board of directors meeting agenda monday january 23, 2017 · doug yeiser and rich goode-allen are...

Board of Directors Meeting Agenda

Monday January 23 2017

Board Members Officers Sally Brown (e) Tom Chesney (c) President Bill Meyer George Garmany (a) Tony Martinez (b) President-Elect Marty Evans (b) Cassidy Murphy (d) Anne-Marie Reader (a) Past President Stan Benson (c) Chad Stamm (d) Brad Wiesley (e) Secretary (non-voting) Mike Brady

Treasurer (non-voting) John Regur Call to Order Presentation of Previous Minutes (approved 1252016) Agreement on Agenda (1 minute) Membership Issues (4 minutes) ndash (Page 4)

bull New members o Frank Bruno (reinstatement) o Sharon Svendsen (December) o Lindsey Sachs o Joanna Cain (10 days after publishing was Jan 20th) o Glenn Lenzen (10 days after publishing was Jan 20th)

bull Resigning members o Sandy Younghans (12192016)

bull Termination of members ndash bull Requests for leave of absence - None bull AE Roots

o Jon Kottke to AE o Jack Thompson to AE

Liaison Reports (5 minutes)

bull Youth Service ndash Chad Stamm (Page 5) bull Local amp Community ndash Tom Chesney bull ON DECK for February due February 22 2017

o Membership ndash Brad Wiesley o Club Meetings ndash Marty Evans o Club Administration ndash Bill Meyer

Presidentrsquos Report (60 minutes)

bull George Browningrsquos election for Assistant Secretary - Unanimously approved bull RI Corporate Engagement (Pages 6 to 8) Chadrsquos sister works at Janus and will take

the letter from RI and see if she can help bull District request for donation (Page 9) Marty moved to support with $250 from club

funds Seconded and approved

bull NW Metro Rotary Satellite Club request for donation (0) Decided not to move forward with supporting this project

bull Carryover of Power of Soap budget to WCSC The Board voted to not carry over the unfunded $7k from Power of Soap over to the 2016-17 budget However the President was encouraged to work the BNGRC to develop the Desing Sprint project

bull Helping Hands Award (Page 11) Motion to allocate the $500 to Imagination Library Seconded and approved

bull District Conference o Attendance (Page 11) Bill encouraged BOD members to attend and will

promote at the meetings o House of Friendship (Page 13) Chad will talk to the PR committee and see if

they can create displays and possibly spearhead bull Membership

o Dropbox Spreadsheet The Membership Committee has created a spreadsheet for referring members The Board was requested to participate in this membership effort and follow up with prospects

o Talk to new members ndash Bill asked BOD take personal responsibility to ensure new or visiting members are welcomed into the meeting and not standing by themselves

bull Garage sale storage ndash President Bill asked for suggestions for places to store items leading up to the event in May

bull Procedure for Raffle disbursements (Page 14) The new procedures were approved and GMIC will ensure minimums are maintained per our BRC approved rules

bull Change in venue ndash revisions to caterer agreement (Pages 15 to 19) Motion Present to the club the recommendation of the BOD to move venue from Avalon to JCC with similar disposable service Seconded and approved

bull Dues bull Process for 2017-18 Budget

Secretaryrsquos Report (5 minutes)

bull Billing update from Carol Treasurerrsquos Report (20 minutes)

bull Review financials o December 31st Financials (Pages 25 to 33) o 2016-2017 Good Works P amp L (Pages 34 to 35) o 2016 ndash 2017 Operations P amp L (Pages 36 to 37) o Filed IRS Form 990 for FY ending June 30 2016 (Pages 38 to 61)

Open discussion (5 Minutes) Adjournment

Board of Directors Meeting 2 January 23 2017

NEXT MEETING Monday February 27 2017 430pm Billrsquos Office



From Bill Rubin Sent Friday January 20 2017 544 PM To Chad Stamm ltrotarychadstammcomgt Subject RE BOD Liaison Reports

Chad

The youth services programs are continuing to function very well

1 Boulder amp Fairview High School Interact Clubs are going strong Theresa Szczurek and I workprimarily with the Boulder High Interact Club Doug Yeiser and Rich Goode-Allen are the leadswith Fairview Currently the clubs are in the planning process for JamFest 2017 This event abattle of the bands from the two schools has happened each year since 2008 and has raised inexcess of $10000 over that time span for various charitable organizations mostly AttentionHomes Inc here in Boulder This year JamFest is scheduled to happen on Friday April 21st atFairview High School Auditorium More information to come in early March

a The Boulder High Club has been busy with various volunteer service projects includingworking with students at the Family Learning Center helping with the Community FoodShare food drive etc Attendance has been steady at about 20 to 25 studentsparticipating each week

b The communication with the Fairview High Club has not been as good as I would like so Icannot give you an update of their most recent projects

2 RYLA and Young RYLA will be kicking off the recruitment drive to encourage students to apply tothe conferences in the next couple of weeks The three Boulder Rotary Clubs are workingclosely together on the project with Alice Weed-Ziegler from Boulder Valley Bill Hendrick fromFlatirons Rotary and myself as the BRC rep collaborating as in past years Timing on theinterviews is the last week of April and first week of May

a Just a reminder to the Board for Young RYLA students currently in their 7th grade yearare eligible to apply to the conferences which will be happening in July2017 Applications are online at wwwrmrylaorg The application period begins onFebruary 15th

b The RYLA high school conferences accept applications from students that are currentlyin 10th or 11th grade This year the High School conferences are happening in the latterhalf of June due to a scheduling issue with the YMCA of the Rockies in Estes Park

c As in past years the conferences are interested in finding Rotarians who would like toserve as volunteer counselors The commitment is one week of time Contact Bill Rubinfor information if interested

Regards

Bill Rubin


From Carol Van DykeTo Michael Brady William D MeyerSubject Fwd Corporate Engagement with RotaryDate Thursday January 19 2017 114101 AMAttachments image001png

image001png

Sent from carol

Begin forwarded message

From Sponsorships ltSponsorshipsrotaryorggtDate January 17 2017 at 33209 PM MSTTo carolboulderrotarygmailcom ltcarolboulderrotarygmailcomgtdarlenedenverrotaryorg ltdarlenedenverrotaryorggtSubject FW Corporate Engagement with Rotary

Dear Carol and Darlene I hope your new year is off to a great start Thank you for your consideration of my messagebelow regarding companies who may benefit from a relationship with Rotary at the InternationalConvention World Polio Day andor with a cause marketing campaign To that end we would like your opinion regarding these companies we have identified in yourarea Janus Capital Group and Samsonite We would like to discover if you may have aconnection or if a member in your club might work for one of the companies Your ideas on thesecompanies as well as any others you may recommend or introductions you can provide areappreciated We in the Partnerships group at Rotary are excited to grow Rotaryrsquos capacity for corporaterelationships and increase the number of our supporters to bring more resources to the importantwork Rotarians are engaged in around the world We strive to be mindful of existing relationshipsyou have and to support you in every way Thank you again for all your consideration andsupport I look forward to hearing from you soon Best WishesMichelle Michelle CangelosiDirector of Corporate EngagementPartnershipsrotaryorg


ROTARY INTERNATIONAL | One Rotary Center | 1560 Sherman Ave | Evanston IL60201 USA Like us facebookcomrotaryFollow us twittercomrotaryWatch us youtubecomuserRotaryInternational From Sponsorships Sent Tuesday 20 December 2016 256 PMTo Sponsorships ltSponsorshipsrotaryorggtCc Wendy Schultz ltwendyschultzrotaryorggtSubject Corporate Engagement with Rotary In October 2015 I had the pleasure of addressing and meeting many of you at the Rotary LargeClub Conference in Milwaukee At that time I was able to share some of the plans for the newlyformed Partnerships office within Rotary International and discuss how we might work together togrow Rotaryrsquos capacity for corporate relationships As part of my officersquos corporate engagement strategy we are developing sponsorship and causemarketing opportunities that will enable Rotary to engage with national and global brands in amanner that Rotary has not been able to before These opportunities include sponsorship ofevents like the International Convention and World Polio Day as well as cause marketingcampaigns that can raise funds for The Rotary Foundation and Rotaryrsquos areas of focusLeveraging these corporate relationships will strengthen and elevate the Rotary brand as acause provide greater reach for our message and increase the number of people who engagewith Rotary across the country I know that the larger Rotary clubs have members that are quite sophisticated Many of youalong with your members have been able to develop strong relationships with national and multi-national companies who are headquartered or operate within your area Your Rotarians mayeven be employees or executives of these companies With our new focus on corporateengagement our work in our six areas of focus and the caliber of our membership a larger ormore integrated relationship with Rotary may be appealing to these companies raise additionalrevenue to support the great work of Rotarians around the world and continue to strengthen anddeepen the relationship of these companies with the local Rotary clubs We are trying to develop a strong list of potential corporations to solicit Thus if you haverelationships with companies that you think might be interested in sponsorships or causemarketing with Rotary International please let me and my sponsorship and cause marketingteam member Wendy Schultz know She also can be reached at 847-866-3366 and can discussthese potential opportunities with you or the contacts you provide and give advice and guidanceWith the 2017 International Convention being held in Atlanta Georgia in June 2017 this is likelythe perfect opportunity to begin to leverage these companies while providing significantrecognition and exposure of these companies to Rotarians I have attached a brochure regardingthe Convention for your reference We look forward to working with you Thank you for all you do and very warm regards for a


joyous holiday season Best WishesMichelleMichelle CangelosiDirector of Corporate EngagementPartnershipsrotaryorg

ROTARY INTERNATIONAL | One Rotary Center | 1560 Sherman Ave | Evanston IL60201 USA Like us facebookcomrotaryFollow us twittercomrotaryWatch us youtubecomuserRotaryInternational


CONTRIBUTION TO THE DISTRICT

From Assistant AG Bob Slyter

DG Bill Downs has indicated that the District needs financial help from each club in District 5450 They asked each club to consider becoming a $25000 sponsor for this yearrsquos District Assembly (they realize this request is incidental to a large club and a burden to smaller clubs)

All clubs can help in another way Since we are Rotarians we are the business leaders and community leaders in our community If you know a business leader who would be responsive to a request from the District Rotary committee to sponsor the event in the $2500-$5000 level please send that name or contact phone number to Timgracen2pubcom You do not have to do any more than that Rotary District Conference Committee will do the contacting and follow through with the sponsorship details Here is DG Downes message

To put it bluntly we need your help

The District has embarked on a new sponsorship program to raise funds on an ongoing basis ndash not just for each individual DGrsquos term in office Effective management of the Districtrsquos affairs ndash conferences events training administration etc - requires funding That funding is sourced through our dues In order to keep this amount to a minimum and to keep registration fees to our conferences as low as possible we have introduced an annual District Sponsorship program to generate such revenues (the sponsor matrix and related benefits are attached)

We are one of the 63 clubs in District 5450 I am asking that you take a moment to take a voyage through your business contacts and colleagues to identify any businesses that you feel might enjoy a closer relationship with the Districts 3000+ members who would be a good fit to market their goods or services to your fellow Rotarians

We are not asking you to lsquosellrsquo any sponsorships All you need to do is send an email including the company name and contact information to TimGraceN2pubcom and then he will do the rest Timrsquos our sponsorship Chair from the Evergreen club Cell 305-926-5894

We cannot tell you how important it is that we make a positive start to this new sponsorship program not only as it pertains to support for this years conference but for many years yet to come

Get that Rolodex out


Bill

My name is Joe Seehusen I am the Co-Chair of the new NW Metro Rotary Satellite Club which is under the Wheat Ridge Rotary Club I lived in Boulder for 12 years before moving to Arvada We are excited to start on a few projects with the first one being Denverrsquos new Levitt Pavilion in Ruby Hill Park We are also looking to grow our club with new members who are interested in meeting only once a month in a happy hour setting every third Tuesday from 6-7pm at a different restaurant If you know of anyone who may be interested in this please send them my way

The main reason for this email is we would like your clubrsquos help sponsoring the new Levitt Pavilion in Denver

wwwlevittdenverorg

This is an exciting opportunity to help this non-profit 7500 person music and arts venue get built and build community through music They will provide 50 free concerts each summer season

Levitt has customized a sponsorship package at my request for the surrounding Denver Rotary clubs which I have attached

We feel this would be a great way to promote Rotary International to younger generations and an excellent way to support local art in our community

We want to ask your club for a $1000 donation or a donation that best fits your budget Our club will match donations up to $1000 and hopefully have District 5450 match our final number raised

If you have any questions or concerns please feel free to call me anytime

Thank you Bill and Happy Holidays

Joe Seehusen

Co-Chair -NW Metro Rotary Satellite Club


Helping Hands Award - $500 to be used for targeting children pre-school through high school who have developmental physical or mental disabilities children at risk and children who are struggling to overcome other obstacles

Suggestions

bull Sponsor a student with mobility challenges to attend the RYLA Plus conference this year That program is for young people who have physical not cognitive disabilities and is a leadership program run by Rocky Mountain RYLA in partnership with Easter Seals

bull Work with Attention Homes to have a special program or scholarship for a student at risk who is being served by their agency

bull Work with the Rotary Community Core to promote youth involvement with the Boulder Rotary Community Core program that focuses on those with physical and developmental disabilities

bull Additional funds for Imagination Library

bull Start the development work on a new initiative with high school students that would be an interactive approach to evaluating career alternatives


28 Apr

2017

Apr 28 2017 200 PM ndash Apr 30 2017 1100 AM

Cheyenne Mountain Resort 3225 Broadmoor Valley Road Colorado Springs CO 80906 United States

REGISTER NOW 2017 District Conference Rotary Serving Humanity - Perseverance Cheyenne Mountain Resort Colorado Springs

Friday Saturday amp Sunday $325 per person ($295 early bird through Jan 31) First Time Attendee Full Conf $295 per person Full Conf with Friday Golf Tournament $390 per person FridaySaturday $285 per person SaturdaySunday $275 per person Saturday Day amp Evening $225 per person Saturday Dinner amp Entertainment $110 per person Friday Only $85 per person Friday Shotgun Golf Tournament $95 per person Friday Highlights Shotgun Golf Tournament - 900 am The Evergreen Players Improvisation Group Subject2Change - good music amp good times Saturday Highlights Guest Speaker Chad Hymas one of the 10 most inspirational people in the world Johnn Hewko - Secretary General of Rotary International Carl Tintsman - polio update Awards presentations Entertainment Tunisia - 10 members strong with a unique chemistry amp sound

Club Presentations - clubs are encouraged to submit a summary of their most important and impactful project by March 1st Four clubs will be chosen to present a 20 minute presentation of their project at the District Conference

For Special Hotel Accommodations call 800-588-0250 (Group Name Rotary District 5450)


2017 House of Friendship ndash Request Form

Youre invited to share your clubs accomplishments in the House of Friendship at the 5450 District Conference Cheyenne Mountain Resort Colorado Springs April 28-30 2017 Join with others to champion your clubs local or international service project a fund-raising project or the Family of Rotary Set-up on Friday (noon to 4 pm) Tear down Sunday Please let us know who will be Point of Contact (POC) for your club exhibit Well share specific details with them when we receive your completed form

Club Name_________________________________________________ Number of 6 ft Tables Requested ______________________________

Club President

Name_________________________________________________

Phone_________________________________________________

Email address___________________________________________

Point of Contact for Exhibit

Name_________________________________________________

Cell Phone_____________________________________________

Email address___________________________________________

Do you Require Electricity ($15 per day cost to the club)

Yes No

Call Patti Foley at 720-218-8704 if you have questions Send your form to Patricia K Foley (pattifoleycomcastnet)


Proposed Resolution concerning Raffle Procedures

The BRC Board authorizes the Treasurer to make withdrawals from the raffle account for use in funding scholarships awarded by BRC The Treasurer shall document the purpose of each withdrawal in writing and inform and receive approval in advance from the Games Manager in Charge for the amount and purpose of each withdrawal The Treasurer shall also inform the BRC Board of the amount and purpose of each withdrawal


Total Costs per Meeting110 100

Avalon JCCPaper 272228$ 278788$ Ceramic 314142$ 316323$

Estimated costs per plate per meeting110 100


Avalon vs JCCPaper vs Ceramic


Reusable Dishware (Why switch)portlandoregongovsustainabilityatworkarticle507480

You Asked We Answer Why is reusable dishware the most sustainable option

Ceramic glass metal and heavy duty plastic can all be washed and reused over and over again

1 Itrsquos the best environmental option

Reusable dishware will use far less energy and resources over its lifetime than its disposablecounterparts (details below)

Even with the energy and water needed to wash items the overall environmental impact issubstantially less than single-use throw-away items

2 Itrsquos cheaper in the long run Over time many businesses save money by switching to reusables

3 Itrsquos healthier Many disposable products have human health impacts during production The chemicalfertilizers and pesticides used in growing some plant-based products can create water and air pollution [2]Refining fossil fuels used in plastic products can create air pollution [2] Additionally some plastic productsleach chemicals that can be harmful to people [2]

4 It may be easier than you think Are your waste containers filled with cups and containers If they are yourcustomers (or office mates) are consuming food onsite and could be using ldquorealrdquo dishware instead

How many times do you have to reuse durable dishware before it becomes more sustainable thandisposables

In a typical restaurant setting reusable dishware will use far less energy over its lifetime than its disposablecounterparts

Why Because the typical restaurant reuses its dishware 2500 times and even the most energy intensive durable(ceramic) surpasses its ldquobreak-event pointrdquo with disposables after 120 uses [3]

The ldquobreak-even pointrdquo of reusables and disposables varies for different materials as shown in the graph below butall quickly pass their break-even points in a restaurant setting

14Board of Directors Meeting 16 January 23 2017

Graph shows how many times each type of durable dishware needs to be used ndash all under 120 times - before itreaches the environmental break-even point with its disposable counterpart Final column shows the typical numberof times durable dishware is reused in a restaurant setting ndash almost 2500 ndash which far surpasses the breaking pointof all types of durable dishware [34578]

Really want to dig into the data

Here are break-even points of different types of durables compared to different types of disposables

Reusable plastic dishes need to be reused 10 times to be more sustainable thansingle use plastic 14 times to be more sustainable than Bagasse or 17 times to bemore sustainable than paper [3410]

Glassware needs to be reused 15 times to be more sustainable than paper products[4]

Stainless steel needs to be reused 24 times to be more environmentally friendlythan paper and its dishwasher safe and non-toxic [8 9]

Using ceramic mugs or dishes rather than paper reduces material consumption airand water pollution and solid waste after just 60 uses There are energy savingsafter 118 uses [3]


To break-even with its paper counterpart in energy use ceramic dishware has to be used 118 times glass 15 timesreusable plastic 17 times and stainless steel 24 times

Questions Ready to start using more reusable items in your workplace but not sure where to startContact us

References

1] Sustainable Disposable Foodservice Products Sustainable Foodservice Disposable Products SustainableFoodservice nd Web 18 June 2014

2] Yepsen Rhodes Compostable Products Bio-Cycle (June 2008) 41-43 Print

3] Denison Richard A Environmental Comparison of Reusable Ceramic Mugs vs Disposable Cups Made fromPolystyrene or Virgin Bleached Paperboard Rep Boston Alliance for Environmental Innovation 1998 Print

4] Hocking Martin B ldquoReusable and Disposable Cups An Energy-Based Evaluationrdquo Environmental Management18 (6) 1994 pp 889-899


5] Harnoto Monica F A Comparative Life Cycle Assessment of Compostable and Reusable Takeout Clamshells atthe University of California Berkeley Rep University of California Berkeley 2013 Web 18 June 2014

6] Carbon Clear Disposable Cups vs Reusable Cups Solving the Carbon Intensity Question Issue brief CarbonClear nd Web 18 June 2014

7] Garrido N Alvarez del Castillo MD (2007) Environmental Evaluation of Single-Use and Reusable Cups Int J LCA12 (4) 252-256

8] Bosque Tomas Battle of the Reusable Bottles Plastic vs Aluminum vs Stainless Steel Battle of the BottlesNp 12 May 2010 Web 19 June 2014

9] Triple Pundit Disposable Cups vs Reusable Mugs Triple Pundit People Planet Profit Np 17 Dec 2007Web 19 June 2014

10] Energy Emissions and Water Comparison between Bagasse Paper and Styrofoam Making Bagasse WorldCentric Zero Waste Solutions nd Web 18 June 2014

Research conducted in 2014















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j

j

j

jj

j

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j

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Initial returnFinal return

Amended returnApplication

Department of the TreasuryInternal Revenue Service

Check ifapplicableAddress change

Name change

If No attach a list(see instructions)

Group exemption number

pending

Form of organization Corporation Trust Association Other Year of formation State of legal domicile

Grossreceipts

BCA

terminated

Under penalties of perjury I declare that I have examined this return including accompanying schedules and statements and to the best of my knowledge and belief it is true correct and complete Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge

Number amp street (or PO box if mail is not delivered to street address) Roomsuite

(insert no)

OMB No 1545-0047Form

501(c)( ) 4947(a)(1) or

Form

527Tax-exempt status

(2015)

Signature of officer Date

Type or print name and title

Check

self-employed

Firms EIN

Phone no

Telephone number

$

Name and address of principal officer

501(c)(3)

ifPrint Type preparers name

Firms name

Firms address

Preparers signature Date PTIN

Name of organization

Doing Business as

City or town state or province country and ZIP or foreign postal code

Is this a group return

for subordinates

Are all subordinates included

Briefly describe the organizations mission or most significant activities

Check this box if the organization discontinued its operations or disposed of more than 25 of its net assetsNumber of voting members of the governing body (Part VI line 1a)Number of independent voting members of the governing body (Part VI line 1b)Total number of individuals employed in calendar year 2015 (Part V line 2a)Total number of volunteers (estimate if necessary)Total unrelated business revenue from Part VIII column (C) line 12Net unrelated business taxable income from Form 990-T line 34

Contributions and grants (Part VIII line 1h)Program service revenue (Part VIII line 2g)Investment income (Part VIII column (A) lines 3 4 and 7d)Other revenue (Part VIII column (A) lines 5 6d 8c 9c 10c and 11e)Total revenue - add lines 8 through 11 (must equal Part VIII column (A) line 12)Grants and similar amounts paid (Part IX column (A) lines 1-3)Benefits paid to or for members (Part IX column (A) line 4)Salaries other compensation employee benefits (Part IX column (A) lines 5-10)Professional fundraising fees (Part IX column (A) line 11e)Total fundraising expenses (Part IX column (D) line 25) Other expenses (Part IX column (A) lines 11a-11d 11f-24e)Total expenses Add lines 13-17 (must equal Part IX column (A) line 25)Revenue less expenses Subtract line 18 from line 12

Total assets (Part X line 16)Total liabilities (Part X line 26)Net assets or fund balances Subtract line 21 from line 20

May the IRS discuss this return with the preparer shown above (see instructions)

Net

Ass

ets

orFu

nd B

alan

ces

Under section 501(c) 527 or 4947(a)(1) of the Internal Revenue Code (except private foundations)

H(a)

H(b)

H(c)

I

Employer identification number

E

G

WebsiteML

Prior Year Current Year

Beginning of Current End of YearYear

C

F

D

Do not enter Social Security numbers on this form as it may be made public

For the 2015 calendar year or tax year beginning 2015 and ending 20

Act

iviti

es amp

Gov

erna

nce

For Paperwork Reduction Act Notice see the separate instructions

3456

1

23456

8

20

AB

JK

7b

7a7b

9101112

Rev

enue

13141516

b171819

Expe

nses

2122

Yes No

Information about Form 990 and its instructions is at

a

a

Open to PublicInspection

PaidPreparerUse Only

Part I Summary

990

Part II Signature Block

SignHere

Return of Organization Exempt From Income Tax2015990

wwwirsgovform990

Yes No

Yes No

BOULDER CO 80308

Jul 01 Jun 30

BOULDER CO 80302

16BOULDER ROTARY CLUB

84-0362489PO BOX 176356 720-772-1091

325488X

X 4wwwboulderrotaryorg

X 1919 COCIVIC CLUB ORGANIZED FOR THE

PROMOTION OF SOCIAL WELFARE

11

200

40343 83016 268533 240538 66 60 7245 1874 316187 325488 85093 89205

242155 252490 327248 341695 -11061 -16207 138182 59415 138757 76197 -575 -16782

JOHN REGUR TREASURER

X

CAROL MARCH CPA84-1491497CAROL MARCH amp ASSOCIATES PC

P00201834736 GRANT PLACE 303-444-3465

jBCA

Form 990 (2015) Page

Form (2015)

Did the organization undertake any significant program services during the year which were not listed onthe prior Form 990 or 990-EZ

Did the organization cease conducting or make significant changes in how it conducts any program servicesIf Yes describe these new services on Schedule O

If Yes describe these changes on Schedule ODescribe the organizations program service accomplishments for each of its three largest program services as measured by expensesSection 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others the total expensesand revenue if any for each program service reported

(Code ) (Expenses $ including grants of $ ) (Revenue $



Other program services (Describe in Schedule O)(Expenses $ including grants of $ )(Revenue $Total program service expenses

Briefly describe the organizations missionCheck if Schedule O contains a response or note to any line in this Part III

1

2Yes No

3 Yes No

4

4a

4b

4c

4d

4e

Statement of Program Service Accomplishments2

Part III

990

)

)

)

)

BOULDER ROTARY CLUB 84-0362489X

Civic club organized for promotion of social welfare

XX

19500 19500Scholarships - Awarded to local area students to assist them with thecost of attending school in a foreign country and to graduating highschool seniors for study at a Colorado college or university

10684 10684Youth exchange program - monthly stipend and expenses for foreignexchange students studying at Boulder Colorado area high schools

4950 4950Youth Relations Programs - Tuition for local high school students toattend the Rotary Youth Leadership Camp conducting 4 Way Test ethicsprograms in the Boulder Valley School District and scholarships tolocal area students at trade and vocational schools in Boulder CO

54071 54071 89205

BCA

Page

Form (2015)

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)

Is the organization required to completeDid the organization engage in direct or indirect political campaign activities on behalf of or in opposition tocandidates for public office

effect during the tax year

Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right toprovide advice on the distribution or investment of amounts in such funds or accounts

Did the organization receive or hold a conservation easement including easements to preserve open spacethe environment historic land areas or historic structuresDid the organization maintain collections of works of art historical treasures or other similar assets

Did the organization report an amount in Part X line 21 for escrow or custodial account liability serve as a custodian

Did the organization report an amount for land buildings and equipment in Part X line 10

Did the organization report an amount for investments - other securities in Part X line 12 that is 5 or moreof its total assets reported in Part X line 16Did the organization report an amount for investments - program related in Part X line 13 that is 5 or moreof its total assets reported in Part X line 16Did the organization report an amount for other assets in Part X line 15 that is 5 or more of its total assetsreported in Part X line 16Did the organization report an amount for other liabilities in Part X line 25Did the organizations separate or consolidated financial statements for the tax year include a footnote that addressesthe organizations liability for uncertain tax positions under FIN 48 (ASC 740)

Did the organization obtain separate independent audited financial statements for the tax year

Was the organization included in consolidated independent audited financial statement for the tax year

Is the organization a school described in section 170(b)(1)(A)(ii)

Did the organization report on Part IX column (A) line 3 more than $5000 of grants or other assistance

Did the organization report on Part IX column (A) line 3 more than $5000 of aggregate grants or other

Did the organization report a total of more than $15000 of expenses for professional fundraising services on Part IXcolumn (A) lines 6 and 11e

Did the organization report more than $15000 total of fundraising event gross income and contributions onPart VIII lines 1c and 8a

Did the organization report more than $15000 of gross income from gaming activities on Part VIII line 9a

Is the organization a section 501(c)(4) 501(c)(5) or 501(c)(6) organization that receives membership dues assessments or similar amounts as defined in Revenue Procedure 98-19

If the organizations answer to any of the following questions is Yes then complete Schedule D Parts VIVII VIII IX or X as applicable

Did the organization directly or through a related organization hold assets in temporarily restrictedendowments permanent endowments or quasi-endowments

Did the organization maintain an office employees or agents outside of the United States

Did the organization have aggregate revenues or expenses of more than $10000 from grantmakingfundraising business investment and program service activities outside the United States or aggregateforeign investments valued at $100000 or more

for amounts not listed in Part X or provide credit counseling debt management credit repair or debt negotiationservices

(see instructions)

Did the organization engage in lobbying activities or have a section 501(h) election in

to or for any foreign organization

assistance to or for foreign individuals

Yes No

Section 501(c)(3) organizations

11

2 23

3

44

55

6

67

78

89

910

1011

11a

12a12a

13 1314a 14a

15

14b

1516

1617

1718

1819

19

b

b

12b

11b

11c

11d11e

11f

a

b

c

d

ef

3Checklist of Required SchedulesPart IV

990

complete Schedule A

Schedule D Part I

complete Schedule D Part III

Schedule D Part VI

Schedule D Parts XI and XII

the organization answered No to line 12a then completing Schedule D Parts XI and XII is optional

If Yes complete Schedule G Part III

If Yes

Schedule B Schedule of Contributors

If Yes complete Schedule C Part I

If Yes complete Schedule C Part II

If Yes complete Schedule C Part III

If Yes complete

If Yes complete Schedule D Part IIIf Yes

If Yes complete Schedule D Part IV

If Yes complete Schedule D Part V

If Yes complete

If Yes complete Schedule D Part VII

If Yes complete Schedule D Part VIII

If Yes complete Schedule D Part IXIf Yes complete Schedule D Part X

If Yes complete Schedule D Part X

If Yes complete

If Yes and if

If Yes complete Schedule E

If Yes complete Schedule F Parts I and IV

If Yes complete Schedule F Parts II and IV

If Yes complete Schedule F Parts III and IV

If Yes complete Schedule G Part I (see instructions)

If Yes complete Schedule G Part II

Form 990 (2015) BOULDER ROTARY CLUB 84-0362489

XXX

X

XXX

XX

XXXX

XXXXXX

XXXX

XX

BCA


Form (2015)

Did the organization receive more than $25000 in non-cash contributionsDid the organization receive contributions of art historical treasures or other similar assets or qualifiedconservation contributionsDid the organization liquidate terminate or dissolve and cease operationsDid the organization sell exchange dispose of or transfer more than 25 of its net assets

Did the organization own 100 of an entity disregarded as separate from the organization under Regulationssections 3017701-2 and 3017701-3Was the organization related to any tax-exempt or taxable entity

Did the organization have a controlled entity within the meaning of section 512(b)(13)

organizationDid the organization conduct more than 5 of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes

An entity of which a current or former officer director trustee or key employee (or a family member thereof)was an officer director trustee or direct or indirect owner

A family member of a current or former officer director trustee or key employeeA current or former officer director trustee or key employee

Did the organization answer Yes to Part VII Section A line 3 4 or 5 about compensation of the organizationscurrent and former officers directors trustees key employees and highest compensated employees

Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than$100000 as of the last day of the year that was issued after December 31 2002

Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exceptionDid the organization maintain an escrow account other than a refunding escrow at any time during the yearto defease any tax-exempt bondsDid the organization act as an on behalf of issuer for bonds outstanding at any time during the year

transaction with a disqualified person during the yearIs the organization aware that it engaged in an excess benefit transaction with a disqualified person in aprior year and that the transaction has not been reported on any of the organizations prior Forms 990 or990-EZ

Was the organization a party to a business transaction with one of the following parties (see Schedule L Part IV instructions for applicable filing thresholds conditions and exceptions)

Did the organization complete Schedule O and provide explanations in Schedule O for Part VI lines 11b and19

Did the organization provide a grant or other assistance to an officer director trustee key employee substantial

of any of these personscontributor or employee thereof a grant selection committee member or to a 35 controlled entity or family member

If Yes to line 35a did the organization receive any payment from or engage in any transaction with acontrolled entity within the meaning of section 512(b)(13)

Did the organization report more than $5000 of grants or other assistance to any domestic organization or domesticgovernment on Part IX column (A) line 1

Did the organization report any amount on Part X line 5 6 or 22 for receivables from or payables to any currentor former officers directors trustees key employees highest compensated employees or disqualified persons

Did the organization engage in an excess benefit

Did the organization make any transfers to an exempt non-charitable related

All Form 990 filers are required to complete Schedule O

Did the organization report more than $5000 of grants or other assistance to or for domestic individualson Part IX column (A) line 2

Did the organization operate one or more hospital facilitiesIf Yes to line 20a did the organization attach a copy of its audited financial statements to this return

Yes No


Section 501(c)(3) 501(c)(4) and 501(c)(29) organizations

28

ab

c

2930

3132

33

34

35a

36

37

38

21

22

23

24a

25a

bc

d

26

27

b

b

28a

28b

28c29

3031

32

33

3435a

36

37

21

22

23

24a24b

24c24d

25a

25b

26

27

38

35b

Note

20ab

20a20b

4Part IV Checklist of Required Schedules

990

If Yes complete Schedule N Part II

III or IV and Part V line 1

Schedule L Part IV

complete Schedule J

24b through 24d and complete Schedule K If No go to line 25a

If Yes complete Schedule I Parts I and II

If Yes complete Schedule I Parts I and III

If Yes

If Yes answer lines

If Yes complete Schedule L Part I


If Yes complete Schedule L Part III

If Yes complete Schedule L Part IVIf Yes complete

If Yes complete Schedule L Part IVIf Yes complete Schedule M

If Yes complete Schedule MIf Yes complete Schedule N Part I

If Yes complete Schedule R Part IIf Yes complete Schedule R Part II

If Yes complete Schedule R Part V line 2


If Yes complete Schedule R Part VI

If Yes complete Schedule H

(continued)

If Yes complete Schedule L Part II

BOULDER ROTARY CLUB 84-0362489

X

XX

X

X

X

X

X

X

XX

XXXXXX

XX

XX

j

BCA

Form 990 (2015)

Form (2015)

Page

If the organization received a contribution of cars boats airplanes or other vehicles did the organization file a

Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicableEnter the number of Forms W-2G included in line 1a Enter -0- if not applicableDid the organization comply with backup withholding rules for reportable payments to vendors and reportablegaming (gambling) winnings to prize winnersEnter the number of employees reported on Form W-3 Transmittal of Wage and TaxStatements filed for the calendar year ending with or within the year covered by this returnIf at least one is reported on line 2a did the organization file all required federal employment tax returns

Did the organization have unrelated business gross income of $1000 or more during the yearIf Yes has it filed a Form 990-T for this yearAt any time during the calendar year did the organization have an interest in or a signature or other authority overa financial account in a foreign country (such as a bank account securities account or other financial account)If Yes enter the name of the foreign country

Was the organization a party to a prohibited tax shelter transaction at any time during the tax yearDid any taxable party notify the organization that it was or is a party to a prohibited tax shelter transactionIf Yes to line 5a or 5b did the organization file Form 8886-T

If Yes did the organization include with every solicitation an express statement that such contributions orgifts were not tax deductible

Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods

If Yes did the organization notify the donor of the value of the goods or services providedDid the organization sell exchange or otherwise dispose of tangible personal property for which it wasrequired to file Form 8282If Yes indicate the number of Forms 8282 filed during the yearDid the organization receive any funds directly or indirectly to pay premiums on a personal benefit contractDid the organization during the year pay premiums directly or indirectly on a personal benefit contract

Did a donor advised fund maintained by the

Did the sponsoring organization make any taxable distributions under section 4966Did the sponsoring organization make a distribution to a donor donor advisor or related person

Initiation fees and capital contributions included on Part VIII line 12Gross receipts included on Form 990 Part VIII line 12 for public use of club facilities

Gross income from members or shareholdersGross income from other sources (Do not net amounts due or paid to other sourcesagainst amounts due or received from them)

If Yes enter the amount of tax-exempt interest received or accrued during the year

and services provided to the payor

Does the organization have annual gross receipts that are normally greater than $100000 and did theorganization solicit any contributions that were not tax deductible as charitable contributions

If the organization recd a contribution of qualified intellectual property did the organization file Form 8899 as required

Is the organization licensed to issue qualified health plans in more than one stateSee the instructions for additional information the organization must report on Schedule O

Enter the amount of reserves the organization is required to maintain by the states in whichthe organization is licensed to issue qualified health plansEnter the amount of reserves on handDid the organization receive any payments for indoor tanning services during the tax yearIf Yes has it filed a Form 720 to report these payments

Form 1098-C

If the sum of lines 1a and 2a is greater than 250 you may be required to

Enter

Is the organization filing Form 990 in lieu of Form 1041

See instructions for filing requirements for FinCEN Form 114 Report of Foreign Bank and Financial Accounts (FBAR)

sponsoring organization have excess business holdings at any time during the year

Check if Schedule O contains a response or note to any line in this Part VYes No

Note


Section 4947(a)(1) non-exempt charitable trusts

Organizations that may receive deductible contributions under section 170(c)

Sponsoring organizations maintaining donor advised funds


1a 1ab 1b

1cc

2a2a

b 2b

3a 3ab 3b

4a4a

b

5a 5ab 5bc 5c

6a6a

b6b

7a

7ab 7bc

7c7dd

e 7ef 7f

g 7gh

7h8

89

9aab 9b

10a 10ab 10b

11a 11ab

11b12a 12a

b 12b13

a

b

c

Section 501(c)(29) qualified nonprofit health insurance issuers13a

13b13c

14a14b

14ab

Note

Statements Regarding Other IRS Filings and Tax CompliancePart V

990

5

If No provide an explanation in Schedule O

If No to line 3b provide an explanation in Schedule O

e-file (see instructions)

Section 501(c)(12) organizations Enter

0


7

X

X

X

XX

X

X

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BCA

Page

Form (2015)

Form 990 (2015)

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

Enter the number of voting members included in line 1a above who are independentDid any officer director trustee or key employee have a family relationship or a business relationship withany other officer director trustee or key employeeDid the organization delegate control over management duties customarily performed by or under the directsupervision of officers directors or trustees or key employees to a management company or other personDid the organization make any significant changes to its governing documents since the prior Form 990 was filedDid the organization become aware during the year of a significant diversion of the organizations assetsDid the organization have members or stockholdersDid the organization have members stockholders or other persons who had the power to elect or appoint one or more members of the governing body

Did the organization contemporaneously document the meetings held or written actions undertaken duringthe year by the followingThe governing bodyEach committee with authority to act on behalf of the governing body

Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form

Did the organization have a written conflict of interest policy

Did the organization regularly and consistently monitor and enforce compliance with the policy

Did the organization have a written whistleblower policyDid the organization have a written document retention and destruction policyDid the process for determining compensation of the following persons include a review and approval byindependent persons comparability data and contemporaneous substantiation of the deliberation and decisionThe organizations CEO Executive Director or top management officialOther officers or key employees of the organizationIf Yes to line 15a or 15b describe the process in Schedule O (see instructions)Did the organization invest in contribute assets to or participate in a joint venture or similar arrangementwith a taxable entity during the yearIf Yes did the organization follow a written policy or procedure requiring the organization to evaluateits participation in joint venture arrangements under applicable federal tax law and take steps to safeguardthe organizations exempt status with respect to such arrangements

List the states with which a copy of this Form 990 is required to be filedSection 6104 requires an organization to make its Forms 1023 (or 1024 if applicable) 990 and 990-T (Section 501(c)(3)s only)available for public inspection Indicate how you made these available Check all that apply

Own website Anothers website Upon requestDescribe in Schedule O whether (and if so how) the organization made its governing documents conflict of interestpolicy and financial statements available to the public during the tax yearState the name address and telephone number of the person who possesses the organizations books and records

Is there any officer director trustee or key employee listed in Part VII Section A who cannot be reachedat the organizations mailing address

Did the organization have local chapters branches or affiliatesIf Yes did the organization have written policies and procedures governing the activities of such chaptersaffiliates and branches to ensure their operations are consistent with the organizations exempt purposes

Describe in Schedule O the process if any used by the organization to review this Form 990

Are any governance decisions of the organization reserved to (or subject to approval by) members stockholders or persons other than the governing body

Enter the number of voting members of the governing body at the end of the tax yearIf there are material differences in voting rights among members of the governing body or if the governingbody delegated broad authority to an executive committee or similar committee explain in Schedule O

Other

Yes

Yes

2

1a 1a

1bb2

33

4 45 56 67a

7a

8

b7b

8aab 8b

99

10a 10a

11a 11a

12a 12ab 12bc

12c13 1314 1415

15aab 15b

16a16a

b

16b

1718

19

20

b10b

b

No

No

Governance Management and Disclosure

Section C Disclosure

Part VI6

990

Section A Governing Body and Management

Section B Policies

describe in Schedule O how this was done

If Yes provide the names and addresses in Schedule O

If No go to line 13

If Yes

(explain in Schedule O)

For each Yes response to lines 2 through 7b below and for a Noresponse to line 8a 8b or 10b below describe the circumstances processes or changes in Schedule O See instructions Check if Schedule O contains a response or note to any line in this Part VI

(This Section B requests information about policies not required by the Internal Revenue Code)

The Club PO BOX 176 BOULDER CO 80308 720-772-1091


X

11

XXXXX

XX

XX

X

X

XX

XXX

X

XX

X

|

|

|

|

|

BCA

any hoursfor related

organizationsbelow

dotted line)

Averagehours perweek (list

Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

Officer

Institutional trustee

Individual trusteeor director

Name and Title Reportablecompensation

fromthe

organization(W-21099-MISC)

Reportablecompensationfrom related

organizations(W-21099-MISC)

Estimatedamount of

othercompensation

from theorganizationand related

organizations

(do not check more than one

box unless person is both an

officer and a directortrustee)

Form 990 (2015)

Complete this table for all persons required to be listed Report compensation for the calendar year ending with or within the organizations

List all of the organizationsof amount of compensation Enter -0- in columns (D) (E) and (F) if no compensation was paid

List the organizations fivewho received reportable compensation (Box 5 of Form W-2 andor Box 7 of Form 1099-MISC) of more than $100000 from theorganization and any related organizations

List all of the organizationsof reportable compensation from the organization and any related organizations

List all of the organizationsorganization more than $10000 of reportable compensation from the organization and any related organizationsList persons in the following order individual trustees or directors institutional trustees officers key employees highestcompensated employees and former such persons

List all of the organizations

Check this box if neither the organization nor any related organizations compensated any current officer director or trustee

officers directors trustees (whether individuals or organizations) regardless

key employees if any See instructions for definition of key employeehighest compensated employees (other than an officer director trustee or key employee)

officers key employees and highest compensated employees who received more than $100000

that received in the capacity as a former director or trustee of the

tax year

Check if Schedule O contains a response or note to any line in this Part VII

(C)

(B)(A) (F)(E)(D)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

current

currentcurrent

former

former directors or trustees

1aSection A Officers Directors Trustees Key Employees and Highest Compensated Employees

Part VII Compensation of Officers Directors Trustees Key Employees Highest CompensatedEmployees and Independent Contractors

990

7

0000000000000

0000000000000

0000000000000


Stan Benson 10President X XBobby Brown 1Vice President X XWilliam Meyer 1Pres Elect X XDeborah Kelly 5Past President X XDiana Smith 20Secretary XJohn Regur 10Treasurer X XDiedre Farrell 1Director XGeorge Garmany 1Director XAnne-Marie Rea 1Director XAmir Massihzad 1Director XDorothy Rupert 1Director XBrad Wiesley 1Director XTom Chesney 1Director X

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BCA


organizationsbelow

dotted line)


Name and title

Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

Officer



Reportablecompensation

fromthe




Estimatedamount of

othercompensation


organizations

(do not check more than one box unless person is both an officer and a directortrustee)

Name and business address Description of services Compensation

Form 990 (2015)

Total number of individuals (including but not limited to those listed above) who received more than $100000 of reportable compensationfrom the organization

Did the organization list anyemployee on line 1aFor any individual listed on line 1a is the sum of reportable compensation and other compensation fromthe organization and related organizations greater than $150000

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual forservices rendered to the organization

Complete this table for your five highest compensated independent contractors that received more than $100000 ofcompensation from the organization Report compensation for the calendar year ending with or within the organizations tax year

Total number of independent contractors (including but not limited to those listed above) who received more than$100000 in compensation from the organization

officer director or trustee key employee or highest compensated

(F)(E)(D)

(C)

(A)

(A) (B) (C)

(B)

1b Sub-total

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)

c Total from continuation sheets to Part VII Section Add Total (add lines 1b and 1c)

(16)

(15)

2

33

4

45

5

1

2

former

Section A Officers Directors Trustees Key Employees and Highest Compensated Employees

Yes No

Section B Independent Contractors

Part VII

990

8

individual

If Yes complete Schedule J for such individual

If Yes complete Schedule J for such

If Yes complete Schedule J for such person

(continued)

000

000

000


X

XX

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BCA

Government grants

All other contributions giftsgrants and similar amountsnot included above

Income from investment of tax-exempt bond proceeds

Less rental

Rental income

Gross amount from

other than inventoryLess cost or other

expenses

Gross income from fundraising events

(not including $

of contributions reported on line 1c)

expenses

or (loss)

sales of assets

basis and sales

(contributions)

Noncash contributionsincluded in lines 1a-1f

Form 990 (2015)

Form (2015)

Page

Total revenue Related orexemptfunctionrevenue

Unrelatedbusinessrevenue

Revenueexcluded from tax

under sections512 - 514

Federated campaignsMembership duesFundraising eventsRelated organizations

All other program service revenue

Investment income (including dividends interest andother similar amounts)

Royalties

Gross rents

Net rental income or (loss)

Gain or (loss)Net gain or (loss)

See Part IV line 18Less direct expensesNet income or (loss) from fundraising eventsGross income from gamingactivities See Part IV line 19Less direct expensesNet income or (loss) from gaming activitiesGross sales of inventory lessreturns and allowancesLess cost of goods soldNet income or (loss) from sales of inventory

Miscellaneous Revenue

All other revenue

See instructions

Add lines 1a-1f

Add lines 2a-2f

Check if Schedule O contains a response or note to any line in this Part VIII

Business Code

Business Code

(A) (B) (C) (D)

Total revenue

Total

Total

TotalCon

trib

utio

ns G

ifts

Gra

nts

and

Oth

er S

imila

r Am

ount

sPr

ogra

m S

ervi

ce

Oth

er R

even

ue

1a 1a1b1c1d1e

1f

bcdef

g

h

2abcdefg3

45

6abcd

7a

b

cd

8a

bc

9a

bc

10a

bc

11abcde

12

Rev

enue

Statement of RevenuePart VIII

990

9

(ii) Other(i) Securities

$

(i) Real (ii) Personal

Add lines 11a-11d

ab

ab

ab


38676

44340 83016

Membership meals 133224 133224Activities 98265 98265Initiation fees 1200 1200Guest meals amp fees 6364 6364Social program fees 1485 1485

240538 60 60

1758 1758 1758

Books 115 115Other 1 1

116 325488 242472

jBCA Form (2015)

PageForm 990 (2015)

Total expenses Program service Management and Fundraisingexpenses general expenses expenses

reported in column (B) joint costs from a combined

educational campaign and fundraising solicitation

Check here if following SOP 98-2 (ASC 958-720)

Complete this line only if the organization

Grants and other assistance to domestic organizations

Prof fundraising services See Part IV line 17

and domestic governments See Part IV line 21Grants and other assistance to domesticindividuals See Part IV line 22Grants and other assistance to foreignorganizations foreign goverments and foreignindividuals See Part IV lines 15 and 16Benefits paid to or for membersCompensation of current officers directorstrustees and key employeesCompensation not included above to disqualifiedpersons (as defined under section 4958(f)(1)) andpersons described in section 4958(c)(3)(B)Other salaries and wages

Other employee benefitsPayroll taxesFees for services (non-employees)ManagementLegalAccountingLobbying

Investment management fees

Advertising and promotionOffice expensesInformation technologyRoyaltiesOccupancyTravelPayments of travel or entertainment expensesfor any federal state or local public officialsConferences conventions and meetingsInterestPayments to affiliatesDepreciation depletion and amortizationInsuranceOther expenses Itemize expenses not coveredabove (List miscellaneous expenses in line 24e Ifline 24e amount exceeds 10 of line 25 column(A) amount list line 24e expenses on Schedule O)

Pension plan accruals and contributions (includesection 401(k) and 403(b) employer contributions)

Other (If line 11g amount exceeds 10 of line 25col (A) amount list line 11g expenses on Sch O)

Check if Schedule O contains a response or note to any line in this Part IX(A) (B) (C) (D)

1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526 Joint costs

990

10Part IX Statement of Functional Expenses

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

Do not include amounts reported on lines 6b7b 8b 9b and 10b of Part VIII

All other expensesTotal functional expenses Add lines 1 through 24e


X

28471 28471 60734 60734

Weekly meeting meals 108267 108267Admin service fee 55567 55567Rotary Intl dues 18495 18495

70161 70161 341695 89205 252490

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BCA

Form (2015)

PageForm 990 (2015)

End of yearCash - non-interest-bearingSavings and temporary cash investmentsPledges and grants receivable netAccounts receivable net

Notes and loans receivable netInventories for sale or usePrepaid expenses and deferred chargesLand buildings and equipment cost or other

Less accumulated depreciationInvestments - publicly traded securitiesInvestments - other securities See Part IV line 11Investments - program-related See Part IV line 11Intangible assetsOther assets See Part IV line 11

Accounts payable and accrued expensesGrants payableDeferred revenueTax-exempt bond liabilitiesEscrow or custodial account liability Complete Part IV of Schedule D

Secured mortgages and notes payable to unrelated third partiesUnsecured notes and loans payable to unrelated third parties

Unrestricted net assetsTemporarily restricted net assetsPermanently restricted net assets

Capital stock or trust principal or current fundsPaid-in or capital surplus or land building or equipment fundRetained earnings endowment accumulated income or other fundsTotal net assets or fund balancesTotal liabilities and net assetsfund balances

basis Complete Part VI of Schedule D

Other liabilities (including federal income tax payables to related thirdparties and other liabilities not included on lines 17-24) Complete Part Xof Schedule D

Loans and other receivables from current and former officers directorstrustees key employees and highest compensated employees CompletePart II of Schedule LLoans and other receivables from other disqualified persons (as definedunder section 4958(f)(1)) persons described in section 4958(c)(3)(B) andcontributing employers and sponsoring organizations of section 501(c)(9) voluntary employees beneficiary organizations (see instructions) Complete

Part II of Schedule L

Loans and other payables to current and former officers directorstrustees key employees highest compensated employees anddisqualified persons Complete Part II of Schedule L

Add lines 1 through 15 (must equal line 34)

Check if Schedule O contains a response or note to any line in this Part X

Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

10a10bb

1213141516

10c111213141516

171819202122

1718192021

22Liab

ilitie

s

232425

26

2324

2526

27

Organizations that follow SFAS 117 (ASC 958) check here andcomplete lines 27 through 29 and lines 33 and 34

272829

3031323334

Net

Ass

ets

or F

und

Bal

ance

s

2829

3031323334

Organizations that do not follow SFAS 117 (ASC 958) check hereand complete lines 30 through 34

990

11Part X Balance Sheet

Beginning of year

Add lines 17 through 25


47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

-575 -16782 138182 59415

BCA

Form (2015)


If Yes did the organization undergo the required audit or audits If the organization did not undergo thethe Single Audit Act and OMB Circular A-133As a result of a federal award was the organization required to undergo an audit or audits as set forth in

audit review or compilation of its financial statements and selection of an independent accountantIf Yes to line 2a or 2b does the organization have a committee that assumes responsibility for oversight of the

Were the organizations financial statements audited by an independent accountant

Were the organizations financial statements compiled or reviewed by an independent accountant

Accounting method used to prepare the Form 990 Cash Accrual Other

If the organization changed either its oversight process or selected process during the tax year explain in Schedule O

required audit or audits explain why in Schedule O and describe any steps taken to undergo such audits

If the organization changed its method of accounting from a prior year or checked Other explain inSchedule O

Total revenue (must equal Part VIII column (A) line 12)Total expenses (must equal Part IX column (A) line 25)Revenue less expenses Subtract line 2 from line 1Net assets or fund balances at beginning of year (must equal Part X line 33 column (A))

Other changes in net assets or fund balances (explain in Schedule O)Net assets or fund balances at end of year Combine lines 3 through 9 (must equal Part X line 33column (B))

Prior period adjustmentsInvestment expensesDonated services and use of facilitiesNet unrealized gains (losses) on investments

If Yes check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis consolidated basis or both

Separate basis Consolidated basis Both consolidated and separate basis

If Yes check a box below to indicate whether the financial statements for the year were audited on aseparate basis consolidated basis or both


Check if Schedule O contains a response or note to any line in this Part XI

Check if Schedule O contains a response or note to any line in this Part XIIYes No

1

2a

b

c

3a

b3b

3a

2c

2b

2a

123456

123456

789

10

789

10Part XII Financial Statements and Reporting

Part XI Reconciliation of Net Assets

990

12 BOULDER ROTARY CLUB 84-0362489

325488 341695 -16207 -575

-16782

X

X

X

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BCA

Internal Revenue ServiceDepartment of the Treasury

OMB No 1545-0047

$$

$

Total number at end of yearAggregate value of contributions to (during year)Aggregate value of grants from (during year)Aggregate value at end of yearDid the organization inform all donors and donor advisors in writing that the assets held in donor advised fundsare the organizations property subject to the organizations exclusive legal controlDid the organization inform all grantees donors and donor advisors in writing that grant funds can be used onlyfor charitable purposes and not for the benefit of the donor or donor advisor or for any other purpose conferring

Donor advised funds Funds and other accounts

Purpose(s) of conservation easements held by the organization (check all that apply)Preservation of land for public use (eg recreation or education)Protection of natural habitatPreservation of open space

Preservation of a historically important land areaPreservation of a certified historic structure

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax yearTotal number of conservation easementsTotal acreage restricted by conservation easementsNumber of conservation easements on a certified historic structure included in (a)Number of conservation easements included in (c) acquired after 81706 and not on a historic

Number of conservation easements modified transferred released extinguished or terminated by the organization during

Number of states where property subject to conservation easement is locatedDoes the organization have a written policy regarding the periodic monitoring inspection handling of violationsand enforcement of the conservation easements it holdsStaff and volunteer hours devoted to monitoring inspecting handling of violations and enforcing conservation easements during the year

Amount of expenses incurred in monitoring inspecting handling of violations and enforcing conservation easements during the year

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i)and section 170(h)(4)(B)(ii)In Part XIII describe how the organization reports conservation easements in its revenue and expense statement and balance sheet andinclude if applicable the text of the footnote to the organizations financial statements that describes the organizations accounting forconservation easements

If the organization elected as permitted under SFAS 116 (ASC 958) not to report in its revenue statement and balance sheet works of arthistorical treasures or other similar assets held for public exhibition education or research in furtherance of public service providein Part XIII the text of the footnote to its financial statements that describes these itemsIf the organization elected as permitted under SFAS 116 (ASC 958) to report in its revenue statement and balance sheet works of arthistorical treasures or other similar assets held for public exhibition education or research in furtherance of public service provide thefollowing amounts relating to these items

Revenue included on Form 990 Part VIII line 1Assets included in Form 990 Part X

If the organization received or held works of art historical treasures or other similar assets for financial gain provide the following amountsrequired to be reported under SFAS 116 (ASC 958) relating to these itemsRevenue included on Form 990 Part VIII line 1Assets included in Form 990 Part X $

the tax year

$

impermissible private benefit

structure listed in the National Register

Complete if the organization answered Yes on Form 990 Part IV line 6



Held at the End of the Tax Year

Name of the organization Employer identification number


For Paperwork Reduction Act Notice see the Instructions for Form 990

Complete if the organization answered Yes on Form 990

Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d

Part IV line 6 7 8 9 10 11a 11b 11c 11d 11e 11f 12a or 12b

Information about Schedule D (Form 990) and its instructions is at

Schedule D (Form 990) 2015

SCHEDULE D(Form 990)

Part I

Part II Conservation Easements

Part III Organizations Maintaining Collections of Art Historical Treasures or Other Similar Assets

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts

Supplemental Financial Statements2015

wwwirsgovform990 BOULDER ROTARY CLUB 84-0362489

jj

j

jBCA

Grants or scholarships


Using the organizations acquisition accession and other records check any of the following that are a significant use of its collection items(check all that apply)

Public exhibitionScholarly researchPreservation for future generations

Loan or exchange programsOther

Provide a description of the organizations collections and explain how they further the organizations exempt purpose in Part XIIIDuring the year did the organization solicit or receive donations of art historical treasures or other similar assets to be soldto raise funds rather than to be maintained as part of the organizations collection

Is the organization an agent trustee custodian or other intermediary for contributions or other assets not includedon Form 990 Part XIf Yes explain the arrangement in Part XIII and complete the following table

AmountBeginning balanceAdditions during the year

Ending balanceDistributions during the year

Did the organization include an amount on Form 990 Part X line 21 for escrow or custodial account liabilityIf Yes explain the arrangement in Part XIII Check here if the explanation has been provided on part XIII

Four years backThree years backTwo years backPrior yearCurrent yearBeginning of yearbalanceContributionsNet investment

and losses

Other expendituresfor facilities andprogramsAdministrativeexpensesEnd of year balanceProvide the estimated percentage of the current year end balance (line 1g column (a)) held asBoard designated or quasi-endowment Permanent endowmentTemporarily restricted endowment

Are there endowment funds not in the possession of the organization that are held and administered for the organization byunrelated organizationsrelated organizations

If Yes on line 3a(ii) are the related organizations listed as required on Schedule RDescribe in Part XIII the intended uses of the organizations endowment funds

Description of property Book valueDepreciation

Cost or otherbasis (other)

Cost or otherbasis (investment)

LandBuildingsLeasehold improvementsEquipmentOtherAdd lines 1a through 1e

Accumulated

The percentages on lines 2a 2b and 2c should equal 100

Page

earnings gains

Complete if the organization answered Yes on Form 990 PartIV line 11a See Form 990 Part X line 10

Part IV line 9 or reported an amount on Form 990 Part X line 21Complete if the organization answered Yes to Form 990



3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc

3a Yes No3a(i)3a(ii)

3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total


Part IV Escrow and Custodial Arrangements

Part V Endowment Funds

Part VI Land Buildings and Equipment

2

(Column (d) must equal Form 990 Part X column (B) line 10c)

(continued) BOULDER ROTARY CLUB 84-0362489

X

000 000

000

18887 18675 212 212

j

j

j

j

BCA

Liability for uncertain tax positions In Part XIII provide the text of the footnote to the organizationrsquos financial statements that reports theorganizations liability for uncertain tax positions under FIN 48 (ASC 740) Check here if the text of the footnote has been provided in Part XIII


(including name of security)Book value Method of valuation

Cost or end-of-year market value

Financial derivativesClosely-held equity interestsOther

Description of investment type Book value Method of valuationCost or end-of-year market value

Description Book value

Description of LiabilityFederal Income Taxes

Description of security or category

(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page

Complete if the organization answered Yes on Form 990 Part IV line 11b See Form 990 Part X line 12

Complete if the organization answered Yes on Form 990 Part IV line 11c See Form 990 Part X line 13

Complete if the organization answered Yes on Form 990 Part IV line 11d See Form 990 Part X line 15

Complete if the organization answered Yes on Form 990 Part IV line 11e or 11f See Form 990 Part Xline 25

1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total

Part VII Investments - Other Securities

Part VIII Investments - Program Related

Part X Other Liabilities

Part IX Other Assets

3

(Column (b) must equal Form 990 Part X col (B) line 12)





Accrued scholarships 14100Due tofrom affiliates 2198Due to Visionaria Global Grant 9593Due to PeruvPromise in Action gr 879Due to Youth Exchange Student 500Due to District Grant 43Due to World Comm Service Grant 10800

38113

jj

jj

BCA

Schedule G (Form 990 or 990-EZ) 2015 Page

col(total number)(event type)(event type)

Rev

enue

Gross receipts

Less ContributionsGross income (line 1minus line 2)

Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs

Other direct expensesDirect expense summary Add lines 4 through 9 in column (d)Net income summary Subtract line 10 from line 3 column (d)

colOther gamingPull tabsinstant

bingoprogressive bingoBingo

Rev

enue

Gross revenue

Noncash prizes

Other direct expenses

Direct expense summary Add lines 2 through 5 in column (d)Net gaming income summary Subtract line 7 from line 1 column d

Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor

Enter the state(s) in which the organization conducts gaming activitiesIs the organization licensed to conduct gaming activities in each of these statesIf No explain

Were any of the organizations gaming licenses revoked suspended or terminated during the tax yearIf Yes explain

(add col

Food and beverages

Entertainment

Event 1 Event 2 Other events Total eventsthrough

Total gaming (addthrough col )

$15000 of fundraising event contributions and gross income on Form 990-EZ lines 1 and 6b List events with gross

Form 990-EZ line 6a

Complete if the organization answered Yes on Form 990 Part IV line 18 or reported more than

Complete if the organization answered Yes on Form 990 Part IV line 19 or reported more than $15000 on

receipts greater than $5000

Schedule G (Form 990 or 990-EZ) 2015

(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III


Brew BQ Wicked Good 2

10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of

cash assistance (book FMV appraisal

other)

non-cash assistance or assistancegrantif applicable

Name of the organization

EIN IRC section Amount of cash Amount of non- Method of valuation Description of Purpose of grant

OMB No 1545-0047

organization or government

Enter total number of section 501(c)(3) and government organizations listed in the line 1 tableEnter total number of other organizations listed in the line 1 table

Does the organization maintain records to substantiate the amount of the grants or assistance the grantees eligibility for the grants or assistance and the selection criteriaused to award the grants or assistanceDescribe in Part IV the organizations procedures for monitoring the use of grant funds in the United States

Part IV line 21 for any recipient that received more than $5000 Part II can be duplicated if additional space is neededComplete if the organization answered Yes on Form 990

(b) (c) (d) (e) (f) (g)


Schedule I (Form 990) (2015)

(h)

Attach to Form 990

(a)

23

Complete if the organization answered Yes on Form 990 Part IV line 21 or 22

Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

Information about Schedule I (Form 990) and its instructions is atOpen to Public

Inspection

SCHEDULE I

Part II Grants and Other Assistance to Domestic Organizations and Domestic Governments

(Form 990)

Part I General Information on Grants and Assistance

Grants and Other Assistance to OrganizationsGovernments and Individuals in the United States 2015

wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X

Univ of CO Found84-6049811 501c3 14500 Scholarshi

Bldr Valley Scho84-6014683 501c3 6200 dist grant

BCA

Schedule I (Form 990) (2015) Page

cash grant

assistance

(book FMV appraisal

other)

recipients non-cash

Type of grant or assistance Number of Amount of Amount of Method of valuation Description of non-cash assistance

Part III can be duplicated if additional space is neededComplete if the organization answered Yes on Form 990 Part IV line 22

Provide the information required in Part I line 2 Part III column b and any other additional information

(b) (c) (d) (e) (f)(a)


Part III Grants and Other Assistance to Domestic Individuals

Part IV Supplemental Information

2

1

2

3

4

5

6

7


College Scholarships 11 35500Rotary Youth Exchange 3 10684Rotary Leadership Conference 11 4950InteractRotaract 2 18

Part I line 2Grant funds are monitored by the grant committees and allgrant requests are required to have full documentation andreceipts as submitted by the chairperson

Part II column bscholarships are awarded through a screening process andthe scholarship committee chairperson requests the amountof scholarships going to various educational institutions

jj

j

j

j

j

BCA


or from theorganization

Corrected

Loan towith organization loan

To From

principal amountcommitteeby board or agreement

OMB No 1545-0047


Name of disqualified personRelationship between disqualified person and

organizationDescription of transaction

Name of interested person Relationship Purpose of OriginalIn default

Balance due Approved Written

Name of interested person Relationship between interested Amount of Type of assistance Purpose of assistanceperson and the organization assistance

$$

Enter the amount of tax incurred by the organization managers or disqualified persons during the year

Complete if the organization answered Yes on Form 990 Part IV line 25a or 25b or Form 990-EZ Part V line 40b

Enter the amount of tax if any on line 2 above reimbursed by the organization

Complete if the organization answered Yes on Form 990-EZ Part V line 38a or Form 990 Part IV line 26 or if the

$


under section 4958

organization reported an amount on Form 990 Part X line 5 6 or 22

(section 501(c)(3) section 501(c)(4) and 501(c)(29) organizations only)

Schedule L (Form 990 or 990-EZ) 2015

Information about Schedule L (Form 990 or 990-EZ) and its instructions is at

(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)


For Paperwork Reduction Act Notice see the Instructions for Form 990 or 990-EZ

Attach to Form 990 or Form 990-EZ 28a 28b or 28c or Form 990-EZ Part V line 38a or 40b

1

2

3

Open To PublicInspection

Total

Complete if the organization answered Yes on Form 990 Part IV line 25a 25b 26 27

(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

Excess Benefit Transactions

(Form 990 or 990-EZ)

Loans to andor From Interested Persons

SCHEDULE L

Grants or Assistance Benefiting Interested Persons

Part I

Part II

Part III

Transactions With Interested Persons2015

wwwirsgovform990

Yes No Yes No Yes No

Yes No


BCA

PageSchedule L (Form 990 or 990-EZ) 2015

Name of interested person Relationship between Amount of Description of transaction Sharing ofinterested person and the

organizationtransaction organizations

revenues

Complete if the organization answered Yes on Form 990 Part IV line 28a 28b or 28c

Provide additional information for responses to questions on Schedule L (see instructions)

(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)

Business Transactions Involving Interested Persons

Supplemental Information

Part IV2

Part V


Royce Arbour Inc Secretary 44320 Office Mgmt X

Schedule L Part IV additional informationRoyce Arbour provided office management services bookkeepinoffice space organizational committee support services

jj

BCA

OMB No 1545-0047

Name of the organizationInternal Revenue ServiceDepartment of the Treasury


Schedule O (Form 990 or 990-EZ) (2015)

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at Attach 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




SCHEDULE O Supplemental Information to Form 990 or 990-EZ2015


Form 990 Part I Line 6Boulder Rotary has over 60 volunteer committees thatcoordinate volunteer activites in five major areasCommunity service world community service youth servicesclub services incl running the Rotary Club vocational servForm 990 Part III Line 4d - all other accomplishmentsWorld community service program literacy committee topromote literacy in Colorado vocational services - highschool mentorship program middle school journaling projectsupport of National Spelling BeeForm 990 Part VI Line 7a Election of members and theirrights Board members are elected to a two-year termMembers have the right to approve budget create committeesand appoint committee members set org policy and proceduresForm 990 Part VI Line 7b - decisions are subject to approvalof members

Form 990 Part VI Line 11b - Organization process to reviewForm 990 Reviewed by Club President Club board financecommittee and audit committee

Form 990 Part VI Line 19 - Governing documents disclosureexplanation Governing documents are avaiable to the publicvia the organizations website wwwboulderrotaryorg

j

j

BCA


Section 512(b)(13)controlled

OMB No 1545-0047

Primary activity End-of-year assets Direct controllingTotal incomeLegal domicile (stateor foreign country)

Name address and EIN (if applicable) of disregarded entity

Primary activity Public charity status Direct controllingentity

Exempt Code section(if section 501(c)(3))

Legal domicile (stateor foreign country)

Name address and EIN of related organization

entity


entity


Complete if the organization answered Yes on Form 990 Part IV line 34 because it hadone or more related tax-exempt organizations during the tax year


(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)

Schedule R (Form 990) 2015For Paperwork Reduction Act Notice see the Instructions for Form 990

Complete if the organization answered Yes on Form 990 Part IV line 33 34 35b 36 or 37Attach to Form 990

Yes No

Information about Schedule R (Form 990) and its instructions is at

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)


SCHEDULE R(Form 990)

Part I Identification of Disregarded Entities

Part II Identification of Related Tax-Exempt Organizations

Related Organizations and Unrelated Partnerships2015

wwwirsgovform990

COPO Box 743 BOULDER CO 80306


Boulder Rotary Club Fou84-1234841BRCsfoundation 501c3 7 NA X

BCA


entity

Disproportionateallocations

Predominantincome (related

excluded fromtax under

sections 512-514)

Primary activity General ormanaging

Legal

foreign

Name address and EIN of

Primary activity Type of entity (C corp Share of totalDirect controllingentity

Legal domicile

foreign country)


Schedule R (Form 990) 2015 Page

Code V-UBIamount in box 20of Schedule K-1

Share of end-of-year assets

Share of totalincome related organization

Direct controllingentitydomicile

(state or

country)

Percentageownership

Share of end-of-year assetsS corp or trust)(state or

Percentageownership

income

(Form 1065)unrelated partner

Complete if the organization answered Yes on Form 990 Part IV line 34because it had one or more related organizations treated as a partnership during the tax year

Complete if the organization answered Yes on Form 990 Part IVline 34 because it had one or more related organizations treated as a corporation or trust during the tax year

(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)

Schedule R (Form 990) 2015

Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No

Part III Identification of Related Organizations Taxable as a Partnership

Part IV Identification of Related Organizations Taxable as a Corporation or Trust


000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA


Amount involvedTransactiontype (a-s)

Name of related organization Method of determiningamount involved

Page

During the tax year did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IVReceipt of Gift grant or capital contribution to related organization(s)Gift grant or capital contribution from related organization(s)Loans or loan guarantees to or for related organization(s)Loans or loan guarantees by related organization(s)

Sale of assets to related organization(s)Purchase of assets from related organization(s)Exchange of assets with related organization(s)Lease of facilities equipment or other assets to related organization(s)

Lease of facilities equipment or other assets from related organization(s)Performance of services or membership or fundraising solicitations for related organization(s)Performance of services or membership or fundraising solicitations by related organization(s)Sharing of facilities equipment mailing lists or other assets with related organization(s)Sharing of paid employees with related organization(s)

Reimbursement paid to related organization(s) for expensesReimbursement paid by related organization(s) for expenses

Other transfer of cash or property to related organization(s)Other transfer of cash or property from related organization(s)If the answer to any of the above is Yes see the instructions for information on who must complete this line including covered relationships and transaction thresholds

Dividends from related organization(s)

Complete line 1 if any entity is listed in Parts II III or IV of this schedule

interest annuities royalties or rent from a controlled entity

Complete if the organization answered Yes on Form 990 Part IV line 34 35b or 36

(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)

Transactions With Related Organizations3

Part V BOULDER ROTARY CLUB 84-0362489

XX

XXXXXXXXXXXXXXXXX

Boulder Rotary Club Foundation c 35000 Cash grants

j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form

Name of exempt organization

Name and title of officer

Officers signature Date

EROs signature Date

(2015)

For calendar year 2015 or fiscal year beginning 2015 amp ending 20

Check the box for the return for which you are using this Form 8879-EO and enter the applicable amount if any from the return Ifyou check the box on linethen leave line-0- on the applicable line below

Form 990 check hereForm 990-EZ check hereForm 1120-POL check hereForm 990-PF check hereForm 8868 check here

Under penalties of perjury I declare that I am an officer of the above organization and that I have examined a copy of theorganizationrsquos 2015 electronic return and accompanying schedules and statements and to the best of my knowledge and belief theyare true correct and complete I further declare that the amount in Part I above is the amount shown on the copy of theorganizationrsquos electronic return I consent to allow my intermediate service provider transmitter or electronic return originator (ERO)to send the organizationrsquos return to the IRS and to receive from the IRS

authorize the US Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to thefinancial institution account indicated in the tax preparation software for payment of the organizationrsquos federal taxes owed on thisreturn and the financial institution to debit the entry to this account To revoke a payment I must contact the US Treasury FinancialAgent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date I also authorize the financialinstitutions involved in the processing of the electronic payment of taxes to receive confidential information necessary to answerinquiries and resolve issues related to the payment I have selected a personal identification number (PIN) as my signature for the

I authorize to enter my PIN as my signature

on the organizations tax year 2015 electronically filed return If I have indicated within this return that a copy of the return isbeing filed with a state agency(ies) regulating charities as part of the IRS FedState program I also authorize the aforementionedERO to enter my PIN on the returns disclosure consent screen

As an officer of the organization I will enter my PIN as my signature on the organizationrsquos tax year 2015 electronically filed returnIf I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part of the IRS FedState program I will enter my PIN on the returnrsquos disclosure consent screen

I certify that the above numeric entry is my PIN which is my signature on the 2015 electronically filed return for the organizationindicated above I confirm that I am submitting this return in accordance with the requirements of(MeF) Information for Authorized IRS

an acknowledgment of receipt or reason for rejection of

number (EFIN) followed by your five-digit self-selected PIN

or below and the amount on that line for the return being filed with this form was blankor whichever is applicable blank (do not enter -0-) But if you entered -0- on the return then enter

complete more than 1 line in Part Iif any (Form 990 Part VIII column (A) line 12)

if any (Form 990-EZ line 9)(Form 1120-POL line 22)

(Form 990-PF Part VI line 5) (Form 8868 Part I line 3c or Part II line 8c)

the transmission the reason for any delay in processing the return or refund and the date of any refund If applicable I

organizationrsquos electronic return and if applicable the organizationrsquos consent to electronic funds withdrawal

Enter your six-digit electronic filing identification

Modernized e-FileProviders for Business Returns

(Whole Dollars Only)


ERO firm namedo not enter all zeros

Enter five numbers but

do not enter all zeros

For Paperwork Reduction Act Notice see back of form

Do not send to the IRS Keep for your recordsInformation about Form 8879-EO and its instructions is at

b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b

Officers PIN check one box only

1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not

b Total revenueb Total tax

b Tax based on investment incomeb Balance Due

(b) (c)

Pub 4163

Do Not Submit This Form To the IRS Unless Requested To Do SoERO Must Retain This Form - See Instructions

Part I Type of Return and Return Information

Part II Declaration and Signature Authorization of Officer

Part III Certification and Authentication

8879-EO

IRSfor an Exempt Organization

Signature Authorization8879-EO

2015

e-file

wwwirsgovform8879eo

e-file Jul 01 Jun 30 16

BOULDER ROTARY CLUB 84-0362489JOHN REGUR TREASURER

X 325488

X CAROL MARCH amp ASSOCIATES PC 12121

84120412121

01112017

cO 2015 Universal Tax Systems Inc andor its affiliates and licensors All rights reserved USWDET$1

AmountType

Name ID

Description

Total

Detail Sheet 2015US BOULDER ROTARY CLUB 84-0362489

Form 990 Part IX line 24e other expense

Social programs expense 1555Rotary District 5450 dues 11655Raffle license expense 200Other membership expense 2431Office expense 10798Newsletter amp Club communication 2100Meeting expense 25Facility rental meeting space 15750Extraordinary adjustment 13730Depreciation 148Conferences 5681Caring committee expense 86Awards 159Bad debt expense 5843

70161

2016 11 - Board Packetpdf

ADPBF55tmp

From Jo Ann Joselyn [30TUmailtomailserviceclubrunnercaU30T] Sent Friday November 04 2016 357 PM To Thomas B Chesney lt30TTBChesneyamgnationalcom30Tgt Subject Share-A-Gift at Rotary

ADP6FC5tmp

From Bill Rubin Sent Friday January 20 2017 544 PM To Chad Stamm lt30TUrotarychadstammcomU30Tgt Subject RE BOD Liaison Reports

2016 Calcs on cost Summary for BODpdf

Summary for BOD

portlandoregongov-Reusable Dishware Why switchpdf

Reusable Dishware (Why switch)


Club Name

Number of 6 ft Tables Requested

Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

bull NW Metro Rotary Satellite Club request for donation (Page 10) Decided not to move forward with supporting this project

bull Carryover of Power of Soap budget to WCSC The Board voted to not carry over the unfunded $7k from Power of Soap over to the 2016-17 budget However the President was encouraged to work the BNGRC to develop the Desing Sprint project

bull Helping Hands Award (Page 11) Motion to allocate the $500 to Imagination Library Seconded and approved

bull District Conference o Attendance (Page 11) Bill encouraged BOD members to attend and will

promote at the meetings o House of Friendship (Page 13) Chad will talk to the PR committee and see if

they can create displays and possibly spearhead bull Membership

o Dropbox Spreadsheet The Membership Committee has created a spreadsheet for referring members The Board was requested to participate in this membership effort and follow up with prospects

o Talk to new members ndash Bill asked BOD take personal responsibility to ensure new or visiting members are welcomed into the meeting and not standing by themselves

bull Garage sale storage ndash President Bill asked for suggestions for places to store items leading up to the event in May

bull Procedure for Raffle disbursements (Page 14) The new procedures were approved and GMIC will ensure minimums are maintained per our BRC approved rules

bull Change in venue ndash revisions to caterer agreement (Pages 15 to 19) Motion Present to the club the recommendation of the BOD to move venue from Avalon to JCC with similar disposable service Seconded and approved

bull Dues bull Process for 2017-18 Budget

Secretaryrsquos Report (5 minutes)

bull Billing update from Carol Treasurerrsquos Report (20 minutes)

bull Review financials o December 31st Financials (Pages 25 to 33) o 2016-2017 Good Works P amp L (Pages 34 to 35) o 2016 ndash 2017 Operations P amp L (Pages 36 to 37) o Filed IRS Form 990 for FY ending June 30 2016 (Pages 38 to 61)

Open discussion (5 Minutes) Adjournment






Chad









Regards

Bill Rubin



image001png

Sent from carol





















Bill



wwwlevittdenverorg







Joe Seehusen




Suggestions







28 Apr

2017











Club President

Name_________________________________________________

Phone_________________________________________________

Email address___________________________________________


Name_________________________________________________

Cell Phone_____________________________________________

Email address___________________________________________


Yes No




































References



























klkl

j

j

j

jj

j

j jj

j

j





Name change



pending


Grossreceipts

BCA

terminated



(insert no)


501(c)( ) 4947(a)(1) or

Form


(2015)



Check

self-employed

Firms EIN

Phone no

Telephone number

$


501(c)(3)


Firms name

Firms address



Doing Business as



for subordinates







Net

Ass

ets

orFu

nd B

alan

ces


H(a)

H(b)

H(c)

I


E

G

WebsiteML



C

F

D



Act

iviti

es amp

Gov

erna

nce


3456

1

23456

8

20

AB

JK

7b

7a7b

9101112

Rev

enue

13141516

b171819

Expe

nses

2122

Yes No


a

a



Part I Summary

990


SignHere


wwwirsgovform990

Yes No

Yes No

BOULDER CO 80308

Jul 01 Jun 30

BOULDER CO 80302


84-0362489PO BOX 176356 720-772-1091

325488X




11

200

40343 83016 268533 240538 66 60 7245 1874 316187 325488 85093 89205

242155 252490 327248 341695 -11061 -16207 138182 59415 138757 76197 -575 -16782


X


P00201834736 GRANT PLACE 303-444-3465

jBCA


Form (2015)









1

2Yes No

3 Yes No

4

4a

4b

4c

4d

4e


Part III

990

)

)

)

)



XX




54071 54071 89205

BCA

Page

Form (2015)























(see instructions)




Yes No


11

2 23

3

44

55

6

67

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23


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1


(1)

(2)

(3)

(4)

(5)

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(7)

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SCHEDULE I


(Form 990)



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1

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Part I

Part II

Part III


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Suggestions







28 Apr

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(continued)



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Part VI6

990


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Form 990 (2015)












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Form 990 (2015)







(F)(E)(D)

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(17)

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(19)

(20)

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(A) (B)

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OMB No 1545-0047

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the tax year

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123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

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9

NoYes

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Part I






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Page

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Volunteer labor



(add col

Food and beverages

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

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9

10

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ab

1011

YesNo

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(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

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Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

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3

4

5

6

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OMB No 1545-0047







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(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






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sections 512-514)


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(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

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28 Apr

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Part VI6

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(F)(E)(D)

(C)

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(A) (B) (C)

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(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

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Part VII

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OMB No 1545-0047

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the tax year

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1

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(1)(2)(3)(4)(5)(6)(7)(8)(9)

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(add col

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

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Part II

Part III



10006 20643 8027 38676

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Name and address of


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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





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j

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Corrected


To From


OMB No 1545-0047







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$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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OMB No 1545-0047














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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






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BCA


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sections 512-514)


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foreign country)







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(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

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(1)

(2)

(3)

(4)

(5)

(6)

(7)

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(4)

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OMB No 1545-1878

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EROs signature Date

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2015

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AmountType

Name ID

Description

Total




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Summary for BOD




Club Name


Name

Phone

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Name_2

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Yes

No

















Bill



wwwlevittdenverorg







Joe Seehusen




Suggestions







28 Apr

2017











Club President

Name_________________________________________________

Phone_________________________________________________

Email address___________________________________________


Name_________________________________________________

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(2015)



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self-employed

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Part I Summary

990


SignHere


wwwirsgovform990

Yes No

Yes No

BOULDER CO 80308

Jul 01 Jun 30

BOULDER CO 80302


84-0362489PO BOX 176356 720-772-1091

325488X




11

200

40343 83016 268533 240538 66 60 7245 1874 316187 325488 85093 89205

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P00201834736 GRANT PLACE 303-444-3465

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Form (2015)









1

2Yes No

3 Yes No

4

4a

4b

4c

4d

4e


Part III

990

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)

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XX




54071 54071 89205

BCA

Page

Form (2015)























(see instructions)




Yes No


11

2 23

3

44

55

6

67

78

89

910

1011

11a

12a12a

13 1314a 14a

15

14b

1516

1617

1718

1819

19

b

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12b

11b

11c

11d11e

11f

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b

c

d

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Schedule D Part I


Schedule D Part VI




If Yes





If Yes complete




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If Yes complete

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XXX

X

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Form (2015)























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28

ab

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2930

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33

34

35a

36

37

38

21

22

23

24a

25a

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26

27

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3031

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33

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990



Schedule L Part IV

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If Yes

If Yes answer lines












(continued)



X

XX

X

X

X

X

X

X

XX

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XX

XX

j

BCA

Form 990 (2015)

Form (2015)

Page


















Form 1098-C


Enter





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1a 1ab 1b

1cc

2a2a

b 2b

3a 3ab 3b

4a4a

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6a6a

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Form 990 (2015)















Other

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12c13 1314 1415

15aab 15b

16a16a

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16b

1718

19

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Part VI6

990


Section B Policies



If No go to line 13

If Yes






X

11

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XX

XX

X

X

XX

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XX

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|

|

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BCA


organizationsbelow

dotted line)


Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

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fromthe




Estimatedamount of

othercompensation


organizations




Form 990 (2015)












tax year


(C)

(B)(A) (F)(E)(D)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

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(C)

(A)

(A) (B) (C)

(B)

1b Sub-total

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

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Part VII

990

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Form 990 (2015)

Form (2015)

Page








Royalties

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Add lines 1a-1f

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Business Code

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11234

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OMB No 1545-0047

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the tax year

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1

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2

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Page





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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

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1

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23

4

5

6

7

8

9

1

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Part III



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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

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1

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3

4

5

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(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

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sections 512-514)


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(k)

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(1)

(2)

(3)

(4)

(5)

(6)

(7)

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(2)

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(4)

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(continued)



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Part VI6

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Form 990 (2015)












tax year


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(5)

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Form 990 (2015)







(F)(E)(D)

(C)

(A)

(A) (B) (C)

(B)

1b Sub-total

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

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(16)

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Part VII

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(continued)

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Form 990 (2015)

Form (2015)

Page








Royalties

Gross rents





All other revenue

See instructions

Add lines 1a-1f

Add lines 2a-2f


Business Code

Business Code

(A) (B) (C) (D)

Total revenue

Total

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trib

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Beginning of year



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OMB No 1545-0047

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the tax year

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123

1

1

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NoYes

NoYes

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2

abcd

3

45

6

7

8

9

NoYes

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a

b

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Part I






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(1)(2)(3)(4)(5)(6)(7)(8)(9)

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Page





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Noncash prizes

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Volunteer labor



(add col

Food and beverages

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

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2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

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BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

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Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

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OMB No 1545-0047














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OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

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Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

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000 000 000 000 000 000 000

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Page










(a) (b) (c) (d)


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(1)

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(3)

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(5)

(6)

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XX

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j

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OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

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Part I

Part II

Part III


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Part VI6

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123

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Part I






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Form 990-EZ line 6a





(b) (c) (d)(a)

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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



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(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

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cash grant

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1

2

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Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

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(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


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revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

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OMB No 1545-0047

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(add col

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

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Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

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Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

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(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

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Corrected


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OMB No 1545-0047







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under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

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BCA


entity




sections 512-514)


Legal

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(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


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(1)

(2)

(3)

(4)

(5)

(6)

(7)

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(2)

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(4)

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OMB No 1545-1878

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EROs signature Date

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b Total revenue

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2015

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a

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Part I Summary

990


SignHere


wwwirsgovform990

Yes No

Yes No

BOULDER CO 80308

Jul 01 Jun 30

BOULDER CO 80302


84-0362489PO BOX 176356 720-772-1091

325488X




11

200

40343 83016 268533 240538 66 60 7245 1874 316187 325488 85093 89205

242155 252490 327248 341695 -11061 -16207 138182 59415 138757 76197 -575 -16782


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P00201834736 GRANT PLACE 303-444-3465

jBCA


Form (2015)









1

2Yes No

3 Yes No

4

4a

4b

4c

4d

4e


Part III

990

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XX




54071 54071 89205

BCA

Page

Form (2015)























(see instructions)




Yes No


11

2 23

3

44

55

6

67

78

89

910

1011

11a

12a12a

13 1314a 14a

15

14b

1516

1617

1718

1819

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11d11e

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Schedule D Part I


Schedule D Part VI




If Yes





If Yes complete




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XXX

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Form (2015)























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28

ab

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33

34

35a

36

37

38

21

22

23

24a

25a

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26

27

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Schedule L Part IV

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If Yes

If Yes answer lines












(continued)



X

XX

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XX

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XX

j

BCA

Form 990 (2015)

Form (2015)

Page


















Form 1098-C


Enter





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1a 1ab 1b

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2a2a

b 2b

3a 3ab 3b

4a4a

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Part VII

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23


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1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

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SCHEDULE I


(Form 990)



wwwirsgovform990

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2No

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cash grant

assistance

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1

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(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

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(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


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revenues



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(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(continued)



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Part VI6

990


Section B Policies



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Form 990 (2015)












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(17)

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Part VII

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See instructions

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Beginning of year



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the tax year

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1

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(add col

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

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1

a

23

4

5

6

7

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Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

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Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

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Corrected


To From


OMB No 1545-0047







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under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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OMB No 1545-0047














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(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


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foreign



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foreign country)







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(a) (b) (c) (d) (e) (f)

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OMB No 1545-1878

Form

Form




EROs signature Date

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8879-EO



2015

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Part VI6

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Add lines 1a-1f

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

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1

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23

4

5

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7

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Part III



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Name and address of


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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

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(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

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OMB No 1545-0047







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(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

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(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

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Yes

No

BCA


Form (2015)























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28

ab

c

2930

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33

34

35a

36

37

38

21

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990



Schedule L Part IV

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If Yes

If Yes answer lines












(continued)



X

XX

X

X

X

X

X

X

XX

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XX

XX

j

BCA

Form 990 (2015)

Form (2015)

Page


















Form 1098-C


Enter





Note






1a 1ab 1b

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2a2a

b 2b

3a 3ab 3b

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Page

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No

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Part VI6

990


Section B Policies



If No go to line 13

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X

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XX

XX

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XX

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|

|

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|

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organizationsbelow

dotted line)


Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

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fromthe




Estimatedamount of

othercompensation


organizations




Form 990 (2015)












tax year


(C)

(B)(A) (F)(E)(D)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

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Page

Position

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fromthe




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othercompensation


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Form 990 (2015)







(F)(E)(D)

(C)

(A)

(A) (B) (C)

(B)

1b Sub-total

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)


(16)

(15)

2

33

4

45

5

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2

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Yes No


Part VII

990

8

individual




(continued)

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Government grants



Less rental

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expenses


(not including $


expenses

or (loss)

sales of assets

basis and sales

(contributions)


Form 990 (2015)

Form (2015)

Page








Royalties

Gross rents





All other revenue

See instructions

Add lines 1a-1f

Add lines 2a-2f


Business Code

Business Code

(A) (B) (C) (D)

Total revenue

Total

Total

TotalCon

trib

utio

ns G

ifts

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990

9


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44340 83016


240538 60 60

1758 1758 1758


116 325488 242472

jBCA Form (2015)

PageForm 990 (2015)















1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526 Joint costs

990






X

28471 28471 60734 60734


70161 70161 341695 89205 252490

j

j

BCA

Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

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1213141516

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26

2324

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272829

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Net

Ass

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or F

und

Bal

ance

s

2829

3031323334


990


Beginning of year



47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

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BCA

Form (2015)



















1

2a

b

c

3a

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j

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jj

jj

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BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

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and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

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2ab

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(A)(B)(C)(D)(E)(F)(G) (H)

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(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

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3







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Noncash prizes

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Noncash prizes



Cash prizes

Dire

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xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

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YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

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BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

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BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

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OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



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Part VI6

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Form 990 (2015)












tax year


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(F)(E)(D)

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(17)

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(19)

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Part VII

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Add lines 1a-1f

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OMB No 1545-0047

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the tax year

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(add col

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Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

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1

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23

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Part III



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Name and address of


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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

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3

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OMB No 1545-0047







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under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

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sections 512-514)


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(1)

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OMB No 1545-1878

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EROs signature Date

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(b) (c)

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8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


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Summary for BOD




Club Name


Name

Phone

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Name_2

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j

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BCA

Page

Form (2015)

Form 990 (2015)















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19

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Part VI6

990


Section B Policies



If No go to line 13

If Yes






X

11

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XX

XX

X

X

XX

XXX

X

XX

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|

|

|

|

|

BCA


organizationsbelow

dotted line)


Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

Officer




fromthe




Estimatedamount of

othercompensation


organizations




Form 990 (2015)












tax year


(C)

(B)(A) (F)(E)(D)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

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Name and title

Form (2015)

Page

Position

Former

Highest com

pensatedem

ployee

Key employee

Officer




fromthe




Estimatedamount of

othercompensation


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Form 990 (2015)







(F)(E)(D)

(C)

(A)

(A) (B) (C)

(B)

1b Sub-total

(17)

(18)

(19)

(20)

(21)

(22)

(23)

(24)

(25)


(16)

(15)

2

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4

45

5

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Part VII

990

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individual




(continued)

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X

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Government grants



Less rental

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expenses


(not including $


expenses

or (loss)

sales of assets

basis and sales

(contributions)


Form 990 (2015)

Form (2015)

Page








Royalties

Gross rents





All other revenue

See instructions

Add lines 1a-1f

Add lines 2a-2f


Business Code

Business Code

(A) (B) (C) (D)

Total revenue

Total

Total

TotalCon

trib

utio

ns G

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ab

ab

ab


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240538 60 60

1758 1758 1758


116 325488 242472

jBCA Form (2015)

PageForm 990 (2015)















1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526 Joint costs

990






X

28471 28471 60734 60734


70161 70161 341695 89205 252490

j

j

BCA

Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

10a10bb

1213141516

10c111213141516

171819202122

1718192021

22Liab

ilitie

s

232425

26

2324

2526

27


272829

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Net

Ass

ets

or F

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Bal

ance

s

2829

3031323334


990


Beginning of year



47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

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BCA

Form (2015)



















1

2a

b

c

3a

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990


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j

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BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

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and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

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(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

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Total

Total

Total

Total





3







38113

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Rev

enue

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Dire

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Cash prizes

Noncash prizes

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Cash prizes

Dire

ct E

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ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

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(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

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BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














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BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

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000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


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XX

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j

jj

jj

j

j j

jj

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BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

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23


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1


(1)

(2)

(3)

(4)

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SCHEDULE I


(Form 990)



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2No

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cash grant

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SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


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8879-EO



2015

e-file

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Name ID

Description

Total




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Form 990 (2015)







(F)(E)(D)

(C)

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(A) (B) (C)

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1b Sub-total

(17)

(18)

(19)

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(21)

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Part VII

990

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individual




(continued)

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Page








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(A) (B) (C) (D)

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1

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Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

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10a

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(b) (c) (d)(a)

(d)

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1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

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Part II

Part III



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00 00 00

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OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




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1

2

3

4

5

6

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OMB No 1545-0047







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(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




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(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


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foreign



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foreign country)







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income




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(h)(g)

(k)

(i)


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(1)

(2)

(3)

(4)

(5)

(6)

(7)

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(4)

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OMB No 1545-1878

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Form




EROs signature Date

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b Total revenue

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(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

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j

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j

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j

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Government grants



Less rental

Rental income

Gross amount from


expenses


(not including $


expenses

or (loss)

sales of assets

basis and sales

(contributions)


Form 990 (2015)

Form (2015)

Page








Royalties

Gross rents





All other revenue

See instructions

Add lines 1a-1f

Add lines 2a-2f


Business Code

Business Code

(A) (B) (C) (D)

Total revenue

Total

Total

TotalCon

trib

utio

ns G

ifts

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nts

and

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r Am

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Rev

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ab

ab

ab


38676

44340 83016


240538 60 60

1758 1758 1758


116 325488 242472

jBCA Form (2015)

PageForm 990 (2015)















1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526 Joint costs

990






X

28471 28471 60734 60734


70161 70161 341695 89205 252490

j

j

BCA

Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

10a10bb

1213141516

10c111213141516

171819202122

1718192021

22Liab

ilitie

s

232425

26

2324

2526

27


272829

3031323334

Net

Ass

ets

or F

und

Bal

ance

s

2829

3031323334


990


Beginning of year



47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

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BCA

Form (2015)



















1

2a

b

c

3a

b3b

3a

2c

2b

2a

123456

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789

10

789



990


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X

X

X

j

j

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j

jj

jj

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jj

BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

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and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

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b

c

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3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

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1p1q

1r

cde

fghij

kl

mno

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2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jBCA Form (2015)

PageForm 990 (2015)















1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526 Joint costs

990






X

28471 28471 60734 60734


70161 70161 341695 89205 252490

j

j

BCA

Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

10a10bb

1213141516

10c111213141516

171819202122

1718192021

22Liab

ilitie

s

232425

26

2324

2526

27


272829

3031323334

Net

Ass

ets

or F

und

Bal

ance

s

2829

3031323334


990


Beginning of year



47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

-575 -16782 138182 59415

BCA

Form (2015)



















1

2a

b

c

3a

b3b

3a

2c

2b

2a

123456

123456

789

10

789



990


325488 341695 -16207 -575

-16782

X

X

X

j

j

j

j

jj

jj

j

jj

BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

j

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and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc


3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

j

j

BCA

Form (2015)

PageForm 990 (2015)















Total assets

Total liabilities

(A) (B)

11234

5

2345

Ass

ets

6

767

8 89 9

10a

11

10a10bb

1213141516

10c111213141516

171819202122

1718192021

22Liab

ilitie

s

232425

26

2324

2526

27


272829

3031323334

Net

Ass

ets

or F

und

Bal

ance

s

2829

3031323334


990


Beginning of year



47742 25635 40103 11007 35101 3084 13931 18558

325 300 18886 18675 360 211

620 620 138182 59415 100466 37759 261 325

38030 38113 138757 76197

X -575 -16782

-575 -16782 138182 59415

BCA

Form (2015)



















1

2a

b

c

3a

b3b

3a

2c

2b

2a

123456

123456

789

10

789



990


325488 341695 -16207 -575

-16782

X

X

X

j

j

j

j

jj

jj

j

jj

BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

j

jBCA












and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc


3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

BCA

Form (2015)



















1

2a

b

c

3a

b3b

3a

2c

2b

2a

123456

123456

789

10

789



990


325488 341695 -16207 -575

-16782

X

X

X

j

j

j

j

jj

jj

j

jj

BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

j

jBCA












and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc


3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

j

j

j

j

jj

jj

j

jj

BCA


OMB No 1545-0047

$$

$













the tax year

$











Attach to Form 990

123

1

1

2

45

6

NoYes

NoYes

(a) (b)

2

abcd

3

45

6

7

8

9

NoYes

NoYes

a

b

(i)(ii)

ab

2a2b2c

2d





Part I






jj

j

jBCA












and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc


3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

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j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jj

j

jBCA












and losses








Accumulated


Page

earnings gains





3

abc

de

Yes No

(a) (b) (c) (d) (e)

45

1a

b

c

Yes No

def

2ab

1a

bc

de

f

Yes No

g2

abc


3b

(i)(ii)

b4

(a) (b) (c) (d)

1abcde

1c1d1e1f

Total





2



X

000 000

000

18887 18675 212 212

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

j

j

j

j

BCA










(1)(2)(3)

(A)(B)(C)(D)(E)(F)(G) (H)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

Book value

Page





1


(b) (c)

(a) (b) (c)

(a) (b)

(a)

2

(b)

(a)

Total

Total

Total

Total





3







38113

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jj

jj

BCA



Rev

enue

Gross receipts


Dire

ct E

xpen

ses

Cash prizes

Noncash prizes

Rentfacility costs




Rev

enue

Gross revenue

Noncash prizes



Cash prizes

Dire

ct E

xpen

ses

Rentfacility costs

Volunteer labor



(add col

Food and beverages

Entertainment




Form 990-EZ line 6a





(b) (c) (d)(a)

(d)

Yes No

Yes No

1

a

23

4

5

6

7

8

9

1

(a) (b) (c)

2

3

4

5

678

9

10

b

ab

1011

YesNo

YesNo

YesNo

(a)(c)

(c)(a)

2Fundraising Events

Gaming

Part II

Part III



10006 20643 8027 38676

10006 20643 8027 38676

38676

00 00 00

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jj

jj

BCA


Name and address of


other)




OMB No 1545-0047





(b) (c) (d) (e) (f) (g)



(h)

Attach to Form 990

(a)

23


Yes

1


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)


Inspection

SCHEDULE I


(Form 990)



wwwirsgovform990

1

2No

4740 W 80301 CO BO6500 E 80301 CO BO


X



BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

BCA


cash grant

assistance

(book FMV appraisal

other)

recipients non-cash




(b) (c) (d) (e) (f)(a)




2

1

2

3

4

5

6

7





jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jj

j

j

j

j

BCA



Corrected


To From


OMB No 1545-0047







$$





$


under section 4958





(b) (c) (d)(a)

(a) (b) (c) (d) (e) (f) (g) (h) (i)

(a) (b) (c) (d) (e)




1

2

3


Total


(1)(2)(3)(4)(5)(6)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)

(1)(2)(3)(4)(5)(6)(7)(8)(9)

(10)




SCHEDULE L


Part I

Part II

Part III


wwwirsgovform990


Yes No


BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

BCA




revenues



(a)


Yes No

(b) (c) (d) (e)

(1)(2)(3)(4)(5)(6)(7)(8)(9)(10)



Part IV2

Part V




jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

jj

BCA

OMB No 1545-0047














j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

j

j

BCA



OMB No 1545-0047







entity


entity




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f) (g)



Yes No


(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)






wwwirsgovform990




BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

BCA


entity




sections 512-514)


Legal

foreign



Legal domicile

foreign country)







(state or

country)

Percentageownership


Percentageownership

income




(a) (b) (c) (d) (e) (f)

(a) (b) (c) (d) (e) (f)

(j)(i)(h)(g)

(h)(g)

(k)

(i)


Yes NoYes No

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(1)

(2)

(3)

(4)

(5)

(6)

(7)

Yes No




000 000 000 000 000 000 000

000 000 000 000 000 000 000

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

BCA




Page










(a) (b) (c) (d)


Note1ab

NoYes

1a1b1c1d1e

1f1g1h1i1j

1k1l1m1n1o

1p1q

1r

cde

fghij

kl

mno

pq

r

2

(1)

(2)

(3)

(4)

(5)

(6)

1ss

(i) (ii) (iii) (iv)



XX

XXXXXXXXXXXXXXXXX


j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

j

jj

jj

j

j j

jj

j

BCA


OMB No 1545-1878

Form

Form




EROs signature Date

(2015)



























b Total revenue

(a)

EROs EFINPIN

1a2a3a4a5a

1b2b3b4b5b


1a 2a 3a 4a 5a1b 2b 3b 4b 5b

Do not



(b) (c)

Pub 4163





8879-EO



2015

e-file

wwwirsgovform8879eo



X 325488


84120412121

01112017


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No


AmountType

Name ID

Description

Total




70161


ADPBF55tmp


ADP6FC5tmp



Summary for BOD




Club Name


Name

Phone

Email address

Name_2

Cell Phone

Email address_2

Yes

No

board of directors meeting agenda monday january 23, 2017 · doug yeiser and rich goode-allen are...

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