

amount o f

o the r

compensation

f r om the

organization

an d re la ted

o rgan i za t i ons

(1 ) MATT BENJ AMIN

BOARD MEMBER

1.00

X 0.

0.

0

( 2 ) M I K E C O R B I N

BOARD MEMBER

1.00

0.

0.

( 3 ) R I C H KELBER

BOARD MEMBER

1.00

0. 0.

-0,

OJ

_0,

_0,

0

( 4 ) MATT LOKAN

BOARD

MEMBER

1.00

X

0.

( 5 ) DON MCPHERSON

BOARD P RES IDENT

2.00

X X 0.

( 6 ) DAVE OKADA

BOARD MEMBER

1.00

0.

( 7 ) SUSAN THOMPSON

BOARD MEMBER

1.00

0.

(8 ) SARAH CAVAZOS

EXECUTIVE D IRECTOR

4 0 . 0 0

X

5 2 , 8 2 2 0.

232007 12-10-12

F orm

99

(201


10/21

F orm 990 (2012 )

MID

V A L L E Y

MENTORS

2 0 - 5 5 3 1 2 3 7 Page S

(A)

Name

and t i t le

(B)

Average

hou rs pe r

week

(list any

h o u r s

for

related

organ i za t i ons

below

l ine)

(C)

Position

(do not c t ieck more than one

box, u n l e s s

person isboth an

officerand a d i rec tor / t rus tee)

(D)

Reportable

compensation

f r o m

the

organization

(W-2 /1099 -MISC)

(E)

Reportable

compensation

f r om re l a ted

o rgan i za t i ons

(W-2 /1099 -MISC)

(F)

Estimated

amount o f

o the r

compensation

f r om the

organization

an d

re la ted

o rgan i za t i ons

(A)

Name

and t i t le

(B)

Average

hou rs pe r

week

(list any

h o u r s

for

related

organ i za t i ons

below

l ine)

I

n

v

d

u

e

t

d

e

o

n

c;

o

1

K

e

e

m

p

o

l

g

e

c

m

p

e

e

m

p

o

s

e

S

(D)

Reportable

compensation

f r o m

the

organization

(W-2 /1099 -MISC)

(E)

Reportable

compensation

f r om re l a ted

o rgan i za t i ons

(W-2 /1099 -MISC)

(F)

Estimated

amount o f

o the r

compensation

f r om the

organization

an d

re la ted

o rgan i za t i ons

l b S u b - t o t a l

5 2 . 8 2 2 . 0. 0.

c

T o t a l from c o n t i n u a t i o n s h e e t s t o Par t V l l ,

S e c t i o n

A

d

To t a l ( add

l ines l b

a n d I c )

0. 0. 0.

T o t a l from c o n t i n u a t i o n s h e e t s t o Par t V l l ,

S e c t i o n

A

d

To t a l ( add

l ines l b

a n d I c )

5 2 . 8 2 2 . 0. 0.

2 To ta l num be r o f i nd i v i d ua l s ( in c l ud ing bu t no t lim i ted to those l i s ted above ) who rece i ved m ore than $100,000 o f r epo r tab l e

Y e s

No

3 D id the o rgan i za t i on l i s t any f o r m e r o f f i ce r , d i r ec to r , o r t r us tee , key em p loyee , o r h i ghes t com pensa ted em p loyee on

line la? If Yes, com plete Schedule J for such individual 3

X

4

For any ind iv id ua l l i s ted on l ine l a , i s the sum o f r epo r tab l e com pen sa t i o n and o the r com pen sa t i o n f r om the o rga n i za t i on

an d r e l a ted o rgan i za t i ons g rea te r than $150,000?

If Yes, complete Schedule J for such individual 4 X

5

Did any pers on l is ted on l ine

l a

r ece i ve o r accm e com pensa t i on f r om any un re l a ted o rgan i za t i on o r i nd i v i d ua l fo r se rv i ces

rendered

to the o roan i za t i on? if Yes,' compiete Schedule J for such person 5

X

S e c t i o nB . I n d e p e n d en t C o n t r a c t o r s

Complete t h i s tab l e fo r you r f i ve h i ghes t com pensa ted i nd epend en t con t rac to rs tha t r ece i ved m ore than $100,000 o f c o m p e n s a t i o n f r o m

(A)

Name a n d b u s i n e s s a d d r e s s NONE

(B)

Description o f serv ices

(C)

Compensation

2 To ta l num be r o f i nd e pend en t con t rac to rs ( Inc lud ing bu t no t l im i ted to thos e l i s ted above ) wh o rece i ved m ore than

$100,000

o f com pen sa t i o n f r om the o rqan i za t i on

0

232008

12-10-12

Fonn

99

(2012)


11/21

F orm 990 (2012 )

MID

V A L L E Y MENTORS

2 0 -5531237 P a g e 9

Pa r t V l l l S t a t e m e n t o f R e ve n u e

Check

i f Sc hed u le 0 con ta in s a resp ons e to any que st io n in th is Par t V l l l EZI

(A)

Total r evenue

(B)

Related o r

exempt f u n c t i o n

revenue

(C)

Unrelated

b u s i n e s s

revenue

Revenueexcluded

from tax under

sections 512,

513,

o r514

n

5 i

1 a F e d e r a t e d c a m p a i g n s

l a

b M e m b e r s h i p d u e s

l b

c

F und ra i s i ng even ts

I c 1 0 , 2 5 0 .

d Re la ted o rgan i za t i ons

I d

e Gov e rnm e n t g ran ts ( con t r i bu t i ons )

f

Al l other contr ibutions, gifts, grants, and

similar amounts not included above

l e 1 5 8 , 4 0 3 .

Gove rnm en t g ran ts ( con t r i bu t i ons )

f

Al l other contr ibutions, gifts, grants, and

similar amounts not included above

If

7 0 . 9 1 1 .

g N o n c a s h

cont r ibut ions inc luded in

l i nes

1a-1f:

3 0 1 6 6

h T o t a l . A d d l in e s 1a-1f

2 3 9 . 5 6 4

8

Eg

y

p

B u s i n e s s C o d e

2 a

b

c

d

e

f

a .

All

o the r p rog ram se rv i ce revenue

To ta l . Ad d l i nes 2a -2 f

3

OC

I

o

4

5

6

a

b

c

d

7

a

c

d

8

a

b

c

9 a

b

c

10a

b

c

Investment i n com e ( i nc l ud ing d i v i d end s , i n te res t , and

o the r s im il a r am oun ts )

Income f r om i nves tm e n t o f tax -exem p t bond p rocee d s

Roya l t i e s

G r o s s

ren ts

Less : r en ta l expenses

Rental i n c o m e o r Ooss)

Net ren ta l income or ( loss)

G ross am oun t f r om sa les o f

a s s e t s

o the r than Inven to ry

Less : cos t o r o the r bas i s

an d sa l es expenses

Gain or ( loss)

Net gain or ( loss)

G ross i ncom e f rom fund ra i s i ng even ts ( no t

including $ 1 0 , 2 5 0 . of

con t r i bu t i ons repo r ted on l i ne I c ) . See

Part IV, l ine 18 a

Less : d i r ec t expenses

b

Net i n co m e o r ( loss ) f r om fund ra i s i ng even ts

Gross i ncom e f rom gam ing ac t i v i t i e s . See

Part IV ,

line

19 a

L e s s : d i r e c t e x p e n s e s

b

Net

inco me or ( loss) f ro m gam ing act iv i t ies . .

G ross sa l es o f i n ven to ry , l e ss re tu rns

an d a l l o w a n c e s

a

Less : cos t o f good s so l d

b

Net

incom e or ( loss) f rom sa les of inventorv . .

(QRea l

(II) Personal

(i)

Sec u r i t i e s

( l i ) o ther

4 , 1 7 9 .

3 . 2 1 3 .

9 6 6 . 9 6 6 .

M i s c e l l a n e o u s

Revenue

11 a

b

c

d

e

12

Ail o the r revenue

T o t a l . A d d l i n e s 11a-1I d

Total revenue.See instructions.

B u s i n e s s

C o d e

2 4 0 . 5 3 0 .

0^

9 6 6 .

232009

12-10-12

Form

9 90

(2012


12/21

F orm 990 (2012 )

MID

V A L L E Y MENTORS

2 0 -5531237 P a g e l O

P a r t

IX

I

S t a t e m e n t o f F u n c t i o n a l

E x p e n s e s

Section 501(c)(3) and 501(c)(4) orqanizations must complete all columns. A ll other organizations must complete column (A).

Check

i f Sche d u le 0 con ta i ns a respo nse to any ques t i on i n th i s P a r t IX

Do

not include amounts reported on lines 6b,

7b, 8b, 9b, and 10b of Part Vlii.

(A)

Total e x p e n s e s

P rog ram se rv i ce

e x p e n s e s

(C)

Management and

general e x p e n s e s

ndra isundraising

e x p e n s e s

1

Grants and other assistance to governments and

organizations

in the United States. See Part IV, line 21

2

G ran ts and o the r ass i s tance to Ind i v i d ua l s i n

th e

Un i ted Sta tes. See Par t IV , l ine 22

3 G r a n t s a n d o t h e r a s s i s t a n c e t o g o v e r n m e n t s ,

o rgan i za t i ons , and i nd i v i d ua l s ou ts i d e the

United S ta tes. See Par t IV , l ines

15

and 16

4

Bene f i t s pa id to o r fo r m em bers

5 Com pen sa t i on o f cu r ren t o f f i ce rs , d i r ec to rs ,

t r u s t e e s , a n d k e y e m p l o y e e s

6 Compe nsation not included above, to disqualified

persons (as defined under section 4958(f)(1)) and

persons

described in section 4958(c)(3)(B)

7

O the r sa l a r ies and wa ges

8 Pension plan accruals and contrib utions (include

section

401(k) and 403(b) employer co ntr ibutions)

9

O the r em p loyee bene f i t s

10 P ayro l l ta xe s

11

F ees fo r se rv i ces ( non -em p loyees ) :

a M a n a g e m e n t

b Lega l

c A c c o u n t i n g

d

L o b b y i n g

e Professional fundra ising services. See Part IV, line 17

f I n v e s t m e n t m a n a g e m e n t f e e s

g Oth er. ( If l ine 11g amount exceeds 10% of line 25,

column

(A) amount, list line

11g

expenses on Sch 0.)

12

A d v e r t i s i n g a n d p r o m o t i o n

13 O f f i c e e x p e n s e s

14

I n f o r m a t io n t e c h n o l o g y

15 Roya l t i e s

16

O c c u p a n c y

17 Trave l

18 P aym en ts o f t r ave l o r en te r ta i nm en t expense s

for any federa l , s ta te , or loca l publ ic o f f ic ia ls

19 C o n f e r e n c e s , c o n v e n t i o n s , a n d m e e t i n g s

20 I n te res t

21 P aym en ts to a f f i l ia tes

22 Dep rec ia t i on , d ep le t i on , and am or t i za t i on

23 I n su rance

24

Other expenses. Itemize expenses not covered

above. (List m iscellaneous expenses in line 24e. If l ine

24e amount exceeds 10% of line 25, column (A)

amou nt, list line 24e expenses on Schedule 0.) ....

a

MATERIALS & S U P P L I E S

b

MISC ELLA NEOUS

c

T R A I N I N G

d S T A F F DEVELOPMENT

e A l l o the r expen ses

25 Total functional expenses.Add lines 1 through 24e

8.000

5 9 , 8 5 9 .

1 2 2 . 6 1 3 .

1 1 . 1 5 1 .

1 8 , 9 0 8 .

1 . 0 0 0 .

4 , 2 7 5 .

2 , 7 1 6 .

1 . 5 9 6 .

3 6 , 5 2 6 .

5 . 0 5 6 .

6 5 .

6 . 0 8 0 .

4 , 8 0 3 .

1 . 0 4 7 .

7 8 4 .

1 0 0 .

2 8 4 . 5 7 9 .

8 , 0 0 0 .

4 7 , 6 4 6 . 1 2 , 2 1 3 .

1 2 2 . 6 1 3 .

1 0 , 4 0 5 .

1 8 . 7 5 8 .

1 . 0 0 0 .

2 . 7 5 3 .

3 7 1 .

4 8 0 .

3 4 , 1 1 2 .

4 , 8 6 9 .

6 . 0 8 0 .

4 , 7 8 6 .

9 7 8

7 8 4

1 0 0

2 6 3 , 7 3 5 .

7 4 6 .

1 5 0 .

1 , 5 2 2 .

2 . 3 4 5 .

1 , 1 1 6 .

2 . 4 1 4 .

1 8 7 .

6 5 .

1 7 .

6 9 .

2 0 , 8 4 4 . 0.

26

Jointcosts.Complete this line only If the organization

reported

in column (B) joint costs from a combined

educational campaign and fundraising solicitation.

C h e c k h e r e [IZl i f follow ing S O P 98-2

l A S C 958-7201

232010 12-10-12

F orm

99

(2012)


13/21

F o r m

990 (2012 )

MID

V A L L E Y

MENTORS

2 0 - 5 5 3 1 2 3 7 Paqe11

Pa r t X I

B a l a n c e

S h e e t

(A)

Beginning o f year

(B)

End

o f year

1

Cash n on - i n te res t - bea r i ng

5 4 , 6 8 7 .

1

4 2 . 9 6 0 .

2

S a v i n g s

a n d t e m p o r a r y c a s h i n v e s t m e n t s

2

3

P led ges and g ran ts rece i vab le , ne t

3

4

A c c o u n t s r e c e i v a bl e , n e t

3 8 . 7 6 2 .

4

1 3 , 4 3 4 .

5

Loans and o the r rece i vab les f r om cu r ren t and fonne r o f f i ce rs , d i r ec to rs ,

t m s t e e s , k e y e m p l o y e e s , a n d h i g h es t c o m p e n s a t e d e m p l o y e e s . C o m p l e t e

Part I I o f Sched u le L

5

6

Loans and o the r rece i vab les f r om o the r d i squa l i f i ed pe rsons (as d e f i ned und e r

section 4958 ( f )( 1 ) ) , pe rson s d esc r i bed i n sec t i on 4958 (c ) (3 ) (B ), and con t r i b u t i ng

e m p l o y e r s a n d sponsoring o rgan i za t i ons o f sec t i on 501 (c )(9 ) vo l un ta ry

em o love es ' bene f i c i a r y o rqan i za t i ons ( see ins t r ) . Com p le te P a r t I I o f Sch L

6

7

Notes and l oans rece i vab le , ne t

7

1

8

I n ven to r i es fo r sa l e o r use

8

9

Prepaid

e xpenses and d e fe r red cha rges

7 7 5 .

9

1 0 a

Land , bu i l d i ngs , and equ ipm en t : cos t o r o the r

bas i s . Com p le te P a r t V I o f Sched u le D

10a

b

L e s s : a c c u m u l a t e d d e p r e c i a t i o n

10b

10c

11

I n ve s tm en ts - oub l i c l v t r ad ed secu r i t i e s

11

12

I n ves tm en ts o the r secu r i t i e s . See P a r t IV, l ine 11

12

13

I n ve s tm e n ts - o roo ram - re l a te d . See P a r t IV , line 11

13

14

Intangible a s s e t s

14

15

Other assets. See Par t IV , l ine 11

15

16

Total

a s s e t s .

Ad d l i nes 1 th rouqh 15 (must equa l l ine 34)

9 4 . 2 2 4 .

16

5 6 . 3 9 4 .

17

A c c o u n t s p a y a b l e a n d a c c m e d e x p e n s e s

6 . 9 4 3 . 17

1 3 , 1 6 2 .

18

G r a n t s p a y a b l e

18

19

Defen-ed r evenue

19

20

Tax-exemot bond l iab i l i t ies

20

21

Escrow o r cus tod ia l acco un t l i ab i li t y . Com p le te P a r t IV o f Sched u le D

21

22

L o a n s

and o the r payab les to cunen t and fo rm e r o f f i ce rs , d i r ec to rs , tm s tees .

o

key e m p l o y e e s , h i g h e s t c o m p e n s a t e d e m p l o y e e s , a n d d i s q u a li f ie d p e r s o n s .

Complete

Par t I I o f Sche du le L

22

23

Secured m or tgages and no tes payab le to un re l a ted th i r d pa r t i e s

23

24

Unsecured no tes and l oans payab le to un re l a ted th i r d pa r t i e s

24

25

Other l iab i l i t ies ( Inc lud ing federa l income tax, payables to re la ted th i rd

par t ies, and other l iab i l i t ies not inc luded on l ines 17-24) . Comple te Par t X of

Schedule D

25

26

Total l i ab i l i t i es . Ad d l i nes 17 t h rough 25

6 . 9 4 3 . 26

1 3 . 1 6 2 .

O r g a n i z a t i o n sthat

follow S F A S

117 ( A S C 95 8 ),

c h e c k

h e r e

1

X

1 and

to

o

c

27

complete l i n e s 27 t h r ough 29 , and l ines 33 and 34 .

Unrestricted ne t asse ts

3 2 , 7 7 3 . 27

3 3 . 6 1 4 .

(S

IS

28

Temporarily r es t r i c ted ne t asse ts

5 4 . 5 0 8 . 28

9 . 6 1 8 .

OQ

O

29

P erm anen t i v r es t r i c ted ne t asse ts

29

c

3

l i .

29

O r g a n i z a t i o n sthat d o n o t

follow S F A S

117( A S C 9 5 8 ), c h e c k h e r e C D

w

o

a n d c o m p l e t e l i n e s 30 t h r ough 34 .

(0

+-I

30

Caoital s toc k o r tm s t o r i nc i oa l , o r cun -en t fund s

30

Q)

l

10

31

Paid-in

o r cap i ta l su rp l us , o r l and , bu i l d i ng , o r equ ipm e n t fun d

31

mid valley mentors 2012 charity report

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