BLESSINGS INTERNATIONAL 73-1130590 · Was a loan to or by a current or former officer, director,...

Form 990 (2011) Part III Statement of Program Service Accomplishments

1 Briefly describe the organization's mission:

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Did the organization undertake any significant program services during the year which were not listed on the2prior Form 990 or 990-EZ? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If "Yes," describe these new services on Schedule O.

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Did the organization cease conducting, or make significant changes in how it conducts, any programservices? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If "Yes," describe these changes on Schedule O.Describe the organization's program service accomplishments for each of its three largest program services, as measured byexpenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount ofgrants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4a (Code: . . . . . . . . ) (Expenses $ . . . . . . . . . . . . . . . . . . . . . . . . including grants of $ . . . . . . . . . . . . . . . . . . . . . . . . ) (Revenue $ . . . . . . . . . . . . . . . . . . . . . . . . )

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)$ . . . . . . . . . . . . . . . . . . . . . . . .(Revenue)$ . . . . . . . . . . . . . . . . . . . . . . . .including grants of$ . . . . . . . . . . . . . . . . . . . . . . . .) (Expenses(Code: . . . . . . . .4b

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4c (Code: . . . . . . . .

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

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4d Other program services. (Describe in Schedule O.)(Revenue )$(Expenses )$including grants of$

4e Total program service expenses Form 990 (2011)DAA

NoYes

Yes No

Check if Schedule O contains a response to any question in this Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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BLESSINGS INTERNATIONAL 73-1130590

X

Blessings International is a non-profit organization whose mission is toalleviate suffering and provide medicines worldwide by facilitatingrelationships to promote health.

X

X

40,181Relief and development programs directed by Blessings International and bycollaboration with other organizationsSee Attachment to IRS Form 990, Part III, Item A

119,012Haiti relief program funded by Blessings International incollaboration with indigenous ministriesSee Attachment to IRS Form 990, Part III, Item B

2,714,321Medicines for short-term medical teamsSee Attachment to IRS Form 990, Part III, Item C

42,982 02,916,496

BLES5575 01/08/2013 11:48 AM

1

Checklist of Required SchedulesPart IVForm 990 (2011)

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7

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,”complete Schedule A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition tocandidates for public office? If “Yes,” complete Schedule C, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h)election in effect during the tax year? If "Yes," complete Schedule C, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,

Did the organization maintain any donor advised funds or any similar funds or accounts for which donorshave the right to provide advice on the distribution or investment of amounts in such funds or accounts? If“Yes,” complete Schedule D, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization receive or hold a conservation easement, including easements to preserve open space,the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

8

9

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11

12a

1314a

b

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16

Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,”complete Schedule D, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in PartX; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”complete Schedule D, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization, directly or through a related organization, hold assets in temporarily restricted

If the organization's answer to any of the following questions is “Yes,” then complete Schedule D, Parts VI,VII, VIII, IX, or X as applicable.

Did the organization obtain separate, independent audited financial statements for the tax year? If “Yes,” completeSchedule D, Parts XI, XII, and XIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization maintain an office, employees, or agents outside of the United States? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking,fundraising, business, investment, and program service activities outside the United States, or aggregate

Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to anyorganization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistanceto individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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18

19

20a

Did the organization report a total of more than $15,000 of expenses for professional fundraising services on

Did the organization report more than $15,000 total of fundraising event gross income and contributions on

Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?

Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No

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14a13

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DAA

Form 990 (2011)

endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes,"complete Schedule D, Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more

Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or moreof its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

reported in Part X, line 16? If "Yes," complete Schedule D, Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets

Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X . . . . . . . . . . . . . . .Did the organization's separate or consolidated financial statements for the tax year include a footnote that addressesthe organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X . . . . . . . . . . . .

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

Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if

Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If "Yes," complete Schedule G, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

a

b

c

d

ef

11a

11b

11c

11d11e

11f

b12a

12b

b If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? . . . . . . . . . . . . . . . . . . . . . . . . . .

20a20b

foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


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BLES5575 01/08/2013 11:48 AM

Form 990 (2011)

DAA

NoYes

Form 990 (2011) Part IV Checklist of Required Schedules (continued)

28

ab

c

2930

31

32

33

34

35a

36

37

Was the organization a party to a business transaction with one of the following parties (see Schedule L,

A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . .A family member of a current or former officer, director, trustee, or key employee? If "Yes," completeSchedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M . . . . . . . . . . . . . . . . . . . . . .Did the organization receive contributions of art, historical treasures, or other similar assets, or qualifiedconservation contributions? If “Yes,” complete Schedule M . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"complete Schedule N, Part II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization own 100% of an entity disregarded as separate from the organization under Regulationssections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III,IV, and V, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization have a controlled entity within the meaning of section 512(b)(13)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization receive any payment from or engage in any transaction with a controlled entity within the

Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitablerelated organization? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization conduct more than 5% of its activities through an entity that is not a related organizationand that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R,

37

36

35a34

33

32

31

30

29

28a

28b

28c

Part VI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

21

22

23

24a24b

24c24d

25a

25b

26

27substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlledDid the organization provide a grant or other assistance to an officer, director, trustee, key employee,disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L, Part II . . . . . . . . . . . . . . .

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or

year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior with a disqualified person during the year? If “Yes,” complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transactionDid the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . .

to defease any tax-exempt bonds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization maintain an escrow account other than a refunding escrow at any time during the yearDid the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? . . . . . . . . . . . . . . . . . . . . . . . . . . .

through 24d and complete Schedule K. If “No,” go to line 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

$100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24bDid the organization have a tax-exempt bond issue with an outstanding principal amount of more than

organization's current and former officers, directors, trustees, key employees, and highest compensatedDid the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the

Did the organization report more than $5,000 of grants and other assistance to individuals in the United States

Did the organization report more than $5,000 of grants and other assistance to any government or organization

27

26

b

25ad

cb

24a

23

22

21in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

employees? If "Yes," complete Schedule J . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If "Yes," complete Schedule L, Part I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part IV instructions for applicable filing thresholds, conditions, and exceptions):

38 Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and3819? Note. All Form 990 filers are required to complete Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

bmeaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35b


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BLES5575 01/08/2013 11:48 AM

Statements Regarding Other IRS Filings and Tax CompliancePart VForm 990 (2011)

Yes No

DAA Form 990 (2011)

1abc

2a

b

3ab

4a

b

5ab

Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable . . . . . . . . . . . . . . . . . . . .Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable . . . . . . . . . . . . . . . . .Did the organization comply with backup withholding rules for reportable payments to vendors andreportable gaming (gambling) winnings to prize winners? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Enter the number of employees reported on Form W-3, Transmittal of Wage and TaxStatements, filed for the calendar year ending with or within the year covered by this return . . . . .If at least one is reported on line 2a, did the organization file all required federal employment tax returns? . . . . . . . . . . . . . . . . . . . . . . .Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)Did the organization have unrelated business gross income of $1,000 or more during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .At any time during the calendar year, did the organization have an interest in, or a signature or other authorityover, a financial account in a foreign country (such as a bank account, securities account, or other financialaccount)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” enter the name of the foreign country: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? . . . . . . . . . . . . . . . . . . . . . .

c6a

b

7a

bc

def

gh

8

9ab

10ab

11ab

12ab

If “Yes” to line 5a or 5b, did the organization file Form 8886-T? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Does the organization have annual gross receipts that are normally greater than $100,000, and did the

If “Yes,” did the organization include with every solicitation an express statement that such contributions orgifts were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Organizations that may receive deductible contributions under section 170(c).Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods

If “Yes,” did the organization notify the donor of the value of the goods or services provided? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it wasrequired to file Form 8282? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” indicate the number of Forms 8282 filed during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? . . . . . . . . . . . . . . . . . . .Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? . . . . . . . . . . . . . . . . . . . . . . .If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? . . . . .If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? . .Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supportingorganizations. Did the supporting organization, or a donor advised fund maintained by a sponsoringorganization, have excess business holdings at any time during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Sponsoring organizations maintaining donor advised funds.Did the organization make any taxable distributions under section 4966? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization make a distribution to a donor, donor advisor, or related person? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Section 501(c)(7) organizations. Enter:Initiation fees and capital contributions included on Part VIII, line 12 . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities . . . . . . . . . .Section 501(c)(12) organizations. Enter:Gross income from members or shareholders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Gross income from other sources (Do not net amounts due or paid to other sourcesagainst amounts due or received from them.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? . . . . . . . . . . . . . . . . . .If “Yes,” enter the amount of tax-exempt interest received or accrued during the year . . . . . . . . . . . .

1c

2b

3a3b

4a

5a5b5c

6a

6b

7a7b

7c

7e7f7g7h

8

9a9b

12a

1a1b

7d7d

10a10b

11a

11b

12b

2a

.

and services provided to the payor? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

organization solicit any contributions that were not tax deductible? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Check if Schedule O contains a response to any question in this Part V . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

13aa13 Section 501(c)(29) qualified nonprofit health insurance issuers.

b

Is the organization licensed to issue qualified health plans in more than one state? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Note. See the instructions for additional information the organization must report on Schedule O.Enter the amount of reserves the organization is required to maintain by the states in whichthe organization is licensed to issue qualified health plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Enter the amount of reserves on hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .c 13c

13b

14a14bb

14a Did the organization receive any payments for indoor tanning services during the tax year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O . . . . . . . . . . . . . . . . . . . . . . . .


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BLES5575 01/08/2013 11:48 AM

Section C. Disclosure

1b

1a

2

Form 990 (2011)DAA

NoYes

Form 990 (2011) Part VI Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a

"No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule

Section A. Governing Body and Management

1a

b2

3

4567a

b

8ab

9

10a

11a

Enter the number of voting members of the governing body at the end of the tax year . . . . . . . . . . . . . . . . . . . . . . .

Enter the number of voting members included in line 1a, above, who are independent . . . . . . . . . . . . . . . . . . . . . . .Did any officer, director, trustee, or key employee have a family relationship or a business relationship withany other officer, director, trustee, or key employee? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization delegate control over management duties customarily performed by or under the directsupervision of officers, directors, or trustees, or key employees to a management company or other person? . . . . . . . . . . . . . . . . . . . .Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? . . . . . . . . . . . . . .Did the organization become aware during the year of a significant diversion of the organization’s assets? . . . . . . . . . . . . . . . . . . . . . .Did the organization have members or stockholders? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization have members, stockholders, or other persons who had the power to elect or appointone or more members of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Are any governance decisions of the organization reserved to (or subject to approval by) members,

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:The governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Each committee with authority to act on behalf of the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization have local chapters, branches, or affiliates? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” did the organization have written policies and procedures governing the activities of such chapters,affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? . . . . . . . . . . . . . . . . . . . . .

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

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached atthe organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3456

7a

7b

8a8b

9

10a

11a

Yes No

12abc

131415

ab

16a

b

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

Did the organization have a written conflict of interest policy? If “No,” go to line 13 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? .Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,”describe in Schedule O how this was done . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization have a written whistleblower policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization have a written document retention and destruction policy? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the process for determining compensation of the following persons include a review and approval byindependent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?The organization’s CEO, Executive Director, or top management official . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other officers or key employees of the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes” to line 15a or 15b, describe the process in Schedule O (see instructions).Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangementwith a taxable entity during the year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate itsparticipation in joint venture arrangements under applicable federal tax law, and take steps to safeguard theorganization’s exempt status with respect to such arrangements? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12a12b

12c1314

15a15b

16a

16b

1718

19

20

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

Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy,and financial statements available to the public during the tax year.State the name, physical address, and telephone number of the person who possesses the books and records of theorganization:

Own website Another's website Upon request

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

O. See instructions. Check if Schedule O contains a response to any question in this Part VI . . . . . . . . . . . . . . .

b10b

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

stockholders, or persons other than the governing body? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If there are material differences in voting rights among members of the governing body, orif the governing body delegated broad authority to an executive committee or similarcommittee, explain in Schedule O.


X

7

6

X

XXXX

X

X

XX

X

X

X

XX

XXX

XX

X

OK

X X X

Bernie Morris 1650 N. Indianwood AvenueBroken Arrow OK 74012 918-250-8101

BLES5575 01/08/2013 11:48 AM

compensation

organization

compensation from

Section A.

Independent ContractorsCompensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, andPart VII

Form 990 (2011)

DAA

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Form 990 (2011)

Officers, Directors, Trustees, Key Employees, and Highest Compensated EmployeesComplete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the1a

List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount ofcompensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

List all of the organization's current key employees, if any. See instructions for definition of "key employee."

who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations.

List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations.

List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations.List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highestcompensated employees; and former such persons.

Check this box if neither the organization nor any related organizations compensated any current officer, director, or trustee.(A) (B) (C) (D) (E) (F)

Name and Title Position

relatedcompensation

Reportable

organizationsorganization

(W-2/1099-MISC)

Reportableamount ofEstimated

from the

otherfromthe

organizationsand related

(W-2/1099-MISC)Individual trusteeor director

employee

Highest com

pensated

Institutional trustee

Officer

Key employee

Former

•organization's tax year.

List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)••

••

Check if Schedule O contains a response to any question in this Part VII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

organizationsin Schedule

week

hours for

Averagehours per

related

(describe

O)

(1)

(2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(4) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(5) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(6) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

officer and a director/trustee)box, unless person is both an(do not check more than one


Harold C. Harder,Ph.D.Chairman 60.00 X X 170,625 0 16,062Chisoo Choi, M.D.

Board Member 1.00 X 0 0 0Doreen Babo

Board Member 0.00 X 0 0 0Paul McClendon, Ph.D.

Board Member 0.50 X 0 0 0Paul Stanton, M.D.

Vice Chairman 2.00 X 0 0 0Roger Youmans, M.D.

Board Member 0.50 X 0 0 0Karyl Stanton, M.D.(non-voting)

Advisory Committee 0.50 X 0 0 0William Mast, M.D.

Treasurer 1.00 X X 0 0 0Mark Babo (non-voting)

Advisory Committee 0.50 X 0 0 0Linda Harder (non-voting)

Advisory Committee 1.00 X 0 0 0Robert E. Stanton, MBA

Secretary/FinOfficer 20.00 X 22,058 0 0

BLES5575 01/08/2013 11:48 AM

5, MBA, DPH

50

Form 990 (2011)DAA

Form 990 (2011) Part VII Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)

d Total (add lines 1b and 1c) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 in

reportable compensation from the organization

3

4

5

Yes No

5

4

3Did the organization list any former officer, director, or trustee, key employee, or highest compensatedemployee on line 1a? If “Yes,” complete Schedule J for such individual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .For any individual listed on line 1a, is the sum of reportable compensation and other compensation from theorganization and related organizations greater than $150,000? If “Yes,” complete Schedule J for suchindividual . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individualfor services rendered to the organization? If “Yes,” complete Schedule J for such person . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section B. Independent Contractors1 Complete this table for your five highest compensated independent contractors that received more than $100,000 of

compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year.

2 Total number of independent contractors (including but not limited to those listed above) whoreceived more than $100,000 of compensation from the organization

(A)Name and business address Description of services

(B) (C)Compensation

Individual trusteeor director

Institutional trustee

Officer

Key employee

employee

Former

Highest com

pensated

and relatedorganizations

thefrom other

from the

Estimatedamount of

(W-2/1099-MISC)organization

Reportablecompensation

Name and title(F)(E)(D)(C)(B)(A)

organization

compensation

O)

(describe

related

hours perAverage

hours for

week

in Scheduleorganizations

(W-2/1099-MISC)

Reportable

organizationsrelated

compensation from

Total from continuation sheets to Part VII, Section A . . . . . . .c1b Sub-total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(15) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(16) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(17) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(18) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(19) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(20) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(21) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(22) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(23) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(24) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(do not check more than onebox, unless person is both anofficer and a director/trustee)

Position


192,683 16,062

192,683 16,062

1

X

X

X

0

BLES5575 01/08/2013 11:48 AM

Form 990 (2011)

DAA

Form 990 (2011) Part VIII Statement of Revenue

(A) (B) (C) (D)Total revenue Related or Unrelated Revenue

exemptfunctionrevenue

businessrevenue

excluded from taxunder sections

512, 513, or 514

1abcdef

gh

Federated campaigns . . . . .Membership dues . . . . . . . . .Fundraising events . . . . . . .Related organizations . . . . .Government grants (contributions) . .All other contributions, gifts, grants,and similar amounts not included above

Noncash contributions included in lines 1a-1f:Total. Add lines 1a–1f . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1a1b1c1d1e

1f

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2a

gfedcb

All other program service revenue . . . . . . . .

$ . . . . . . . . . . . . . . . . . . .

Total. Add lines 2a–2f . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Con

tribu

tions

, G

ifts,

Gra

nts

and

Oth

er S

imila

r A

mou

nts

Prog

ram

Ser

vice

Reve

nue

3

45

6abcd

Investment income (including dividends, interest,and other similar amounts) . . . . . . . . . . . . . . . . . . . . . . . .Income from investment of tax-exempt bond proceedsRoyalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Gross rentsLess: rental exps.Rental inc. or (loss)Net rental income or (loss) . . . . . . . . . . . . . . . . . . . . . . . .

Busn. Code

(i) Real (ii) Personal

(ii) Other(i) Securities

dc

b

7a Gross amount fromsales of assetsother than inventoryLess: cost or otherbasis & sales exps.Gain or (loss)Net gain or (loss) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

ab

8a

bc

Gross income from fundraising events(not includingof contributions reported on line 1c).See Part IV, line 18 . . . . . . . . . . . . . .

$ . . . . . . . . . . . . . . . . . . .

Less: direct expenses . . . . . . . . .Net income or (loss) from fundraising events . . . . . .

Gross income from gaming activities.See Part IV, line 19 . . . . . . . . . . . . . .Less: direct expenses . . . . . . . . .Net income or (loss) from gaming activities . . . . . . .

Gross sales of inventory, lessreturns and allowances . . . . . . .Less: cost of goods sold . . . . . .Net income or (loss) from sales of inventory . . . . . . .

11abcde

Total revenue. See instructions. . . . . . . . . . . . . . . . . .

10a

9a

b

b

c

c

ba

ab

12

All other revenue . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Add lines 11a–11d . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Busn. CodeMiscellaneous Revenue

Oth

er R

even

ue


57,279

145,993

203,272

Net sales (Pharmaceuticals) 3,510,962 3,510,962

3,510,962

22,477 22,477

Restocking, misc. income 6,588 6,588

6,5883,743,299 3,540,027 0 0

BLES5575 01/08/2013 11:48 AM

Statement of Functional ExpensesPart IXForm 990 (2011)

DAA Form 990 (2011)

required to complete columns (B), (C), and (D).Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not

Do not include amounts reported on lines 6b,7b, 8b, 9b, and 10b of Part VIII.1

2

3

45

6

78

91011

abcdefg

12131415161718

192021222324

abcde

2526

Grants and other assistance to governments andorganizations in the U.S. See Part IV, line 21 . . .Grants and other assistance to individuals inthe U.S. See Part IV, line 22 . . . . . . . . . . . . . .Grants and other assistance to governments,organizations, and individuals outside theU.S. See Part IV, lines 15 and 16 . . . . . . . . .Benefits paid to or for members . . . . . . . . . . .Compensation of current officers, directors,trustees, and key employees . . . . . . . . . . . . . .Compensation not included above, to disqualifiedpersons (as defined under section 4958(f)(1)) andpersons described in section 4958(c)(3)(B) . . . . .Other salaries and wages . . . . . . . . . . . . . . . . .Pension plan accruals and contributions (includesection 401(k) and 403(b) employer contributions)Other employee benefits . . . . . . . . . . . . . . . . . .Payroll taxes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Fees for services (non-employees):Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Legal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Accounting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Lobbying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Professional fundraising services. See Part IV, line 17Investment management fees . . . . . . . . . . . . .Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Advertising and promotion . . . . . . . . . . . . . . . .Office expenses . . . . . . . . . . . . . . . . . . . . . . . . . .Information technology . . . . . . . . . . . . . . . . . . . .Royalties . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Occupancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Travel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Payments of travel or entertainment expensesfor any federal, state, or local public officialsConferences, conventions, and meetings .Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Payments to affiliates . . . . . . . . . . . . . . . . . . . . .Depreciation, depletion, and amortization .Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other expenses. Itemize expenses not coveredabove. (List miscellaneous expenses in line 24e. Ifline 24e amount exceeds 10% of line 25, column(A) amount, list line 24e expenses on Schedule O.)

All other expenses . . . . . . . . . . . . . . . . . . . . . . . .Total functional expenses. Add lines 1 through 24e . . .

fundraising solicitation. Check here if

organization reported in column (B) joint costsfrom a combined educational campaign and

following SOP 98-2 (ASC 958-720) . . . . . . . . . . . .

(A) (B) (C) (D)Total expenses Program service Management and

general expensesexpensesFundraisingexpenses

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Check if Schedule O contains a response to any question in this Part IX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Joint costs. Complete this line only if the


32,917 32,917

1,956,623 1,956,623

170,625 136,500 25,594 8,531

487,964 390,371 78,415 19,178

42,976 34,381 7,400 1,19533,799 27,039 4,420 2,34047,362 37,890 7,262 2,210

36,768 36,76812,098 12,098

488 488

23,820 19,056 4,76426,313 26,313

2,000 2,000

145,121 116,097 29,02436,623 29,298 7,135 190

Postage and shipping 149,786 149,149 637Regulatory expenses 80,000 80,000Processing supplies 23,451 23,451Equip rental/maintenance 22,189 17,751 4,438

-45,042 -80,340 29,431 5,8673,285,881 2,916,496 329,874 39,511

BLES5575 01/08/2013 11:48 AM

Form 990 (2011)

DAA

Form 990 (2011) Part X Balance Sheet

(A) (B)Beginning of year End of year

12345

6

789

10a

b111213141516171819202122

232425

26

272829

3031323334

22

212019181716151413121110c

9876

5

4321

292827

2625

2423

3433323130

Cash—non-interest bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Pledges and grants receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Accounts receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Receivables from current and former officers, directors, trustees, keyemployees, and highest compensated employees. Complete Part II of

Receivables from other disqualified persons (as defined under section4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing

Notes and loans receivable, net . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Inventories for sale or use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Land, buildings, and equipment: cost or

Less: accumulated depreciation . . . . . . . . . . . . . . . . . . . . .Investments—publicly traded securities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Investments—other securities. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Investments—program-related. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Intangible assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other assets. See Part IV, line 11 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total assets. Add lines 1 through 15 (must equal line 34) . . . . . . . . . . . . . . . . . . . . . . . . . .

Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Tax-exempt bond liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Escrow or custodial account liability. Complete Part IV of Schedule D . . . . . . . . . . . . . . .Payables to current and former officers, directors, trustees, keyemployees, highest compensated employees, and disqualified persons.Complete Part II of Schedule L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Secured mortgages and notes payable to unrelated third parties . . . . . . . . . . . . . . . . . . . .Unsecured notes and loans payable to unrelated third parties . . . . . . . . . . . . . . . . . . . . . . .Other liabilities (including federal income tax, payables to related third

Total liabilities. Add lines 17 through 25 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Organizations that follow SFAS 117, check here lines 27 through 29, and lines 33 and 34.

and complete

Unrestricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Temporarily restricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Permanently restricted net assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

complete lines 30 through 34.Organizations that do not follow SFAS 117, check here

Capital stock or trust principal, or current funds . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Paid-in or capital surplus, or land, building, or equipment fund . . . . . . . . . . . . . . . . . . . . . . .Retained earnings, endowment, accumulated income, or other funds . . . . . . . . . . . . . . . .Total net assets or fund balances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total liabilities and net assets/fund balances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Ass

ets

Liab

ilitie

sN

et A

sset

s or

Fun

d B

alan

ces

10a10b

Schedule L . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

other basis. Complete Part VI of Schedule D . . . . . . . .

and

employers and sponsoring organizations of section 501(c)(9) voluntaryemployees' beneficiary organizations (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

of Schedule D . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

parties, and other liabilities not included on lines 17-24). Complete Part X


303,057 478,5151,461,544 1,626,201

56,069 38,462115,261 110,671

27,608,744 615,53182,540 230,682

3,848,283436,354 3,518,527 3,411,929

9,35033,145,742 6,521,341

119,416 52,456

35,238 20,978154,654 73,434

X

5,343,720 6,405,48327,647,368 42,424

32,991,088 6,447,90733,145,742 6,521,341

BLES5575 01/08/2013 11:48 AM

OtherAccrualCash

3b

3a

2c

2b2a

NoYes

If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo thethe Single Audit Act and OMB Circular A-133? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

As a result of a federal award, was the organization required to undergo an audit or audits as set forth in

of the audit, review, or compilation of its financial statements and selection of an independent accountant? . . . . . . . . . . . . . . . . . . . . .

If “Yes” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversightWere the organization's financial statements audited by an independent accountant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Were the organization's financial statements compiled or reviewed by an independent accountant? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Accounting method used to prepare the Form 990:

b

3a

cb

2a

1

Part XII Financial Statements and Reporting

Form 990 (2011)

DAA

Form 990 (2011)

d If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year wereissued on a separate basis, consolidated basis, or both:

Separate basis Consolidated basis Both consolidated and separate basis

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

If the organization changed either its oversight process or selection process during the tax year, explain inSchedule O.

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

Reconciliation of Net AssetsPart XICheck if Schedule O contains a response to any question in this Part XI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

11 Total revenue (must equal Part VIII, column (A), line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total expenses (must equal Part IX, column (A), line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 2

345

6

Check if Schedule O contains a response to any question in this Part XII . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

3 Revenue less expenses. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) . . . . . . . . . . . . . . . . . . . . . . . . .Other changes in net assets or fund balances (explain in Schedule O) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33,column (B)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

456


X

3,743,2993,285,881

457,41832,991,088

-27,000,599

6,447,907

X

XX

X

X

X

BLES5575 01/08/2013 11:48 AM

Employer identification number

DAA

Name of the organization

Internal Revenue ServiceDepartment of the Treasury

OMB No. 1545-0047

For Paperwork Reduction Act Notice, see the Instructions for

Attach to Form 990 or Form 990-EZ.

Complete if the organization is a section 501(c)(3) organization or a section(Form 990 or 990-EZ)

Reason for Public Charity Status (All organizations must complete this part.) See instructions.Part I

SCHEDULE A Public Charity Status and Public Support2011

(i) Name of supported

Open to PublicInspection

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)1234

5

67

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name,city, and state: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .An organization operated for the benefit of a college or university owned or operated by a governmental unit described insection 170(b)(1)(A)(iv). (Complete Part II.)A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).An organization that normally receives a substantial part of its support from a governmental unit or from the general publicdescribed in section 170(b)(1)(A)(vi). (Complete Part II.)A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)8

9 An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and grossreceipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 33 1/3% of itssupport from gross investment income and unrelated business taxable income (less section 511 tax) from businessesacquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

1011

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out thepurposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.a Type I Type IIb c Type III–Functionally integrated Type III–Otherd

e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified personsother than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1)or section 509(a)(2).

f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supportingorganization, check this box . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Since August 17, 2006, has the organization accepted any gift or contribution from any of thefollowing persons?(i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and

(iii) below, the governing body of the supported organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(ii) A family member of a person described in (i) above? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .(iii) A 35% controlled entity of a person described in (i) or (ii) above? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Provide the following information about the supported organization(s).

organization(ii) EIN (iii) Type of organization

(described on lines 1–9above or IRC section governing document?

in col. (i) listed in your(iv) Is the organization

col. (i) of yourthe organization in(v) Did you notify

U.S.?

organization in col.(vi) Is the

(i) organized in the

Yes No NoYes Yes No

(vii) Amount ofsupport

11g(i)11g(ii)11g(iii)

Yes No

TotalSchedule A (Form 990 or 990-EZ) 2011

4947(a)(1) nonexempt charitable trust. See separate instructions.

(see instructions)) support?

Form 990 or 990-EZ.

(E)

(D)

(C)

(B)

(A)


X

BLES5575 01/08/2013 11:48 AM

(Explain in Part IV.) . . . . . . . . . . . . . . . . . . .

governmental unit or publicly

Section A. Public Support

Total support. Add lines 7 through 10

loss from the sale of capital assetsOther income. Do not include gain or

is regularly carried on . . . . . . . . . . . . . . . . .

activities, whether or not the businessNet income from unrelated business

rents, royalties and income from similarpayments received on securities loans,Gross income from interest, dividends,

line 1 that exceeds 2% of the amountsupported organization) included on

each person (other than aThe portion of total contributions byTotal. Add lines 1 through 3 . . . . . . . . . .

The value of services or facilities

to or expended on its behalf . . . . . . . . . . organization's benefit and either paidTax revenues levied for the

First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)Gross receipts from related activities, etc. (see instructions) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amounts from line 4 . . . . . . . . . . . . . . . . . .

Public support. Subtract line 5 from line 4

include any "unusual grants.") . . . . . . . .

membership fees received. (Do notGifts, grants, contributions, and

Page 2Schedule A (Form 990 or 990-EZ) 2011

131211

9

8

6

4

3

2

1

(e) 2011(d) 2010(c) 2009(b) 2008(a) 2007

(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify underSupport Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)Part II

Calendar year (or fiscal year beginning in) (f) Total

furnished by a governmental unit to theorganization without charge . . . . . . . . . .

5

Section B. Total Support

7

sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

10

organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Section C. Computation of Public Support Percentage

12

14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Public support percentage from 2010 Schedule A, Part II, line 14 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .15

16a 33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check thisbox and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b 33 1/3% support test—2010. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more,check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is17a10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain inPart IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported

b 10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line

Explain in Part IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly15 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here.

18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see

1415

%%

DAA

Schedule A (Form 990 or 990-EZ) 2011

Calendar year (or fiscal year beginning in) (f) Total

Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011

shown on line 11, column (f) . . . . . . . . . .

organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

supported organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


BLES5575 01/08/2013 11:48 AM

Section B. Total Support

unrelated trade or business under section 513

Part III Support Schedule for Organizations Described in Section 509(a)(2)(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II.

1

2

3

6

8

Schedule A (Form 990 or 990-EZ) 2011 Page 3

Gifts, grants, contributions, and membershipfees received. (Do not include any "unusual

Public support (Subtract line 7c from

Gross receipts from admissions, merchandisesold or services performed, or facilitiesfurnished in any activity that is related to the

Gross receipts from activities that are not an

Total. Add lines 1 through 5 . . . . . . . . . .

Section A. Public Support

organization’s tax-exempt purpose . . . . . . . .

Tax revenues levied for the4organization's benefit and either paidto or expended on its behalf . . . . . . . . . .

organization without charge . . . . . . . . . .

furnished by a governmental unit to the5 The value of services or facilities

Amounts included on lines 1, 2, and 37areceived from disqualified persons . . . .Amounts included on lines 2 and 3breceived from other than disqualifiedpersons that exceed the greater of $5,000or 1% of the amount on line 13 for the year .

c Add lines 7a and 7b . . . . . . . . . . . . . . . . . .

Amounts from line 6 . . . . . . . . . . . . . . . . . .9

royalties and income from similar sources . .

payments received on securities loans, rents,10a Gross income from interest, dividends,

Unrelated business taxable income (lessbsection 511 taxes) from businessesacquired after June 30, 1975 . . . . . . . . .

c Add lines 10a and 10b . . . . . . . . . . . . . . . .

Net income from unrelated business11activities not included in line 10b, whetheror not the business is regularly carried on . .

(Explain in Part IV.) . . . . . . . . . . . . . . . . . . .

loss from the sale of capital assets12 Other income. Do not include gain or

Total support. (Add lines 9, 10c, 11,13

14 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)organization, check this box and stop here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Section C. Computation of Public Support Percentage

Public support percentage from 2010 Schedule A, Part III, line 15 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15 Public support percentage for 2011 (line 8, column (f) divided by line 13, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16Section D. Computation of Investment Income Percentage

18Investment income percentage for 2011 (line 10c, column (f) divided by line 13, column (f)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17Investment income percentage from 2010 Schedule A, Part III, line 17 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . . . . . .

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line19a

b 33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3%, andline 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization . . . . . . . . . . . .

20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions . . . . . . . . . . . . . . . . . . . .

%%

1615

1718

%%

DAA


(f) Total(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011

(f) Total

line 6.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Calendar year (or fiscal year beginning in)

Calendar year (or fiscal year beginning in)

and 12.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the organization fails to qualify under the tests listed below, please complete Part II.)

(e) 2011(d) 2010(c) 2009(b) 2008(a) 2007

grants.") . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


23,379,476 53,159,419 35,821,999 58,073,817 203,272 170,637,983

1,899,307 2,416,035 3,150,817 3,189,301 3,510,962 14,166,422

25,278,783 55,575,454 38,972,816 61,263,118 3,714,234 184,804,405

1,645,535 1,859,447 2,760,579 2,576,424 3,473,529 12,315,5141,645,535 1,859,447 2,760,579 2,576,424 3,473,529 12,315,514

172,488,891

25,278,783 55,575,454 38,972,816 61,263,118 3,714,234 184,804,405

93,529 74,000 39,053 24,406 22,477 253,465

93,529 74,000 39,053 24,406 22,477 253,465

4,930 9,362 11,972 177 6,588 33,029

25,377,242 55,658,816 39,023,841 61,287,701 3,743,299 185,090,899

93.1994.82

X

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Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (SeeSupplemental Information. Complete this part to provide the explanations required by Part II, line 10;Part IV

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Schedule A (Form 990 or 990-EZ) 2011DAA

instructions).


Part III, Line 12 - Other Income Detail

Restocking fees, misc.(5 year total) $ 33,029

Supplemental Information

Schedule A, Part III, Line 1 - Contributions Received

See "General Footnote" regarding change in accounting principle effective

September 1, 2011. The amount shown for Line 1 for 2011 represents cash

contributions only, as Blessings International has not received any noncash

contributions of pharmaceuticals since 2009. For 2010 and prior years

shown, the reported amount consisted primarily of the estimated average

wholesale value of purchased pharmaceuticals, as well as cash

contributions.

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Attach to Form 990. See separate instructions.

Schedule D (Form 990) 2011

Conservation Easements. Complete if the organization answered “Yes” to Form 990, Part IV, line 7.

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)

Number of states where property subject to conservation easement is located . . . . . .

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the

2011Supplemental Financial StatementsSCHEDULE D

Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the

(Form 990)Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.


OMB No. 1545-0047

Department of the TreasuryInternal Revenue Service


Complete if the organization answered “Yes,” to Form 990,

(a) Donor advised funds (b) Funds and other accounts

abcd

Total number of conservation easements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total acreage restricted by conservation easements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Number of conservation easements on a certified historic structure included in (a) . . . . . . . . . . . . . . . . . . . . . . . . . . . .Number of conservation easements included in (c) acquired after 8/17/06, and not on a

Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Revenues included in Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Assets included in Form 990, Part X . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Held at the End of the Tax Year

organization answered “Yes” to Form 990, Part IV, line 6.

works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide, in Part XIV, the text of the footnote to its financial statements that describes these items.If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheetworks of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide the following amounts relating to these items:(i)(ii)

Revenues included in Form 990, Part VIII, line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12345

6

Total number at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Aggregate contributions to (during year) . . . . . . . . . . . . . . . . . . . . . . . . . . .Aggregate grants from (during year) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Aggregate value at end of year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization inform all donors and donor advisors in writing that the assets held in donor advisedfunds are the organization’s property, subject to the organization’s exclusive legal control? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be usedonly for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose

Yes

Yes

No

NoPart II

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation

Purpose(s) of conservation easements held by the organization (check all that apply).

2

1

easement on the last day of the tax year.

Preservation of land for public use (e.g., recreation or education)Protection of natural habitatPreservation of open space

Preservation of a certified historic structurePreservation of an historically important land area


tax year . . . . . . . . . . . . . .

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

45 Does the organization have a written policy regarding the periodic monitoring, inspection, handling of

violations, and enforcement of the conservation easements it holds? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year6

7 Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year

8(i) and section 170(h)(4)(B)(ii)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes the9 In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and

organization’s accounting for conservation easements.

NoYes

Yes No

Complete if the organization answered “Yes” to Form 990, Part IV, line 8.Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.Part III

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet1a

b

2following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

ab

$ . . . . . . . . . . . . . . . . . . . . . . . . .$ . . . . . . . . . . . . . . . . . . . . . . . . .

$ . . . . . . . . . . . . . . . . . . . . . . . . .$

DAAFor Paperwork Reduction Act Notice, see the Instructions for Form 990.

conferring impermissible private benefit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

2a2b2c

2d

. . . . . . . . . . . . . . .

$ . . . . . . . . . . . . . . . . . . . . . . . . .

historic structure listed in the National Register . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


BLES5575 01/08/2013 11:48 AM

(a) Current year

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

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


DAA


line 9, or reported an amount on Form 990, Part X, line 21.

Amount

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)Part IIIPage 2

Public exhibition

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its3

a

collection items (check all that apply):

Scholarly researchPreservation for future generations

bc

e Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

d Loan or exchange programs

XIV.4 Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in Part

During the year, did the organization solicit or receive donations of art, historical treasures, or other similar5assets to be sold to raise funds rather than to be maintained as part of the organization’s collection? . . . . . . . . . . . . . . . . . . . . . . . . . . . . NoYes

Part IV Escrow and Custodial Arrangements. Complete if the organization answered “Yes” to Form 990, Part IV,

Yes Noincluded on Form 990, Part X? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not

b If “Yes,” explain the arrangement in Part XIV and complete the following table:

Beginning balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .cd Additions during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Distributions during the year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ef Ending balance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization include an amount on Form 990, Part X, line 21? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2aIf “Yes,” explain the arrangement in Part XIV.b

NoYes

Endowment Funds. Complete if the organization answered “Yes” to Form 990, Part IV, line 10.Part V

Contributions . . . . . . . . . . . . . . . . . . . . . . . . .bBeginning of year balance . . . . . . . . . . . .1a

c Net investment earnings, gains, and

Grants or scholarships . . . . . . . . . . . . . . . .de Other expenditures for facilities and

Administrative expenses . . . . . . . . . . . . . .fg End of year balance . . . . . . . . . . . . . . . . . .

programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(b) Prior year (c) Two years back (d) Three years back (e) Four years back

c Temporarily restricted endowment . . . . . . . . . . . . .

Permanent endowment . . . . . . . . . . . .b

2a Board designated or quasi-endowment . . . . . . . . . . . . .%

%%

3aorganization by:(i)(ii)

unrelated organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .related organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If “Yes” to 3a(ii), are the related organizations listed as required on Schedule R? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .b4 Describe in Part XIV the intended uses of the organization’s endowment funds.

Yes No3a(i)3a(ii)

3b

Part VI Land, Buildings, and Equipment. See Form 990, Part X, line 10.

1abcde

Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Buildings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Leasehold improvements . . . . . . . . . . . . . . . . .Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).) . . . . . . . . . . . . . . . . . . . . . . . . . .

(d) Book value(c) Accumulated(b) Cost or other basis(a) Cost or other basis(investment) (other)

Description of property

1c1d1e1f

losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

depreciation

The percentages in lines 2a, 2b, and 2c should equal 100%.


253,649 253,6492,907,953 131,674 2,776,279

686,681 304,680 382,001

3,411,929

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Cost or end-of-year market value(b) Book value (c) Method of valuation:

Page 3Part VII Investments—Other Securities. See Form 990, Part X, line 12.



(a) Description of security or category(including name of security)

Financial derivatives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Closely-held equity interests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

(a) Description of investment type

Investments—Program Related. See Form 990, Part X, line 13.Part VIII(c) Method of valuation:(b) Book value

Cost or end-of-year market value

(b) Book value

Other Assets. See Form 990, Part X, line 15.(a) Description

Part IX

DAA

Part X(a) Description of liability

Other Liabilities. See Form 990, Part X, line 25.(b) Book value

FIN 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization’s financial statements that reports theorganization’s liability for uncertain tax positions under FIN 48 (ASC 740).

Federal income taxes


Total. (Column (b) must equal Form 990, Part X, col. (B) line 15.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


1.

2.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(1)

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

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

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

(10)

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

(11)

(I). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

(3)(2)


Accrued pension plan contribution 11,010Accrued payroll 10,000Other accrued liabilities -32

20,978

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Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

Reconciliation of Revenue per Audited Financial Statements With Revenue per Return

DAA


Schedule D (Form 990) 2011Reconciliation of Change in Net Assets from Form 990 to Audited Financial StatementsPart XI

Page 4

123456789

10

Total revenue (Form 990, Part VIII, column (A), line 12) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total expenses (Form 990, Part IX, column (A), line 25) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Excess or (deficit) for the year. Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Net unrealized gains (losses) on investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Investment expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Prior period adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total adjustments (net). Add lines 4 through 8 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9 . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part XII

a

1 Total revenue, gains, and other support per audited financial statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2

bcde

bc

a

34

5

Amounts included on line 1 but not on Form 990, Part VIII, line 12:Net unrealized gains on investments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Recoveries of prior year grants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amounts included on Form 990, Part VIII, line 12, but not on line 1:Investment expenses not included on Form 990, Part VIII, line 7b . . . . . . . . . . . . . . . . .Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

1

2a2b2c2d

2e3

4a4b

4c5

1

Add lines 4a and 4b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Subtract line 2e from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Investment expenses not included on Form 990, Part VIII, line 7b . . . . . . . . . . . . . . . . .

Amounts included on Form 990, Part IX, line 25, but not on line 1:

Add lines 2a through 2d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other (Describe in Part XIV.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Other losses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Donated services and use of facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Amounts included on line 1 but not on Form 990, Part IX, line 25:

5

43

a

cb

e

Prior year adjustments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .cb

2Total expenses and losses per audited financial statements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

a

54c

4b

d

4a

32e

2d2c2b2a

Part XIII

Part XIV Supplemental InformationComplete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b;Part V, line 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide

123456789

10

Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

any additional information.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .


3,743,2993,285,881

457,418

0

457,418

3,739,499

3,739,499

3,8003,800

3,743,299

3,285,881

3,285,881

3,285,881

Part XII, Line 4b - Revenue Amounts Included on Return - OtherIncrease in temporarily restricted net assets $ 3,800

BLES5575 01/08/2013 11:48 AM

Part XIV Supplemental Information (continued)



DAA

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BLES5575 01/08/2013 11:48 AM

region (by type) (e.g.,

investments,

Totals (add

and investmentsexpenditures for

service(s) in region

a program service,describe specific type of

grants to recipients

fundraising, program services,

in region

employees, agents,and independentregion

offices in the(f) Total(e) If activity listed in (d) is(d) Activities conducted in(c) Number of(b) Number of(a) Region

Part I General Information on Activities Outside the United States. Complete if the organization answered “Yes” to

Part IV, line 14b, 15, or 16.

Employer identification numberName of the organization


OMB No. 1545-0047

Attach to Form 990.

(Form 990)SCHEDULE F Statement of Activities Outside the United States

2011Open to PublicInspection

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule F (Form 990) 2011DAA

Form 990, Part IV, line 14b.1

2

3

For grantmakers. Does the organization maintain records to substantiate the amount of its grants and otherassistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award thegrants or assistance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and otherassistance outside the United States.

Activities per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.)

Yes No

Complete if the organization answered “Yes” to Form 990,

See separate instructions.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

(10)

(11)

(12)

(13)

(14)

(15)

(16)

(17)

contractors

located in the region)

in region

c

b3a Sub-total . . . .

Total from continuation

sheets to Part I . .

lines 3a and 3b)


X

Central America and CarribeanProgram services Pharmaceuticals/cash 1,337,052

East Asia and PacificProgram services Pharmaceuticals/cash 71,672

EuropeProgram services Pharmaceuticals/cash 18,857

Middle East and North AfricaProgram services Pharmaceuticals 11,143

North AmericaProgram services Pharmaceuticals 41,455

Russia and the Newly Independent StatesProgram services Pharmaceuticals/cash 18,457

South AmericaProgram services Pharmaceuticals 142,588

South AsiaProgram services Pharmaceuticals/cash 39,053

Sub-Saharan AfricaProgram services Pharmaceuticals/cash 276,346

1,956,623

1,956,623

BLES5575 01/08/2013 11:48 AM

Sche

dule

F (F

orm

990

) 201

1

(h)D

escr

iptio

nof

non

-cas

has

sist

ance

assi

stan

ceno

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sh(g

)Am

ount

of

(a)N

ame

of(b

)IR

S co

de(c

)Reg

ion

(d)P

urpo

se o

f(e

)Am

ount

of

(f)M

anne

r of

sect

ion

and

EIN

gran

tca

sh g

rant

cash

disb

urse

men

t

1Part

IIG

rant

s an

d O

ther

Ass

ista

nce

to O

rgan

izat

ions

or

Entit

ies

Out

side

the

Uni

ted

Stat

es. C

ompl

ete

if th

e or

gani

zatio

n an

swer

ed “

Yes”

to F

orm

990

,Pa

ge 2

Sche

dule

F (

Form

990

) 20

11

2 3

Ente

r to

tal n

umbe

r of

rec

ipie

nt o

rgan

izat

ions

list

ed a

bove

that

are

rec

ogni

zed

as c

harit

ies

by th

e fo

reig

n co

untry

, rec

ogni

zed

as ta

x-ex

empt

by th

e IR

S, o

r fo

r w

hich

the

gran

tee

or c

ouns

el h

as p

rovi

ded

a se

ctio

n 50

1(c)

(3)

equi

vale

ncy

lette

r .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. .En

ter

tota

l num

ber

of o

ther

org

aniz

atio

ns o

r en

titie

s .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

. . .

.

Part

IV, l

ine

15, f

or a

ny r

ecip

ient

who

rec

eive

d m

ore

than

$5,

000.

Che

ck th

is b

ox if

no

one

reci

pien

t rec

eive

d m

ore

than

$5,

000

. . .

. . .

. . .

. . .

. . .

. . .

Part

II ca

n be

dup

licat

ed if

add

ition

al s

pace

is n

eede

d.

DAA

(if a

pplic

able

)

(16)

(15)

(14)

(13)

(12)

(11)

(10)(9)

(8)

(7)

(6)

(5)

(4)

(3)

(2)

(1)

othe

r)ap

prai

sal,

(boo

k, F

MV,

valu

atio

n(i)

Met

hod

of

orga

niza

tion

BLESSINGS

INTERNATIONAL

73-1130590

Sub-Saharan

Africa

Help those

in need

8,011

Medicines

Est. Value

East Asia &

Pacific

Help those

in need

14,641

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

29,768

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

6,150

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

42,335

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

5,443

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

6,451

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

42,138

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

34,406

Medicines

Est. Value

Russia &

Newly

Independent

States

Help those

in need

7,606

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

'7,007

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

8,532

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

7,717

Medicines

Est. Value

Central

America

& Carribean

Help those

in need

6,539

Medicines

Est. Value

100

BLES

5575

01/

08/2

013

11:4

8 AM

Schedule F (Form 990) 2011 Page 4Foreign FormsPart IV

Schedule F (Form 990) 2011

DAADAA

1

2

3

4

5

6 Did the organization have any operations in or related to any boycotting countries during the tax year? If

Did the organization have an ownership interest in a foreign partnership during the tax year? If “Yes,”

Was the organization a direct or indirect shareholder of a passive foreign investment company or a

Did the organization have an ownership interest in a foreign corporation during the tax year? If “Yes,”

Did the organization have an interest in a foreign trust during the tax year? If “Yes,” the organization

Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If “Yes,”the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a ForeignCorporation (see Instructions for Form 926) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts andReceipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With aU.S. Owner (see Instructions for Forms 3520 and 3520-A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

the organization may be required to file Form 5471, Information Return of U.S. Persons With Respect ToCertain Foreign Corporations. (see Instructions for Form 5471) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

qualified electing fund during the tax year? If “Yes,” the organization may be required to file Form 8621,Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

the organization may be required to file Form 8865, Return of U.S. Persons With Respect To CertainForeign Partnerships. (see Instructions for Form 8865) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

“Yes,” the organization may be required to file Form 5713, International Boycott Report (see Instructionsfor Form 5713) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes No

NoYes

Yes No

NoYes

Yes No

NoYes


X

X

X

X

X

X

BLES5575 01/08/2013 11:48 AM

DAADAA


. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f)Part V Supplemental Information

Page 5Schedule F (Form 990) 2011

(accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III(accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part toprovide any additional information (see instructions).


Part I, Line 2 - Procedures for Monitoring the Use of Grant Funds

Blessings International monitors the use of non-cash assistance to other

organizations and partners through its Pharmaceutical Application

process. Each organization is required to complete a Pharmaceutical

Application before pharmaceuticals are delivered to that organization.

The Christian mission or qualified organization must document the

country or region where the pharmaceuticals will be distributed and that

adequate arrangements are in place for the ultimate distribution of those

pharmaceuticals. Each Pharmaceutical Application must be signed by the

recipient's medical team primary physician or a medical professional and

proof of certification must also be provided. For ongoing clinics, only an

initial application is required. At the conclusion of a mission trip, a

"feedback" form is requested which provides information about the

utilization of medicine, the disposition of any unused medicine, and the

success of the mission trip.

Part I, Line 3 - Activities per Region

Region Expenditures Investments

Central America and Carribean $ 1,337,052 $ 0

East Asia and Pacific $ 71,672 $ 0

Europe $ 18,857 $ 0

Middle East and North Africa $ 11,143 $ 0

North America $ 41,455 $ 0

Russia and the Newly Independent States $ 18,457 $ 0

South America $ 142,588 $ 0

South Asia $ 39,053 $ 0

BLES5575 01/08/2013 11:48 AM

DAADAA


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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f)Part V Supplemental Information

Page 5Schedule F (Form 990) 2011

(accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III(accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part toprovide any additional information (see instructions).


Sub-Saharan Africa $ 276,346 $ 0

Part V - Additional Information

Part II, Line 1 - Valuation of noncash assistance - Noncash assistance to

organizations outside the United States is being reported using an

estimated value based on Blessings' sales price charged to its user

organizations for medicines and other pharmaceutical products, resulting in

a conservative estimate of the fair value of the assistance provided.

For financial statement reporting purposes, noncash assistance is reported

based on the actual purchase cost of the pharmaceutical products, including

freight and any customs fees and duties associated with products imported

from overseas suppliers, as well as an allocation of processing costs of

bulk-purchased imported items for sorting, bottling and labeling.

BLES5575 01/08/2013 11:48 AM

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1(a

) N

ame

and

addr

ess

of o

rgan

izat

ion

or g

over

nmen

t(b

) EIN

(c) IR

C

if ap

plica

ble(d

) Amo

unt o

f cas

h(e

) Amo

unt o

f non

-ca

sh a

ssist

ance

For

Pape

rwor

k R

educ

tion

Act

Not

ice,

see

the

Inst

ruct

ions

for

Form

990

.Sc

hedu

le I

(For

m 9

90) (

2011

)D

AA2 3En

ter

tota

l num

ber

of s

ectio

n 50

1(c)

(3)

and

gove

rnm

ent o

rgan

izat

ions

list

ed in

the

line

1 ta

ble

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. .

Ente

r to

tal n

umbe

r of

oth

er o

rgan

izat

ions

list

ed in

the

line

1 ta

ble

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. . .

.

(f) M

ethod

of v

aluati

on(bo

ok, F

MV, a

pprai

sal,

other)

non-c

ash

assis

tance

(g) D

escri

ption

of

(h) P

urpos

e of

grant

or as

sistan

ce

. .

. . .

. . .

. . .

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.

secti

on

A

ttach

to F

orm

990

.

(1)

(2)

(3)

(4)

(5)

(6)

(7)

(8)

(9)

grant

BLESSINGS

INTERNATIONAL

73-1130590

X

Good Samaritan

Health Svc.

7600 S. Lewis

Ave.

Tulsa

OK

74136

73-1559561

35,214Est. ValueMedicines

Help people in need

BLES

5575

01/

08/2

013

11:4

8 AM

FMV,

app

rais

al,

othe

r)(e

) M

etho

d of

val

uatio

n (b

ook,

(d) A

mou

nt o

fca

sh g

rant

(c) A

mou

nt o

f(b

) Num

ber o

f(a

) Ty

pe o

f gra

nt o

r ass

ista

nce

Gra

nts

and

Oth

er A

ssis

tanc

e to

Indi

vidu

als

in th

e U

nite

d St

ates

. Com

plet

e if

the

orga

niza

tion

answ

ered

“Ye

s” to

For

m 9

90, P

art I

V, li

ne 2

2.Pa

rt III

Part

III c

an b

e du

plic

ated

if a

dditi

onal

spa

ce is

nee

ded.

Sche

dule

I (F

orm

990

) (2

011)

Page

2

reci

pien

tsno

n-ca

sh a

ssis

tanc

e(f)

Des

crip

tion

of n

on-c

ash

assi

stan

ce

Part

IVSu

pple

men

tal

Info

rmat

ion.

Com

plet

e th

is p

art t

o pr

ovid

e th

e in

form

atio

n re

quire

d in

Par

t I, l

ine

2, a

nd a

ny o

ther

add

ition

al in

form

atio

n.

Sche

dule

I (F

orm

990

) (20

11)

DAA.

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.

1 2 3 4 5 6 7

BLESSINGS

INTERNATIONAL

73-1130590

Part I, Line 2

- Procedures for

Monitoring the

Use

of Grant

Funds

Blessings

International

monitors the

use

of non-cash assistance by only

dealing

with organizations

within the

U.S. that have an established

record of providing

medicines

to those

in need.

The

application

process

includes the

name of the

responsible

executive

director/manager,

functional location address, contact

information, telephone

and

fax

numbers, IRS

Letter of Determination

(501c3),mission

statement, and

verification of medical

license.

BLES

5575

01/

08/2

013

11:4

8 AM

Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form1a

Questions Regarding CompensationPart I

InspectionOpen to Public

2011 Attach to Form 990. See separate instructions.


Compensation InformationSCHEDULE J(Form 990)

Part IV, line 23.


OMB No. 1545-0047

Department of the TreasuryInternal Revenue Service

Compensated Employees Complete if the organization answered "Yes" to Form 990,

Yes No

990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.First-class or charter travelTravel for companionsTax indemnification and gross-up paymentsDiscretionary spending account Personal services (e.g., maid, chauffeur, chef)

Health or social club dues or initiation feesPayments for business use of personal residenceHousing allowance or residence for personal use

b If any of the boxes on line 1a are checked, did the organization follow a written policy regarding paymentor reimbursement or provision of all of the expenses described above? If "No," complete Part III to

directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,21b

2

3 Indicate which, if any, of the following the filing organization uses to establish the compensation of theorganization’s CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a

Written employment contractCompensation survey or studyApproval by the board or compensation committeeForm 990 of other organizations

Independent compensation consultantCompensation committee

4 During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing

Receive a severance payment or change-of-control payment? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ab Participate in, or receive payment from, a supplemental nonqualified retirement plan? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Participate in, or receive payment from, an equity-based compensation arrangement? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .c

4a4b4c

If "Yes" to any of lines 4a–c, list the persons and provide the applicable amounts for each item in Part III.

Only section 501(c)(3) and 501(c)(4) organizations must complete lines 5–9.

compensation contingent on the revenues of:For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any5

Any related organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ba The organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If “Yes” to line 5a or 5b, describe in Part III.

Any related organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ba The organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any6compensation contingent on the net earnings of:

5b5a

6a6b

payments not described in lines 5 and 6? If “Yes,” describe in Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7 For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixedIf “Yes” to line 6a or 6b, describe in Part III.

Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject8to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If “Yes,” describein Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7

8

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2011

DAA

For certain Officers, Directors, Trustees, Key Employees, and Highest

9Regulations section 53.4958-6(c)? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

9 If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in

explain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

organization or a related organization:

related organization to establish compensation of the CEO/Executive Director. Explain in Part III.


XXX

XX

XX

X

X

BLES5575 01/08/2013 11:48 AM

DAA

Sche

dule

J (F

orm

990

) 201

1

(A)

Nam

e

(B)

Brea

kdow

n of

W-2

and

/or

1099

-MIS

C c

ompe

nsat

ion

Part

IIO

ffice

rs, D

irect

ors,

Tru

stee

s, K

ey E

mpl

oyee

s, a

nd H

ighe

st C

ompe

nsat

ed E

mpl

oyee

s. U

se d

uplic

ate

copi

es if

add

ition

al s

pace

is n

eede

d.Pa

ge 2

Sche

dule

J (

Form

990

) 20

11

For

each

indi

vidu

al w

hose

com

pens

atio

n m

ust b

e re

porte

d in

Sch

edul

e J,

rep

ort c

ompe

nsat

ion

from

the

orga

niza

tion

on r

ow (

i) an

d fro

m r

elat

ed o

rgan

izat

ions

, des

crib

ed in

the

inst

ruct

ions

, on

row

(ii)

. Do

not l

ist a

ny in

divi

dual

s th

at a

re n

ot li

sted

on

Form

990

, Par

t VII.

Not

e. T

he s

um o

f col

umns

(B)

(i)–(

iii) fo

r ea

ch li

sted

indi

vidu

al m

ust e

qual

the

tota

l am

ount

of F

orm

990

, Par

t VII,

Sec

tion

A, li

ne 1

a, a

pplic

able

col

umn

(D)

and

(E)

amou

nts

for

that

indi

vidu

al.

(i) B

ase

com

pens

atio

nco

mpe

nsat

ion

(ii)

Bonu

s &

ince

ntiv

e

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.

(iii)

Oth

erre

porta

ble

(C)

Ret

irem

ent a

nd

com

pens

atio

nbe

nefit

s(D

) N

onta

xabl

e(E

) To

tal o

f col

umns

(B)(i

)–(D

)re

porte

d as

def

erre

d in

(F)

Com

pens

atio

n

prio

r Fo

rm 9

90

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.

com

pens

atio

n

othe

r de

ferre

d

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

(i) (ii)

(ii)

(i) (i) (ii)

(ii)

(i) (i) (ii)

(ii)

(i) (i) (ii)

(ii)

(i) (i) (ii)

(i) (ii)

(ii)

(ii)

(i) (i)(i) (ii)

(i) (ii)

(ii)

(i)(ii)

(i)

BLESSINGS

INTERNATIONAL

73-1130590

Harold C. Harder,Ph.D.

160,625

10,000

00

16,062

186,687

00

00

00

00

BLES

5575

01/

08/2

013

11:4

8 AM

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.

Sche

dule

J (

Form

990

) 20

11Pa

ge 3

Supp

lem

enta

l In

form

atio

nPa

rt III

Sche

dule

J (F

orm

990

) 201

1

Com

plet

e th

is p

art t

o pr

ovid

e th

e in

form

atio

n, e

xpla

natio

n, o

r des

crip

tions

requ

ired

for P

art I

, lin

es 1

a, 1

b, 3

, 4a,

4b,

4c,

5a,

5b,

6a,

6b,

7, a

nd 8

, and

for P

art I

I.Al

so c

ompl

ete

this

par

t for

any

add

ition

al in

form

atio

n.

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.

DAA

BLESSINGS

INTERNATIONAL

73-1130590

BLES

5575

01/

08/2

013

11:4

8 AM

Form 990 or 990-EZ or to provide any additional information.

Employer identification numberName of the organization


OMB No. 1545-0047

Complete to provide information for responses to specific questions on(Form 990 or 990-EZ)SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2011


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For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2011)DAA

Attach to Form 990 or 990-EZ.


Form 990, Part III, Line 4d - All Other Accomplishment

U.S.A. Indigent Care

See Attachment to IRS Form 990, Part III, Item D

Form 990, Part VI, Line 2 - Related Party Information Among Officers

Bob Stanton Paul Stanton

Sec/FinOfr BOT Member

Father/Son

Form 990, Part VI, Line 11b - Organization's Process to Review Form 990

All members of the Board of Directors are provided a copy of the draft

Form 990 for review and comment before it is filed. Questions and

concerns are directed to Management for clarification.

Form 990, Part VI, Line 12c - Enforcement of Conflicts Policy

Board members sign a no conflict of interest statement when joining

the Board of Directors. Additionally, an annual affirmation statement is

signed, and they are required to list any possible conflicts of interest.

Conflicts involving Board members are decided by the Board of Directors.

The Blessings' Employee Manual contains a paragraph concerning an

employee's possible conflict of interest. Each employee signs a written

acknowledgement of the Manual's provisions. Blessings' President resolves

all matters related to actual or potential conflicts of interest involving

employees.

BLES5575 01/08/2013 11:48 AM

DAA

Page 2Schedule O (Form 990 or 990-EZ) (2011)

DAA

Schedule O (Form 990 or 990-EZ) (2011)

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Name of the organization Employer identification number

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Form 990, Part VI, Line 15a - Compensation Process for Top Official

BI attempts to pay its CEO a salary competitive with those paid by

other relief and development organizations, consistent with the

applicable labor markets. A Compensation Committee, consisting of

three members of the Board of Directors determine the salary of the

CEO on an annual basis. Salary increases are based on availability

of funds, performance evaluation, changes in and performance of

responsibilities.

Form 990, Part VI, Line 15b - Compensation Process for Key Employees

BI attempts to pay its support staff salaries competitive with those

paid by other relief and development organizations, consistent with

the applicable labor markets. Salary increases are based on availability

of funds, performance evaluations, changes in responsibilities, and

adjustments based on annual market surveys. The salaries of the

support staff are reviewed and approved by the Board of Directors.

Board members, other than the CEO, are not compensated.

Form 990, Part VI, Line 15b - Compensation Process for Officers

Same as for Officers

Form 990, Part VI, Line 19 - Governing Documents Disclosure Explanation

The following documents are available to the public on the Blessings

website (www.blessing.org):

Annual Report (Current)

Form 990 (Current)

The following documents are available to the public at Blessings'

office, 1650 N. Indianwood Avenue, Broken Arrow, OK 74012:

BLES5575 01/08/2013 11:48 AM

DAA

Page 2Schedule O (Form 990 or 990-EZ) (2011)

DAA

Schedule O (Form 990 or 990-EZ) (2011)

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Oklahoma Articles of Incorporation and By Laws

Annual Reports (for last three years)

Form 990 (for the last three years)

Audited financial statements (for last three years)

Form 990, Part XI - Additional Information

Line 5 - Prior period adjustment to pharmaceutical inventory

(See "General Footnote" regarding change in accounting principle for

valuation of pharmaceutical products effective Septmber 1, 2011)

BLES5575 01/08/2013 11:48 AM

BLES5575 BLESSINGS INTERNATIONAL 1/8/2013 11:48 AM73-1130590 Federal StatementsFYE: 8/31/2012

Form 990 - Federal General Footnote

DescriptionCHANGE IN ACCOUNTING PRINCIPLE FOR 2011 (FISCAL YEAR ENDING AUGUST 31,2012)Effective September 1, 2011, Blessings International (the "Ministry")changed its method of valuing pharmaceutical inventory products to thelower of cost or market, with cost determined by the average cost orspecific identification methods. The cost of pharmaceutical inventoryproducts was determined from the actual purchase costs of the products,including freight and any customs fees and duties, as well as an allocationof processing costs of bulk-purchased imported products from overseassuppliers. In previous fiscal years, the Ministry had recordedpharmaceutical products acquired by either purchase or gifts-in-kind (GIK)donations at their estimated average wholesale price (AWP) or the AWP ofsubstantially equivalent products obtained from the Thomson Reuters "RedBook", whose AWP's were meant to approximate wholesale prices in the UnitedStates.

Through the fiscal year ended August 31, 2011, the Ministry treatedpurchased pharmaceuticals as equivalent to GIK donations, as the Ministrywas able to purchase pharmaceuticals at significantly discounted prices farbelow their AWP values, and recorded both purchased an donatedpharmaceuticals in accordance with nonprofit industry standards referred toas the Interagency GIK Standards. Due to a revision in the Interagency GIKStandards in December 2009, it became impractical for the Ministry tocomply with the requirements for determinining estimated fair values, asthe majority of the value of the Ministry's hundreds of pharmaceuticalproducts was represented by products that were not legally permissable tobesold in the United States, and such products would now have to be valuedusing estimated wholesale prices determined from an undeterminable numberof foreign exit markets.

In addition to the above, there is currently considerable controversyrelated to the alleged use of inflated AWP valuations by nonprofitorganizations to overvalue their GIK donations as well as theircorresponding program services accomplishments. For these reasons, andbecause all pharmaceutical products have been acquired solely by purchasesince 2009, management of the Ministry determined that a change to the costmethod of valuing its pharmaceutical products was in order as preferable,since it utilizes a conservative and objectively verifiable measure of thevalue of the Ministry's pharmaceutical products distributed to userorganizations. The use of the cost method also aligns the financialreporting of purchased pharmaceuticals with other nonprofits, althoughtBlessings International is unique in that it relies solely on pruchasedpharmaceuticals to achieve its program services goals, while the vastmajority of all other nonprofits primarily utilize GIK donations ofpharmaceuticals.

The change in accounting principle described above had a very significantimpact on reported revenues and expenses (Lines 8 and 13 of Part I, Form990, as further explained below)

Line 8 - DIRECT PUBLIC SUPPORTThe amount shown in Line 8 of Form 990 for 2011 (year endedAugust 31, 2012) represent cash contributions only, as Blessings


Form 990 - Federal General Footnote (continued)

DescriptionInternational has not received any noncash contributions ofpharmaceuticals since 2009. In 2010, the reported amount representedprimarily the estimated average wholesale value of purchasedpharmaceuticals, as well as cash contributions.

Line 13 - GRANTS AND OTHER ASSISTANCEThe amount shown in Line 13 of Form 990 for 2011 represents the estimatedtotal cost of pharmaceutical products shipped to recipients within theUnited States and overseas in addition to cash payments. In 2010, thereported amount represented the estimated average wholesale value ofpharmaceutical products shipped plus any cash assistance payments.

Line 16b - FUND-RAISING EXPENSESOther than a fund-raising dinners held in November 2007 and March 2011,and year-end Christmas appeals, Blessings International has yet to conductany special fund-raising events or appeals for the purpose of inducingpotential donors to contribute money, services, materials,other assets ortime. In addition, the Ministry's various informational materials andoutreach newsletters generally do not contain a fund-raising appeal.TheMinistry's fund-raising efforts through normal operations consist of theallocated portion of the salaries and related overhead of the Ministry'sPresident, Executive Assistant and other employees, and certainidentifiable costs related to fund-raising, including consulting servicesand advertisements for cash donations placed in variouspublications.

Total costs allocated to fund-raising expenses were $39,511 for thefiscal year ended August 31, 2012.


Taxable Interest on Investments

DescriptionUnrelated Exclusion Postal Acquired after US

Amount Business Code Code Code 6/30/75 Obs ($ or %)Interest Income(savings,CD's)

$ 22,477Total $ 22,477

BLES

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$16,282

$

$ 16,282

$Supplies

12,081

9,665

2,416

Printing &

publications

8,165

8,165

Dues and

subscriptions

6,549

6,549

Fund-raising costs

5,867

5,867

Telephone

4,726

3,781

945

Loss-pharmaceuticals

4,228

4,228

Miscellaneous

2,296

1,850

446

Entertainment

1,599

1,599

Auto expenses

1,449

1,159

290

Advertising

948

948

Credit card process

fees

924

924

Bank charges

764

764

Recruitment

140

140

Books

and

tapes

1313

Allocated

processing cost

-111,073

-111,073

Total

$-45,042

$-80,340

$29,431

$5,867

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Pharmaceutical purchases

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(See General

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Other

undesignated offerings

94,774

Other

designated offerings

51,219

Teva Pharmaceuticals

Pharmaceutical products

(various dates)

SANDOZ Ph

armaceutical products

Total

$203,272


Schedule A, Part III, Line 7b - Excess Gross Receipts

Donor Name Total ExcessNet handling charges $ $

2011 3,540,027 3,502,5942010 3,189,301 2,576,4242009 3,150,817 2,760,5792008 2,416,035 1,859,4472007 1,899,307 1,645,535

Total $ 14,195,487 $ 12,344,579

Blessings International 73-1130590 Attachment to IRS Form 990, Part III FYE September 1, 2011 to August 31, 2012

Part III Organization’s Primary Exempt Purpose:

Alleviating suffering and providing medicines worldwide by facilitating relationships to promote health

Part III Statement of Program Service Accomplishments:

Consistent with the above mission statement, Blessings International provided the following program services:

A. Relief and development programs directed by Blessings International and by collaboration with other organizations: This includes specific programs designed to supply pharmaceuticals, and medical supplies for relief and development efforts following national disasters, wars or various types of armed conflict, as well as in developing nations struggling to improve basic medical services (including a special fund set up to help the TB and Malaria Treatment Program in Myanmar): Program Service Expense: $40,181

B. Haiti Relief program funded by Blessings International in collaboration with Indigenous Ministries:

Blessings International continues to be committed to help Haiti long after the acute recovery phase of the January 2010 earthquake. Blessings International has been equipping indigenous ministries with vitamins, pharmaceuticals and medical supplies at major discounts. Blessings International has been making it possible for these permanent clinics to have adequate resources for treating patients long into the rebuilding and rehabilitation phases. Program Service Expense: $119,012

C. Medicines for short-term medical teams: This is Blessings major mission, to provide pharmaceuticals and medical supplies to short-term medical teams visiting developing nations who in turn serve indigent children and adults suffering from various diseases and illnesses. These teams are organized by ministries and churches that are independent of Blessings International. Program Service Expense: $2,714,321

D. USA Indigent Care: This program supplied purchased medicines for indigents and the working poor

that were treated through non-profit and church-based clinics in the USA. Once again this year, Blessings received major cash contributions for US clinics. These donations were used to give a major discount on all shipments of purchased medicines to US clinics up to a certain dollar amount. In this way Blessings International has been able to spread the blessing of these gifts to include very small as well as the very large clinics. This year BI served 27 clinics operated by Christian/charitable organizations throughout the United States. Even though the total value of shipments to US clinics is

less than 1% of the value of all shipments, Blessings International is committed especially to helping the working poor of this nation. The potential impact of the newly passed nationwide health plan on these efforts cannot be predicted; nevertheless with the deep economic recession still gripping the USA, we would not expect much impact to occur for another year. Therefore B.I. will continue to help the many US clinics working to fill the urgent need of providing medical care to the least fortunate among us. Program Service Expense $42,982

Total Program Service Expenses for FY 11-12: $2,916,496 A detailed breakdown is attached showing the countries where the program services were distributed for the fiscal year ended August 31, 2012.

Blessings International WORLDWIDE DISTRIBUTON OF PHARMACEUTICALS Year Ending August 31, 2012

9. Sub-Saharan Africa Cost 7. South America CostAngola 936.78 <.1% Argentina 3,326.43 0.17%Burkino Faso 3,826.52 0.19% Bolivia 9,993.65 0.51%Burundi 1,725.76 <.1% Brazil 15,103.13 0.77%Cameroon 7,345.91 0.37% Columbia 1,417.40 <.1%Central African Republic 1,959.50 <.1% Ecuador 52,740.57 2.68%Chad 1,542.97 <.1% Guyana 764.31 <.1%Benin 2,898.54 0.15% Paraguay 929.07 <.1%Congo, Democratic Republic 214.73 <.1% Peru 58,080.38 2.95%Ethiopia 12,083.91 0.61% Venezuela 233.19 <.1%Gambia 5,300.01 0.27%Ghana 21,431.75 1.09% Subtotal: 142,588.13 7.24%Ivory Coast (Cote d'lvoire) 1,142.85 <.1%Guinea 698.43 <.1%Kenya 41,089.42 2.09%Liberia 8,942.46 0.45% Belize 33,313.75 1.69%Malawi 12,155.16 0.62% Costa Rica 9,603.27 0.49%Mali 3,725.03 0.19% Cuba 2,533.69 0.13%Mozambique 435.79 <.1% Dominica 31.03 <.1%Namibia 1,395.16 <.1% Dominican Republic 83,306.57 4.23%Niger 294.21 <.1% El Salvador 32,665.43 1.66%Nigeria 61,087.73 3.10% Guatemala 238,558.30 12.12%Rwanda 363.42 <.1% Haiti 524,722.24 26.65%Senegal 2,573.28 0.13% Honduras 241,625.36 12.27%Sierra Leone 6,237.37 0.32% Jamaica 34,655.09 1.76%South Africa 3,496.25 0.18% Nicaragua 104,280.73 5.30%Sudan 6,686.75 0.34% Panama 27,362.79 1.39%Swaziland 854.46 <.1% Trinidad and Tobago 2,093.67 0.11%Tanzania 23,753.33 1.21%Togo 2,342.61 0.12% Subtotal: 1,334,751.91 67.79%Uganda 13,807.62 0.70%Zambia 17,341.98 0.88% 3. EuropeZimbabwe 5,284.54 0.27% Albania 1,389.93 <.1%Madagascar 2,071.73 0.11% Bulgaria 898.28 <.1%Subtotal: 275,045.96 13.97% Switzerland 193.41 <.1%

Romania 16,275.74 0.83%2. East Asia & PacificCambodia 12 023 79 0 61% Subtotal: 18 757 36 0 95%

1. Caribbean & Central America

Cambodia 12,023.79 0.61% Subtotal: 18,757.36 0.95%China 3,322.82 0.17%Vanuatu 751.47 <.1%Indonesia 471.60 <.1% Egypt 1,504.54 <.1%Kiribati 295.88 <.1% Jordan 1,986.72 0.10%Marshall Islands 326.88 <.1% Israel 1,347.20 <.1%Micronesia, Federal State 3,840.71 0.20% Morocco 6,304.81 0.32%Mongolia 1,626.31 <.1%Myanmar 12,903.41 0.66% Subtotal: 11,143.26 0.57%North Korea (DPRK) 1,089.89 <.1%Papua, New Guinea 1,035.78 <.1%Philippines 17,091.52 0.87% Afghanistan 307.22 <.1%Thailand 4,620.61 0.23% Bhutan 24.67 <.1%Vietnam 8,271.63 0.42% Nepal 4,084.34 0.21%Subtotal: 67,672.30 3.44% Bangladesh 5,314.42 0.27%

India 25,066.29 1.27%Sri Lanka 256.20 <.1%

Armenia 86.14 <.1% Subtotal: 35,053.13 1.78%Moldova 2,531.73 0.13%Ukraine 9,606.37 0.49%Kyrgyzstan 1,232.68 <.1% U.S.A.Subtotal: 13,456.92 0.68% U.S.A. 29,016.63 1.47%

Subtotal: 29,016.63 1.47%5. North America (NOT U.S.)Mexico 41,099.99 2.09%Puerto Rico 354.95 <.1% GRAND TOTAL 1,968,940.54 100.00%Subtotal: 41,454.93 2.11%

4. Middle East and North Africa

8. South Asia

6. Russia and Newly Independent States

BLESSINGS INTERNATIONAL 73-1130590 · Was a loan to or by a current or former officer, director,...

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