Embed Size (px)
Citation preview
OMB No 1545-0047
Form 990 Return of Organization Exempt From Income Tax 2005Under section 501(c ), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation) •.Department of the TreasuryInternal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements • -
A For the 2005 calendar year, or tax year beginning July 1 , 2005, and ending June 30, , 20 06
B Check if appltcal f ' ' I I
11 o eee ee e^ee^e^^uleuelie^ee^^^eeeieeei^e^ule^ee^ee^ )
D Employer identification number
e 581475675I
q Name change 29 I B 2 0 0 6 0 6 03 15 3 0000E Telephone number
® Initial return PENCIL FOUNDATION R ( 615 ) 242-3167421 GREAT CIRCLE RD
q Final return NASHVILLE TN 37228-1407 S F Accounting method: q Cash ® Accrual
c -1 q Amended return q Other (specify) ► Modified
q Application pending • Section 501 (c)(3) organizations and 4947 (a)(1) nonexempt charitable H and I are not applicable to section 527 organizations
r r rn f affH(a) I th s a t l t ? q Y ® Ntrusts must attach a completed Schedule A (Form 990 or 990-EZ). i g oup or i ias e u es es o
G Websrte: ► www pencilfd. org H(b) If "Yes," enter number of affiliates ► ...............
H(c) Are all affiliates included? q Yes No
LMJ Organization type (check only one) ► ® 501(c) ( 3 ) -4 (insert no) q 4947(a)(1) or q 527 (If "No," attach a list See Instructions )
K Check here ► q it the organization's gross receipts are normally not more than $25,000 TheH(d) Is this a separate return filed by an
organization covered by a group ruling? q Yes ® Noorganization need not file a return with the IRS, but if the organization chooses to file a return, besure to file a complete return. Some states require a complete return. I Group Exemption Number ►
M Check ► q if the organization is not requiredL Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 ► 1,731,785 to attach Sch. B (Form 990, 990-EZ, or 990-PF).
FURTF Revenue. Expenses . and Chances in Net Assets or Fund Balances (See the Instructions.)
1 Contributions, gifts, grants, and similar amounts received:
a Direct public support . is 515,294
b Indirect public support . . . . . . 1b
c Government contnbutions (grants) 1c 1,104,021 -
d Total (add lines 1a through 1c) (cash $ 1,619,315 noncash $ ) , 1d 1,619,315
2 Program service revenue I e) 4t -g ontracts (from Part VII line 93) 2,
3 Membership dues and a sessrr lECEIVED 3. . .4 Interest on savings and t m 0 4 18,125,0
5 Dividends and interestfr® 'he f/> 5pn
6a Gross rents . ^^^^ , Q 6a
b Less: rental expenses . 6bcc-c Net rental income or (lo s) (su t frgr t the 6 . .. 6cs p . .
7 Other investment income des I`^ar4line 7 ther invest income ) 7
C 8a Gross amount from sales of assets other "n'^ Iel Diner
than inventory . . . 8a
b Less cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) . . . 8c
d Net gain or (loss) (combine line 8c columns (A) and (B)) Schedule 1 8d, . . . . . . .
9 Special events and activities (attach schedule). If any amount is from gaming, check here ► q _
a Gross revenue (not including $ ofcontnbutions reported on line 1a) . . . . 9a 94,345
b Less: direct expenses other than fundraising expenses 9b 22,932
c Net income or (loss) from special events (subtract line 9b from line 9a) Schedule 2 9c 71,413
10a Gross sales of inventory, less returns and allowances 10a
b Less, cost of goods sold . _ . . . . . Schedule 3 10b
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c.11 Other revenue (from Part VII, line 103) . . . . . . . . . . . . . 11
12 Total revenue (add lines 1d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 1Oc, and 11) . 12 1,7081853
13 Program services (from line 44 column (B)) 13 1,409,817, . . . . . . . . .
14 Management and general (from line 44 column (C)) 14 225,593, . . . . . .
15 Fundraising (from line 44 column (D)) 15 104,297LW
, . . . . . . . .16 Payments to affiliates (attach schedule) . . . . . . . . . . . Schedule 4 16
17 Total expenses (add lines 16 and 44, column (A)) 17 1,739,706
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 (30,853 )
Q
.
19 Net assets or fund balances at beginning of year (from line 73 column (A)) 19 879,340, . . . .20 Other changes in net assets or fund balances (attach explanation). . . . . . . 20
z 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 848,487
For Privacy Act and Paperwork Reduction Act Notice , see the separate instructions . Cat. No 11282Y Form 990 (2005)
"G15"
Form 990 (2005) Page 2
Statement of All organizations must complete column (A). Columns (B), (C), and (D) are required for section 501 (c)(3) and (4)Functional Expenses organizations and section 4947(a)(1) nonexempt chartable trusts but optional for others. (See the instructions)
Do not include amounts reported on line
6b, 8b, 9b, 10b, or 16 of Part I(A) Total (B ) Program
services(C) Management
and general (^) Fundraising
22 Grants and allocations (sch) Schedule 5
(cash $ 45,900 noncash $ )If this amount includes foreign grants, check here ► q
2245,900 45,900
23 Specific assistance to individuals (attachschedule) . . . . . . Schedule 6 23
24 Benefits paid to or for members (attachschedule) . Schedule 7 24
25 Compensation of officers, chrectorsSch dule 8 25
26 Other salaries and wages . , • . 26 1,097,419 838,524 173,597 85,298
27 Pension plan contributions 27 28,035 18, 881 6,944 2,210
28 Other employee benefits . . . 28 87,638 78,398 5,340 3,900
29 Payroll taxes . . . - . . 29 80 ,331 60,526 13,280 6,525
30 Professional fundraising fees 30
31 Accounting fees 31 10,500 10.500
32 Legal fees . . . . 32
33 Supplies . . 33 15,849 15,849
34 Telephone . . 34 21,608 21,608
35 Postage and shipping 35 8,867 8,642 225
36 Occupancy . . , . . 36 79,239 71,564 5,117 2.558
37 Equipment rental and maintenance . . . 37 14,057 14,057
38 Printing and publications . 38 69 , 684 66,104 3,580
39 Travel . . . . . . . . . . 39 12 ,829 12,617 212
40 Conferences, conventions, and meetings . 40
41 Interest . . . . . 41
$2 Depreciation, depletion, etc. (attach schedule) 42
13 Other expenses not covered above (itemize).a _General- Insurance
--------------- ---------------------- 43a 10,603 10,603
b Student Assistance 43b 220 220
C Program Activities 43c 61,462 61,462
d Professional Development 43d 4,202 4,202
e InternetlTechnology
----------- - -----
43e 19,241 19,241
f -Miscellaneous---------------•-----------------------
43f 38,312 38,312
Professional Services -g --- -----------------
43g 33,710 33,710
1.4 Total functional expenses . Add lines 22through 43. (Organizations completingcolumns (B)-(D), carry these totals to lines13-15) 4 ,739,706 , ,409,817 , 25,593 04,297
Joint Costs. Check ► ® if you are following SOP 98-2.Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services' . ► (a Yes q NoIf "Yes," enter (i) the aggregate amount of these joint costs $ 21,486 , (ii) the amount allocated to Program services $ 19,666
(iii) the amount allocated to Management and general $ ; and (v) the amount allocated to Fundraising $ 1,820
Form 990 (2005)
Form 490 (2005) Page 3
FUNM Statement of Program Service Accomplishments (See the instructions.)
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about aparticular organization. How the public perceives an organization in such cases may be determined by the information presentedon its return. Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization'sprograms and accomplishments
W
Alloforg
at is the organization's primary exempt purpose? ► - Link community resources with public schools Program Service
organizations must describe their exempt purpose achievements in a clear and concise manner State the numberExpenses
(Required for 50t(c)(3) andclients served , publications issued , etc. Discuss achievements that are not measurable . (Section 501(c)(3) and (4) (4) orgs , and 4947(a)(1)
anizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others) frusta , but optional forothers
Jobs for Tennessee Graduates serves 450 at-risk students annually.
Students receive academic assistance and fob- readiness skills
with the goal of graduating from . high school and transitioning successfully to theworkforce or to post -secondary education.-----------------------------------••---•------- ---------------- -------------------------------------------- ---------Graduation rate exceeds 90% annually.
- -----•-------------------------------------------------5(08, I59
(Grants and allocations $ 0) If this amount includes foreign grants, check here ► q 9
Jobs Skills Training and Employment program serves nearly 800
Families First clients , providing job readiness and placement services to those-- - -•---- -•----- -- -------------•-•---receiving public assistance . Clients are referred to PENCIL by the Department
------------------------------------------- -------------------------- ------------------of Human Services.- -------------------- ------------ -- ----------------- ---- - ------•----------------------------------------•-----
--------------•---•-------- -------------------------- ----- -------------- -------------------------•-•---------------
------ ---- --- ---- ------------- ------------ --- - - - -- ---- -• -- --- -- -- - ----- -- 3is ,1110(Grants and allocations $ 0) If this amount includes foreign grants, check here ► q
PENCIL Partners serves over 70,000 students annually.------------------------------------------------•-------- - ------------------------------------------------------
PENCIL Partners encourages a business or other community organization--------------•-----------------
to "partner with" a specific Metro Nashville Public School and conduct-------------•------ - --------------------
activities that enhance the . learning. experience for students.---------------------- ------- -----------------------------------------------•----•------------- - --- -----------------------------•-------------------------------------------------•-----•----------------••---
--- -------------------------------------------- - ----- -------------110,102
-- ---------------(Grants and allocations $ 0) If this amount includes foreign grants , check here ► q
Reading Partners serves over 2,000 students annually.-•-----•---------------
The-program recruits , trains and places volunteers to work with students---------•---------------- --------•----•---•----------...--
in grades K through 4 with the goal of improving children's reading ability------------------------------------- ---------------------------------------------------------------------------------and enjoyment.
-- ---- --- --- -- - - ----- - ------ - ---- ------ - -- -q^, 3(o
--- --(Grants and allocations $ 0) If this amount includes foreign grants , check here ► q-- 8
Other program services (attach schedule) Schedule 9(Grants and allocations $ ) If this amount includes foreign grants, check here ► q
h
lgy, 37
b
d
f Total of Program Service Expenses (should equal line 44, column (B), Program services). . ► 1,409,817
Form 990 (2005)
Form 990 (2005) Page 4
Balance Sheets (See the instructions.)
Note: Where required, attached schedules and amounts within the description (A) (B)column should be for end-of-year amounts only. Beginning of year End of year
45 Cash-non-interest-bearing . . . 178,249 45 197,389
46 Savings and temporary cash investments . . . . . . . 525,693 46 582,231
47a Accounts receivable _ . . . _ 47a
b Less: allowance for doubtful accounts 47b 47c
48a Pledges receivable 48a 70,500
b Less: allowance for doubtful accounts . 48b 132,500 48c 70,500
49 Grants receivable . . . . . . , 61,803 49 86,728..
50 Receivables from officers, directors, trustees, and key employees(attach schedule) . . . . . , Schedule 10 50
51a Other notes and loans receivable (attachschedule) . Schedule 11 51a
b Less- allowance for doubtful accounts 51b 51c
a 52 Inventories for sale or use . . 52
53 Prepaid expenses and deferred charges . 13,919 53 14,058
54 Investments-securities (schedule) Schedule 12 ► q cost[-] FMV 54
55a Investments-land, buildings, andequipment: basis . . . . . . . 55a -
b Less accumulated depreciation (attachschedule) . Schedule 13 55b 55c
56 Investments-other (attach schedule) . , Schedule 14 56
57a Land, buildings, and equipment: basis , 57a -
b Less- accumulated depreciation (attachschedule) . . . . . . Schedule 15 57b 57c
58 Other assets (describe ► -Part 4 line 58 description ------. ) 58
Schedule 16
59 Total assets (must equal line 74). Add lines 45 through 58 912,164 59 950,906
60 Accounts payable and accrued expenses . 32,824 60 37,791
61 Grants payable . . . . . . . . . 61
62 Deferred revenue . . . . . . . . . 62
w
. .
63 Loans from officers, directors, trustees, and key employees (attach -schedule) . . . . . . . . . . . . . . . Schedule 17 63
M Schedule 1864a Tax-exempt bond liabilities (attach schedule) . 64a.
b Mortgages and other notes payable (attach schedule) . Schedule 19 64b
65 Other liabilities (describe ► _64,628___________________________________) 65 64,628
Schedule 2066 Total liabilities . Add lines 60 through 65 32,824 66 102,419
Organizations that follow SFAS 117, check here ► E1 and complete lines67 through 69 and lines 73 and 74.
U . . . .67 Unrestricted . . . . . . . . . 740,890 67 777,987
20
. ..
68 Temporarily restricted . . . 138,450 68 70,500
W
. . . . . .
69 Permanently restricted . . . . 69
C
. . .
Organizations that do not follow SFAS 117, check here ► q and
LL complete lines 70 through 74.
0 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 other funds 72,
73 Total net assets or fund balances (add lines 67 through 69 or lines
Z 70 through 72;column (A) must equal line 19; column ( B) must equal line 21) 879,340 73 848,487
74 Total liabilities and net assets/fund balances . Add lines 66 and 73. 912.164 74 950,906
Form 990 (2005)
Form 990 (2005) Page rJ
Reconciliation of Revenue per Audited Financial Statements With Revenue per Return (See the
a Total revenue, gains, and other support per audited financial statements . . . .b Amounts included on line a but not on Part I, line 12:
1 Net unrealized gains on investments . . b1
2 Donated services and use of facilities . . . . . . . . . . . b2
3 Recoveries of prior year grants . . . . . b3
4 Other (specify): P4A-b41 Schedule 21-------------P4A-b42 b4
Add lines b1 through b4 . . . . . . . . . . . .
c Subtract line b from line a . . . . . . . . . . .
d Amounts included on Part I, line 12, but not on line a:
1 Investment expenses not included on Part I, line 6b . . d1
2 Other (specify)* ?4JN-A?1------------------------------------ Schedule 22- - -----------P4A-d22 d2---------------------------------------------------------------------------------Add lines dt and d2
a 1,782,954
101
b 74.101
C 1,708,853
e Total revenue (Part I, line 12). Add fines c and d . ►0
1,708,853
Reconciliation of Expenses -per Audited Financial Statements With Expenses per Return
a Total expenses and losses per audited financial statements . . . . . . . . . . a 1,813,807
b Amounts included on line a but not on Part I, line 17:
1 Donated services and use of facilities . . b1 74,101
2 Prior year adjustments reported on Part I, line 20 . . . b2
3 Losses reported on Part I, line 20 . . . . . . M
4 Other (specify): P4137b4- - - -
Schedule 23---- ----
P4B-b42 b4--------------- --------------------------------------- ----------------------Add lines b1 through b4 . . . . . . . . . . . . . . . . . b 74,101
c Subtract line b from line a . . . . . . . . . . . . . . . . . c 1,739,706
d Amounts included on Part I, line 17, but not on line a:
1 Investment expenses not included on Part I, line 6b d1
2 Other (specify): P4B-d21 Schedule 24---------------- --------------------------------------------- = • =:
P4B-d22 d2------------------- ----------- ------------------- -----------------------------Add lines dl and d2 . . . . , . , . . d 0
e Total expenses (Part I, line 17). Add lines c and d . ► e 1,739,706
Current Officers , Directors , Trustees , and Key Employees (List each person who was an officer, director, trustee,or key employee at any time durfna the year even if they were not compensated.) (See the instructions.)
(A) Name and address Title and averagega hours perweek devoted to position
(C) Compensation( if paid , enter
-0-. )
( 0) Contributions to employeebenefit plans & deferredcompensation plans
( E) Expense accountand other allowances
Please see attached list- - - ------- -----------------•-----•-----------•--••-•----Officer Address 1
Officer Title 1 0 0 0
Officer Name 2.64i ---•-•--------------------- -----------------------------cer Address 2
Officer Title 2 0 0 0
Officer Name 3-------------•-----------------------------------------------Officer Address 3
Officer Title 3 0 0 0
---------------------------------------------------------------
---------------------- ------ -- ----------------------------
------•---------------------- -------------------------------
----•--•--------••- ------------•-•-•---------------------
--•-•-••------•--•-•----------••-•--------------•---..-----
----------------------------- ------------------------------
Form 990 (2005)
Form 990 (2005) Page 6
Current Officers, Directors , Trustees, and Key Employees (continued) Yes No
75a Enter the total number of officers, directors, and trustees permitted to vote on organization business at boardmeetings . . . . . . . . . ----------40
b Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensatedemployees listed in Schedule A, Part 1, or highest compensated professional and other independent = . -contractors listed in Schedule A, Part II-A or II-B, related to each other through family or business - --relationships? If "Yes," attach a statement that identifies the individuals and explains the relationship(s) . 75b 3
Schedule 25c Do any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated
employees listed in Schedule A, Part I, or highest compensated professional and other independent -contractors listed in Schedule A, Part II-A or II-B, receive compensation from any other organizations, whether -tax exempt or taxable, that are related to this organization through common supervision or common control? 75c 3
Note . Related organizations include section 509(a)(3) supporting organizations.
If "Yes," attach a statement that identifies the individuals, explains the relationship between thisorganization and the other organization(s), and describes the compensation arrangements,including amounts paid to each individual by each related organization.
d Does the organization have a written conflict of interest policy? . . 75d A
Former Officers, Directors, Trustees, and Key Employees That Received Compensation or Other Benefits (If any formerofficer, director, trustee, or key employee received compensation or other benefits (described below) during the year, list thatperson below and enter the amount of compensation or other benefits in the appropriate column. See the instructions.)
(A) Name and address (B) Loans and Advances (C) CompensationID) Crnb fait s to employee
benefit plans & deferredcom bon plans
(E) Expenseaccount and other
allowances
Not applicable
Former Officer Address 1
Former Offier Name 2-------•--------------------•-- -----------------------------Former Officer Address 2
Former Officer Name 3--------------------------- ----------------------------------Former Officer Address 3
------------------------------------------ ---------------- -
------------------------------------------------------ --------
---------------------------------------------------------------
•---------•-•------ -- --•-----------------------------------
---------------------------------------------------------------
---------------------------------------------------------------
--------------------------------------------------------------
Other Information (See the instructions. Yes No
76 Did the organization engage in any activity not previously reported to the IRS? If "Yes," attach a detailed. .description of each activity . . . . . . . . . . . . . . . . . . . .
- ' <76
-3..
77 Were any changes made in the organizing or governing documents but not reported to the IRS? 77 3. . . .
If "Yes," attach a conformed copy of the changes.
78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by. .this return ? . . . . . . . . . . . . . . . . . .
-
-78a 3. . .. . . .
b If "Yes," has it filed a tax return on Form 990-T for this year?. 78b MA. . . . . . .
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attacha statement . . . . . . . . . . . . . . . . . . .. . .
-79
- - -3. . .
80a Is the organization related (other than by association with a statewide or nationwide organization) throughcommon membership, governing bodies, trustees, officers, etc., to any other exempt or nonexempt
. . . . .. .organization? . . . . . . . .
---80a 3. . .
b If "Yes," enter the name of the organization ► _P art 6 -80a_line 1
-Part 6-80a line 2-- - _ _ _ _ _ - _ _ _ _ _ _ _ and check whether it is © exempt or q nonexempt81a Enter direct and indirect political expenditures. (See line 81 instructions.) . 81a
b Did the organization file Form 1120-POL for this year? . . . . 1b
-
3
Form 990 (2005)
Form 990 (2005) Page 7
Other Information continued Yes No
82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge 3or at substantially less than fair rental value? . 82a
b If "Yes," you may indicate the value of these items here. Do not include thisamount as revenue in Part I or as an expense in Part II.(See instructions in Part III.) . . . . . . . . . . . 82b 74,101 3
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . 83b 3
84a Did the organization solicit any contributions or gifts that were not tax deductible? . . . . . . . 84a 3
b If "Yes," did the organization include with every solicitation an express statement that such contributions orgifts were not tax deductible? . . . . . . . . . . . . . . . . . . 84b N A
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members? 85a WA
b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b N FAIf "Yes" was answered to either 85a or 85b, do not complete 85c 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
d Section 162(e) lobbying and political expenditures . . . . . . 85d
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f'? . . . . . . 85g N IA
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85fto its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the N A
following tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . 85h
86 501(c)(7) orgs. Enter: a Initiation fees and capital contributions included online 12 . . . . . . . . . . . . . _ . . . . . 86a -
b Gross receipts, included on line 12, for public use of club facilities . . . 86b =
87 501(c)(12) orgs Enter a Gross income from members or shareholders 87a
b Gross income from other sources. (Do not net amounts due or paid to other _sources against amounts due or received from them.) . . . . . . 87b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or f - - - -_partnership, or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 1 -and 301.7701-39 If "Yes," complete Part IX . . . . . . . . . . . . . . . . . . . . 88 3
89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under:
section 4911 section 4912 section 4955 -
b 501(c)(3) and 501(c)(4) orgs. Did the organization engage in any section 4958 excess benefit transactionduring the year or did it become aware of an excess benefit transaction from a prior year? If "Yes," attacha statement explaining each transaction . . . . . . . . . . . . . . . . . . . . , 89b
c Enter: Amount of tax imposed on the organization managers or disqualified persons during the yearunder sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . ►
d Enter: Amount of tax on line 89c, above, reimbursed by the organization . . . . . ►90a List the states with which a copy of this return is filed ► Tennessee
b Number of employees employed in the pay penod that includes March 12, 2005 (Seeinstructions) . . . . _ . . . . . . . . . . . . . . . . 190b 1 27
91a The books are in care of ► Laura Ross-------------------------------------- Telephone no. ► -(.615) 242-3167
Located at ► 421-Great Circle Road Suite_100, Nashville,-TN------------- ZIP + 4 ► ___-__---__-___ 37228 _
b At any time during the calendar year, did the organization have an interest in or a signature or other authorityover a financial account in a foreign country (such as a bank account, securities account, or other financial Yes No
account)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 b 3
If "Yes," enter the name of the foreign country ► .Foreign Country Name _ -;- _' -
See the instructions for exceptions and filing requirements for Form TD F 90-22.1, Report of Foreign Bank - -and Financial Accounts. -
c At any time during the calendar year, did the organization maintain an office outside of the United States? 91c 3
If "Yes," enter the name of the foreign country ► ..............................92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041-Check here . . . . . . ► q
and enter the amount of tax-exempt interest received or accrued during the tax year . . . ► 192 1Form 990 (2005)
Form 990 (2005) Page 8
FOMM Analysis of Income -Producing Activities (See the instructions.
Note:indicat
93
a
b
c
d
e
f
994
95
96
97
a
b
98
99
100
101
102
103
b
c
d
e
104
Enter gross amounts unless otherwise Unrelated business income Excluded by section 512, 513, or 514 (E)
ed
Program service revenue'
(A)Business code
(B)Amount
(C)Exclusion code
(D)Amount
Related orexempt function
income
Line 93a 100100 01
Line 93b 100200 02
Line 93c 100300 03
Line 93d 100400 04
Line 93e 100500 05
Medicare/Medicaid payments 100600 06
Fees and contracts from government agencies 100700 07
Membership dues and assessments . , 100800 08
Interest on savings and temporary cash investments 18,125
Dividends and interest from securities . .
Net rental income or (loss) from real estate-
debt-financed property . . , . . 101100 11
not debt-financed property . 101200 12
Net rental income or (loss) from personal property 101300 13
Other investment income 101400 14
Gain or (loss) from sales of assets other than inventory 101500 15
Net income or (loss) from special events . 71.413
Gross profit or (loss) from sales of inventory 101700 17
Other revenue: a Line 103a 101800 18
Line 103b 101900 19
Line 103c 102000 20
Line 103d 102100 21
Line 103e 102200 22
Subtotal (add columns (B), (D), and (E)) 18,125 71,413
105 Total (add line 104, columns (B), (D), and (E)) . . . . . . . . . . . . . . .. 89,538
Note: Line 105 olus line 1d. Part 1. should equal the amount on line 12. Part 1.
Relationshi p of Activities to the Accomplishment of Exempt Purposes (See the instructions. )
Line No .y
Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishmentof the organization's exempt purposes (other than by providing funds for such purposes).
101 Su pported the work of PENCIL' s education programs
95 Supported the work of both PENCIL's education and workforce development programs
Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructions.(A)
Name, address, and EIN of corporation,partnershi p , or disregarded entity
BPercenttage of
ownership interest Natureof
activities TotalaDncomeEnd^of^year
assets
'Al%
PleaseSignHere
Li^ inTOrmatlon liegaroing 1 ransTerS ASSOCIaieo wnn Personal beneTlt L ontracts (see me InSifJCtionS.)
(a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? . q Yes ® No
(b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? q Yes ® NoNote : If "Yes" to (b), file Form 8870 and Form 4720 (see ,nst
SCHEDULE A Organization Exempt Under Section 501( c)(3) OMB No 1545-0047
(Form 990 or 990-EZ) (Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n),or 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information-(See separate instructions .) 2005Department of the TreasuryInternal Revenue Service ► MUST be completed by the above organizations and attached to their Form 990 or 990-EZ
Name of the organization Employer identification number
PENCIL Foundation 58 ; 1475675
Compensation of the Five Highest Paid Employees Other Than Officers , Directors, and Trustees(See oaae 1 of the instructions. List each one. If there are none. enter "None.")
(a) Name and address of each employee paid more (b) Title and average hours(c) Compensation
(d) Contributions toemployee benefit plans &
(e) Expenseaccount and otherthan $50,000 per week devoted to position deterred compensation allowances
Laura Ross _- Finance/HR 65,024
-
4,041 0Nashville, TN
Denise Nickerson Development 56,188 6,148 0Nashville, TN
Jacquelyn Green----------------------------
- JSTEP 56,299 6,152 0Nashville, TN
----------------------- ------•-------------- ----- -
------------------ ----------- ------------------------
Total number of other employees paid over $50,000 . ► - - - - - -
n Ulv:1 Compensation of the Five Highest Paid Independent Contractors for Professional Services(See Daae 2 of the instructions. List each one (whether individuals or firms). If there are none. enter "None.")
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
Not_applicable ----------------------
------------------------------------------------------------------- -------- ---------
------------------ ----------------------------------- -------------------------------
------------------------------------------------- ----------------- -----------------
------------ ------•----•--------------- ---------------------------------------------
Total number of others receiving over $50,000 forprofessional services . ► " .' _ -
Lj0LjM- Compensation of the Five Highest Paid Independent Contractors for Other Services(List each contractor who performed services other than professional services, whether individuals orfirms. If there are none, enter "None." See page 2 of the instructions.)
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
Total number of other contractors receiving over$50,000 for other services . . . . . . ► -
For Paperwork Reduction Act Notice , see the Instructions for Form 990 and Form 990-EZ Cat No 11285F Schedule A (Form 990 or 990-EZ) 2005
Schedule A (Form 990 or 990-EZ) 2005 Page 2
Statements About Activities (See page 2 of the instructions.) Yes No
1 During the year, has the organization attempted to influence national, state, or local legislation, including anyattempt to influence public opinion on a legislative matter or referendum's If "Yes," enter the total expenses paid 3or incurred in connection with the lobbying activities ► $ (Must equal amounts on line 38,Part VI-A, or line i of Part VI-B) . . . . . . . . . . . . . . . . . . . . . . 1
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other
organizations checking "Yes" must complete Part VI-B AND attach a statement giving a detailed description of
the lobbying activities Schedule 1
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, orwith any taxable organization with which any such person is affiliated as an officer, director, trustee, majority -owner, or principal beneficiary? (if the answer to any question is "Yes," attach a detailed statement explaining the -transactions) Schedule 2 , -
a Sale , exchange, or leasing of property? . . . . . . . . . . . . . . . . . . . . 2a 3
b Lending of money or other extension of credit? . . . . . . . . . . . . . . 2b 3
c Furnishing of goods, services, or facilities? . . . . . . . . . . . . . . . . 2c 3
d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? . . . 2d 3
e Transfer of any part of its income or assets ' . . . . . . . . . . . . . 2e 3.
3a Do you make grants for scholarships, fellowships, student loans, etc.' (If "Yes," attach an explanation of howyou determine that recipients qualify to receive payments) . Schedule .3 . . . , . 3a 3
b Do you have a section 403(b) annuity plan for your employees ? . . . . . . . . . . 3b 3
c During the year, did the organization receive a contribution of qualified real property interest under section 170(h)? 3c 3
4a Did you maintain any separate account for participating donors where donors have the right to provide advice onthe use or distribution of funds? . . . 3
b Do you provide credit counseling, debt management, credit repair, or debt negotiation services? 4b 3
Reason for Non-Private Foundation Status (See pages 3 through 6 of the instructions.)
The organization is not a private foundation because it is: (Please check only ONE applicable box.)
5 q A church, convention of churches, or association of churches Section 170(b)(1)(A)(i).
6 q A school. Section 170(b)(1)(A)(u). (Also complete Part V.)
7 q A hospital or a cooperative hospital service organization. Section 170(b)(1)(A)(iii).
8 q A Federal, state, or local government or governmental unit. Section 170(b)(1)(A)(v).
9 q A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(ni). Enter the hospital's name, city,and state ► -Part IV Line 9
-----•-------------------------------------••-------------------10 q 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 Section170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) Schedule 4
11b q A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A.)
12 q An organization that normally receives: ( 1) more than 33'/a% of its support from contributions, membership fees, and gross receiptsfrom activities related to its charitable, etc , functions-subject to certain exceptions, and (2) no more than 331/3% of its supportfrom gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by theorganization after June 30, 1975 See section 509(a)(2). (Also complete the Support Schedule in Part IV-A) Schedule 5
13 q An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizationsdescribed in. (1) lines 5 through 12 above, or (2) sections 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). Checkthe box that describes the type of supporting organization: ► q Type 1 q Type 2 q Type 3
Provide the following information about the supported organizations. (See page 6 of the instructions )
(a) Name(s) of supported organization(s)(b) Line number
from above
Part IV Line 13a- 1
Part IV Line 13b- I
Part IV L 13a2
Part IV L 13b2
14 q An organization organized and operated to test for public safety. Section 509(a)(4). (See page 6 of the instructions )
Schedule A (Form 990 or 990-EZ) 2005
Schedule A (Form 990 or 990-EZ) 2005 Page 3
Support Schedule (Complete only if you checked a box on line 10, 11, or 12) Use cash method of accounting.Note : You may use the worksheet in the instructions for converting from the accrual to the cash method of accnunhno
Calendar year (or fiscal year beginning in) ► (a) 2004 (b) 2003 (c) 2002 (d) 2001 (e) Total
15 Gifts, grants, and contributions received. (Donot include unusual grants See line 28). 1,685 ,740 2,096,228 2,007,576 2,170,956 7,960,500
16 Membership fees received
17 Gross receipts from admissions, merchandisesold or services performed, or furnishing offacilities in any activity that is related to theorganization's chartable, etc., purpose
18 Gross income from interest, dividends,amounts received from payments on securitiesloans (section 512(a)(5)), rents, royalties, andunrelated business taxable income (lesssection 511 taxes) from businesses acquiredby the organization after June 30, 1975 6,952 3,432 4,093 2,227 16,704
19 Net income from unrelated businessactivities not included in line 18.
20 Tax revenues levied for the organization'sbenefit and either paid to it or expended onits behalf . -
21 The value of services or facilities furnished tothe organization by a governmental unitwithout charge. Do not include the value ofservices or facilities generally furnished to thepublic without charge .
22 Other Income. Attach a schedule Do notinclude gain or (loss) from sale of capital assets
23 Total of lines 15 through 22 . 1,692,692 2, 099,660 2,011,669 2,173,183 7,977,20424 Line 23 minus line 17 . 1 , 692 , 692 2 , 099 , 660 2 , 011 , 669 2 , 173 , 183 7.977.20425 Enter 1% of line 23 16,927 20,997 20,117 21,732 - -
26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 . . . ► 26a 159,544.
b Prepare a list for your records to show the name of and amount contributed by each person (other than agovernmental unit or publicly supported organization) whose total gifts for 2001 through 2004 exceeded theamount shown in line 26a. Do not file this list with your return . Enter the total of all these excess amounts ► 26b 0
c Total support for section 509(a)(1) test Enter line 24, column (e) ► 26c 7,977,204. . . . . . . . . . . .
d Add: Amounts from column (e) for lines: 18 16,704 19 0
. ►22 0 26b 0 26d 16,704. .
e Public support (line 26c minus line 26d total) . . . . . - . ► 26e 7,960,500
f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) . ► 26f 99.79% %
27 Organizations described on line 12: a For amounts included in lines 15, 16, and 17 that were received from a "disqualifiedperson," prepare a list for your records to show the name of, and total 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
(2004) -------------------------- (2003) -------------------------- (2002) - ........................ (2001) --------------------------b 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 for the year or (2) $5,000.(Include in the list organizations described in lines 5 through 11 b, as well as individuals.) Do not file this list with your return . After computingthe difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excessamounts) for each year.
(2004) -------------------------- (2003) ------------------...----- (2002) -------------------------- (2001) --------------------------
c Add Amounts from column (e) for lines: 15 7,960, 500 16 0
17 0 20 0 21 0 ► 27c 7, 960,500
d Add. Line 27a total. 0 and line 27b total 0 . . . . . ► 27d 0
e Public support Qlne 27c total minus line 27d total). . . . . . lip. 27e 7, 960,500
f Total support for section 509(a)(2) test. Enter amount from line 23, column (e) . lo- 27f 7,977,204
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)). ► 27g 99.79% %
h Investment income percentage (line 18 , column (e) (numerator) divided by line 27f (denominator)). ► 27h .21% %
28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2001 through 2004,prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a briefdescription of the nature of the grant. Do not file this list with your return . Do not include these grants in line 15.
Schedule A (Form 990 or 990-EZ) 2005
,Schedule A (Form 990 or 990-EZ) 2005 Page 4
Private School Questionnaire (See page 7 of the instructions.)(To be completed ONLY by schools that checked the box on line 6 in Part M
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter bylaws Yes No, ,other governing instrument, or in a resolution of its governing body? - . . . . . . . , 29 N IA
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all itsbrochures, catalogues, and other written communications with the public dealing with student admissions,
. .programs, and scholarships? . . . . . . . . . . . . . . . 30 N A. ..
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media duringthe period of solicitation for students, or during the registration period if it has no solicitation program, in a way
Schedule 7that makes the policy known to all parts of the general community it serves? 31 N A. . . . . .
If "Yes," please describe, it "No," please explain. (If you need more space, attach a separate statement.)Part V line 31 - 1......................................... ---------•------•-------....---•---•----------•-•--•---------••---••-------•-Part V line 31 - 2- ----------•-------------------------- --------•----------------------•-----------------------------------•--- -----Part V line 31 - 3
Part V line 31 - 4
32 Does the organization maintain the following
a Records indicating the racial composition of the student body, faculty and administrative staff? 32a N IA, . . . .
b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory N Abasis?. . . . . . . . . . . . . . . 32b. . . . . . . . . . .
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing N Awith student admissions, programs, and scholarships? . . . . . . . . . . . 32c. .. . . .
d Copies of all material used by the organization or on its behalf to solicit contributions? . 32d N A. .. . . .
Schedule 8 - ,If you answered "No" to any of the above, please explain (If you need more space, attach a separate statement.)Part V line 32d - 1................... ---•-----------••--- ------------------------------------------------------------Part V line 32d - 2- ----------------------- ------------------------------- ------------------------------------------------•------------
33 Does the organization discriminate by race in any way with respect to-
a Students' rights or privileges?
b Admissions policies? . 33b
c Employment of faculty or administrative staff? . . . . . . . . . . . . . .
d Scholarships or other financial assistance? . . . . . . . . . . . . . .
e Educational policies? . . . . . . . . . . . . . . . . . r33
f Use of facilities? . . . . . . . . . . . . . . . . . . . . . .
CLN
g Athletic programs?. . . . . . . . . . . . . . . . . . . . . . .
A
A
h Other extracurricular activities?. . . . . . . . . . . - . . 33h
Schedule 9If you answered "Yes" to any of the above, please explain. (If you need more space, attach a separate statement) =Part Vline33h-1 ..'
• •-•-----------------------------------------•-•--------------•-----•-------------------.........----------...--•---Part V line 33h - 2 -------- -----•------------•-••-------•-•----------------•------------•--•-------------..-.--------........-----------•Part V line 33h - 3----------------------------------------------------------------------------------------- ----------------------------
I IA ^34a Does the organization receive any financial aid or assistance from a governmental agency? . . . . a
b Has the organization's right to such aid ever been revoked or suspended? . . . . . . . . . . 34b
If you answered "Yes" to either 34a or b, please explain using an attached statement. Schedule 10
Schedule 11Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4 05of Rev. Proc. 75-50, 1975-2 C.B. 587, covering racial nondiscnmination? If "No," attach an explanation . . 35 N P.
35
Schedule A (Form 990 or 990-EZ) 2005
Schedule A (Form 990 or 990-EZ) 2005 Page 5
Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions.)(To be completed ONLY by an eligible organization that filed Form 5768)
Check ► a q if the organization belongs to an affiliated group. Check ► b r1 if you checked "a" and "limited control" provisions aooly.
Limits on Lobbying Expenditures I (a) I To be completedAffiliated group for ALL electing(The term "expenditures" means amounts paid or incurred) Schedule 12 totals organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) . . 37.
38 Total lobbying expenditures (add lines 36 and 37) . . . . . . . . . . 38
39 Other exempt purpose expenditures . . . . . . . . . . . 3940 Total exempt purpose expenditures (add lines 38 and 39) . . . . 40
41 Lobbying nontaxable amount. Enter the amount from the following table-
If the amount on line 40 is- The lobbying nontaxable amount is-
Not over $500,000. . . . . . 20% of the amount on line 40 •
Over $500,000 but not over $1,000,000 . $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 1
"' -
Over $1,500,000 but not over $17,000,000. $225,000 plus 5% of the excess over $1,500,000
Over $17,000,000. . . . . . . $1,000,000 . . . .42 Grassroots nontaxable amount (enter 25% of line 41) . . . . . .
-
42
-
.
43 Subtract line 42 from line 36. Enter -0- If line 42 is more than line 36. . 43
44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38. . . .
Caution : If there is an amount on either line 43 or line 44, you must file Form 4720. -
4-Year Averaging Period Under Section 501(h)(Some organizations that made a section 501(h) election do not have to complete all of the five columns below
See the instructions for lines 45 through 50 on page 11 of the instructions.)
Schedule 13 f Lobbying Expend itures During 4-Year Averaging Period
Calendar year (orfiscal year beginning in) ►
(a)2005
(b )2004
(c)2003
(d)2002
(e)Total
45 Lobbying nontaxable amount . .
46 Lobbying ceiling amount (150% of line 45(e))
47 Total lobbying expenditures . . . . . .
48 Grassroots nontaxable amount .
49 Grassroots ceiling amount (150% of line 48(e))
50 Grassroots lobbying expenditures -
Lobbying Activity by Nonelecting Public Charities(For reporting only by organizations that did not complete Part VI-A) (See page 11 of the instructions.)
During the year, did the organization attempt to influence national, state or local legislation, including anyattempt to influence public opinion on a legislative matter or referendum, through the use of.
Yes No Amount
a Volunteers . . . . . . . . . . . . . . . . . .. N 'A _. . . . . . . .
b Paid staff or management (Include compensation in expenses reported on lines c through h.). . . N 'A
c Media advertisements . . . . . . . . . .. . . . . . N A. . . . . . . . .
d Mailings to members legislators, or the public NIA, . . . . . . . . . . . . . . . .
e Publications, or published or broadcast statements N A. . . . . . . . . . . . . . . .
f Grants to other organizations for lobbying purposes . . . . . A. . . . . . . . -
g Direct contact with legislators, their staffs government officials or a legislative body A, , . . . . .h Rallies, demonstrations seminars, conventions speeches lectures or any other means A, , , ,i Total lobbying expenditures (Add lines c through h.) . . . . . Schedule 14
If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities.
Schedule A (Form 990 or 990-El) 2005
Schedule A (Form 990 or 990-EZ) 2005 Page 6
LjU" Information Regarding Transfers To and Transactions and Relationships With NoncharitableExempt Organizations (See page 12 of the instructions.)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization describe501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
d in section
a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No
(i) Cash . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51a i N 'A
(ii) Other assets . . . . . . . . . . . . . . . . . . . . . . . . . a (ii) N A
b Other transactions
(i) Sales or exchanges of assets with a noncharitable exempt organization b
N A
(ii) Purchases of assets from a nonchantable exempt organization . . . . . . . . . . . . . . b ii N A
(iii) Rental of facilities, equipment, or other assets b iii NIA
(iv) Reimbursement arrangements . . . b iv
(v) Loans or loan guarantees . . . . . . . . . . . . . . b v. . .(vi) Performance of services or membership or fundraising solicitations b (vi ) NIA
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . . . . . . c
d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair marketgoods, other assets, or services given by the reporting organization. If the organization received less than fair market vtransaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received-
valuealue i
of then any
Schedule A (Form 990 or 990-EZ) 2005
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizationsdescribed in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 ? . . . . . ► q Yes ® No
Attachments to IRS Form 990PENCIL Foundation
58-1475675
Tax Year 2005
Schedule 2 : Part I, Line 9 - Special Events and Activities
Number of
Activity Times
(A) Little Night of Music 1
(B)
(C)
Other
(A) (B) (C) Other Total
Amounts Carried to Part I. Line 9
Gross Receipts 94,345 94,345
Less Contributions 0
Gross Revenue 94,345 0 0 0 94,345
Less- Direct Expenses 22,932 22,932Net Income or (Loss) 71,413 0 0 0 71,413
Carry to Part VII, Line 101 - See Note
Amounts Carried to Part VII , Line 101
Column B - Unrelated Business Income
Gross Receipts 0 0 0 0 0Less Contributions 0 0 0 0 0Gross Revenue 0 0 0 0 0
Less Direct Expenses 0 0 0 0 0Net Income or (Loss) 0 0 0 0 0
Column D - Excluded by Sec 512, 513, or 514
Gross Receipts 0 0 0 0 0
Less. Contributions 0 0 0 0 0
Gross Revenue 0 0 0 0 0
Less Direct Expenses 0 0 0 0 0Net Income or (Loss) 0 0 0 0 0
Column E - Related / Exempt Function Income
Gross Receipts 94,345 0 0 0 94,345
Less: Contributions 0 0 0 0 0
Gross Revenue 94,345 0 0 0 94,345
Less: Direct Expenses 22,932 0 0 0 22,932Net Income or (Loss) 71,413 0 0 0 71,413
Note : Numeric codes used are
1 - if Unrelated Business Income (Part VII, Column B),2 - if Excluded by Sec 512, 513, or 514 (Part VII, Column D)Balance is Related / Exempt Function Income (Part VII, Column E).
Attachments to IRS Form 990PENCIL Foundation
58-1475675
Tax Year 2005
Schedule 5 : Part II, Line 22 - Grants and Allocations
Part II . line 22 Portion Relationship
Total Property Other Approved, But ifClass of Activity: Cash than Not Paid by Individual
Grantee 's Name Grantee 's Address Amount Cash ( 1) Due Data (2) (3)Schedule 5 - Grants 1
1 1 Giles County High School Grantee Address 1 45,900 0 0 n/aTotal - Schedule 5 - Grants 1 45,900 0 0
Total - All Types Part II. line 22 45,900 0 0
(1) Additional information for property other than cash included on continuation sheet
(2) Grants or allocations that were approved during the year, but not paid by the due date for filing Form 990 (including extensions).
(3) In the case of grants to individuals, show the relationship of the grantee if related by blood, marriage, adoption, or employment
including employees' children) to any person or corporation with an interest in the organization, such as a creator, donor, director,
trustee, officer, etc
Additional Information for Property Other Than Cash
Line Number from prior page Book How Fair Market How Date of
Description of Property Value Determined Value (4) Determine Gift
1 1 Property Description 1
1.2 Property Description 2
1.3 Property Description 3
2.1 Property Description 4
22 Property Description 5
(4) If the fair market value of the property when the organization gave it is the measure of the award or grant, record any differencebetween fair market value and book value in the organization's books of account and on line 20
Information Required by Colleges, Universities, and Primary and Secondary Schools
for Scholarships or Other Financial Assistance Number of Aggregate
Individuals Dollar
Type of Financial Aid Recelvina Aid Amount
1 Schedule 5 - Type of Aid 1
2 Schedule 5 - Type of Aid 2Total 0
Attachments to IRS Form 990PENCIL Foundation
58-1475675
Tax Year 2005
Schedule 9: Part III , Line e - Other Program Services
Other Service
1 Math Partners
2 Caterpillar Student Writers Showcase
3 Choices
4 Reading College
5 LP PENCIL Box
6 PENCIL
7 Monroe Harding Youth InitiativeTotal Part III. line e
Grants Program
and Service
Allocations Expenses (1)
0 75,191
0 22.493
0 7,398
0 12,661
0 28,707
0 35,542
0 2.3830 184,374
(1) Required for Section 501 (c)(3) and (4) organizations , and section 4947(a)(1) nonexempt chartable trusts
Attachments to IRS Form 990PENCIL Foundation
68-1475675
Tax Year 2005
Schedule 20: Part IV, Line 65 - Other Liabilities
Description Amount
Funds held for others 64,628
PENCIL Foundation is serving as the fiscal agent for
Alignment Nashville
Total Part IV. line 65 64,628
loss pencilfoun da tion
PENCIL FOUNDATION BOARD OF DIRECTORS 2005-2006
CONTACT INFORMATION
4 1 1 d I c+o rsNo d i t-ec++u rs
No d i t-c c1-ors
WO rk.ed`- Ics s -I-hOy)
"7-" Compen1SQ +e1J,,
hGd Ox n+-ri b u o
a houvs/ ujc¢,re
in 4-he- err,ploye1,bereh+ Plows
No d I cforsCAI lowances.
rece i vrd expense Ccco Lij.1 s or d4-h.er-
September 2005
Mr. DeVan Ard, Jr ., Board AdvisorCEO & PresidentReliant BankP.O. Box 1469Brentwood , TN 37024Phone: 372-8700Fax: 372-0200E-mail: [email protected]
Ms. Sue Atkinson, Immediate Past
Board ChairChairmanAtkinson Public Relations2100 West End Avenue, Suite 700Nashville, TN 37203Phone: 320-7532
Contact: Rita [email protected]
Fax: 329-2848E-mail: [email protected]
Dr. Camilla P. BenbowPatricia and Rodes Hart Dean of Educationand Human DevelopmentPeabody College of Vanderbilt UniversityPeabody #329Nashville, TN 37203-5721Phone: 322-8407Fax: 322-8501E-mail: [email protected]
Dr. Terri BreedenExecutive Director, 5-12Metropolitan Nashville Public Schools2601 Bransford AvenueNashville, TN 37204Phone: 259-8653
Contact: Jackie Edmondson
Fax: 259-8734E-mail: [email protected]
Ms. Karen ChristianSenior Vice PresidentBank of America414 Union StreetNashville, TN 37219Phone: 749-3114Fax: 749-3637E-mail:[email protected]
Mr. John L. Clark, Jr.Vice President-Tennessee OperationsNashville Gas665 Mainstream DriveNashville, TN 37228Phone: 734-1709
Contact: Delores DockumFax: 734-1815E-Mail: [email protected]
Mr. Thomas ConnerPresident and Chief Financial OfficerMonster Labs, Inc.1103 oth Avenue North, Suite 5Nashville, TN 37203Phone:301-2600, ext. 137Fax: 301-2602E-mail: [email protected]
Ms. Jana Joustra DavisVice President of CommunicationsHCAOne Park PlazaNashville, TN 37203Phone: 344-1593
Contact: Paula Broadway [email protected]
Fax: 344-2291E-mail: [email protected]
Mrs. Teresa DennisPrincipalRuby Major Elementary School5141 John Hager RoadHermitage, TN 37076Phone: 232-2203Fax: 232-7108E-mail: [email protected]
Mr. Marty G . Dickens, Board TreasurerPresident - TennesseeBellSouth333 Commerce Street, Suite 2104Nashville, TN 37201-3300Phone: 214-6522
Contact: Linda [email protected]
Fax: 214-8858E-mail: [email protected]
Mr. Vernon ( Sonnye) H. Dixon, Jr.
Pastor
Hobson United Methodist Church1107 Chapel AvenueNashville, TN 37206Phone: 228-7334Mobile: 498-7573Fax:E-mail: [email protected]
Dr. Robert C. FisherPresidentBelmont University1900 Belmont BoulevardNashville, TN 37212-3757Phone : 460-6793
Contact: Sue HeflinFax: 460-5555E-mail: heflins@ mail.belmont.edu
Ms. Joan M. GallagherSenior Vice President-CorporateCommunicationsCaremark Rx Inc.211 Commerce StreetNashville, TN 37201Phone:743-6652
Contact: Ann Loughridge743-6648
Fax: 743-6651E-Mail: Joan [email protected]
Dr. Pedro E . GarciaDirector of SchoolsMetropolitan Nashville Public Schools2601 Bransford AvenueNashville, TN 37204Phone : 259-8421
Contact: Julie [email protected]
Fax: 259-8418Email: [email protected]
Mr. Jeff GreggAgentCreative Artists Agency, Inc.3310 West End Avenue, 5th FloorNashville, TN 37203Phone: 383-8787Fax: 383-4937E-mail: [email protected]
Mr. Chris R. JohnsonDirector-Business Systems DivisionDellOne Dell ParkwayNashville, TN 37217Phone: 795-7224
Contact: Cheryl Groleau795-8191
[email protected]: 309-0123E-mail: chris r johnson(@dell.com
Ms. Sarah L . KnestrickCommunity Volunteer903 Bowring ParkNashville, TN 37215Phone: 385-2995Fax: 256-7578 (Walter Knestrick)E-mail: [email protected]
Mr. Karl LangExecutive PrincipalHillwood Comprehensive High School400 Davidson RoadNashville, TN 37205Phone: 353-2025Fax: 353-2027E-mail: [email protected]
Mr. Patrick Drew MadduxSales ExecutiveEclipsys Corporation336 Red Feather LaneBrentwood, TN 37027Phone: 332-9500Fax: 332-9515E-mail: [email protected]
Mr. Steve MasieVice PresidentRogers Group, Inc.421 Great Circle RoadNashville , TN 37228Phone : 780-5735
Contact: Connie Edwardsconnie.edwards @ rogersgroupinc.comFax: 780-5722E-mail: steve . [email protected]
Mr. Edmund D. McClureSenior Vice President ofInformation Technology
AIG American General258N American General CenterNashville, TN 37250Phone: 749-1103
Contact: Annette StoneFax: 749-1626E-mail: [email protected]
Dr. Nancy Flatt MeadorExecutive Director, Pre-K-4Metropolitan Nashville Public Schools2601 Bransford AvenueNashville, TN 37204Phone: 259-8596Fax: 259-8734E-mail: [email protected]
Ms. Kathy NevillMember of the Board of EducationMetropolitan Nashville Public Schools4989 John Hager RoadHermitage, TN 37076Phone: 885-7212 (H)
834-0123 x 170 (W)Fax: 834-0192E-mail: [email protected]
Mr. Robert J. ObrohtaVice President of EducationNashville Area Chamber of Commerce211 Commerce Street, Suite 100Nashville TN 37201Phone: 743-3150Fax: 256-0393E-mail: [email protected]
Mr. Enrico J . Pennisi , Jr., Board ViceChairmanManaging Director- Head of TennesseeOperationsMarsh1801 West End Avenue , Suite 1500Nashville, TN 37203Phone : 340-2489
Contact: Ginnie HandFax: 340-2436E-mail: [email protected]
The Honorable Bill PurcellMayor of Nashville225 Polk AvenueNashville, TN 37203Phone: 862-6000
Contact: Melinda Mofield862-6012
Fax: 862-6040E-mail: [email protected]
Ms. Jennie D. RenwickVice President & Manager-Private Client
Financial ServicesFirst Tennessee Bank2525 West End Avenue, Suite 300Nashville, TN 37203Phone: 734-6163Fax: 734-6011E-mail: [email protected]
Jeff A . SanbornGroup Vice President, Retail BankingSunTrust Banks, Inc.Mail Code TN-NAS-2200201 4th Avenue North, Suite 16Nashville, TN 37219Phone: 748-5675Fax: 748-5936E-mail: [email protected]
Mrs. Sue Spickard , Board AdvisorPENCIL Founder & Community Volunteer2435 Bear RoadNashville, TN 37215Phone: 298-3243
Contact: Andy Spickard 936-9675Fax: 936-0676E-mail: [email protected]
Ms. Kelli A . StokesBusiness Technology ManagerCaterpillar Financial Services2120 West End AvenueNashville, TN 37203Phone: 341-1210Fax: 341-1210E-mail: [email protected]
Mr. Byron R. Trauger, BoardChairmanPartnerTrauger, Ney & Tuke222 Fourth Avenue NorthNashville, TN 37219-2117Phone:256-8585Fax: 256-7444E-mail: btrauger@tntlaw. net
Mr. John Van MolPartner, President & CEODye Van Mol & Lawrence209 Seventh Avenue, NorthNashville, TN 37219Phone: 244-1818
Contact: Bonnie [email protected]
Fax: 780-3396E-mail: [email protected]
Ms. Betsy WalkupCommunity Leader3710 Richland AvenueNashville, TN 37205Phone: 269-4295E-mail: [email protected]
Mr. Jason K. WestPresident & Chief Operating OfficerPrimeTrust BankP.O. Box 210287Nashville, TN 37221Phone: 646-4556Fax: 646-0121E-mail: jason.west(a)primetrustbank.com
Ms. Lynn WilliamsChairwomanMetro Council Education Committee4020 Dorcas DriveNashville, TN 37215Phone: 385-3859Fax: 385-8103E-mail: [email protected]
Key employees:Connie Williams, Executive Director421 Great Circle RoadSuite 100Nashville, TN 37228
b. Works more than 40 hours per weekc. Compensation: $112,148d. Benefit plan contributions: $8,386e. No expense account or other allowances
Foy, '8868 Application for Extension of Time To File an(Rev December 2004) Exempt Organization Return OMB No. 1545-1709
Department of the Treasury ► File a separate application for each returnI nternal Revenue Service
• If you are filing for an Automatic 3-Month Extension , complete only Part I and check this box . . . . . . . . ► LVJ• If you are filing for an Additional (not automatic) 3-Month Extension , complete only Part 11 (on page 2 of this form).Do not complete Part ll unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.
Automatic 3-Month Extension of Time-Only submit original (no copies needed)
Form 990-T corporations requesting an automatic 6-month extension-check this box and complete Part I only . . . ► q
All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns.Partnerships, REM/Cs, and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041.
Electronic Filing (e-file). Form 8868 can be filed electronically if you want a 3-month automatic extension of time to file one of thereturns noted below (6 months for corporate Form 990-T filers). However, you cannot file it electronically if you want the additional(not automatic) 3-month extension, instead you must submit the fully completed signed page 2 (Part II) of Form 8868. For moredetails on the electronic filing of this form, visit www.irs.gov/efile.
Type or N e of Exempt Or rnzation Employer identification number
print P'FF13 Gll_ " d o-H oy) 58 i 147-5075File by the N mber, str et , and room or suite no . If a P.O box , see Indue date for ' MQ +
CircleRd . LU 1,s I 0
filing your"`ttt
tructions.
^^^
T TC., freturn Seeinstructions Ci town or post office, state , and ZIP code For a foreign address , see instructions.
A V i I c -M 3 7.X) $' 140 -4eck type of return to be filed (file a separate application for each return):
Form 990 q Form 990-T (corporation ) q Form 4720
q Form 990-BL q Form 990-T (sec . 401(a) or 408(a) trust) q Form 5227
q Form 990-EZ q Form 990-T (trust other than above) q Form 6069
q Form 990-PF q Form 1041-A q Form 8870
_a o _h_0_• The books are in the care of _ -L-qa R- ss E Vc "-7H
Telephone No. ► (-Lo15 )__ 4.l - 3 ^7----y,2 14 FAX No. 0- ) 254- ly 7 Ll o -..
• If the organization does not have an office or place of business in the United States, check this box . . . . . . ► q
• If this is for a Group Return , enter the organization's four digit Group Exemption Number (GEN) . If thisis for the whole group, check this box ► q . If it is for part of the group, check this box ► q and attach a list with thenames and EINs of all members the extension will cover.
1 I request an automatic 3-month (6-months for a Form 990-T corporation) extension of time until ----- 21.15 -------- , 20-07
to file the exempt organization return for the organization named above. The extension is for the organization's return for:
► q calendar year 20 _-- or
10- Rb5 ^^,^ - - 30 Qtax year beginning ----------------^ -------- , 20 _.., and ending
----------- , 20
2 If this tax year is for less than 12 months, check reason: q Initial return q Final return q Change in accounting period
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less anynonrefundable credits. See instructions . . . . . . . . . . . . . . . . . . . . . . $
b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax paymentsmade. Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . $
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, depositwith FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). Seeinstructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Caution . If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EOfor payment instructions.
For Privacy Act and Paperwork Reduction Act Notice , see Instructions . Cat. No 27916D Form 8868 (Rev 12-2004)
Form 8868 (Rev. 12-2004)
• If you are filing for an Additional (not automatic) 3-Month Extension , complete only Part II and check this box . . ► qNote. Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed Form 8868.• If you are filing for an Automatic 3-Month Extension , complete only Part I (on page 1).
Additional (not automatic) 3-Month Extension of Time-Must File Original and One Copy,Type or Name of Exempt Organization Employer identification number
File by the Number, street, and room or suite no If a P 0 box , see instructions . For IRS use onlyextendeddue date forfiling the City , town or post office, state, and ZIP code For a foreign address, see instructionsY .return Seeinstructions
Check type of return to be filed ( File a separate application for each return):
q Form 990 q Form 990-T (sec. 401(a) or 408(a) trust) q Form 5227
q Form 990-BL q Form 990-T (trust other than above) q Form 6069q Form 990-EZ q Form 1041-A q Form 8870q Form 990-PF q Form 4720
STOP: Do not complete Part 11 if you were not already granted an automatic 3-month extension on a previously filed Form 8868.
• The books are in the care of ► ------ •----------------------------- •-------------•------------------------------------Telephone No. ►
(---------- ---------------•------------ FAX No. ► ( ---------- L --------------------- ------• If the organization does not have an office or place of business in the United States , check this box . . . . . ► q
• If this is for a Group Return , enter the organization ' s four digit Group Exemption Number (GEN) If this isfor the whole group, check this box ► q . If it is for part of the group, check this box ► q and attach a list with thenames and EINs of all members the extension is for.
4 I request an additional 3-month extension of time until __________________________________________ _ 20
5 For calendar year ....... orother taxyear beginning ------------------------ - 20------ andending ------------------------- 20--___.
6 If this tax year is for less than 12 months, check reason : q Initial return q Final return q Change in accounting penoc
7 State in detail why you need the extension -------------------------------------------------------------------------------------•-------
----------------------------------------------------•------------------•--------- -------------------------------------------- -------8a 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 is for Form 990-PF, 990-T, 4720, or 6069 , enter any refundable credits and estimatedtax payments made. Include any prior year overpayment allowed as a credit and any amount paidpreviously with Form 8868 . . . . . . . . . . . . . . . . . . . . . . .
.. . . $
c Balance Due. Subtract line 8b from - line-8a. Include your payment with this form, or, if required , depositwith FTD coupon or, if required , by using EFTPS (Electronic Federal Tax Payment System). See instructions. $
Signature and VerificationUnder penalties of perjury, 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 , correc},,zfnd complete, and tht I am authorized to prepare this form
Signature ► Title ►Hnan CX D i-Grote ► I .2s O^
Notice to Applicant-To Be Completed by the IRSq We have approved this application. Please attach this form to the organization 's return.
q We have not approved this application. However, we have granted a 10-day grace period from the later of the date shown below or the duedate of the organization ' s return (including any prior extensions). This grace period is considered to be a valid extension of time for electionsotherwise required to be made on a timely return . Please attach this form to the organization ' s return.
q We have not approved this application . After considering the reasons stated in item 7, we cannot grant your request for an extension of timeto file . We are not granting a 10-day grace penod.
q We cannot consider this application because it was filed after the extended due date of the return for which an extension was requested
q Other ----------------------------------------------- -----------------------------------------------------------------------------------------
ByDirector Date
Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3-month extension
returned to an address different than the one entered above.
Name
Type or Number and street (include suite, room , or apt no.) or a P.O. box number
City or town, province or state, and country (including postal or ZIP code)
Form 8868 (Rev. 12-2004)n r7
