OMB No 1545-1150

F orm

990'1-EZ

Return of Organization Exempt From Income Tax

Under section 501(c ), 527, or 4947( a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ^ Sponsoring organizations of donor advised funds and controlling organizations as defined in section 512(b)(13) must file Form 990 All other organizations with gross receipts less than $500,000 and total
assets less than $1,250,000 at the end of the year may use this form ^ The organization ma y have to use a coj)V of this return to satisf state re o ortin o re uirements

20009

Department of the Treasury

Internal Revenue Service

A
B I I

For the 2009 calendar year, or tax year beginning

Check if applicable Address change Name change Initial return Terminated Amended return Please use IRS label or print or type See Specific C Name of organization

, and ending
D Employer identification number 84-1141304 E Telephone number ( 970 ) 247-2703 State ZIP + 4

ROCKY MOUNTAIN RETREAT Number and street (or P 0 box, if mail is not delivered to street address) 2409 DELWOOD City, town, or country Room/ suite

Application pending Number DURANGO CO 81301 Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach G Accounting Method a completed Schedule A (Form 990 or 990-EZ) Other (specify) ^ H Website . ^ N/A Tax- exempt status (check only one)E501 (c) ( 3 ) -4 (insert no )E 4947(a)(1) or Ej 527

nstructions .

F Group Exemption ^ FX Cash Accrual

I J

Check ^ a if the organization is not required to attach Schedule B (Form 990 990-EZ, or 990-PF)

K Check If the organization is not a section 509(a )( 3) supporting organization and its gross receipts are normally not more than $25,000 A Form 990-EZ or Form 990 return is not required , but if the organization chooses to file a return , be sure to file a complete return
L Add lines 5b, 6b, and 7b , to line 9 to determine gross receipts , if $500,000 or more , file Form 990 instead of Form 990-EZ ^ $ 148,672

ff^ Revenue . Expenses . and Chances in Net Assets or Fund Balances (See the instructions for Part I )
1 2 3
4

Contributions, gifts, grants, and similar amounts received Program service revenue including government fees and contracts Membership dues and assessments
Investment income

1 2 3
4

148,625

47

o C >

5a b
C

Gross amount from sale of assets other than inventory Less cost or other basis and sales expenses G ain or (loss) from sale of assets oiitet llldl l inventory (ubvu.nis traca^.r ine t Gross revenue (not including
reported on line 1)

5a 5b
Sb . .w from !:ne 5a) ..,

0 0
Sc 0

Special events and activities (complete applicable parts of Schedule G) If any amount is from gaming , check here

^ 0

a b c 7a b c 8 9 10 11
12

0 of contributions
6a

jj

Less direct expenses other than fundraising expenses 6b Net income or (loss) from special events and activities (Subtract line 6b from line 6a) Gross sales of inventory, less returns and allowances 7a Less cost of goods sold 7b Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a) Other revenue (describe ^ Total revenue. Add lines 1, 2, 3, 4, 5c, 6c, 7c, and 8 Grants and similar amounts paid (attach schedule) cm it Benefits paid to or for members d
Salaries, other compensation, and employee benefits

0 6c 0

) ^

7c 8 9 10 11
12

0 0 148,672 0

W X w

,) y Q t Z

13 14 15 16 17 18 19 20 21

Professional fees and other payments to independent contracto mAY 18 ZW Q 13 Occupancy, rent, utilities, and maintenance 14 9,582 Printing, publications, postage, and shipping 15 Other expenses (describe ^ See Attached Statement OGDEN , UT ) 16 148,110 Total ex p enses . Add lines 10 throu g h 16 ^ 17 157,692 Excess or (deficit) for the year (Subtract line 17 from line 9) 18 -9,020 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with end-of-year figure reported on prior year's return) 19 182,778 Other changes in net assets or fund balances (attach explanation) 20 0 Net assets or fund balances at end of year Combine lines 18 throu g h 20 ^ 21 173,758 Balance Sheets . If Total assets on line 25, column ( B ) are $1,250,000 or more, fi le Form 990 instead of Form 990-EZ (A) Beginning of year (B) End of year (See the Instructions for Part II)
20,784 22 19,352

22

Cash, savings, and investments

23 Land and buildings 24 Other assets (describe ^

25 Total assets

) )

197,494 0
218 ,278

23 24
25

193,276 0
212,628

26 Total liabilities (describe ^ loan 27 Net assets or fund balances ( line 27 of column ( B ) must a g ree with line 21 )
For Privacy Act and Paperwork Reduction Act Notice , see the separate instructions . (HTA)

35,500 182,778

26 27

38,870 173,758
Form 99U-tL (2009

Form 990-EZ (2009) ROCKY MOUNTAIN RETREAT 84-1141304 Pa g e 2 Expenses MMEStatement of Pro g ram Service Accom p lishments ( See the Instructions for Part III What is the organization's primary exempt purpose? su pp ort other communit y non- p rofit org anizations b y p ro (Required for section
Describe what was achieved in carrying out the organization's exempt purposes In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title o rganizaationsa (C )(4)on 501 (c)(3) snd 501 s organizaon and 4947(a)(1) trusts optional for others )

28 non profit community service bullding_for education, charitable, religious, scientific activities promoting goo --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- -----------(Grants $ 0 ) If this amount includes foreign grants , check here ^ u 29 -------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- -----------(Grants $ 0 ) If this amount includes foreign grants, check here ^ u --------------------------------------------------------------------------------------- ------------------------- - ------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------- -----------(Grants $ n ) If this amount includes foreign grants, check here ^ u 30a 31a 0 0

28a

157,69

29a

30

31 Other program services (attach schedule)

(Grants $ 0 ) If this amount includes foreign grants, check here ^ u

^ 32 Total p ro g ram service ex p enses . ( add lines 28a throu g h 31 a 157,691 32 List of Officers , Directors , Trustees , and Key Employees . List each one even if not compensated (See the Instructions for Part IV )
(a) Name and address (b) Title and average hours per week devoted to p osition ( c) Compensation ( if not paid , enter - 0(d) Contributions to

employee benefit plans & deferred com p ensation

(e) Expense account and other allowances

Robert Blair _______________________________________ Title President 2409 Delwood Duran g o CO 81301 Hr/WK Patricia Blalr_______________________________________ Title Sec/Tre 2409 Delwood Duran g o CO 81301 Hr/WK
Title

10 00 20 00

0 0 0
0

0 0 0
0

0 0 0
0

on
Title Hr/WK
Title

00

HrIWK Title

00

HrfWK
Title Hr/WK -------------------------------------------------Title Hr/WK Title Hr/WK Title Hr/WK Tale Hr/WK Title Hr/WK Title Hr/WK Title
Hr/WK Title

00
00

0
0

0
0

0
0

00

00

00

00

00

00

00

Hr/WK Title Hr/WK Title

00

00

Hr/WK
Title

00

Form

990-EZ (2009)

Form 990-EZ ( 2009 ) Jj= 33 34 35

ROCKY MOUNTAIN RETREAT Other Information ( Note the statement requirements in the instructions for Part V )

84-1141304

Pa g e 3

Yes Did the organization engage in any activity not previously reported to the IRS'? If "Yes," attach a detailed description of each activity
Were any changes made to the organizing or governing documents' If "Yes," attach a conformed copy of the changes If the organization had income from business activities, such as those reported on lines 2, 6a, and 7a (among others), but not reported on Form 990-T, attach a statement explaining why the organization did not report the income on Form 990-T Did the organization have unrelated business gross income of $1,000 or more or was it subject to section 6033(e) notice, reporting, and proxy tax requirements' 33 34

No
X X

35a

36 37 38

39

40

b If "Yes," has it filed a tax return on Form 990-T for this year's 35b Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during the year? If "Yes," complete applicable parts of Schedule N 36 a Enter amount of political expenditures, direct or indirect, as described in the instructions ^ 1 37a 37b b Did the organization file Form 1120-POL for this year? a Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee or were any such loans made in a prior year and still outstanding at the end of the period covered by this return? 38a b If "Yes," complete Schedule L, Part II and enter the total amount involved 38b 38,870 Section 501(c)(7) organizations Enter a Initiation fees and capital contributions included on line 9 39a b Gross receipts, included on line 9, for public use of club facilities 39b a Section 501 (c)(3) organizations Enter amount of tax imposed on the organization during the year under
section 4911 ^ , section 4912 ^ , section 4955 ^

X X X

b Section 501 ( c)(3) and 501 ( c)(4) organizations Did the organization engage in any section 4958 excess benefit transaction during the year or is it aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization ' s prior X Forms 990 or 990-EZ ? If "Yes," complete Schedule L, Part I 40b c Section 501 (c)(3) and 501 ( c)(4) organizations Enter amount of tax imposed on organization managers or disqualified persons during the year under sections 49 i 2, ^ 4955 , and 4958 d Section 501 (c)(3 ) and 501 ( c)(4) organizations Enter amount of tax on line 40c ^ reimbursed by the organization e All organizations At any time during the tax year , was the organization a party to a prohibited tax shelter X transaction ? If "Yes," complete Form 8886-T 40e ^ C o t. b 2A--b o 41 List the states with which a copy of this return is filed 42 a The organization ' s books are in care of ^ Patricia Blair _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Telephone no ^ _ _ (970)_247.2703 --ZIP + 4 Bo- 81 301 Located at ^ 2409 Delwood 9ty__D9!agRq ____________ ST- -CO-- -------------------- ---------------- ----------------b At any time during the calendar year , did the organization have an interest in or a signature or other authority over a financial account in a foreign country ( such as a bank account , securities account , or other financial Yes No account)? 42b X If "Yes," enter the name of the foreign country ^ See the instructions for exceptions and filing requirements for Form TD F 90-22 . 1, Report of Foreign Bank and Financial Accounts. X c At any time during the calendar year , did the organization maintain an office outside of the U S ? 42c If "Yes ," enter the name of the foreign country ^
43 Section 4947 ( a)(1) nonexempt charitable trusts filing Form 990 - EZ in lieu of Form 1041 -Check here ^ E

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

^ 1 43 IN/A Yes No X X

44 45

Did the organization maintain any donor advised funds '? If "Yes ," Form 990 must be completed instead of Form 990-EZ Is any related organization a controlled entity of the organization within the meaning of section 512(b)(13)? If "Yes," Form 990 must be completed instead of Form 990-EZ

44 45
Form

990-EZ (2009)

Form 990-EZ (2009 )

ROCKY MOUNTAIN RETREAT

84-1141304

Page 4

I 9TLATA I

Section 501 ( c)(3) organizations and section 4947( a)(1) nonexempt charitable trusts only. All section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts must answer questions 46-49b and com p lete the tables for lines 50 and 51
Yes 46 47 48 49a No X X X X

46 47 48 49 a

Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office's If "Yes," complete Schedule C, Part I Did the organization engage in lobbying activities? If "Yes," complete Schedule C, Part II Is the organization a school as described in section 170(b)(1)(A)(tl)9 If "Yes," complete Schedule E Did the organization make any transfers to an exempt non-charitable related organization?

50

b If "Yes," was the related organization a section 527 organization? 49b Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization If there is none, enter "None "
(b) Title and average
(a) Name and address of each employee paid more than $100 , 000 hours per week devoted to p osition Title

( c) Compensation

( d) Contributions to
employee benefit plans & deferred com p ensation

(e) Expense
account and other allowances

Name None ---------------- Str

City
Name

ST
Sir

ZIP

Hr/WK
Title

00

Cit y
Name

ST
Sir

ZIP

Hr/wK
Title

00

City
Name

ST
Sir

ZIP

Hr/WK
Title

00

Ci ty
Name

ST
Str

ZIP

HrIWK
Title

00

-- Cit ---------------------- ST ------ ZIP --------------

Hr/WK

00

f 51

Total number of other employees paid over $100,000

Complete this table for the organization ' s five highest compensated independent contractors who each received more than $100,000 of compensation from the organization If there is none , enter "None "
(a) Name and address of each independent contractor paid more than $100,000 1 (b) Type of service I (c) Compensation

Name None Cit Name City

Name

Str ST Str ZIP

Str

----------------ZIP

Cit y Name City Name City d

ST Str ST

ZIP

ZIP

----------------------------------- Str--------------------ST ZIP Total number of other independent contractors each receiving Under penalties of perjury , I declare that I have examined this return, inclu and belief , it is true, ect, and complete Declaration of preparer (other

Sign

J
Signature of officer

Here

-PATRtGI A
T ype or print name and title

LA/^

Co-1bi

Paid Preparer' 0 Use Only

Preparer's si g nature if

Bard Hero y Firm ' s name (or yours ' H&R Block self-employed
),

address , and ZIP + 4

305 S Camino del Rio Suite T , Dui

May the IR S discuss this return with the preparer shown above? See

SCHEDULE A (Form 990 or 990-EZ)

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. ^ Attach to Form 990 or Form 990-EZ. ^ See separate instructions.

OMB No 1545.0047

2009

Department of the Treasury Internal Revenue Service

Name of the organization

Employer identification number

84-1141304 KY MOUNTAIN RETREAT Reason for Public Charity Status (All organizations must complete this part ) See instructions INMU The or anlzatlon not a private foundation because it is (For lines 1 through 11, check only one box ) is 1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

2 3 4 5 6 7 8 9

u A school described in section 170 (b)(1)(A)(ii). (Attach Schedule E ) u A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). u A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii) Enter the hospital's name, city, and state ------------------------------------------------------------------------------------u An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II ) u A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). u An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170 (b)(1)(A)(vi). (Complete Part II ) u A community trust described in section 170(b)(1)(A)(vi). (Complete Part II ) An organization that normally receives (1) more than 33 1/3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions-subject to certain exceptions, and (2) no more than 33 1/3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975 See section 509 (a)(2). (Complete Part III ) u An organization organized and operated exclusively to test for public safety See section 509(a)(4)
u An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) See section 509 ( a )( 3 ). Check the bux that describes the type of supporting organization and complete lines 11 a through 11 h

10
11

a u Type I

b u Type II

C u Type III-Functionally integrated

d u Type III-Other

e u By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2) f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box Since August 17, 2006, has the organization accepted any gift or contribution from any of the g following persons? Yes No (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) X 11 t and (III) below, the governing body of the supported organization? 11 X (ii) A family member of a person described in (I) above? it 11 to X (iii) A 35% controlled entity of a person described in (I) or (ii) above? h Provide the following information about the supported organization(s)
(i) Name of supported organization (ii) EIN
(it) Type of organization (described on fines 1-9 above or IRC section (see instructions ))

(iv) Is the organization in col (i) listed in your governing document?

(v) Did you notify the organization in cot (i) of your sup ort'

(vi) Is the organization in col (i) organized in the U S '2

(vii) Amount of support

Yes

No

Yes

No

Yes

No

0
0 0

0
0

Total
For Privacy Act and Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990-EZ
(HTA)

0
Schedule A (Form 990 or 990-EZ) 2009

Schedule A (Form 990 or 990-EZ) 2009 ROCKY MOUNTAIN RETREAT 84-1141304 Page 2 Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I ) Section A . Public Su pp ort Calendar year (or fiscal year beginning in) ^ ( b) 2006 (d) 2008 (f) Total ( a ) 2005 (c ) 2007 (e) 2009 1 Gifts, grants, contributions, and membership fees received (Do not include any "unusual grants ") Tax revenues levied for the organization's benefit and either paid to or expended on its behalf The value of services or facilities furnished by a governmental unit to the organization without charge Total. Add lines 1 through 3 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) Included on line 1 that exceeds 2% of the amount shown on line 11, column (f) Public su pp ort. Subtract line 5 from line 4 ^ ( a ) 2005 0

0 0

0 0 0 0 0

0 0

4 5

0 ( b ) 2006 0 ( c ) 2007 0 ( d ) 2008 0 ( e ) 2009 0 (f) Total 0

Section B. Total Su pp ort

Calendar year (or fiscal year beginning in) Amounts from line 4 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated business
act:v!t!ec whether or not tha husiness is

214

72

47

333

regularly carried on 10
Other Income Do not include gain or loss from the sale of capital assets (Explain in Part IV )

11 12 13

0 0 0 0 Total support. Add lines 7 through 10 Gross receipts from related activities, etc (see instructions) 12 First five years. If the Form 990 is for the organization's first , second , third, fourth , or fifth tax year as a section 501 (c)(3) organization, check this box and stop here

0 333

Secti on C. Computation of Public Support Percentage

14 15 16a b 17a Public support percentage for 2009 (line 6, column (f) divided by line 11, column (f)) 14 0 00% Public support percentage from 2008 Schedule A, Part II, line 14 15 0 00% 33 1/3% support test-2009 . If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here . The organization qualifies as a publicly supported organization ^ El 33 1/3% support test-2008 . If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here . The organization qualifies as a publicly supported organization ^ 10%-facts -and-circumstances test-2009 . If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly supported organization ^ 10%-facts -and-circumstances test-2008 . If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here . Explain in Part IV how the organization meets the "facts-and-circumstances" test The organization qualifies as a publicly supported organization ^
Private foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see instructions ^

18

Schedule A (Form 990 or 990-EZ) 2009

Schedule A (Form 990 or 990-EZ) 2009 ROCKY MOUNTAIN RETREAT Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I Section A. Public Su pp ort Calendar year ( or fiscal year beginning in) ^ ( b ) 2006 c 2007 ( a ) 2005 1 Gifts, grants, contributions, and membership fees received (Do not Include any "unusual grants ")
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose Gross receipts from activities that are not an unrelated trade or business under section 513

84-1141304

Page 3

( d ) 2008

( e ) 2009

( f) Total

78 , 540

102 , 210

110 , 835

128,836

148,625

569,046

0 0

Tax revenues levied for the organization's benefit and either paid to or expended on its behalf The value of services or facilities 5 furnished by a governmental unit to the organization without charge 6 Total. Add lines 1 through 5 7a Amounts included on lines 1, 2, and 3 received from disqualified persons b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1 % of the amount on line 13 for the year c Add lines 7a and 7b Public support (Subtract line 7c from 8 line 6

0 78,540

0 102,210

110,835

128,836

148,625

0 569,046 0

0 0 569,046

Section B. Total Support

Calendar year (or fiscal year beginning in) ^ 9 10a Amounts from line 6 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 Add lines 1Oa and 1Ob
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on Other Income Do not include gain or loss from the sale of capital assets (Explain in Part IV )

( a ) 2005 78,540

( b ) 2006 102,210

( c ) 2007 110,835

( d ) 2008 128,836

( e ) 2009 148,625

f) Total 569,046

c
11

0 0

12

13 14

^ u Section C. Computation of Public Support Percentage 15 100 00% 15 Public support percentage for 2009 (line 8, column (f) divided by line 13, column (f)) 100 00% 16 16 Public support percentage from 2008 Schedule A, Part III, line 15 Section D. Com p utation of Investment Income Percenta g e 17 0 00% Investment income percentage for 2009 (line 10c, column (f) divided by line 13, column (f)) 17 18 0 00% Investment income percentage from 2008 Schedule A, Part III, line 17 18 19a 33 1/3% support tests-2009. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is
b 20 not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization 33 1/3% support tests-2008. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization Private foundation. If the organizat i on did no t che ck a box on lin e 14, 19a, or 19b, c heck this box and see instructions ^ ^ u ^ u

0 0 Total support. (Add lines 9, 1Oc, 11, and 12) 148 , 625 1 78 , 540 , 102,210 , 128 , 836 1 110 , 835 1 First five years . If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) o rg a ni zation, check t h is box and stop here

0 569,046

Schedule A (Form 990 or 990-EZ) 2009

Schedule A (Form 990 or 990-EZ) 2009 ROCKY MOUNTAIN RETREAT 84-1141304 Page 4 Supplemental Information . Complete this part to provide the explanations required by Part II, line 10, MIT-11 LVA

Part II, line 17a or 17b, and Part III, line 12 Provide any other additional information See Instructions

Schedule A (Form 990 or 990-EZ) 2009

SCHEDULEL
(Form 990 or 990-EZ)

OMB No 1545-0047

Transactions With Interested Persons

^ Complete if the organization answered
"Yes" on Form 990, Part IV, line 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b ^ Attach to Form 990 or Form 990-EZ. ^ See se p arate instructions

0009
Employer identification number 84-1141304

Department of the Treasury Internal Revenue Service

Name of the organization ROCKY MOUNTAIN RETREAT

EEDMM

Excess Benefit Transactions (section 501 (c)(3) and section 501 (c)(4) organizations only)
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b
((c) Corrected (a) Name of disqualified person (b) Description of transaction Yes No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year

under section 4958 Enter the amount of tax, if any, on line 2, above, reimbursed by the organization

^ ^

$ $

0 0

Loans to and /or From Interested Persons. Complete if the oraanlzatlon answered "Yes" on Form 990. Part IV. line 26. or Form 990-EZ. Part V. line 38a
(a) Name of interested person and purpose
( b) Loan to or from the organizations (c ) Original principal amount

( d) Balance due

( e) In default ?

(f) Approved by board or committee?

( g) Written agreement?

To

From

Yes

No

Yes

N.

Yes

No

Rob Blair O p erations Katrina Blair O p erations

X X

D 50D 39-699 1 1,9 ^ 032.. 8 , 8 7

30 , 500 8,370

X X

X X

X X

0
0 0 0 $

n
0 0 0 38,870

Total JjULLj,

IGrants or Assistance Benefiting Interested Persons. Com p lete if the org anization answered "Yes" on Form 990, Part IV, line 27
( b) Relationship between interested person and the organization

(a) Name of interested person

(c) Amount of grant or type of assistance

LLI

Business Transactions Involving Interested Persons.

Complete if the oroanization answered "Yes" on Form 990 Part IV. line 28a_ 28b. or 28c
( b) Relationship between interested person and the organization (c) Amount of transaction

(a) Name of interested person

(d) Description of transaction

(e) Sharing of organ i zat i on s revenues?

Yes

No

0 0 0 0 0 0
For Privacy Act and Paperwork Reduction Act Notice , see the Instructions for Form 990 or 990-EZ.
(RTA)

Schedule L (Form 990 or 990-EZ) 2009

ROCKY MOUNTAIN RETREAT

84-1141304

Part I, Line 16 (990-EZ ) - Other Expenses

1 Travel. 2 Meals and entertainment 3 F61ndraising
4 Amortization

148,110
1 2 3
4

9,403

5 Conferences, conventions, and meetings 6 Depreciation

7 Depletion

5 6
7

5,885

8 9 10 11 12 13
14 15 16 17

Equipment rental and maintenance Interest Supplies Telephone Unrelated business income taxes Donati o ns to other orga ni z ation s
Education Re pairs an d clea ning Utilities Licenses and fees

8 9 10 11 12 13
14 15 16 17

370 29,196 0 2,100

20,906 8,604 2,013

18 19 20 21
22 23 24 25

Misc Consult a tion Homegrown Festival ----

18 19 20 21
22 23 24 25

51 69,093 489

26
27 28

26
27 28

29

29

ROCKY MOUNTAIN RETREAT

84-1141304

Part II, Line 26 (990-EZ) - Liabilities

Descri ption 1 2 3
4 5

loan

35,500 Be g innin g 35,500

38.870 End 38,870

6
7

8 9 10

05/14 / 2010

13:39

19702474391

H&R BLOCK

PAGE

02/02
84.11'13C

ROCKY MOUt'!TAIN RETREAT

Part I , Line 1 (990- )-Contributi o n s , Gifts , Grants and Similar Amou nts Received
1 Contributions , . . . 2 Noncash contributions 3 Membership dues and assessments (ccntrioutlans from the public) . 1 2 3 144 508

4 Government contributions (grants)

5 Commercial co-v'entire 6 Special events contributions (Line 6 - Special Events) 7 Associated organization contributions

4
5 6 7

4,017
C

10 11 Total

--- -------. ---

- -- . ----- -

10 11

448 625

Part I, Line 4 (990-EZ) - Investment Income

I Interest on savings and temporary cash investments . 2 Dividends and interest from securities 1 2 1,7 47

3 Gross rents .
4 Other investment income 5 Total

3
4 5