201~ Department of the Treasury. Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

Transcription

1 Form Rtrn of Orgniztion Exmpt From Inom Tx OMB. 1- Unr stion 1(),, or ()(1) of th Intrnl Rvn Co (xpt privt fontions) 1~ Dprtmnt of th Trsry... Do not ntr soil srity nmrs on this fonn s it my m pli. Intrnl Rvn Srvi Op1m to \:lli~... Informtion ot Fnn n its instrtions is t lnsotion A For th 1 lnr vr or tx vr innin /1 I 1 n nin / / 1 B Chk if pplil: Arss hng D Nm hng D Initil rtrn Finl rtrn/ tnmint D Amn rtrn Applition pning C Nm of orgnizlion Doing sinss s BRIDGES of Willimson Conty Nmr n strt (or P.O. ox if mil is not livr to strt rss) P.. Box 1 City or town, stt or provin, ontry, n ZIP or forign postl o Frnklin TN F Nm n rss of prinipl offi Lin Croktt Jkson Wst En Cirl Frnklin TN Tx-xmpt stts: II 1()() I I 1() ( ) ~ (insrt no.) I I ()(1) or wsit:... www. risv. or K Form of ornizlion: I I Corportion I I Trst I I Assoition I I Othr... Prt I Smmrv 1 Brifly sri th orgniztion's mission or most signifint tivitis:. [)orn~s ti viol n intrvntion I I I Room/sit O Employr intifition nmr - E Tlphon nmr 1-- G Gross riots $ 1, 1 H() Is this grop rtrn for sorints? D!RJ H() Ar ll sorints inl? If "," tth list. (s instrtions) H() Grop xmption nmr... I L Yr of fonmtion: 1 I M Stt of ll omiil: TN I.,, l Cl). >< w Ch~~k.ti{i~. ~~,.: D. if th orgniztion isontin its oprtions or ispos of mor thn % of its nt ssts. Nmr of voting mmrs of th govrning oy (Prt VI. lin 1) Nmr of inpnnt voting mmrs of th govrning oy (Prt VI, lin 1 ) Totl nmr of inivils mploy in lnr yr 1 (Prt V, lin ) Totl nmr of volntrs (stimt if nssry) Totl nrlt sinss rvn from Prt VIII, olmn (C), lin 1 Nt nrlt sinss txl inom from Form -T, lin. Contritions n grnts (Prt VIII, lin 1h)..... Progrm srvi rvn (Prt VIII, lin g) 1 Invstmnt inom (Prt VIII, olmn (A), lins,, n ) Othr rvn (Prt VIII, olmn (A), lins,, B,, 1, n ) 1 Totl rvn - lins throgh (mst ql Prt VIII. olmn (A). lin 1) 1 Grnts n similr monts pi (Prt l, olmn (A), lins 1-) 1 Bnfits pi to or for mmrs (Prt I, olmn (A), lin ) 1 Slris, othr ompnstion, mploy nfits (Prt I, olmn (A), lins -1) 1 Profssionl fnrising fs (Prt I, olmn (A), lin ) Totl fnrising xpnss (Prt I, olmn (D), lin )... I... OJ.. 1 Othr xpnss (Prt I. olmn (A). lins -, f-) 1 Totl xpnss. A lins 1-1 (mst ql Prt I. olmn (A), lin ) 1 Rvn lss xpnss. Strt lin 1 from lin 1. Totl ssts (Prt. lin 1) Totl liilitis (Prt. lin ) Nt ssts or fn lns. Strt lin 1 from lin. Signtr Blok Prior Yr 1, 1-1,, 1. 1, 1 Bginning of Crrnt Yr,,, 1 1 Crrnt Yr I ) En of Yr 1,,. L f Sign Hr Typ or print nm n titl Croktt Ex Dirtor Dt Pi Prprr Us Only Print/Typ prprr's nm Ptrii Prsons Firm's nm ~ Prsons & Assoits Forth Av N Firm's rss ~ Frnklin, TN My th IRS isss this rtrn with th prprr shown ov? (s instrtions). For Pprwork Rtion At ti, s th sprt instrtions. Ph on no. P J 1 Form ' (1 )

2 Form (1) Pg Prt III Sttmnt of Progrm Srvi Aomplishmnts 1 Brifly sri th orgniztion's mission: Di th orgniztion nrtk ny signifint progrm srvis ring th yr whih wr not list on th prior Form or -EZ?. If "," sri ths nw srvis on Shl O. Di th orgniztion s onting, or mk signifint hngs in how it onts, ny progrm srvis? If "," sri ths hngs on Shl O. Dsri th orgniztion's progrm srvi omplishmnts for h of its thr lrgst progrm srvis, s msr y xpnss. Stion 1()() n 1()() orgniztions r rqir to rport th mont of grnts n llotions to othrs, th totl xpnss, n rvn, if ny, for h progrm srvi rport. (Co: ) (Expnss $ inling grnts of $ ) (Rvn $ ) ) $ (Rvn ) $ inling grnts of $ ) (Expnss (Co: (Co: $ inling grnts of $ ) ) (Expnss $ ) (Rvn. Othr progrm srvis (Dsri in Shl O.) (Rvn ) $ (Expnss ) $ inling grnts of $ Totl progrm srvi xpnss Form (1) Chk if Shl O ontins rspons or not to ny lin in this Prt III BRIDGES of Willimson Conty - Domsti violn intrvntion,1 To srv womn, mn n hilrn in Willimson Conty n Spring Hill fft y omsti violn, nsring sf trnsition to sssfl inpnnt ommnity living throgh tion, intrvntion n s mngmnt.,1

3 Form (1) Prt IV f BRIDGES of Willimson Conty - Chklist of Rqir Shls Is th orgniztion sri in stion 1()() or ()(1) (othr thn privt fontion)? If, omplt Shl A Is th orgniztion rqir to omplt Shl B, Shl of Contritors (s instrtions)? Di th orgniztion ngg in irt or inirt politil mpign tivitis on hlf of or in opposition to nits for pli offi? If, omplt Shl C, Prt I. Stion 1()() orgniztions. Di th orgniztion ngg in loying tivitis, or hv stion 1(h) ltion in fft ring th tx yr? If "," omplt Shl C, Prt II.. Is th orgniztion stion 1()(), 1()(), or 1()() orgniztion tht rivs mmrship s, ssssmnts, or similr monts s fin in Rvn Pror -1? If "," omplt Shl C, Prt III.. Di th orgniztion mintin ny onor vis fns or ny similr fns or onts for whih onors hv th right to provi vi on th istrition or invstmnt of monts in sh fns or onts? If, omplt Shl D, Prt I... Di th orgniztion riv or hol onsrvtion smnt, inling smnts to prsrv opn sp, th nvironmnt, histori ln rs, or histori strtrs? If, omplt Shl D, Prt II Di th orgniztion mintin olltions of works of rt, historil trsrs, or othr similr ssts? If, omplt Shl D, Prt III Di th orgniztion rport n mont in Prt, lin 1, for srow or stoil ont liility, srv s stoin for monts not list in Prt ; or provi rit onsling, t mngmnt, rit rpir, or t ngotition srvis? If, omplt Shl D, Prt IV.. Di th orgniztion, irtly or throgh rlt orgniztion, hol ssts in tmporrily rstrit nowmnts, prmnnt nowmnts, or qsi-nowmnts? If, omplt Shl D, Prt V..... If th orgniztion's nswr to ny of th following qstions is, thn omplt Shl D, Prts VI, VII, VIII, I, or s pplil. Di th orgniztion rport n mont for ln, ilings, n qipmnt in Prt, lin 1? If "," omplt Shl D, Prt VI Di th orgniztion rport n mont for invstmnts othr sritis in Prt, lin 1 tht is % or mor of its totl ssts rport in Prt, lin 1? If "," omplt Shl D, Prt VII.. Di th orgniztion rport n mont for invstmnts progrm rlt in Prt, lin 1 tht is % or mor of its totl ssts rport in Prt, lin 1? If "," omplt Shl D, Prt VIII.. Di th orgniztion rport n mont for othr ssts in Prt, lin 1 tht is % or mor of its totl ssts rport in Prt, lin 1? If "," omplt Shl D, Prt I. Di th orgniztion rport n mont for othr liilitis in Prt, lin? If "," omplt Shl D, Prt... Di th orgniztion's sprt or onsolit finnil sttmnts for th tx yr inl footnot tht rsss th orgniztion's liility for nrtin tx positions nr FIN (ASC )? If "," omplt Shl D, Prt Di th orgniztion otin sprt, inpnnt it finnil sttmnts for th tx yr? If, omplt Shl D, Prts I n II Ws th orgniztion inl in onsolit, inpnnt it finnil sttmnts for th tx yr? If "," n if th orgniztion nswr "" to lin 1, thn omplting Shl D, Prts I n II is optionl... Is th orgniztion shool sri in stion 1()(1)(A)(ii)? If, omplt Shl E. Di th orgniztion mintin n offi, mploys, or gnts otsi of th Unit Stts?..... Di th orgniztion hv ggrgt rvns or xpnss of mor thn $1, from grntmking, fnrising, sinss, invstmnt, n progrm srvi tivitis otsi th Unit Stts, or ggrgt forign invstmnts vl t $1, or mor? If, omplt Shl F, Prts I n IV. Di th orgniztion rport on Prt I, olmn (A), lin, mor thn $, of grnts or othr ssistn to or for ny forign orgniztion? If, omplt Shl F, Prts II n IV.. Di th orgniztion rport on Prt I, olmn (A), lin, mor thn $, of ggrgt grnts or othr ssistn to or for forign inivils? If, omplt Shl F, Prts III n IV. Di th orgniztion rport totl of mor thn $1, of xpnss for profssionl fnrising srvis on Prt I, olmn (A), lins n? If, omplt Shl G, Prt I (s instrtions).... Di th orgniztion rport mor thn $1, totl of fnrising vnt gross inom n ontritions on Prt VIII, lins 1 n? If "," omplt Shl G, Prt II... Di th orgniztion rport mor thn $1, of gross inom from gming tivitis on Prt VIII, lin? If "," omplt Shl G, Prt III f Pg Form (1)

4 Form (1) Pg 1 1 Prt IV BRIDGES of Willimson Conty - Chklist of Rqir Shls (ontin) Di th orgniztion oprt on or mor hospitl filitis? If, omplt Shl H If to lin, i th orgniztion tth opy of its it finnil sttmnts to this rtrn?.... Di th orgniztion rport mor thn $, of grnts or othr ssistn to ny omsti orgniztion or omsti govrnmnt on Prt I, olmn (A), lin 1? If, omplt Shl I, Prts I n II Di th orgniztion rport mor thn $, of grnts or othr ssistn to or for omsti inivils on Prt I, olmn (A), lin? If, omplt Shl I, Prts I n III..... Di th orgniztion nswr to Prt VII, Stion A, lin,, or ot ompnstion of th orgniztion's rrnt n formr offirs, irtors, trsts, ky mploys, n highst ompnst mploys? If "," omplt Shl J..... Di th orgniztion hv tx-xmpt on iss with n otstning prinipl mont of mor thn $1, s of th lst y of th yr, tht ws iss ftr Dmr 1,? If, nswr lins throgh n omplt Shl K. If, go to lin Di th orgniztion invst ny pros of tx-xmpt ons yon tmporry prio xption?..... Di th orgniztion mintin n srow ont othr thn rfning srow t ny tim ring th yr to fs ny tx-xmpt ons?... Di th orgniztion t s n on hlf of issr for ons otstning t ny tim ring th yr?.... Stion 1()(), 1()(), n 1()() orgniztions. Di th orgniztion ngg in n xss nfit trnstion with isqlifi prson ring th yr? If, omplt Shl L, Prt I..... Is th orgniztion wr tht it ngg in n xss nfit trnstion with isqlifi prson in prior yr, n tht th trnstion hs not n rport on ny of th orgniztion's prior Forms or -EZ? If "," omplt Shl L, Prt I. Di th orgniztion rport ny mont on Prt, lin,, or for rivls from or pyls to ny rrnt or formr offirs, irtors, trsts, ky mploys, highst ompnst mploys, or isqlifi prsons? If "," omplt Shl L, Prt II Di th orgniztion provi grnt or othr ssistn to n offir, irtor, trst, ky mploy, sstntil ontritor or mploy throf, grnt sltion ommitt mmr, or to % ontroll ntity or fmily mmr of ny of ths prsons? If, omplt Shl L, Prt III Ws th orgniztion prty to sinss trnstion with on of th following prtis (s Shl L, Prt IV instrtions for pplil filing thrshols, onitions, n xptions): A rrnt or formr offir, irtor, trst, or ky mploy? If "," omplt Shl L, Prt IV..... A fmily mmr of rrnt or formr offir, irtor, trst, or ky mploy? If "," omplt Shl L, Prt IV An ntity of whih rrnt or formr offir, irtor, trst, or ky mploy (or fmily mmr throf) ws n offir, irtor, trst, or irt or inirt ownr? If, omplt Shl L, Prt IV Di th orgniztion riv mor thn $, in non-sh ontritions? If, omplt Shl M Di th orgniztion riv ontritions of rt, historil trsrs, or othr similr ssts, or qlifi onsrvtion ontritions? If, omplt Shl M Di th orgniztion liqit, trmint, or issolv n s oprtions? If, omplt Shl N, Prt I... Di th orgniztion sll, xhng, ispos of, or trnsfr mor thn % of its nt ssts? If "," omplt Shl N, Prt II Di th orgniztion own 1% of n ntity isrgr s sprt from th orgniztion nr Rgltions stions 1.1- n 1.1-? If, omplt Shl R, Prt I. Ws th orgniztion rlt to ny tx-xmpt or txl ntity? If, omplt Shl R, Prts II, III, or IV, n Prt V, lin Di th orgniztion hv ontroll ntity within th mning of stion 1()(1)? If "" to lin, i th orgniztion riv ny pymnt from or ngg in ny trnstion with ontroll ntity within th mning of stion 1()(1)? If, omplt Shl R, Prt V, lin... Stion 1()() orgniztions. Di th orgniztion mk ny trnsfrs to n xmpt non-hritl rlt orgniztion? If, omplt Shl R, Prt V, lin. Di th orgniztion ont mor thn % of its tivitis throgh n ntity tht is not rlt orgniztion n tht is trt s prtnrship for frl inom tx prposs? If, omplt Shl R, Prt VI. Di th orgniztion omplt Shl O n provi xplntions in Shl O for Prt VI, lins n 1? t. All Form filrs r rqir to omplt Shl O. 1 1 Form (1)

5 Form (1) Prt V 1 1 f g h 1 Sttmnts Rgring Othr IRS Filings n Tx Complin Chk if Shl O ontins rspons or not to ny lin in this Prt V Entr th nmr rport in Box of Form 1. Entr -- if not pplil Entr th nmr of Forms W-G inl in lin 1. Entr -- if not pplil... Di th orgniztion omply with kp withholing rls for rportl pymnts to vnors n rportl gming (gmling) winnings to priz winnrs? Entr th nmr of mploys rport on Form W-, Trnsmittl of Wg n Tx Sttmnts, fil for th lnr yr ning with or within th yr ovr y this rtrn.. If t lst on is rport on lin, i th orgniztion fil ll rqir frl mploymnt tx rtrns?. t. If th sm of lins 1 n is grtr thn, yo my rqir to -fil (s instrtions) Di th orgniztion hv nrlt sinss gross inom of $1, or mor ring th yr?. If, hs it fil Form -T for this yr? If to lin, provi n xplntion in Shl O... At ny tim ring th lnr yr, i th orgniztion hv n intrst in, or signtr or othr thority ovr, finnil ont in forign ontry (sh s nk ont, sritis ont, or othr finnil ont)? If, ntr th nm of th forign ontry: S instrtions for filing rqirmnts for FinCEN Form, Rport of Forign Bnk n Finnil Aonts Ws th orgniztion prty to prohiit tx shltr trnstion t ny tim ring th tx yr? Di ny txl prty notify th orgniztion tht it ws or is prty to prohiit tx shltr trnstion? If to lin or, i th orgniztion fil Form -T?.... Dos th orgniztion hv nnl gross ripts tht r normlly grtr thn $1,, n i th orgniztion soliit ny ontritions tht wr not tx til s hritl ontritions?... If, i th orgniztion inl with vry soliittion n xprss sttmnt tht sh ontritions or gifts wr not tx til? Orgniztions tht my riv til ontritions nr stion 1(). Di th orgniztion riv pymnt in xss of $ m prtly s ontrition n prtly for goos n srvis provi to th pyor?. If, i th orgniztion notify th onor of th vl of th goos or srvis provi?.... Di th orgniztion sll, xhng, or othrwis ispos of tngil prsonl proprty for whih it ws rqir to fil Form? If, init th nmr of Forms fil ring th yr Di th orgniztion riv ny fns, irtly or inirtly, to py prmims on prsonl nfit ontrt? Di th orgniztion, ring th yr, py prmims, irtly or inirtly, on prsonl nfit ontrt?. If th orgniztion riv ontrition of qlifi intlltl proprty, i th orgniztion fil Form s rqir?... If th orgniztion riv ontrition of rs, ots, irplns, or othr vhils, i th orgniztion fil Form 1-C? Sponsoring orgniztions mintining onor vis fns. Di onor vis fn mintin y th sponsoring orgniztion hv xss sinss holings t ny tim ring th yr?.. Sponsoring orgniztions mintining onor vis fns. Di th sponsoring orgniztion mk ny txl istritions nr stion?.. Di th sponsoring orgniztion mk istrition to onor, onor visor, or rlt prson? Stion 1()() orgniztions. Entr: Initition fs n pitl ontritions inl on Prt VIII, lin Gross ripts, inl on Form, Prt VIII, lin 1, for pli s of l filitis Stion 1()(1) orgniztions. Entr: Gross inom from mmrs or shrholrs Gross inom from othr sors (Do not nt monts or pi to othr sors ginst monts or riv from thm.) Stion ()(1) non-xmpt hritl trsts. Is th orgniztion filing Form in li of Form? If, ntr th mont of tx-xmpt intrst riv or r ring th yr Stion 1()() qlifi nonprofit hlth insrn issrs. (FBAR). BRIDGES of Willimson Conty - Is th orgniztion lins to iss qlifi hlth plns in mor thn on stt?.... t. S th instrtions for itionl informtion th orgniztion mst rport on Shl O. Entr th mont of rsrvs th orgniztion is rqir to mintin y th stts in whih th orgniztion is lins to iss qlifi hlth plns..... Entr th mont of rsrvs on hn Di th orgniztion riv ny pymnts for inoor tnning srvis ring th tx yr? If "," hs it fil Form to rport ths pymnts? If "," provi n xplntion in Shl O.. Form (1) f g h Pg

6 Form (1) Pg Prt VI Govrnn, Mngmnt, n Dislosr For h "" rspons to lins throgh low, n for "" rspons to lin,, or 1 low, sri th irmstns, prosss, or hngs in Shl O. S instrtions. Chk if Shl O ontins rspons or not to ny lin in this Prt VI Stion A. Govrning Boy n Mngmnt 1 1 Stion C. Dislosr Entr th nmr of voting mmrs of th govrning oy t th n of th tx yr If thr r mtril iffrns in voting rights mong mmrs of th govrning oy, or Entr th nmr of voting mmrs inl in lin 1, ov, who r inpnnt Di ny offir, irtor, trst, or ky mploy hv fmily rltionship or sinss rltionship with ny othr offir, irtor, trst, or ky mploy?..... Di th orgniztion lgt ontrol ovr mngmnt tis stomrily prform y or nr th irt sprvision of offirs, irtors, or trsts, or ky mploys to mngmnt ompny or othr prson? Di th orgniztion mk ny signifint hngs to its govrning omnts sin th prior Form ws fil?. Di th orgniztion om wr ring th yr of signifint ivrsion of th orgniztion s ssts? Di th orgniztion hv mmrs or stokholrs?.... Di th orgniztion hv mmrs, stokholrs, or othr prsons who h th powr to lt or ppoint on or mor mmrs of th govrning oy?. Ar ny govrnn isions of th orgniztion rsrv to (or sjt to pprovl y) mmrs, stokholrs, or prsons othr thn th govrning oy? Di th orgniztion ontmpornosly omnt th mtings hl or writtn tions nrtkn ring th yr y th following: Th govrning oy? Eh ommitt with thority to t on hlf of th govrning oy? Is thr ny offir, irtor, trst, or ky mploy list in Prt VII, Stion A, who nnot rh t th orgniztion s miling rss? If, provi th nms n rsss in Shl O.. Stion B. Poliis (This Stion B rqsts informtion ot poliis not rqir y th Intrnl Rvn Co.) Di th orgniztion hv lol hptrs, rnhs, or ffilits?.. If, i th orgniztion hv writtn poliis n prors govrning th tivitis of sh hptrs, ffilits, n rnhs to nsr thir oprtions r onsistnt with th orgniztion's xmpt prposs? Hs th orgniztion provi omplt opy of this Form to ll mmrs of its govrning oy for filing th form?.. Dsri in Shl O th pross, if ny, s y th orgniztion to rviw this Form BRIDGES of Willimson Conty - if th govrning oy lgt ro thority to n xtiv ommitt or similr ommitt, xplin in Shl O. Di th orgniztion hv writtn onflit of intrst poliy? If, go to lin Wr offirs, irtors, or trsts, n ky mploys rqir to islos nnlly intrsts tht ol giv ris to onflits? Di th orgniztion rglrly n onsistntly monitor n nfor omplin with th poliy? If, sri in Shl O how this ws on.... Di th orgniztion hv writtn whistllowr poliy? Di th orgniztion hv writtn omnt rtntion n strtion poliy? Di th pross for trmining ompnstion of th following prsons inl rviw n pprovl y inpnnt prsons, omprility t, n ontmpornos sstntition of th lirtion n ision? Th orgniztion s CEO, Extiv Dirtor, or top mngmnt offiil..... Othr offirs or ky mploys of th orgniztion If to lin 1 or 1, sri th pross in Shl O (s instrtions). Di th orgniztion invst in, ontrit ssts to, or prtiipt in joint vntr or similr rrngmnt with txl ntity ring th yr?. If, i th orgniztion follow writtn poliy or pror rqiring th orgniztion to vlt its prtiiption in joint vntr rrngmnts nr pplil frl tx lw, n tk stps to sfgr th orgniztion s xmpt stts with rspt to sh rrngmnts?. List th stts with whih opy of this Form is rqir to fil..... Stion 1 rqirs n orgniztion to mk its Forms 1 (or 1 if pplil),, n -T (Stion 1()()s only) vill for pli insption. Init how yo m ths vill. Chk ll tht pply. Own wsit Anothr's wsit Upon rqst Dsri in Shl O whthr (n if so, how) th orgniztion m its govrning omnts, onflit of intrst poliy, n finnil sttmnts vill to th pli ring th tx yr. Othr (xplin in Shl O) Stt th nm, rss, n tlphon nmr of th prson who posssss th orgniztion's ooks n rors: Brigs of Wmson Co P O Box 1 Frnklin TN 1-- TN Form (1)

7 Form (1) Prt VII Stion A. Compnstion of Offirs, Dirtors, Trsts, Ky Employs, Highst Compnst Employs, n Inpnnt Contrtors Chk if Shl O ontins rspons or not to ny lin in this Prt VII..... Offirs, Dirtors, Trsts, Ky Employs, n Highst Compnst Employs 1 Complt this tl for ll prsons rqir to list. Rport ompnstion for th lnr yr ning with or within th orgniztion's tx yr. List ll of th orgniztion's rrnt offirs, irtors, trsts (whthr inivils or orgniztions), rgrlss of mont of ompnstion. Entr -- in olmns (D), (E), n (F) if no ompnstion ws pi. List ll of th orgniztion's rrnt ky mploys, if ny. S instrtions for finition of "ky mploy." List th orgniztion's fiv rrnt highst ompnst mploys (othr thn n offir, irtor, trst, or ky mploy) who riv rportl ompnstion (Box of Form W- n/or Box of Form 1-MISC) of mor thn $1, from th orgniztion n ny rlt orgniztions. List ll of th orgniztion's formr offirs, ky mploys, n highst ompnst mploys who riv mor thn $1, of rportl ompnstion from th orgniztion n ny rlt orgniztions. List ll of th orgniztion s formr irtors or trsts tht riv, in th pity s formr irtor or trst of th orgniztion, mor thn $1, of rportl ompnstion from th orgniztion n ny rlt orgniztions. List prsons in th following orr: inivil trsts or irtors; instittionl trsts; offirs; ky mploys; highst ompnst mploys; n formr sh prsons. Chk this ox if nithr th orgniztion nor ny rlt orgniztion ompnst ny rrnt offir, irtor, or trst. (A) (B) (C) (D) (E) (F) Nm n Titl BRIDGES of Willimson Conty - Avrg hors pr wk (list ny hors for rlt orgniztions low ott lin) Position (o not hk mor thn on ox, nlss prson is oth n offir n irtor/trst) Inivil trst or irtor Instittionl trst Offir Ky mploy Highst ompnst mploy Formr Rportl ompnstion from th orgniztion (W-/1-MISC) Rportl ompnstion from rlt orgniztions (W-/1-MISC) Estimt mont of othr ompnstion from th orgniztion n rlt orgniztions (1) Br Dk Dirtor. () E Lnstr Co-Chir. () Lynn Gor Dirtor. () Pm Lwis Dirtor. () Grr Crlisl Dirtor. () Dn Lngfitt Dirtor. () Kthy Birl Chir. () Ginn Cmpll Dirtor. () Rort Pittmn Trsrr. (1) Jn Klly Srtry. () Monsrrt Sntigo Dirtor. Form (1) Pg

8 Form (1) BRIDGES of Willimson Conty - Pg Stion A. Offirs, Dirtors, Trsts, Ky Employs, n Highst Compnst Employs (ontin) Prt VII (A) Nm n titl (B) Avrg hors pr wk (list ny hors for rlt orgniztions low ott lin) Inivil trst or irtor Instittionl trst Offir (C) Position (o not hk mor thn on ox, nlss prson is oth n offir n irtor/trst) Ky mploy Highst ompnst mploy Formr (D) Rportl ompnstion from th orgniztion (W-/1-MISC) (E) Rportl ompnstion from rlt orgniztions (W-/1-MISC) (F) Estimt mont of othr ompnstion from th orgniztion n rlt orgniztions (1) Sztt Ln Dirtor. (1) Donn R Dirtor. (1) Drk Smith Dirtor. (1) Wn Hollowy Dirtor. (1) Chrli Ksr Skinnr Dirtor S-totl Totl from ontintion shts to Prt VII, Stion A.. Totl ( lins 1 n 1). Totl nmr of inivils (inling t not limit to thos list ov) who riv mor thn $1, of rportl ompnstion from th orgniztion Di th orgniztion list ny formr offir, irtor, or trst, ky mploy, or highst ompnst mploy on lin 1? If, omplt Shl J for sh inivil For ny inivil list on lin 1, is th sm of rportl ompnstion n othr ompnstion from th orgniztion n rlt orgniztions grtr thn $1,? If, omplt Shl J for sh inivil Di ny prson list on lin 1 riv or r ompnstion from ny nrlt orgniztion or inivil for srvis rnr to th orgniztion? If, omplt Shl J for sh prson Stion B. Inpnnt Contrtors 1 Complt this tl for yor fiv highst ompnst inpnnt ontrtors tht riv mor thn $1, of ompnstion from th orgniztion. Rport ompnstion for th lnr yr ning with or within th orgniztion's tx yr. (A) (B) Nm n sinss rss Dsription of srvis (C) Compnstion Totl nmr of inpnnt ontrtors (inling t not limit to thos list ov) who riv mor thn $1, of ompnstion from th orgniztion Form (1)

9 Form (1) Pg Prt VIII Contritions, Gifts, Grnts n Othr Similr Amonts Progrm Srvi Rvn Othr Rvn 1 f g h f g Sttmnt of Rvn Chk if Shl O ontins rspons or not to ny lin in this Prt VIII.... Frt mpigns Mmrship s Fnrising vnts Rlt orgniztions Govrnmnt grnts (ontritions).... All othr ontritions, gifts, grnts, n similr monts not inl ov 1f,1 nsh ontritions inl in lins 1-1f: $., Totl. A lins 1 1f All othr progrm srvi rvn. Totl. A lins f.. Invstmnt inom (inling ivins, intrst, n othr similr monts) Inom from invstmnt of tx-xmpt on pros Royltis..... Gross rnts Lss: rntl xps. Rntl in. or (loss) (i) Rl (ii) Prsonl Bsn. Co Nt rntl inom or (loss) Gross mont from (i) Sritis (ii) Othr sls of ssts othr thn invntory Lss: ost or othr 1 sis & sls xps. Gross sls of invntory, lss rtrns n llowns Lss: ost of goos sol Nt inom or (loss) from sls of invntory Totl rvn. S instrtions.. Gin or (loss) Nt gin or (loss) Gross inom from fnrising vnts (not inling $.. of ontritions rport on lin 1). S Prt IV, lin , Lss: irt xpnss Nt inom or (loss) from fnrising vnts Gross inom from gming tivitis. S Prt IV, lin Lss: irt xpnss Nt inom or (loss) from gming tivitis. 1 BRIDGES of Willimson Conty - Misllnos Rvn All othr rvn Totl. A lins , Bsn. Co (A) (B) (C) (D) Totl rvn Rlt or Unrlt Rvn xmpt fntion rvn sinss rvn xl from tx nr stions 1-1, Misllnos 1, 1, 1, 1, 1, 1,1 1, 1, Form (1)

10 Form (1) Prt I Sttmnt of Fntionl Expnss Stion 1()() n 1()() orgniztions mst omplt ll olmns. All othr orgniztions mst omplt olmn (A). Chk if Shl O ontins rspons or not to ny lin in this Prt I (A) (B) (C) (D) Do not inl monts rport on lins, Totl xpnss Progrm srvi Mngmnt n Fnrising,,, n 1 of Prt VIII. xpnss gnrl xpnss xpnss 1 BRIDGES of Willimson Conty - Grnts n othr ssistn to omsti orgniztions Pg 1 n omsti govrnmnts. S Prt IV, lin 1. Grnts n othr ssistn to omsti 1 f g inivils. S Prt IV, lin.... Grnts n othr ssistn to forign orgniztions, forign govrnmnts, n forign inivils. S Prt IV, lins 1 n 1. Bnfits pi to or for mmrs.... Compnstion of rrnt offirs, irtors, trsts, n ky mploys Compnstion not inl ov, to isqlifi prsons (s fin nr stion (f)(1)) n prsons sri in stion ()()(B) Othr slris n wgs Pnsion pln rls n ontritions (inl stion 1(k) n () mployr ontritions) Othr mploy nfits. Pyroll txs... Fs for srvis (non-mploys): Mngmnt... Lgl. Aonting..... Loying Profssionl fnrising srvis. S Prt IV, lin 1 Invstmnt mngmnt fs Othr. (If lin g mont xs 1% of lin, olmn,1,,,,,,,,1,,,,,, (A) mont, list lin g xpnss on Shl O.) Avrtising n promotion Offi xpnss Informtion thnology... Royltis Opny..... Trvl Pymnts of trvl or ntrtinmnt xpnss for ny frl, stt, or lol pli offiils Confrns, onvntions, n mtings.... Intrst Pymnts to ffilits.... Dprition, pltion, n mortiztion.... Insrn Othr xpnss. Itmiz xpnss not ovr ov (List misllnos xpnss in lin. If lin mont xs 1% of lin, olmn (A) mont, list lin xpnss on Shl O.) All othr xpnss Totl fntionl xpnss. A lins 1 throgh..... Joint osts. Complt this lin only if th orgniztion rport in olmn (B) joint osts from omin tionl mpign n fnrising soliittion. Chk hr if following SOP - (ASC -).....,, 1,,,1,,1,1,,, 1,,1,,1, Progrm Srvis,1,1 Spil Evnts,, Rpirs / Mintnn,, 1 Ds n ssriptions,,,,,1,1,, Form (1)

11 Form (1) Pg Assts Liilitis Nt Assts or Fn Blns Prt BRIDGES of Willimson Conty - Bln Sht Chk if Shl O ontins rspons or not to ny lin in this Prt (A) (B) Bginning of yr En of yr Csh non-intrst ring... 1,1 1, Svings n tmporry sh invstmnts Plgs n grnts rivl, nt....., 1, Aonts rivl, nt Lons n othr rivls from rrnt n formr offirs, irtors, trsts, ky mploys, n highst ompnst mploys. Complt Prt II of Shl L Lons n othr rivls from othr isqlifi prsons (s fin nr stion (f)(1)), prsons sri in stion ()()(B), n ontriting mployrs n sponsoring orgniztions of stion 1()() volntry mploys' nfiiry orgniztions (s instrtions). Complt Prt II of Shl L ts n lons rivl, nt Invntoris for sl or s.... Prpi xpnss n frr hrgs Ln, ilings, n qipmnt: ost or,, othr sis. Complt Prt VI of Shl D. 1 Lss: mlt prition.... 1,, 1, Invstmnts plily tr sritis. Invstmnts othr sritis. S Prt IV, lin Invstmnts progrm-rlt. S Prt IV, lin Intngil ssts Othr ssts. S Prt IV, lin Totl ssts. A lins 1 throgh 1 (mst ql lin ).., 1 1,, 1 Aonts pyl n r xpnss Grnts pyl Dfrr rvn..., 1, 1 Tx-xmpt on liilitis.... Esrow or stoil ont liility. Complt Prt IV of Shl D Lons n othr pyls to rrnt n formr offirs, irtors, 1 trsts, ky mploys, highst ompnst mploys, n isqlifi prsons. Complt Prt II of Shl L Sr mortggs n nots pyl to nrlt thir prtis..... Unsr nots n lons pyl to nrlt thir prtis Othr liilitis (inling frl inom tx, pyls to rlt thir prtis, n othr liilitis not inl on lins 1-). Complt Prt of Shl D Totl liilitis. A lins 1 throgh Orgniztions tht follow SFAS (ASC ), hk hr n omplt lins throgh, n lins n. Unrstrit nt ssts Tmporrily rstrit nt ssts Prmnntly rstrit nt ssts Orgniztions tht o not follow SFAS (ASC ), hk hr n omplt lins throgh. Cpitl stok or trst prinipl, or rrnt fns... Pi-in or pitl srpls, or ln, iling, or qipmnt fn Rtin rnings, nowmnt, mlt inom, or othr fns. Totl nt ssts or fn lns Totl liilitis n nt ssts/fn lns ,,,,, 1,, 1, 1,,, 1,, Form (1)

12 Form (1) Prt I Prt II 1 1 Finnil Sttmnts n Rporting Chk if Shl O ontins rspons or not to ny lin in this Prt II..... Aonting mtho s to prpr th Form : Csh Arl Wr th orgniztion's finnil sttmnts ompil or rviw y n inpnnt ontnt? If "," hk ox low to init whthr th finnil sttmnts for th yr wr ompil or Wr th orgniztion's finnil sttmnts it y n inpnnt ontnt?.. If "," hk ox low to init whthr th finnil sttmnts for th yr wr it on of th it, rviw, or ompiltion of its finnil sttmnts n sltion of n inpnnt ontnt? If th orgniztion hng ithr its ovrsight pross or sltion pross ring th tx yr, xplin in th Singl Ait At n OMB Cirlr A-1?. If, i th orgniztion nrgo th rqir it or its? If th orgniztion i not nrgo th Othr If th orgniztion hng its mtho of onting from prior yr or hk Othr, xplin in Shl O. If to lin or, os th orgniztion hv ommitt tht ssms rsponsiility for ovrsight Shl O. Ronilition of Nt Assts Chk if Shl O ontins rspons or not to ny lin in this Prt I Totl rvn (mst ql Prt VIII, olmn (A), lin 1) Totl xpnss (mst ql Prt I, olmn (A), lin ) Rvn lss xpnss. Strt lin from lin 1. Nt ssts or fn lns t ginning of yr (mst ql Prt, lin, olmn (A)).. Nt nrliz gins (losss) on invstmnts Dont srvis n s of filitis..... Invstmnt xpnss. Prior prio jstmnts Othr hngs in nt ssts or fn lns (xplin in Shl O).. 1 Nt ssts or fn lns t n of yr. Comin lins throgh (mst ql Prt, lin, olmn (B)) rviw on sprt sis, onsolit sis, or oth: Sprt sis Consolit sis Both onsolit n sprt sis sprt sis, onsolit sis, or oth: Sprt sis BRIDGES of Willimson Conty - Consolit sis As rslt of frl wr, ws th orgniztion rqir to nrgo n it or its s st forth in rqir it or its, xplin why in Shl O n sri ny stps tkn to nrgo sh its. Both onsolit n sprt sis Pg 1 1,1,1,, 1,, Form (1)