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Form 990-EZ
Department of the Treasury
Short FormReturn of Organization Exempt From Income Tax
Under section 501 (c), 527, or 4947(a)(1) of the Internal Revenue Code(except black lung benefit trust or private foundation)
'Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities,
and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions)
All other organizations with gross receipts less than $200,000 and total assets less than $500,000
at the end of the year may use this form► The organization may have to use a copy of this return to satisfy state reporting requirements
OM$. No 1545-1150
2012
A For the 2011 calendar year , or tax year beginning 01/01 , 2012 ,and ending 03/30 , 20 12
B Check if applicable C Name of organization D Employer identification number
Address change
Name change AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
Number and street (or P 0 box, If mail is not delivered to street address ) Room /suite E Telephone numberInitial return
X Terminated P.O. BOX 66308 (832 ) 548-5253
Amended returnCity or town, state or country, and ZIP + 4
F Group Exemption
Application pending HOUSTON, TX 77266-6308 Number ►
G Accounting Method Cash LJX Accrual Other (specify) ► H Check ► Li If the organization is not
I Website : I. WWW . CENTERFORAI DS . ORG required to attach Schedule B
J checonpone) - X 501 c 3 501 c 1 Insert no 4947(a)(1) or 527 (Form 990, 990-EZ, or 990-PF)
K Check ► if the organization is not a section 509(a)(3) supporting organization or a section 527 organization and its gross receipts are normally
not more than $50,000 A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions) But if
the organization chooses to file a return, be sure to file a complete return
L Add lines 5b, 6c , and 7b , to line 9 to determine gross receipts If gross receipts are $200 , 000 or more , or If total assets (Part II,
line 25 , column ( B) below ) are $500 ,000 or more, file Form 990 instead of Form 990-EZ . . . . . . . . 110. $ 108,739,. . . . . . . .
GEN Revenue, Expenses , and Changes in Net Assets or Fund Balances (see the instructions for Part I.)Check if the organization used Schedule 0 to respond to any ciuestlon in this Part I ............... n
1 Contributions , gifts, grants, and similar amounts received . . . . . . . . . . . . . . . . . . . . . . 1 107,394.
2 Program service revenue including government fees and contracts 2 1,231.. . . . . . . . . . . . . . .
3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . .ATCIJ . 1. . . 4 114.
5 a Gross amount from sale of assets other than inventory , , , , , , 5a
b Less cost or other basis and sales expenses . . . . . . . . . . 51b
c Gain or (loss) from sale of assets other than inventory ( Subtract line 5b from line 5a) . . . . . . . . . . 5c
6 Gaming and fundraising events
a Gross income from gaming ( attach Schedule G if greater than
6a$15,000) . . . . . . . . . . . . . . . .b Gross income from fundraising events (not including $ of contributions
from fundraising events reported on line 1 ) (attach Schedule G if the
sum of such gross income and contributions exceeds $15 , 000) 6b
C Less direct expenses from gaming and fundraising events . . 6c
!^! d Net income or (loss ) from gaming and fundraising events (add lines 6a and 6b and subtract
line6c) ............................ . .............. 6d
7 a Gross sales of inventory , less returns and allowances . . . . . . 7a
b Less cost of goods sold , , , , , , , , , , , , , , , , , , , , 7b
C Gross profit or (loss ) from sales of inventory ( Subtract line 7b from line 7a) 7c.
, , ,8 Other revenue (describe in Schedule 0) 8, , , , , , , , , , , , , , , , , , , , , , , , ,
9 Total revenue . Add lines 1 , 2, 3, 4, 5c , 6d, 7c , and 8 . ..................... 9 108,739.
10 Grants and similar amounts paid (list in Schedule 0)
Tz-H
12 10 270,126.
11 Benefits paid to or for members 8D V-1Ef 11
4)E ........12 Salaries , other compensation, and employee benefits , 12 53,127.
c 13 Professional fees and other payments to independent co tt or y 13 8,582.
^ ^a , O14 Occupancy, rent, utilities, and maintenance ..... 14 6,072.XW
, , , .
15 Printing , publications , postage, and shipping , 15 13,340.
C2e16 Other expenses ( describe in Schedule O) 0G ( I 16 9,527.'
17 Total expenses . Add lines 10 through 16 J v (^ 17 360, 774 .
18 Excess or (deficit ) for the year (Subtract line 17 from line 9) 18 -252,035., , , , , , , , , , , , , , , , ,
19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end- of-year figure reported on prior year's return ) _ 19 443, 676.
Z 20 Other changes in net assets or fund balances (explain in Schedule 0) ATCJ-I, 3. . . . . 20 -191,641.
21 Net assets or fund balan ces at end of year Combine lines 18 through 20 ► 21
For Paperwork Reduction Act Notice, see the separate instructions.
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Form 990-EZ (2011)
go-'1PAGE
1
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391E90
Form 990 - EZ (2011) Page 2
• . Balance Sheets. (see the instructions for Part II.)Check if thin nrnnni7ntinn ucPd Schedule 0 to resnond to any auestlon in this Part II . . . . . n
(A) Beginning of year (B) End of year
22 Cash, savings, and investments . . . .aTTACIUI`1EtJT . 4 . . . . 310, 891. 22 0
23 Land and buildings . . . . . . . . . .. . . . . . 415, 245. 23 0
24 Other assets (describe in Schedule O) . ATTACHMENT 5 5,286. 24 0
25 Total assets . . . . . . . . . . . . . . . 731, 422. 25 0
26 Total liabilities (describe in Schedule O) ATTACHMENT . 6 . . . . 287,746. 26 0
27 Net assets or fund balances (line 27 of column ( B) must agree with line 21) . 443, 676. 27 0
Offm Statement of Program Service Accomplishments (see the instructions for Part III)
Check if the organization used Schedule 0 to respond to any question in this Part III . . XExpenses
(Required for section
What is the organization's primary exempt purpose? ATTACHMENT 7
Describe the organization's program service accomplishments for each of its three largest program services, as measured
by expenses In a clear and concise manner, describe the services provided, the number of persons benefited, and other
relevant information for each program title
501(c)(3) and 501(c)(4)organizations and section
4947(a)(1) trusts ; optionalfor others )
28 ATTACHMENT 8
( Grants $ If this amount includes forei gn grants, check here . . ► 28a 25,757.
29 ATTACHMENT 9
(Grants $ If this amount includes foreign grants, check here . . ► 29a 13,130.
30 ATTACHMENT 10
( Grants $ If this amount includes foreign grants, check here . . . ► 30a 9, 474 .
31 Other program services (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(Grants $ 270,126. ) If this amount includes foreign grants, check here . . ► 31a 281,500.
32 Total program service expenses (add lines 28a through 31a) . ► 32 329,861.
List of Officers, Directors , Trustees , and Key Employees . List each one even if not compensated (see the instructions for Part IV )
.................... .Check if the oraanlzatlon used Schedule 0 to respond to any auestion in this Part IV . F-1
(a) Name and address(b) Title and average
hours per week
devoted to position
(C) Reportablecompensation
(Forms W-2/1099-MISC)(K not paid , enter - )-)
(d) Health benefits,
contributions to employeebenefit plans , and
deferred compensation
(e) Estimated amount of
other compensation
ATTACHMENT 1 3
1J 5A Form 990-EZ (2011)7 E 1009 1 000
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-039190
Form 990 -EZ (2011) Page 3
Other Information ( Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V. ) Check if the organization used Schedule 0 to respond to any q uestion in this Part V X
Yes No
33 Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a
detailed description of each activity in Schedule 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 X
34 Were any significant changes made to the organizing or governing documents? If "Yes ," attach a conformed A CH 11copy of the amended documents if they reflect a change to the organization 's name Otherwise , explain the
34 Xchange on Schedule 0 (see instructions) . .
35a Did the organization have unrelated business gross income of $ 1,000 or more during the year from business
activities ( such as those reported on lines 2 , 6a, and 7a , among others ) ? , , , , , , , , , , , , , , , , , , 35a X
b If "Yes ," to line 35a , has the organization filed a Form 990-T for the year? If " No," provide an explanation in Schedule 0 . . . 35b
c Was the organization a section 501 ( c)(4), 501 ( c)(5), or 501 ( c)(6) organization subject to section 6033 ( e) notice,
reporting , and proxy tax requirements during the year's If "Yes ," complete Schedule C, Part III , , , , , , , 35c X
36 Did the organization undergo a liquidation , dissolution , termination , or significant disposition of net assets
during the year? If "Yes," complete applicable parts of Schedule N . . .. . . . . . . . . . . . . . . . . . . . . . 36 X
37a Enter amount of political expenditures , direct or indirect , as described in the instructions . ► 37a
b Did the organization file Form 1120 - POL for this year's . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37b X
38a Did the organization borrow from , or make any loans to , any officer , director , trustee , or key employee or were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return ? , , . 38a X
b If "Yes," complete Schedule L, Part II and enter the total amount involved 38b ''
39 Section 501(c)( 7) organizations Enter
a Initiation fees and capital contributions included on line 9 39a 311,b Gross receipts , included on line 9, for public use of club facilities , , , , , , , , , , . 39b ===== " i
40a Section 501(c)( 3) organizations Enter amount of tax imposed on the organization during the year under
JY`~Vr
section 4911 ► Q section 4912 ► Q section 4955 ► 0 , w
b Section 501 ( c)(3) and 501 ( c)(4) organizations Did the organization engage in any section 4958 excess benefit ,w 1?1_^
transaction during the year , or did it engage in an excess benefit transaction in a prior year that has not been
reported on any of its prior Forms 990 or 990-EZ? If "Yes ," complete Schedule L, Part I , , , , , , , , , , , , , 40b X
c Section 501(c)(3) and 501 ( c)(4) organizations Enter amount of tax imposed on ='=
Eorganizationmanagers or disqualified persons during the year under sections 4912,
4955 , and 4958 ► 0 w
d Section 501 ( c)(3) and 501 ( c)(4) organizations Enter amount of tax on line 40c`°'#' 3
reimbursed by the organization ►e All organizations At any time during the tax year , was the organization a party to a prohibited tax shelter s FM -a_;z
transaction? If "Yes ," complete Form 8886-T . . . . . . , 40e X
41 List the states with which a copy of this return is filed ►42a The organization ' s books are in care of GLISAN Telephone no ► ----------------------------------------32-548-5052
- -Located at .1415 CALIFORNIA HOUSTON, TX ZIP+4 77006
b At any time during the calendar year , did the organization have an interest in or a signature or other authority over Yes No
a financial account in a foreign country ( such as a bank account , securities account , or other financial account)? 42b X
If "Yes ," enter the name of the foreign country ►See the instructions for exceptions and filing requirements for Form TD F 90-22 . 1, Report of Foreign Bank = !<
and Financial Accounts.,...:
c At any time during the calendar year , did the organization maintain an office outside the U S ? , , , 42c X
If "Yes ," enter the name of the foreign country ►43 Section 4947( a)(1) nonexempt charitable trusts filing Form 990 -EZ in lieu of Form 1041 - Check here . . . . . . . . . . ► q
and enter the amount of tax-exempt interest received or accrued during the tax year , , , , , , , , ► 43Yes No
44a Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be
completed instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44a X
b Did the organization operate one or more hospital facilities during the year? If "Yes," Form 990 must be
completed instead of Form 990 -EZ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44b X
c Did the organization receive any payments for indoor tanning services during the year's ' , , , , , . 44c X
d If "Yes" to line 44c , has the organization filed a Form 720 to report these payments ' If "No," provide an :,, ,'
explanation in Schedule 0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44d
45a Did the organization have a controlled entity within the meaning of section 512 ( b)(13)? , , , , , . . , . . . . 45a X
45 b Did the organization receive any payment from or engage in any transaction with a controlled entity within the
meaning of section 512(b )(13)9 If "Yes," Form 990 and Schedule R may need to be completed instead of
Form 990 -EZ (see instructions), 45b XSSA Form 990-EZ (2011)
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76•-0391690
Form -990 -EZ(2011Page4
Yes No
46 Did the organization engage , directly or indirectly, in political campaign activities on behalf of or in opposition
to candidates for public office? If "Yes," complete Schedule C, Part I . 46 X
Section 501 ( c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts only. All section
501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 47-49b
and 52, and complete the tables for lines 50 and 51.
Check if the organization used Schedule 0 to respond to any question in this Part VI .............. q
47 Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax Yes No
year? If "Yes," complete Schedule C, Part II 47 X
48 Is the organization a school as described in section 170(b)(1)(A)(n)? If "Yes," complete Schedule E 48 X
49a Did the organization make any transfers to an exempt non-charitable related organization? . , . . . . , 49a X
b If "Yes," was the related organization a section 527 organization? . . . . . . . . . . . . . . . . . . . . . 49b
50 Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and keyemoioueecl who oarh roroivart more than T,1 nn nnn of rmmnensafinn from the nrnanvatlnn If there Is none enter "None "
(a) Name and address of each employeepaid more than $ 100,000
( b) Title and averagehours per week
devoted to position
(c) Reportablecompensation
(Forms W-2/1099-MISC)
(d) Health benefits,con piautions to employeebenefitt plans, and deferred
com p ensation
e) Estimated amount ofother compensation
--------------------------------------NONE
--------------------------------------
--------------------------------------
--------------------------------------
--------------------------------------
f Total number of other employees paid over $100,000 ►51 Complete this table for the organization's five highest compensated independent contractors who each received more than
$100.000 of comoensatlon from the organization If there is none, enter "None "
(a) Name and address of each independent contractor paid more than $100,000 (b ) Type of service (c) Compensation
-----------------------------------------------NONE
-----------------------------------------------
-----------------------------------------------
-----------------------------------------------
---------------------------------------------
d Total number of other independent contractors each recelvl
52 Did the organization complete Schedule A? Note: All sectionnonexem pt charitable trusts must attach a com p leted Sch _
Under penalties of perjury, I declare that I have examined this return , including accotrue , correct , and complete Declaration of preparer ( other than officer) is based on all i
'!
Sign Signature of officer
Here r "es" 7 -scType or print name and title
Print/Type preparers name Preparers signaturePaid BRIAN D. TODD I
&1;
4
Preparer
Use Only Firm's name No- BKD, LLP
Firm's address ► 910 E ST LOUIS #200/PO BC
SPRINGFIELD, MO 65806-252
May the IRS discuss this return with the preparer shown above? S
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SCHEDULE A(Form 990 or 990-EZ)
Department of the TreasuryInternal Revenue Service
Public Charity Status and Public SupportComplete if the organization is a section 501(c )(3) organization or a section
4947( a)(1) nonexempt charitable trust
► Attach to Form 990 or Form 990-EZ. ► See separate instructions.
OMB No 1545-0047
2112
Name of the organization Employer identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is* (For lines 1 through 11, check only one box)
I A church, convention of churches, or association of churches described in section 170(b )(1)(A)(i).
2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E )
3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4 A medical research organization operated in conjunction with a hospital described in section 170(b )(1)(A)(iii). Enter the
hospital's name, city, and state
5 r An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II )
6 B A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7 An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part II )
8 A community trust described in section 170(b)(1)(A)(vi). (Complete Part II )
9 X An organization that normally receives (1) more than 331/3%of Its support from contributions, membership fees, and gross
receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 331/3% of its
support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a )(2). (Complete Part III )
10 8 An organization organized and operated exclusively to test for public safety See section 509(a)(4).
11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the
purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section
509(a )(3). Check the box that describes the type of supporting organization and complete lines 11 a through 11 h
a Type I b Type II c Type III - Functionally integrated d Type III - Other
e El By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified
persons other than foundation managers and other than one or more publicly supported organizations described in section
509(a)(1) or section 509(a)(2)f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting
organization, check this box . . El
g Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) Yes No
and (iii) below, the governing body of the supported organizations . . . . . . . . . . . . . . . . . . . . .
(ii) A family member of a person described in (I) above? 119(i)
(iii) A 35% controlled entity of a person described in (I) or (II) above?
.119(i)
11g(iii)
h Provide the following information about the supported orcianizatlon(s)(i) Name of supported
organization(ii) EIN (iii) Type of organization
(described on lines 1-9above or IRC sectionsee instructions ))
(iv) is theorganization incol (1) listed inyour ent?
t^e
(v) Did you notifythe organization
in col (i) ofyour support?
(vi) Is theorganization in
col (i) organizedin the U S
(vii) Amount ofsupport
Yes No Yes No Yes No
(A)
(B)
(C)
(D)
(E)
Total T-,For Paperwork Reduction Act Notice, see the Instructions for Schedule A (Form 990 or 990-EZ) 2011Form 990 or 990-EZ.
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76.03916,90
Schedule A ( Form 990 or 990-EZ ) 2011 Page 2
Support Schedule for Organizations Described in Sections 170(b)( 1)(A)(iv) and 170 (b)(1)(A)(vi)(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify underPart III If the organization fails to qualify under the tests listed below, please complete Part III )
Ser-tinn A Public Snnnnrt
Calendar year (or fiscal year beginning in) ► (a) 2007 (b) 2008 (c) 2009 ( d) 2010 (e) 2011 (f) Total
I Gifts , grants , contributions, andmembership fees received (Do notinclude any "unusual grants ") . . . . . .
2 Tax revenues levied for theorganization's benefit and either paidto or expended on its behalf . . . . . . .
3 The value of services or facilitiesfurnished by a governmental unit to theorganization without charge . . . . . . .
4 Total. Add lines 1 through 3 . . . . . . .
z =
•s
5 The portion of total contributions by T m = -=! ,_4- Veach person ( other than a °• 0 - m
governmental unit or publicly n K ;^5 Vsupported organization ) included on
line 1 that exceeds 2% of the amountn•'
=-
ps
=,"'
V V' '°' am ' „ ='shown on line 11, column (f). . . . . . ==• =
6 Public support. Subtract line 5 from brie 4 ' l
Section B. Total SupportCalendar year (or fiscal year beginning in) ► (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4 . . . . . . . . . .
8 Gross income from interest, dividends,payments received on securities loans,rents, royalties and income from similarsources . . . . . . . .
9 Net income from unrelated business
activities, whether or not the businessis regularly carried on . . . . . . . . . .
10 Other income. Do not include gain orloss from the sale of capital assets(Explain in Part IV) . . . . . . . . . . .
11 Total support Add lines 7 through 10
12 Gross receipts from related activities, etc (see instructions ) . . . . . . . . . . . . . . . . . . . . . . . . . . 12
13 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)organization , check this box and stop here ► q
Section C. Computation of Public Support Percentage
14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) . . . . . . . . 14 %
15 Public support percentage from 2010 Schedule A, Part II, line 14 . . . . . . . . . . . . . . . . . . . 15
16a 331/3% support test - 2011 . If the organization did not check the box on line 13, and line 14 is 331/3% or more, check
this box and stop here . The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . .. . . . . ► q
b 331/3% support test - 2010 . If the organization did not check a box on line 13 or 16a, and line 15 is 331/3% or more,
check this box and stop here . The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . ► q
17a 10%-facts-and-circumstances test - 2011 . If the organization did not check a box on line 13, 16a, or 16b, and line 14 is
10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain in
Part IV how the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly supported
organization ......... .................................................... ► q
b 10%-facts -and-circumstances test - 2010 . If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organzation meets the "facts-and-circumstances" test The organization qualifies as a publicly
supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . ► q
18 Private foundation . If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ............................................................. q
Schedule A (Form 990 or 990 -EZ) 2011
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76c-0391690
Schedule A ( Form 990 or 990-EZ ) 2011 Page 3
GEM Support Schedule for Organizations Described in Section 509(a)(2)( Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II.If the organization fails to qualify under the tests listed below, please complete Part II.)
Ra_r_tinn A Piihlir Sunnnrt
Calendar year ( or fiscal year beginning in) ► (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts , grants , contributions , and membership fees
received (Do not include any "unusual grants ") 418,732 357,665 366, 649 347 , 857 107, 394 1 598, 297.
2 Gross receipts from admissions , merchandise
sold or services performed , or facilities
furnished in any activity that is related to the
organization ' s tax-exempt purpose
3 Gross receipts from activities that are not an
unrelated trade or business under section 513
4 Tax revenues levied for the
organization's benefit and either paid
to or expended on its behalf , , , , ,
5 The value of services or facilities
furnished by a governmental unit to the
organization without charge , , , , , , ,
6 Total . Add lines 1 through 5 , , , , , , , 418 , 732 357 , 665 366, 649 347 , 857 107, 394 1,598 , 297
7a Amounts included on lines 1, 2, and 3
received from disqualified persons . . . .
.
6,000 6,000b Amounts included on lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year
c Add lines 7a and 7b. . . . . . . . . . . 6,000 6 , 000.
8 Public support (Subtract line 7c from
line 6 1 , 592 , 297.
Section B. Total SupportCalendar year ( or fiscal year beginning in) ►
9 Amounts from line 6. . . . . . . . . . .10a Gross income from interest, dividends,
payments received on securities loans,rents, royalties and income from similarsources . . . . . . . . . . . . . . . . .
b Unrelated business taxable income (less
section 511 taxes) from businesses
acquired after June 30, 1975 , , , , , ,
c Add lines 10a and 10b
11 Net income from unrelated businessactivities not included in line 10b,whether or not the business is regularly
carried on • • • • •
12 Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part IV) . . . . . . . . . . .
13 Total support. (Add lines 9, 1Oc, 11,
and 12)
(a) 2008 (b) 2009 (c) 2010 (d) 2011 ( e) 2012 (f) Total
418,732 357,665. 366 , 649 347,857 107,394 1 598,297
5,748. 170 23 923 114 6,978
5 , 748. 170 23 923 114 6,978
424,480 357 835. 366,672 348 , 780. 107,508 1 , 605 , 275
14 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here . ► TiCorfinn f_ (_mmnh.t Linn of Prihlir Siinnnrt Porcanfnna
15 Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) . . . . . . . . . . . . . . 15 y 3 . 1 y %
16 Public support percentage from 2011 Schedule A, Part III, line 15 . 16 99.12%
Section D . Computation of Investment Income Percentage
17 Investment income percentage for 2012 ( line 1 Oc , column (f) divided by line 13 , column (f)) , , , , , , , , , , 17 .43%
18 Investment income percentage from 20,11 Schedule A, Part III, line 17 , , , , , , , , , , , , , , , , , , , , 18 .57%
19a 331 /3% support tests - 2012 If the organization did not check the box on line 14 , and line 15 is more than 331 / 3%, and line
17 is not more than 331 /3%, check this box and stop here The organization qualifies as a publicly supported organization ► q
b 331 /3% support tests - 2011 If the organization did not check a box on line 14 or line 19a , and line 16 is more than 331/30/0, and
line 18 is not more than 331 /3%, check this box and stop here The organization qualifies as a publicly supported organization ►20 Private foundation . If the organization did not check a box on line 14, 19a , or 19b , check this box and see instructions ►
JSA1E 1221 1 000
Schedule A (Form 990 or 990 -EZ) 2011
9118EM K929 1/20/2013 7:32:26 PM V 11 -6.4 PAGE 8
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76c0391690
Schedule A ( Form 990 or 990 - EZ) 2011 Page 4
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;Part II, line 17a or 17b , and Part III , line 12 . Also complete this part for any additional information. (Seeinstructions).
SSA Schedule A (Form 990 or 990-EZ) 2011
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SCHEDULE N(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Liquidation, Termination, Dissolution, or Significant Disposition of Assets
► Complete if the organization answered "Yes" to Form 990, Part IV , lines 31 or 32; or Form 990-EZ, line 36.
► Attach certified copies of any articles of dissolution, resolutions , or plans.
► Attach to Form 990 or 990-EZ.
OMB No 1545-0047
20'12
Name of the organization Employer Identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
JiM Liquidation , Termination, or Dissolution . Complete this part if the organization answered "Yes" to Form 990, Part IV, line 31, or Form 990-EZ, line 36.0...a I ...,.. I-s ,.1. lif A if -1r44innnl ennrc ie nonrlcrt
1 (a) Description of asset(s)distributed or transaction
expenses paid
(b) Date ofdistribution
(c) Fair market value of
asset( s) distributed or
amount of transaction
expenses
(d) Method of
determining FMV for
asset( s) distributed or
transaction expenses
(e) EIN of recipient (f) Name and address of recipient (g) IRC section of
recipient(s) (if
tax-exempt) or type
of entity
CASH 03/30/2012 327 , 375 BOOK VALUE 76-0009637
LEGACY COMMUNITY HEALTH SERVICES
PO BOX 66308 HOUSTON TX 77266-6308 501 ( C )( 3 )
ACCOUNTS RECEIVABLE 03/30/2012 1 , 000 BOOK VALUE 76-0009637
LEGACY COMMUNITY HEALTH SERVICES
PO BOX 66308 HOUSTON TX 77266-6308 501 ( C )( 3 )
PREPAID ASSETS 03/30/2012 2 , 669 BOOK VALUE 76-0009637
LEGACY COMMUNITY HEALTH SERVICES
PO BOX 66308 HOUSTON TX 77266-6308 501 ( C )( 3 )
BUILDING 03/30/2012 231 015 SUBSE QUENT SALE 76-0009637
LEGACY COMMUNITY HEALTH SERVICES
PO BOX 66308 HOUSTON TX 77266-6308 501 ( C )( 3 )
LAND 08/30/2012 68 , 986 SUBSE QUENT SALE 76-0009637
LEGACY COMMUNITY HEALTH SERVICES
PO BOX 66308 HOUSTON TX 77266-6308 501 C ( 3 )
Yes No
2 Did or will any officer , director , trustee , or key employee of the organization
. . . . . . . . . . . . . . . . . . . .a Become a director or trustee of a successor or transferee organization? 2a X. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .a successor or transferee organization ?or independent contractor forb Become an employee of 2b X. . . . . . . . . . . . . . . . . . . . .,,. . . . . . . . . .c Become a direct or indirect owner of a successor or transferee organization? 2c X. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d Receive . or become entitled to . comoensatlon or other similar payments as a result of the organization 's liquidation , termination , or dissolution? . . . . . . . . . . . . . . . . . . 2d X
e If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III ►
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or Form 990-EZ. Schedule N (Form 990 or 990-EZ) (2011)
JSA
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC.
Schedule N ( Form 990 or 990-EZ ) (2011)
76-0391690
Page 2
uidation, Termination , or Dissolution ,
Note . If the organization distributed all of its assets during the tax year, then Form 990, Part X, column (B), line 16 (Total assets), and line 26 (Total liabilities), should Yes No .,'
equal -0-
3 Did the organization distribute its assets in accordance with its governing instrument(s)? If "No," describe in Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 X
4 a Is the organization required to notify the attorney general or other appropriate state official of its intent to dissolve, liquidate, or terminates . . . . . . . , , , 4a X
b If "Yes," did the organization provide such notice? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4b X
5 Did the organization discharge or pay all of its liabilities in accordance with state laws? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 X
6 a Did the organization have any tax-exempt bonds outstanding during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6a X
b Did the organization discharge or defease all of its tax-exempt bond liabilities during the tax year in accordance with the Internal Revenue Code and state laws? , , , , , , , 6 b
c If "Yes" to line 6b . describe in Part III how the organization defeased or otherwise settled these liabilities If "No , " explain in Part III
Sale, Exchange , Disposition , or Other Transfer of More Than 25% of the Organization 's Assets . Complete this part if the organization answered
"Yes" to Form 99n Part IV line 32 or Form 990-EZ. line 36. Part II can be duplicated if additional space is needed.
(a) Description of asset(s)distributed or transaction
expenses paid
(b) Date ofdistribution
(c) Fair market value ofasset(s) distributed oramount of transaction
expenses
(d) Method ofdetermining FMV forasset( s) distributed ortransaction expenses
(e) EIN of recipient (f) Name and address of recipient (g) IRC section ofrecipient(s) (if
tax-exempt) or typeof entity
Yes No
2 Did or will any officer, director, trustee , or key employee of the organization
a Become a director or trustee of a successor or transferee organization? 2a X. , , , ,
, , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,b Become an employee of, or independent contractor for, a successor or transferee organization? 2 b X, , , , , , , , , ,
, , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,c Become a direct or indirect owner of a successor or transferee organization? 2c X, , , , , , , , , , , , , , , , , ,
d Receive, or become entitled to , compensation or other similar payments as a result of the organization 's significant disposition of assets? , , , , , , , , , , , , , , , , , , , , , , 2d X
e If the organization answered "Yes" to any of the questions in this line, provide the name of the person involved and explain in Part III 10.
Schedule N (Form 990 or 990 -EZ) (2011)
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AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
Schedule N ( Form 990 or 990-EZ ) 2011 Page 3
Supplemental Information . Complete to provide the information required by Part I, lines 2e and 6c, and PartII, line 2e . Also complete this part to provide any additional information
LIQUIDATION, TERMINATION, OR DISSOLUTION
SCHEDULE N, PART I, LINE 1
THE FOLLOWING LIABILITIES AND FUND BALANCE AMOUNTS WERE ALSO ASSUMED IN
THE MERGER BY LEGACY COMMUNITY HEALTH SERVICES:
LIABILITIES $(286,576)
TRNA $( 74,343)
THESE ITEMS ARE NOT REFLECTED IN THE ASSET VALUES IN PART I ABOVE.
DIRECTOR OF SUCCESSOR ORGANIZATION
SCHEDULE N, PART I, LINE 2A
CENTER FOR AIDS' BOARD MEMBERS ALTON LADAY AND BRYAN HLAVINKA BECAME
BOARD MEMBERS OF LEGACY COMMUNITY HEALTH SERVICES, THE SUCCESSOR
ORGANIZATION.
EMPLOYEE OF SUCCESSOR ORGANIZATION
SCHEDULE N, PART I, LINE 4B
CENTER FOR AIDS' OFFICER, PAUL SIMMONS, IS NOW EMPLOYED AS A NURSE BY
LEGACY COMMUNITY HEALTH SERVICES, THE SUCCESSOR ORGANIZATION.
SSA Schedule N (Form 990 or 990-EZ) (2011)
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SCHEDULE O
(Form 990 or 990-EZ)
Department of the TreasuryInternal Revenue Smote
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.
to Form 990 or 990-EZ.
I OMB No 1545-0047
20 12
Name of the organization Employer identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
DOING BUSINESS AS NAME
FORM 990, SECTION C
THE FULL DOING BUSINESS AS NAME OF THE ORGANIZATION IS CENTER FOR AIDS
INFORMATION & ADVOCACY.
OTHER PROGRAM SERVICE ACCOMPLISHMENTS
FORM 990, PART III, LINE 4D
PROJECT LEAP: THIS PROGRAM PROVIDES A COMPREHENSIVE CONSUMER ADVOCACY
TRAINING PROGRAM THAT TEACHES PARTICIPANTS SKILLS AND KNOWLEDGE TO
PARTICIPATE IN THE HIV COMMUNITY PLANNING PROCESS - THIS PROGRAM IS
FUNDED BY HARRIS COUNTY (TEXAS) GRANT ADMINISTRATION, RYAN WHITE PART A.
ATTACHMENT 1
FORM 990EZ, PART I - INVESTMENT INCOME
DESCRIPTION AMOUNT
OTHER INVESTMENTS 114.
TOTAL 114.
For Privacy Act and Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990-EZ.
JSA1E1227 2 000
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Schedule 0 (Form 990 or 990-EZ) (2011)
PAGE 17
Schedule 0 ( Form 990 or 990 -EZ) 2011 Page 2
Nance of the organization Employer Identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
ATTACHMENT 2
FORM 990EZ, PART I - OTHER EXPENSES
TRAVEL 365.
INTEREST 6,089.
PROGRAM CATERING 1,091.
DUES & SUBSCRIPTIONS 182.
ADVERTISING 500.
INFORMATION TECHNOLOGY 1,300.
TOTAL 9,527.
FORM 990EZ, PART I - OTHER CHANGES IN FUND BALANCE S
ATTACHMENT 3
DECREASES IN FUND BALANCES
UNREALIZED LOSS ON CONTRIBUTION OF ASSET 191,641.
TOTAL 191,641.
ATTACHMENT 4
FORM 990EZ, PART II - CASH, SAVINGS AND INVESTMENTS
BEGINNING
DESCRIPTION OF YEAR
CASH 78,613.
SAVINGS 232,278.
TOTALS 310,891.
JSASchedule 0 (Form 990 or 990-EZ) 2011
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Schedule O (Form 990 or 990-EZ) 2011 Page 2
Name of the organization Employer identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
FORM 990EZ , PART II - OTHER ASSETS
ATTACHMENT 5
BEGINNING
DESCRIPTION OF YEAR
PLEDGES RECEIVABLE 1,600.
PREPAID EXPENSES OR DEFERRED CHARGES 3,686.
TOTALS 5,286.
FORM 990EZ, PART II - TOTAL LIABILITIES
DESCRIPTION
ACCOUNTS PAYABLE
MORTGAGES AND OTHER NOTES PAYABLE
TOTALS
ATTACHMENT 6
BEGINNING
109.
287,637.
287,746.
FORM 990EZ, PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE
THE CENTER FOR AIDS INFORMATION & ADVOCACY EMPOWERS PEOPLE LIVING
WITH HIV TO MAKE INFORMED DECISIONS ABOUT THEIR HEALTHCARE BY
PROVIDING THE LATEST RESEARCH AND TREATMENT INFORMATION AND BY
ADVOCATING FOR ACCESSIBLE, AFFORDABLE, AND EFFECTIVE TREATMENT
OPTIONS UNTIL THERE'S A CURE.
ATTACHMENT 7
ATTACHMENT 8
FORM 990EZ, PART III - STATEMENT OF PROGRAM SERVICE ACCOMPLISHMENTS
PROGRAM SERVICE ACCOMPLISHMENT 1
EDUCATION/INFORMATION CENTER - OPERATES THE L. JOEL MARTINEZ
INFORMATION CENTER, THE LARGEST WALK-IN REPOSITORY IN THE
SOUTHWEST UNITED STATES OF HIV/AIDS TREATMENT INFORMATION. IN
ADDITION TO PRINT MEDIA AND INTERNET ACCESS, STAFF IS AVAILABLE TO
ASSIST ONE-ON-ONE WITH INDIVIDUAL INFORMATION NEEDS. PROVIDES A
WIDE VARIETY OF INFORMATIVE AND INTERACTIVE PROGRAMS TARGETING HIV
POSITIVE INDIVIDUALS AS WELL AS SERVICE PROVIDERS. RECORDED 520
CONTACTS IN THE SHORT-YEAR ENDED MARCH 30, 2012.
JSA
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Schedule 0 (Form 990 or 990-EZ) 2011
PAGE 19
Schedule 0 ( Form 990 or 990-EZ ) 2011 Page 2
Name of the organization Employer identification number
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391690
PROGRAM SERVICE ACCOMPLISHMENT 2
ATTACHMENT 9
PUBLICATIONS AND WEBSITE - PRODUCES FACT SHEETS AND NEWSLETTERS
ONLINE, INCLUDING RESEARCH INTIATIVE / TREATMENT ACTION
PUBLICATIONS, HIV TREATMENT ALERTS, AND ISSUES OF CENTER FOR AIDS
ORGINAL PUBLICATIONS. ALL PUBLICATIONS ARE AVAILABLE ON-LINE OR AT
THE L. JOEL MARTINEZ INFORMATION CENTER.
PROGRAM SERVICE ACCOMPLISHMENT 3
TREATMENT AND RESEARCH ADVOCACY - PARTICIPATES AS COMMUNITY
REPRESENTATIVES FOR MEETINGS AND ADVISORY BOARDS OF GROUPS THAT
CONDUCT RESEARCH ON HIV/AIDS (GOVERNMENT, THE PHARMACEUTICAL
INDUSTRY, AND ACADEMIC/RESEARCH INSTITUTIONS). EXECUTIVE DIRECTOR
WAS CO-CHAIR OF THE COMMUNITY SCIENCE COMMITTEE OF THE AIDS
CLINICAL TRIALS GROUP.
ATTACHMENT 10
ATTACHMENT 11
FORM 990EZ, PART V - EXPLANATION FOR SIGNIFICANT CHANGES MADE TO ORGANIZING DOCUMENTS
THE ORGANIZATION DISCONTINUED OPERATIONS IN MARCH 2012. SEE SCHEDULE N
FOR MORE INFORMATION.
JSA
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Schedule 0 (Form 990 or 990-EZ) 2011
PAGE 20
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC. 76-0391 690ATTACHMENT 13
FORM 990EZ, PART IV - LIST OF OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES
TITLE AND REPORTABLE
AVERAGE HOURS COMPENSATION
PER WEEK DEVOTED (FORM W-2/
BRYAN HLAVINKA
P.O. BOX 66308 HOUSTON, TX 77266-6308
JULIE EBERLY
P.O. BOX 66308 HOUSTON, TX 77266-6308
JC PEREZ
P.O. BOX 66308 HOUSTON, TX 77266-6308
GARY VOTH
P.O. BOX 66308 HOUSTON, TX 77266-6308
SALLY JOZWIAK
P.O. BOX 66308 HOUSTON, TX 77266-6308
LONA LEIGH
P.O. BOX 66308 HOUSTON, TX 77266-6308
TOM LOONEY
P.O. BOX 66308 HOUSTON, TX 77266-6308
ALTON LADAY
P.O. BOX 66308 HOUSTON, TX 77266-6308
„HHiK
1.00 0 0
LST VICE CHAIR
1.00 0 0
SECRETARY
1.00 0 0
TREASURER
1.00 0 0
DIRECTOR
1.00 0 0
DIRECTOR
1.00 0 0
DIRECTOR
1.00 0 0
DIRECTOR
1.00 0 0
0
0
0
0
0
0
0
0
ATTACHMENT 13
9118EM K929 1/20/2013 7:32:26 PM V 11-6.4 PAGE 22
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC.
FORM 990EZ, PART IV - LIST OF OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES
TITLE AND
AVERAGE HOURS COMPENSATION
PER WEEK DEVOTED (FORM W-2/
76-0391 690ATTACHMENT 13 (CONT'D)
NAME AND ADDRESS TO POSITION DEFFERED COMPENSATION
KAREN MINOTT DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
AUSTIN R. SMITH DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
SHARON WILLIAMS DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
PATRICK GIBSON DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
STEVE LODEN DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
KEITH DAVIS DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
CLAUDINE ALEXANDRE-MCGILL DIRECTOR
P.O. BOX 66308 HOUSTON, TX 77266-6308 1.00 0 0
PAUL SIMMONS CO-EXECUTIVE DIRECTOR/PROGRAMS
P.O. BOX 66308 HOUSTON, TX 77266-6308 40.00 17,063. 0
GRAND TOTALS 17,063. 0
0
0
0
0
0
0
0
0
0
r
ATTACHMENT 13
9118EM K929 1/20/2013 7: 32:26 PM V 11-6 .4 PAGE 23
AIDS RESEARCH CONSORTIUM OF HOUSTON, INC
FORM 990EZ, PART I - GRANTS AND SIMILAR AMOUNTS
TN Fxrccc OF SS( 1 RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR
AND
RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT
GRANTS PAID
LEGACY COMMUNITY HEALTH SERVICES UNRELATED
PO BOX 66308 EXEMPT
HOUSTON, TX 77266-6308
76-0391690
ATTACHMENT 12
PURPOSE OF GRANT OR CONTRIBUTION
MERGER
TOTAL CONTRIBUTIONS PAID
AMOUNT
270,126
i
ATTACHMENT 12
9118EM K929 1/20/2013 7 32 26 PM V 11-6 4 PAGE 21
Corporations SectionP.O.Box 13697Austin, Texas 78711-3697
1
Office ofthe Secretary of State
CERTIFICATE OF MERGER
Hope Andrade'Secretary of State
The undersigned, as Secretary of State of Texas, hereby certifies that a filing instrument merging
AIDS RESEARCH CONSORTIUM OF HOUSTONDomestic Nonprofit Corporation
[File Number: 125828701 ]
Into
LEGACY COMMUNITY HEALTH SERVICES, INC.Domestic Nonprofit Corporation
[File Number: 593850011
has been received in this office and has been found to conform to law.
'• Accordingly, the undersigned, as Secretary of State, and by the virtue of the authority vested in thesecretary by law, hereby issues this certificate evidencing the acceptance and filing of the merger on
the date shown below.
Dated: 03/28/2012
Effective: 03/3012012 05:00 pm
Hope AndradeSecretary of State
Come visit us an the internet at hap://www.sos..vtate-&-ustPhone: (512) 463-5555 Fax: (512) 463-5709 Dial: 7-1-I fbr Relay Services
Prepared by: Lisa Sartin TID: 10343 Document 414835700002
Form 624(Revised 05/11)
• Return in duplicate to:Secretary of StateP.O. Box 13697Austin, TX 78711-3697512 463-5555FAX: 512 463-5709
Filing Fee: see instruel
ow"x
Certificate ofMergerfor Nonprofit Corporations
This space reserved for office use.
' aiitis u'tie=1tigerPursuant to chapter 10 an Title 2 of the Texas Business Organizations Code, the undersigned parties submit thiscertificate ofmerger.
The name, organizational form, state ofincorporation, and file number, if any, issued by the secretaryof state for each organiz^ation that is a party to the merger are as follows:
Party i
Legacy Community Health Services, Inc.Name ofOrg^
The organization is a nonprofit corporation. It is organized under the laws of:
Texas Harris The file number, if any, is 58385001State Cozmb Texas Secretory ofStatefle number
Its principal place of business is 1415 California Street Houston TXN Address city State
t ® The organization will survive the merger. q The organization will not survive the merger.
q The plan ofmerger irmends the name ofthe organization . The new name is set forth below.
Name as AmendedParty 2
AIDS Research Consortium of HoustonName ofOrganization
The organization is a nogprofit corporation. It is organized under the laws of.
Texas Harris The file number, if any, is 01258287State C Texas Secretary ofStatefle number
Its principal place of busness is 1407 Hawthorne Street Houston TXdadtew try Slate
q The organization will survive the merger. The organization will not survive the merger.
q The plan ofmerger amnends the name ofthe organization. The new name is set forth below.
Name as Amended
Party 3
Name ofOrganizationt. }
Form 6214 5
The organization is a nonprofit corporation. It is organized under the laws of.
The file number, if any, isState Country Texas Secretary ofStole,Ella numberIts principal place of business is
Address City Slate
q The organization will survive the merger. q The organization will not survive the merger.
q The plan of merger amends the name ofthe organization. The new name is set forth below.
Name as Amended
Flap ofMerger,
q The plan of merger is attached.Ifthe plan ofmerger is not attached thefbllomin statements must be completed
Alternative Stat melts
By checking the following boxes, each domestic nonprofit corporation certifies that
A signed plan of merger is on file at the principal place of business of each surviving, acquiring,or new domestic or foreign nonprofit corporation that is named in this form as a party to the merger oran organization created by the merger.
(- \ ® On written request, a copy ofthe plan of merger will be furnished without cost by each surviving,acquiring, or new domestic or foreign nonprofit corporation to any member of any domestic nonprofitcorporation that is a party to or created by the plan ofmerger.
Ifa,lling entity is to swvtve the merger, complete eitherA or B. YB is selected provide relevant information in the space provided
I Amendments
N A. No amendments to the certificate of formation of any domestic nonprofit corporation that is aarty to the merger are effected by the merger.
q B. The plan ofmerger effected changes or amendments to the certificate of formation of
Name offiing enW ee ABmwn&wts
The changes or amendments to the filing entity's certificate of formation, other than any name changenoted previously, are stated below.
Ameedment Text Area
•.1 I. Organizatioes Created by. Merger
The name, jurisdiction of formation, principal place ofbusiness address, and entity description of eachForam 624 6
domestic or foreign nonprofit corporation to be created pursuant to the plan of merger are set forthbelow. The certificate of formation of each new domestic nonprofit corporation to be created is beingfiled with this certificate ofmerger.
NEW ORGANIZATION I
Nonprofit corporationName Jz,rtsd aIon Emily Type
Principal Place o Bustnees Addneq C Ave Code
NEW ORGANIZATION 2
No rofit corporationName Jivlsdldfon Ennity Type
Principal Place o Btafnesa Address Ci State ZAP Code
NEW ORGANIZATION 3
Nonprofit corporationName Jurisdiction Entity 7);w
P Place o Bu frtexv Adds. city State zip
Approval :of the Plait dMerger,
( --^ The plan ofmerger has been approved as required by the laws ofthe jurisdiction of formation of eachorganization that is a party to the merger and by the governing documents ofthose organizations.
q The approval of the members ofanre omoeatia narpmJl^ av^porntian
was not required by the provisions ofthe 130C.
• EffeCtlvelim -ofMW (fisted eithea A,1 , )C.)
A. q This document becomes effective when the document is accepted and filed by the secretary ofstate.
B. ® This document becomes effective at a later date, which is not more than ninety (90) days from
the date of signing. The delayed effective date is: Friday, March 30, 2012 at 5PM
C. q This document takes effect on the occurrence ofthe future event or fact, other than thepassage oftime. The 9e day after the date of signing is:
The following event or fact will cause the document to take effect in the manner described below:
Foun 624
Execution
The undersigned signs this document Subject to the pules imposed by lawtthe 8U sion ofa
n aterianp false or fiBUdderd l06trmnent
Date: Marrb2l-2012^irv^r.2S
Q"Z
y7 OA^&
Of ^01lOA
ReseOch CQnwyh-Jm of 1#ou+on
l.C EXecyt;ve D: fCCAOrS edweaod tIU OfIU hDd d peon
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8> mre and dge oreWUDdz per^w
8
i
