Beruflich Dokumente
Kultur Dokumente
1S45-I ISO
I
6 Special events and activities (attach schedule):
a Gross revenue (not including $ of contributions
reported on line 1) 6a
b Less: direct expenses other than fundraising expenses 6b
c Net income or (loss) from special events and activities (line 6a less line 6b) 6c
7a Gross sales of inventory, less returns and allowances 7a 14 31
b Less: cost of goods sold 7b 1431
c Gross profit or (loss) from sales of inventory (line 7a less line 7b) 7c
8 Other revenue (describe ►
9 Total revenue (add lines 1. 2. 3. 4. 5c. 6c, 7c, and 8)
96280
10 Grants and similar amounts paid 10
11 Benefits paid to or for members ii
12 Salaries, other compensation, and employee benefits 12
13 Professional fees and other payments to independent contractors
I 14
15
16
Occupancy, rent, utilities, and maintenance
Printing, publications, postage, and shipping
See Statement 4
13
14
15
8163
13770
46714
Other expenses (describe ►
17 Total expenses (add lines 10 through 16)
See Statement 1 j 16 29246
18
17 97893
Excess or (deficit) for the year (line S less line 17)
19
18 -1613
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 -12961
41 20 Other changes in net assets or fund balances (attach explanation)
20
z 21 Net assets or fund balances at end of year (combine lines 18 through 20)
21 -14574
Balance Sheets If Total assets on line 25. column IB) are $250.000 or more. Form 990 must be filed instead of Form 990-EZ
(A) Beginning of year (Bl End of year
22 Cash, savings, and investments
23
-71 22 830.
Land and buildings
23
24 Other assets (describe ► See Statement 2 3931 24 13507
25 Total assets
26
3860 25 14337
Total liabilities (describe ► DUE TO CAROL SPIZZIRI
27
16821 26 28911
w Net assets or fund balances (line 27 of column (B) must agree with line 21)
2-54 S430 For Paperwork Reduction Act Notice, see page 1 of the separate instructions.
-12961 27 -14574
Form 9 9 0 - E Z (1994)
Form 990-tZ 11994) SAVE A L I F E FOUNDATION, INC 36-3869459 Pa9e2
Statement of Program Service Accomplishments Expenses
What is the organization's primary exempt purpose? See Statement 6 (Requited loi SDKclU) and (4)
Otganiraiions and 4947(a)(1)
Describe what was achieved in carrying out the organization's exempt purposes. Fully describe the services provided, the number of Irusis; optional lot ottieis.l
persons benefited, or other relevant information tor each program title.
28 TO PROMOTE EDUCATION & CONTINUING EDUCATION IN CPR & FIRST
AID NATIONALLY. TO PROMOTE, CONSISTENCY, UNIFORMITY &
SAFETY IN THE APPLICATION OF FIRST AID & (Grants $ 28a
29 CPR. TO ASSURE THAT THE BEST PROCEDURES AND HIGHEST
QUALITY MATLS ARE USED & ACCESSIBLE. TO PROMOTE GOOD
SAMARITAN LAWS. " (Grants $ 29a 99324
30
(Grants $ 30a
31 Other program services (attach schedule) (Grants S 31a
32 Total program service expenses (add lines 28a through 31a) 32 99324
■ i f T i i r i List of Officers. Directors, Trustees, and Key Employees (list each one even if not compensated.)
(B) Title and average hours (Cl Compensation (D) Contiibulioiii 10 (El Expense
(Al Name and address per week devoted to (if not paid, enter employee beoelit account and
position plans & detente
See Statement 5 -0-I compensation other allowances
(al Name and address of each independent contractor paid more than $50,000 (blType of service I d Compensation
None
14 \_i An organization organized and operated to test for public safely. Section 509(a)(4). (See instructions.)
Support Schedule (Complete only if you checked boxes on lines 10, 11, or 12 above.) Use cash method of accounting.
Calendar year (or fiscal year
beginning inl ► (al 1993 (b) 1992 (cl 1991 (d) 1990 (el Total
15 Cilti, gums, and conuibuiiont received.
(Do not include unusual grams. See
line 2 8 ) 7199. 7199.
16 Membership fees received
, A h ™ w ° S h ° W ' '"[ !?'? " T 9 h 1 9 9 3 ' , h e """" ' ' • " n d * m 0 U n t i n C ' u d e d in N n e 1 7 , 0 r ' M e h p e f s o n , 0 , h e r , h a n a "disqualified person") from whom
the organization rece.ved. during that year an amount that was more than the larger of (1l the amount on line 25 for the year or IZI $5 000 IncLie
organizations described on lines 5 through 11. as well as individuals. After computing the difference between the amount received an"d the larger amount
3
descnbed in (1) or 12). enter the sum of all these differences (the excess amounts) lor each year-
,1993)
< L L H992I (K 099,) 0 . (1990) 0.
28 For an organization described in line 10.11. or 12. that received any unusual grants during 1990 through 1993. attach a list (which is not open to
public inspection) lor each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant
Do not include these grants in line 15. (See instructions.) None
B S D Private School Questionnaire
(To be completed ONLY by schools that checked the box on line 6 in Part IV)
N/A
29 Ooes the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing Yes No
instrument, or in a resolution of its governing body?
30 29
Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues
and other written communications with the public dealing with sludent admissions, programs, and scholarships?
31 30
Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period ol
solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known
to all parts of the general community it serves?
31
If "Yes." please describe; .f "No." please explain. (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to: ~
a Students' rights or privileges?
33a
b Admissions policies?
33b
c Employment of faculty or administrative staff?
33c
d Scholarships or other financial assistance?
a Educational policies? 33d
33e
f Use of facilities?
g Athletic programs? 331
34 a Does the organization receive any financial aid or assistance from a governmental agency? ~ ~
34a
b Has the organization's right to such aid ever been revoked or suspended?
34b
If you answered "Yes" to either 34a or b. please explain using an attached statement
35 Cef,i,y
WB
1 8 7 W« 7 ^ f " ^ " h M C ° m P " e d W U h , h B 8 P P " e a b , e r e " " f e m e n , s • ' "<«'<"« 4.01 through 4.05 ol Rev. Pr.c. 7 5 - 5 0 .
" • 587, covering racial nondiscrim.nation? If "No," attach an explanation. (See instructions for Part V.)
35
«23I21
12-12-94
350713 758985 SAVE50 060 SAVE A LIFE FOUNDATION, INC. 18616924
Seneduie AlForm 990) 1994 SAVE A L I F E FOUNDATION, I N C . 36-3869459 p8qe4
' fiETWJP^ I Ohhyinrf F w p a nHifr a , k y C l ^ ^ f i ^ j D..U|;^ ^ h l r j T j r -
_ (To be completed ONLY by an eligible organization that filed form 5768) N/A
Check here ► a l I If the organization belongs to an affiliated group.
Check here ► b [ | If you checked a and "limited control" provisions apply.
lb)
Limits on Lobbying Expenses (al
To be completed for ALL
Affiliated group totals
(The term "expenditures" means amounts paid or incurred) electing organizations
N~7A
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures (see Part Vl-A instructions) 39
4 0 Total exempt purpose expenditures (add lines 38 and 39) 40
4 1 Lobbying nontaxable amount. Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount is -
NolovorS 500.000 20% ol ihe jmouni on lint 40
Ortf $600,000 bul noi Dvtr SI.OOO.000 $100,000 plus 15% ol Ihc ticcsi o>» $500,000
0«ei S 1.000.000 bm col over SI.500.DO0 SI75.000 plus 10% ol Ihe m t i i o . t i $1,000,000 41
OiorS1.SOO.000 bul not o««f S17.000.0U0
Over $17.000.000
42 Grassroots nontaxable amount (enter 2 5 % of line 41)
$225,000 plus Sk ol lot i i c t s t o«oi S 1.500.000
S 1,000.000
] 42
43 Subtract line 42 from line 36. E n t e r - 0 - i f line 42 is more than line 36 43
44 Subtract line 41 from line 38. E n t e r - 0 - i f line 41 is more than line 38 44
Caution: File Form 4720 if there is an amount on either line 43 or line 44.
52 a Is the organization directly or .nd.rec.y affiliated with, or related to. one or more tax-exempt organizations described in section 501(c) of the
Code (other than section 501(c)(3)) or in section 527?
b '< "Yes," complete the following schedule. N/A □ es v [X]Nc
~W ~ 1 (bl (cl
Nime
"' organization Type of organization Description of relationship
423141
12-12-94
J350713 758985 SAVE50 060 SAVE A LIFE FOUNDATION, INC 18616924
SAVt A Lift* FOUNDATION, INC. 36-3869459
Description Amount
CONFERENCE 2011.
MEALS AND ENTERTAINMENT 2465.
OFFICE SUPPLIES & EXPENSE 4502.
MERCHANDISE PRODUCTS 9569.
TRAVEL 7861.
MISCELLANEOUS 2838.
Total to Form 990-EZ, line 16 29246
Description
Amount
Depreciation/Amortization
Other Expenses 2731.
11039.
Total to Form 990-EZ, line 14
13770.
Average Employee
Hours Compen- Ben Plan Expense
Name and Address Title per Week sation Contrib Acct
CAROL SPIZZIRRI - 17479 W. PRESIDENT 100
DARTMOOR DR, GRAYSLAKE IL
STEPHEN J. COLE - 17377 W.
DARTMOOR DR, GRAYSLAKE IL
DONNA SIEGFRIED - 1121
SPRING LAKE DR, ITASCA, IL
ADAM ZAKROCZYMSKI - 384 9
SWANSON CT, GURNEE, IL
0. 0. 0.
*ALPH SHENEFELT - 76 N.
PARKSIDE AVE, GLEN ELLYN,
IL
0. 0. 0.
.'xplanation
•ROMOTE EDUCATION & CONTINUING EDUCATION IN CPR & FIRST AID NATIONALLY,
10
J350713 758985 SAVE50 «^„ Statement(s) 4, 5. 6, 7
060 SAVE A LIFE FOUNDATION, INC. 18616924
Form 4562 Depreciation and Amortization
(Including Information on Listed Property) 990 -EZ
0MB No. 1615-0172
■ I f f T i l l l MACRS Depreciation For Assets Placed in Service ONLY During Yout 1994 Tax Year IDo Not Include Listed Propertyl
lb) Month and
(il Classification ol properly yeir pieced (c) Basis lot depreciation Id) Recovery
(Business/investment use only) period le] Convention II) Method (gl Depreciation deduction
in stl«ict
%
24 Properly used 60% or less in a qualified business use:
S/L
S/L
S/L
S/L
25 Add amounts in column (h). Enter the total here and on line 19, page 1
25
26 Add amounts in column d). Enter the total here and on line 7. page 1
26
Section B - Information Regarding Use of Vehicles - If you deduct expenses for vehicles:
• Always complete this section for vehicles used by a sole proprietor, partner, or other "more than 5% owner," or related person
. If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section
for those vehicles.
(al lb) (cl (dl (e) (fl
27 Total business/investment miles driven during the Vehicle Vehicle Vehicle Vehicle Vehicle Vehicle
year (DO NOT include commuting miles)
28 Total commuting miles driven during the year
29 Total other personal (noncommuting) miles driven
30 Total miles driven during the year.
Add lines 27 through 29
Yes No Yes No Yes No Yes No Yes No Yes No
31 Was the vehicle available for personal use
during off-duty hours?
32 Was the vehicle used primarily by a more
than 5% owner or related person?
33 Is another vehicle available for personal
use?
Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B. Note: Section B must always
be completed for vehicles used by sole proprietors, partners, or other more than 5% owners or related persons.
Yes No
34 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your
employees?
35 0o you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? (See instructions for vehicles used by corporate officers, directors, or 1 % or more owners.)
36 Oo you treat all use of vehicles by employees as personal use?
37 Do you provide more than five vehicles to your employees and retain the information received from your employees
concerning the use of the vehicles?
38 Do you meet the requirements concerning qualified automobile demonstration use?
■ . u ! - " " V°Uf a"SWef'" 34
' "• 36
' 37
' or 3 B is
"Yes/' y o u n e e d no1 c o n
"" e l e Sec,ion B
<°r " « " v « e d vehicles
I r f T i M l Am 0 r ii„tion ~ '
(bl Date
(•I Otscription ol cons imoilililion (c) Araoiti/tbl* Id) Cote (el Amortiittign
ptiiod or III Atnadizttion
atnounl stcli'on
piictnl»9« lor (hit y e n
39 Amortitation of costs that begins during your 1994 tax year:
Form 990 Under section 501 (c) ol the Internal Revenue Code (except black lung benefit trust or
1995
Department ol the Treasury private Inundation) or section 4947(a)(1) noneiempl charitable trust
This Form Is Open
Internal Revenue Service Note: The organization may have to use a copy ol this return to satisfy state reporting requirements. to Public Inspection
A For the 1995 calendar year. OR tax year period beginning ,1995. and ending ,19
g Chock it
C Name of organization D Employer identification number
90 Please
OS"" use IRS
label or
oddresft
print or [SAVE A L I F E FOUNDATION, INC. 36-3869459
□ Initial
return
type-
Number and street (or P.O. box if mail is not delivered to street address) Room/suite E State registration number
□
□
Jn
Final
return
See
Specific
Amended Instruc'
return lions.
17479 W. DARTMOOR DR.
City, town, or post office, state, and ZIP code
01026498
(rtawedttse F Check ► C D if exemption
bSsc
rtfioftno
IGRAYSLAKE, I L 60030 application is pending
6 Type of organization G O Exempt under 501(c) ( 3 )A (insert number) OR ►! 1 section 4947(a)(1) nonexempt chartitable trust
Note: Section 501 (c)(3) exempt organliations and 4947(a)(1) nonexempt charitable trusts MUST attach a completed Schedule A (Form 990)
H(a) Is this a group return filed for affiliates? I I Yes l"X I Ha If either box in H is checked *Yes,* enter four-digit group
(b) If *Yes.' enter the number of affiliates for which this exemption number (GEN) ►
return is filed: ► 1 Accounting method: I X I Cash I 1 Accrual
□ Yes I S NO
f C) tt Uira a separate return Hied by an omanteallon covered by a croup ruling? Other (specify) ►
K Check here ► C D if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS; but
if it received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return.
Note: Form 990-EZ may be used by organizations with gross receipts less than $100,000 and total assets less than $250,000 at end of year.
ranirStatement of Revenue, Expenses, and Changes in Net Assets
Contributions, gifts, grants, and similar amounts received:
a Direct public support la 110,761
b Indirect public support 1b
c Government contributions (grants) 1c
d Total (add lines 1 a through 1 c) (attach schedule of contributors) S T M T 1 STMT 2
(cash$ 4 2 , 9 1 1 . noncashS 67,850 ) 1d 110,761,
2 Program service revenue including government fees and contracts (from Part VII, line 93)
3 Membership dues and assessments 1,410.
4 Interest on savings and temporary cash investments
5 Dividends and interest from securities
6 a Gross rents 6a
b Less: rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe ►
8 a Gross amount from sale of assets other (A) Securities (B) Other
than inventory 8a
b Less: cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
d Net gain or (loss) (combine line 8c, columns (A) and (8)) 8d
Special events and activities (attach schedule):
Gross revenue (not including $ of contributions
reported on line 1a)
b Less: direct expenses other than fundraising expenses 9b
c Net income or (loss) from special events (subtract line 9b from line 9a) 9c
10 a Gross sales of inventory, less returns and allowances 10a 14
b Less: cost ol goods sold 10b 14
c Gross profit or (loss) from sales of inventor/ (attach schedule) (subtract line 10b from line 10a) STMT .3 10c
11 Other revenue (from Part VII. line 103) 11
12 Total revenue (add lines 1d. 2.3.4.5.6c. 7.8d. 9c. 10c. and I D 12 112,171
13 Program services (from line 44,column (B)) 13 62,445
8 14 Management and general (from line 44, column (Q)
c 14 14,711
& 15 Fundraising (from line 44. column (D)) 15 33,318
16 Payments to affiliates (attach schedule) 16
17 Total expenses (add lines 16 and 44. column (AH 17 110,474
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 1,697
to 19 Net assets at beginning of year (from line 73. column (A)) 19 <14,574
20 Other changes in net assets (attach explanation) SEE STATEMENT 4 20 <7^_24 3
21 Net assets at end of year (combine lines 16.19. and 20) 21 <20,120
LHA For Paperwork Reduction Act Notice, see page 1 of the separate Instructions. Form 990 (1995)
S23O01
01-03-96
Form 990 (1995)
SAVE A LIFE FOUNDATION, INC. 36-39604^9 Page2
■ti»»lll Statement of AH organizations must complete column (A). Columns (B). (C). and (0) are required for section 501(c)(3) and
I K I U I I Functional E x p e n s e s (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.
Do not include amounts reported on line (B) Program (C) Management
6b. 8b, 9b. 10b. or 16 of Part I. (A) Total services and general (D) Fundraising
22 Grants and allocations (attach schedule)
cash S noneash $ 22 / ' ' '
23 Specific assistance to individuals (attach schedule) 23
24 Benefits paid to or for membe rs (attach schodult) 24
31 Accounting fees 31
32 Legalfees 32 150. 150.
33 Supplies 33 1,618. 1,618.
34 Telephone 34 3,788. 3,788.
35 Postage and shipping 35 778. 778.
36 Occupancy 36 1,200. 1,200.
37 Equipment rental and maintenance 37 3,650. 3,650.
38 Printing and publications 38 9,293. 9,293.
39 Travel 39 8,005. 8,005.
40 Conferences, conventions, and meetings 40 1,773. 1,773.
41 Interest 41
42 Depreciation, depletion, etc. (attach schedule) 42 3,935. 3,935.
43 Cither expenses (itemize):
a 43a
b 13b
c 43c
d 13d
e SEE STATEMENT 5 tI3e 76,284. 33,255. 9,711. 33,318.
44 Total functional expenses (add lines 22 through 43)
Organizations completing columns (B>(D), cony these
totals to lines 13-15 44 110,474. 62,445. 14,711. 33,318.
Reporting of Joint Costs. - Did you report in column (B) (Program services) any joint costs from a combined educational campaign and
fundraising solicitation? ► I I yes Q T | No
If •Yes." enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program
services $ ; (iii) the amount allocated to Management and general $ ;and
r
rv) the amount
frv) amo allocated lo Fundraising $ .
Statement of Program Service Accomplishments
What is the organization's primary exempt purpose? ► S E E S T A T E M E N T 6 Program Service
Ail organiiotions must describe their exempt purpose achievements. State the number of cflenls served, publications Issued, etc. Oiscuss achievements
Expenses
(Required tor 501(c)(3) and
that are not nwasurabla. (Section 501(c)(3) and (4) organliationa and 4947(a)(1) nonexempt charitable busts must also enter the amount ol grants and (4) ergs., and 4947(a)(1)
allocations to others.) trusts; but optional far others.)
a SEE STATEMENT 7
47 a Accounts receivable
b Less: allowance for doubtful accounts
47a
47b
I
48 a Pledges receivable
b Less: allowance for doubtful accounts
48a
48b
i
49 Grants receivable 49
SO Receivables due fiom officers, directors, trustees, and key employees (attach
schedule) 50
J3
« 51 a Other notes and loans receivable 51a 111;
1 52
b Less: allowance for doubtful accounts
Inventories for sale or use
Sib 51c
schedule) 55b
56 Investments - other (attach schedule) 56
57a 17,406.
57 a
b
Land, buildings, and equipment: basis .
Less: accumulated depreciation S T A T E M E N T 8 57b 1 7,091. 13,507. ii! 10,315.
58 Other assets (describe ► D E S I G N A T E D CASH 57e
1 8,477.
59 Total assets (add lines 45 through 58) (must equal line 74) .. 1 4 , 3 3 7 . 59 19,888.
60 Accounts payable and accrued expenses 60
61 Grants payable 61
8 62 Deferred revenue
jg*
63 Loans from officers, directors, trustees, and key employees 28,911. 63 40,008.
JS 64 a Tax-exempt bond liabilities 64 a
b Mortgages and other notes payable 64b
65 Other liabilities (describe ► ) 65
0
c
Organizations that follow SFAS 117, check here ►
67
69 and lines 73 and 74
Unrestricted
L K J and complete lines 67 through
■
< 1 4 , 5 7 4 . : "67 <20,120.>
a 68 Temporarily restricted 0. 0.
& 69 Permanently restricted 0 . 64 0.
■v
c Organizations that do not follow SFAS 117, check here ► I I and complete lines
a
L. 70 through 74
0
70 Capital stock, trust principal, or current funds 70
• 71 Paid-in or capital surplus, or land, bldg., and equipment fund 71
<in 72 Retained earnings, accumulated income, endowment, or other funds 72
Z
o
_L
73
r
4
Tnlal net assets or fund balancess (add lines 67 through 69 OR lines)r 0 through 72;
column (A) must equal line 19 and column (B) must equal line 21) ...
Total liabilities and net assets/fund balances (add lines 66 and 73) r
<14,574.>
1 4 , 3 3 7 . 1 74
w <20,120.>
19,888.
S23021
12-27-95
Form 990 (1995) SAVE A LIFE FOUNDATION. INC
Part IV-A Reconciliation of Revenue per Audited 36-3869459 Page 4
Part IV-B Reconciliation of Expenses per Audited
Financial Statements with Revenue per Financial Statements With Expenses per
Return Return
a Total revenue, gains, and other support
a Total expenses and losses per
per audited financial statements "NTA" audited financial statements "N7A~
b Amounts included on line a but not on b Amounts included on line a but not on
line 12, Form 990: line 17. Form 990:
(1) Net unrealized gains (1) Donated services
on investments $ and use of facilities $
(2) Donated services (2) Prior year adjustments
and use of facilities $ reported on line 20,
(3) Recoveries of prior Form 990 L
yeargrants $ (3) Losses reported on
(4) Other (specify): line 20. Form 990
(4) Other (specify):
Add amounts on lines (1) and (2) . Add amounts on lines (1) and (2)
Total revenue per line 12. Form 990 Total expenses per line 17, Form 990
(line c plus line d) (line c plus tine d)
X List of Officers, Directors, Trustees, and Key Employees (Ust each one even if not compensated.)
(B) Title and average hours (C) Compensation (D)ContnDutiom to
employee benefit
(E) Expense
(A) Name and address per week devoted to (If not paid, enter plant 1 deferred account and
position other allowances
CAROL S P I Z Z I R R I PRESIDENT
1 7 4 7 9 W. DARTMOOR DR, GRAYSLAKE, I L 100 0. 0. 8,000.
STEPHEN J . COLE TREASURER
1 7 3 7 7 W. DARTMOOR DR, GRAYSLAKE, I L O. 0. 0.
SANDY ENGBER SECRETARY
1 7 5 9 3 W. DARTMOOR DR, GRAYSLAKE, I L 0. 0. 0.
LEE JUNGKANS VICE PRES.
8 3 2 0 W. BLUE MOUND AVE, WAUWATOSA, WI O. 0. 0.
Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100.000 from your
organization and all related organizations, of which more than $10,000 was provided by the related organizations? ► C D Yes QG No
If "Yes," attach schedule (see instructions).
623031
12-27-95
Form990(1995) SAVE A LIFE FOUNDATION, INC. 36-3869459 Pages
f iftjyil Other Information
Yes N o
76 Did the organization engage in any activity not previously reported to the IRS? II •Yes.* attach a detailed description of each activity 76
77 Were any changes made in the organizing or governing documents, but not reported to IRS?
77
II "Yes," attach a conformed copy of the changes.
78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a
b If "Yes," has it filed a tax return on Form 990T, Exempt Organization Business Income Tax Return, for this year? .N/A. 78li
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year?
79
it'Yes," attach a statement;
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,
governing bodies, trustees, officers, etc.,to any otherexempt or nonexempt organization? 80a
b If "Yes," enter the name of the organization ►
and check whether it is L3 exempt OR □ nonexempt.
81 a Enter the amount of political expenditures, direct or indirect, as described in the
instructions for line 81 | gj3 |
b Did the organization file Form 1120-P0L. U.S. Income Tax Return for Certain Political Organizations, for this year? 81b
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than
fair rental value? 82a X
b If •Yes.* you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an
expense in Part II. (See instructions for reporting In Part III) | Mb I 13,000. %.-.
83 a Did the organization comply with the public Inspection requirements for returns and exemption applications? 83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b
84 a Did the organization solicit any contributions or gifts (hit were not tax deductible? 84a
b If *Yes.' did the organization include with every solicitation an express statement that such contributions or gifts were not
tax deductible? N/A
84b
65 Section 501(c)(4). (5). or (6) organizations. - a Were substantially ail dues nondeductible by members? ...N/A 65a
Did the organization make only in-house lobbying expenditures of $2,000 or less? N/A 85b
If "Yes" to either 85a or 85b do not complete 65c through 85h below unless the organization received a waiver for proxy tax owed
lor the prior year.
Oues, assessments, and similar amounts from members 85c N/A
Section 162(e) lobbying and political expenditures 65d N/A
Aggregate nondeductible amount of section 6033(e)(1 )(A) dues notices 85e WA
Taxable amount of lobbying and political expenditures (line 85d less B5e) 851 N/A
g Does the organization elect to pay the section 6033(e) tax on the amount in 851? .7ZZZZZI N/A
85o
h II section 6033(e)(1)(A) dues notice were sent, does the organization agree to add the amount in 851 to its reasonable estimate of dues
allocable to nondeductible lobbying and political expenditures for the following tax year? N/A 85h
86 Section 501 (c)(7) organizations. - Enter:
a Initiation fees and capital contributions included on line 12 66a N/A
b Gross receipts, included on line 12. for public use of club facilities 86b "N7A"
87 a Section 501 (c)(12) organizations. - Enter: Gross income from members or shareholders 87a WA"
b Gross income from other sources. (Do not net amounts due or paid to other sources
against amounts due or received from them.) 87b N/A
At any time during the year, did the organization own a 50% or greater interest In a taxable corporation or partnership?
If ■Yes.* complete Part IX
86
89 Public interest law firms. - Attach information described in the instructions.
90 List the states with which a copy of this return is filed ► I L L I N O I S
91 The books are in care of ►CAROL SPIZZIRRI Telephone no. ► 8 4 7 - 5 4 9 - 7 3 5 3
Located at ► J / 7 4 7 9 W. DARTMOOR D R . , GRAYSLAKE, I L ZIP Code ^ 6 0 0 3 0
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041. U.S. Income Tax Return for Estates and Trusts, check here
and enter the amount of tax-exempt interest received or accrued during the tax year **» I gz I N/A
► □
823041
M-27-9S
Form990(1995) FOUNDATION,
SAVE A LIFE INC. 3 6 -- 3 8 6 9 4 5 9 Page6
|*£ i|2{J| Analysis of Income-Producing Activities
Enter gross amounts unless otherwise Unrelated business income Excluded by section 512. 513, or SI 4 rci
(B) (C) (D) Related or exempt
indicated. Exclu
Business Amount sion Amount
93 Program service revenue: code code
function income
(al
fbl
10
(dl
(el
(1)
(g)Fees and contracts from government agencies
94 Membership dues and assessments 1,410.
95 Interest on savings and temporary
cash investments
96 Dividends and interest from securities
97 Net rental income or (loss) from real estate: -
(a) debt-financed property
(b)nol debt-financed property
98 Net rental income or (loss) from personal property
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory
103 Other revenue:
a
b
c
d
e
104 Subtotal (add columns (B).(D). and (E)) ■M§MM 0. 0. 1,410.
105 TOTAL (add line 104, columns (B), (D), and (E)) 1,410.
Note: (Line 105 plus line I d . Part I. should equal the amount on line 12. Part I.)
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's
exempt purposes (other than by providing funds for such purposes).
94
r MEMBERSHIP DUES - CORPORATE AND INDIVIDUALS
Under penalties or perjury, I declare that I have examined this relum, including accompanying schedules and statement*, and to the best ol my knowtedgs and twtief, it is true.
correct, and complete. Declaration ol preparer (outer than officer) is based on all information of which prapsror has any knowledge.
Please
Sign
Here Signature of officer Date Title
Date Check if Preparer's social security no.
Preparer's ^
self- . .
Paid signature r employed ► I I
Preparer*; Firms name (or yours COLE, MARTIN & C O . , L T D . E.I. NO. ►
Use Only if self-employed) L 7 3 0 1 N . LINCOLN A V E , S T E . 140
and address ZIPcode ► 60646
623161
LINCOLNWOOD, ILLINOIS
1227 95
SCHEDULE A
(Form 990) Organization Exempt Under 501(c)(3) CMBNo 1S45-0O47
(Except Private Foundation), and Section 501 (e). 501 (I), 501 (k). or Section 4947(a)(l)
Nonexempl Charitable Trust
Department or lha Treasury
Internal Revenue Servica
Supplementary Information
► Must be completed by the above organization! and attached to their Form 990 (or Form 99QE2)
1995
Name of the organization
Employer identification number
_ „ SAVE A LIFE FOUNDATION, INC. J366:j
3a fiQdSQ
3869459
| M U Compensation of the Five Highest Paid Employees Other Than Offtcers, Directors, a n d Trustees
(See instructions.) (List each one. If there are none, enter •Wone • irusiees
(a) Name and address of each employee paid (b) Title and average hours
(c) Compensation i remptoyoo
e barteM (e)Expense
. joni/ibuttons to
more than $50,000 per week devoted to account and other
position
hss
componmion
| COI
allowances
NONE
13
□ An organization that is not controiled by any disqualified persons (other than foundation managers) and supports organizations described in-
_ .
(11
;
hies
—
5 through
;
12 above;■ -or ■-.
(2) section 501fc)f4,. a\. nr ,6V if they meet the test of section 509ra)/2,. « M m m - 509(a)(3))
.-..^... . w „ ». iv,,. ii t .i B y nisei UIB IB
lOWinO information annul trip simnnrlort n«,»nh,ii...... / e „ . ! . . . _ . - . : ?l°n*i- l J " >emuii 3U»(a||j).)
Provide the following information about the supported organizations. (See instructions 'on paoe 4.1 . . ~
14 □ An organization organized and operated to test for public safety. Section 509(a)(4). (See Instructions on page 4.)
623111
12-1996
Schedule A (Form 990) 1995 SAVE A L I F E FOUNDATION, INC. 36-3869459 Pages
Support Schedule (Complete only if you checked a box on lines 1 0 , 1 1 , or 12 above.) Use cash m e t h o d of accounting.
Note: You may use the worksheet in the instructions tor converting from the accrual to the cash method of accounting.
Calendar year (or fiscal year
beginning In) (a) 1994 (b) 1993 (c) 1992 (d) 1991 (e) Total
"J 5 Oitta. grants, and contributions received.
(Do not include unusual grants. S n
tint 88.) 93,405. 7,199. 100,604.
16 Membership fees received 2,875. 2,875.
17 Gross receipts from admissions,
merchandise sold or services
performed, or furnishing of facilities
in any activity that is not a business
unrelated to the organization's
charitable, etc.. purpose
18 Gross income from interest.
dividends, amounts received from
payments on securities loans (sec
tion 512(a)(5)). rents, royalties, and
unrelated business taxable income
(less section 511 taxes) from
businesses acquired by the
organization after June 30,1975
19 Net income from unrelated business
activities not included in fine 18
20 Ta> revenues levied lor the organization's
benefit and diner paid to it or upended
on Its behalf
c Total support for section 509(a)(1) test: Enter line 24, column (e) .► 26c N/A
d Add: Amounts from column (e) for lines: 18 _ | 19 J _ • MVVASW
22 J 26b X > 26d N/A
e Public support (line 26c minus line 26d total) > 26e ~N7A"
f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) N/A
► 261
27 Organlialtons described on line 12: a For amounts included in lines 15.16, and 17 that were received from a "disqualified person.'atlach a list to show the name
of. and total amountsjecieved in each year from each 'disqualified person,' Enter the sum of such amounts for each year.
0994) P..-.. (1993) 0 . . . (1992) 0 . . . (1991) 0...
For any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount received for each year.
that was more than theiargerof (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11. as weft as
individuals.) After computing the difference between the amount received and the larger amount decribed in (1) or (2). enter the sum of these differences (the
excess amounts) for each year:
099«) P./!. (1993) 0.,. (1992) Q.... (1991) 0...
'">?
33 Does the organization discriminate by race in any way with respect to:
a Students' rights or privileges?
33a
b Admissions policies?
c Employment of faculty or administrative staff?
33b
33c
d Scholarships or other financial assistance?
33d
e Educational policies?
f Use of facilities?
33e
33f
9 Athletic programs?
33a
h Other extracurricular activities?
33h
If you answered •Yes' to any of the above, please explain. (If you need more space, attach a separate statement!)
34 a Does the organization receive any financial aid or assistance from a governmental agency?
34a
b Has the organization's right to such aid ever been revoked or suspended? 34b
if you answered Yes' to either 34a or b, please explain using an attached statement.
35 Does the organization certify lhat it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50
1975-2 C.B. 587. covering racial nondiscrimination? If 'Mo.' attach an explanation
35
8*3131
12-19 95
Schedule A (Form 990) 1995 SAVE A L I F E FOUNDATION/ INC. 36-3869459 PT<
Part Vl-A Lobbying Expenditures by Electing Public Charities
(To be completed ONLY by an eligible organization that filed Form 5768)
N/A
Check here ► a 0 If the organization belongs to an affiliated group.
Check here ► b I — I If you checked "a* above and 'limited contror provisions apply.
Caution: if there is an amount on either line 43 or line 44. file Form 4720.
52 a Is the organization directly or indirectly affiliated with, or related to. one or more tax-exempt organizations described in section 501(c) of the
Code (other than section 501(c)(3)) or in section 527? \—] Y
6S LXlNo
b If 'Yes.' complete the following schedule. N/A —
(a) (b)
Name of organization Type of organization Description of relationship
823151
12-19-95
Depreciation and Amortization Detail
FORM 990 PAGE 2 990
Asset Description of property
Number Dale
placed Method/ Life Line Cost or
IRC sec. or rate No. Basis Accumulated
in service other basis reduction Current year
depreciation/amortization deduction
ORGANIZATION COSTS
JJWiiP 60M 41 2,120. 530. 424.
OFFICE EQUIPMENT
12,31,93|200DB|7.00 117 2,236.
OFFICE EQUIPMENT 86777 391.
i|06,30,94|2QODB|7.00 TT 12,307.
OFFICE EQUIPMENT 1,759 3,014
ii106,30,95|200DB|7.00 |l5CT 743
** TOTAL 990" PAGE 2 DEPRECIATION & AMORTIZATION 106.
17,406. 3,156. 3,935.
J L
J L
J L
INCOME
1. GROSS RECEIPTS 14
2. RETURNS AND ALLOWANCES
3. LINE 1 LESS LINE 2 14
4. COST OF GOODS SOLD (LINE 15) 14
5. GROSS PROFIT (LINE 3 LESS LINE 4)
COST OF GOODS SOLD
8. INVENTORY AT BEGINNING OF YEAR
9. MERCHANDISE PURCHASED 14
10. COST OF LABOR
11. MATERIALS AND SUPPLIES
12. OTHER COSTS
13. ADD LINES 8 THROUGH 12 14
14. INVENTORY AT END OF YEAR
15. COST OF GOODS SOLD (LINE 13 LESS LINE 14). . 14
STATEMENT(S) 3
SAVE A LIFE FOUNDATION, INC.
36-3869459
DESCRIPTION
AMOUNT
1994 FINANCIAL STATEMENTS RESTATED FOR ADDITIONAL TRAVEL
EXPENSES
<7,243.>
TOTAL TO FORM 990, PART I, LINE 20
<7,243.>
IXPLANATION
STATEMENT(S) 4, 5, 6
SAVE A LIFE FOUNDATION, INC.
36-3869459
STATEMENT
GRANTS EXPENSES
TO FORM 990, PART III, LINE A
62,445
COST OR ACCUMULATED
DESCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE
ORGANIZATION COSTS 2,120. 954. 1,166.
OFFICE EQUIPMENT 2,236. 1,258. 978.
OFFICE EQUIPMENT 12,307. 4,773. 7,534.
OFFICE EQUIPMENT 743. 106. 637.
TOTAL TO FORM 990, PART IV, LINE 57 17,406 7,091 10,315.
STATEMENT(S) 7, 8
foim 4562 Depreciation and Amortization
(Including Information on Listed Property)
OMB No 1545-017J
:v ^ ?<f-\
_.
7 Listed property. Enter amount from line 27
6 Total elected cost ol section 179 property. Add amounts in column (c), lines 6 and 7
9 Tentative deduction. Enter the smaller of line 5 or line 8
10 Carryover of disallowed deduction from 1994
10
11 Taxable income limitation. Enter the smaller of taxable income (not less than zero) or line 5
11
12 Section 179 expense deduction. Add lines 9 and 10. but do not enter more than line 11
12
13 Carryover of disallowed deduction to 1996. Add lines 9 and 10. less line 12 ► !""»"
o „ 0 , ! f ; l 0 l 0 i , U Srecreation,
entertainment,
e P a
1 " o r or
Part
' " b e l 0 w .!°f Instead,
amusement).
,is ,ed p r o p e r t y
. use Part ( » V« 'for
« ™listed
l * « . property.
« t a i n other vehicles, cellular telephones, certain
. « " computers
• tuwuuwi*.ormproperty
propenyused
useoforror
k i f l i l l l MACRS Depreciation For Assets Placed In Service ONLY During Your 1995 Tax Year (Do Not Include Listed Property)
— Section A • General Asset Account Election
14 II you are making the election under section 168(i)(4) to group any assets placed in service during the tax year into one or more general asset accounts
check this box. See instructions
(a) CltssiicaHon of property
(b) Month and
yew pieced (c) Basis (or depredation (d) Recovery
>□
(Business/Investment use only) period I (e) Convention (Q Method (gl Depreciation deduction
in service
' ^ -.s
15 a 3-year property
•* * f \f v.
b 5-year property f
c 7-year property -> 'V *,, ', 743. 7 YRS. HY 200DB 106.
d 10-year property
e 15-year property s> \^
f 20-year property ' ' ' V
%
%
%
25 Property used 50% or less in a qualified business use
% S/L-
sn.<
S/L-
% S/L-
26 Add amounts in column (h). Enter the total here and on line 20. page 1
27 Add amounts in column (i). Enter the total here and on line 7. page 1 1
Section B • Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner ■ or related person
II you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles.
Yes No
3S DO you maintain a written policy statement that prohibits all personal use of vehicles, including commuting by your
employees?
36 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting by your
employees? (See instructions for vehicles used by corporate officers, directors, or 1% or more owners.)
37
Do you treat all use of vehicles by employees as personal use?
38
Do you provide more than five vehicles to your employees, obtain information from your employees about
the use of the vehicles, and retain the information received?
39
Do you meet the requirements concerning qualified automobile demonstration use?
rJs&t^ZninZn > 0 3 5 ' 3 6 ' 3 7 ' 3 8 ' " " " " " nWi> 0tCOm MBg
" ° ^'"Mtt"«"^''^''''*''
(a) (b)
Description of costs <0 (d) (e) M
fOileiinortaion Amoftfnbt* Coda
topics amount Amoffottoei Amortluliafl
soction (of mil y«w
40 Amortization of cosls that begins during your 1995 tax year:
□□
Initial
return
Final
return
type.
See
Specific
Number and street (or P.O. box if mail is not delivered to street address)
17479 W. DARTMOOR DR.
Room/suite E State registration number
01-026,498
□ A m e n d e d Instruc
return tions. City, town, or post office, state, and ZIP code F Check if exemption
[teoHtdiso
SRAYSLAKE, I L 60030 application is pending
G Type of«>
icpo
organization - ► Q D Exempt under 501(c) ( 3 )<4 (insert number) OR ► □ section 4947(a)(l) nonexempt chartitable trust
Note: Section S01 (c)(3) exempt ornanlzatlons and 4947(a)(1) nonexemptcharitable trusts M U S T attach a completed Schedule A (Form 090).
H(a) is this a group return filed for affiliates? C U Yes Q O No I If either box in H Is checked "Yes,* enter four-digit group
(b) If "Yes.* enter the number of affiliates for which this exemption number (GEN) ► _
return is filed: ► J Accounting method: I X I Cash I I Accrual
( t ) Is Iha a separate return Bled ay i n organiiilion covered by a group ruling? □ Yes [ E H No □ Other (specify) ►
X Check here ► I I if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS; but
if it received a Form 990 Packaoe in Ihe mail, it should file a return without financial data. Some states require a complete return.
No e: Form 9S0-EZ may be used bv organizations with Ofoss receiots less than $100,000 and total assets less than $250,000 at end of year.
oH I U 1
Revenue, Expenses, a n d Changes in Net Assets or Fund Balances
Contributions, gifts, grants, and similar amounts received:
a Direct public support 1a 37,566.
b Indirect public support 1b
c Government contributions (grants! 1c
d Total (add.lines 1a through 1c) (attach schedule of contributors) S T M T 1 :■ ■■
59 Total assets (add lines 45 through 58) (must equal line 74) . . 19,888. 59 23,406.
60 Accounts payable and accrued expenses 60
61 Grants payable 61
8 62 Deferred revenue 62
•* 63 Loans from officers, directors, trustees, and key employees 40,008. 63 58,870.
.3 64 a Tax-exempt bond liabilities 64a
b Mortgages and other notes payable 64b
65 Other liabilities (describe ► ) 65
<
1 71
72
Paid-in or capital surplus, or land, building, and equipment fund
Retained earnings, endowment, accumulated Income, or other ftmds ....
71
72
« JZ Total net assets or fund balances (add lines 67 through 69 OR ines 70 through 72;
z column (A) must equal line 19 and column (B) must equal line 2 D < 2 0 , 1 2 0 . > 73 <35,464.>
''4 Total liabilities and net assets / lund balances (add tin es66< ind 73) 1 9 , 8 8 8 . 1 74 23,406.
13021
J-13-86
mom; cavern 070 SftVE a T.TFF. FOUNDATION. TNC. SAVE50 1
Form 990 (1996) SAVE A LIFE FOUNDATION, INC. 36-3869459 Page 4
Part IV-A Reconciliation of Revenue per Audited R e c o n c i l i a t i o n of E x p e n s e s p e r A u d i t e d
Financial Statements with Revenue per Financial Statements With Expenses per
Return Return
a Total revenue, gains, and other support a Total expenses and losses per
per audited linancial statements ~N7A~ audited financial statements "N7A
b Amounts included on line a but not on
bAmounts included on line a but not on line 17. Form 990:
line 12, Form 990:
(1) Donated services
(1) Net unrealized gains and use of facilities... $
on investments $ (2) Prior year adjustments
(2) Donated services reported on line 20,
and use ol facilities $ Form 990 $
0) Recoveries of prior (3) Losses reported on
yeargrants $ line 20, Form 990 ..$
(«) Other (specify): (4) Other (specify):
Add amounts on lines (1) through (4) ► Add amounts on lines (1) through (4) ►
e Line a minus line b ► c Line a minus line b ►
d Amounts included on line 12, Form d Amounts included on line 17, Form
990 but not on line a: 990 but not on line a:
(l) Investment expenses (D Investment expenses
not included on not included on
line 6b. Form 990 $. line 6b, Form 990 ..$_
|2) Other (specify): (2) Other (specify):
Add amounts on lines (1) and (2) I Add amounts on lines (1) and (2)
e Total revenue per line 12. Form 990 Total expenses per line 17, Form 990
(line c plus line d) ^ Ie (line c plus line d)
m-*nmm List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated)
(B) Title and average hours (C) Compensation (D)Contributiont to (E) Expense
(A) Name and address per week devoted to employes>benefit
benefit
(II not paid, enter pltnt&defMTSd
JelefToc account and
position eornaeneatton other allowances
CAROL SPIZZIRRI PRESIDENT
Oid any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related
organisations, of which more than $10.000 was provided by the related organizations? It 'Yes: attach schedule. ► C H Yes Q T ] No
Form 990(1996} SAVE A L I F E FOUNDATION, INC 36-3869459 Page 5
Other Information Yes No
76 Oid the organization engage in any activity not previously reported to the IRS? It "Yes," attach a detailed description of each activity 76
77 Were any changes made in the organizing or governing documents but not reported to IfiS? 77
If "Yes." attach a conformed copy of the changes.
7Ba Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a
b If "Yes," has it filed a tax return on Form 990-T for this year? N/A 78b
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? 79
If "Yes," attach a statement;
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,
governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? 80a
If "Yes," enter the name of the organization ►
and check whether it is | I exempt OR I I nonexempt.
81 a Enter the amount of political expenditures, direct or indirect, as described in the
instructions for line 81 I 61 a I 0 <
b Did the organization file Form 1120-POL for this year? 81b
62 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than
fair rental value? 82a
b If "Yes," you may indicate the value of these items here. Do not include this amount as revenue in Part I or as an
expense in Part II. (See instructions for reporting in Part III) I 82b I 3 ,OOP
83 a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b
84 a Did the organization solicit any contributions or gifts that were not tax deductible? 84a
b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not
tax deductible? N / A 84b
85 501(c)(4), (5), or (6) organizations, -a Were substantially all dues nondeductible by members? N/A.. 85a
b Did the organization make only in-house lobbying expenditures of $2,000 or less? N / A B5b
if "Yes" to either 85a oi 85b, do not complete 65c through 85h below unless the organization received a waiver for proxy tax owed
for the prior year.
c Dues, assessments, and similar amounts from members 85c N/A
d Section 162(e) lobbying and political expenditures 85d N/A
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices B5e N/A
I Taxable amount of lobbying and political expenditures (line 85d less 85e) . 851 "NTA"
g Does the organization elect to pay the section 6033(e) tax on the amount in 851? NTA" 85q
h If section 6033(e)(1 )(A) dues notice were sent, does the organization agree to add the amount in 851 to its reasonable estimate of dues
ailocable to nondeductible lobbying and political expenditures for the following tax year? N/A_ B5h
501(c)(7) organizations. - Enter:
a Initiation fees and capital contributions included on line 12 86a N/A
b Gross receipts, included on line 12, for public use of club facilities 86b "NTA"
87 501(c)(12) organizations. -Enter: a Gross income from members or shareholders 87a NTA
b Gross income from other sources. (Oo not net amounts due or paid to other sources
against amounts due or received from them.) 87b N/A
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership?
If "Yes," complete Part IX 88
89 a 501(c)(3) organizations. - Enter: Amount of tax paid during the year under:
section4911 ► 0 ^ ; s e c t i o n 4912 ► 0 ^ ; s e c t i o n 4955 ► 0.
b 501(c)(3) and 501(c)(4) organizations. - Oid the organization engage in any section 4958 excess benefit
transaction during the year? If "Yes," attach a statement explaining each transaction 89b
c Enter: Amount of tax paid by the organization managers or disqualified persons during the year under
section 4958 ► 0_
t Enter: Amount of tax in 89c, above, reimbursed by the organization 0,
90 list the states with which a copy of this return Is filed ► I L L I N O I S
Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in' lieu of Form 1041.- Check here ► □
and enter the amount of tax-exempt interest received or accrued during the lax year 92 N/A
?3041
1-1396
inarm RAVES0 070 SAVE A LIFE FOUNDATION, INC SAVE50 1
'orm 990 (1996) SAVE A LIFE FOUNDATION, INC 36-3869459 Page 6
lyijeVill Analysis of Income-Producing Activities
Unrelated business income Excluded by section SI?, 513. Q' 514
Enter gross amounts unless otherwise (E)
IB) (C) (0) Related or exempt
indicated o '*'
Business Exclu
Amount sion Amount function income
93 Program service revenue: code code
(a)
(b)
(e)
W
(e)
(f)
(g) Fees and contracts from government agencies
94 Membership dues and assessments 1,527.
95 Interest on savings and temporary
cash investments
96 Oividends and interest from securities
97 Net rental income or (loss) Irom real estate:
(a)debt-financed property
(b) not debt-financed property
98 Net rental income or (loss) Irom personal property
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory
103 Other revenue:
a
b
c
d _ _ _
e
104 Subtotal (add columns (fl).(D), and (E)) O. 1,527.
105 TOTAL (add line 104. columns (B), (0). and (E)) 1,527.
Hole: (Line 105 plus line 1d. Part I. should equal the amount on line 12. Part I.)
pjSBMIII Relationship of Activities to the Accomplishment of Exempt Purposes
Line No Explain how each activity for which income is reported in column (E) of Part VII contributed Importantly to the accomplishment of the organization's
T exempt purposes (other than by providing funds for such purposes),
94 MEMBERSHIP DUES - CORPORATE AND INDIVIDUALS
IJJHIKI Information Regard ng Taxable Subsidiaries (Complete this Part HlneTes" box on 86 Is checked.)
Name, address, and employer identification Percentage of End-of-year
Nature of business activities Total income
number of corporation or partnership ownership interest assets
N/A
%
%
ja
Under penalties ol penury, I deeltrs that I havo examined this retum. Including accompanying schedules and statements, and to the best ol my knowledge and betlel. It Is true.
correct, and compielo Declaration of prepamr (other than officer) is based on all information ol which preparer has any knowledge
Please
Sign
Here Signature of officer Date W Type or print name and title
Date Check if Preparer's SSN
Preparer's ^ self-
Paid signature r employed ► o
Preparer's Firm's name (or yours MARTIN, & C O . , LTD.
COLE , EIN
it self-employed) ^ 7 3 0 1 N . LINCOLN A V E . , 140
Use Only
673161
and address ►i
LINCOLNWOOD, I L ZIP+ 4 60646
1M3-96 8
/ i n an i c A\7c«;n 070 RRVK A T.TFF. FOUNDATION, INC. SAVE50 1
OMBNo 1S45-C047
SCHEDULEA Organization Exempt Under 501(c)(3)
(Form 990) (Except Private Foundation), and Section 501(e), 501(0.501(h). 501(n) or Section 4947(a)(1)
NONE __
NONE
13 □ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in:
(1) lines 5 through 12 above: or (2) section 501(c)(4). (5). or 161. if they meet the test of section 509(a)(2). (See section 509(a)(3).)
Provide the following information about the supported organizations. (See instructions on page 4 )
(b) Line number
(a) Namefs) of supported organizational from above
14 | J An organization organized and operated to lest for public safety. Section 509(a)(4). (See instructions on page 4.]
Z3111
Z-16-96 10
Rnvpsn 070 RAVE A T.TFK FOUNDATION. TNC SAVE50 1
Schedule A (Form 990) 1996 SAVE A LIFE FOUNDATION, INC. 36-3869459 Pages
Support Schedule (Complete only if you checked a box on lines 1 0 . 1 1 . or 12 above.) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year
beginning In) (a) 1995 (b) 1994 (c) 1993 (d) 1992 (e) Total
1Q Gifts, grants, and contributions received.
(Do nol include unusual grants See
line 28) 110,761 93,405. 7,199 211,365
16 Membership fees received 1,410 2,875 4,285
17 Gross receipts from admissions,
merchandise sold or services
performed, or furnishing of facilities
in any activity that is not a business
unrelated to the organization's
charitable, etc., purpose
18 Gross income from interest.
dividends, amounts received from
payments on securities loans (sec
lion 512(a)(5)), rents, royalties, and
unrelated business taxable income
(less section 511 taxes) from
businesses acquired by the
organization after June 30.1975
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied lot trie organization's
benefit and either paid to it or expended
on Its behalf ,
Total support for section 509(a)(1) test: Enter line 24, column (e) 26c N/A
Add: Amounts from column (e) for lines: 18 J 19 .
22 J 26b 26d N/A
Public support (line 26c minus line 26d total) 26e "NTA"
I Public support percentage (line 26e (numerator) divided by line 26c (denominator)) 261 ~N7A"
27 Organizations described on line 12: a For amounts included in lines 15,16, and 17 that were received from a 'disqualified person,' attach a list to show the name
of. and total amounts received in each year from each 'disqualified person.* Enter the sum of such amounts for each year.
(1995) 0. (igg4) 0 . (1993) Q.... (1992) P •.
b For any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount received for each year,
that was more than thelargerof (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as
individuals.) After computing the difference between the amount received and the larger amount decribed in (1) or (2). enter the sum of these differences (the
excess amounts) tor each year:
(1995) P . . . (1994) 0 . (1993) P..-. (1992) P.-.
c Add: Amounts from column (e) for lines: IS $ 211,365. 16$ 4,285.
17 $ 20 $ 21 $ 27c 215,650.
d Add: Line 27a total $ 0 . and line 27b total $ o. ► 27d 0.
e Public support (line 27c, total minus line 27d total) ► 27e 215,650.
1 Total support for section 509(a)(2) test: Enter amount on line 23. column (e) ► 1 271 f S 215,650.
g Public support percentage (line 27e (numerator] divided by line 27f, (denominator)) ► 27fl 100%
h Investment income percentane (lino 18 column e) (numerator) divided by line 271 (denominator)) ► 27h .0000%
•8 Unusual Grants: For an organization described in line 10.11, or 12, that received any unusual grants during 1992 through 1995, attach a list (which is not open to
public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant.Oo not include
these grants in line 15. (See instructions.) NONF
M121
3-2S-97 11
RBVPSO 070 SAVE A T.TFR FOUNDATTON. INC. SAVE50 1
Schedule A (Form 990) 1996 SAVE A L I F E FOUNDATION, INC
TT 36-3869459 Page 4
Private School Questionnaire
(To be completed ONLY by schools that checked the box on tine 6 in Part IV) N/A
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charier, bylaws, other governing Yes No
instrument, or in a resolution of its governing body? 29
30 Does the organization include a statement ot its racially nondiscriminatory policy toward students in all its brochures, catalogues.
and other written communications with the public dealing with student admissions, programs, and scholarships? 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of
solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known
to all parts of the general community it serves? 31
It "Yes." please describe; if "No." please explain. (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to:
Students'rights or privileges?
33a
Admissions policies?
33b
Employment of faculty or administrative staff?
33c
Scholarships or other financial assistance?
33d
Educational policies?
33e
Use of facilities?
331
g Athletic programs?
33o
h Other extracurricular activities?
33h
If you answered "Yes" to any of the above, please explain. (If you need more space, attach a separate statement.)
M a Does the organization receive any financial aid or assistance from a governmental agency?
34a
b Has the organization's right to such aid ever been revoked or suspended? 34b
If you answered "Yes" to either 34a or b, please explain using an attached statement.
15 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50.
1875-2 C.B. 5B7, covering racial nondlscrlmlnation? It •No." attach an explanation
36
1131
»fr96
12
">nn«;
savR^n 0 70 SAVR A T.TFR FOUNDATION. INC. SAVE50 1
Schedule A (Form 990) 1996 SAVE A LIFE FOUNDATION, INC. 36-3869459
Part Vl-A Lobbying Expenditures by Electing Public Charities
(To be completed ONLY by an eligible organization that tiled Form 5768) N/A
Check here ► a C D II the organization belongs to an affiliated group.
Check here ► b U3 It vou checked "a* above and limited control" provisions apply.
(b)
Limits on Lobbying Expenditures U) To be completed for ALL
Affiliated group totals
electing organizations
(The term "expenditures' means amounts paid or incurred)
N/A
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Totalexempt purpose expenditures (add tines 38 and 39) 40
41 Lobbying nontaxable amount. Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount Is •
Not over $500,000 20M ot the amounl on lino 40
Over $500,000 bul not over 11.000,000 $100.000 pus 1 5 « ol lite excess over $500,000
Over SI ,000,000 but not over Si .£00.000 S17S.000 plus 10H ol the excess over S1,000,000 41
Over SI.SOO.OOO out not over $17,000.030 $225,000 plus 9 W ol the excess over S1.9O0.O0O
OverS17,000,000 $1.000.000
Caution: if lhare is an amount on either line 43 or line 44. file Form 4720.
45 Lobbying nontaxable
amount
0.
46 Lobbying ceiling amount
(150% of line 45(e))
0.
47 Total lobbying
expenditures
0.
46 Grassroots nontaxable
amount
0.
49 Grassroots ceiling amount
- > \ • - 0.
(150% of line 48(e))
SD Grassroots lobbying
expenditures
0.
Part Vi-B Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part Vl-A) N/A
During the year, did the organization attempt to influence national, state or local legislation, including any attempt to
Yes No Amount
influence public opinion on a legislative matter or referendum, through the use of:
a Volunteers
b Paid staff or management (include compensation In expenses reported on lines c Ihrough h)
c Media advertisements
d Mailings to members, legislators, or the public
e Publications or published or broadcast statements
I Grants to other organizations for lobbying purposes
g Direct contact with legislators, theirstaffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures. or any other means
I Total lobbying expenditures (add lines c through h)
II "Yes' lo any of the above, also attach a statement giving a detailed description of the lobbying activities.
623141
12 16 36 13
f l A n o n e CnVFRO 070 SAVE A LIFE FOUNDATION, INC. SAVE50 1
Schedule A (form 990} 1996 SAVE A L I F E FOUNDATION, INC. 36-3869459 Page 6
I t f l i ' l l l Information Regarding Transfers To and Transactions and Relationships With Noncharitabte
Exempt Organizations
SI Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No
(I) Cash Sia(l) X
(II) Other assets a(ii) X
b Other transactions:
(i) Sales of assets to a noncharitable exempt organization b(l) X
(if) Purchases of assets from a noncharitable exempt organization b(ll) X
(Hi) Rental of facilities or equipment b(lll) X
(Iv) Reimbursement arrangements b(lv) X
(») Loans or loan guarantees b(v) X
(vl) Performance of services or membership or fundraising solicitations b(vl) X
e Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d II the answer to any of the above is "Yes," complete the following schedule. Column (b) should always indicate the fair market value of the
goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any
transaction or sharing arrangement, indicate In column (d) the value of the goods, other assets, or services received- N/A
(a) (b) (e) (d)
Line no Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the
Code (other than section 501(c)(3)) or in section 527? a> | ) Y e s [K] No
b If 'Yes,' complete the following schedule. N/A
(a) (b)
Name of organization Type of organization Description of relationship
S23191
12-16-96 14
inRrm RAVRSn 070 SAVR A T.TFK FOUNDATION. INC. SAVE50 1
SAVE A LIFE FOUNDATION, INC. 36-3869459
IXPLANATION
'O PROMOTE EDUCATION AND CONTINUING EDUCATION IN CPR AND FIRST AID
IATIONALLY.
16 STATEMENT(S) 2 , 3
fiinnfln"; KAVP.SO 070 SAVE A LIFE FOUNDATION, INC. SAVE50_1
SAVE A LIFE FOUNDATION, INC. 36-3869459
GRANTS EXPENSES
0 FORM 990, PART III, LINE A 33,938.
COST OR ACCUMULATED
2SCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE
17 STATEMENT(S) 4, 5
"»'"":n A-7CI C7\T7E> A T Tup ETtMKinBTTflM TVJC fi&VFSn 1
Depreciation and Amortization Detail pQRM 990 PAGE 2 990
Description of property
Number Date Method/ Life Line Cost or Basis Accumulated Current year
placed IRC sec. or rate No. other basis reduction depreciation/amortization deduction
in service
: ORGANIZATION COSTS
S 12,31,93 60M 4 1 2,120. 1 954. 424.
i D F F I C E EOUIPMENT
:lljl2,31,93 2 0 0 D B 7 . 0 0 1 7 2,236. 1,25B. 279.
O F F I C E EQUIPMENT
06.30.94200DBI7.00 17 12,307. 4,773. 2,152.
A 3 F F I C E EQUIPMENT
06,30,95 2 0 0 D B I 7 . 0 0 1 7 743. 106. 182.
c COPIER
01|15|96200DB5.00 15B 8,000. 1,600.
6 COMPUTER
|02|15|96200DB5.00 15B 1,500. | 3 0 0 .
7 PRINTER
^|02,15,96200DB5.00 15B 500. 100.
t COMPUTER
p4,15|96200DB5.00 15B 1,200. 240.
* * TOTAL 9 9 0 PAGE 2 DEPRECIATION & AMORTIZATION
28,606. 7,091. 5,277.
1 1 1 '
, , 1
■:.11 , ,
i i
■m . ,
m\ , , i
,:.V V | |
■m . .
i i
iM , ,
ill , ,
%'i i i
N . .
m , , 1
M , , 1 1
m . .
m . . 1 1
m . .
-1 i . l
16261
# - Current year section 179 (0) ■ Asset disposed
1-22-88 18
^nnRnR KAVRSO 070 SAVE A LIFE FOUNDATION, INC. SAVE50 1
OMB No 1545-017?
Department ol he Treasury
Internal Revenue Sen/tec
(Including Information on Listed Property) 990
► Attach this form to your return.
1996
Attachment
Sequence No. 6 7
Nameis) shown on return Business or activity lo which this form relates Identifying number
15 a 3-year property
b 5-year property 11,200. 5 YRS. HY 200DB 2,240.
c 7-year property
d 10-year property
e 15-year property
f 20-year property
g 25-year property 25 yrs. S/L
/ 27.5 yrs.
MM S/L
h Residential rental property
/ 27.5 yrs.
MM S/L
/ MM S/L
/ MM S/L
Section C • Alternative Depreciation System (ADS) (See instructions.)
16 a Class life S/L
b 12-year 12 yrs. S/L
c 40-year / 40 yrs. MM S/L
Other Depreciation (Do Not Include Listed Property)
17 GDS and ADS deductions for assets placed In service in tax years beginning before 1996 17 2,613
18 Property subject to section 168(0(1) election 18
19 ACRS and other depreciation 19
■■rsliem Summary
20 Listed property. Enter amount from line 26 20
21 Total. Add deductions on line 12, lines 15 and 16 in column (g), and lines 17 through 20. Enter here
and on the appropriate lines of your return. Partnerships and S corporations - see instructions 21 4,853.
22 For assets shown above and placed in service during the current year, enter the
portion of the basis attributable to section 263A costs . . . . 22 I
LHA For Paperwork Reduction Act Notice, see page 1 of the separate instructions. Form 4562 (1996)
'» 19
'noon* RBVPSn 070 RAVK A T.TFE FOUNDATION. INC SAVES0 1
Form 4562 (1996)
Listed Property • Automobiles, Certain Other Vehicles, Cellular Telephones, Certain Computers, and Property Used for
Entertainment, Recreation, or Amusement
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 23a. 23b. columns (a)
through (c) of Section A, all of Section B. and Section C if applicable.
Section A - Depreciation and Other Information (Caution: See instructions for limitations for automobiles.)
23a Do you have evidence to support the business/investment use claimed? I "1 Yes I I No 23blf 'Yes.' is the evidence written? I I Yes P H No
(c) <e) (0 (9) (h) (i)
(a) (b) Date (d)
Elected
placed in Business/ Cost or
Basil (or depreciation Recovery
Method/ Depreciation
Type of property investment (buitness/mveslmcnt section 179
(list vehicles first) service other basis use only)
period Convention deduction
use percentage cost
24 Property used more than 50% in a qualified business use
%
JL
%
%
25 Property used 50% or less in a aualified business use:
% S/L- ^SM:0-:M-
% S/L- ^^M&ti&M
% S/L- ^iilmM'mi}
% S/L- M^SmM^
26 Add amounts in column (h). Enter the total here and on line 20. page 1 26 &£££&■ ^ : ->.
27 Add amounts in column (i). Enter the total here and on line 7, page 1 27
Section B • Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner.* or related person.
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles.
(a) (b) (c) (d) (e) (f)
28 Total business/investment miles driven during the Vehicle Vehicle Vehicle Vehicle Vehicle Vehicle
year (00 NOT include commuting miles)
29 Total commuting miles driven during the year
30 Total other personal (noncommuting) miles
Section C • Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section B for vehicles used by employees who are not more than 5%
owners or related persons.
Yes No
35 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your
employees?
36 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See instructions for vehicles used by corporate officers, directors, or 1 % or more owners
37 Do you treat all use of vehicles by employees as personal use?
38 Do you provide more than five vehicles to your employees, obtain information from your employees about
the use of the vehicles, and retain the Information received?
39 Do you meet the requirements concerning qualified automobile demonstration use?
Note: If your answer to 35.36.37.38. or 39 Is 'Yes.' you need not complete Section B for the covered vehicles.
Amortization
(a) (b) (c) (d) (e) (f)
Description ol costs Oifctmoruiecn Amort n« bio Codo Arwttltion Amortization
beomj amount section peitcd Of pcrcenBgt for this year
8 a Gross amount from sale of assets other (A) Securities <B) Other
than inventory 8a
b Less: cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
d [C0£n.bjnesline*!fcblumns (A) and (B)) 8d
ihedule):
of contributions
b
ela)
191
pejisffs 6$!f§@an 1
fqf}8raising expenses.
9a
9b
c itcome_p^jlojsifarawpe«i3rtvHrife (subtract line 9b from line 9a) 9c
10 a }ross saJes.pf»ip^tM l e y returns and allowances 10a 3,339
b ISSdisoId-rrrT. . 10b 3,339
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) STMT.. .3. 10c
11 Other revenue (from Part Vil, line 103) 11
12 Total revenue (add lines Id, 2,3,4,5,6c, 7,8d, 9c, 10c, and 11) 12 101,880,
13 Program services (from line 44, column (6)) 13 64,992,
14 Management and general (from line 44, column (C)) 14 23,219.
1 15
1B
17
Fundraising (from line 44,column (D))
Payments to affiliates (attach schedule)
Total expenses (add lines 16 and 44, column (A)) .
18
16
17
7,215,
95,426,
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 6,454
19 Met assets or fund balances at beginning of year {from IHIB 73, column (A)) <35,464.>
A
19
20 Other changes fn net assets or fund balances (attach explanation) 20 0.
21 Met assets or fund balances at end of year (combine lines 18,19, and 20) . 21 <29,010.>
IHA For Paperwork Reduction Act Notice, see page 1 of the separate instructions Form 990 (1997)
723001
12-05-97
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC, SAVE50_1 |
Form 990 {1997) SAVE A L I F E FOUNDATION. INC. 36-3869459 Page2
M ^ f f l l l S t a t e m e n t of Alt organizations must complete column (A). Columns (3), (C), and (D) are required for section 505(c)(3) and
I W i l l l l l Functional Expenses (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.
Do not Include amounts reported orl line
6b, Sti,9b. 10b, or 16 of Parti. If (A) Total
(B) Program
services
(C) Management
and qeneral (D) Fundraising
22 Grants and allocations (attach schedule)
cash $ noncash$ 22 l§^?Si|!^ii
23 Specific assistance to individuals (attach schedule) 23 ismsssiisitt
;
24 Benefits paid to or for rnernbers (attach schedule) 24 $ S | ^::?Sf!§sl*^SltMflil
25 Compensation of officers, directors, etc. 25 O. 0. 0. 0.
26 Other salaries and wages 26
27 Pension plan contributions 27
28 Other employee benefits 28
29 Payroll taxes 29
30 Professional fundraising fees 3D
31 Accounting fees 31
32 Legal fees 32
33 Supplies 33
34 Telephone 34 4,222. 2,533. 1,689.
35 Postage and shipping 35 2,034. 2,034.
36 Occupancy 36 1,200. 1,200.
37 Equipment rental and maintenance 37 18,080. 10,848. 7,232.
A",
38 Printing and publications 38 3,893. 3,893.
39 Travel 39 2j.622. 1,573. 1,049.
40 Conferences, conventions, and meetings 40 17,184. 17,184.
41 Interest . 41
42 Depreciation, depletion, etc, (attach schedule) 42 9,308. 8,884. 424.
43 Other expenses (itemize):
a 43a
b 43b
c 43c
d i 43d
B SEE STATEMENT 4 43e 36,883. 18,043. 11,625. 7,215.
44 Total functional expenses (add lines 22 through 43)
OrganizattonS'completing columns (BHD), cam/ these
44 95,426. 64,992. 23,219. 7,215.
departing of Joint Costs, - Did you report in column (B) (Program services) any joint costs from a combined educational campaign and
fundraising solicitation? ► □ Yes QT) No
If "Yes,' enter (i) the aggregate amount of these Joint costs $ _ ; (ii) the amount allocated to Program services $ ,
(iii) the amount allocated to Management and general $ and (iv) the amount allocated to Fundraising $
]ffl Statement of Program Service Accomplishments
What Is the organization's primary exempt purpose? ► S E E S T A T E M E N T 5
Program Service
Expenses
(Ml organizations must describe inelr exempt purpose achieverncnts In a clear and concise manner. State the number or clients served, publications Issued, etc. Discuss (Required for B01 (c)(3) and
achievements that are not measurable. (Section 501(c)(3) and (4) organizations and 4947(a)(1) nonaxempt charitable trusts Imust also enter the amount of grants and <4) orgs., and4947(aj<1)
allocations to others.) _____ trusts; but optional for others.)
a SEE STATEMENT 6
59 Total assels (add lines 45 through 58) (must equal line 74) 23,406. 59 31,060.
60 Accounts payable and accrued expenses . .. 60
61 Grants payable 61
in
62 Deferred revenue ... 62
•*£
63 Loans from officers, directors, trustees, and key employees 58,870. 63 60,070.
ID 64 a Tax-exempt bond liabilities .. 64a
3 b Mortgages and other notes payable 64b
65 Other liabilities (describe ► ') 65
723021
12-05-97
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related
organizations, of which more than $10,000 was provided by the related organizations? If "Yes," attach schedule, ► I I Yes [ X J Ho
Form 990(1997) SAVE A LIFE FOUNDATION, INC. 36-3869459
M l Other Information Yes No
76 Did the organization engage in any activity not previously reported to the IRS? If "Yes,- attach a detailed description of each activity 76
77 Were any changes made in the organizing orgoveming documents but not reported to the IRS? 77
If "Yes," attach a conformed copy of the changes. 11
78 a Did the organization have unrelated business gross Income of $1,000 or more during the year covered by this return? 78a X
b If "Yes," has it filed a tax return on Form 990-T for this year? N/A 78b
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? 79
If Yes," attach a statement;
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,
governing bodies, trustees, officers, etc., to any other exempt or nonexempt organization? 80a x""
b IfYes/enterthenameoftheorganization ►
and check whether it is I I exempt OR I I nonexempt. mm
81 a Enter the amount of political expenditures, direct or Indirect, as described in the
instructions for line 81 „ | 81a I O,
Did the organization file Form 1120-POL for this year? am
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than
fair rental value? 82a
b If "Yes," you may indicate the value of these items here. Do not Include this amount as revenue In Part l or as an
expense in Part II, (See instructions for reporting in Part III) j 82b I 6,000
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b X
84 a Did the organization solicit any contributions or gifts that were not tax deductible? 84a X
b if "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not
tax deductible? N/A 84b
85 501(c)(4), (5), or (6) organizations.-a WBre substantially all dues nondeductible by members? N/A 85a
Did the organization make only in-house lobbying expenditures of $2,000 or lass? N/A 85b
If "Yes" was answered to either 85a or 85b, do not complete 85c Ih rough 85h below unless the organization received a waiver for proxy tax
owedfortheprioryear.
c Dues, assessments, and similar amounts from members 85c N/A
d Section 162(e) lobbying and political expenditures 85d N/A
B Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices N/A
f Taxable amount oflobbying and political expenditures (line 85d less 85e) 85f N/A
g Does the organization elect to pay the section 6033(e) tax on the amount in 85f? N/A 85q
h If section 6033(e)(1)(A) dues notice were sent, does the organization agree to add the amount In 85f to its reasonable estimate of dues
■
allocable to nondeductible lobbying and political expenditures forthe following tax year? , N/A 85h
86 501(c)(7) organizations. - Enter:
a Initiation fees and capital contributions Included on line 12 86a N/A
b Gross receipts, included on line 12, for public use of club facilities 86b N/A
87 501(c)(12) organizations.-Enter: a Gross Income from members or shareholder? 87a N/A
;?:$■#■:
b Gross income from other sou rces. (Do not net amounts due or paid to other sources
against amounts due or received from them.) 87b N/A
88 At any time during the year, did thB organization own a 50% or greaterinterest in a taxable corporation or partnership?
if "Yes," complete Part IX
89 a 501 (c)(3) organizations. - Enter: Amount of tax Imposed during the year under:
section4911 ► 0^_;section 4912 ► 9_^;section4955 ►
b 501(c)(3) and 501(c)(4) organizations. - Did the organization engage In any section 4958 excess benefit
89b
IIS
transaction during the year? If Yes," attach a statement explaining each transaction
c Enter: Amount of tax imposed on the organization managers or disqualified persons du ring the year under
sections 4912,4955, and 4958 0.
6 Enter: Amount of tax in 89c, above, reimbursed by the organization , 0.
90 a List the states with which a copy of this return Is filed ► . . . I L L I N O I S
b Number of employees employed in the pay period that includes March 12,1997 90b
gz Section 4947(a)(1) nonexempt charitable trusts filing Form 990 In lieu of Form 1041.- Check here, ► □
and enter the amount of tax-exempt interest received or accrued during the tax year 92 N/A
723041
12-05-97
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC. SAVE50 1
Fornri990Q997) SAVE A L I F E FOUNDATION, I N C . 36-3869459 Page 6
VJhiWtm Analysis of Income-Producing Activities ~
Enter gross amounts unless otherwise > Unrelated business Income Excluded bv section 512, 513, or 514
(E)
indicated. <A) <B) (C)
Exclu (0) Related or exempt
Business Amount sion
93 Program service revenue: code code
Amount function income
fa)
(b)
(c)
(d)
(e)
(f) Medicare/Medicaid payments
(g)Fees and contracts from government agencies
94 Membership dues and assessments 550.
95 Interest on savings and temporary
cash investments
98 Dividends and interest from securities
97 Net rental income or (loss) from real estate: * :-- , - ^ ** * s, ' -N s
V, v > V
(a)debt-financed property
jb) not debt-financed property
98 Net rental income or (loss) from personal property . . . .
99 Other investment income
10Q Gain o r (loss) from sales of assets
otherthan inventory
101 Wet income o r (loss) from special events
102 Gross profit or (loss) from sales of inventory
103 Other revenue:
a
b
C
d
e
104 Subtotal (add columns (B), (D), and (E)) 1111111: 0. ws. 0. 550.
105 TDTAL (add line 104, columns (6), (0), and (E)) 550,
Note: (Line 105 plus line 1 d, Part I, should equal the amount on line 12. Part I.)
1 Relationship of Activities to the Accomplishment of Exempt Purposes
Line No. Explain how each activity for which income is reported in column <E) of Part VII contributed importantly to the accomplishment of the organization's
T exempt purposes (otherthan by providing funds for such purposes).
94 MEMBERSHIP DUES - CORPORATE AND INDIVIDUALS
HET11H1 I n f o r m a t i o n R e g a r d i n g T a x a b l e S u b s i d i a r i e s (CompletethisPartiltiie"Yes"boxona8ischecKed,)
Name, address, and employer identification Percentage of End-of-year
Nature of business activities Total income
number of corporation or partnership ownership interest assets
N/A
Under penalties of perjury, a declare that I have examined thisreturn,Including accompanying schedules and statements, and to the best of my knowledge and belief, It is true,
•ect, andxorrpleta.jBedaratlon of preparer (other than officer) Is based on all information of which preparer has any Knowledge.
Please
Sign Kl&\
Here Oats/ V Type or print name arjd title
Date Check if Preparer's S9N
I
SCHEDULE A
(Form 990)
Organization Exempt Under 501(c)(3) OMB No. 1545-0047
(Except Private Foundation), and Section 501(e), 5Q1(I), 501(k), 50l(n) or Section 4947(a)(1)
NONE
(a) Name and address of each independent contractor paid more than $50,000 (6) Type of service (c) Compensation
NONE
723101
12-05-97
13 I I An organization that Is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in:
, (1) lines 5 through 12 above: or 12) section 501 (c)(4), (5), or (6), if they mBet the test of section 509(a)(2). (See section 509(a)(3).)
Provide the following information about the supported organizations, (See Instructions on page 4.)
(b) Line number
from above
(a)Hamefs^ of supported organization^
14 | | An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions on page 4.)
723111
12-05-97 8
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC, SAVE50 1
Schedule A (Form 990) 1997 SAVE A L I F E FOUNDATION, IMC 36-3869459 Page3
liHilt'gil Support Schedule (Complete only If you checked a box on line 1 0 , 1 1 , or 12 above.) Use cash m e t h o d of accounting.
Note: You may use the worksheet in the instructions forconverting from the accrual to the cash method of accountinq.
Calendar year (or fiscal year
beginning in) ► (a) 1996 (b) 1995 (c) 1994 (d) 1993 (B) Total
15 Gifts, grants, and contributions received.
(Do not Include unusual grante. See
Jine2a.) 37,566. 110,761. 93,405. 7,199. 248,931.
16 Membership fees received 1,527. 1,410. 2,875. 5,812.
17 Gross receipts from admissions,
merchandise sold or services
performed, orfurnishing of facilities
In any activity that Is not a business
unrelated to the organization's
charitable, etc., purpose
18 Gross income from Interest,
dividends, amounts received from
payments on securities loans (sec
tion 512(a)(5)), rents, royalties, and
unrelated business taxable income
(less section 511 taxes) from
businesses acquired by the
organization after June 30,1975
19 Net income from unrelated business
activities notfnduded in line 18 ...
20 Taxrevenueslevied for the organization's
benefit and either paid to It or expended
on Ite behalf . .. .
c Total support for section 509(a)(1) ft st: Enter line 24, column (e) ► 26c N/A
d Add: Amounts from column fe) for lines: 18 19 •;-; ^ y^ * ^
22 26 b ► 26d N/A
e Public support (line 26c minus line 26d total) ► 26e N/A
f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) ► 26f N/A %
27 Organizations described on line 12: a For amounts included in lines 15,16, and 17 that werereceivedfrom a "disqualified person," attach a list to show Ihe name
of, and total amounts received In each year from each "disqualified person." Enter the sum of such amounts for each year.
(1996) P.. (1995) P... (1994) P.«. (1993) 0,
For any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount received for each year,
that was more than thelargerof (1) the amount on line 25 for the year or (2) $5,000. (Include in the list organizations described in lines 5 through 11, as well as
individuals.) After computing the difference between the amount received and the larger amount decribed in (1) or (2), enter the sum of these differences (the
excess amounts) for each year:
(1996) 0.. (1995) Q... (1994) P.-. (1993) 0.
Add: Amounts from column (e) for lines: 15. 248,931. 16. 5,812.
17 20 21 ► 27c 254,743,
Add: Line 27a total 0 . and line 27b total L . ... ► 27d 0,
Public support (line 27c, total minus line 27d total) 27e 254,743.
►
Total support for section 509(a)(2) test: Enter amount on line 23, column (e) 254,743. ZTf I $
Public support percentage (line 27e (numerator) divided by line 27f, (denominator)) ► 27g, 100%
Investment income percentage (line 18 column (e) (numerator) divided b y l i n e 27f (denominator)) ► 27h .0000%
2g Unusual Grants: For an organization described In line 10,11, or 12, that received any unusual igrants during 1993 through 1996, attach a list (which Is not open to
public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Oo not include
these grants in line 15. (See Instructions.)
WON-R
723121
12-05-97
-, * *
•o
32 Does the organization maintain the following:
a Records indicating the racial composition of the student body, faculty, and administrative staff? 32a
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondlscriminatory basis? 32b
o Copies of all catalogues, brochures, announcements, and other written communications to the public dealing with student
admissions, programs, and scholarships? 32c
d Copies of all material used by the organization or on its behalf to solicit contributions? 32d
If you answered "No" to any of the above, please explain. (If you need more space, attach a separate statement.)
■:
■v
33 Does the organization discriminate by race in any way with respect to:
a Students'rights or privileges? 33a
b Admissions policies? 33b
c Employment of faculty or administrative staff? .... 33c
d Scholarships or otherfinancial assistance? . ... 33d
a Educational policies? . . . . 33e
f Use of facilities? 33f
g Athletic programs? 33q
h Other extracurricular activities? . 33h
If you answered "Yes" to any of the above, pleasB explain. {If you need more space, attach a separate statement.)
iljl
$&■:?:??
Ipllli
f;^^
34 a Does the organization receive any financial aid or assistance from a governmental agency? , 34a
b Has the organization's right to such aid ever been revoked or suspended? 34b
i % *
If you answered "Yes" to either 34a or b, please explain using an attached statement. "*
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc. 75-50,
1975-2 C.B. 587, covering racial nondlscrimination? If "No," attach an explanation 35
723131
12-05-97 10
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC. SAVE50_1
ScheduleiA£orn990)3957 SAVE A L I F E FOUNDATION, INC, 36-3869459 Pages
liiflilMgil Lobbying Expenditures by Electing Public Charities
(To be completed ONLY by an eligible organization that filed Form S768) N/A
Check here ► a I I If the organization belongs to an affiliated group.
Checkhere ► ti I I ifyminhHcked'a'aboveand'limitedcontrorprovisionsapply,
(b)
Limits on Lobbying Expenditures To be completed for ALL
Affiliated group totals
(The term "expenditures' means amounts paid orincurred)
N/A
36 Total lobbying expenditures to Influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount. Enter the amount from the following table -
If the amount on line 40 Is - The lobbying nontaxable amount is -
Not over $500,000 20% of the amount on line 40 -i
Ov6r$500,000butnotover$1,O00,000 . . .. $100,000 p l u s 1 E % oftheexcesa over$500,000 1
■
44 Subtract line 41 from line 38. Enter-0-if line 41 is more than line 38 44
Caution: If there is an amount on either line 43 or line 44, you must file Form 4720. ll|l|lllllllS;RK| aiiiiliiii
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns
below. See the Instructions for lines 45 through 50.)
lillSliSISI IlllillliililllllIlllSIISSIIli
45 Lobbying ceiling amount
(150%ofllne45fe)) 0.
47 Total lobbying
expenditures 0.
48 Grassroots nontaxable
0.
49 Grassroots ceiling amount
(150% of line 48(e))
50 Grassroots lobbying
illiiliiiililiiiililii
llllllllllllil
■milillltil 0.
expenditures 0.
Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part Vl-A) N/A
During the year, did the organization attempt to Influence national, state or local legislation, Including any attempt to
Yes No Amount
influence public opinion on a legislative matter or referendum, througli the use of:
a Volunteers
h Paid staff or management (include compensation In expenses reported on lines c through fi)
c Media advertisements
d Mailings to members, legislators, or the public ,
e Publications or published or broadcast statements
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
1 Total lobbying expenditures (add lines c through h)
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities.
12-05-87 11
13230902 758985 SAVE50 050 SAVE A L I F E FOUNDATION, INC. SAVES0 1
Schedule A (Form 990) 1997 SAVE A L I F E FOUNDATION, I N C . 36-3869459 Page6
l i l W i H Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
51 Old the reporting organization directly or indirectly engage In any of the following with any other organization described in section
501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No
(I) Cash 51a(i) X
(ii) Other assets a(il) X
b Other transactions:
(i) Sales otassets to a noncharitable exempt organization _ b(l) X
(II) Purchases of assets from a noncharitable exempt organization b(H) X
(iii) Rental of facilities orequipment b(iii) X
(Iv) Reimbursement arrangements h(iv) X
(v) Loans or loan guarantees _ _ n(v) X
<vi) Performance of services or membership orfundraising solicitations D(Vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always Indicate the fair market value of the
goods, other assets, or services given by the reporting organization. If the organization received less than fair market value In any
transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received, N/A
(a) (b) <<0 (d)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described In section 501(c) of the
Code (otherthan section 501(c)(3))orin section 527? ,,..► CZ3 Yes D D No
b If "Yes," complete the following schedule. N / A
723151
12-05-97 12
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC SAVES0 1
Depreciation and Amortization Detail
990
Description of property
Asset
Number % \ placedDate Method/ Life Line Cost or Basis Accumulated Current year
In service IRC SBC. or rate No. otharbasis reduction depreciation/amortization deduction
1 3RGANIZATION COSTS
--v 12|31|9 3 ;60M 41 2,120. 1,378. 424.
2 DFFICE EQUIPMENT
VH12|31,93200DB7.00 17 2,236. 1,537. 200.
3 DFFICE EQUIPMENT
V;06|30|94200DB7.00 17 12,307. 6,925. 1,537.
4 DFFICE EQUIPMENT
; J r\06,3O^52OODB7.OO 17 743. 288. 130.
5 COPIER
^101,15,96 200DB 5 . 0 0 17 8,000. 1,600. 2,560.
6 COMPUTER
; ;^i02|15|96 2 0 0 D B 5 . 0 0 17 1,500. 1 300.1 480.
7 PRINTER
C;;';; 02,15,9 6 200DB5 . 0 0 17 500. 100. 160.
8 COMPUTER
,v;04|15,96 2 0 0 D B 5 . 0 0 17 1,200. 240. 384.
9 COPIER
;
vOL15|97|200DB 5 . 0 0 15B 8,000. ! 1,600.
10 COMPUTER
f^O 2,05,972 OODB5 . 0 0 15B 2,000. 400.
1 1 OFFICE EQUIPMENT
-^-02^5^720006 7.00 |15C 850. 121.
12 COMPUTER
-:\ 04,17,9 7|200DB 5 . 0 0 15B 1,200. 240.
1 3 COMPUTER
•yi;05,18|97200DB5.00 15B 2,698. ._! 540.
14 COMPUTER MONITER
<55J0 6|07|97|200DB5 . 0 0 15B| 275.1 55.
1 5 COMPUTER
_.. 1
A,108,01,9712000615.00 |15B| 1,937. 1 387.
1 6 PRINTER
:*,. 11,10,97 200DB 5 . 0 0 15B 450. 90.
* * TOTAL 9 9 0 PAGE 2 DEPRECIATION & A M O R T I Z A T I O N
1
:■>! i i 46,016. 12,368. 9,308.
;. . i i 1
:H , , 1 1 1 1
^ i l l 1
i i I t
«> . i i 1 1
*. . . 1 1 1 1 1
«V i i i 1 1 1 1
; ;
~ 1 i i 1
-v i i 1
M i l ' 1
716261
# - Cu rrent year section 179 (D) ■ Asset disposed
10-07-97
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC, SAVE50 1
SAVE A LIFE FOUNDATION, INC. 36-3869459
INCOME
1. GROSS RECEIPTS 3,339
2. RETURNS AND ALLOWANCES
3. LINE 1 LESS LINE 2 3,339
16 STATEMENT(S) 3
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC. SAVE50_1
maom
BANK CHARGES 0.
DUES & SUBSCRIPTIONS 744. 744.
OUTSIDE SERVICES 19,371. 11,623. 7,748.
INSURANCE 825. 825.
OFFICE EXPENSE 2,210. 2,210.
OTHER TAXES 8. 8.
RAFFLE PRIZES &
AWARDS 5,645. 5,645.
ART WORK AND
SUPPLIES 6,100. 6,100.
PROMOTION 1,570. 1,570.
SEMINARS 320. 320.
1 MISCELLANEOUS
TOTAL TO FM 990, LN 43
90.
36,883. 18,043.
90.
11,625. 7,215.
It
EXPLANATION
TO PROMOTE EDUCATION AND CONTINUING EDUCATION IN CPR AND FIRST AID
NATIONALLY.
17 STATEMENT(S) 4, 5
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC. SAVE50_1
)
r SAVE A LIFE FOUNDATION, INC. 36-3869459
:>
DESCRIPTION OF PROGRAM SERVICE ONE
TO PROMOTE EDUCATION & CONTINUING EDUCATION IN CPR & FIRST
AID NATIONALLY. TO PROMOTE, CONSISTENCY, UNIFORMITY &
SAFETY IN THE APPLICATION OF FIRST AID & CPR. TO ASSURE
THAT THE BEST PROCEDURES AND HIGHEST QUALITY MATERIALS ARE
USED AND ARE ACCESSIBLE. TO PROMOTE GOOD SAMARITAN LAWS.
GRANTS EXPENSES
TO FORM 990, PART III, LINE A 64,992.
COST OR ACCUMULATED
DESCRIPTION OTHER BASIS DEPRECIATION BOOK VALUE
18 STATEMENTS) 6, 7
13230902 758985 SAVE50 050 SAVE A LIFE FOUNDATION, INC. SAVE50_1
OMB No. 1545-0172
15 a 3-year property
b 5-year property 16,560. 5 YRS. HY 200DB 3,312.
c 7-year property 850. 7 YRS. HY 200DB 121.
d
e
10-year property
15-year property mm
f
g
20-year property
25-year property wm /
25yrs.
27.5 yrs.
MM
S/L
S/L
h Residential rental property 27.5 yrs.
MM S/L
/
/ MM S/L
i Nonresidential real property
/ MM S/L
Section C - Alternative Depreciation System (ADS) (See instructions.)
16 a Class We
b 12-year
c 40-year /
mt& 12 yrs.
40 yrs. MM
S/L
S/L
S/L
Hi/itiMllh Other Depreciation (Do Not Include Listed Property.) (See instructions.)
17 GDS and ADS deductions for assets placed in service In tax years beginning before 1997 17 5,451.
18 Property subject to section 168(f)(1) election 18
19 ACRS and other depreciation 19
m n j j ^ J Summary (See instructions.)
20 Listed property. Enter amount from line 26 20
21 Total. Add deductions on line 12, lines 15 and 16 in column (g), and lines 17 through 20. Enter here
and on the appropriate lines of your return. Partnerships and S corporations ■ see instructions. 21 8,884.
22 For assets shown above and placed jn service during the current year, enter the
portion of the basis attributable to section 263A costs 22
LHA For Paperwork Reduction Act Notice, see the separate instructions. Form 4562 (1997)
716251 1 Q
10-22-97
%
%
,a senf.'
If you want a copy of this form to be returned to an address otherthan that shown above, please enter the address to which the copy should be enrrf C*t*
Name
Please COLE, MARTIN, & C O . , LTD.
Type Number, street (or P.O. box no. if mail Is not delivered to street address)
or 7 3 0 1 N . LINCOLN A V E . , 140
Print City, town, or post office, state, and ZIP code. For a foreign address, see instructions.
LINCOLNWOOD, I L 60646
LHA For Paperwork Reduction Act Notice, see separate instructions. Form 2758 (Rev. 5-95)
613941
11-08-96
19
SAVE50 080 SAVE A LIFE FOUNDATION, INC. SAVE50 1
16200805
OMB No. 154S-0047
Form 990 Return of Organization Exempt From Income Tax
Under section 501(c) of the Internal Revenue Code (except black lung benefit
trust or private foundation) or section 4947(a)(1) nonexempt charitable trust
1998
This Form la
D e p a r t m e n t of t h a Treasury Open to Public
Note: The organization may have to use a copy of this return to satisfy state reporting requirements.
Intern a.] R e v e n u e Service
Inspection
A For the 199B calendar year, OR tax year period beginning ■.ijaSJBranfreiraTnlfl ,19
B Check if: Please C Name of organization, number and street, clfyytowj nm^tate^TiJIgi; Employer Identification number
Change of use IRS
address label or Save a L i f e Foundation 36-3869459
Initial return
print or Telephone number
type.
Final return See 4825 N. Scott Street #7#A! (847)928-9683
Specific
Amended return Instruc Schiller Park, IL 6017 .Checks ( J if exemption application
(required also for
stats reporting) tions. is pending
G Type of organization • Kj Exempt under section 501 (c)(3 ) * (ins,sjjjiuiffief) ;
0FriF,[^fsectlon
[iiBer>0FriF ,
rrsictli 4947(a)(l) nonexempt charitable trust
Note: Section 501(c)(3) exempt organizations and 4947(a)(1) nonexempt charitable trusts MUST attach a completed Schedule A (Form 990).
H(a) Is this a group return filed for affiliates? [ J Yes [R] No 1 if either box in H is checked 'Yes," enter four-digit
group exemption no. (GEN)^
(b) If "Yes," enter number of affiliates for which return Is filed: ►_ J Accounting method: [ ] Cash JX] Accrual
( c ) Is thisaseparate retqm filed by an organization covered byagragp ruling? . . Y e s X NO [~l0'her (specify) ►
K Check here ► Q if the organization's gross receipts are normally not more than $25,000. The organization need not file a return with the IRS;
but if it received a Form 990 Package in the mail, it should file a return without financial data. Some states require a complete return.
Note: Form 990-EZ may be used by organizations with gross receipis less than $100,000 and total assets less than $250,000 at end of year-
R e v e n u e , E x p e n s e s , and Changes in Net A s s e t s or Fund Balances (See Specific Instructions on page 13.)
Contributions, gifts, grants, and similar amounts received:
a Direct public support 1a 21,289,
b Indirect public support 1b
c Government contributions (grants) 1c 600,000.
d Total (add lines 1 a through 1c) (attach schedule of contributors)
(cash $ 6 2 1 , 2 8 9 . noncash $ 621,289.
2Program service revenue including government fees and contracts (from Part VII, line 93).
3Membership dues and assessments
4Interest on savings and temporary cash investments 67 6.
5Dividends and Interest from securities
6a
Gross rents 6a
b
Less: rental expenses 6b
c
Net rental income or (loss) (subtract line 6b from line 6a). 6c
7Other investment income (describe ►
Revenue Gross amount from sale of assets other
8a (A) Securities (B) Other
than inventory 8a
b Less: cost/other basis & sales expenses. 8b
ffi c Gain or (loss) (attach schedule) 8c
d Net gain or (loss) (combine line 8c, columns (A) and (B)).. 8d
Q
i Special events and activities (attach schedule)
Gross revenue (not including $ of
z contributions reported on line 1a) 9a 6,134
m b Less: direct expenses other than fundraising expenses 9b 1,660.
o c Net income or (loss) from special events (subtract line 9b from line 9a) 9c 4,474,
-£? 1 0 a Gross sales of inventory, less returns and allowances 110a
as b Less: cost of goods sold |10b
CD C Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a). 10c
S3 1 1 Other revenue (from Part VII, line 103) : 11
1 2 Total revenue (add lines 1d, 2, 3,4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 626,439,
13 Program services (from line 44, column (B)) 13 132,799,
14 Management and general (from line 44, column (C)) 14 25,031.
Expenses 15 Fundraising (from line 44, column (D)) 15 1,879.
16 Payments to affiliates (attach schedule) 16
17 Total expenses (add lines 16 and 44, column (A)).. 17 159,709.
1 8 Excess or (deficit) for the year (subtract line 17 from line 12) 18 466,730,
Net 1 9 Net assets or fund balances at beginning of year (from line 73, column (A)). 19 -29,010,
Assets 2 0 Other changes in net assets or fund balances (attach explanation) 20
21 Net assets or fund balances at end of year (combine lines 18,19, and 20).. 21 437,720,
For Paperwork Reduction Act Notice, see page 1 of the separate Instructions, CAA 8 99012 NTF ia76a GLD 4224 Form 9 9 0 (1998)
\o
Form 990 (1998) Save a Life Foundation 36-3869459 Page 2
H H H i Statement of All organizations must complota column (A), Columns (B), (C), and (O)ara required lor section 5D1(c)(3) and (4) organizations and
Functional Expenses section 4947(aX1)nonoxempt charitable trusts but optional for others. (Sea Specific Instructions on page 17.)
22
Do not include amounts reported on line
Bb, 8b, 9b, 10b, or 16 of Part I.
Grants and allocations (attach schedule) . . .
1 (A) Total (B) Program
services
(C) Management
and general
(D) Fundraising
(cash? cash$ 22
23 Specific assistance to Individu als (attach sen.). 23
24 Benefits paid to or for members (attach sch.) . 24
25 Compensation of officers, directors, etc 25 35,000 33,125 625 1,250.
26 Other salaries and wages 26 25,044. 25,044
27 Pension plan contributions 27
28 Other employee benefits 28 262 262
29 Payroll taxes 29 1,709 1,709
30 Professional fundraising fees 30
31 Accounting fees ■, 31 1,191 1,191
32 Legal fees 32 10,000 10,000
33 Supplies 33 7,120 6,992 113. 15.
34 Telephone 34 6,554 6,255 100. 199.
35 Postage and shipping 35 1,022 941 27. 54
36 Occupancy 36 314 275, 33
37 Equipment rental and maintenance 37 200 170, 10 20,
38 Printing and publications 38 7,412 7,412
39 Travel 39 6,262 5,712 215 335.
40 Conferences, conventions, and meetings... 40 2,200 1,455 745,
41 Interest 41 154 154
42 Depreciation, depletion, etc. (attach schedule) , 42 12,527 12,527,
43 Other expenses (itemize): a S t l t l t A t t 43a 42,738 32,256 10,482
43b
43c
43d
43e
44 Total functional expenses (add linos 22 through
43)Organizations completing columns
(B)-(D), carry these totals to lines 13-15.. 44 159^709, 132,799 25,031 1,879.
Reporting of Joint Costs, - - Did you report in column (B) (Program services) any joint costs from a combined educational
campaign and fundraising solicitation? > D Yes g No
if "Yes," enter (I) the aggregate amount of these joint costs . . . $ ; (II) amt. allocated to Prog, services . . $_
(ill) the amount allocated to Management and general $ ; and(lv) amt allocated to Fundraising $
Statement of Program Service Accomplishments (See Specific instructions on page 20.)
m
What is the organization's primary exempt purpose?^- Promote L i f e Saving F i r s t A i d Program Service
Expenses
Ail organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of clients (Required for501(cX3)
served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) organizations and and (4) orgi., and 4947(aX1)
4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) trusts; but optional
for others.)
a IL PILOT PROGRAM-Teach Life Saving First Aid to
IL School Children
8000 T a u g h t (Grants and allocations $ 132,799,
59 Total assets (add lines 45 through 58) (must equal line 74). 31,060 59 525,550.
60 Accounts payabla and accrued expenses , 60 1,474
61 Grants payable < 61
62 Deferred revenue 62
63 Loans from officers, directors, trustees, and key employees (attach mm
schedule) , 6 0 , 0 7 0 , 63 61,521
6 4 a Tax-exempt bond liabilities {attach schedule) 64a
b Mortgages and other notes payable (attach schedule) 64b 19,907.
liabilities (describe ► S tlTTC AttCnU 65 4,928
3
$
Add amounts on lines (1) and (2) ► Add amounts on lines (1) and ( 2 ) . . . .
e Total revenue per line 12, Form 990 Total expenses per Una 17, Form 990
(Una c plus line d) ► e 626,439 (line c plus line d), 159,709.
® List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see Specific
Instructions on page 22.}
(B) Title and average (C) Compensation (D) Contributions to (E) Expense
(A) Name and address hours per week (if not paid, employee benefit plans account and other
devoted to position enter -0-.) & deferred comp. allowances
See A t t a c h e d
0. 0. 0.
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your
organization and all related organizations, of which more than $10,000 was provided by the related organizations? ► QYes No
If "Yes," attach schedule — see Specific Instructions on page 22.
liflKBfl Information Regarding Taxable Subsidiaries (Complete this Part if "Yes" box on line 88 is checked.)
Name, address, and employer identification Percentage of Nature of Tolal End-of-year
ownersnip
number of corporation or partnership interest business activities income assets
%
Under penaltiss of perjury, I declare that I have examined this return, including accompanying achadulaa and statements, and to the best of my knovuladgo and
Please belief . i t is truo, correct, and complete. Dec[aratiarM>tprHparBr(otherthan officer) is based an all information of which praparer hasany knowledge. (Sea
Sign
'ir-?Wl
Here Type or print name and title.
NONE
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
NONE
3 Does the organization make grants for scholarships, fellowships, student loans, etc.? X
4 a Do you have a section 403(b) annuity plan for your employees? 4a
b Attach a statement to explain how the organization determines that individuals or organizations receiving grants or loans
from it in furtherance of its charitable programs qualify to receive payments. (See instructions on page 2.) • ■
:
'iPa Reason for Non-Private Foundation Status (See instructions on pages z through 4.)
■-Hal" mm®
The organization is not a private foundation because it is: (Please check only ONE applicable box.)
5 A church, convention of churches, or association of churches. Section 170(b)(1)(A)(i).
6 A school. Section 170(b)(1)(A)(ii). (Also complete Part V, page 4.)
7 A hospital or a cooperative hospital service organization. Section i70(b)(1)(A)(iii).
8 A Federal, state, or local government or governmental unit. Section i70(b)(i)(A)(v).
9 A medical research organization operated in conjunction with a hospital. Section 17Q(b)(1)(A)(iil). Enter the hospital's name, city,
and state ►
10 Q An organization operated for tha benefit of a college or university owned or operated by a governmental unit. Section 170(b)(l)(A)(iv).
(Also complete the Support Schedule in Part IV-A.)
11a JXJ An organization that normally receives a substantial part of its support from a governmental unit or from the general public.
Section 170(b)(l)(A)(vi). (Also complete the Support Schedule in Part IV-A.)
11 b _ A community trust. Section 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.)
12 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 charitable, etc., 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). (Also complete the Support Schedule in Part IV-A.)
13 \\ An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See
section 509(a)(3).)
Provide the following information about the supported organizations. (See instructions on page 4.)
(b) Line number
(a) Name(s) of supported organization(s) from above
Schedule A (Form 990) 199B Save a Life Foundation 36-3869459 Page 3
^m S u p p o r t S c h e d u l e (Complete only if you checked a box on lina 10,11, or 12.) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting.
Calendar year (or fiscal year beginning i n ) ^ - (a) 1997 (b) 1996 (C) 1995 (d) 1994 (e) Total
G i f t s , grants, and contributions
15
recaivad. ( D o not include unusual
grants. See line 28.)
101,330 37,566 110,761 93,405 343,062
M e m b e r s h i p f s s s received .
550 1,527 1,410 2,875 6,362
17 Grose receipts f r o m admissions,
merchandise sold or services
p e r f o r m e d , or furnishing of
facilities fn any activity t h a t is n o t
a business unrelated t o t h a
organization's c h a r i t a b l e , e t c . ,
purpose
20 T a x revenues levied f o r t h e
organization's b e n e f i t and e i t h e r
p a i d to it or e x p e n d e d on its
bahaif
22 O t h e r income. A t t a c h a s c h e d u l e .
Do notinclude gain or (loss) f r o m
sate of capital assets ,
Total support for section 509(a)(1) test: Enter line 24, column (e).
Add: Amounts from column (e) for lines: 18 19
22 26b" 3,012.
Public support (line 26c minus line 26d total)
Public support percentage (line 26e (numerator) divided by line 26c (denominator)). 99.138 %
27 Organizations described on line 12: a For amounts included In lines 15,16, and 17 that were received from a "disqualified person,"
attach a list to show the name of, and total amounts received in each year from, each "disqualified person." Enter the sum of such amounts
for each year:
33 Does the organization discriminate by race in any way with respect to:
If you answered "Yes" to any of the above, please explain. (If you need more space, attach a separate statement.)
34a Does the organization receive any financial aid or assistance from a governmental agency?. 34a
b Has ihe organization's right to such aid ever been revoked or suspended? 34b
If you answered "Yes' to eilher 34a or b, please explain using an attached statement.
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of
Rev. Proc. 75-50,1975-2 C.B. 587, covering racial nondiscrimination? If "No," attach an explanation 35
CAA 8 990A34 NTF18400 GLD 3275
Schedule A (Form 990) 1998 S a v e a L i f e Foundation 36-3869459 Page 5
iBJBi^il Lobbying- Expenditures by Electing Public Charities (See Instructions on page e.)
(To be completed O N L Y by an eligible organization that filed Form 5768)
Check here ►• a if the organization belongs to an affiliated group.
Check here ► b if you checked " a " above and "limited control" provisions apply.
Caution: If there is an amount on either line 43 or line 44, you must file Form 4720.
4-Year Averaging Period Under Section 501(h) •
(Some organizations that made a section 501 (h) election do not have to camplete all of the fivB columns below.
See the instructions for lines 45 through 50 on page 7.)
If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities.
CAA a 990A56 NTF18491 GLD 3276
Schedule A (Form 990) 1998
—F5BT '
Save a Life Foundation 36-3869459 Page 6
Information-Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations
51 Did the reporting organization directly or Indirectly engage in any of the following with any other organization described in section 501(c) of
the Code (other ihan section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of; Yes No
(i) Cash 51a(i) X
(ii) Other assets a(il) X
b Other transactions:
(I) Sales of assets to a noncharitable exempt organization b(i) X
(Ii) Purchases of assets from a noncharitable exempt organization b(!i) X
(ill) Rental of facilities or equipment b(iii) X
(Iv) Reimbursement arrangements b(iv) X
(v) Loans or loan guarantees b(v) X
(vl) Performance of services or membership or fundraising solicitations b(vi) X
C Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value of the
goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in any transaction
or sharing arrangement, show in column (d) the value of the goods, other assets, or services received:
■ -
5 2 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in
section 501(c) of the Code (other than section 501(c)(3)) or in section 527? ► [~j Yes (R]rto
b If "Yes," complete the following schedule:
(a) (b) (0
Name of organization Type of organization Description of relationship
Supplemental Schedules -1998 Page: 1
Company: Save a Life Foundation EIN: 36-3869459
Continued on Page 2
Form 990 (1998) Save a Life Foundation 36-2171716
Part IV
Line 57
The above individuals put in time at Save a Life Foundation as needed, except where indicated.
otherwise.
Supplemental Schedules-1998 Page: 2
Company: Save a Life F6undation EIN: 36-3869459
Description Amount
TOTAL 19,907,
Description Amount
TOTAL 4,928.
OMBNo. 1545-0047
" Form 9 9 0 Return of Organization Exempt from Income Tax
I Under section 501(c) of the Internal Revenue Code (except black lung benefit trust 1999
*I . or private foundation) or section 4947(aX1) nonexempt charitable trust This Form Is Open
inie.rai P « « I S St-/« ' Note: The organization may have to use a copy of this return to satisfy state reporting requirements. to Public Inspection
For the 19S9 calendar year, Or tax year period beginning , 1999, and ending
Checx if: C Name of organization D Employer Identification Number
please use
) C-,a-ja of? ioz'iss IRSIibd Save A Life Foundation 36-3869459
or print
1 crfype.
See
Number & street (or P.O. box if mail is not delivered to street add;) Room/suita E Telephone number
A
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 109,984.
Hi 19 Net assets or fund balances at beginning of year (from line~7 19 437,720.
20 Other changes in net assets or fund balances (attach explanation) 20
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 547,704.
BAA For Paperwork Reduction Act Notice, see separate instructions. TEEA0I01 OS/,10/39 Form 990 (1999)
^
8478244B12
S5-1^-08 88:64- AHLBECK AND COMPANY 1D=8478244S12 P ■ Q2
47a 1.750.
47b 0. 0. 47c 1.750.
48a
b Less: allowance for doubtful accounts 48 b 48 c
49 Grants receivable 49
1
B
71 Paid-in or capital surplus, or land, building, and equipment f und
70
71
72 Retained earnings, endowment, accumulated income, or olh er funds 72
t
73 TblaJ net assets or fund balances (add lines 67 through 69 o r lines 70 Ihrough
72; column (A) must equal line 19 and column (B) must equ;al line 21) 437,720. 73 547,704.
74 Total liabilities and net assets/fund balances (add line s66 and73) 525,550. 74 617,345.
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore,
please make sure the return is complete and accurate and fuity describes, in Part III, Irre organization's programs and accomplishments.
BAA
TEEA0103 08/M/99
Q5-19-QS Q8:G5 AHLBECK AMD COMPANY ID = B 4 7 B 2 4 4 - Q 1 2 P . S3
S
Add amounts on lines (1) and (2) Add amounts on lines O ) and (?) . . . *■
t Total revenue per line 12, Form Total expenses per line 17, Form
030 (line c plus line d ) , . . 562,948. 990 (Una c plus line d) *■ 552,964,
;Sfe$tl L i s t of O f f i c e r s . D i r e c t o r s , T r u s t e e s , a n d K e y E m p OVees (List each one even if not compensated; see instructions.)
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted (if not paid, employee benafit account and othsr
(A) Name and address to position enter-Q-) plans and deferred sltau/ances
compensation
_ClL°J_§pJ zz i_rj_ i.
Pres/Exec Dir 40 83.359, 372-, _0,
_DI L. _ s iarL LltiJ 9.
Director 20.832, 0.
Carlos Costes
Director 0.
Jam L. Amirante
Director 0.
Scott Anderson
Pi rector
Deloris M. Burnam
Director o.
Dr. Scott Betzelos
Director 1,666 0.
_Bob _Cpnroy_
Pi rector 0.
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000
from your organization and all related organizations, of which more than $10,000 was provided by the
related organizations? □ Yes' .0N*
If 'Yes,' attach schedule - see instructions. .
TE£Jdr« tf/?j«g Form 99D{1999)
BAA
Form990 (1999) Save A L i f e Foundation 36-3869459 Page 5
l U f i & M I ] Other Information (See specific instructions.) Yes No
76 Die the crzanzabori engage in any activity not previously reported to the IRS? If 'Yes,' attach a detailed description mm.
cf sacr at- , -, 76
77 Were any craves made in the organizing or governing documents but not reported to the IRS? 77
'' 'Yes,' a:?acr a conformed copy ol !he changes. mm
78a D;c r.e z-'czr-zaticn nave unrelated business gross income of $1,000 or more during the year covered by this return? 78a
b If v es, ras it Sled a tax return on Form 990-T for this year? 78 b
79 Was there a liqu.dation, dissolution, termination, or substantial contraction during the year? If 'Yes/ attach
a statement 79 X
30a 's (he organisation related (olher than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc, to any olher exempt or nonexempt organizalion? 80 a lii
X
b Jf'Yes,' enter Ihe name of Ihe organization *- ' #§3 IP
and check whether it is [ j exempt or
81 a Enter the amount of political expenditures, direct or indirect, as described in the instructions [_81aJ
b Did Ihe organization file Form 1120-POL for this year?
f_| nonexempt.
0_
81b
#mm s
KB8HS-
x
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value? 82 a
HP
b If 'Yes,' you may indicate the value of these items here. Do not include this amount as
revenue in Part I or as an expense in Part II. (See instructions for reporting in Part III.) .1 82b] 13,150, lii
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a
b Did-the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b
84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax
nnt rax deductible?
rffiriuclihlR? 84b
%i$m Wi
85 501(c)(4), (5), or (6) organizations, a Were substantially all dues nondeductible by members? 85a
b Did the organization make only in-house lobbying expendilures ol $2,000 or less? 85b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for ihe prior year.
-Sift*
c Dues, assessments, and similar amounts from members
d Section 162(e) lobbying and political expenditures
85c
85d
>w ? '04
e Aggregate nondeductible amount of Section 6033(e)(1)(A) dues notices 85 e > S3*
:W&
f Taxable amount of lobbying and political expendilures (line 85d less 85e) 85f
g Does the organization elect to pay the Section 6033(e) tax on the amount in 85f? 85 g
h If Section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount in 85f to its reasonable
estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85 h
86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on ?'?$>
line 12 86a
b Gross receipts, included on line 12, for public use of club facilities 86 b
87 501(c)(12) organizations. Enter: a Gross income from members or shareholders 87a
b Gross income from other sources. (Do not net amounts due or paid to olher sources
against amounts due or received from them.) 87b
88 At any time during Ihe year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from Ihe organization under Regulations Sections 301.7701-2 and 301.7701-3?
If "Yes,' complete Part IX 88
x
89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under: mm.
Section4911 »■ 0 . ; Section4912»- 0 . ; Section4955*
b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any Section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes," attach a statement
explaining each transaction 69b
c Enter: Amount of tax imposed on the organization managers or disqualified persons during Ihe year under
Sections 4912, 4955, and 4958
d Enter: Amount of tax on line 89c, above, reimbursed by the organization *"
90a List Ihe states with which a copy of this return is filed *■ _I I l_1_no \S
b Number of employees employed in the pay period that includes March 12, 1999 (see instructions) ~ [90 b£
91 The books are in care of v _CaLOJ-_ 1.RJ^^i-TX ] Telephone number »- _(847)_928-9683 _
Located at »■ 4 8 2 5 . N.__ J c o t X 1t_._ f ^ A ^ S j r h m e r _Pa?k _ J I L _ ZIP +■ 4 «► 6pi7_6_"
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lien of Form 1041 - Check here ►" [j
and enter the amount o( tax-exempt interest received or accrued during the tax year ►"[ 92 [
BAA Form 990 (1999)
TEEA0105 IJ/20W
Form 990 (1999) Save A L i f e Foundation 36-3869459 Page 6
[If fftfsai Analysis of In come-Producing Activities (See instructions.)
Unrelated business income Excluded by section 512, 513, or'514 (E)
Er.:sr g'css S T C . - I S -nless (A) (B) (C) Related or exempt
othervTss ~z :=tec:. Amount Exclusion code Amount function income
Business cade
93 Program ser.ce revenue:
a Proe-ar, Fees 16,831.
b
c
d
e
f Meaicare/Medicaid payments
g Fees 3. contracts from government agencies . . .
94 Membership dues and assessments ..
95 Interest en savings & temporary cash invmnts.. 14 24.575.
96 Dividends & interest from securities ..
97 fet rental income ac (loss) from real estate: S1.v.:':W-*"*'K|iis«:f:-S-:»":>
naMiiwmmmmmmm
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other Investment income
TOO Gain or (loss) from sales of assets
MrJBflll Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions.) N/A
(A) (B> (C)
Name, address, and EIN of corporation, Percenlape ol Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
%
Under penalties of perjury, ' declare that I have examined this return, including accompanying schedules and statements, and to the best of m y knowledge and befief, it is
Please true, cofrect, ana complete. Declaration of prepurer (other than orticer) is based on all inrormabon of which prepaier has any knowledge, (See instructions.)
Sign
Here Signature of Officer Date Type or Print N a m e and TiWe
(Except Private Foundation) and Section 501(e), 501(f), 501(|ri, 501(r>), pr Section 4947(aX1) L™B No. 1545-0047
Nonex«mpt Charitable Trust Supplementary Information - (See separate Instructions.)
Must be completed by the above organizations and attached to their Form 990 or 990-EZ.
ISsrr.e z' r e Cr;ar zii'Z^ Employer Identification Number
None
(a) Name and address of each Independent contractor paid more than $50,000 (b) Type of service (c) Compensation
None
FEEA0401 CS/W/99
Schedule A ( F e n 9=2) 1999 Save A L i f e Foundation 36-3869459 Page 2
D-r.-.g tie ,ear, ias the organization attempted to influence national, state, or local legislation, including any attempt
:c r.tCs-.:s z'joiic cp',r,,on on a legislative matter or referendum?
: v
e=, »i>er ".-e :olal expenses paid or incurred in connection with Ihe lobbying activities . . . . K $ .
Ogarizarors 'rat made an election under section 501(h) by filing Form 5768 must complete Part Vl-A. Other
crga-'zatiors chewing 'Yes,' must complete Part Vl-B and attach a statement giving a detailed description of the
Icoo/ ~g activities.
2 D. r ~.~ iwe year, has the organization, either directly or indirectly, engaged in any of the following acts with any of its
trustees, cl rectors, officers, creators, key employees, or members ol their families, or with any taxable organization
w'th which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary: 3>;
*#A
</■<■
d Payment of compensation (or payment or reimbursement of expenses it more than $1,000)? S e e . P.t. .V,. . F/n. 3 9 0 . 2d
3 Does the organization make grants for scholarships, fellowships, student loans, etc?
4a Da you have a section 403(b) annuity plan for your employees?
b Attach a statement to explain how the organization determines that individuals or organizations receiving grants
or loans from it in furtherance of its charitable programs qualify to receive payments. (See instructions.)
Provide the following information about the supported organizations. (See instructions.)
14 1 1 An organization organized and operated to test for public safely. Section 509(a)(4). (See instructions.)
BAA TEEA0402 12/20/39 Schedule A (Form 990) 1999
Schedule A (Form 99C) 1999 Save A L i f e Foundation 36-3869459 Page 3
Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting.
Note: Ycu may use Ihe worksheet in the instructions for converting from the accrual to the cash method of accounting.
30 Does '.he organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scnclarsnips? 30
a -f^>
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
»;.'«
Ihe period of solicitation for students, or during the registration period if if has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves? 31
If 'Yes,1 please describe; if 'No,' please explain. (If you need more space, attach a separate statement.)
KU
If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to:
®
a Students' rights or privileges? 33 a
e Educational policies? 33 B
If you answered 'Yes' to any of the above, please explain. (If you need more space, attacti a separate statement.)
mi
mm
34a Does the organization receive any financial aid or assistance from a governmental agency? 34a
■ill
b Has the organization's right to such aid ever been revoked or suspended? 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement.
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev Proc 75-50, 1975-2 C.B. 587, covering racial nondiscnmination? if 'No,' attach an explanation 35
BAA TEEAQ404 12/20/99 Schedule A (Form 990) 1999
Schedule A (Form sso) :999 Save A L i f e Foundation 36-3869459 Page 5
WM^^Mi Lobbying Expenditures by Electing Public Charities (See instructions.)
(To t s C2r-,p;sted Only by an eligible organization that filed Form 5768) N/A
u
Check e-e *■ a i if U-e organization belongs to an affiliated group.
Check -ere ► b if you checked 'a' above and 'limited control' provisions apply.
45 Lobbying nontaxable
amount
V"t ?/lVCS! ~> >< < if
46 Lobbying ceiling amount
(150% of line 45(e)) . . . . '
47 Total lobbying
expenditures
48 Grassroots non-
taxable amount
":-'■ V> t.1 ^' --* J: •" !,$'l • "v> .-'
49 Grassroots ceiling amount
(150% of line 48(e))
50 Grassroots lobbying
a Volunteers X
b Paid staff or management (include compensation in expenses reported on lines c through h.) X
X
JLJ
IT
XJ
X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means "X
i Total lobbying expenditures (add lines c through h) J:J:J:>::¥?:>?i?::<;--!:w
If 'Yes' to any of the above, also attach a statement giving a detailed description oi the lobbying activities.
BAA TEEAM05 }2f20m Schedule A (Form 990) 1999
Schedule A (Form 590; 1999 Save A L i f e Foundation 36-3869459 Page 6
£$ I Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 C d r e -=rc r>g cganizaticn directly or indirectly engage in any of the following with any other organization described in section 501(c)
zt i:e Czza ^ec tnan section 501(c)(3) organizations) or in section 527, relating to political organizations?
a T-a~s?e*s 'rom t-e reporting organization to a noncharitable exempt organization of: Yes No
(i)Cas- 51 a (1) X
(ii)C'r-e' assets a(ii) X
b O r e ' :ransacticns:
(i)Sa =s o' exchanges of assets with a noncharitable exempt organization b(i) X
(ii)pjrchases of assets from a noncharitable exempt organization b(ii) X
(iii)Renal of facilities, equipment, or other assets b(iii) X
(iv)Reirr.bursement arrangements b(!u) X
(v)Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization. If Iho organization received less than fair mark ' ---■■■- '
any transaction or sharing arrangement show in column (d) the value of the goods, other assets, or services received:
(a) <b) (c) (d)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations .—. .—.
described in section 501 (c) of the Coda (other than section 501(c)(3)) or in section 527? *" U ^ e s CJ ^°
b If 'Yes,1 complete the following schedule:
(a) j (b) (c)
Name of organization Type of organization Description of relationship
Beginning End of
Line 65 - Other Liabilities: of Year Year
Payroll L i a b i l i t i e s -747. 0.
I n t e r e s t due t o S t a t e o f IL 5,675. 0.
Save A Lite Foundation 36-3869459 2
Beginning End of
Line 65 - Other Liabilities: of Year Year
Total 4,928. 0.
Total
Save A Life Foundation 36-3869459 3
Description . Amount
O f f i c e Equipment-Program D e p r e c i a t i o n 8,316.
Vehicles-Program Depreciation 4,570.
Total 12,886.
Description Amount
Total 403.
Description Amount
Total 808.
Description Amount
Total 65,475.
Form 2758 Application for Extension of Time to File
Certain Excise, Income, Information, and Other Returns
OMB No. 1545-0148
5a If this form is for Form 706-GS(D), 706-GS(T), 990-BL, 990-PF, 990-T, 1041 (estate), 1042. 1120-ND, 4720,
6069, 8612, 8613, 8725, 8804, or 8831, enter the tentative tax, less any nonrefundable credits. See instructions
b If this form is for Farm 990-PF, 990-T, 1041 (estate), 1042, or 8804, enter any refundable credits and
estimated tax payments made. Include any prior year overpayment allowed as a credit $
c Balance due. Subtract line 5b from line 5a. Include your payment with this form, or deposit with FTD
coupon if required. See instructions $
Signature,>■ ' f w C /. ^ C e ^ f Till. » M M BJ< BLVD. OES PLA1NES. IL 6QQlft M» " * / ' O o
File Original and One Copy. The IRS will show below whether or not your application Is approved and will return the copy.
Notice to Applicant - To be completed by the IRS
n We Have approved your application. Please attach this form to your return.
We Have Not approved your application. However, wa have granted a 10-day grace period from the later of the date shown below or the
due date of your return (including any prior extensions). This grace period is considered to be a valid extension of time for elections
otherwise required to be made on a timely filed return. Please attach this form to your return.
| | We Have Not approved your application. After considering (he reasons stated in item 4, we cannot grant your request for an extension
of time to file. We are not granting the 10-day grace period.
H We cannot consider your application because it was filed after the due date of the return for which an extension was requested.
Other:
By:
If you want a copy of this form to be returned to an address other than that shown above, please enter the address to which the copy should he senL
Nam»
Under section 501(c) of the Internal Revenue Code (except black lung benefit trust 2000
or private foundation), section 527, or section 4947<aX1) nonexempt charitable trust Open 1o Public
_*pa-r-«e-- r* ?>* i -eatery
l - ' r ~ i = *.#'«jt Service The organization may have to use a copy of this return to satisfy state reporting requirements. inspection
Fo- the 2000 calendar year, or tax year period beginning . 2000, and ending ,20
!>ec^ ' applicant; C Name of organization D Employer Identification Number
Pleaee Uftt
X Otango of addre&s IRS libel
or print
Save A Life Foundation 36-3869459
Change of name or type. Number I street (or P.O. box it mail is not delivered to street adoV) Room/mite E Telephone number
See
| Srubal return e pacific
Inetruc-
9950 Lawrence 300 (847) 928-9683
r-i tlon*. City, Town or Country Stats ZJP code F Check it application pending
received a Form 990 Package in the mail, it should tile a return without financial data. I Enter 4-digit group etempb'on no. (GEN)**
Some states require a complete return. Check this box if the organization is not required
to attach Schedule B (Form 990 or 990-EZ) ►■ Q j
jPaj#ii;;l Revenue, Expenses, and Changes in Net Assets or Fund Balances (see instructions)
1 Contributions, gifts, grants, and similar amounts received:
a Direct public support 1a 32,878
b Indirect public support lb
c Government contributions (grants) 1c 650,000
Ta Ehiougn Ic) (cash*_,
otal (add
d Total (adi lines
noncash i ) Id 682,878.
2 39,186.
Program service revenue including government fees and contracts (from Part VII, line 93)
3
Membership dues and assessments
4 8,725.
Interest on savings and temporary cash investments
5
Dividends and interest from securities
6aGross rents 6a
b
Less: rental expenses 6b
c
Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe *"
(A) Securities (B) Other
8a Gross amount from sales of assets other
than inventory 8a
b Less: cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d
9 Special events and activities (attach schedule)
a Gross revenue (not including . $ 6 , 540
of contributions reported on line la) 9a 15,579.
b Less: direct expenses other than fundraising expenses 9b 14,928.
c Net income or (loss) from special events (subtract line 9b from line 9a) See L T 9 . S t i n t . . 9c 651.
10a Gross sales of inventory, less returns and allowances IOI
b Less: cost of goods sold 10b
c Gross piofit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c
11 Other revenue (from Part VII, line 103) 11 136.
12 Total revenue (add lines Id, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 731,576.
1
^ > ^ p _^grrim "jpruirni (*rrrn l!mr "\ column (B)) 13 711,626.
~~x 14 M a n a p e J i ^ J g i P ^ E ^ I (fr( line 44, column (C)) 14 143,155.
<=£ 15 Fiimuidlsing {.ntm ime m (D)) 15 43,601
16 <f$ lyments to affiliates
tes (atta
(attai Cfe :hedule) J6_
roc
17 !jat»iEW»jfc3s6dr~ l | f t id 44, column (A)) 17 898,382.
Fi new nr frjeflf't) far <h* subtract line 17 from line 12) 18 ■166,806.
Net aQ^S glfunVcj ba^rfes at jeginning of year (from line 73, column (A)) 19_ 547,704.
20 iiOther ehtiiiguj. n nd balances (attach explanation) 20_
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 380,898.
BAA For Paperwork Reduction Act Notice, see separate instructions. TEEA010I 12/26/00 Form 990 (2000)
l<
. Form $90-?:o: Save A L i f e Foundation 36-3869459 Page 2
Eftfrf"' 1 S t a t e m e n t Of F u n c t i o n a l E x p e n s e s All organizations must complete column (A). Columns (8), (C), and (D) are
■ «ecj -»i - c sect cr. 501 (c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.
Z?z -cv .--ctr's 5.-r*x;nrs reported on line (B) Program (C) Management
£c 5c ?r, " 5 or 16 cf Part 1. (A) Total services and general (D) Fundraising
Note. ,'.'-~?e 'equired, attached schedules and amounts within the description (A) (8)
:>~rrm should be (or end-of-year amounts only. D
Beginning of year End of year
45 Cash - noninterest-bearmg 8,925. 45 500.
46 Savngs and temporary cash investments
1,750.
■46 332,812.
3,987.
48a
b Less: allowance for doubtful accounts 48b 48c
49 Grants receivable 49
57b
117,663.
63,038.
)..
■56
6 0 , 8 4 3 . 57c
1 6 2 . 58
54,625.
162.
59 Total assets (add fines 45 through 58) (must equal line 74) 6 1 7 , 3 4 5 . 59 455.579.
60 Accounts payable and accrued expenses 4 , 1 6 6 . 60 8,648.
L 61 Grants payable 61
A 62 Deferred revenue 62
B
1 63 Loans from officers, directors, trustees, and key employees (attach schedule) .. 6 5 , 4 7 5 . 63 65,450.
L
64a Tax-exempt bond liabilities (attach schedule) 64a
T
1 b Mortgages and other notes payable (attach schedule) 0 . 64b
S 65 Other liabilities (describe »• See L i n e 65 S t Ht ) 0 . 65 583.
1
A
S
66 Total liabilities (add lines 60 through 65)
Organizations that follow SFAS 117, check here ► [XJ and complete lines 67
through 69 and lines 73 and 74.
67 Unrestricted
68 Temporarily restricted
49,294.
498,410.
■
6 9 , 6 4 1 . 66
67
68
74,681.
-27,648.
408,546.
I
8
°
69 Permanently restricted
Organizations that do not follow SFAS 117, check here »■
70 through 74.
70 Capital stock, trust principal, or current funds
Q and complete lines
70
71
72 Retained earnings, endowment, accumulated income, or o Iher funds 72
73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through
72; column (A) must equal line 19 and column (B) must equal line 21) 547,704. 73 380,898.
74 Total liabilities and net assets/fund balances (add hn es 66 and 73) 617,345. 74 455.579.
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization. How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore,
please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments.
BAA
TEEA0I03 12/22/00
FormMC T.OJ) Save A L i f e Foundation 36-3869459 Page 4
Ifairt'lV-A -; Reconciliation of Revenue per Audited ;!rl%i$^&'ijj Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions.) per Return
a ~?A rwenue, gains, and other support a Total expenses and losses per audited
::- audited financial statements 786.251 financial statements * 953,057.
:::":':; >:':i>:":u:':<:>:::>^i'>:":oS':o::«:»: :":«£:><
b Amounts included on line a but :
; 'ft v f:": vfft vfhv:';": v'\: w :":':«>:1'; >:':«: : i ^ : : b Amounts included on line a but not
not on line 12, Form 990: i'MjJf ftjjft ft*: ft;ft :>■>: :jvf ij.vfSHlvftlyftv
online 17, Form 990: " J: v ! : S i x " i - : v ! : f t " j f t " jft : $ft-A v ! : f t v : Ji:! v i \'i
(1) Net unrealized (1) Donated serv ii! : :i 'y\ i^Ji v / f t ^ftv Jft^Jft>;Ji v >: i j i *ft|>?ftj j ? :11
gains on ices and use
investments . . . . $ of facilities . . . $
(2) Donated serv (2) Prior year adjust £»:*;¥->;':■>;:<•: :«;_:oft : o " : » : :¥>:IK:; :^>;j : ' 1 - -
ices and use ments reported on :■>::«:<■: » K W : < * : :<■: :w :o: ■■:■■•:.;.: >><;w: ;.
i ft* if: j> > :ft-:t:"ft ■ f :":; |ft'i j j jfi ;■> j j :t|:| j,: '*£ ;,:<* J;
of facilities . . . . line 20, Form 990 . . . . $_ ft:*fi>:
>^>f1o:":«1w! > !:T»fto>"?:« :t¥: :i>>::o>u^
"ivftfvSjvJftl^
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000
from your organization and all related organizations, of whicn more than $10,000 was provided by the
related organizations? □ Yes 0NO
If 'Yes,' attach schedule - see instructions.
BAA TCEA0104 09/21/00 Form 990 (2000)
Form 990 :?:>:0) Save A L i f e Foundation 36-3869459 Page5
%'j|r|yi' j Other Information (See specific instructions.) N/A Yes No
76 2 z r e c-ganization engage in any activity not previously reported to the IRS? If 'Yes,1 attach a detailed description SO!
: ' each activity 76
77 tVere any changes made in the organizing or governing documents but not reported to the IRS? 77
x
' 'Yes,' attach a conformed copy of the changes.
78a D d ihe organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78a
b !f 'Yes,' has it filed a tax return on Form 990-T for this year? 78b
79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If 'Yes,' attach
a statement 79
80a Is the organization related (other than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization? 80a
b If 'Yes,' enter the name of the organization *■ _ _
and check whether it is [ J exempt or
81 a Enter the amount ol political expenditures, direct or indirect, as described in the instructions I 81a
b Did the organization file Form 1120-POL for this year?
\_j nonexempt.
81b
i
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at vA':wi:t>:
87b
At any time during the year, did trie organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations Sections 301.7701-2 and 301,7701-3?
i ■
If 'Yes,' complete Part IX 88
89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under:
Section 4911 ►• 0 . ; Section 4912 ► 0 . ; Section 4955' 0. Mil
b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any Section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement
explaining each transaction 89b
c Enter: Amount of tax imposed on the organization managers or disqualified persons during the year under
Sections 4912. 4955, and 4958
d Enter: Amount of tax on line 89c, above, reimbursed by the organization
90a List the states with which a copy of this return is filed * Illinois
b Number of employees employed in the pay period that includes March 12, 2000 (see instructions) | 90b|
91 The books are in care of ► .Car_0_l_SpJ ZZi_r_r ^ Telephone number ► J847_)_92_8_;96_83_
Located at ► _995_0_ Lawrenc_e_ Suj t e J O Q 3sh C J i f JacX. _1 IL _ ZIP code ■- _60176
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of form 1041 - Check here
and enter the amount of tax-exempt interest received or accrued during the tax year *"| 92 |
*"D
BAA Form 990 (2000)
TEEA0105 12/20/OO
Form 990 rZJX: Save A L i f e Foundation 36-3869459 Page 6
IMUM^t Analysis of Income-Producing Activities (See instructions.)
Unrelated business income Excluded by section 512, 513, a: 5)4
<E)
Er-.e- C-J-SS a-ncjrts unless (A) (B) (C) (D) Related or exempt
: r s ' « s « rdcated Business code Exclusion code Amount function income
Amount
93 Program serv.ce revenue:
a Program Fees 38,386,
b Conferences 800.
c
d
e
f Medicare/Medicaid payments
g Fees & contracts fiom government agencies ,.
94 Membership dues and assessments ..
95 Interest on savings & temporary cash mvmnts.. 14 8.725.
96 Dividends & interest from securities ..
97 Net rental income or (loss) from real estate: !f|a|t!$|5ysi|:}
a debt-financed property
^^i|i^i|ji|i|i|i||i^|i§
ilPiililllittli
b not debt-financed property
98 Net rental income or (loss) from pers prop ..
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events . . . . 651.
102 Gross profit or (loss) from sales of inventory . . . .
b Miscellaneous 136.
c
d
e
104 Subtotal (add columns (B), (D), and (E)) . . . . ;£&!*:>■;:*>:'&*&::?: s;i^S;?i:SII; 8.725. 39,973.
105 Total (add line 104, columns (B), (D), and (E)) . 48,698.
Note: Line 105 plus line Id. Part I. should equal the amount on line 12, Part I.
mmmInformation
(A)
Reqardinq Taxable Subsidiaries and Disregarded Entities (See instructions.)
(B) (CO (D) (E)
N/A
Name, address, and EIN of corporation, Percentage ot Nature of activities Total End-of year
partnership, or disregarded entity ownership inteiest income assets
%
%
%
%
I P r t l X i i i Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions.)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal
Yes QNo
benefit contract?
bDid the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
Note: If 'Yes' to b. file Form 8870 and Form 4720 (see instructions).
Yes 0 LJNo
e n a l t e l of perjury, I declare that I have ciammed tils return, including accompanying schedules and sbtements,, and to the
t h * best
b « t of my knowledge and belief, it-i
itjs I
Please rrect.^ana^oinplel*^ Declaration ol preparer (oths£fran officer) is based on air information o^w/ych pre^iarer has aipHurowledge.
arw^tnowlftdge. ( S e e instructions.)
instructions. * ) i /
Sign
Here •ouaipag
Datt Tyfcrw'oj P r i r ^ N a m * and ' itlft '
Mmj
Date CJieck if Preparer s S S N or PTIN
Paid Pieparer'i
Of A o'OI self-
Pre-
arer's
Signature
(Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n), or Section 4947(aX1) OMB No. 1545-0047
Nonexempt Charitable Trust Supplementary Information - (See separate instructions.)
► Must be completed by the above organizations and attached to their Form 990 or 990-EZ
N a - * c' r * Cnjaruiabon Employer Identification Number
None
(a) Name and address of each independent contractor paid more than $50,000 (b)Type of service (c) Compensation
None
TEEA0401 09(19/00
Schedu.e A - - — 99C o- 390-EZ) 2000 Save A Life Foundation 36-3869459 Page 2
;
|Paft©' : i Statements About Activities Yes No
1 Z-jrq r e yea', nas the organization attempted to influence national, state, or local legislation, including any attempt
:: r ' _erce outi ic opinion on a legislative matter or referendum?
f • es, enter the total expenses paid or incurred in connection with the lobbying activities . . . . * " $
Organizations that made an election under section 501(h) by filing Form 5758 must complete Part Vl-A. Other
o-ganizations checking 'Yes,' must complete Part Vl-B and attach a statement giving a detailed description of the
lobbying activities.
3:":i ;>"!": 3 :
Jj;>vJSc*l i
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any of its
trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization
with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary:
a Sale, exchange, or leasing of property? 2a
;;•£;$;•< i
b Lending of money or other extension of credit? 2b
d Payment ol compensation (or payment or reimbursement of expenses if more than $1,000)? See - P t V , . . Fm . 9 9 0 . 2d
3 Does the organization make grants for scholarships, fellowships, student loans, etc?
4a Do you have a section 403(b) annuity plan for your employees? 4a
b Attach a statement to explain how the organization determines that individuals or organizations receiving grants
or loans from it in furtherance of its charitable programs quality to receive payments, (See instructions.)
13 [ J An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in: (1) lines 5 through 12 above; or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2). (See
section 509(a)(3).)
Provide the following information about the supported organizations. (See instructions.)
14 f l An organization organized and operated to test for public safety. Section 509(a)(4). (See instructions.)
BAA TEEA0402 12)11/00 Schedule A (Form 990 or Form 990-EZ) 2000
Schedule A --..— 99C ;• 990-EZ) 2000 Save A L i f e Foundation 36-3869459 Page 3
&jfi$fV~A 1 Support Schedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting.
Calenear year (or fiscal year (e)
beginning in) ** 1999 1958 1997 1996 Total
*
15 Gifts, grants, and contributions
-ece:ved. (Do not include
'_r_sjal grants. See line 28.) ... 621,043. 621.289. 101,330. 37,566. 1.381.228.
16 Membership fees received 550. 1.527. 2,077.
17 Gross receipts from admissions,
merchandise sold or services performed,
oi furnishing o1 facilities in any activity
that is not a business unrelated to the
organization's charitable, etc, purpose 41,158. 6.134. 47,292.
18 Gross income from interest, dividends,
amounts received from payments on
securities loans (Section 512(a)(5)),
rents, royalties, and unrelated business
taxable income (less Section 511 taxes)
from businesses acquired by the organ
ization after June 30, 1975 24,575. 676. 25,251.
19 Net income from unrelated business
activities not included in line 13
20 Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf
21 The value of services or
facilities furnished to the
organization by a governmental
unit without charge. Do not
include the value of services or
facilities generally furnished to
the public without charge
22 Other income. Attach a
schedule. Do not include
gain or (loss) from sale of
capital assets
23 Total of lines 15 through 22 . . . . 686,776. 628,099. 101,880. 39,093. 1,455,848.
24 Line 23 minus line 17 645.618. 621.965. 101.880. 39.093. 1,408,556.
25 Enter 1% of line 23 6,868. 6,281. 1,019. 3 9 1 . £ i!"i :■$;-: 3JxX?-J;>;;!>J-,;K: :Kjj;<f>: :'■">: ■%
26 Organizations described on lines 10 or 11: a Enter 2% of amount in co lumn (e), line 24 *■ 26a 28,171.
b Attach a list (which is not open to public inspection) showing the name of and amount contributed by each
person (other than a governmental unit or publicly supported organization) whose total gifts for 1996 through
1999 exceeded the amount shown in line 26a. Enter the sum of all these exc ess amounts *■ 26 b
c Total support for Section 509(a)(1) test: Enter line 24, column (e) »- 26 c 1,408,556.
ft:":iv':Si.':>!
d Add: Amounts from column (e) for lines: 18
22
25,251. 19
26b ....►" 26 d
iiiiifiill!
25,251.
• Public support (line 26c minus line 26d total) *■ 26 e 1,383,305.
f Public support percentage (line 2 He (numerator) divided by line 26c (denominator)) ►■ 26 f 98.21 %
27 Organizations described on line 12:
a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' attach a list (which is not open to public
inspection) to show the name of, and total amounts received in each year from, each 'disqualified person.' Enter the sum ol such amounts
for each year:
(1999) (1998) (1997) (1996)
bFor any amount included in line 17 that was received from a nondisqualified person, attach a list to show the name of, and amount
received for each year, that was more than the larger of (1) 'he amount on line 25 for the year or (2) $5,000. (Include in the list
organizations described in lines 5 through 11, as well as individuals.) After computing the difference between the amount received
and the larger amount described in (l)or (2), enter the sum of these differences (the excess amounts) for each year:
(1999) (1998) (1997) (1996)
c Add: Amounts from column (e) for lines: 15 16
17 20 21 27c
d Add: Line 27a total and line 27b total 27d
e Public support (line 27c total minus line 27d total) 27e S!!K.l!MI«.i!!*!!!;Wi!;
f Total support for section 509(a)(2) test: Enter amount on line 23, column ( e ) . . . . 27f ;:3::SCii::5?S:>SisiSS!?:s?iiSSiS
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 27g %
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)). 27h
28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 19% through 1999, attach a
list (which is not open to public inspection) for each year showing the name of the contributor, the date and amount of the grant, and a
brier description of the nature of the grant. Do not include these grants in line 15. (See instructions.)
BAA TEEAM03 12/10/00 Schedule A (Form 990 or 990-EZ) 2000
Schedule A :^c—i 99C or 990EZ) 2000 Save A L i f e Foundation 36-3869459 Page 4
j j j j p i i r ^ l Private School Questionnaire (See instructions.)
(To be completed Only by schools that checked the box on line 6 in Pert IV) N/A
Yes No
29 I/oes r e cganization have a racially nondiscriminatory policy toward students by statement rn its charter, bylaws,
or.er governing instrument, or in a resolution of its governing body? 29
30 Does S~e organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
ard scholarships? 30
> >
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves? 31
If 'Yes,' please describe; if 'No,' please explain. (It you need more space, attach a separate statement.)
1
■> > ^
< t o
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondiscriminatory basis? 32b
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing
with student admissions, programs, and scholarships? 32c
d Copies of all material used by the organization or on its behalf to solicit contributions? 32d
11
If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.) w$$
33 Does the organization discriminate by race in any way with respect to:
a Educational policies? 33 e
■
h Other extracurricular activities? 33h
's"s™»-
If you answered 'Yes1 to any of the above, please explain. (If you need more space, attach a separate statement.)
ft ■iSlffiUj
34a Does the organization receive any financial aid or assistance from a governmental agency? 34i
b Has the organization's right to such aid ever been revoked or suspended? 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement.
35 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05
of Rev Proc/5-50, 1975-2 C.B. 587, covering racial nondiscrimination? If 'No,' attach an explanation 35
TEEA04M 12/1 WOO Schedule A (Form 990 or 990-EZ) 2000
Schedule A (Fz--^ 990 zr 990-EZ) 2000 Save A L i f e Foundation 36-3869459 Page 5
Pij|E:ffi-Av>l Lobbying Expenditures by Electing Public Charities (See instructions.)
c oe completed Only by an eligible organization that filed Form 5768)
Over 1500.000 but not ovei $1,000,000 $100,000 plus 15% of the excess over $500,000 ■:>-:;:^r;;;>:£:^:w>:^>:>L>>;l<:^&:^>
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41
.. :■>: :o: :*■:::■>: :w>:*>: :<■>:«■: :<■>: :(*>::<•:l>o:j
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% ot the excess over $1,500,000 ■>::■>: :v. :*>::■>: w.:»: K-K :►-:■:■!*: : « : : » : :«:>
:■»::«:■»■: :<•>: :•>: :<■>: : « : < « r : o * r * : : :■>: » > „ *
45 Lobbying nontaxable
amount
48 Grassroots non-
taxable amount
50 Grassroots lobbying
expenditures
RlrWBPLobbvinqAc ;tivity by Nonelecti ng Public Charitie;
(For reporting only by organizations that did not complete Part Vl-A) (See instructions.)
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of: Yes No Amount
to- :>:*:*■<£■$■ ■&■£■ ■&■ :•>>■<!* 0 i * x S
a Volunteers X
b Paid staff or management (include compensation in expenses reported on lines c through h.) X vJivj:v::^^iv^x^:iv«:^x?S3Kvjs^
c Media advertisements X
d Mailings to members, legislators, or the public X
e Publications, or published or broadcast statements X
f Grants to other organizations for lobbying purposes X
g Direct contact with legislators, their staffs, government officials, or a legislative body X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X
i Total lobbying expenditures (add lines c through h) Mliilil!
If 'Yes' to any of the above, also attach a statement givmg a detailed description of the lobbying activities.
BAA TEEA0405 Ian/Do Schedule A (Form 990 or 990-EZ) 2000
Schedule A ^ : ~ i 990 ;^ 990-EZ) 2000 Save A L i f e Foundation 36-3869459 Page 6
Pajli^Tiinformation Regarding Transfers to and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 Dia r e .-eocmng organization directly or indirectly engage in any of the following with any other organization described in section 501(c)
c' r e Cede (ether than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Tra-s'e's from the reporting organization to a noncharitable exempt organization of: Yes No
(i)Cash 51 a (i) X
(ii)Cther assets «(") X
b Other transactions:
(i)Sales or exchanges of assets with a noncharitable exempt organization b(i) X
(ii)Purchases ol assets from a noncharitable exempt organization b(ii) X
(iii)Rental of facilities, equipment, or other assets b (lii) X
(iv)Reimbursement arrangements b(iv) X
(v)Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraising solicitations b(wi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in
any transaction or sharing arrangement, show in column (a) the value of the goods, other assets, or services received:
(b) (c)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations . . . .
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? * [_J Yes |Xj No
b If 'Yes.' complete the following schedule:
(b) (c)
Name of organization Type of organization Description of relationship
TEEA0701 12/20/00
Schedule B :~s~-, 990 z' 990-EZ) (2CO0) Page 1 of 2 of Part I
Nanto of Orgiiurteii Employtr Identification Number
1 Individual X
Payroll
$ 600,000. Noncash
(Complete Part II if a
noncash contribution.)
2 Individual JX
Payroll _
$ 50a000. Noncash \_
(Complete Part II if a
noncash contribution.)
Individual
Payroll
$ Noncash
(Complete Part II if a
noncash contribution.)
Individual
Payroll
$ Noncash
(Complete Part II if a
noncash contribution.)
Individual
Payroll
% Noncash
(Complete Part II if a
noncash contribution.)
\
■ Save A Life Fcurcation 36-3869459 1
New Program Development - Research & development for new ways (o serve the community
Program Service Expenses $2,301
\
Save A Life Foundation 36-3869459 2
Beginning End of
Line 65 - Other Liabilities: of Year Year
I n s t r u c t o r Deposits 0. 190.
Due t o M o r e l l i Fund 393.
Total 583.
Total
Save A Life Foundation 36-3869459 3
Description Amount
Total 16,858.
Description Amount
Total 65,475.
OMBNo 1545-0047
Form 990 Return of Organization Exempt from Income Tax
Under Section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
2001
(except black lung benefit trust or pnvate foundation)
Department of the Treasury
Open to Public
Internal Revenue Service - The organization may have to use a copy of this return to satisfy state reporting requirements Inspection
For the 2001 calendar year, or tax year beginning , 2001, and ending
Check if aptdtcatJ* C Name of organization D Employer Identification Number
Please use
Address change IRS label Save A L i f e Foundation 36-3869459
or print
Name change or type Number street (or P 0 box il mail is not delivered to street addr) Room/suite Telephone number
Sea
Initial return •pacific 9950 Lawrence 300 (847) 928-9683
Instruc
Final return
Amended return
tion* City Town or Country
Schiller Park
State
IL
ZIP code + 4
Application pending • Section 501 (cX3) organizations and 4947(a)(1) nonexempt H sndl or» notapplKabh to Section 527 orgoniZations
chantable trusts must attach a completed Schedule A H ( a ) Is this a group return for affiliates' | j Ye» j X j No
(Form 990 or 990-EZ).
H ( b ) If yes, enter number of affiliates
G Web site- »■ www s a l f org
H ( C ) Are all affiliates melided* Q ] Ye* \_\ No
J Organization type ,-, ,—. ,-, (If no, attach a list See instructions )
( C h e c k O n l y One) *" | X ] 501(c) 3 * (insert n o ) | _ ) 4947(a)(1) or [_J 527
H ( d ) It tfus a separate return hied by an
K Check here * | ) if the organization's gross receipts are normally not more than
organization covered by a group ruling' y M | x j No
$25,000 The organization need not file a return with the IRS, but if the organization
received a Form 990 Package in the mail, it should U\e a return without financial data Enter 4 digit group GEN
Some states require a complete return M Check *• [_j it the organization is not required
L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 » 1 , 7 5 8 , 8 9 9 to attach Schedule B (Form 990, 990 EZ, or 990 PF)
[Part F,^>-:::J Revenue, Expenses, and Changes in Net Assets or Fund Balances (see instructions)
1 Contributions, gifts, grants, and similar amounts received
a Direct public support la 88.699 3$&
b Indirect public support lb
c Government contributions (grants) 1c 1,470,470 ■
d
Ta°t"^dcilTcS)S(caSh$ encash $ ) Id 1,559,169
2 Program service revenue including government fees and contracts (from Part VII, line 93) 115,423
3 Membership dues and assessments
4 Interest on savings and temporary cash investments 3,275
5 Dividends and interest from securities
6 a Gross rents 6a
b Less rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe **
(A) Securities (B) Other
8a Gross amount from sales of assets other
than inventory 8a
b Less cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d
9 Special events and activities (attach schedule) iV:-
a Gross revenue (not including $ 4 4 , 564 of contributions
reported on line la) 9a 73,491
b I riv rlirnnt tiripffmn nthrr than fundraising expenses 9b 70,761
c^£UeVr5&; .) froiT special events (subtract line 9b from line 9a) See L-9 Stoit 9c 2,730
I P * Gross sales of invent) ess returns and allowances 10a
bxess. cx>si Qjjaaods 10b
ITJT nossiirom .tfgqof inventory (attach schedule) (subtract line 10b from line 10a) 10c
fl' OUltJI I H U I U C (IllWH VII, line 103) 11 7,541
i2QQDBMi»U5F lines d, 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 1.688.138
T3 PlUyrmil bmvii.es (fi urn-tine 44, column (B)) 13 749.494
14 Management and general (from line 44, column (C)) 14 111.917
15 Fundraising (from line 44, column (D)) 15 13.630
16 Payments to affiliates (attach schedule) 16
17 Total expenses (add lines 16 and 44, column (A)) 17 875,040
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 813.098
19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 380,898
20 Other changes in net assets or fund balances (attach explanation) 20
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 1,193.996
BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA0101 01/16/02 Form 990 (2001)
V" n
Form 990(2001) Save A Li f e Foundation 36-3869459 Page 2
P a t t t e n S t a t e m e n t Of F u n c t i o n a l E x p e n s e s All organizations must complete column (A) Columns (B), (C), and (D) are
required for section 501(c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others
Do not include amounts reported on line • 0 koV (B) Program (C) Management
6b, 8b. 9b, 10b or 16 of Part 1 (A) Total services and general (D) Fundraising
Note Where required attached schedules and amounts within the description (B)
column should be for end of-year amounts only Beginning of year End of year
45 "Cash — non interest bearing 500 45 115,104
46 Savings and temporary cash investments 332.812 46 300.464
N
through 69 and lines 73 and 74
?
A 67 Unrestricted -27,648 67 112.566
S
S 68 Temporarily restricted 408,546 68 1,081.430
J 69 Permanently restricted 69
0 Organizations that do not follow SFAS 117, check here ►■ Q and complete lines
R
70 through 74
G 70 Capital stock, trust principal, or current funds 70
B 71 Paid in or capital surplus, or land, building, and equipment fund 71
8 72 Retained earnings, endowment, accumulated income, or other funds 72
\ 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through
i 72, column (A) must equal line 19 and column (B) must equal line 21) 380,898 73 1.193.996
74 Total liabilities and net assets/fund balances (add lirles 66 and 73) 455,579 74 1,271.793
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore,
please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments
BAA
TEEA0I03 09/25/01
Form990 (2001) Save A L i f e Foundation 36-3869459 Page 4
[RartlfeAa Reconciliation of Revenue per Audited PartiVrB:]Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions ) per Return
a Total revenue, gams, and other support a Total expenses and losses per audited
per audited financial statements 1,838,502 financial statements ■
b Amounts included on line a but b Amounts included on line a but not
not on line 12, Form 990 on line 17, Form 990
(1) Net unrealized (1) Donated serv
gains on ices and use
investments of facilities
(2) Donated serv (2) Prior year adjust
ices and use ments reported on
of facilities line 20, Form 990
(3) Recoveries of prior (3) Losses reported on
year grants line 20, Form 990
(4) Other (specify) (4) Other (specify)
-*- " V ^ V w >■-
See A t t a c h e d See Attached
150,364
Add amounts on lines (1) through (4) 150,364 Add amounts on lines (1) through (4)
c Line a minus line b 1.688,138 c Line a minus line b
'"•0*0
d Amounts included on line 12, d Amounts included on line 17,
Form 990 but not on line a Form 990 but not on line a.
& - >r,
0 ) Investment expenses 0 ) Investment expenses
not included on line not included on line
6b, Form 990 $ 6b, Form 990
(2) Other (specify) (2) Other (specify)
$ $
Add amounts on lines (1) and (2) Add amounts on lines (1) and (2)
e Total revenue per line 12, Form Total expenses per line 17, Form
990 (line c plus line d) 1,688,138 990 (line c plus line d) 875,040
Part V -j List of Officers, Directors, Trustees, and Key Emp o y e e s (List each one even if not compensated, see instructions )
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
(A) Name and address per week devoted Of not paid, employee benefit account and other
to position enter -0-) plans and deferred allowances
compensation
£ i rol _ Spj z z i_r_r ^
P r e s / E x e c Di r 40 94,309 2,290
Sam Amirante
Vice President 0
Daniel Caravello
Treasurer
Martin A Sandoval
Secretary
Carlos M Azcotia
Director
Dr _ Stanl ey_ Z^dlo_
Director
Or Scott Betzelos
Director
Deloris M Burnam
Director
Michael Lavalle
Director
I
87 501(c)( 12) organizations Enter a Gross income from members or shareholders 87a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them ) 87b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations Sections 301 7701 2 and 301 7701 3 7
If 'Yes,' complete Part IX 88
89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under
Section4911 ► 0 , Section 4912*■ 0 , Section 4 9 5 5 " 0 $J
b 501(c)(3) and 501(c)(4) organizations Did the organization engage in any Section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year 7 If 'Yes,' attach a statement
explaining each transaction 89b
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under Sections 4912, 4955, and 4958 * ■
0
d Enter Amount of tax on line 89c, above, reimbursed by the organization * ■
0
90a List the states with which a copy of this return is filed *■ _I l l_1_pp 1_S
b Number of employees employed in the pay period that includes March 12, 2001 (see instructions) r90bi 9
91 The books are in care of ■• _Car_q_l_5pJ z z i _ r j ] _ Telephone number * (847) 928-9683
Located at *■ _9950_ Lawrenc_e_ Sui t e _300,_Schi_l_ler_ _Park IL ZIP+4 - 60176
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here TJ
and enter the amount of tax exempt interest received or accrued during the tax year 92
BAA Form 990 (2001)
TEEA0105 01JD1TO
Form990(200l) Save A L i f e Foundation 36-3869459 Page6
f PartVft; Analysis of Income-Producing Activities (See instructions)
Unrelated business income Excluded by section 512, 513, or 514
(E)
Note Enter gross amounts unless (A) (Q Related or exempt
otherwise indicated Business code Amount Exclusion code Amount function income
93 Program service revenue
a Program Fees 17,979
b Course M a t e r i a l s 97,444
c
d
e
1 Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash invmnts 14 3.275
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate ;*$?,% ^ % y S ;.--;■■;'&y-» > ? ^ " > X ^ > * ^ " V v V i I £«%¥£&&!$
a debt financed property
b not debt financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gam or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events 1 2.730
102 Grots profit or 0 ° " ) fro™ sales of inventory
103 Other revenue a - > ■ > , ,■-> * V j *-C *<*>*,*<*' i V i . v &*■£" *?>,<?>**?', ,*&ust &&$ ^ > X C |
b Miscellaneous 7.541
c
d
e
104 Subtotal (add columns (B), (0), and (E)) ■■ *V ^V***1**; v/^ ( --r^ 6.005 122,964
105 Total (add line 104, columns (B), (D), and (E)) 128.969
Note Line W5plus line Id, Part I, should equal the amount on line 12 Part I
frfrrtW Relationship of Activities to the Accomplishment of Exempt Purposes (See instructions)
Line No Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes)
93a,93b Promote and teach life saving first aid programs
103a To supplement funding required to perform and carry out the life
saving first aid programs
Part DC* Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions) N/A
(A) (B) (C) (D) <E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of year
partnership, or disregarded entity ownership interest income assets
girtX? Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract'
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract 7
Note If 'Yes' to (b), file Form 8870 andForm 4720 (see instructions)
UndoTpenalbes perjur d«c|are that I have examined this return including accompanying schedules and statements and to the. best of my knowledge and belief, it is
true icon-act and qpleti arabon of prsparer (other than officer) le-osied on
f i air
alt information
information of
ol which
whic preparer has any knowM '
^
M Date
OMBNo 1545-0047
Organization Exempt Under
Schedule A Section 501(c)(3)
(Form 990 or 990-EZ)
(Except Pnvate Foundation) and Section 501(e), 501(f), 501(k), 50l(n), or Section 4947(a)(1)
Nonexempt Chantable Trust Supplementary Information — (See separate instructions )
Supplementary Information — (see separate instructions)
2001
Department ol (he Treasury
Internal Revenue Service *■ Must be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name of the Organization Employer Identification Number
Laura F i l l Q p e l l I
(a) Name and address of each independent contractor paid more than $50,000 (b)Type of service (c) Compensation
None
TEEA0401 01/24/02
Schedule A (F orm990or990EZ)2001 Save A L i f e Four dat i o n 36-3869459 Page 2
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendum 7 If "Yes," enter the total expenses paid
or incurred in connection with the lobbying activities ^ $
(Must equal amounts on line 38, Part Vl-A, or line i of Part Vl-B)
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI A Other
organizations checking 'Yes,' must complete Part VI 8 and attach a statement giving a detailed description of the
lobbying activities M
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary7 (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions ) sty
a Sale, exchange, or leasing of property 7 2a
2c
c Furnishing of goods, services, or facilities 7
See Pt V. Fm 990
2d
d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)7
3 Does the organization make grants for scholarships, fellowships, student loans, etc 7 (See Note below)
4 Do you have a section 403(b) annuity plan for your employees7
Note Attach a statement to explain how the organization determines that individuals or organizations receiving > .^ .O ••/■. O 0> -J.CO O OJ
■ ■*-H-o w o o : o/io-o. o0 o.°J
grants or loans from it in furtherance of its charitable programs qualify' to receive payments ■. ■"■ ■.O^O.O, . o ^ of ./o, ^*
The organization is not a private foundation because it is (please check only One applicable box)
5 A church, convention of churches, or association of churches Section 170(b)(l)(A)(i)
6 ~ A school Section 170(b)(l)(A)(n) (Also complete Part V )
7 A hospital or a cooperative hospital service organization Section 170(b)(l)(A)(m)
8 A federal, state, or local government or governmental unit Section 170(b)(1)(A)(v)
9 _ A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(m) Enter the hospital's name, city,
and state *■
10 L | An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)
(Also complete the Support Schedule in Part IV A )
11a 0 An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV A )
11 b Q A community trust Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV A )
12 L_) An organization that normally receives O) more than 33-1/3% of its support from contributions, membership fees, and gross receipts
from activities related to its charitable, etc, 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) (Also complete the Support Schedule in Part IV A )
13 C j An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3))
Provide the following information about the supported organizations (See instructions )
14 I t An organization organized and operated to test for public safety Section 509(a)(4) (See instructions )
BAA TEEAM02 01/21/02 Schedule A (Form 990 or Form 990 EZ) 2001
Schedule A (Form 990 or 990 EZ) 2001 Save A L i f e Foundation 36-3869459 Page 3
|PartlV-AHSupport Schedule (Complete only if you checked a box on line 10, 11, or 12) Use cash method of accounting.
Note You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year (e)
beginning in) * 2000 .& 1998 .& Total
15 Gifts, grants, and contributions
received (Do not include
unusual qrants See line 28 ) 682,878 621.043 621.289 101.330 2,026.540
16 Membership fees received 550 550
17 Gross receipts from admissions,
merchandise sold or services performed,
or furnishing of facilities in any activity
that is related to the organization's
charitable, etc, purpose 52,664 41,158 6,134 99.956
18 Gross income from interest, dividends,
amounts received from payments on
securities loans (Section 512(a)(5)),
rents, royalties, and unrelated business
taxable income (less Section 511 taxes)
from businesses acquired by the organ
ration after June 30, 1975 8,725 24.575 676 33.976
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf
21 The value of services or
facilities furnished to the
organization by a governmental
unit without charge Do not
include the value of services or
facilities generally furnished to
the public without charqe
22 Other income Attach a
schedule Do not include
gain or (loss) from sale of
capital assets
23 Total of lines 15 through 22 744,267 686.776 628,099 101,880 2,161.022
24 Line 23 minus line 17 691,603 645.618 621.965 101,880 2,061.066
25 Enter 1% of line 23 7,443 6.868 6.281 1,019 _ -f 3 o < - . - : \ , o ft ^ j t
29 Does the organization have a racially nondiscnminatory policy toward students by statement in its charter, bylaws,
other "governing instrument, or in a resolution of its governing body' 29
30 Does the organization include a statement of its racially nondiscnminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships7 30
if
iW
■ % *
31 Has the organization publicized its racially nondiscnminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves7 31
If Yes," please describe, if 'No,' please explain (If you need more space, attach a separate statement)
381
& !i $8*
32 Does the organization maintain the following Hit*? ■M*
a Records indicating the racial composition of the student body, faculty, and administrative staff7 32a
b Records documenting that scholarships and other financial assistance are awarded on a racially
nondiscnminatory basis 7 32b
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing
with student admissions, programs, and scholarships7 32c
32 d
d Copies of all material used by the organization or on its behalf to solicit contributions7
If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement)
is
3ft
+j-.<r?
If you answered 'Yes to any of the above, please explain (If you need more space, attach a separate statement)
:lt
i :o< •
34a Does the organization receive any financial aid or assistance from a governmental agency7 34a
b Has the organization's right to such aid ever been revoked or suspended7 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement
H ¥£3
35 Does the organization certify that it has complied with the applicable requirements of
sections 4Oi through 4 05 of Rev Proc 75 50, 1975 2 C B 587, covering racial
nondiscrimmation7 If 'No,' attach an explanation 35
TEEADW4 09/2M)l Schedule A (Form 990 or 990 EZ) 2001
Schedule A (Form 990 or 990 EZ) 2001 Save A L i f e Foundation 36-3869459 Page5
»arfe>VfcA£lLobbying Expenditures by Electing Public Charities (See instructions)
(To be completed Only by an eligible organization that filed Form 5768)
Check if the organization belongs to an affiliated group Check *■ b | | if you checked a' and 'limited control' provisions apply
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for all electing
(The term 'expenditures' means amounts paid or incurred ) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table - 'JvK ..V V £ V<
If the amount on line 40 is - The lobbying nontaxable amount is — V l• ^*s- <
.<Vs,
— ■^ / h :
Not over $500,000 20% of the amount on line 40
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 - 41
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000
Over $17,000,000 $1,000,000 _
42 Grassroots nontaxable amount (enter 25% of line 41) 42
43 Subtract line 42 from line 36 Enter 0 if line 42 is more than line 36 43
44 Subtract line 41 from line 38 Enter -0 if line 41 is more than line 38 44
Caution If there is an amount on either line 43 or line 44, you must file Form 4720 'V/^^: !->^v:V4<S*l
4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five columns below
See the instructions for lines 45 through 50 )
45 Lobbying nontaxable
amount
■ IP IXIJ'i.n,uauj i■inwunn 1.1 HIi g u v
T^T'^t
46 Lobbying ceiling amount ■.-,'XMr:
(150% of line 45(e))
47 Total lobbying
expenditures
48 Grassroots n o n
taxable a m o u n t
50 Grassroots lobbying
expenditures
PafEYH&^l Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part VI A) (See instructions)
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount
a Volunteers X
b Paid staff or management (include compensation in expenses reported on lines c through h ) X
c Media advertisements X 0
d Mailings to members, legislators, or the public X 0
e Publications, or published or broadcast statements X 0
f Grants to other organizations for lobbying purposes X 0
g Direct contact with legislators, their staffs, government officials, or a legislative body X 0
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X 0
i Total lobbying expenditures (add lines c through h ) V** „*"*%<& 0
If 'Yes to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 990 EZ) 2001
TEEA040S 12/31/01
Schedule A (Form 990 or 990 EZ) 2001 Save A L i f e F o u n d a t i o n 36-3869459 Page 6
iFirfcyiK-j Information Regarding Transfers To and Transactaons and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 Did the reporting organization directly or indirectly engage in any ol the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations7
a Transfers from the reporting organization to a noncharitable exempt organization of Yes No
(i)Cash 51 a (i) X
(n)Other assets a(iO X
b Other transactions
(i)Sales or exchanges ot assets with a noncharitable exempt organization b(i) X
(ii)Purchases of assets from a noncharitable exempt organization b(ii) X
(iu)Rental ot facilities, equipment, or other assets b (m) X
(iv)Reimbursement arrangements b(iv) X
(v)Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization If the organization received less than fair market value in
any transaction or sharing arrangement, show in column (a) the value of the goods, other assets, or services received
(b) (c) (d)
Line no Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax exempt organizations .—. .—.
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527' *■ | j Yes [Xj No
b If 'Yes,' complete the following schedule
(a) (b) (c)
Name of organization Type of organization Description of relationship
Check if your organization is covered by the general rule or a special rule (Note Only a Section 501(c)(7), (8), or (W) organization can check
box(es) for both the general rule and a special rule - see instructions )
General Rule —
r~] For organizations filing Form 990, 990 EZ, or 990 PF that received, during the year, $5,000 or more (in money or property) from any one
contributor (Complete Parts I and I I )
Special Rules -
[x]For a Section 501(c)(31 organization filing Form 990, or Form 990 EZ, that met the 33 1/3% support test of the regulations under sections
509(a)(l)/170(b)(l)(A)(vi) and received from any one contributor, during the year, a contribution of the greater of 55,000 or 2% of the
amount on line 1 of these forms (Complete Parts I and II)
DFor a Section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990 EZ, that received from any one contributor, during the year,
aggregate contributions or bequests of more than $1,000 for use exclusively tor religious, charitable, scientific, literary, or educational
purposes, or the prevention of cruelty to children or animals (Complete Parts I, II, and III)
□ For a Section 501(c)(7), (8), or (10) organization filing Form 990, or Form 990 EZ, that received from any one contributor, during the year,
some contributions for use exclusively for religious, charitable, etc, purposes, but these contributions did not aggregate to more than
$1,000 (If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable,
etc, purpose Do not complete any of the Parts unless the general rule applies to this orgainization because it received nonexclusively
religious, charitable, etc , contributions of $5,000 or more duing the year) ** $
Caution Organizations that are not covered by the general rule and/or the special rules do not file Schedule B (Form 990, 990 EZ, or 990-PF)
but must check the box in the heading of their Form 990 Form 990 EZ, or on line 1 of their Form 990 PF, to certify that they do not meet the
filing requirements of Schedule B (Form 990, 990 EZ, or 990 PF)
BAA Schedule B (Form 990, 990 EZ, or 990 PF) (2001)
TEEA07O1 I2/3CW1
Schedule B (Form 990, 990 EZ, 990 PF) (2001) Page 1 to 1 of Part I
Name of Organization Employer Identification Number
Person X
Payroll _
$ 600.000 Noncash
(Complete Part II if there is
noncash contribution)
Person X
Payroll
$ 870,470 Noncash
(Complete Part II if there is
noncash contribution)
Person
Payroll
$ Noncash
(Complete Part II if there is
noncash contribution)
Person
Payroll
$ Noncash
(Complete Part II if there is
noncash contribution)
Person
Payroll
$ Noncash
(Complete Part II if there is
noncash contribution)
Person
Payroll ^^
$ Noncash
(Complete Part II if there is
noncash contribution)
BAA TEEA0702 01/D2AJ2 Schedule B (Form 990, 990 EZ, 990 PF) (2001)
Save A Life Foundation 36-3869459 1
Beginning End of
Line 58 - Other Assets: of Year Year
Deposits 162 0
Save A Life Foundation 36-3869459 2
Beginning End of
Line 5 8 - O t h e r A s s e t s : of Year Year
Beginning End of
Line 65 - Other Liabilities' of Year Year
Robert Conroy
Director 0 0 0
Wayne Roberts
Director 0 0 0
Note The individuals above
except as noted, spend time
as needed in t h e i r capacity
on the Board, They can be
contacted c/o Save a L i f e
Foundation, 9950 Lawrence
Ste 300 S c h i l l e r Park, I L 60176
Total
Save A Life Foundation 36-3869459 3
Supporting Statement of
Description Amount
Total 16,662
Description Amount
Total 1,808
Supporting Statement of
Description Amount
Total 68,755
Supporting Statement of
Description Amount
Total 150,364
Save A Life Foundation 36 3869459 4
Description Amount
Total 150,363
ON© No 1S45-0047
Return of Organization Exempt from Income Tax
Under section 501(c), 527, or 4947(a)(1) ° f the Internal Revenue Code 2002
(except black lung benefit trust or private foundation)
Department of the Treasury Open to Public
Internal Revenue Service *■ The organization may have to use a copy of this return to satisfy state reporting requirements Inspection
For the 2002 calendar year, or tax year beginning , 2002, and ending
Chech if applicable C Name of organization D Employer I d e n l i B c i t o n Number
Pleas* u s *
Address change IRS l « b d Save A L i f e Foundation 36-3869459
or print
Name change or type Number iUeel (01 P O box it mail ra not delivered I D s t i e t t addr) Roomrsurte E Telephone number
Set
Initial return specific 9950 Lawrence 300 (847) 9 2 8 - 9 6 8 3
Instruc
Final return tions. City town or country State ZIP code <-4
F ftSBSS1"" U«" 0
Amended return
Application pending
Schiller Park
Section 501(cX3) organizations and 4947(a)(1) nonexempt
IL 60176 n Other (specify) 1
H and I are net appftcablc to section 527 organizations
Accrual
chantable trusts must attach a completed Schedule A H ( a ) Is this a group return for affiliate*' I | Yes [ X ] No
(Form990or990-EZ).
H ( b ) II "Yes, enter number of affiliates * "
G Website www s a l f orR
H (C) Are all affiliates included 7 Q Yes Q No
J
K
Organization type
(check only one) 501(c) m
3 ■* (insert n o ) | | 4947(a)(1) or
Check here ^ Q if the organization's gross receipts are normally not more than
I I SZ7
(If No attach a Bst See instructions )
73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through
72, column (A) must equal line 19, column (B) must equal line 21) 1,193,996 73 873,291
74 Total liabilities and net assets/fund balances (add lines 66 and 73) 1,271,793 74 972,418
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization How the public perceives an organization in such cases may be determined by the information presented on its return Therefore,
please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments
BAA
TEEA0103 09/0-VO2
Form990(2002) Save A L i f e Foundation 36-3869459 Page 4
Part IV-A | Reconciliation of Revenue per Audited P a r t h A B j Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions ) per Return
a Total revenue, gams, and other support Total expenses and losses per audited
per auditedfinancialstatements 1,284,609 financial statements ■ 1,605,314
b Amounts included on line a but Amounts included on fine a but not
not on line 12, Form 990 on line 17, Form 990
(1) Net unrealized ' - . _ ' Ji 0 ) Donated serv
gains on ices and use
investments of facilities
(2) Donated serv (2) Prior year adjust
ices and use merits reported on
of facilities line 20, Form 990
$ $
and
Add amounts on tines (1) and (2) Add amounts on lines (1) (2)
Total revenue per line 12, Form Total expenses per hne 17, Form
990 (line c plus line d) 1.101,982 990 (line c plus line d) 1,422.687
Part V List of Officers, Directors, r u s t e e s , a n d K e y E m p l o y e e s (List each one even if not compensated, see instructions )
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted (if not paid, employee benefit account and other
(A) Name and address to position enter -0-) plans and deferred allowances
compensation
_Car_o_l_Sp_i zz I_rr i_
Treasurer
Martin A Sandoval
Secretary
Carlos M Azcotia
Director
_pr _Stanley_ _Z^dl_o_
Director
75 Did any officer director, trustee, or key employee receive aggregate compensation of more
than $100,000 from your organization and all related organizations, of which more than
$10,000 was provided by the related organizations 7 * D Yes 0 No
If 'Yes, attach schedule - see instructions
BAA Form 990 (2002)
TEEA01W 01/2203
Form 990 (2002) Save A L i f e F o u n d a t i o n 36-3869459 Page5
Part VI | Other Information (See instructions) Yes No
76 Did the organization engage in any activity not previously reported to the IRS 7 If 'Yes,'
attach a detailed description of each activity 76
77 Were any changes made in the organizing or governing documents but not reported to the IRS 9 77
tf "Yes," attach a conformed copy of the changes
553
78 a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return 7 78 a
b If 'Yes,' has it filed a tax return on Form 990-T for this year 7
x
78 b
79 Was there a liquidation, dissolution, termination, or substantial contraction during the ^21;
year 7 If 'Yes,' attach a statement 79
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common J.SS
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization 7 80 a
x
b If 'Yes,' enter the name of (he organization +■
and check whether it is [ J exempt or | j nonexempt
81 a Enter direct or indirect political expenditures See tine 81 instructions | 81 a| 0_
b Did the organization file Form 1120-POL for this year 7 81b
82 a Did the organization receive donated services or the use of materials equipment, or facilities at no charge or at
substantially less than fair rental value 7 82a
b l f "Yes,' you may indicate the value of these items here Do not include this amount as
revenue in Part I or as an expense in Part II (See instructions in Part III ) 82 b 123,081
83a Did the organization comply with the public inspection requirements for returns and exemption applications 7 83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions 7 83b
84a Did the organization solicit any contributions or gifts that were not tax deductible 7 84a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were k*a
not tax deductible 7 84b
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members 7 85 a
b Did the organization make only in house lobbying expenditures of $2,000 or less 7 85 b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year
c Dues, assessments, and similar amounts from members 85c
d Section 162(e) lobbying and political expenditures 85d
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) | 85 f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f 7
h If section 6033(eXlXA) dues notices were sent, does the organization agree to add the amount on line S5f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year7
86 501(c)(7) organizations Enter a Initiation fees and capital contributions included on
line 12 86a
b Gross receipts, included on line 12, for public use of club facilities 86b
87 501(c)(\2) organizations Enter a Gross income from members or shareholders 87a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them ) 87b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 7701 -2 and 301 7701 -3 7
If Yes, complete Part IX
89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under
section 4911 * 0 section 4912 *■ 0 , section 4955 *■
b 501(c)(3) and 501(c)(4) organizations Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year7 If Yes,' attach a statement
explaining each transaction
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912, 4955, and 4958 ►
0
d Enter Amount of tax on tine 89c, above, reimbursed by the organization ** 0
90 a List the states with which a copy of this return is filed ■■ J l l A P P ! 5
b Number of employees employed in the pay period that includes March 12, 2002 (See instructions ) hob] 10
91 The books are in care of *■ _ C a r p _ l _ S p j z z i_rr ] Telephone number »- (847) 928-9683
Located at - 9950_ Law_rence_Su_i_te _300,_Schi_Uer_ Par_k_ IL ZIP i-4 »- 60176
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here
and enter the amount of tax exempt interest received or accrued during the tax year 92
u
BAA Form 990 (2002)
TEEA0105 01/22/03
Form990(2002) Save A L i f e F o u n d a t i o n 36-3869459 Paae 6
Part VII Analysis of Income-Producing Activities (See instructions)
Unrelated business income Excluded by section 512, 513, or 514 (E)
Note Enter gross amounts unless (A) (B) (C) (D) Related or exempt
otherwise indicated Business code Amount Exclusion code Amount function income
93 Program service revenue
a Program Fees 31.693
b Course M a t e r i a l s 149.980
c Branch Fee -2.916
d Membership Dues 205
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash invmnts 14 2.154
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate i
a debt financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory 18 -3.091
101 Net income or (loss) from special events 1 -32.128
102 Gross profit or (loss) from sales of inventory
r s- * *■
103 Other revenue a - , .vr- -r - - M.v-i
b Miscellaneous 225
c
d
e
104 Subtotal (add columns (B), (D), and (E)) >i '-*-- " fct* '-*>iM^fetottA& -33,065 179.187
105 Total (add line 104, columns (B), (D), and (E)) 146.122
Note: Line 105 plus line Id, Part I, should equal the amount on line 12. Part I
Part VIII- Relationship of Activities to the Accomplishment of Exempt Purposes (See instructions)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes)
93a,93b, Promote and teach life saving first aid programs
93c,93d Promote and teach life saving first aid programs
103a To supplement f u n d i n g r e q u i r e d t o p e r f o r m and c a r r y out the l i f e
s a v i n g f i r s t a i d programs
Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions) N/A
(A) I (B) I (C)
(C) \ (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End of year
partnership, or disregarded entity ownership interest income assets
%
%
%
Part X 1 Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions)
a Did the organization, dunng me year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract7 Yes X No
7
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract _ Yes X No
Note If 'Yes' to(b), file Form 8870 and Form 4720 (see instructions)
ties ot penury I declare that I have examined this return including accompanying schedules and statements and to the best of my knowledge and belief ■tis
and cotfiplfije ^eQlara^lOfl ot preparer (other than ofl^eO is cased on all wiformalion of w h * h preparer has any knowledge .
Date'
IbELNT/fiUflSbeR
OMB No 1545-0047
Organization Exempt Under
SCHEDULE A Section 501(c)(3)
(Form 990 or 990-EZ)
(Except Private Foundation) and Section 501(e), 501(0. 501 (k),
501(n), or Section 4947(aX1) Nonexempt Charitable Trust
Supplementary Information — (See separate instructions )
2002
Department of the Tieasuiy
Internal Revenue Sennce MUST be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name of the onjanizalwn Employer identification nunber
None
(a) Name and address of each independent contractor paid more than $50,000 (b)Type of service (c) Compensation
Bennett R Krause
TEEA0401 01/22/03
Schedule A (Form 990 or 990-EZ) 2002 Save A L i f e Foundation 36-3869459 Page 2
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence pubtic opinion on a legislative matter or referendum 7 If "Yes," enter the total expenses paid
or incurred in connection with the lobbying activities *" $
(Must equal amounts on line 38, Part VI A, or line i of Part VI B )
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part Vl-A Other
organizations checking 'Yes,' must complete Part VI B AND attach a statement giving a detailed description of the
lobbying activities
2 During the year, has (he organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary 7 (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )
3 Does the organization make grants for scholarships, fellowships, student loans, etc 7 (See Note below )
4 Do you have a section 403(b) annuity plan for your employees 7
Note Attach a statement to explain how the organization determines that individuals or organizations receiving
grants or loans from it in furtherance of its charitable programs 'qualify' to receive payments
12 | _ | 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 charitable, etc, 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) (Also complete the Support Schedule in Part IV A )
13 L J An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3))
Provide the following information about the supported organizations (See instructions)
14 I | An organization organized and operated to test for public safety Section 509(a)(4) (See instructions )
BAA TEEAM02 01/22/03 Schedule A (Form 990 or Form 990 EZ) 2002
Schedule A (Form 990 or 990 EZ) 2002 Save A L i f e Foundation 36-3869459 Page 3
P a r t IV-A | S u p p o r t S c h e d u l e (Complete only if you checked a box on line 10, 11, or 12 ) Use cash method of accounting.
Note You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year (a) (b) Ce)
beginning in) 2001 2000 1999 Total
15 Gifts, grants, and contributions
received (Do not include
unusual grants See line 28 ) 820.282 682,878 621,043 621,289 2,745.492
16 Membership fees received
17 Gross receipts from admissions,
merchandise sold or services performed,
or furnishing of facilities in any activity
that is related to the organization's
charitable, etc, purpose 197,535 52,664 41, 158 6.134 297,491
18 Gross income from interest, dividends,
amounts received from payments on
securities loans (section 512(aX5)),
rents, royalties, and unrelated business
taxable income (less section 511 taxes)
from businesses acquired by the organ
izabon after June 30, 1975 3,275 8,725 24,575 676 37,251
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf
21 The value of services or
facilities furnished to the
organization by a governmental
unit without charge Do not
include the value of services or
facilities generally furnished to
the public without charge
22 Other income Attach a
schedule Do not include
gam or (loss) from sale of
capital assets
23 Total of lines 15 through 22 1,021,092 744.267 686,776 628,099 3,080.234
24 Line 23 minus line 17 823,557 691,603 645.618 621,965 2,782,743
25 Enter 1 % of line 23
26 Organizations described on lines 10 or 11
10,211 7,443
a Enter 2% of amount in column (e), line 24
6,868 6,281
26 a
2SED
.55,655
b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly
supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 26a Do not Me this list with your
return Enter the total of all these excess amounts 26 b
c Total support for section 509(a)(1) test Enter line 24, column (e) 26 c 2,782.743
d Add Amounts from column (e) for tines 18 37,251 19 ,■*-*. * J
22 26 b 26 d 37,251
e Public support (line 26c minus line 26d total) 26 e 2,745.492.
f Public support percentage (line 26e (numerator) divided by line 26c (denominator)) 26 f 9 8 66 %
27 Organizations described on line 12
a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the
name of, and total amounts received in each year from, each 'disqualified person ' Do not file this list with your return Enter the sum of
such amounts for each year
(2001) (2000) (1999) (1998)
bFor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to
show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2)
$5,000 (Include in the list organizations described in lines 5 through 11, as welt as individuals ) Do not file this list with your return After
computing the difference between the amount received and the larger amount described m(1) or (2), enter the sum of these differences
(the excess amounts) for each year
(2001) (2000) (1999) (1998)
c Add Amounts from column (e) for lines 15 16
17 20 21 27 c
d Add Line 27a total and line 27b total 27d
e Public support (line 27c total minus line 27d total) 27 e
I Total support for section 509(a)(2) test Enter amount from line 23, column (e) 27 f
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 27a %
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)) 27 h %
28 Unusual Grants For an organization described in line 10 11, or 12 that received any unusual grants during 1998 through 2001 prepare a
list for your records to show, lor each year, the name of the contributor, the date and amount of the grant, and a brief description of the
nature of the grant Do not file this list with your return Do not include these grants in line 15
BAA TEEA0-103 08/12/02 Schedule A (Form 990 or 990 E2) 2002
Schedule A (Form 990 or 990 EZ) 2002 Save A L i f e Foundation 36-3869459 Page 4
PartV (Private School Questionnaire (See instructions)
(To be completed ONLY by schools that checked the box on line 6 in Part IV) N/A
Yes No
29 Does the organization have a racially nondiscnminatory policy toward students by statement in its charter bylaws,
other governing instrument, or in a resolution of its governing body 7 29
-
30 Does the organization include a statement of its racially nondiscnminatory policy toward students in all its brochures,
catalogues, and other written commumcalions with the public dealing with student admissions, programs,
and scholarships7 30
31 Has the organization publicized its racially nondiscnminatory policy through newspaper or broadcast media during ■5
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves 7 31
If 'Yes,' please describe, if 'No,' please explain (If you need more space, attach a separate statement)
If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement)
P|
33 Does the organization discriminate by race in any way with respect to
>.,>*v?
7
a Students' rights or privileges 33 a
b Admissions policies 7 33 b
e Educational policies 7 33 e
f Use of facilities 7 33 f
If you answered Yes' to any of the above, please explain (If you need more space, attach a separate statement)
34a Does the organization receive any financial aid or assistance from a governmental agency 7 34a
b Has the organization's right to such aid ever been revoked or suspended 7 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement 1
35 Does the organization certify that it has complied with the applicable requirements of - —
sections 4 01 through 4 05 of Rev Proc 75 50, 1975 2 C B 587, covering racial
nondiscnmination 7 If 'No,' attach an explanation 35
BAA TEEA0404 01/24/03 Schedule A (Form 990 or 990 EZ) 2002
Schedule A (Form 990 or 990-EZ) 2002 Save A Life Foundation 36-3869459 Page5
[Part Vl-A I Lobbying Expenditures by Electing Public Chanties (See instructions)
(To be completed ONLY by an eligible organization that filed Form 5768)
Check *■ a | | if the orqanization belongs to an affiliated group Check +■ b if you checked 'a' and 'limited control" provisions aDDlv
(a) 0>)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for ALL electing
(The term 'expenditures' means amounts paid or incurred ) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table — t
\
If the amount on line 40 is - The lobbying nontaxable amount is - t ' . » 3 " V ^ i i - ' - «*~ ', *
45 Lobbying nontaxable
amount
J
46 Lobbying ceiling amount .- ■■ / ;t ^ *- r-_
s - 4 ,
{150% of line 45(e))
47 Total lobbying
expenditures
48 Grassroots non
taxable amount
49 Grassroots ceiling amount - ,
(150% of line 48(e))
50 Grassroots lobbying
expenditures
PartVI-B lLobbvinqA*:tivity by Nonelect inc Public Chantie S
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount
a Volunteers X
b Paid staff or management (Include compensation in expenses reported on lines c through h ) X
c Media advertisements X 0
d Mailings to members, legislators, or the public X 0
e Publications, or published or broadcast statements X 0
f Grants to other organizations for lobbying purposes X 0
g Direct contact with legislators, their staffs, government officials, or a legislative body X 0
h Rallies demonstrations, seminars, conventions, speeches, lectures, or any other means X 0
i Total lobbying expenditures (add lines c through h ) 0
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 990 EZ) 2002
TEEA0405 08/12AJ2
Schedule A(form 990 or 990 EZ) 2002 Save A L i f e Foundation 36-3869459 Page 6
Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions) ^ ^
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations 7
a Transfers from the reporting organization to a noncharitable exempt organization of Yes No
(i)Cash 51 a (i) X
ODOther assets a 00 X
b Other transactions
(i)Sales or exchanges of assets with a noncharitable exempt organization b(i) X
(ii)Purchases of assets from a noncharitable exempt organization bC'D X
(iii)Rental of facilities, equipment, or other assets b(iii) X
(iv)Reimbursement arrangements b(.v) X
(v)Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of Ihe above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of
the goods, other assets, or services given by Ihe reporting organization If the organization receivea less than fair market value in
any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received
(a) (b) (c) (d)
Line no Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax exempt organizations .—.
described in section 501(c) of the Code (other than section 501 (c)(3)) or in section 527? *" | _ | Yes |Xj No
b If 'Yes,' complete Ihe following schedule
(a) (b) <c)
Name of organization Type of organization Description of relationship
Part-k -% Automatic 3-Month Extension of Time — Only submit original (no copies needed)
Note Form 990-T corporations requesting an automatic 6 month extension — check this box and complete Part I only
All other corporations Ohduding Form 990 C filers) must use Form 7004 to request an extension of time to rile income tax returns Partnershin^
□
FtEMICs and trusts must use Form 8736 to request an extension of time to file Form 1065 1066, or 1041 '
Name ol Exempt Organization Employer tdenltCicauon number
Type or
pnnt Save A L i f e Foundation 36-3869459
File by Ihe Number street and room or suite number If a P O box see instructions
due dale for
filing your 9950 Lawrence , #300
return See City town or post otfce For a foreign address see nstructions stale ZIP code
instructions
Schiller Park IL 60176
Check type of return to be filed (file a separate application for each return)
X Form 990 Form 990-T (corporation) Form 4720
Form 990 BL Form 990 T (Section 401(a) or 408(a) trust) Form 5227
Form 990 EZ Form 990 T (trust other than above) Form 6069
Form 990-PF Form 1041 A Form 8870
* If the organization does not have an office or place of business in the U n i t e d States, check this box
► If this is for a Group Return, enter the organization's four digit Group E x e m p t i o n Number (GEN) If this is for the whole group
=rr
check this box *- |_J If it is for part of the group, check this box *• [ _ ] and attach a list with the names and EINs of all members
the extension will cover
1 I request an automatic 3-month (6-month, for 990-T corporation) extension of time until A u g 15 ,20 03
to file the exempt organization return for the organization named above The extension is for the organization's return for
calendar year 20 0 2
tax year beginning 20 , and ending , 20
2 If this tax year is for less than 12 months, check reason Q j Initial return l l Final return 1 I Change in accounting period
3a If this application is for Form 990 BL, 990-PF, 990 T. 4720, or 6069, e n t e r the tentative tax, less any
nonrefundable credits See instructions $
b If [his application is for Form 990-PF or 990 T, enter any refundable credits and estimated tax payments made
Include any prior year overpayment allowed as a credit $
c Balance Due Subtract line 3b from line 3a Include your payment with this form, or. if required, deposit with FTD
coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $
Signature and Verification
Under penalties of perjury I declare that I hove examined this return including accompanying schedules and statements and to the best of mv krtowledae and belief itl l i< i,... ~ —■
s Hue
complete and that I am authorized to prepare thrt form ' * ' " " W and
Signature
BAA For Paperwork Reduction Act Notice, see instructions Form 8868 (12 2000)
Form 990 Schedule of Gains and Losses from 2002
Line 8(A) and 8(B) Sale of Assets Other than Inventory
Statement *■ Attach to return
Public Securities
Gross
Description Sales Price Basis
N o n p u b l i c Securities
Total Securities
Beginning End of
Line 58 - Other A s s e t s of Year Year
Beginning End of
Line 58 - Other Assets: of Year Year
Total 11,185
Beginning End of
Line 65 - Other Liabilities: of Year Year
Dr Scott Betzelos
Director
0 0 0
Deloris M Burnam
Director
0 0 0
Michael Lavalle
Oirector
0 0 0
Robert Conroy
Director
0 0 0
Wayne Roberts
Director
0 0 0
Note The individuals above,
except as noted, spend time
as needed in t h e i r capacity
on the Board, They can be
c o n t a c t e d c/o Save a L i f e
Foundation, 9950 Lawrence
Ste300 S c h i l l e r Park IL 60176
Total
Save A Life Foundation 36-3869459 3
Description Amount
Total 17,059
Supporting Statement of
Description Amount
Total 68,755
Description Amount
Total 72.227
Description Amount
Total 182,627
Supporting Statement of
Description Amount
Continued
Supporting Statement of.
Description Amount
Total 182,627
OMB No 1545-0047
Form, 990 Return of Organization Exempt from Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
2003
(except black lung benefit trust or private foundation)
Open to Public
Department of the Treasury
Internal Revenue Service ►• The organization may have to use a copy of this return to satisfy state reporting requirements Inspection
For the 2003 calendar year, or tax year beginning , 2003, and ending
Check if applicable C Name of organization D Employer Identification Number
Please use
Address change IRS label Save A L i f e Foundation 36-3869459
or print
Name change or type. Number and street (or P O box if mail is not delivered to street addr) Room/suite Telephone number
See
Initial return specific 9950 Lawrence 300 (847) 928-9683
instruc
Final return tions. City, town or country State ZIP code + 4 F m S ' " 9
Dcash 0 Accrual
Application pending • Section 501(c)(3) organizations and 4947(aX1) nonexempt H and I are not applicable to section 527 organizations
charitable trusts must attach a completed Schedule A H ( a ) Is this a group return for affiliates' | | Yes [ X j No
(Form 990 or 990-EZ).
H ( b ) If 'Yes,' enter number of affiliates *
G Website: »~ www, s a l f .OTR
H ( c ) Are all affiliates included' \_\ Yes \_\ No
J Organization type r-n r-, r-i (If 'No,' attach a list See instructions)
(Check only o n e j * [ A ] 501(C) 3 - (insert no) I I 4947(a)(1) or I I 527
H ( d ) Is this a separate return filed by an
K Check here *" [ J if the organization's gross receipts are normally not more than
organization covered by a group ruling' yes \X\ No
$25,000 The organization need not file a return with the IRS, but if the organization
received a Form 990 Package in the mail, it should file a return without financial data I Group Exemption Number *~
Some states require a complete return. ffl Check ►■ Q if the organization is not required
L Gross receipts- Add lines 6b, 8b, 9b, and 10b to line 12 *~ 3 7 2 , 9 5 8 . to attach Schedule B (Form 990, 990-EZ, or 990-PF).
Part I 1 Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions)
1 Contributions, gifts, grants, and similar amounts received:
a Direct public support la 193,165
b Indirect public support lb
c Government contributions (grants) 1c 37,488,
d Total
la through IcMcash $ 2 33 00 ,, 66 55 33 . . noncash $ _ 0 . ) Id 230.653
2 Program service revenue including government fees and contracts (from Part VII, line 93) 131,166.
3 Membership dues and assessments
4 Interest on savings and temporary cash investments 795,
5 Dividends and interest from securities
6 a Gross rents 6a
b Less, rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
_JL-Othewnvestmant income (describe
(A) Securities (B) Other
^ -furossjrnauntjn
l a a u n t lfrom sales of assets other
" A w f inventory 8a 5,250
b Less, cost or other basis and sales expenses 8b 7,926
1 GalhorVlosI)(attachschedule) See L - 8 Strut 8c ■2,676
_ d Net gam or'(loss) (combine line 8c, columns (A) and (B)) 8d ■2,676.
•' Y -— :, ~vSnts and activities (attach schedule). If any amount is from gaming, check here
-a-Gross"revenue (not including $ 0. of contributions
'□
reported on line la) 9a 1,504.
b Less, direct expenses other than fundraising expenses 9b 100.
c Net income or (loss) from special events (subtract line 9b from line 9a) See L-9 Stmt 9c 1.404.
10a Gross sales of inventory, less returns and allowances 10a
b Less cost of goods sold 10b
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c
11 Other revenue (from Part VII, line 103) 11 3,590.
12 Total revenue (add lines I d , 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 364,932,
13 Program services (from line 44, column (B)) 13 861,501.
14 Management and general (from line 44, column (Q) 14 92,611.
15 Fundraising (from line 44, column (D)) 15 168,086.
16 Payments to affiliates (attach schedule) 16
17 Total expenses (add lines 16 and 44, column (A)) 17 1,122,198.
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 -757,266.
19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 873,291.
20 Other changes in net assets or fund balances (attach explanation) 20 •20,000.
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 96,025.
BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA0101 11/24/03 Form 990 (2003)
SCANNED M *■ 8 2004 ',y\
Form990(2003) Save A L i f e Foundation 36-3869459 Page 2
Part II S t a t e m e n t Of F u n c t i o n a l E x p e n s e s
All organizations must complete column (A) Columns (B), (C), and (D) are
required for section 501(c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others
Note: Where required, attached schedules and amounts within the description (A) (B)
column should be for end-of-year amounts only Beginning of year End of year
45 Cash — non-interest-bearing 176,046. 45 -5,556.
46 Savings and temporary cash investments 301,108. 46
BAA
TEEA0103 10/01/03
Form990 (2003) Save A L i f e Foundation 36-3869459 Page 4
Part IV-A Reconciliation of Revenue per Audited PartlV-B 1 Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions.) per Return
a Total revenue, gams, and other support a Total expenses and losses per audited
per audited financial statements 625,261 financial statements * 1,382,527.
b Amounts included on line a but b Amounts included on line a but not
not on line 12, Form 990 on line 17, Form 990
(1) Net unrealized (1) Donated serv
gams on ices and use
investments $ of facilities
(2) Donated serv (2) Prior year adjust
ices and use ments reported on
of facilities line 20, Form 990
$ $
Add amounts on lines (1) and (2) Add amounts on lines (1) and (2)
e Total revenue per line 12, Form Total expenses per line 17, Form
990 (line c plus line d) 364,932, 990 (line c plus line d) 1,122,198.
Part V 1 List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated, see instructions.)
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted Of not paid, employee benefit account and other
(A) Name and address to position enter -0-) plans and deferred allowances
compensation
_Ca r o l _ S p j z z i_r r i_
Vice Chairman
Alan Thavisouk
Secretary/Treasurer
J o tLn_ P °_nJ 5 avy _
Director
Mark Mitchell
Director 0.
TEEA0104 10/02/03
Form 990 (2003) Save A L i f e Foundation 36-3869459 Page 5
Part VI Other Information (See instructions.) Yes No
7
76 Did the organization engage in any activity not previously reported to the IRS If 'Yes,'
attach a detailed description of each activity 76
77 Were any changes made in the organizing or governing documents but not reported to the IRS7 77
If 'Yes,' attach a conformed copy of the changes.
78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78 a
b If 'Yes,' has it filed a tax return on Form 990-T for this year 7 78 b
80a Is the organization related (other than by association with a statewide or nationwide organization) through common
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization7 80 a
b If 'Yes,' enter the name of the organization *■
and check whether it is L J exempt or \_J nonexempt
81 a Enter direct and indirect political expenditures See line 81 instructions | 81 a| (L
b Did the organization file Form 1120-POL for this year 7 81b
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value 7 82 a
blf 'Yes,' you may indicate the value of these items here Do not include this amount as
revenue in Part I or as an expense in Part II (See instructions in Part III) 82 b 301,609.
83a Did the organization comply with the public inspection requirements for returns and exemption applications 7 83 a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions7 83 b
84a Did the organization solicit any contributions or gifts that were not tax deductible7 84a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible7 84b
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members 7 85 a
b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85 b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year.
c Dues, assessments, and similar amounts from members 85c
d Section 162(e) lobbying and political expenditures 85 d
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85 e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85 f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f7 85 g
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85 h
86 501(c)(7) organizations Enter, a Initiation fees and capital contributions included on
line 12 86a
b Gross receipts, included on line 12, for public use of club facilities 86b
87 501 (c)(l2) organizations Enter a Gross income from members or shareholders 87 a
b Gross income from other sources. (Do not net amounts due or paid to other sources
against amounts due or received from them.) 87 b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301.7701 -2 and 301 7701 -3 7
If 'Yes,' complete Part IX 88
89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under
section 4911 ►• 0. , section 4912 ►■ 0. , section 4955 ►- 0.
b 501(c)(3) and 501(c)(4) organizations Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year 7 If 'Yes,' attach a statement
explaining each transaction 89 b
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912, 4955, and 4958 *"_ 0.
d Enter- Amount of tax on line 89c, above, reimbursed by the organization *•_ 0.
90a List the states with which a copy of this return is filed ► J I L i i i p i _ s _ , _ W i _ s c o n s j i n , _ P e n n s y l v a n i a
b Number of employees employed in the pay period that includes March 12, 2003 (See instructions ) f90b1 13
91 The books are in care of »- _ C a r o l _ S p j z z i _ r n Telephone number »■ _(847_)_928-96_83_
Locatedat - _9950_ Law_renc_e_S_uj t e JP0,_Schi_Uer_f ar_k_ IL_ ZIP + 4 ►
■ _6017_6_
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here
and enter the amount of tax-exempt interest received or accrued during the tax year H 92 |
-n
BAA Form 990 (2003)
TEEA0105 12/23/03
Form990(2003) Save A L i f e Foundation 36-3869459 Page6
Part VII | Analysis of Income-Producing Activities (See instructions)
Unrelated business income Excluded by section 512, 513, or 514
(E)
Note: Enter gross amounts unless (A) (B) (C) (D) Related or exempt
otherwise indicated Business code Amount Exclusion code Amount function income
93 Program service revenue
a Program Fees 36,016.
b Course M a t e r i a l s 95,150.
c
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash invmnts 14 795.
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate 1
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory 18 -2,676.
101 Net income or (loss) from special events 1 1,404.
102 Gross profit or (loss) from sales of inventory
103 Other revenue a 1
b Miscellaneous 3,590.
c
d
e
104 Subtotal (add columns (B), (D), and (E)) -477. 134,756.
134,279.
Note: Line 105 plus line Id, Part I, should equal the amount on line 12, Part I
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See instructions.)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes).
93a,93b Promote and teach life saving first aid programs.
103a To supplement f u n d i n g r e q u i r e d t o perform and c a r r y out the life
s a v i n g f i r s t a i d programs.
Part IX 1 Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions) N/A
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
%
%
%
%
Part X I Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions.)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Yes No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract7 Yes No
Note: If 'Yes' to (b), file Form 8870 andform 4720 (see instructions)
Underfpefftelties 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, dorreot, and aBrnplele Jjeclaration of preparer (otherttian officerVis based on all information of which preparer has any knowledge
I q-ii-o4-
H Date
OMBNo 1545-0047
- Organization Exempt Under
SCHEDULE A Section 501(c)(3)
(Form 990 or 990-EZ)
(Except Private Foundation) and Section 501(e), 501(f), 501 (k),
501 (n), or Section 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information — (See separate instructions.)
2003
Department of the Treasury
Internal Revenue Service *• MUST be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name of the organization Employer identification number
None
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
Bennett R. Krause
TEEA0401 08/28/03
Schedule A (Form 990 or 990-EZ) 2003 Save A L i f e Foundation 36-3869459 Page2
Part III Statements About Activities (See instructions) Yes No
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid
or incurred in connection with the lobbying activities *" $
(Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) 1 X
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part VI-A Other
organizations checking 'Yes,' must complete Part Vl-B AND attach a statement giving a detailed description of the
lobbying activities.
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary7 (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions.)
11a [Xj An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A.)
11 b L J A community trust Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV-A )
12 L J 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 charitable, etc, 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) (Also complete the Support Schedule in Part IV-A )
13 L J An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in: (1) lines 5 through 12 above, or (2) section 501 (c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3))
Provide the following information about the supported organizations (See instructions )
14 I | An organization organized and operated to test for public safety Section 509(a)(4) (See instructions )
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body7 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships7 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves 7 31
If 'Yes,' please describe, if 'No,' please explain (If you need more space, attach a separate statement)
If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to.
b Admissions policies 7 33 b
f Use of facilities 7 33 f
If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement)
34a Does the organization receive any financial aid or assistance from a governmental agency7 34a
b Has the organization's right to such aid ever been revoked or suspended7 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of
sections 4 01 through 4 05 of Rev Proc 75-50, 1975-2 C B 587, covering racial
nondiscrimination7 If 'No,' attach an explanation 35
BAA TEEA0404 08/28/03 Schedule A (Form 990 or 990-EZ) 2003
Schedule A (Form 990 or 990-EZ) 2003 Save A L i f e Foundation 36-3869459 Page 5
Part Vl-A Lobbvinq Expenditures by Electinq Public Charities (See mstructions)
(To be completed ONLY by an eligible organization that filed Form 5768)
Check *■ a if the organization belongs to an affiliated group Check *■ b if you checked 'a' and 'limited control' provisions apply
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for ALL electing
(The term 'expenditures' means amounts paid or incurred ) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount is —
Not over $500,000 20% of the amount on line 40
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000
Over $17,000,000 $1,000,000
42 Grassroots nontaxable amount (enter 25% of line 41) 42
43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 43
44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 44
Caution: If there is an amount on either line 43 or line 44, you must file Form 4720
4 -Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501 (h) election do not have to complete all of the five columns below.
See the instructions for lines 45 through 50 )
45 Lobbying nontaxable
amount
46 Lobbying ceiling amount
(150% of line 45(e))
47 Total lobbying
expenditures
48 Grassroots non-
taxable amount
49 Grassroots ceiling amount
(150% of line 48(e))
50 Grassroots lobbying
expenditures
Part Vl-B | Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part Vl-A) (See instructions)
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount
a Volunteers X
b Paid staff or management (Include compensation in expenses reported on lines c through h.) X
c Media advertisements X
d Mailings to members, legislators, or the public X
e Publications, or published or broadcast statements X
f Grants to other organizations for lobbying purposes X
g Direct contact with legislators, their staffs, government officials, or a legislative body X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X
i Total lobbying expenditures (add lines c through h.)
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 990-EZ) 2003
TEEA0405 08/28/03
Schedule A (Form 990 or 990-EZ) 2003 Save A L i f e Foundation 36-3869459 Page 6
Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations7
a Transfers from the reporting organization to a noncharitable exempt organization of' Yes No
(i)Cash 51 a (i) X
(ii)Other assets a(ii) X
b Other transactions'
(i)Sales or exchanges of assets with a noncharitable exempt organization b(i) X'
(ii)Purchases of assets from a noncharitable exempt organization b(ii) X
(iii)Rental of facilities, equipment, or other assets b(iii) X
(iv)Reimbursement arrangements b(iv) X
(v)Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization If the organization received less than fair market value in
any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received
(a) (b) (c) (d)
Line no Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations .—. . .
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? *" |_j Yes [Xj No
b If 'Yes,' complete the following schedule-
(a) (b) (c)
Name of organization Type of organization Description of relationship
Gross
Description Sales Price Basis
Nonpublic Securities
Total Securities
Beginning End of
Line 65 - Other Liabilities: of Year Year
Richard Stipher
Director
0. 0. 0.
Note: The individuals above,
except as noted, spend time
as needed in thei r capacity
on the Board, They can be
contacted c/o Save a L i f e
Foundation, 9950 Lawrence
S t e 3 0 0 , S c h i l l e r Park, IL 60176
Total
0.
Save A Life Foundation, 36-3869459 3
Description Amount
Total ■20,000.
Description Amount
Total 3,900.
Description Amount
Total 22,718.
Description Amount
Total 72,227.
Description Amount
Continued
Supporting Statement of:
Description Amount
Total 139,648.
Description Amount
Total 260,329.
Description Amount
Total 260,329.
Form 8868 Application for Extension of Time to File an
(December 2000)
Exempt Organization Return OMB No 1545-1709
Parti I Automatic 3-Month Extension of Time - Only submit original (no copies needed)
Note: Form 990-Tcorporations requesting an automatic 6-month extension — check this box and complete Part I only
D
All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns Partnerships,
REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041.
Name of Exempt Organization Employer identification number
Type or
print
File by the Save A Life Foundation 36-3869459
due date for Number, street, and room or suite number If a P 0 box. see instructions
filing your
return See 9950 Lawrence , #300
instructions City, town or post office For a foreign address, see instructions state ZIP code
3a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions . . . $
b if this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made.
Include any prior year overpayment allowed as a credit .. $
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD
coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions $
Signature and Verification
Under penalties of per|ury, 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, and that I am authorized to prepare this form
Signature TW r J&S
BAA For Paperwork Reduction Act Notice, see instructions.
Title
Cf/- Date r f> /OS
Form 8868 (12-2000)
FIFZ0501 01/05/04
Form W 3 (12-2000) Save A Life Foundation 36-3869459 Page 2
? If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II and check this box GX
Note: Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed
Form 8868.
? If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1),
Pdrt II | Additional (not automatic) 3-Month Extension of Time Must File Original and One Copy
Name of Exempt Organization Employer Identification number
Type or
print Save A Life Foundation 36-3869459
Number, street, and room or suite number If a P O box, see instructions For IRS Use Only
File by the
extended
due date for
flling the 9950 Lawrence , #300
return See
Instructions City, town or post office, state and ZIP code For a foreign address, see Instructions
8 a If this application Is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits See instructions
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax
payments made. Include any prior year overpayment allowed as a credit and any amount paid-previously with
Form 8868 ... $
c Balance due. Subtract line 8b from line 8a. Include your payment with this form, or, If required, deposit with
FTP coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See Instructions . $
Signature and Verification
Under penalties of perjury, I declare that I have examined this form. Including accompanying schedules and statements, and lo the best of my knowledge and belief, It Is true,
correct, and complete, and that I am authorized to prepare this form
B We have approved this application Please attach this form to the organization's return.
We have not approved this application. However, we have granted a 10-day grace period from the later of the date shown below or the
due date of the organization's return (including any prior extensions). This grace period is considered to be a valid extension of time for
elections otherwise required to be made on a timely filed return. Please attach this form to the organization's return.
□ We have not approved this application. After considering the reasons stated in item 7, we cannot grant your request for an extension of
time to file. We are not granting a 10-day grace period
B We cannot consider this application because it was filed after the due date of the return for which an extension was requested.
Other- !>'
IAL
Director
Alternate Mailing Address ' Enter the address if you want the copy of this application for an<additional 3-month extension returned to an
address different than the one entered above
Number and street (Include suite, room, or apartment number) or a P O box number
Type or
print
City or town, province or state, and country (including postal or ZIP code)
Note: Only complete Part II if you have already been granted an automatic 3-month extension on a previously filed
Form 8868.
? If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1).
Part II Additional (not automatic) 3-Month Extension of Time ' Must File Original and One Copy
Name of Exempt Organization Employer identification number
Type or
print Save A Life Foundation 36-3869459
Number, street, and room or suite number If a P O box. see instructions For IRS Use Only
File by the
extended
due date lor
Tiling the 9950 Lawrence, #300 "i;-:^":
return See
instructions City, town or post office, state, and ZIP code For a foreign address, see instructions
8 a If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions
b If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax
payments made Include any prior year overpayment allowed as a credit and any amount paid previously with
Form 8868 $
c Balance due. Subtract line 8b from line 8a Include your payment with this form, or, if required, deposit with
FTP coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions $
Signature and Verification
Under penalties of perjury, I declare that I have examined this form, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,
correct, and complete, and that I am authorized to prepare this form
D We have not approved this application. After considenng the reasons stated in item 7, we cannot grant your request for an extension of
time to file. We are not granting a 10-day grace period.
R We cannot consider this application because it was filed after the due date of the return for which an extension was requested.
Other
By
Alternate Mailing Address ' Enter the address if you want the copy of this application for an additional 3-month extension returned to an
address different than the one entered above
Number and street (include suite, room, or apartment number) or a P.O box number
Type or
print
City or town, province or state, and country (including postal or ZIP code)
^2003~2OO4
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
Open to Public
Department of the Treasury
Internal Revenue Service The organization may have to use a copy of this return to satisfy state reporting requirements Inspection
A For the 2003 calendar year, or tax year beginning Jan 1 —r-gew, and ending Jun 30 2004
B Check if applicable C Name of organization 2004 D Employer Identification Number
Please use
Address change IRS label Save A L i f e Foundation 36-3869459
or print
Name change or type. Number and street (or P O box if mail is not delivered to street addr) Room/suite Telephone number
See
Initial return specific 9950 Lawrence 300 (847) 928-9683
instruc
Final return tions. City, town or country State ZIP code + 4 Cash
IxJ Accrual
Amended return Schiller Park IL 60176 I | Other (specify)* -
Application pending > Section 501 (cX3) organizations and 4947(a)(1) nonexempt H and I are not applicable to section 527 organizations
charitable trusts must attach a completed Schedule A H ( a ) Is this a group return for affiliates' | | Yes | X j No
(Form 990 or 990-EZ).
H ( b ) If 'Yes,' enter number of affiliates ^
G W e b s i t e : ^ WWW, s a l f . o r g
H ( c ) Are all affiliates included' [_J Yes \_\ No
J Organization type r—i r—i r—i (If 'No,' attach a list See instructions)
( C h e c k Only o n e ) *~ | X J 501(c) 3 ■* (insert n o ) | _ J 4947(a)(1) or I I 527
H ( d ) Is this a separate return filed by an
K Check here *" [_} if the organization's gross receipts are normally not more than
organization covered by a group ruling' yes | X | No
$25,000 The organization need not file a return with the IRS, but if the organization
received a Form 990 Package in the mail, it should file a return without financial data I Group Exemption Number *■
Some states require a complete return.
M Check *■ [ J if the organization is not required
L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 »- 1 , 1 5 4 , 7 5 5 to attach Schedule B (Form 990, 990-E2, or 990-PF)
Part I 1 Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions)
1 Contributions, gifts, grants, and similar amounts received
a Direct public support la 87,988.
b Indirect public support lb
c Government contributions (grants) 1c 1,040,000.
d Total (add lines t 1 1 3 7 QQQ u t
la through lc) (cash > L , i c l , J O O ■ noncash 3> _
0, ) Id 1,127,988.
2 Program service revenue including government fees and contracts ( f r o m Part V I I , line 93) 27,856.
3 Membership dues and assessments
4 Interest on savings and temporary cash investments
5 Dividends and interest from securities
6 a Gross rents 6a
b Less, rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe **
(A) Securities (B) Other
8 a Gross amount from sales of assets other
than inventory 8a_
b Less- cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8_£
d Net gain or (loss) (combine line 8c, columns (A) and (B)) 8d
-ss- 9 Special events and activities (attach schedule) If any amount is from gaming, check here d
a Gross revenue (not including $ 2 , 638 . of contributions
S3
reported on line la) 9a 600,
OO b Less, direct expenses other than fundraising expenses | 9b 600.
c Net income or (loss) from special events (subtract line 9b from line 9a) See L-9 Stmt 9c
LU 10a Gross sales of inventory, less returns and allowances 10a
CD
b Less, cost of goods s o l d / v > ^ I 10b
Q c Gross profit or (loss) from sales of jnvSntOQfJattach schedule) (subtract line 10b from line 10a) 10c
11 ■1,698.
LU 11 Other revenue (from p/rt f l j ^
12 Total revenue (add hr/es>)d, [-9c,J0c, and 11) 12 1,154,155
2
13 Program services (fy mnl|B>K^' 13 151,664.
14 Management and (from lifie^j^okjmn\%bj 14 21,328.
15 Fundraising (from 15 7,215.
S 16 Payments to affiliate: 16
E
S 17 Total expenses (add lines 1 17 180,207.
18 a c H u j e V 7 fro 18 973,948.
19 Net assets or fund balances at beginning
u n g of yea?
year (1
(from line 73, c o l u m n (A)) 19 96,025
20 Other changes in net assets or fund balances (attach explanation) 20
21 Net assets or fund balances at end of year (combine lines 18, 19, a n d 20) 21 1,069,973.
BAA For Paperwork Reduction Act Notice, see the separate instructions. TEEA010I 11/24/03 Form 9 9 0 4 2 9 e 9 T
2004
1
2004
Form 99(M38e3r Save A L i f e Foundation 36-3869459 Page 2
Part If S t a t e m e n t Of F u n c t i o n a l E x p e n s e s
All organizations must complete column (A) Columns (B), (C), and (D) are
required for section 501 (c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.
151,664.
BAA TEEA0102 10/03/03 Form 990-(eee3r
2004
2004
Form990.^aeo3T Save A L i f e Foundation 36-3869459 Page 3
Note: Where required, attached schedules and amounts within the description (A) (B)
column should be for end-of-year amounts only Beginning of year End of year
45 Cash - non-interest-bearing -5,556. 45 3,399.
46 Savings and temporary cash investments 0. 46 9,892.
BAA
TEEA0103 10/01/03
i 2004
Form990^aeear Save A L i f e Foundation 36-3869459 Page 4
Part IV-A Recbnciliafion of Revenue per Audited Part IV-B I Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions.) per Return
a Total revenue, gains, and other support a Total expenses and losses per audited
per audited financial statements 1,227,755, financial statements ■ 253,807.
b A m o u n t s included on line a but b Amounts included on line a but not
not on line 12, Form 990 on line 17, Form 990
(1) Net unrealized (1) Donated serv
gains on ices and use
investments of facilities 72,500.
(2) Donated serv (2) Prior year adjust
ices and use ments reported on
of facilities 72,500. line 20, Form 990
$ $
Add amounts on lines (1) and (2) Add amounts on lines (1) and (2)
e Total revenue per line 12, Form e Total expenses per line 17, Form
990 (line c plus line d) 1,154,155. 990 (line c plus line d) 180,207,
Part V List of Officers, Directors, rustees, and Key Emp o y e e s (List each one even if not compensated, see instructions.)
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted (if not paid, employee benefit account and other
(A) Name and address to position enter -0-) plans and deferred allowances
compensation
_C a r_oJ _ Sp_i z z_i_r r i_
Chai rwoman
_f 6 &gy_ T_rj m ble_
Vice Chairwoman
Nadme Levick
Secretary
J)ou!g_ Browne
Treasurer
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value 7 82 a
b If 'Yes,' you may indicate the value of these items here Do not include this amount as
revenue in Part I or as an expense in Part II (See instructions in Part III ) 82b 73,000.
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83 a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions7 83 b
84a Did the organization solicit any contributions or gifts that were not tax deductible7 84a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible7 84b
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members 7 85 a
b Did the organization make only m-house lobbying expenditures of $2,000 or less 7 85 b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year
c Dues, assessments, and similar amounts from members 85c
d Section 162(e) lobbying and political expenditures 85 d
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85 f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f7 85 g
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year7 85 h
86 501 (c)(7) organizations Enter a Initiation fees and capital contributions included on
line 12 86a
b Gross receipts, included on line 12, for public use of club facilities 86 b
87 501(c)(12) organizations Enter' a Gross income from members or shareholders 87 a
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.) 87 b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 7701 -2 and 301 7701 -3 7
If 'Yes,' complete Part IX 88
89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under.
section 4911 ► 0. , section 4912 - 0. ; section 4955 ► 0
b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year7 If 'Yes,' attach a statement
explaining each transaction 89 b X
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912, 4955, and 4958 *" 0.
d Enter1 Amount of tax on line 89c, above, reimbursed by the organization ►
90a List the states with which a copy of this return is filed ►■ _ I I L i _ n o i _ s _ , _ W i _ s c o n _ s j n , _ Pennsy_l_yani_a
b Number of employees employed in the pay period that includes March 12, 2003 (See instructions ) IJObl
91 The books are in care of * _Car_oJ_Spj z z _ i _ r r i Telephone number - _(847J_928-9683.
Located at «► _?950_ Lawjence_Su_i te _300 ,_Schi_Uer_ Par_k_ IL ZIP + 4 ► _60176 '_
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 — Check here
and enter the amount of tax-exempt interest received or accrued during the tax year ._. H 92 |
-n
BAA Form 990 (2093)—
TEEA0105 12/23/03 2004
2004
FormS»90-(20Q3ySave A L i f e Foundation 36-3869459 Page 6
Part VII Analysis of Income-Producing Activities (See instructions)
Unrelated business income Excluded by section 512, 513, or 514
Note: Enter gross amounts unless (E)
(A) (B) (C) (D) Related or exempt
otherwise indicated
Business code Amount Exclusion code Amount function income
93 Program service revenue
a Program Fees 23,160.
b Course M a t e r i a l s 1,340.
c Branch Fee 3,356.
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash mvmnts 14 9.
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate I
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory
103 Other revenue a .- ■ ■
1
b Miscellaneous -1,698.
c
d
e
104 Subtotal (add columns (B), (D), and (E)) 9. 26,158.
105 Total (add line 104, columns (B), (D), and (E)) 26,167,
Note: Line 105 plus line Id, Part I, should equal the amount on line 12, Part I
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See instructions)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes).
93a - 93c Promote and teach life saving first aid programs.
103a To supplement funding required to perform and carry out the life
saving first aid programs
Part IX 1 Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions.) N/A
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
%
%
%
%
Part X | Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions.)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract' Yes No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract7 Yes No
Note: If 'Yes' to (b), file Form 8870 and Form 4720 (see instructions)
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, aOrMCt, arts conmlete Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge
dge
"X
Please fY&ide'vf ff-ound^y II
Date
\wr\def
Date Check if Preparer's SSN or PTIN (see
General Instruction W)
I self-
« OMBNo 1545-0047
Organization Exempt Under
SCHEDULE A Section 501 (cX3)
(Form 990 or 990-EZ) 2004
(Except Private Foundation) and Section 501(e), 501(0, 501 (k),
501 (n), or Section 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information — (See separate instructions.)
Department of the Treasury
Internal Revenue Service *- MUST be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name of the organization Employer identification number
None
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
None
i
Total number of others receiving over i
$50,000 for professional services *" None 1
BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or 99O-EZ)-20©3
TEEA0401 08/28/03
2004
Schedule A (Form 990 or 990-EZ)-eee»- Save A L i f e Foundation 36-3869459 Page 2
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendum? If 'Yes,' enter the total expenses paid
or incurred in connection with the lobbying activities *" $
(Must equal amounts on line 38, Part Vl-A, or line i of Part Vl-B )
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part Vl-A Other
organizations checking 'Yes,' must complete Part Vl-B AND attach a statement giving a detailed description of the
lobbying activities
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary' (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )
11 b Q A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A )
12 O 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 charitable, etc, 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) (Also complete the Support Schedule in Part IV-A )
13 L J An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in 0 ) l|r)es 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3))
Provide the following information about the supported organizations (See instructions )
14 [ I An organization organized and operated to test for public safety. Section 509(a)(4) (See instructions )
31 Has the organization publicized its racially nondiscnminatory policy through newspaper or broadcast media during i
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that . _J
makes the policy known to all parts of the general community it serves7 31
If 'Yes,' please describe, if 'No,' please explain (If you need more space, attach a separate statement)
If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement)
b Admissions policies? 33 b
f Use of facilities 7 . . . 33 f
If you answered 'Yes' to any of the above, please explain (If you need more space, attach a separate statement)
34a Does the organization receive any financial aid or assistance from a governmental agency? 34a
b Has the organization's right to such aid ever been revoked or suspended7 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of
sections 4 01 through 4 05 of Rev Proc 75-50, 1975-2 C.B. 587, covering racial
nondiscrimmation7 If 'No,' attach an explanation 35
BAA TEEA0404 08/28/03 Schedule A (Form 990 or 990-EZ) 2Q63-—
2004
2004
'Schedule A (Form 990 or 990-EZ)-3eer Save A Life Foundation 36-3869459 Page 5
Part Vl-A Lobbying Expenditures by Electing Public Charities (See instructions)
(To be completed ONLY by an eligible organization that filed Form 5768)
Check *• a ~~| if the organization belongs to an affiliated group Check " b if you checked 'a' and 'limited control' provisions apply
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for ALL electing
(The term 'expenditures' means amounts paid or incurred.) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table - i
45 Lobbying nontaxable
amount
48 Grassroots non-
taxable amount
50 Grassroots lobbying
expenditures
PartVI-B | Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part Vl-A) (See instructions )
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount
a Volunteers X I
b Paid staff or management (Include compensation in expenses reported on lines c through h.) X |
c Media advertisements X
d Mailings to members, legislators, or the public X
e Publications, or published or broadcast statements X
f Grants to other organizations for lobbying purposes X
g Direct contact with legislators, their staffs, government officials, or a legislative body X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X
i Total lobbying expenditures (add lines c through h.)
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 99O-EZ)-2003—
2004
TEEA0405 08/28/03
2004
Schedule A (Form 990 or 990-EZ) 2663" Save A L i f e Foundation 36-3869459 Page 6
Part VII I Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations7
a Transfers from the reporting organization to a noncharitable exempt organization of Yes No
(i)Cash 51 a (i) X
(ii)Other assets a(ii) X
b Other transactions
(i)Sales or exchanges of assets with a noncharitable exempt organization b(i) X
(ii)Purchases of assets from a noncharitable exempt organization b(ii) X
(iii)Rental of facilities, equipment, or other assets b (iii) X
(iv) Reimbursement arrangements b(iv) X
(v) Loans or loan guarantees b(v) X
(vi)Performance of services or membership or fundraismg solicitations b(v.) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes,' complete the following schedule. Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization If the organization receweo less than fair market value in
any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received
(a) (b) (c) (d)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations . . . .
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? *" |_| Yes (Xj No
b If 'Yes,' complete the following schedule
(a) (b) (c)
Name of organization Type of organization Description of relationship
Beginning End of
Line 65 - Other Liabilities: of Year Year
Beginning End of
Line 65 - Other Liabilities: of Year Year
Mark Mitchell
Di r e c t o r
0. 0. 0.
Irv Bock
Director
0. 0. 0.
Steve Orebaugh
Director
0. 0. 0.
Joseph Sabato
Di r e c t o r
0. 0. 0.
Note' The individuals above,
except as noted, spend time
as needed in t h e i r capacity
on the Board, They can be
contacted c/o Save a L i f e
Foundation, 9950 Lawrence
S t e 3 0 0 , Schi H e r Park, IL 60176
Total
0. 0. 0.
Save A Life Foundation 36-3869459 3
Description Amount
Total 16,958.
Description Amount
Total 139,648.
Description Amount
Total 194,416.
Description Amount
Total 157,655
Save A Life Foundation 36-3869459 1
Description Amount
Total 137,155.
Description Amount
Total 1,100.
Description Amount
Total 1,100.
Form 8868 Application for Extension of Time to File an
(December 2000)
Exempt Organization Return OMB No 1545-1709
Patil I Automatic 3-Month Extension Of Time — Only submit original (no copies needed)
Note: Form 990-T corporations requesting an automatic 6-month extension — check this box and complete Part I only
All other corporations (including Form 990-C filers) must use Form 7004 to request an extension of time to file income tax returns Partnerships,
□
REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041.
Name of Exempt Organization Employer identification number
Type or
print
File by the Save A L i f e Foundation 36-3869459
due date for Number, street, and room or suite number If a P 0 box, see instructions
filing your
return. See 9950 Lawrence , #300
instructions City, town or post office For a foreign address, see instructions state ZIP code
Signature
M.3 ,/uf.
BAA For Paperwork Reduction Act Notice, see instructions.
Title c# Date » (O/K/C*
Form 8868 (12-2000)
FIFZ0501 01/05/04
OMBNo 1545-0047
Form 990 Return of Organization Exempt from Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
2004
(except black lung benefit trust or private foundation)
Open to Public
Department of the Treasury
Internal Revenue Service *■ The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection
A For the 2004 calendar year, or tax year beginning Jul 1 , 2004, and ending Jun 30 , 2005
B Check if applicable C Name of organization D Employer Identification Number
Please use
Address change IRS label Save A Life Foundation 36-3869459
or print
Name change or type. Number and street (or P O box if mail is not delivered to street addr) Room/suite E Telephone number
See
Initial return specific 9950 Lawrence 300 (847) 928-9683
instruc
Final return tions. City, town or country State ZIP code + 4
F fSSSSSf [Jcash E Accrual
Amended return Schiller Park IL 60176 | j Other (specify) * "
I Application pending • Section 501 (cX3) organizations and 4947(a)(1) nonexempt H and I are not applicable to section 527 organizations
charitable trusts must attach a completed Schedule A H ( a ) Is this a group return for affiliates' | | Yes |XJ No
(Form 990 or 990-EZ).
H ( b ) If 'Yes,' enter number of affiliates ^
G Website: ^ www, s a l f . o r g
H ( c ) Are all affiliates included' £ j Yes \_\ No
J Organization type r—• n n (If 'No,' attach a list See instructions)
(Check only O n e ) * |XJ 501(c) 3-* (insert n o ) [_} 4947(a)(1) T 1 _ | 527
H ( d ) Is this a separate return filed by an
K Check here *~ {_} if the organization's gross receipts are normally not more than organization covered by a group ruling' yos R j l No
$25,000 The organization need not file a return with the IRS, but if the organization
received a Form 990 Package in the mail, it should file a return without financial data I Group Exemption Number ►
Some states require a complete return.
M Check ►• [ ] if the organization is not required
L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 ► 1 , 7 3 2 , 1 4 0 . to attach Schedule B (Form 990, 990-EZ, or 990-PF).
Part 1 I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions)
Contributions, gifts, grants, and similar amounts received:
a Direct public support 1a 125,822.
b Indirect public support . . . . lb
c Government contributions (grants) 1c 1,196,000.
d Total (add lines <*- 1 *3 -i T T o o ,_ e*
la through 1c) (cash 5 1 , 3 1 / , i Z l . 4,500.)
noncash > Id 1,321,822,
2 Program service revenue including government fees and contracts (from Part VII, line 93) 310,971.
3 Membership dues and assessments
4 Interest on savings and temporary cash investments 1,933.
5 Dividends and interest from securities
6a Gross rents 6a
b Less: rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) 6c
7 Other investment income (describe *~
(A) Securities (B) Other
8a Gross amount from sales of assets other
than inventory 8a
b Less: cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
d Net gam or (loss) (combine line 8c, columns (A) and (B)) 8d
Special events and activities (attach schedule) If any amount is from gaming, check here
Gross revenue (not including $ 1 1 5 , 7 7 7 . of contributions
*□
reported on line la) 9a 34,312
b Less direct expenses other than fundraismg expenses 9b 34,312.
c Net income or (loss) from special events (subtract line 9b from line 9a) See L-9 Stmt 9c
Q 10a Gross sales of inventory, less returns and allowances 10a 62,234.
b Less, cost of goods sold 10b 13,149.
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c 49,085.
11 Other revenue (from Part VII, line 103) 11 868.
12 Total revenue (add lines I d , 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 1,684,679.
13 Program services (from line 44, column (B)) 13 1,699,901.
14 Management and general (from line 44, column (C)) 14 80,431,
15 Fundraismg (from line 44, column (D)) 15 170.
16 Payments to affiliates (attach schedule) 16
17 Total expenses (add lines 16 and 44, column (A)) 17 1,780,502
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 -95,823.
19 Net assets or fund balances at beginning of year (from line 7: J9_ 1,069,973.
20 Other changes in net assets or fund balances (attach explanation) 20_
21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 21 974,150.
BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TEEAOIOI 01/07/05 Form 990 (2004)
Form 990 (2004) Save A L i f e F o u n d a t i o n 36-3869459 Page 2
Part II S t a t e m e n t Of F u n c t i o n a l E x p e n s e s
All organizations must complete column (A). Columns (B), (C), and (D) are
required for section 501(c)(3) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others.
non-cash $ ) 22 ., ,
23 Specific assistance to individuals (att sch) 23
24 Benefits paid to or for members (att sch) 24
25 Compensation of officers, directors, etc 25 120,000. 114,000. 6,000. 0.
26 Other salaries and wages 26 286,094. 260,920. 25,174. 0.
27 Pension plan contributions 27
28 Other employee benefits 28 9,332. 8,565. 767. 0.
29 Payroll taxes 29 44,168. 40,767. 3,401. 0.
30 Professional fundraismg fees 30
31 Accounting fees 31
32 Legal fees 32 3,000. 3,000. 0. 0.
33 Supplies 33 12,209. 12,958. -751. 2.
34 Telephone 34 10,847. 10,817. 6. 24.
35 Postage and shipping 35 6,032. 6,147. -140. 25.
36 Occupancy 36 101,425. 101,425. 0. 0.
37 Equipment rental and maintenance 37 762. 762. 0. 0.
38 Printing and publications .. 38
39 Travel 39 29,308. 29,044. 264. 0.
40 Conferences, conventions, and meetings 40 13,479. 13,479. 0. 0.
41 Interest 41 6,938. 728. 6,210. 0.
42 Depreciation, depletion, etc (attach schedule) 42 30,301. 0. 30,301. 0.
43 Other expenses not covered above (itemize):
aA u t o Expense 43 a 2,281. 2,281. 0. 0.
bBank S e r v i c e Fees 43b 262. 264. -2. 0.
cBranch Development 43 c 463,853. 463,853. 0. 0.
dComputer Expenses 43 d 30. 30. 0. 0.
eSee Other Expenses Stmt 43 e 640,181. 630,861. 9,201. 119.
44 Total functional expenses (add lines 22 - 43)
Organizations completing columns (8) - (D),
carry these totals to lines 13-15 44 1,780,502. 1,699,901. 80,431. 170.
Joint Costs. Check " G if you are following SOP 98-2
Are any joint costs from a combined educational campaign and fundraismg solicitation reported in (B) Program services? * " [ J Yes [x] No
If 'Yes,' enter (i) the aggregate amount of these joint costs $ ; (ii) the amount allocated to Program services
$ ; (iii) the amount allocated to Management and general and (iv) the amount allocated
to Fundraismg $
Part III 1 Statement of Program Service Accomplishments
What is the organization's primary exempt purpose7 *• See Attached Program Service Expenses
(Required for 501(c)(3) and
All organizations must describe their exempt purpose achievements in a clear and concise manner State the number of (4) organizations and
clients served, publications issued, etc. Discuss achievements that are not measurable (Section 501(c)(3) & (4) organ- 4947(a)(1) trusts, but
izations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants & allocations to others ) optional tor others)
a _Kid '_s_Progr_ams _-_ Pronroticpii. _and _teachincj_ of_ _li f_e_ sayinq_ f i r s t _
_aid _to _ I l l i n o i s _ s c h o o l j : h i l d r e n _ _[2_9_, 889_ childr_en_taug;ht2
Note: Where required, attached schedules and amounts within the description (A) (B)
column should be for end-of-year amounts only Beginning of year End of year
45 Cash - non-interest-bearing 3,399. 45 3,758.
46 Savings and temporary cash investments 9,892. 46 810,218.
a 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through
1,069,973. 73
c 72; column (A) must equal line 19; column (B) must equal line 21) 974,150.
74 Total liabilities and net assets/fund balances (add I nes 66 and 73) 1,403,584. 74 1,643,498.
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization How the public perceives an organization in such cases may be determined by the information presented on its return. Therefore,
please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments
BAA
TEEA0103 01/07/05
Form990 (2004) Save A L i f e Foundation 36-3869459 Page 4
Part IV-A 1 Reconciliation of Revenue per Audited RartlV-B 1 Reconciliation of Expenses per Audited
Financial Statements with Revenue Financial Statements with Expenses
per Return (See instructions.) per Return
a Total revenue, gams, and other support a Total expenses and losses per audited
per audited financial statements 1,937,220. financial statements. * 2,033,043
Add amounts on lines (1) and (2) Add amounts on lines O) and (2)
Total revenue per line 12, Form Total expenses per line 17, Form
990 (line c plus line d) 1,684,679. 990 (line c plus line d) 1,780,502
Part V | List of Officers, Directors, rustees, and Key Emp o y e e s (List each one even if not compensated; see instructions.)
(B) Title and average hours (C) Compensation (D) Contributions to (E) Expense
per week devoted (if not paid, employee benefit account and other
(A) Name and address to position enter -0-) plans and deferred allowances
compensation
_C§£°J-_ 5fii ^ z i r r i
Vice Chairwoman
J J o u g l a s J3rowne_
Treasurer
_Peggy_ T r i m b l e _
V i c e Chairwoman
Mark M i t c h e l l
Director
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more
than $100,000 from your organization and all related organizations, of which more than
$10,000 was provided by the related organizations? []Yes (X]NO
If 'Yes,' attach schedule - see instructions
BAA Form 990 (2004)
TEEA0104 01/07/05
Form 990 (2004) Save A L i f e Foundation 36-3869459 Page 5
Part VI Other Information (See instructions) Yes No
76 Did the organization engage in any activity not previously reported to the IRS? If 'Yes,'
attach a detailed description of each activity 76 X
77 Were any changes made in the organizing or governing documents but not reported to the IRS7 . . 77 X
If 'Yes,' attach a conformed copy of the changes. " - * • ■ - —
. i
78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return 7 78 a X
b If 'Yes,' has it filed a tax return on Form 990-T for this year? 78 b
80 a Is the organization related (other than by association with a statewide or nationwide organization) through common
'- ' 'i
membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization? 80 a X
b If 'Yes,' enter the name of the organization ►
„
and check whether it is |_| e>tempt or \_j nonexempt
81 a Enter direct and indirect political expenditures. See line 81 instructions 81 a| 0.
b Did the organization file Form 1120-POL for this year? 81b X
'' J
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value 7 82 a X
b If 'Yes,' you may indicate the value of these items here Do not include this amount as
revenue in Part 1 or as an expense in Part II (See instructions in Part III.) 82b| 205,080.
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83 a X
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions7 83b X
84a Did the organization solicit any contributions or gifts that were not tax deductible 7 84a X
-J
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible7 84b
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members? 85 a
b Did the organization make only in-house lobbying expenditures of $2,000 or less? ... . 85 b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the orga iization received a
waiver for proxy tax owed for the prior year
c Dues, assessments, and similar amounts from members 85 c
d Section 162(e) lobbying and political expenditures 85 d
e Aggregate nondeductible amount of section 6033(e)(l )(A) dues notices 85 e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) . . 85 f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f7 85 g
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85 h
86 501(c)(7) organizations Enter: a Initiation fees and capital contributions included on
line 12 86 a
b Gross receipts, included on line 12, for public use of club facilities 86 b
87 501(c)(12) organizations Enter a Gross income from members or shareholders 87 a
.
b Gross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them) 87 b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable cc rporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 77C)1-2 and 301 7701-37
If 'Yes,' complete Part IX 88 X
89a 501(c)(3) organizations. Enter Amount of tax imposed on the organization during the year under: i
section 4911 ►■ 0 . , section 4912 »• 0 . , section 4955 ►■ 0.
-I
b 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess ben jfit transaction
during the year or did it become aware of an excess benefit transaction from a prior year7 If 'Yes,' i attach a statement
explaining each transaction 89 b X
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912, 4955, and 4958 . *" 0.
d Enter Amount of tax on line 89c, above, reimbursed by the organization *"_ 0.
90a List the states with which a copy of this return is filed *■ J l l i n o i s _ , _Wiscqnsin_,_ PejinsyJ-yania,_ _Arizona_, I n d i a n a
b Number of employees employed in the pay period that includes March 12, 2004 (See instructions) f^bl 1
91 The books are in care of > _ C a r o l _ S p J . z z i r r i Telephone number ►• J 847_)_928-96_83
Located at »• _?950_ Lawrenc_e_ S u i t e _3 00 ,_Schi_ller . P a r k . IL ZIP + 4 »• _6017_6
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here *■ | |
and enter the amount of tax-exempt interest received or accrued during the tax year H 92 |
BAA Form 990 (2004)
TEEA0105 01/07/05
Form 990 (2004) S a v e A L i f e Foundation 36-3869459 Page 6
Part VM Analysis of Income-Producing Activities (See instructions.)
. Unrelated business income Excluded by section 512, 513, or 514
(E)
Note: Enter gross amounts unless (A) (B) (C) (D) Related or exempt
otherwise indicated Amount Exclusion code function income
Business code Amount
93 Program service revenue.
a P r o g r a m Fees 35,265.
b Course M a t e r i a l s 259,353.
c B r a n c h Fee 5,433.
d C o n f e r e n c e / S e m i n a r Income 10,920.
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash mvmnts 14 1,933.
% Dividends & interest from securities
1 wt '■ " - ■* - *■
97 Net rental income or (loss) from real estate
X
"&), r f' \, ' , . |
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gam or (loss) from sales of assets
other than inventory
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory 49,085.
103 Other revenue: a < - ' , , ■■ * * ^ < -rf; ,~< .- '., •*/< - ^ »'• t'-f , .. |
b Miscellaneous 868.
c
d
e
104 Subtotal (add columns (B), (D), and (E)) 1,933. 360,924.
(D), and (E)) 362,857.
Note: Line 105 plus line Id, Part I, should equal the amount on line 12, Part I
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See instructions.)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes).
Part IX [Information Regarding Taxable Subsidiaries and Disregarded Entities (See instructions.) N/A
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
%
Part X | Information Regarding Transfers Associated with Personal Benefit Contracts (See instructions)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract' Yes No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract7 Yes No
Note: If 'Yes' to (b), file Form 8870 and Form 4720 (see instructions)
Under peaatbesVof periury, 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, anUcomplele (Declarajipn of preparer (otherihafiiofficerVs
JhotficerVs based on all infoi
information of which preparer has any knowledge
•1?./? JAW
Check if General Instruction W)
Paid Preparer's self-
Pre-
signature
12/12/05 employed
n
arer's Ahlbeck & Company
B
Firm's name (or
yours if self-
se employed), ► 1665 Elk Blvd. EIN
address, and
Only [847)824-4000
ZIP+ 4 Des P l a i n e s IL 60016-4721 Phone no
Dane N e a l
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. Schedule A (Form 990 or 990-EZ) 2004
TEEA0401 07/22/04
Schedule A (Form 990 or 990-EZ) 2004 Save A L i f e Foundation 36-3869459 Page 2
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendum7 If 'Yes,' enter the total expenses paid
or incurred in connection with the lobbying activities *" $
(Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) X
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part Vl-A. Other
organizations checking 'Yes' must complete Part VI-B AND attach a statement giving a detailed description of the
lobbying activities.
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary' (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )
11 b L J A community trust. Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV-A)
12 L J 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 charitable, etc, 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) (Also complete the Support Schedule in Part IV-A.)
13 I I An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in (1) lines 5 through 12 above, or (2) section 501(c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See
section 509(a)(3))
Provide the following information about the supported organizations (See instructions )
14 I | An organization organized and operated to test for public safety. Section 509(a)(4) (See instructions )
BAA TEEA0402 07/27/04 Schedule A (Form 990 or Form 990-EZ) 2004
Schedule A (Form 990 or 990-EZ) 2004 Save A L i f e Foundation 36-3869459 Page 3
P a r t IV"A | S u p p o r t S c h e d u l e (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year (b) (c) (d) (e)
beginning in) *" 2003 2002 2001 2000 Total
15 Gifts, grants, and contributions
received. (Do not include
unusual grants. See line 28) 448,621. 1,371,684. 820,282. 682,878. 3,323,465.
16 Membership fees received
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body7 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships? 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves7 31
If 'Yes,' please describe, if 'No,' please explain (If you need more space, attach a separate statement.)
c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing
with student admissions, programs, and scholarships? 32 c
d Copies of all material used by the organization or on its behalf to solicit contributions? 32 d
If you answered 'No' to any of the above, please explain (If you need more space, attach a separate statement)
i
33 Does the organization discriminate by race in any way with respect to:
b Admissions policies? 33 b
e Educational policies7 33 e
f Use of facilities? 33 f
g Athletic programs7 33 g
If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement)
—-
34a Does the organization receive any financial aid or assistance from a governmental agency7 34a
bHas the organization's right to such aid ever been revoked or suspended? 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of
sections 4 01 through 4.05 of Rev Proc 75-50, 1975-2 C.B 587, covering racial
nondiscnmination? If 'No,' attach an explanation. 35
BAA TEEA04C4 07/23/04 Schedule A (Form 990 or 990-EZ) 2004
Schedule A (Form 990 or 990-EZ) 2004 Save A L i f e F o u n d a t i o n 36-3869459 Page 5
Part Vl-A | Lobbying Expenditures by Electing Public Charities (See instructions)
(To be completed ONLY by an eligible organization that filed Form 5768)
N/A
Check ►• a (~~ if the organization belongs to an affiliated group Check ►■ b if you checked 'a' and 'limited control' provisions apply
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for ALL electing
(The term 'expenditures' means amounts paid or incurred ) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table —
s. £■ •' •*•
If the amount on line 40 is — The lobbying nontaxable amount is -
Not over $500,000 20% of the amount on line 40
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 - 41
h~
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000
Over $17,000,000 $1,000,000 — „';* ** A '* i . ~$ ' ;
45 Lobbying nontaxable
amount
48 Grassroots non-
taxable amount
a Volunteers X 1
b Paid staff or management (Include compensation in expenses reported on lines c through h.) X 1
c Media advertisements X
d Mailings to members, legislators, or the public X
e Publications, or published or broadcast statements X
f Grants to other organizations for lobbying purposes X
g Direct contact with legislators, their staffs, government officials, or a legislative body X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X
i Total lobbying expenditures (add lines c through h.) ,
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities.
BAA Schedule A (Form 990 or 990-EZ) 2004
TEEA0405 07/23/04
Schedule A (Form 990 or 990-EZ) 2004 Save A L i f e F o u n d a t i o n 36-3869459 Page 6
Part VII I Information Regarding Transfers To and Transactions and Relationships With Noncharitable
j Exempt Organizations (See instructions)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501(c)
of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of' Yes No
(i)Cash 51 a (i) X
(ii)Other assets . . a(ii) X
b Other transactions.
(i)Sales or exchanges of assets with a noncharitable exempt organization b(i) X
(ii)Purchases of assets from a noncharitable exempt organization b(ii) X
(iii)Rental of facilities, equipment, or other assets b(iii) X
(iv)Reimbursement arrangements b(iv) X
(v)Loans or loan guarantees b(v) X
(vi) Performance of services or membership or fundraising solicitations b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees c X
d If the answer to any of the above is 'Yes complete the following schedule Column (b) should always show the fair market value of
tne gooas, oiner asseis, or services given by the reporting organization If the organization received less than fair market value in
any transaction or sharing arrangement, show in column {d) trie value of the goods, other assets, or services received,
(a) (b) (c) «0
Line no Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501 (c) of the Code (other than section 501 (c)(3)) or in section 527' 0 Yes 0 No
b If 'Yes,' complete the following schedule:
(a) (b) (c)
Name of organization Type of organization Description of relationship
TEEA0406 11/29/04
Save A Life Foundation 36-3869459 1
Beginning End of
Line 65 - Other Liabilities: of Year Year
I r v Bock
Director
0. 0. 0.
Emil J o n e s , Jr.
Director
0. 0. 0.
Steven Orebaugh
Director
0. 0. 0.
Ernesto Pretto
Director
0. 0. 0.
Note: The individuals above,
except as noted, spend time
as needed in t h e i r capacity
on the Board, They can be
contacted c/o Save a Life
Foundation, 9950 Lawrence
Ste300, Schiller Park, IL 60176
Total
Save A Life Foundation 36-3869459 3
Description Amount
Building 9,096.
Vehicle 7,826.
O f f i c e Equipment 13,379.
Total 30,301.
Description Amount
Due t o C a r o l S p i z z i r r i , P r e s i d e n t / E x e c . D i r e c t o r 157,655.
I n t e r e s t Rate - Variable
Total 157,655.
Description Amount
Total 137,155.
Description Amount
Due t o C a r o l S p i z z i r r i , P r e s i d e n t / E x e c . D i r e c t o r
I n t e r e s t Rate - Variable 163,654.
Total 163,654.
Save A Life Foundation 36-3869459 4
Description Amount
Total 61,746.
Description Amount
Total 61,746.
Additional Information For Tax Return
Training and developing "Bystanders", including children as volunteers equipped with Life Saving First Aid Skills
to aid in an emergency.
Form 8868 Application for Extension of Time to File an
(Rev December 2004)
Exempt Organization Return 0MB No 1545-1709
Type or
print
File by the Save A Life Foundation 36-3869459
due date for Number, street, and room or suite number If a P O box, see instructions
filing your
return See 9950 Lawrence , #300
instructions City, town or post office. For a foreign address, see instructions state ZIP code
c Balance Due. Subtract line 3b from line 3a Include your payment with this form, or, if required, deposit with FTD
coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions . .
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for
payment instructions
BAA For Privacy Act and Paperwork Reduction Act Notice, see instructions. Form 8868 (Rev 12-2004)
FIFZ0501 01/07/05
Form 990 Return of Organization Exempt From Income Tax
OMB No. 1545-0047
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code 2005
(except black lung benefit trust or private foundation)
Department of the Treasury Open to Public
Internal Revenue Service The organization may have to use a copy of this return to satisfy state reporting requirements. Inspection
A For the 2005 calendar year, or tax year beginning Jul 1 , 2005, and ending Jun 30 2006
B Check if applicable C Name of organization D Employer Identification Number
Pleas* use
Address change IRSIaM Save A L i f e Foundation 36-3869459
or print
Name change orjype. Number and street (or P O box if mail is not delivered to street addr) Room/suite E Telephone number
SM
Initial return specific 9950 L a w r e n c e 300 (847) 928-9683
Instruc
Final return tions. City, town or country State ZIP code + 4 F USea?"" LJcash | x j Accrual
Amended return Schiller Park IL 60176 I | Other (specify)*1
Application pending • Section 501(c)(3) organizations and 4947(a)(1) nonexempt H and I are not applicable to section 527 organizations
charitable trusts must attach a completed Schedule A
(Form 990 or 990-EZ). H (a) Is this a group return for affiliates' | | Yes | x j No
H (b) If 'Yes,' enter number of affiliates *
G Web site: ^ www. s a l f . orcj
H (C) Are all affiliates included? Q Yes Q No
J Organization type r—, . _ . . _ . (If 'No,' attach a list See instructions)
(Check Only one) ■ »• |XJ 501(c) 3 •* (insert no) | _ | 4947(a)(1) or | _ | 527
H (d) Is this a separate return filed by an
K Check here ** [ J if the organization's gross receipts are normally not more than
$25,000. The organization need not file a return with the IRS, but if the organization organization covered by a group ruling? yM R{1 No
chooses to file a return, be sure to file a complete return. Some states require a I Group Exemption Number *
complete return.
M Check *■ |_J if the organization is not required
L Gross receipts: Add lines 6b, 8b, 9b, and 10b to line 12 *■ 9 0 2 , 4 2 6 . to attach Schedule B (Form 990, 990-EZ, or 990-PF).
Parti Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions)
Contributions, gifts, grants, and similar amounts received:
a Direct public support ... 1a| 94,403.
b Indirect public support lb
c Government contributions (grants) 1c 700,000
d
ISlnrougn'rcf^ash $ 794,403, noncash $ ) Id 794,403.
2 Program service revenue including government fees and contracts (from Part VII, line 93) 95,335.
3 Membership dues and assessments
4 Interest on savings and temporary cash investments 4,882,
5 Dividends and interest from securities
6a Gross rents 6a
CO
b Less: rental expenses 6b
c Net rental income or (loss) (subtract line 6b from line 6a) . 6c
7 Other investment income (describe
v (A) Securities (B) Other
8a Gross amount from sales of assets other
than inventory 8a 5,800.
I"
b Less: nses . .. 8b 11,732
L..U
Z? c Gam or Strut... 8c -5,932
Net gajn d,r (loss) (comb.i ns (A) and (B)) . 8d -5,932.
O
CO
Speci
a Gross r£v"dnue (not includjrr
idule). If any amount is from gaming, check here
of contributions
'□
reportel 9a
b Less: dlteiLe^^re^o^BPffiaTrfunBfaising expenses 9b
c Net income or (loss) from special events (subtract line 9b from line 9a) 9c
10a Gross sales of inventory, less returns and allowances . 10a
b Less: cost of goods sold ... 10b
c Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10a) 10c
11 Other revenue (from Part VII, line 103) 11 2,006.
12 Total revenue (add lines I d , 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 11) 12 890,694.
13 Program services (from line 44, column (B)) . . . 13 1,005,527.
14 Management and general (from line 44, column (Q) 14 55,716.
15 Fundraising (from line 44, column (D)) . . . 15
16 Payments to affiliates (attach schedule) .... 16
17 Total expenses (add lines 16 and 44, column (A)) 17 1,061,243.
18 Excess or (deficit) for the year (subtract line 17 from line 12) 18 -170,549,
19 Net assets or fund balances at beginning of year (from line 73, column (A)) 19 974,150.
20 Other changes in net assets or fund balances (attach explanation) 20
' 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) . 21 803,601.
BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. TEEA0101 02/03/06 Form 990 (2005)
TEEA0102 11/OlrtS
Form990 (2005) Save A L i f e Foundation 36-3869459 Page 3
3
Statement of Program Service Accomplishments
Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular
organization. How the public perceives an organization in such cases may be determined by the information presented on its return Therefore,
please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments.
What is the organization's primary exempt purpose? ►■ See . A t t a c h e d Program Service Expenses
(Required tor 501(c)(3) and
All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of (4) organizations and
clients served, publications issued, etc. Discuss achievements that are not measurable. (Section 501(c)(3) and (4) organ- 4947(a)(1) trusts: but
izations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) optional for others.)
a
. N a t i o n a l ^ Programs^- _which_deliver_ 1 ife_supporting^ J i r _ s t _ a i d _ t r a i n i n g
_to _kj 12_ _students_ i n _?A.j_ _WJi. J™_and_FL_, _ u t i 1 i z i n g _stip_end
.compensated _ins t r u e t o r s _(2 6 ,_114 JtaughtJ.
(Grants and allocations $ 0 . ) If this amount includes foreign grants, check here *" \ \ 401,055.
b_State_Programs_-^ which_dejive_r_lif e_s_uppqrting_f i r s t _aid_training_
S-2-Hrl?. -Stu^P-Dt.3-i*l _?.I , _ , i.tilizinc[_ s t i p e n d compensated . . i n s t r u c t o r s _
Jil 6 -/2§_ 6 _ t a u g h t )
(Grants and allocations $ 0 . ) If this amount includes foreign grants, check here ^ \[ 604,472
c^ranch_Programs _-_which _ d e l i v e r JLife s u p p o r t i n g _ f i r s t _ a i d J;ra_ining_
_to _Kr 12_ _students_ through. .Jn-^Kind _time_ donatiqns_frpm . v o l u n t e e r
i n s t r u c t o r s _(4^153_taught)
(Grants and allocations $ 0 . ) If this amount includes foreign grants, check here *" \ \
(Grants and allocations $ ) If this amount includes foreign grants, check here *~ \ \
e Other program services
(Grants and allocations ) If this amount includes foreign grants, check here *~ \ | |
f Total of Program Service Expenses (should equal line 44, column (B), Program services) 1,005,527.
BAA Form 990 (2005)
TEEA0103 10714/05
Form 990 (2005) Save A L i f e Foundation 36-3869459 Page 4
PartIV 1 Balance Sheets (See instructions)
Note: Where required, attached schedules and amounts within the description (A) (B)
column should be for endof-year amounts only. Beginning of year End of year
45 Cash - non-interest-bearing.... .... 3 , 7 5 8 . 45 1,007.
46 Savings and temporary cash investments 8 1 0 , 2 1 8 . 46 591,786.
TEEA0104 10/17/05
Form990 (2005) Save A L i f e F o u n d a t i o n 36-3869459 Page5
Part IV-A 1 Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See
instructions.)
Total revenue, gains, and other support per audited financial statements 1,877,081.
Amounts included on line a but not on Part I, line 12:
1 Net unrealized gains on investments . . . . bl
2Donated services and use of facilities b2 973,687,
3 Recoveries of prior year grants b3
40ther (specify): . D o n a t e d JSugpJLies
b4 12,700
Add lines bl through b4 . .. 986,387.
Subtract line b from line a 890,694.
Amounts included on Part I, line 12, but not on line a:
11nvestment expenses not included on Part I, line 6b dl
20ther (specify).
d2
Add lines dl and d2 .
Total revenue (Part I, line 12) Add lines c and d , 890,694,
Part IV-B I Reconciliation of Expenses per Audited Financial Statements with Expenses per Return
Vice Chairwoman 0. 0. 0.
Douglas Browne
Treasurer 0. 0. 0.
Peggy Trimble
Vice Chairwoman 0. 0. 0.
Mark Mitchell
Director 0. 0. 0.
See List of Officers, Etc. Statement
TEEA0106 11/03/05
Form990 (2005) Save A L i f e F o u n d a t i o n 36-3869459 Page 7
Part VI I Other Information (continued) Yes No
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value? . . . .... 82a
b If 'Yes,' you may indicate the value of these items here Do not include this amount as
revenue in Part I or as an expense in Part II. (See instructions in Part III.) 82b 986,387.
83 a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a
b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? 83b
84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a
b If 'Yes,' did the organization include with every solicitation an express statement that such contributions or gifts were
not tax deductible? 84b
85 501(c)(4), (5), or (6) organizations, a Were substantially all dues nondeductible by members? . . . . . 85a
b Did the organization make only m-house lobbying expenditures of $2,000 or less? . 85b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year.
c Dues, assessments, and similar amounts from members 85c
d Section 162(e) lobbying and political expenditures ... 85 d
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices . 85e
f Taxable amount of lobbying and political expenditures (line 85d less 85e) . . 85 f
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f? . . 85g
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of
dues allocable to nondeductible lobbying and political expenditures for the following tax year? 85 h
86 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on
line 12 86a
b Gross receipts, included on line 12, for public use of club facilities 86b
87 501(c)(12) organizations. Enter- a Gross income from members or shareholders 87 a
b Gross income from other sources. (Do not net amounts due or paid to other sources
against amounts due or received from them ) 87 b
88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301 7701-3?
If 'Yes,' complete Part IX . . . . 88
89a 501(c)(3) organizations. Enter: Amount of tax imposed on the organization during the year under:
section 4911 ► 0 . , section 4912 »• 0 . ; section 4955 *■
b 501(c)(3) and 501 (c)(4) organizations. Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year? If 'Yes,' attach a statement
explaining each transaction 89b
c Enter: Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912,4955, and 4958 •••*"_
d Enter: Amount of tax on line 89c, above, reimbursed by the organization . . . . . . . *•
90a List the states with which a copy of this return is filed *■ _ I l l i n o i _ s _ , _ W i j c q n s i n _ , _ P e n n s y l v a n i a , _ _ A r i z o n a _ , Indiana
b Number of employees employed in the pay period that includes March 12, 2005 (See instructions.) . . | 90 b] 9
91 a The books are in care of »• £ a r q l _ S j ) i z z i r r i Telephone number *■ _(847_)_928-9683
Located at ► 9950 L a w r e n c e S u i t e 3 0 0 , S c h i l l e r P a r k IL ZIP + 4 ► 60176
b At any time during the calendar year, did the organization have an interest in or a signature or other authority over a Yes No
financial account in a foreign country (such as a bank account, securities account, or other financial account)' 91b 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 Statements
c At any time during the calendar year, did the organization maintain an office outside of the United States? 91c
If 'Yes,' enter the name of the foreign country *■
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 — Check here
and enter the amount of tax-exempt interest received or accrued during the tax year . . ► 92
□
BAA Form 990 (2005)
TEEA0107 02/03/06
Form 990 (2005) Save A L i f e F o u n d a t i o n 36-3869459 Paqe 8
Part VII1 Analysis of Income-Producinq Activities (See the instructions )
Unrelated business income Excluded by section 512, 513, or 514
(E)
Note: Enter gross amounts unless (A) (B) (C) Related or exempt
otherwise indicated. Business code Amount Amount function income
Exclusion code
93 Program service revenue:
a P r o g r a m Fees 23,780.
b Course M a t e r i a l s 67,133.
c B r a n c h Fee 4,422.
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash invmnts 14 4,882.
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate: , ■ ."I
a debt-financed property . .
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
100 Gain or (loss) from sales of assets
other than inventory 18 -5,932.
101 Net income or (loss) from special events
102 Gross profit or (loss) from sales of inventory .
103 Other revenue: a j
_ -"< • e - -. , - ,
b Miscellaneous 2,006.
c
d
e
104 Subtotal (add columns (B), (0), and (E)) ' . " -. -1,050. 97,341.
96,291,
Note: Line 105 plus line Id, Part I, should equal the amount on line 12, Part I.
Part VIII Relationship of Activities to the Accomplishment of Exempt Purposes (See the instructions.)
Line No. Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment
of the organization's exempt purposes (other than by providing funds for such purposes).
93a-c Provide l i f e s a v i n g f i r s t a i d s k i l l s t o v o l u n t e e r s t o a i d i n an
emergency.
103b M i s c e l l a n e o u s income t o c a r r y o u t t h e l i f e s a v i n g f i r s t a i d programs.
Part IX I Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructions.) N/A
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
%
%
Part X I Information Regarding Transfers Associated with Personal Benefit Contracts (See the instructions.)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay [
b Did the organization, during the year, pay premiums, directly or mdl
Note: If 'YesLjo (b), file Form 8870 and Form 4720 (see instructions)!
examined this return, includini
— '-"- "--n officer; - ' —
Please
Sign
Here
Type or print name and title
Paid
Pre-
arer's
Preparer's
signature
► a / ->.Auf
Ahlbeck & Company
G
Firm's name (or
yours if self-
se employed), k 1665 Elk Blvd
address, and
Only ZIP+ 4 Des Plaines
BAA
OMBNo 1545-0047
Organization Exempt Under
SCHEDULE A Section 501 (cX3)
(Form 990 or 990-EZ)
(Except Private Foundation) and Section 501(e), 501(0,501 (k),
501(n), or 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information — (See separate instructions.)
2005
Department of the Treasury
Internal Revenue Service MUST be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name of the organization Employer identification number
_Dane_ N e a l
9950 Lawrence, Suite 300, Schiller Park, IL 60176 National Policy Director 4 0 63,500. 1,800.
Total number of others receiving over ." > •'■;■- >'* V-". -''•■j V \ "■■ " "
$50,000 for professional services ** None
Part II — B I Compensation of the Five Highest Paid Independent Co ntractors for Other Services
(List each contractor who performed services other than professional services, whether individuals or firms. If there are none,
enter 'None.' See instructions )
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
None
TEEA0401 08/09(05
Schedule A (Form 990 or 990-EZ) 2005 Save A L i f e Foundation 36-3869459 Page 2
11a [x] An organization that normally receives a substantial part of its support from a governmental unit or from the general public.
Section 170(b)(l)(A)(vi). (Also complete the Support Schedule in Part IV-A.)
11 b \_j A community trust. Section 170(b)(l)(A)(vi). (Also complete the Support Schedule in Part IV-A.)
12 L J 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 charitable, etc, 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). (Also complete the Support Schedule in Part IV-A.)
13 L J An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations
described in: (1) lines 5 through 12 above; or (2) section 50Hc)(4), (5), or (6), if they meet the test of section 509(a)(2). Check the
box that describes the type of supporting organization:
35 Type 1 l~l Type 2 I ! Type 3
Provide the following information about the supported organizations. (See instructions)
14 M An organization organized and operated to test for public safety Section 509(a)(4). (See instructions.)
BAA TEEA04O2 08/09/05 Schedule A (Form 990 or Form 990-EZ) 2005
Schedule A (Form 990 or 990-EZ) 2005 Save A L i f e Foundation 36-3869459 Page 3
P a r t I V - A 1 S u p p o r t S c h e d u l e (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting.
Calendar year (or fiscal year (e)
beginning in) ** 2004 2003 2002 2001 Total
15 Gifts, grants, and contributions
received (Do not include
unusual grants. See line 28 ) 1,882,822. 448,621. 1,371,684. 820,282. 4,523,409.
16 Membership fees received
17 Gross receipts from admissions,
merchandise sold or services performed,
or furnishing of facilities in any activity
that is related to the organization's
charitable, etc, purpose 399,546. 120,316. 207,836. 197,535. 925,233.
18 Gross income from interest, dividends,
amounts received from payments on
securities loans (section 512(aX5)),
rents, royalties, and unrelated business
taxable income (less section 511 taxes)
from businesses acquired by the organ
ization after June 30,1975 1,933. 795. 2,154. 3,275. 8,157.
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf . .
21 The value of services or
facilities furnished to the
organization by a governmental
unit without charge. Do not
include the value of services or
facilities generally furnished to
the public without charge . ..
22 Other income. Attach a
schedule. Do not include
gam or (loss) from sale of
capital assets
23 Total of lines 15 through 22 2,284,301. 569,732. 1,581,674. 1,021,092. 5,456,799.
24 Line 23 minus line 17 1,884,755. 449,416. 1,373,838. 823,557. 4,531,566.
25 Enter 1 % of line 23 . 22,843. 5,697. 15,817. 10,211.
26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 *" 26 a 90,631.
b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly
supported organization) whose total gifts for 2001 through 2004 exceeded the amount shown in line 26a. Do not file this list with your
return. Enter the total of all these excess amounts . . . . *■ 26 b 0.
c Total support for section 509(a)(1) test: Enter line 24, column (e) . . . ... *• 26 c 4,531,566.
d Add: Amounts from column (e) for lines: 18 8,157. 19 - _. . _J
22 26b 0. . * 26 d 8,157.
e Public support (line 26c minus line 26d total) *• 26e 4,523,409.
f Public support percentage (line t !6e (numerator) divid ed by line 26c (denorrlinator)) * 26 f 99.82 %
27 Organizations described on line 12:
a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the
name of, and total amounts received in each year from, each 'disqualified person.' Do not file this list with your return. Enter the sum of
such amounts for each year:
(2004) (2003) (2002) _ _ (2001)
bFor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records
to show the name of, and amount received for each year, that was more than the larger of (1) the amount on dne 25 for the year or (2)
$5,000. (Include in the list organizations described in lines 5 through 11 b, as well as individuals.) Do not file this list with your return.
After computing the difference between the amount received and the larger amount described in (1)or (2), enter the sum of these
differences (the excess amounts) for each year:
(2004) (2003). (2002) (2001)
c Add Amounts from column (e) for lines: 15 16
17 20 21 *• 27c
d Add: Line 27a total . and line 27b total 27d
e Public support (line 27c total minus line 27d total) 27 e
f Total support for section 509(a)(2) test Enter amount from line 23, column (e) 27 f
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 27fl
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator)) 27 h %
28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2001 through 2004, prepare a
list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the
nature of the grant. Do not file this list with your return. Do not include these grants in line 15.
BAA TEEA04O3 02/03/06 Schedule A (Form 990 or 990-EZ) 2005
Schedule A (Form 990 or 990-EZ) 2005 Save A L i f e Foundation 36-3869459 Page 4
Part V 1 Private School Questionnaire (See instructions.)
(To be completed ONLY by schools that checked the box on line 6 in Part IV) N/A
Yes No
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body? . . .. 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs,
and scholarships? . . . . .... 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves? . 31
If 'Yes,' please describe; if 'No,' please explain. (If you need more space, attach a separate statement.)
If you answered 'No' to any of the above, please explain. (If you need more space, attach a separate statement.)
33 Does the organization discriminate by race in any way with respect to:
If you answered 'Yes' to any of the above, please explain (If you need more space, attach a separate statement)
34 a Does the organization receive any financial aid or assistance from a governmental agency? 34a
b Has the organization's right to such aid ever been revoked or suspended? 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement.
35 Does the organization certify that it has complied with the applicable requirements of
sections 4.01 through 4.05 of Rev Proc 75-50, 1975-2 C.B. 587, covering racial
nondiscrimination? If 'No,' attach an explanation. 35
BAA TEEA0404 08/08/05 Schedule A (Form 990 or 990-EZ) 2005
Save A Life Foundation
Schedule A (Form 990 or 990-EZ) 2005 36-3869459 Page5
Part Vl-A I Lobbying Expenditures by Electing Public Charities (See instructions.^
(To be completed ONLY by an eligible organization that filed Form 5768) N/A
Check » a | | if the organization belongs to an affiliated group. Check *■ b if you checked 'a' and 'limited control' provisions apply.
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed
totals for ALL electing
(The term 'expenditures' means amounts paid or incurred.) organizations
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) ... 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) . . . 38
39 Other exempt purpose expenditures . 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount. Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount is —
Not over $500,000 . .... 20% of the amount on line 40 . . j
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 .. $175,000 plus 10% of the excess over $1,000,000 41
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000 -
Over $17,000,000 $1,000,000
42 Grassroots nontaxable amount (enter 25% of line 41) . 42
43 Subtract line 42 from line 36. Enter -0- if line 42 is more than line 36 .. .... 43
44 Subtract line 41 from line 38. Enter -0- if line 41 is more than line 38 44
Caution: If there is an amount on either line 43 or line 44, you must file Form 4720.
45 Lobbying nontaxable
amount .. .
46 Lobbying ceiling amount
(150% of line 45(e)) .
47 Total lobbying
expenditures
48 Grassroots non-
taxable amount ..
49 Grassroots ceiling amount
(150% of line 48(e))
50 Grassroots lobbying
expenditures
Part Vl-B I Lobbying Activity by Nonelect no Public Charities
(For reporting only by organizations that did not complete Part Vl-A) (See instructions.)
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of: Yes No Amount
a Volunteers X
b Paid staff or management (Include compensation in expenses reported on lines c through h.) X
c Media advertisements. . X
d Mailings to members, legislators, or the public X
e Publications, or published or broadcast statements X
f Grants to other organizations for lobbying purposes X
g Direct contact with legislators, their staffs, government officials, or a legislative body X
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X
i Total lobbying expenditures (add lines c through h.) ...
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities.
BAA Schedule A (Form 990 or 990-EZ) 2005
TEEA04O5 08/08/05
Schedule A (Form 990 or 990-EZ) 2005 Save A L i f e F o u n d a t i o n 36-3869459 Page 6
Part VII I Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501 (c)
of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to political organizations?
a Transfers from the reporting organization to a noncharitable exempt organization of: Yes No
(OCash .. . . . . 51 a 0) X
(ii)Other assets ... afli) X
b Other transactions:
(QSales or exchanges of assets with a noncharitable exempt organization b(D X
(ii)Purchases of assets from a noncharitable exempt organization bOi) X
(iii)Rental of facilities, equipment, or other assets b(iii) X
(iv) Reimbursement arrangements .... .... b(iv) X
(v)Loans or loan guarantees . . . b(v) X
(vi)Performance of services or membership or fundraising solicitations .. ... b(vi) X
c Sharing of facilities, equipment, mailing lists, other assets, or paid employees . . . . c X
d If the answer to any of the above is 'Yes,' complete the following schedule Column (b) should always show the fair market value of
the goods, other assets, or services given by the reporting organization. If the organization received less than fair market value in
any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received:
(a) (b) (c) (d)
Line no. Amount involved Name of noncharitable exempt organization Description of transfers, transactions, and sharing arrangements
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? *■ \_\ Yes [x] No
b If 'Yes,' complete the following schedule:
(a) (b)
Name of organization Type of organization Description of relationship
TEEA0406 08/08/05
Form 990 Schedule off Gains and Losses ffrom 2005
Line 8(A) and 8(B) Sale of Assets Other than Inventory
Statement *■ Attach to return
Gross
Description Sales Price Basis
Nonpublic Securities
Total Securities
Additional Information
I r v Bock
Director
0. 0. 0.
Emil J o n e s , Jr.
Director
0. 0. 0.
Steven Orebaugh
Director
0. 0. 0.
Ernesto Pretto
Director
0. 0. 0.
Note: The individuals above,
except as noted, spend time
as needed in t h e i r capacity
on the Board, They can be
c o n t a c t e d c / o Save a Life
Foundation, 9950 Lawrence
Ste300, S c h i l l e r Park, IL 60176
Save A Life Foundation 36-3869459 2
Description Amount
Program S e r v i c e S a l a r i e s :
Carol S p i z z i r r i 123,500.
Total 123,500.
Description Amount
Total 6,500.
Description Amount
Building 9,096.
Equipment 22,624.
Vehicles 1,882.
Total 33,602.
Description Amount
Due t o Carol S p i z z i r r i , P r e s i d e n t / E x e c . D i r e c t o r
I n t e r e s t Rate - V a r i a b l e 163,654.
Total 163,654.
Save A Life Foundation 36-3869459 4
Description Amount
Due t o Carol S p i z z i r r i , P r e s i d e n t / E x e c . D i r e c t o r
I n t e r e s t Rate-Variable 170,183.
Total 170,183.
Description Amount
Carol S p i z z i r r i b e n e f i t s :
Medical i n s u r a n c e 1,900.
Total 1,900.
OMBNo 1545-0047
Form 990
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
2006
(except black lung benefit trust or private foundation)
Open to Public
Department of the Treasury
Internal Revenue Service *• The organization may have to use a copy of this return to satisfy state reporting requirements Inspection
A For the 2006 calendar year, or tax year beginning 7/01 2006, and ending 6/30 2007
B Check il applicable D Employer Identification Number
gross receipts are normally not more than $25 000 A return is not required but if the I Group Exemption Number »»
organization chooses to file a return, be sure to file a complete return
M Check > | _ | if the organization is not required
L 925,545.
Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 to attach Schedule B (Form 990, 990-EZ, or 990-PF).
Part I | Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions.
Contributions, gifts, grants, and similar amounts received
a Contributions to donor advised funds la
b Direct public support (not included on line la) lb 31,945.
c Indirect public support (not included on line la) 1c
d Government contributions (grants) (not included on line la) Id 700,000.
Total (add lines
la through Id) (cash $ 7 3 1 , 9 4 5 . noncash $
) 1e 731,945.
2 Program service revenue including government fees and contracts (from Part VII line 93) 179,171,
3 Membership dues and assessments
4
5
Interest on savings and temporary cash investments RECEIVED 13,684,
Dividends and interest from securities
6a Gross rents M fi 2008
b Less rental expenses 6b
c Net rental income or (loss) Subtract line 6b from line 6a 6c
R
E
7 Other investment income (describe
(A) Sei
:IT
W^nirJ
V 8a Gross amount from sales of assets other
than inventory 8a
b Less, cost or other basis and sales expenses 8b
c Gain or (loss) (attach schedule) 8c
1
ir—=J
d Net gain or (loss) Combine line 8c, columns (A) and (B)
Special events and activities (attach schedule) If any amount is from gaming, check here . ►
Gross revenue (not including $ of contributions
*D
8d
(317 II
Form 990 (2006) SAVE A LIFE FOUNDATION 36-3869459 Page 2
Part II Statement of Functional Ex p e n s e s All organizations must complete column (A) Columns (B), (C), and (D) are
lequned lui section 001(c)(J) and (4) organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others
Do not include amounts reported on line (A) Total (B) Program (C) Management (D) Fundraising
6b, 8b, 9b, 10b, or 16 of Part1 services and general
22 a Grants paid from donor advised
funds (attach sch)
(cash $
non-cash $ )
If this amount includes _,
foreign grants, check here *" [_| 22 a
22 b Other grants and allocations (att sch)
(cash $
non-cash $ )
If this amount includes ,_.
foreign grants, check here * (J 22 b
(Grants and allocations $ ) If this amount includes foreign grants, check here
c.BRANCH_P_RQGRAMS _-_ WHICH .DELIVER _LIFE_ SUPPORTING _FIRST_AI_D_TRAINI_NG_TO_
n 218,280.
" "
(Grants and allocations $ ) If this amount includes foreign grants, check here 809,346.
(Grants and allocations $ ) If this amount includes foreign grants, check here
n
e Other program services
(Grants and allocations $ ) If this amount includes foreign grants, check here
f Total of Program Service Expenses (should equal line 44, column (B), Program services) 1,330,239.
BAA Form 990 (2006)
TEEA0103L 01/18/07
Form 990 (2006) SAVE A L I F E FOUNDATION 36-3869459 Page4
Part IV Balance Sheets (See the instructions.)
Note: Where required, attached schedules and amounts within the description (A) (B)
column should be for end-of-year amounts only Beginning of year End of year
45 Cash — non-interest-beanng 1,007. 45 52,909.
46 Savings and temporary cash investments 591,786. 46 130,655.
TEEA0104L 01/18/07
Form 990 (2006) SAVE A LIFE FOUNDATION 36-3869459 Page 5
Part IV-A Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See the
instructions.)
a Total revenue, gains, and other support per audited financial statements a 1,256,155.
b Amounts included on line a but not on Part 1, line 12
1 Net unrealized gains on investments bl
2Donated services and use of facilities b2 330,610.
3Recovenes of prior year grants b3
40ther (specify)
-
b4
Add lines b l through b4 b 330,610.
c Subtract line b from line a c 925,545.
d Amounts included on Part 1, line 12, but not on line a:
1 Investment expenses not included on Part 1, line 6b dl
20ther (specify). J
d2
Add lines dl and d2 d
e Total revenue (Part 1, line 12) Add lines c and d *■
e 925,545.
Part IV-B Reconciliation of Expenses per Audited Financial Statements with Expenses per Return
TEEA0106L 01/18/07
Form 990 (2006) SAVE A LIFE FOUNDATION 36-3869459 Page 7
I Part VI I Other Information (continuedQ Yes No
82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at
substantially less than fair rental value7 82 a
blf 'Yes,' you may indicate the value of these items here. Do not include this amount as
revenue in Part I or as an expense in Part II (See instructions in Part I I I ) 82 b I 330,610
M
83a Did the organization comply with the public inspection requirements for returns and exemption applications? 83a X
bDid the organization comply with the disclosure requirements relating to quid pro quo contributions7 83 b X
84a Did the organization solicit any contributions or gifts that were not tax deductible 7 84a
*?*-
'Uti^^^™
not tax
include with every solicitation an express statement that such contributions or gifts were
84b 'A
85 501(c)(4), (5), or (6) organizations a Were substantially all dues nondeductible by members 7 85 a N
b Did the organization make only in-house lobbying expenditures of $2,000 or less 7 85 b
If 'Yes' was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a
waiver for proxy tax owed for the prior year.
c Dues, assessments, and similar amounts from members 85 c N/A
d Section 162(e) lobbying and political expenditures 85 d N/A
e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 85 e N/A
f Taxable amount of lobbying and political expenditures (line 85d less 85e) 85 f N/A
g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f 7 851 N/A
h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on llne 85f to its reasonable estimate of &
dues allocable to nondeductible lobbying and political expenditures for the following tax year' 85 h N/A
86 501(c)(7) organizations Enter a Initiation fees and capital contributions included on
line 12 86 a N/A
b Gross receipts, included on line 12, for public use of club facilities 86 b N/A ; %
87 501(c)(12) organizations Enter, a Gross income from members or shareholders 87 a N/A
b Gross income from other sources (Do not net amounts due or paid to other sources I *
against amounts due or received from them )
88 a At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership,
or an entity disregarded as separate from the organization under Regulations sections 301 7701 -2 and 301 7701 -3 7
If 'Yes,' complete Part IX
87 b N/A
88 a
m
b At any time during the year, did the organization, directly or indirectly, own a controlled entity within the meaning of
section 512(b)(13)7 If 'Yes,' complete Part XI » 88 b
89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under
section 4911 ► 0._ , section 4912 - jCL , section 4955 ► _0_.
b 501(c)(3) and 501(c)(4) organizations Did the organization engage in any section 4958 excess benefit transaction
during the year or did it become aware of an excess benefit transaction from a prior year 7 If 'Yes,' attach a statement # Ife
explaining each transaction 89 b
c Enter Amount of tax imposed on the organization managers or disqualified persons during the
year under sections 4912, 4955, and 4958 0.
d Enter Amount of tax on line 89c, above, reimbursed by the organization *- 0.
e All organizations At any time during the tax year, was the organization a party to a prohibited tax shelter transaction 7 89e
f All organizations Did the organization acquire a direct or indirect interest in any applicable insurance contract 7 89 f
g For supporting organizations and sponsoring organizations maintaining donor advised funds Did the supporting &■?
organization, or a fund maintained by a sponsoring organization, have excess business holdings at any time during
89 g
90a List the states with which a copy of this return is filed ► _ I L , _ W I , _ PA,_ A Z , _ V T
b Number of employees employed in the pay period that includes March 12, 2006
(See instructions) 90 bl
91 a The books are in care of * CARO_ S P I Z Z I R R I Telephone number » (847) 928-9683
Located at * _9950_ LAWJtfNCjfsTujTE l o g J S C H J L L E X P A R K T L , ^p"^"j0Vl_l
Yes No
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 account)7 91b 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
Ml
BAA Form 990 (2006)
TEEA0107L 01/18/07
Form 990 (2006) SAVE A LIFE FOUNDATION 36-3869459 Page 8
Part VI Other Information (continued) Yes No
c At any time during the calendar year, did the organization maintain an office outside of the United States7 91c X
If 'Yes,' enter the name of the foreign country . -
92 Section 4947(a)(1) nonexempt charitable trusts filing Form 990 in lieu of Form 7041 - Check here
and enter the amount of tax-exempt interest received or accrued during the ax year H 92
N/A
N/A
n
Part VII Analysis of Income-Producing Activities (See the instructions.)
Unrelated business income Excluded by section 512, 513, or 514
Note: Enter gross amounts unless (A) (B) (C) (D) Related or exempt
otherwise indicated Business code Amount Exclusion code Amount function income
93 Program service revenue
a COURSE M A T E R I A L S 165,155.
b PROGRAM FEES 14,016.
c
d
e
f Medicare/Medicaid payments
g Fees & contracts from government agencies
94 Membership dues and assessments
95 Interest on savings & temporary cash mvmnts 14 13,684.
96 Dividends & interest from securities
97 Net rental income or (loss) from real estate
a debt-financed property
b not debt-financed property
98 Net rental income or (loss) from pers prop
99 Other investment income
Part IX [ Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructtons.
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total End-of-year
partnership, or disregarded entity ownership interest income assets
N/A
Part X I Information Regarding Transfers Associated with Personal Benefit Contracts (See the instructions.)
a Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefft contract? Yes No
b Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract7 Yes No
Note: If 'Yes' to (b), file Form 8870 and Form 4720 (see instructions).
BAA TEEA0108L 04/04/07 Form 990 (2006)
Form 990 (2006) SAVE A LIFE FOUNDATION 36-3869459 Page 9
Part XI 1 Information Regarding Transfers To and From Controlled Entities. Complete only if the
organizaiion is a controlling organization as defined in section 512(b)(13).
Yes No
106 Did the reporting organization make any transfers to a controlled entity as defined in section 512(b)(13) of the Code7 If
'Yes,' c o m p l e t e the schedule below for each controlled entity
Totals
Yes No
107 Did the reporting organization receive any transfers from a controlled entity as defined in section 512(b)(13) of the Code? If
'Yes,' complete the schedule below for each controlled entity
(A) (B) (C)
Employer Identification (D)
N a n
c ^ K ! , y a c h Number Amount of transfer
Totals
- . ■ • ' ; # < ■ &
Yes No
108 Did the organization have a binding written contract in effect on August 17, 2006, covering the interest, rents, royalties, and
annuities described in question 107 above7
Underpwalties of penury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is
tnief correi^. a n d ^ p n ^ e l e Declaration of preparer (otherjh^n^officer) f based on all lnformation of which preparer has any knowledge ;
Please ■r//v/cs
Paid
Pre-
F,rmsname(or C B I Z ACCTG ■ , TAX & ADVISORY SERVICES, L'LC
Bas?r's yours ,f self- „ „
e^pioyedf ► One S o u t h Wacker Dr
„ g ^ l g 0 0
EIN > 34-1853929
Only address.and C h i c a g o , IL 6 0 6 0 6 - 4 6 3 0 Phone no - (312) 602"6800
BAA Form 990 (2006)
TEEA0110L 01/19/07
OMBNo 15450047
Organization Exempt Under
SCHEDULE A Section 501(c)(3)
(Form 990 or 990-EZ)
(Except Private Foundation) and Section 501(e), 501(0, 501(k),
501 (n), or4947(aX1) Nonexempt Charitable Trust
Supplementary Information - (See separate instructions.)
2006
Department of the Treasury
Internal Revenue Service MUST be completed by the above organizations and attached to their Form 990 or 990-EZ.
Name ol the organization Employer identification number
-See.Statement. 6.
113,520. 0. 1,308.
See Statement 7
77,039.
_None_
TEEA0401L 01/19/07
Schedule A (Form 990 or 990-EZ) 2006 SAVE A LIFE FOUNDATION 36-3869459 Page2
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt
to influence public opinion on a legislative matter or referendum7 If 'Yes,' enter the total expenses paid
or incurred in connection with the lobbying activities ►■
$ N/A
(Must equal amounts on line 38, Part Vl-A, or line i of Part Vl-B > X
Organizations that made an election under section 501(h) by filing Form 5768 must complete Part Vl-A Other
organizations checking 'Yes' must complete Part Vl-B AND attach a statement giving a detailed description of the
lobbying activities
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any
substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any
taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal
beneficiary7 (If the answer to any question is 'Yes,' attach a detailed statement explaining the transactions )
_X_
b Did the organization have a section 403(b) annuity plan for its employees7 3b X
c Did the organization receive or hold an easement for conservation purposes, including easements
to preserve open space, the environment, historic land areas or historic structures7 If
'Yes,' attach a detailed statement 3c X
d Did the organization provide credit counseling, debt management, credit repair, or debt negotiation services7 3d X
4a Did the organization maintain any donor advised funds7 If 'Yes,' complete lines 4b through 4g If 'No,' complete lines
4f and 4g 4a X
b Did the organization make any taxable distributions under section 4966? 4b N/A
c
Did the organization make a distribution to a donor, donor advisor, or related person7 4c N/A
d Enter the total number of donor advised funds owned at the end of the tax year *• N/A
e Enter the aggregate value of assets held in all donor advised funds owned at the end of the tax year N/A
f Enter the total number of separate funds or accounts owned at the end of the tax year (excluding donor advised
funds included on line 4d) where donors have the right to provide advice on the distribution or investment of
amounts in such funds or accounts
g Enter the aggregate value of assets held in all funds or accounts included on line 4f at the end of the tax year ►-
0.
BAA TEEA0402L 04/04/07 Schedule A (Form 990 or Form 990-EZ) 2006
Schedule A (Form 990 or 990-EZ) 2006 SAVE A LIFE FOUNDATION 36-3869459 Page 3
9 L]] A medical research organization operated in conjunction with a hospital Section 170(b)(l)(A)(m) Enter the hospital's name, city,
and state »• _,
10 n An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)
(Also complete the Support Schedule in Part IV-A )
11a f x ] An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV-A )
11 b Q A community trust Section 170(b)(l)(A)(vi) (Also complete the Support Schedule in Part IV-A )
12 n 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 charitable, etc, 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) (Also complete the Support Schedule in Part IV-A.)
13 □
An organization that is not controlled by any disqualified persons (other than foundation managers) and otherwise meets the
requirements of section 509(a)(3) Check the box that describes the type of supporting organization •
|~|Type |~~|Type II I~~|Type lll-Functionally Integrated |~|Type Ill-Other
Provide the following information about the supported organizations. (See instructions )
(a) (b) (c) (d) (e)
Name(s) of supported Employer identification Type of Is the supported Amount of
organization(s) number (EIN) organization (described organization listed in support
in lines 5 through 12 the supporting
above or IRC section) organization's
governing
documents?
Yes No
K
Total 0.
14 | ~ I An organization organized and operated to test for public safety Section 509(a)(4) (See instructions )
BAA Schedule A (Form 990 or 990-EZ) 2006
TCEA0407L 01/22/07
Schedule A (Form 990 or 990-EZ) 2006 SAVE A LIFE FOUNDATION 36-3869459 Page 4
PartIV-A | S u p p o r t S c h e d u l e (Complete only if you checked a box on line 10, 11, or 12) Use cash method of accounting.
Note: You may use the worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year (a) (b) (c) (d) (e)
beginning in) •" 2005 2004 2003 2002 Total
15 Gifts, grants, and contributions
received (Do not include
unusual grants See line 28 ) 1,034,403. 1,882,822. 448,621. 1,371,684. 4,737,530.
16 Membership fees received 0.
17 Gross receipts from admissions,
merchandise sold or services performed,
or furnishing of facilities in any activity
that is related to the organization's
charitable, etc, purpose 112,094. 399,546. 120,316. 207,836. 839,792.
18 Gross income from interest, dividends,
amounts received from payments on
securities loans (section 512(a)(5)),
rents, royalties, and unrelated business
taxable income (less section 511 taxess
from businesses acquired by the organ
ization after June 30, 1975 4,882. 1,933. 795. 2,154. 9,764.
19 Net income from unrelated business
activities not included in line 18 0.
20 Tax revenues levied for the
organization's benefit and
either paid to it or expended
on its behalf 0.
21 The value of services or
facilities furnished to the
organization by a governmental
unit without charge Do not
include the value of services or
facilities generally furnished to
the public without charge 0.
22 Other income Attach a
schedule Do not include
gam or (loss) from sale of
capital assets S e e S t i n t 8 2,006. 2,006.
23 Total of lines 15 through 22 1,153,385. 2,284,301. 569,732. 1,581,674. 5,589,092.
24 Line 23 minus line 17 1,041,291. 1,884,755. 449,416. 1,373,838. 4,749,300.
25 Enter 1 % of llne 23 11,534. 22,843. 5,697. 15,817. , :-.WM&
26 Organizations described on lines 10 or 11: a Enter 2% of amount in column (e), line 24 *- 26 a 94,986.
b Prepare a list tor your records to show the name of and amount conttrbuted by each pprson nother rhaa n agvernmentaa luit to rpulicly
supported organization) whose total gifts for 2002 through 2005 exceeded the amount shown in line 26a Do not file this list with your ,vfi*£ft&
return Enter the total of all these excess amounts . *• 26 b
c Total support for section 509(a)(1) test Enter line 24, column (e) •" 26 c 4,749,300.
d A d d Amounts from column (e) for lines 18 9,764. 19 . V^^*l
22 2,006. 26b 26 d 11,770.
e Public support (line 26c minus line 26d total) »* 26 e 4,737,530.
f Public support percentage (line 26e (numerator) divid ed by line 26c (deno minator)) - 26 f 99.75 %
27 Organizations described on line 12: N/A
a For amounts included in lines 15, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show the
name of, and total amounts received in each year from, each 'disqualified person ' Do not file this list with your return. Enter the sum of
such amounts for each year
(2005) (2004) (2003) (2002)
bFor any amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records
to show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2)
$5,000 (Include in the list organizations described in lines 5 through l i b, as well as individuals ) Do not file this list with your return.
After computing the difference between the amount received and the larger amount described in (1)or (2), enter the sum of these
differences (the excess amounts) for each year:
(2005) (2004) (2003) (2002)
c Add Amounts from column (e) for lines 15 16
17 20 21 27 c
d Add Line 27a total and line 27b total 27 d
e Public support (line 27c total minus line 27d total) ► 27e
f Total support for section 509(a)(2) test- Enter amount from line 23, column (e) H 27f |
g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) 27g
h Investment income percentage (line 18, column (e) (numerator) divided by line 27f (denominator) 27 h %
28 Unusual Grants: For an organization described in line 10, 11, or 12 that received any unusual grants during 2002 through 2005, prepare a
list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the
nature of the grant Do not file this list with your return. Do not include these grants in line 15
BAA TEEA04O3L 01/19/07 Schedule A (Form 990 or 990-EZ) 2006
Schedule A (Form 990 or 990-EZ) 2006 SAVE A LIFE FOUNDATION 36-3869459 Page5
Part V Private School Questionnaire (See instructions.)
(To be completed ONLY by schools that checked the box on line 6 in Part IV) N/A
Yes No
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws,
other governing instrument, or in a resolution of its governing body7 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures,
catalogues, and other written communications with the public dealing with student admissions, programs, '
and scholarships 7 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during
the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that
makes the policy known to all parts of the general community it serves7 31
If 'Yes,' please describe, if 'No,' please explain (If you need more space, attach a separate statement)
-J-Z.
33 Does the organization discriminate by race in any way with respect to •A','
b Admissions policies 7 33 b
f Use of facilities 7 33 f
g Athletic programs 7 33 g
If you answered 'Yes' to any of the above, please explain. (If you need more space, attach a separate statement.)
34a Does the organization receive any financial aid or assistance from a governmental agency 7 34a
bHas the organization's right to such aid ever been revoked or suspended 7 34b
If you answered 'Yes' to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of &
sections 4 01 through 4 05 of Rev Proc 75-50, 1975-2 C.B 587, covering racial
nondiscrimmation7 If 'No,' attach an explanation. 35 |
BAA TEEA04O4L 01/19/07 Schedule A (Form 990 or 990-EZ) 2006
Schedule A (Form 990 or 990-EZ) 2006 SAVE A LIFE FOUNDATION 36-3869459 Page 6
Part Vl-A Lobbying Expenditures by Electing Public Charities (See instructions )
(To be completed ONLY by an eligible organization that filed Form 5768) N/A
Check - a if the organization belongs to an affiliated group. Check ► b if you checked 'a' and 'limited control' provisions apply
(a)
Limits on Lobbying Expenditures Affiliated group To be completed
totals
(The term 'expenditures' means amounts paid or incurred )
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table -
If the amount on line 40 is - The lobbying nontaxable amount is -
Not over $500,000 20% of the amount on line 40
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 - 41
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000
Over $17,000,000 $1,000,000
42 Grassroots nontaxable amount (enter 25% of line 41) 42
43 Subtract line 42 from line 36 Enter -0- if line 42 is more than line 36 43
44 Subtract line 41 from line 38 Enter -0- if line 41 is more than line 38 44
Caution: If there is an amount on either line 43 or line 44, you must file Form 4720 \-.>~;:v^ .-; ■ V '
45 Lobbying nontaxable
ISSn'SSSSS0
47
48 Grassroots non-
taxable amounL
49 Grassroots ceiling amount
(150% of line 48(e)) ^iSKr
50 Grassroots lobbying
expenditures
PartVI-B | Lobbying Activity by Nonelecting Public Charities
(For reporting only by organizations that did not complete Part Vl-A) (See instructions ) N/A
During the year, did the organization attempt to influence national, state or local legislation, including any
attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount
a Volunteers -•'■-./
b Paid staff or management (Include compensation in expenses reported on lines c through h.)
c Media advertisements
d Mailings to members, legislators, or the public
e Publications, or published or broadcast statements
f Grants to other organizations for lobbying purposes
g Direct contact with legislators, their staffs, government officials, or a legislative body
h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means
i Total lobbying expenditures (add lines c through h.)
If 'Yes' to any of the above, also attach a statement giving a detailed description of the lobbying activities
BAA Schedule A (Form 990 or 990-EZ) 2006
TEEAC405L 01/19/07
Schedule A (Form 990 or 990-EZ) 2006 SAVE A L I F E FOUNDATION 36-3869459 Page 7
Part VII I Information Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See instructions)
51 ^ W o T T ^ ^ ^ ^ descnbed in section501(c)
52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations „ _
described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527? ► \J Yes [X] No
b If 'Yes,' complete the following schedule
(a) (b) (c)
Name of organization Type of organization Description of relationship
N/A
TEEA0406L 01/19/07
2006 Federal Statements Page1
Client 18015 SAVE A LIFE FOUNDATION 36-3869459
5/14/08 0253PM
Statement 1
Form 990, Part II, Line 43
Other Expenses
Statement 2
Form.990 , Part III
Orgaiization's Primary Exempt Purpose
Statement 3
Form 990, Part IV, Line 57
Land, Buildings, and Equipment
Accum. Book
Category Basis Deprec. Value
Machinery and Equipment $ 166,583. $ 140,353. $ 26,230.
Buildings 181,912. 36,382. 145,530.
Land 20,000. 20,000.
Miscellaneous 31,190. 9,357. 21,833.
Total $ 399,685. $ 186,092. $ 213,593.
2006 Federal Statements Page 2
Client 18015 SAVE A LIFE FOUNDATION 36-3869459
5/14/08 02 53PM
Statement 4
Form 990, Part IV, Line 63
Loans from Officers, Directors Trustees, and Key Employees
B a l a n c e Due
L e n d e r ' s Name: CAROL SPIZZIRRI
Lender's T i t l e : PRESIDENT
Repayment Terms: DUE ON DEMAND
I n t e r e s t Rate: 5.00%
Purpose of Loan: OPERATIONS
O r i g i n a l Amount: 61,496.
Balance Due:
ft* J—Mt
Statement 5
Form 990, Part IV, Line 65
Other Liabilities
Statement 6
l ^ a ^ V i v e H i g h e s t Paid Employees
DANE NEAL
Name and Address
T i t l e & Average
Hours Worked
NATL POLICY DIR
Compen-
sation
63,520.
Contribut.
EBP & DC ssss 584.
9950 LAWRENCE, SUITE 300 40
SCHILLER PARK, IL 60176 0.
Statement 7
Paid Professional Service Contractors
Name and Address TvDe of Se rvice (Compensation
HOGAN & HARTSON LLP CONSULTING 77,039.
COLUMBIA SQUARE, 555 THIRTEENTH ST
WASHINGTON, DC 20004
Total $ 77,039.
f
OMBNo 1545-0047
Return of Organization Exempt From Income Tax
Forrr.* * J * J U
Department of the Treasury
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung
benefit trust or private foundation)
2007
Open to Public
Internal Revenue Service ► The organization may have to use a copy of this return to satisfy state reporting requirements inspection
A For the 2007 calendar year, or tax year beginning JUL 1 , 2007 and ending JUN 30, 2008
B Check if C Name of organization D Employer identification number
applicable
use IRS
□ Address
change
label or
pnnt or SAVE A LIFE FOUNDATION 36-3869459
□ Name
change
□Initial
type
See Number and street (or P 0 box if mail is not delivered to street address) Room/suite E Telephone number
return Specific 9 950 LAWRENCE 300 (847) 928-9683
□ Termin
Instruc
tions City or town, state or country, and ZIP + 4 r Accounting method: Accrual
□
□
ation
Amended
return
Application
SCHILLER PARK, IL 60176
• Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable trusts
□ Other ^
(specify) W-
What is the organization's primary exempt purpose 9 ► SEE STATEMENT 4 Program Service
Expenses
(Required for 501(c)(3)
All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number of and(4)orgs ,and
clients served, publications issued, etc Discuss achievements that are not measurable. (Section 501(c)(3) and (4) 4947(a)(1) trusts, but
organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations to others.) optional for others)
(Grants and allocations $ ) If this amount includes foreign grants, check here 181,849
b STATE PROGRAMS - WHICH DELIVER AGE-APPROPRIATE LIFE
SUPPORTING FIRST AID TRAINING TO K-12 STUDENTS IL UTILIZING
LOCAL EMERGENCY MEDICAL SERVICE PROVIDERS AS INSTRUCTORS
(Grants and allocations $ ) If this amount includes foreign grants, check here ► □ 63,434
c BRANCH PROGRAMS - WHICH DELIVER AGE APPROPRIATE LIFE
SUPPORTING FIRST AID TRAINING K-12 STUDENTS AL, AK, AZ, AR,
CA, FL, GA, HI, IL, IN, KY, LA, MA, MI, MS, MO, NJ, NM, NC,
OK, OR, PR, SC, TX, WV, WI, WY UTILIZING LOCAL EMERGENCY
MEDICAL SERVICE PROVIDERS AS INSTRUCTORS.
(Grants and allocations $ ) If this amount includes foreign grants, check here ~^TJ 450,408
(Grants and allocations $ If this amount includes foreign grants, check here ► □
e Other program services (attach schedule)
(Grants and allocations $ If this amount includes foreign grants, check here ► □
f Total of Program Service Expenses (should equal line 44, column (B), Program services) 695,691.
Form 9 9 0 (2007)
723021
12-27-07
723031
12-27-07
4
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
Form 990 (2007) SAVE A L I F E FOUNDATION 36-3869459 page5
Part iV-A Reconciliation of Revenue per Audited Financial Statements With Revenue per Return (See the
instructions )
a Total revenue, gains, and other support per audited financial statements a 1,003,158.
b Amounts included on line a but not on Part 1, line 12:
1 Net unrealized gains on investments b1
2 Donated services and use of facilities b2 375,790.
3 Recoveries of prior year grants b3
4 Other (specify): SEE STATEMENT 7 b4 7,814.
Add lines b1 through b4 b 383,604.
c Subtract line b from line a c 619,554.
d Amounts included on Part I, line 12, but not on line a:
1 Investment expenses not included on Part I, line 6b d1
2 Other (specify). d2
Add lines d1 and d2 d 0.
e Total revenue (Part I, line 12). Add lines c and d ► e 619,554.
Part IV-B Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
a Total expenses and losses per audited financial statements a 1,109,654.
b Amounts included on line a but not on Part I, line 17
1 Donated services and use of facilities b1 375,790.
2 Prior year adjustments reported on Part I, line 20 b2
3 Losses reported on Part I, line 20 b3
4 Other (specify)- SEE STATEMENT 8 b4 7,814.
Add lines b1 through b4 b 383,604.
c Subtract line b from line a c 726,050.
d Amounts included on Part I, line 17, but not on line a:
1 Investment expenses not included on Part I, line 6b d1
2 Other (specify)- d2
Add lines d1 and d2 d 0.
e Total expenses (Part I, line 17) Add lines c and d ► e 726,050.
Part V-A Current Officers, Directors, Trustees, and Key Employees (List each person who was an office ', director, trustee,
Form 9 9 0 (2007)
723041 12-27-07
b Are any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees
listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A,
Part ll-A or 11-8. related to each other through family or business relationships'' If "Yes," attach a statement that identifies
the individuals and explains the relationship(s) 75b
c Do any officers, directors, trustees, or key employees listed in Form 990, Part V-A, or highest compensated employees
listed in Schedule A, Part I, or highest compensated professional and other independent contractors listed in Schedule A,
Part ll-A or ll-B, receive compensation from any other organizations, whether tax exempt or taxable, that are related to the
organization? See the instructions for the definition of "related organization." 75c
If "Yes," attach a statement that includes the information described in the instructions.
d Does the organization have a written conflict of interest policy 9 75d
Part V-B Former Officers, Directors, Trustees, and Key Employees That Received Compensation or Other
B e n e f i t s (If any former officer, director, trustee, or key employee received compensation or other benefits (described below) during
the year, list that person below and enter the amount of compensation or other benefits in the appropriate column See the instructions)
(C) Compensation (D) Contributions to (E)Expense
(A) Name and address (B) Loans and Advances (if not paid, employee benefit
plans & deferred account and
NONE enter-0-) compensation plans other allowances
723161/12-27-07
723162/12-27-07
Part IX Information Regarding Taxable Subsidiaries and Disregarded Entities (See the instructions)
(A) (B) (C) (D) (E)
Name, address, and EIN of corporation, Percentage of Nature of activities Total income End-of-year
partnership, or disregarded entity ownership interest assets
%
N/A %
%
%
Part X Information Regarding Transfers Associated with Personal Benefit Contracts (See the instructions.)
(a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract' 1 1 Yes 1 X 1 No
(b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract' 1 1 Yes 1 X 1 No
Note: If "Yes" to (b), file Form 8870 and Form 4720 (see instructions).
Form 9 9 0 (2007)
723163
12-27-07
8
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
Form 990 (2007) SAVE A L I F E FOUNDATION 36-3869459 page9
Part XI | Information Regarding Transfers To and From Controlled Entities. Complete only if the organization is a
controlling organization as defined in section 512(b)(13). N/ A
Yes No
106 Did the reporting organization make any transfers to a controlled entity as defined in section 512(b)(13) of the Code? If "Yes,
complete the schedule below for each controlled entity,
(A) (B) (C) (D)
Name, address, of each Employer Description of Amount of
controlled entity Identification transfer transfer
Number
Totals
Yes No
107 Did the reporting organization receive any transfers from a controlled entity as defined in section 512(b)(13) of the Code? If "Yes,"
complete the schedule below for each controlled entity
(A) (B) (C) (D)
Name, address, of each Employer Description of Amount of
controlled entity Identification transfer transfer
Number
Totals
Yes No
108 Did the organization have a binding written contract in effect on August 17, 2006, covering the interest, rents, royalties, and
annuities described in question 107 above 9
Under penaltws 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 Declarationof preparer (other than officer) is based on all information of which preparer has any knowledge
Please
Sign Signature of officer
VMA /hpj£- Date
Here
Type or print name and title
i?J> IEJU %Fs I Yrin!L-
Preparer's ^ Check if Preparer's SSN or PTIN (See Gen Inst X)
Paid self- . .
signature W employed ►• I I
Preparer's Firm's name (or
Use Only yours if BORHART SPELLMEYER & COMPANY EIN ►
self-employed), ^ 2 2 0 5 POINT BLVD, SUITE 160
address, and
ZIP+ 4 ELGIN, IL 6 0 1 2 3 - 7 8 4 0 Phoneno ► ( 8 4 7 ) 695-1775
Form 9 9 0 (2007)
723164/12-27-07
(Forrh 990 or 990-EZ) (Except Private Foundation) and Section 501(e), 501(f), 501 (k),
(a) Name and address of each independent contractor paid more than $50,000 (b)Type of service (c) Compensation
NONE
(a) Name and address of each independent contractor paid more than $50,000 (b) Type of service (c) Compensation
NONE
723101/12-27-07 LHA For Paperwork Reduction Act Notice, see the Instructions tor Form 990 and Form 990-EZ Schedule A (Form 990 or 990-EZ) 2007
10
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
Schedule A (Form 990 or 990-EZ) 2007 SAVE A L I F E FOUNDATION 36-3869459 Page2
P a r t HI S t a t e m e n t s A b o u t A c t i v i t i e s (See page 2 of the instructions) Yes No
1 During the year, has the organization attempted to influence national, state, or local legislation, including any attempt to influence
public opinion on a legislative matter or referendum' If "Yes," enter the total expenses paid or incurred in connection with the
lobbying activities ► $ $ (Must equal amounts on line 38, PartVI-A, or
line i of Part Vl-B)
Organizations that made an election under section 501 (h) by filing Form 5768 must complete Part Vl-A. Other organizations
checking "Yes" must complete Part Vl-B AND attach a statement giving a detailed description of the lobbying activities
2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any substantial contributors,
trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such
person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary' (If the answer to any question is "Yes,"
attach a detailed statement explaining the transactions )
a Sale, exchange, or leasing of property' 2a X
b Lending of money or other extension of credit' 2b X
c Furnishing of goods, services, or facilities' 2c X
d Payment of compensation (or payment or reimbursement of expenses if more than $ 1 , 0 0 0 ) ' S E E PART V—A, FORM 990 2d
e Transfer of any part of its income or assets' 2e
3 a Did the organization make grants for scholarships, fellowships, student loans, etc ' (If "Yes," attach an explanation of how
the organization determines that recipients qualify to receive payments) 3a
b Did the organization have a section 403(b) annuity plan for its employees' 3b
c Did the organization receive or hold an easement for conservation purposes, including easements to preserve open space,
the environment, historic land areas or historic structures' If "Yes," attach a detailed statement 3c
d Did the organization provide credit counseling, debt management, credit repair, or debt negotiation services' 3d
4 a Did the organization maintain any donor advised f u n d s ' If "Yes," complete lines 4b through 4g If "No," complete lines 4f
and4g 4a
b Did the organization make any taxable distributions under section 4 9 6 6 ' N / A 4b
c Did the organization make a distribution to a donor, donor advisor, or related person' N / A 4c
d Enter the total number of donor advised funds owned at the end of the tax year ► N/A
e Enter the aggregate value of assets held in all donor advised funds owned at the end of the tax year ► N/A
f Enter the total number of separate funds or accounts owned at the end of the year (excluding donor advised funds included on
line 4d) where donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts ► 0.
g Enter the aggregate value of assets in all funds or accounts included on line 4f at the end of the tax year ► 0.
723111
12-27-07
11
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
Schedule A (Form 990 or 990-EZ) 2007 SAVE A L I F E FOUNDATION 36-3869459 Page3
Part
P a r t IV
IV I F
R e a s o n f o r N o n - P r i v a t e F o u n d a t i o n S t a t u s (See pages 4 through 8 of the instructions)
1 certify that theorganization is not a private foundation because it is (Please check only ONE applicable box)
5 CZl A church, convention of churches, or association of churches Section 170(b)(1)(A)(i)
6 □ A school Section 170(b)(1)(A)(n) (Also complete Part V )
7 □ A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(m)
8 □ A federal, state, or local government or governmental unit Section 170(b)(1)(A)(v)
9 □ A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(m) Enter the hospital's name, city,
and state ►
10 □ An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)
(Also complete the Support Schedule in Part IV-A)
11a m An organization that normally receives a substantial part of its support from a governmental unit or from the general public
Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A)
11b □ A community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A)
12 □ An organization that normally receives (1) more than 3 3 1 / 3 % of its support from contributions, membership fees, and gross
receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired
by the organization after June 30,1975 See section 509(a)(2) (Also complete the Support Schedule in Part IV-A)
13 □ An organization that is not controlled by any disqualified persons (other than foundation managers) and otherwise meets the requirements of section
509(a)(3) Check the box that describes the type of supporting organization
□ Type I Type II □ Type lll-Functionally Integrated □ Type Ill-Other
Provide the following information about the supported organizations. (See page 8 of the instructions)
Yes No
Total ►
14 I I An organization organized and operated to test for public safety Section 509(a)(4) (See page 8 of the instructions )
Schedule A (Form 990 or 990-EZ) 2007
723121
12-27-07
12
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
Schedule A (Form 990 or 990-EZ) 2007 SAVE A L I F E FOUNDATION 36-3869459 Page4
P a r t 1V-A Support Schedule (C Dmplete only if you checked a box on line 10,11, or 12.) Use cash method of accounting.
Note: You may use tin? worksheet in the instructions for converting from the accrual to the cash method of accounting
Calendar year (or fiscal year
beginning In) ► (a) 2006 (b) 2005 (c) 2004 (d) 2003 (e) Total
15 Gifts, grants, and contributions
received (Do not include unusual
grants See line 28 ) 983,046. 1,034,403. 1,882,822. 448,621. 4,348,892.
16 Membership fees received
17 Gross receipts from admissions,
merchandise sold or services
performed, or furnishing of
facilities in any activity that is
related to the organization's
charitable, etc, purpose 181,416. 112,094. 399,546. 120,316. 813,372.
18 Gross income from interest, divid
ends, amounts received from pay
ments on securities loans (section
512(a)(5)), rents, royalties, income
from similar sources, and unrelated
business taxable income (less
section 511 taxes) from businesses
acquired by the organization after
June 30,1975 13,684. 4,882. 1,933. 795. 21,294.
19 Net income from unrelated business
activities not included in line 18
20 Tax revenues levied for the
organization's benefit and either
paid to it or expended on its behalf
21 The value of services or facilities
furnished to the organization by a
governmental unit without charge
Do not include the value of services
or facilities generally furnished to
the public without charge
22 Other income Attach a schedule SEE STATEME NT 11
Do not include gam or (loss) from
sale of capital assets 745. 2,006. 2,751.
23 Total of lines 15 through 22 1,178,891. 1,153,385. 2,284,301. 569,732. 5,186,309.
24 Line 23 minus line 17 997,475. 1,041,291. 1,884,755. 449,416. 4,372,937.
25 Enter 1 % of line 23 11,789. 11,534. 22,843. 5,697.
26 Organizations described on lines 10 or 1 1 : a Enter 2% of amount in column (e), line 24 ► 26a 87,459.
b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental
unit or publicly supported organization) whose total gifts for 2003 through 2006 exceeded the amount shown in line 26a
Do not file this list with your return Enter the total of all these excess amounts ► 26b 0.
c Total support for section 509(a)(1) test Enter line 24, column (e) ► 26c 4,372,937.
d Add Amounts from column (e) for lines 18 2 1 , 2 9 4 . 19
22 2 , 7 5 1 . 26b ► 26d 24,045.
e Public support (line 26c minus line 26d total) ► 26e 4,348,892.
f Public support percentaqe (line 26 e (numerator) divided by line 26c (denominator) ► 26f 99.4501%
27 Organizations described on line 12: a For amounts included in lines 15,16, and 17 that were received from a "disqualified person," prepare a list for your
records to show the name of, and total amounts received in each year from, each "disqualified person " Do not file this list with your return Enter the sum of
such amounts for each year N/A
(2006) (2005) (2004) (2003)
For any amount included in line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records to show the name of,
and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations
described in lines 5 through 11b, as well as individuals ) Do not file this list with your return. After computing the difference between the amount received and
the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year N / A
(2006) (2005) (2004) (2003)
Add Amounts from column (e) for lines 15 16
17 20 21 ► 27c N/A
d Add Line 27a total and line 27b total ► 27d N/A
e Public support (line 27c total minus line 27d total) ► 27e N/A
f Total support for section 509(a)(2) test Enter amount on line 23, column (e) ► | 27f | N/A
q Public support percentage (line 27e (numerator) divided by line 271 (denominator)) ► 27q N/A %
h Investment income percentaqe (line 18, column (e) (numerator) divided by line 27f (denominator)) ► 27h N/A %
28 Unusual Grants: For an organization described in line 10,11, or 12 that received any unusual grants during 2003 through 2006, prepare a list for your records to
show, for each year, the name of the contnbutor, the date and amount of the grant, and a brief description of the nature of the grant Do not file this list with your
return. Do not include these grants in line 15 vrrwr-ci
723131 12-27-07 NONE Schedule A (Form 990 or 990-EZ) 2007
13
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
Schedule A (Form 990 or 990-EZ) 2007 S A V E A L I F E F O U N D A T I O N 36-3869459 Pages
PartV Private School Questionnaire (See page 9 of the instructions) N/A
(To be completed ONLY by schools that checked the box on line 6 in Part IV)
Yes No
29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing
instrument, or in a resolution of its governing b o d y ' 29
30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues,
and other written communications with the public dealing with student admissions, programs, and scholarships' 30
31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of
solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known
to all parts of the general community it serves' 31
If "Yes," please describe, if "No," please explain (If you need more space, attach a separate statement)
34 a Does the organization receive any financial aid or assistance from a governmental agency' 34a
b Has the organization's right to such aid ever been revoked or suspended' 34b
If you answered "Yes" to either 34a or b, please explain using an attached statement
35 Does the organization certify that it has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,
1975-2 C B 587, covering racial nondiscrimination' If "No," attach an explanation 35
Schedule A (Form 990 or 990-EZ) 2007
723141
12-27-07
14
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
Schedule A (Form 990 or 990-EZ) 2007 SAVE A L I F E FOUNDATION 36-3869459 Page 6
Part Vr-A Lobbying Expenditures by Electing Public Charities (See page 11 of the instructions) N/A
(To be completed ONLY by an eligible organization that filed Form 5768)
Check ► a I I if the organization belonqs to an affiliated group Check ► b I I if you checked "a" and "limited control" provisions apply
(a) (b)
Limits on Lobbying Expenditures Affiliated group To be completed for all
(The term "expenditures" means amounts paid or incurred ) totals electing organizations
N/A
36 Total lobbying expenditures to influence public opinion (grassroots lobbying) 36
37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37
38 Total lobbying expenditures (add lines 36 and 37) 38
39 Other exempt purpose expenditures 39
40 Total exempt purpose expenditures (add lines 38 and 39) 40
41 Lobbying nontaxable amount Enter the amount from the following table -
If the amount on line 40 is ■ The lobbying nontaxable amount is -
Not over $500,000 20% of the amount on line 40
Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000
Over $1.000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000 41
Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000
Caution If there is an amount on either line 43 or line 44, you must file Form 4720
52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the
Code (other than section 501(c)(3)) or in section 527' ► [ Z H Yes CK] No
b If "Yes," complete the following schedule N/A
(a) (b) (c)
Name of organization Type of organization Description of relationship
723152
12-27-07 Schedule A (Form 990 or 990-EZ) 2007
16
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065
SAVE A LIFE FOUNDATION 36-3869459
17 STATEMENT(S) 1
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
SAVE A LIFE FOUNDATION 36-3869459
INCOME
1. GROSS RECEIPTS 17,523
2. RETURNS AND ALLOWANCES
3. LINE 1 LESS LINE 2 17,523
18 STATEMENT(S) 2
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
SAVE A LIFE FOUNDATION 36-3869459
EXPLANATION
19 STATEMENT(S) 3, 4
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
SAVE A LIFE FOUNDATION 36-3869459
ORIGINAL
LENDER'S NAME AND TITLE LOAN AMOUNT
DATE OF MATURITY
NOTE DATE TERMS OF REPAYMENT INTEREST RATE
NONE OPERATIONS
FMV OF
DESCRIPTION OF CONSIDERATION CONSIDERATION BALANCE DUE
NONE 0. 247,112
BEGINNING
DESCRIPTION OF YEAR END OF YEAR
INSTRUCTOR DEPOSITS 2,700. 2,700,
ROUNDING 1.
TOTAL TO FORM 990, PART IV, LINE 65 2,701 2,700
DESCRIPTION AMOUNT
SPECIAL EVENT EXPENSE NETTED AGAINST REVENUE ON 990 1,764.
COST OF GOODS SOLD NETTED AGAINST REVENUE ON 990 6,050.
20 STATEMENT(S) 5, 6, 7
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
SAVE A LIFE FOUNDATION 36-3869459
DESCRIPTION AMOUNT
SPECIAL EVENT EXPENSE NETTED AGAINST REVENUE ON 990 1,764.
COST OF GOODS SOLD NETTED AGAINST REVENUE ON 990 6,050.
STATES
IL,AL,AK,AR,AZ,CA,CO,CT,DE,FL,GA,HI,ID,IN,KS,KY,LA,ME,MD,MA,MI/MN,MS,MO,MT
NE,NV,NJ,NM,NY,NC,ND,OH,OK,OR,PA,RI,SC,SD,TN,UT,VT,VA,WA,WV,WI,WY,TX,NH,IA
93A SALF WAS GRANTED $590,000 TO TRAIN 170 EMERGENCY MEDICAL SERVICE
PROVIDERS AS INSTRUCTORS AT 33 MILITARY BASES IN 2 7 STATES AL, AK, AZ,
AR, CA, FL, GA, HI, IL, IN, KY, LA, MA, MI, MS, MO, NJ, NM, NC, OK,OR,
PR, SC, TX, WV, WI, WY TO TEACH THEIR 7,000 AT-RISK HIGH SCHOOL AGE
STUDENTS LIFE SUPPORTING FIRST AID TRAINING AND PROVIDE ALL TRAINING
EQUIPMENT, MATERIALS, TESTING SUPPLIES FOR BOTH NEW INSTRUCTORS AND
STUDENTS. SALF MONITORED AND EVALUATED TRAINING, COLLECTED DATA AND
REPORTED SUCCESS OF TESTING COMPONENT FOR EACH INSTRUCTOR AND OF THE
STUDENTS.
93B PROGRAMS TO PROVIDE LIFE SAVING FIRST AID SKILLS TO VOLUNTEERS TO AID
IN AN EMERGENCY.
103A MISCELLANEOUS NON-CLASSIFIABLE INCOME
21 STATEMENT(S) 8, 9, 10, 11
12211201 758549 6065 2007.07000 SAVE A LIFE FOUNDATION 6065 1
OMBNo 1545-0172
6 (a) Descnption of property (b) Cost (business use only) (c) Elected cost