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Attorney General LISA M A D I G A N State of Illinois Charitable Trust Bureau, 100 West Randolph CO# 3rd Floor, Chicago, Illinois 60601 Report for the Fiscal Period: Beginning^ & Ending^.
MO E Yes D No
L
INIT
01
_X
03
/ 31
/ 03
Federal ID # 3 3869459 Are contributions to the organization tax deductible? LEGAL NAME ^ ave ^ ^e Foundation ' Lawrence #300 CITY, STATE Schiller Park, IL 50176 I. MAIL ADDRESS " 5 0
w
DAY YR
0 Auuited dinancial Statements ftyawsto Copy of Form IFC %?* n $15.00 Annual Report Filing Fee ReportDAY Fee Filing YR auwoftwf n $100.00 Late MO
D)ate Organization i #as created:
02
uy
,93
Year-end amounts
A)ASSETS B) LIABILITIES C)NET ASSETS A) $460309 B) $ 364,284
C
) $ 96.025
SUMMARY OF A L L REVENUE ITEMS DURING THE YEAR: D) PUBLIC SUPPORT. CONTRIBUTIONS & PROGRAM SERVICE REV, (GROSS AMTS.) E) GOVERNMENT GRANTS & MEMBERSHIP DUES F) OTHER REVENUES G) TOTAL REVENUE, INCOME AND CONTRIBUTIONS RECEIVED (ADD D,E. * F)
%
%
%
% % % 100%
K)$ L ) $ 861,501
M ) $
92,611
N ) 5 168,086 ) $ 1,122,198
% %
S)$ o
^ 0C.T A
i
oftflMScV
^
T)$
71,250
X"LU^^
ATTORNt^ ^ W ^ J g ^
List on back side of instructions CHAW/TABLE PROGRAM (3 HIGHEST a r t EXPENPED) CODI CATEGORIES CODE
CHAWlABtfei
w># on
X)# Y)#
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY?
as
.2. 4.
3.
DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION?
5.
6.
DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER? (ATTACH FORM IFC ) _ _ 6.
7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?
7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS5 ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iw) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? 9. HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.
8.
ra
10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK. BRIBE, OR ANY THEFT, DEFALCATION f ^ ^ P = MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. | I l/l 11. LIST THE NAME, ADDRESS AND THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS: Bank One, NA Illinois Market, P.O. Box 260180, Baton Rouge, LA 70826-0180, i
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Sptaiffi (B47) 92B-9693 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS. h ^ BE SURE TO.INCLUDE ALL FEES DUEE 1.') REPORTS AREDUE wrfHIN fx" " " MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY, * .. J~$
PRESIDENT oATRUSlfctttPRINTN M E AE
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GNATURE | BATE1 DATE DATE
SIGNATURE
T)t
ft"
T.
A/^gEtt*.
SIGNAIUKt
PMT
Form AG990-T] *"-oWj " L l 4 b 4 N 0 , s CHARITABLE ORGANIZATION ANNUAL REPORT Revised I/O D t e n T J " / 0 / ' A t t o r n e y General LISA MADIGAN State of Illinois Charitable Trust Bureau, 100 West Randolph C Q 3rd Floor, Chicago, Illinois 60601 # 01026498
y pi
04
06
MO
/ 3P / 04
Check alt items attached: Q Copy of IRS Return *,*.<;/,*j K Audited Financial Statements P^,0 D Copy of Form IFC eh*,'* CJ $15.00 Annual Report Filing Fe. * . . * * Q $100.00 Late Report Filing Fee
MO DAY YR
Yes No
Q2 /OQ / Q3
LEGAL NAMESave A L i f e
MAIL ADDREESS 950
w
Foundation
S u i t e 300
- Lawrence
B) LIABILITIES C) N E T ASSETS
B)$ C)$
PERCENTAGE
10.04 %
QOH
D) S E)$ F)$
115,844
i.tun,000 (1,689!
(.15)
100%
G)$
y
J
84.16 % 84.16 %
H) $ i) $ J)$
Ji> JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J ) : K> GRANTS T O OTHER CHARITABLE ORGANIZATIONS L) T O T A L C H A R I T A B L E PROGRAM SERVICE EXPENDITURE ( A D D J & K) M) MANAGEMENT A N D GENERAL EXPENSE N) FUNDRAISING EXPENSE O) T O T A L E X P E N D I T U R E S THIS P E R I O D ( A D D L, M, & N)
K)X
84.16 % 11.84 %
4.00 %
100 %
o>$
100 %
P) $ Q)$ R)$
iri.fc> U g S .
% %
S) $
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR:
T) NAME, TITLE: Carol S p i z z i r r i . CEO U) NAME, TITLE: p a ne N e a l . N a t i o n a l Program Coordinator V) N M , TITLE: Donna Achs. Accountant A E
T)$
U)$ V)$
20.000
21,663
1,923
List on back side of instructions V. CHARITABLE PROGRAM DESCRIPTIONtcHARfwaLE PROGRAM p HIGHEST BY J EXPENDED) CODE CATEGORIES CODE W) DESCRIPTION: L X) DESCRIPTION: ) DESCRIPTION:
i f e
Saving
F l r s t
A i d
T r a l n i n s
W)#
011
RECEIVED
ULl' 0 3 2004
- - IVl! ATTORNEY GENERAL^ CHARITABLE TRUST
v
X) # Y)#
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? 1.
YES
NO
2.
3.
DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER. DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?( ATTACH FORM IFC )
4.
5.
5. 6.
6.
7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION. MAILING. ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?
1
7b. IF "YES". ENTER (I) THE AGGREGATE AMOUNT OF THESE JOINT COSTS % ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION S U S P E N D E D OR R E V O K E D BY ANY GOVERNMENTAL AGENCY? 9. X
8.
9.
10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT. DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME, ADDRESS AND THE ACCOUNT # OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:
UNDER PENALTY OF PERJURY. 1 (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I IWE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS. INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED A R E TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON, t HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.
BE SURE TO INCLUDE ALL FEES DUE: 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.
PREPARER (PRINT N A M E !
SIGNATURE
DATE
ForOfflMUieOnl
/ o*
/ 30
DAY
/ o
/ 05
Check all items attached: Copy of IRS Return Audited Financial Statements Copy of Form IFC $15.00 Annual Report Filing Fee 10.00 Late Report Filing FeF
MO DAY YR
Federal ID # I Are contributions to the organization tax deductible? LEGAL NAME MAIL ADDRESS CITY, STATE ZIP CODE "950 W- Lawrence, Sutte 3 0
MO
B Yes D NO
/ 09
/ 93
Year-end amounts
A)ASSETS B) LIABILITIES C) NET ASSETS
PERCENTAGE
J1) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE E X P f f l p 0 p V / B M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE '"^
%
Q ^_^^ - LuvQfjgJ
K)$
>*
1827963
100 %
P) $ Q)$
%
S) TOTAL AMOUNT PAID TO PROFESSIONAL FUNDRAISING CONSULTANTS
R)$
l-'IJJ.l>l.J.JI!-.1 "M.'Ja
S)$
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE: Carol Spizzirri, President/Founder
U) NAME, TITLE: Dane Neal, National Policy Director V) NAME, TITLE: Ciprina Spizzirri, National Communication Director
T)S 120000
U ) $ 54381 V ) $ 35446 List on back side of instructions CODE
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION, FINE, PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR, TRUSTEE, OFFICER OR EMPLOYEE THEREOF, EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? 1.
YES NO
2.
3.
DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION?._ . _. 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? .4. IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?( ATTACH FORM IFC )_
5.
5. 6.
6.
7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7.
7b. IF "YES", ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $. ;(ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.
8.
9.
10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:
Bank One N.A., P.O. Box 260180, Baton Rouge, LA 70826-0180 Wacho'via Bank N.A. P.O. Box 50015, Roanoke, VA 24040-7350
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Spizzim (847) 928-9683 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THEKEGISJRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS. _ Cflltcl J S i < : t i it< \2(3lt^
I ^J/^uU.X*
\W/i Aft iLurk
BE SURE TO INCLUDE ALL FEES DUE: 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE"SUBJECT TO A $100.00 PENALTY.
E<3JiTi?37il!!SiraiEn! S B
NAME)
Jj/Ji/Oj
DATE
SIGNATURE
SIGNATURE
(DATE
/v* /
RINT NAME)
SIGNATURE
DATE
AM*^fc~~ri~i
FOfOmc. UnQniy
Fo
attached;
/
f
Q1
/
/
Q5
30
DAY
yn
E! $15.00 Annual Report Filing Fee a*.-** n $100.00 Late Report Filing Fee
MO DAY YH
E l Yes No
/ 09
/ 93
Year-end amounts
A)ASSETS B) LIABILITIES C) NET ASSETS A ) $ 1,161,576 B)$ 357,975
C)$ 803,601
AMOUNT
PERCENTAGE
94.75
<%
94.75
j ) $ 1,005,527
Ji) JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J): K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L) TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE (ADD J & K) M) MANAGEMENT AND GENERAL EXPENSE N) FUNDRAISING EXPENSE O) TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
% 5.25 % %
100%
K)$ L)S
M)S 55,716
N)$ 0 0)$ 1,061,243
% %
R)$ S)$
IV. COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T) NAME, TITLE: Carol Spizzirri, President/Founder U) NAME, TITLE: Dane Neal, National Policy Director V) NAME. TITLE: Robert Barnes, Director
V . C H A R I T A B L E P R O G R A M DESCRIPTIONreww/MflL*PROGRAMPH/GHESTBYSCXKHDB,) W) DESCRIPTION: Life Saving First A i d Training X) DESCRIPTION: Y) DESCRIPTION:
fciis^^^^a^&&^
T ) $ 130,000
U) $ 63,500 V) S 55,000
Vston oac^ side of instructions coJWMnWsT ' CODE W) # 0J 1 X|# Y) #
IF THE ANSWER TO ANY OF THE FOLLOWING IS YES, ATTACH A DETAILED EXPLANATION: 1. 2. WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION. FINE. PENALTY OR JUDGMENT? HAS THE ORGANIZATION OR A CURRENT DIRECTOR. TRUSTEE, OFFICER OR EMPLOYEE THEREOF. EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR MISAPPROPRIATION OF FUNDS OR ANY FELONY? . .. 1
YES NO
2.
3.
DID THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS IT A PPATY YO ANY TRANSACTIOO IN WHICH ANY OF ITS OFFICERS. DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3. HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER. DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSON OR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?{ATTACH FORM IFC )_
.4.
5.
. 5. 6.
6.
7a. DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES?
7.
7b. IF "YES". ENTER (i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS 5 :() THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (iii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8. DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9.
8.
9.
10. WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK. BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS? 10. 11. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:
Bank One N.A., P.O. Box 260180, Baton Rouge, LA 70826-0180 TCF National Bank, 500 W, Joliet Rd., Willowbrook, IL 60527
12. NAME AND TELEPHONE NUMBER OF CONTACT PERSON: Carol Spizzun (847) 928-9683 ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS. INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STATE OF ILLINOIS.
PfSJJ.Rfi.tQ INCJ-PPE_AJJ_ FEES.DU.E.: 1.) REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. 2.) FOR FEES DUE SEE INSTRUCTIONS. 3.) REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.
SIGNATURE
DATE
CO#
Check all items
01026498
attached:
Copy of IRS Return Audited Financial Statements Copy of F o r m IFC 515.00 Annual Report Filing Fee 5100.00 Late Report Filing Fee
Federal ID #
|X| Yes
No
MI A L
RECEIVED
f\
n n
nvtir'VTrT't^
I
2/09/1993
A$ B$
MO
DAY
YR
-(
MAY 1 6
1<M
c$
Attorney General
I SUMMARY OF ALL REVENUE ITEMS DURING THE T^R 1 -*
D E F G PUBLIC SUPPORT, CONTRIBUTIONS AND PROGRAM SERVICE REVENUE (GROSS AMOUNTS) GOVERNMENT GRANTS AND MEMBERSHIP DUES OTHERREVENUES See. .Statement.1
1U>>
PERCENTAGE
D$ E$ F$ G$ H$ 1$ J$
211,116.
700,000.
J l JOINT COSTS ALLOCATED TO PROGRAM SERVICES (INCLUDED IN J) K L M N O GRANTS TO OTHER CHARITABLE ORGANIZATIONS TOTAL CHARfTABLE PROGRAM SERVICE EXPENDrTURE (ADD J AND K) MANAGEMENT AND GENERAL EXPENSE ..' FUNDRAISING EXPENSE TOTAL EXPENDITURES THIS PERIOD (ADD L, M, AND N)
% 90.46%
9.54%
K$
L$ M$
% 100%
N$ 0$
I I
100% % %
P$ Q$ R$
TOTAL AMOUNT RAISED BY PAID PROFESSIONAL FUNDRAISERS TOTAL FUNDRAISERS FEES AND EXPENSES NET RECEIVED BY THE CHARITY (P MINUS Q=R) PROFESSIONAL FUNDRAISING CONSULTANTS:
IV COMPENSATION TO THE (3) HIGHEST PAID PERSONS DURING THE YEAR: T NAME. TITLE: CAROL SPIZZIRRI, PRESIDENT/FOUND U NAME, TITLE: DANE NEAL, DIRECTOR V NAME, TITLE: VINCENT DAVIS, DIRECTOR
V CHARITABLE PROGRAM DESCRIPTION: CHARITABLE PROGRAM (3 HIGHEST BY $
EXPENDED) CODE CA TEGORIES
MMMM
T$
U$
v$
W# X# Y#
ILVA0212L osnero
011
Page 2
YES NO
IX
3 4 5 6
4 5 6
X X
7a DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING, ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAISING EXPENSES? 7b IF 'YES', ENTER (.) THE AGGREGATE AMOUNT OF THESE JOINT COSTS $ ; (ii) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ ; (ii) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL $ ; AND (iv) THE AMOUNT ALLOCATED TO FUNDRAISING $ 8 9 10 11 DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT, DEFALCATION MISAPPROPRIATION, COMMINGLING OR MISUSE OF ORGANIZATIONAL FUNDS?.
8 9 10
LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:
See Statement 2
ALL ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS UNDER PENALTY OF PERJURY, I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT AND THE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE TRUE AND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE STATE OF ILLINOIS RELY THEREUPON. I HEREBY FURTHER AUTHORIZE AND AGREE TO SUBMIT MYSELF AND THE REGISTRANT HEREBY TO THE JURISDICTION OF THE STA """'
BE SURE TO INCLUDE ALL FEES DUE: 1 2 3 REPORTS ARE DUE WITHIN SIX MONTHS OF YOUR FISCAL YEAR END. FOR FEES DUE SEE INSTRUCTIONS. REPORTS THAT ARE LATE OR INCOMPLETE ARE SUBJECT TO A $100.00 PENALTY.
SIGNATURE
'
SIGNAT
CBIZ ACCTG., TAX & ADVISORY SERVICES, LL One South Wacker Dr., Ste 1800 Chicago, IL 60606-4630
1LVA0212L 08/16/05
DC^DT Fom)AG990-IL ReviSKl m Attorney General LISA MADIGAN State of Illinois Charitable Trust Bureau, 100 West Randolph ^ , ^ _ ^ , , - /-> CO# 0 1 0 S l ^ M M O 11th Floor, Chicago, Illinois 60601 Report for the Frscal Penod: f oogrj ms Return J Beginning * / y w I " &* n r^Lnf P Z ? ^ T,errts
&Ending__, l_JU _ / > ( *
MY
fderal(D#_
B
MO
Q Yet NQ
1 amounts
JUN 1 0 2010
Grayslake,
Charitable Trust
K) GRANTS TO OTHER CHARITABLE ORGANIZATIONS L! TOTAL CHARITABLE PROGRAM SERVICE EXPENDITURE {ADD J 4 K) M) MANAGEMENT AND GENERAL EXPENSE ti] FUNDRAISING EXPENSE OI TOTAL EXPENDITURES THIS PERIOD (ADD L, M, & N)
ANSWER TO ANY OF THE FOLLOWING fS YES, A n A C ^ A C ^ ^ ^ WAS THE ORGANIZATION THE SUBJECT OF ANY COURT ACTION. FINE. PENALTY OR JUDGMENT?
i.
YES/W
HAS THE ORGANIZATION OR A CURRENT DIRECTOR. TRUSTEE, OFFICER OR EMPLOYEE THEREOF EVER BEEN CONVICTED BY ANY COURT OF ANY MIDSDEMEANOR INVOLVING THE MISUSE OR ' MISAPPROPRIATION OF FUNDS OR ANY FELONY?
2.
i.
D10 THE ORGANIZATION MAKE A GRANT AWARD OR CONTRIBUTION TO ANY ORGANIZATION IN VYHICH ANY OF ITS OFFICERS DIRECTORS OR TRUSTEES OWNS AN INTEREST; OR WAS I I T AARTY TO ANY TRANSACTION IN WHICH ANY OF ITS OFFICERS, DIRECTORS OR TRUSTEES HAS A MATERIAL FINANCIAL INTEREST; OR DID ANY OFFICER, DIRECTOR OR TRUSTEE RECEIVE ANYTHING OF VALUE NOT REPORTED AS COMPENSATION? 3 HAS THE ORGANIZATION INVESTED IN ANY CORPORATE STOCK IN WHICH ANY OFFICER, DIRECTOR OR TRUSTEE OWNS MORE THAN 10% OF THE OUTSTANDING SHARES? IS ANY PROPERTY OF THE ORGANIZATION HELD IN THE NAME OF OR COMMINGLED WITH THE PROPERTY OF ANY OTHER PERSONOR ORGANIZATION? DID THE ORGANIZATION USE THE SERVICES OF A PROFESSIONAL FUNDRAISER?(ATTACH FORM IFC) DID THE ORGANIZATION ALLOCATE THE COST OF ANY SOLICITATION, MAILING. ADVERTISEMENT OR LITERATURE COSTS BETWEEN PROGRAM SERVICE AND FUNDRAlSlNG EXPENSES?
4.
5. 6.
Li4
7.
IF T c S " , ENTER <i) THE AGGREGATE AMOUNT OF THESE JOINT COSTS | ;(B) THE AMOUNT ALLOCATED TO PROGRAM SERVICES $ : (Hi) THE AMOUNT ALLOCATED TO MANAGEMENT AND GENERAL S ; AND 0v) THE AMOUNT ALLOCATED TO FUNDRAIS/NG S DID THE ORGANIZATION EXPEND ITS RESTRICTED FUNDS FOR PURPOSES OTHER THAN RESTRICTED PURPOSES? HAS THE ORGANIZATION EVER BEEN REFUSED REGISTRATION OR HAD ITS REGISTRATION OR TAX EXEMPTION SUSPENDED OR REVOKED BY ANY GOVERNMENTAL AGENCY? 9. 8.
WAS THERE OR DO YOU HAVE ANY KNOWLEDGE OF ANY KICKBACK, BRIBE, OR ANY THEFT. DEFALCATION MISAPPROPRIATION. COMMINGLING OR MISUSE OF ORGANiZATiONAL FUNDS? 10. LIST THE NAME AND ADDRESS OF THE FINANCIAL INSTITUTIONS WHERE THE ORGANIZATION MAINTAINS ITS THREE LARGEST ACCOUNTS:
NAME AND TELEPHONE NUMBER OF CONTACT PERSON: ATTACHMENTS MUST ACCOMPANY THIS REPORT - SEE INSTRUCTIONS : PENALLY OF PERJURY. I (WE) THE UNDERSIGNED DECLARE AND CERTIFY THAT I (WE) HAVE EXAMINED THIS ANNUAL REPORT IE ATTACHED DOCUMENTS, INCLUDING ALL THE SCHEDULES AND STATEMENTS AND THE FACTS THEREIN STATED ARE \ND COMPLETE AND FILED WITH THE ILLINOIS ATTORNEY GENERAL FOR THE PURPOSE OF HAVING THE PEOPLE OF THE
Yro^WimSSfS^S^wnSms*U7EE
Tox 2$0555 tifwaui
gTOJMCLUDeALLFEESDLlE: MS C M Y O U R FISCAL YSA6;ND. eeSTSUE SEE INSTRUCTIONS. RTS THAT ARE LATE OH -.
*Pl_ET ARE SUBJECT TO A
OF II LINOIS RELY T H E R E U P O N I MFRFBY FURTHFR AtfTHORl7F AMft AfSRFF T<"1 H I AMIT MVQF1 M 4 M n L F A N B C KiE C T D i M f AGREE 8M[T F E TUF D T f l W G , S
SU
YS
TRA N T
SIGMTURE
*tl^r
DIVIDER
990
i
QMS Mo
IW5CW7
^003^004
Open to Public Inspection 2004
Employe r Wenti He atio n Number
The organization may have to use a copy of this return to satisfy state reporting requirements
year, o r tax y e a r b e g i n n i n g Jan 1
A
9
Jun
30
D
C
Pleasouso IRS Inbel
Name r orfjanizalron :
2004
Room/smle
Save A L i f e
Foundation
E F
36-3869459
Telephone number
Nomtjet and street (Or P O box L mail is not detivered tg *lreet addr) E
SS
lions.
9950 Lawrence
Cily, i o l or country Stale
300
ZIP code + 4
(847)
928-98
3
Accrual
Schiller
Park
IL
60176
I I
Olher (specify)*
Section 501(c)(3) organizations and 4947(a)(1) nortexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-EZ).
H and I are nor applicable lo sec/ion 52? onjaraiofions H ( a ) Is this a Qroup return f Mfitettt? : H ( b ) II Tes,' eriler number ot aHihates H(c) Are all atlHiales included' (If 'No,4 attach a lisl See instructions ) H ( d ) Is this a separate return filed by an organization cohered by a group ruling' *
0
[fj riy |x1
No
G J K
Website:
www.saIf.ore
iTTl r I
r-,
* (JiJ 50i(C)
3 *
(*nser! no)
| _ J W 7 (a)(1) of
D7
Check here "* [_| if the organization's gross receipts are normally not more than $25,000 The organization need not file a return with the IRS, but if the organization received a Form 990 Package in the mail, it should file a return without financial data Some states require a complete return, Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 1 , 1 5 4 , 755 1 Contributions, gifts, grants, and similar amounts received a Direct public support b indirect public support c Government contributions (grants) d
g f t ^ f f W $ 1,127,988. noncasn
$ 0.
I M
Check [~Q ji fhe orgaaization ii sot teqqired to attach Schedule B (Form 990, 990-EZ, or 990- PF)
Part I
|Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructtons
la lb 1c 87,988.
1,040,000
Id
2 3 4 5 6a b c 7 8a b c d 9 a CD
Program service revenue including government fees and contracts (from Part VII, line 93) Membership dues and assessments Interest on savings and temporary cash investments Dividends and tnteiest from securities 6a Gross rents Less, rental expenses 6b Net renlat income or (loss) (subtract line 6b from line 6a) Olher irvestment income (describe P (A) Securities (B) Other Gross amount from sales of assets other 8a than inventory 8b Less- cost or other basis and sales expenses 8c Gain or (loss) (attach schedule} Nel gam or (loss) (combine line 8c, columns (A) and (B)) Special events and activities (attach schedule) If 3ny amount is from gaming, check here Gross revenue (not including $ 1, 6 3 8 , , of contributions 9a 9b
10a|
10b
1,127,988, 27,856. 9.
6c
*
600.
8rJ
reported on line la) b Less, direct expenses other than fundraismg expenses c Net income or (loss) from special events (subtract line 9b from line 9a)
10a Gross sales of inventory, less returns and allowances b Less, cost of goods s o l d ^ ^ ^
9c
Q
11 12 13 14
< E
c Gross profit or (loss) from saldOrnvSntaqjattach scherjule) (subtract liue 10b from line 10a)
Other revenue (from Pirt V J L i r ^ k j p a j ^ Total revenue (add h r j W / d , ! ? & & % & & & > , c J 0 c , and 11) Program services (f r 6 r f t \ f n e % ^ c 0 u m n 7 B 7 ^ ^ ' i n e r i l Orom !&8&MW*<$& Management and g^ner| flrorn" iirie &$%
10c 11 12 13 14 15 16 17 18 19 20 21
TEEAOIOI 1HJ4I03
cm
^(D)) 15 Fundraising (fr M 16 Payments to s t W > * f e f r j & $ ^ f t ^ A S E 17 Total expenses (add lines \ S 18 Excess or (deficit) lor the yea, ( s u b h a c H ^ l 7 Ir&m line 12) 19 Net assets or fund balances at beginning ofyea7(from line 73, column (A)) 20 Other changes in net assets or fund balances (attach explanation) 21 Net assets or fund balances at end of year (combine lines IB, 19, and 20) BAA For Paperwork Reduction Act Notice, see the separate instructions.
i 2004 Form990<3ee3r Save A L ' Foundation Part IV-A | Rec6nciliafion of Revenue per Audited Financial Statements with Revenue per Return (See instructions.)
i ] Total revenue, gains, ,ad dthhe rupport per audited financial statements Amounts included on line a but not on line 12, Form 990 (1) Net unrealized
36-3869459 PartIV-B IReconciliation of Expenses per Audited Financial Statements with Expenses per Return
a Total expenses and losses per audited financial statements Amounts included on line a but not on line 17, Form 990 0 ) Donated serv ices and use of facilities (2) Prior /ear adjustments reported on line 20, Form 990 (3) Losses reported on line 20, Form 990 (4) Other (specify)'
Page 4
1,227,755.
b
253,807.
LSSSU
(2) Donated serv ices and use of facilities
s.
$_
$_
72,500.
72,500.
$_ $_
SeeAttached
1,100. 1,100. 73,600 1.154,155
Add amounts on lines (1) through (-1) Line a minus line b Amounts included on line 17, Form 990 but not on line a: O) Investment eipenses not included on line 6b, Form 990 (2) Other (specify),
Add amounts on lines (1) through (4) Line a minus line b . Amounts included on line 12, Form 990 but not on line a: 0 ) Investment expenses not included on line 6b, Form 990 $_ (2) Other (specify)
73,600. 180.207
$_
I
Add amounts on lines (1) and {2} e Total revenue per line 12, Form 990 (line c plus lined) e
$
Add amounts on lines <1> and (2)
180,207.
1,154.155
Total expenses per line 17, Form 990 (line c plus lined)
!Part V
V u s t e e s , a n d K e y E m p l o y e e s (List each one even ii not tomppensteed ,se instructions. <C) Compensation (B) Title and average hours (O) Contributions to (E) Expense per week devoted employee benefit account and other to position plans and deferred allowances compensation
CarPj_Spjzz.UIL.
Chairman/ExecDir40
20,000
1,334.
0.
0.
Treasurer
_Jee_List_pf_0_licers_|tc_ Statemenl
0.
0.
0.
75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations'* If 'Yes/ attach schedule - see instructions
* Yes
__ No
Form 99<H2J3)
BAA
TEEA01M 10/02/03
2004
Fom990
Departrrtent Df It-,- r..,..-.-.,..-y Internal Revenue Servce
OMB No 1545-0W7
2004
Open to Public Inspection 2005
Employer Identification Number
Jul 1
J u n 30
D
Name of organization
36-3869459
Tefepbon* number
Name change Initial return Final return Amended return Applies lion pending
EC
Se
9950 Lawrence
City, town or country Slate
300
ZIP coda ^ 4
Accrual
Schiller Park
IL
60176
Section 501 (0(3) organizations and 4947(a)(1) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-EZ).
H and ( are nol applicable lo sertion 537 atQamzaUatn H ( a ) Is tnis a group return for affiliates' H ( b ) It "res,' enlet number of affiliates * H ( c ) Are ah arlihates included1 (II No,' ehich a list See mstrucirons) H ( d ) Is this a separate return Wed by an organiiatron covered by a group rulmg' M~| y [ x ] m> J V ~J No _) Vs ! X ] NO
G Website:" w w w , s a l f , o r c J K Organization type I I jj n 3 (insert na ) ( J 4 9 4 7 ( 3 ) 0 1 " {check only One) [Xj 501(C) J5Z7 Check here ** [_J if the organizations gross receipts are normally not more than $25 QO0 Trie oroanizatian need riot hie a return with the IRS but if the organization received a f o S ^ it shouldI fileta return wtthoul financial data Some states require a complete return, Gross receipts Add lines 6b, 8b: 9b, and 10b to llne 12 1 , 7 3 2 , 1 4 0 . Contributions, gifts, grants, and similar amounts received: a Direct public support . b Indirect public support c Government contributions (grants)
I M
Group Exemption Number * Check -> \_\ il the organiraljon is sot required to attach Schedule 3 (Form 990.990-EZ, or r99- Pf>
Part I
I Revenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions)
la lb 1c 4,500.)
125,822 1,196,000
1d
d 2 3 4 5 6a b c 7
T 1 1 T T T T
1T i i . I , SAZ . noncash
Ij
Cvl
o
<
Program service revenue including government fees and contracts (from Part VII, line 93) Membership dues and assessments Interest on savings and temporary cash investments Dividends and interest from securities Gross rents 6b Less: rental expenses Net rental income or (loss) (subtract line 6b from line 6a) Other investment income (describe (B) Other (A) Securities Ba Gross amount from sales of 3ssets other Sa than inventory 8b b Less: cost or olher basis and sales expenses 6c c Gam or (loss) (attach schedule) d Net gam or (foss) (combine line 8c, columns (A) and (B)) Special events and aclivities (attach schedule) if any amount is from gaming, check here Gross revenue (not including $ 1 1 5 , 7 7 7 . of contributions 9a 34,312 reported on line la) b Less direct expenses olher than fundraising expenses 9b 34,312 See L - 9 Strut c Net income or (loss) from special events (subtract line 9b from line 9a) 10a 62,234. 10a Gross sales of inventory, less returns and allowances
6c
8d
9c
22
aj
b Less, cost of goods sold c Gross profit or (loss) from sales ol inventory (attach schedule) (subtract line 10b ffom line 10a) 11 Other revenue (from Part Vlt, line 103) 12 Total revenue (add lines Id, 2, 3,4, S. 6c, 7, 8d, 9c, 10c, and 11 13 14 15 IS 17 18 19 20 21 Program services (from line 44, column (B)) Management and general (from line 44, column (C)) Fundraising (from line44, column (D)) Payments to affiliates (attach schedule) Total expenses (add lines 16 and 44, column (A)) Excess or (deficit) for the year (subtract line 17 from line 12) 1 Q A Net assets or fund balances a! beginning of year (from line 73LcoJymt, Other changes in net assets or fund balances (attach explanation) Nel assets or (und balances at end of yeai (combine lines IS, 19, and 20)
10b
13,149
10c 11 12 13 14 15 16 17 18 19
aieliwi?
Fw] y y
(FIB 1 3 MS |on
20
21
TEEAOlOt 01/D7fGS
BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
il*
Form990(2004)
Save A L i f e
Foundation
36-3869459
Page4
Part IV-A Reconciliation of Revenu e per Audited Financial Statements withi Revenue per Return (See mstructio ns,)
a b Total revenue, gains, and other supporr per audited financial statements Amounts included on line a but not on line 12, Form 9900 ) Net unrealized gains on investments (2) Donated serv ices and use of facilitles (3) Recoveries of frior year grants (4) Other (specify): See A t t a c h e d $ 61,746. Add amounts on lines (1) through (A) * b Line a minus line b * c Amounts included on line 12, Form 990 but not on line a: (1) Investment expenses not included on line 6b, Form )90 $ (2) Olher (specify), $ Add amounts on lines (1) a i d (2) e Total re/enue per line 12, Form 990 (line c plus lined) 4 ... - 252,541. 1,684,679. a v
*
PartlV-B Reconcilia tion of Expenses per Audited Financial!Statements with Expenses per Retum
a Total expenses and losses per audited financial statements. * Amounts included on line a but not on line 17, Form 990 (1) Donated serv ices and use of facilities (2) Pnor year adjust ments reported on line 20, Form 99C (3) Losses reported on line 20, Form 990 ( 4) Other (specify): See At t a c h e d 61,746. $ Add amounts on lines (1) through (4) ** b c d Line a minus line b Amounts included on line 17, Form 990 but not on line a: (1) Investment expenses not included on line 6b, Form 990 (2) Other (specify)*" c ' 252,541. 1,780,502. a 2,033,043.
1,937,220. b . -:
>
.-. :,
'
. . .
$ 190,795.
1*
-V
$ $
rt*
$ $
- of
c d
$
* i --
;.
S-
* d
Part V
e Total expenses per line 17, Form 1,684,679. e 1,780,502. 990 (line c plus line d) * e (List of Officers, Directors,"" r u s t e e s , a n d K e y E m p l o y e e s (List each one even if not compensated; see instructions.) (B) Tide and average hours (C) Compensation (O) Contributions to (E) Expense (Knot paid, per week devoted employee benefit account and other (A) Name and address enter-0-) to position plans and deferred allowances compensation
Carol
Rita
Douglas
Browne Treasurer 0, 0. 0.
Peggy
Mark M i t c h e l l
Director SeeJ.ist^1_Oj!cers,Etc_ Statement 0. 75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? If 'Yes,' attach schedule - see insttucttons BAA
TEEA010* 01/07/O5
0.
0.
0.
0.
0.
Yes
FtSmn
990
OW.BN.o. I M S 0047
2005
Open to Public Inspection 2006
DnpioyerIdentdflceUonNumber D
* The organiiation may have to uss a copy of fhis return to satisfy state reporting requiiements
Jul 1 2005, and ending J u n 30
C P l H H UK Name of orflanizatinn
A
B
Life Foundation " Save Aand street (or P O ton it mail is HOI detrvered to street sddr) Number
N n m r v r *rv1 <trft*l Irt, P O h n i It ma.l K n r
36-3869459
Roorrv'surle Telephon* number
9950 L a w r e n c e
Crty. town or country
Slate
300
ZIP code + 4
(8471
928-91 J
Cash
Accrual
Schiller Park
IL
60176
"jOther (speedy)*
Section 501(cX3) organizations and 4947(a)m rtonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-E7).
Haind! aia net appiizabieft)section 527 oroanttafronf H ( a ) Is this 1 group return tor affilates7 H ( b ) tr 'Yes,' enter number of affiliates " H(c) Are all affiliates included? . . . . . . [ ] Tee Q _| Yd |x]
G Website:* w w w . s a l f . o r c
J Organization type
(Check only one) -
,,
|Xj 5o.(c> 3 < (inserr)
Check here " [ _ ] ) ( the organization's gross receipts are normally nol more than complete return. Gross receipts: Add lines 6D, 3b, 9b, and 10b to line 12 1
M
[x] |
902_,_426
Check * [ J if the organization is not required to attach Scrtedula B {Form 990, 990- U, ,o r30-PF).
Parti
IRevenue, Expenses, and Changes in Net Assets or Fund Balances (See instructions
Contributions, gifts, grants, and simitar amounts received a Direct public support b Indirect public support ... . c Government contributions (grants)
d TfSiouXlTttash $ 794,403. noncasb $
la lb
94,403.
700,000,
1c
id
2 3 4 5 6a b c 7
Program service revenue including government fees and contracts (from Part VII, tine 93) Membership dues and assessments Interest on savings and temporary cash investments .... Dividends and interest from securities Gross rents 6a Less: rental expenses 6b Net rentat income or (loss) (subtract line 6b from line 6a) Other investment income (describe * (A) Securities (B) Other 8a Gross amount from sales of assets other than inventory Sa 5,800 8b b L e s s : p s T c ^ r ^ b ^ ^ ^ e s exofenses 11,732 c 8iffrflfpj| f i n p ^ f f i l S E e T ^ S . Stud: 8c -5,932. d Net ga|n \r (loss) (combi ms (A) and ( B ) ) . 9 Speci tfule). If any amount is from flaming, check here a Gross fWdnue ( of contributions report) 9a 9b b Less: d^Sgggffi&ligffi&Ssw expenses
794,403 95,335
4,882
6c
8d
-5,932
c Net income or (loss) from special events (subtract line 9b from line 9a) 10a Gross sales of inventory, less returns and allowances . b Less: cost of goods sold
c Gross profit or (loss) from sates of inventor) (attach schedule) (subtract line 10b from llne 10a)
11 12 13 14 15 16 17 18 19 ll 20
Other revenue (from Part VII, line 103) . Total revenue (add lines i d , 2, 3, 4, 5, 6c. 7, 8d, 9c, IQc, and 11) Program services (from line 44, column (B)) . . Management and general (from line 44, column (C)) Fundraising (from line 44, column (D)) . . . Payments to affiliates (3ttach schedule) . . . . Total expenses (add lines 16 and 44, column (A)) Excess or (deficit) for the year (subtract line 17 from line 12)
13
14 15 16 17
Net assets or fund balances at beginning of year (from line 73. column (A)) Other changes m net assets or fund balances (attach explanation) . . 21 Net assets or fund balances at end of year (combine lines 18, 19. and 20) . BAA For Privacy A d and Paperwork Reduction Act Notice, see the separate instructions.
18 19 20
21 TEEAOtOl 020106
&~l
Form990 (2005) S a v e A L i f e F o u n d a t i o n 36-3869459 Part IV-A I Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See instructions.)
a b Total revenue, gains, and other support per audited financial statements Amounts included on line a but not on Part 1, line 12: 1 Net unrealized gains on investments . . . . . . 2Donated services and use ol facilities 3Recovenesof prior year grants 4Other (specify): D o n a t e d S u p p a i e s Add lines bl through b4 . .. Subtract line b from line a Amounts included on Part 1, line 12, but not on line a: 11nvestment expenses not included on Part 1, line 6b 20ther (specify). Add tines d1 and d2 Total revenue (Part I, line 12) Add lines c and d , . . . bl b2 b3 b4 c d
* * * T
Page5
1,877,081.
. . . .
973,687.
dl d2
^ I Part (V-B | Reconciiiation of Expenses per Audited Financial Statements with Expenses per RetuTn
Total expenses and losses per audited financial statements Amounts included on line a but not on Part I, line 17: t Donated services and use of facilities 2Pnor year adjustments reported on Part I, line 20 3Losses reported on Part I, line 20 40ther (specify): D o n a t e d . S u p p l i e s . _ Add Itnes b l through b4 Subtract line b from line a . .. Amounts included on Part I, line 17, but not on line a: 11nvestment expenses not included on Part I, line 6b 2Other (specify): Add lines d l and d2 Total expenses (Part I, line 17). Add lines c and d or hey employee at any time during the year even if they were not compensated.) (See the instructions.) (B) Title and average hours per week devoted to position (C) Compensation (if not paid, enter -0-)
d e
890,694.
2^047,630.
bl b2 b3 b4
973,687
dl d2
t PartV-A Current Officers, Directors, Trustees, and Key Employees (List each person who was an officer, ,irector, trusteee
(A) Name and address Carol Sppizzrri Chairman/Exec Dir40 130,000. 1,900. 0. (D) Contributions to employee benefit (E) Expense account and other allowances
1,061,243.
R i t a Mullins
Vice Douglas Browne Treasurer Pe2gy Trimble vice Mark Mitchell Director See List of OJficers^Etc^ Statement 0. 0. 0. Chairwoman 0. 0. 0. 0. 0. 0Chairwoman 0. 0. 0.
BAA
TEEA0105
1W17/05
4 CMSNo 1545.0047
Forrn
990
2006
Open to Public Inspection
2007
lilirihrrh h
* Section 501(cX3 organizations and 4947(aX1) nonexempt charitable trusts must attach a completed Schedule A (Form 990 or 990-EZ).
H andI are not applicable lo section 527 organizations H ( a ) Is (his a group return lor atliliates? H ( b ) It res,J emer number of affiliates * H ( C ) Are alt altiliates mclmfeiP (If JNo,' attach a fist See instructions > H ( d ) Is Ihis a separate return died by art organization covered by a group ruling' [ I ymi, f x ] ^o JY.5 Q No ~^IVn I X ' No
G J K
Website:* W W W . s a l f , o r c Organization type 4947(3,(1) r (check only one) 501(c) .^ (insert no ; sn Check here * Q ' f the orgariiiatioft is nol a 509(a)(3) supporting organization and its gross receipts are normally not more than $25 000 A return ts nol required but if the organization chooses lo life a return, be sure to file a complete return
[x]
I M
Gross receipts Add lines 5b, 8b, 9b, and 10b to tine 12
925,545,
Group Exemption Number " Chech - [ Jil trie organization is not required to attach Scfted-jle 8 (Form 980,990 U, or 990- PF).
Part I
a b c d
j Revenue, Expenses, and Changes in Net Assets or Fund Balances (See the instructions.
Contributions, gifts, granls, and similar amounts received Contributions lo donor advised funds Direct public support (nol included on tine la) Indirect public support (nol included on Itne l a ) Government conlnbutions (grants) (not included on line la)
[",! (add lines g la tnrougn ro) (casn v -J-J-I ' ^ ^ r q*e -* ^ -* ' ,,h "UHLJ^H e y
la lb 1c Id
31,945
700,000. le
e
2 3 4 5 6a b c 7 8a b c d 9 a
1
S
b c Net income or (loss) from special events Subtract line 9b from line 9a 10a Gross sales of inventory, less returns and allowances 10a b Less' cost of goods sold 10b c Gross profit or (loss) from sales of inventory (attach schedule). Subtract line IDb from line 10a 11 Olher revenue (from Part VII, line 103) 12 Total revenue. Add lines l e , 2, 3, 4, 5, 6c, 7, 8d, 9c, 10c, and 1 1 13 Program services (from line 44, column (8)) 14 Management and general (from llne 44. column ( C ) 15 Fundraismg (from line 44, column (D)) 16 Payments to affiliates (attach schedule) 17 Total expenses. Add lines 16 and 44, column (A) 18 Excess or (deftctt) (or the year. Subtract line 17 from line 12 19 Net assels or rund balances at beginning of year (from llne 73. column (A)) 20 Other changes in net assets or fund balances (attach explanation) 21 Net assets or fund balances at end ol year. Combine lines IS, 19, and 20 BAA For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions.
1 Program service revenue including governmenl lees and contracts (from Part VII, line 93) Membership dues and assessments Interest on savings and lemporary cash investments Dividends and interest from securities Gross rents MAIL. ft 2008 Less rental expenses 6b Net rental income or (loss) Subtract line 6b from line 6a Olher investment income (describe > (A) Set tBromer Gross amount from sales of assets other than inventory 8a Less, cost or olher basis and sales expenses 8b Gain or (loss) (attach schedule) 8c Net gain or (loss) Combtne line 8c, columns (A) and (B) Special evenls and activities (attach schedule) If any amount ts from gaming, check here Gross revenue (not including $ of contributions 9a reportedonlinelb) 9b Less direct expenses other than fundraismg expenses
RECEIVED
onnFN.UT
6c
8d
9c
745.
1,470,538
544,993 803,601
258,608. Form 990 (2006)
si
car?
<J
36-3869459 Form 990 (2006) SAVE A LIFE FOUNDATION Part IV-A Reconciliation of Revenue per Audited Financial Statements with Revenue per Return (See the instructions.)
Total revenue, gains, and other support per audited financial statements Amounts included on line a but not on Part I. line 12 INet unrealized gams on investments 2Donaled services and use of facilities 3Recovenes of prior year grants 40ther {specify) Add lines b l through b4 Subtract line b from tine a Amounts included on Parl I, line 12, but not on line a: 1 Investment expenses not included on Part I, line 6b 20ther (specify). Add lines d l and d2 Total revenue (Part 1, line 12) Add lines c and d
a
Page5
1,256,155.
bl b2 b3 b4
330,610.
330,610 92\,545.
dl
J
d2 e
925,545.
Part IV-B Reconciliation of Expenses per Audited Financial Statements with Expenses per Return
Total expenses and losses per audited financial statements Amounts included on line a but not on Parl I, line 17, 1 Donated services and use of facilities 2Pnor year adjustments reported on Part f, line 20 3Losses reported on Part f, line 20 40ther (specify) Add lines b l through M Subtract line b from line a Amounts included on Part 1, line 17, bul not on line a: 1 Investment expenses nol included on Part I, line 6b 20lher (specify) Add lines d l and d2 Total expenses (Part I. line 17) Add lines c and d a bl b2 b3 b4 330,610 1,470,538. dl d2 e 1,470,538 1,801,148
330,610.
PartV-A
I C u r r e n t O f f i c e r s , D i r e c t o r s , T r u s t e e s , a n d K e y E m p l o y e e s (Lisl each person who was an officer, director, trustee, or key employee at any time during the year even if they were not compensated ) (See the instructions) (A) Name and address (B) Title and average hours per week devoted lo position (C) Compensalion Of not paid, enter -0-) 130,000. (D) Contribulions to employee benefit (E) Expense account and other allowances
CAROL SPIZZIRRI 9950 LAWRENCE #300 SCHILLER PARK, I L 60176 RITA MULLINS 9950 LAWRENCE #300 SCHILLER PARK, I L 60176 DOUGLAS BROWNE 9950 LAWRENCE #300 SCHILLER PARK, I L 60176 JOHN DONLEAVY 9950 LAWRENCE #300 SCHILLER PARK, I L 60176 ANDY KNAPP 9950 LAWRENCE #300 SCHILLER PARK, I L 60176
0.
838.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0,
0.
0.
BAA
TEEAOI05L oma/OJ
F 0 r m ggg (2006)
Font.,.
990
P l . _ :
OMBMa
ISJS-COi7
2007
n.ifilms
change
36-3869459
Boom/suite E Telephone number 300 (847) 928-9683
Nam i
] *#
i Amended reliim Joining
Change Initial I
Number and street (or P 0 box if mail is not delivered to street address) See Specihc 9 9 5 0 LAWRENCE
Instruclions
K and I are not applicable to section 527 organizations I T h e s IXiHn H[a) Is this a group return for affiliates? H(b) If 'Yes," enter number of affiliates N/A G Website'>HTTP: //WWW.SALF.COM J Organization type KrMfcww)r* S T ] 501(c) ( 3 )^ [insert n Pi | I 4947(a)(1) or i J 527 H(c) Are all affiliates included' N/A _ J T B S f I Nn (ifNo.'sttachalist) K Check here it the organization is not a 509(a)(3) supporting organization and its gross HfrJ) Is this a separate return hied by an or- , , , , receipts are normally not more than $25,000 A return is not required, but if the organization gamzation covered by a group ruling? [ H Y H S 1 X 1 MO chooses to hie a return, be sure to file a complete return N/A I Group Exemption Number M I Gross receipts Add lines 6t>, 8b, 9b, and 10b to tine 12 1 Contributions, gifts, grants, and similar amounts received Contributions to donor advised funds b Direct public support (not included on line la) c Indirect public support {not included on line 1a) rj Government contributions (grants) (not included on line 1a) e Total (add lines 1a through Irj) (cash S i
Section 501(c)(3) organizations and 4947(a)(1) nonenempt charitable trusts must attach a completed Schedule A {Form 990 or 990-EZ).
toOUIrtnfirainwt I
Olnei ,(special W
I Castl I X I Accrual
627,368
Check L X j if the organization is not required to attach Set) B (Form 990, 990-EZ, or 990-PF)
750.
2 3 4 5 6a b c 7 6a
noncashS Program service revenue including government tees and contracts (from Part VII, line 93) Membership dues and assessments Interest on savings and temporary cash investments Dividends and interest from securities Gross rents 6a
750
1e
750. 598,359.
774.
I
r^l
Less rental expenses 1 6b Net rental income or (loss) Subtract line 6b from line 6a Other investmenl income (describe > ^ _ Gross amount from sales of assets Other (A) Securities (B) Other than inventory 8a_ 8b_ b Less cost or other basis and sales expenses | I Be c Gain or (loss) (attach schedule) Net gam or (loss) Combine line 8c. columns (A) and (B) rj 9 Special events and activities (attach schedule) It any amount is from gaming, check here > I I 3,125. 0 . ol cocroucons ttpvvn on line i M 9a 3 :;:>- -.'.-,: [fiot . - j T V -j 1 9b b Less direct expenses other than fundraising expenses 1,764 c Net income or (loss) from special events Subtract line 9b from line 9a SEE STATEMENT 1 17,523 10 a Gross sates of inventory, less returns and allowances 10a 10b 6,050. 0 Less cost of goods sold
6c
8d
9c
1,361.
11
a
<
12 13 14 15 16 17 18 19 20 21
c Gross profit or (loss) from sales of inventory (attach schedule) Subtract line 10b from line 10a Other revenue {from Part VII, line 103) Total revenue. Add lines le, 2,3,4,5,6c, 7, Bd, 9c, 10c, 3nd 11 Program services (from line 44, column (8)) Management and general (from line 44, column (C)) Fundraismg (from line44, column (D)) Payments to affiliates (attach schedule) Tola! expenses Add lines 16 and 44, column (A) Excess or (deficit) tor Ihe year Subtract line 17 Irom line 12 Met assets or fund balances at beginning ot year (from line 73. column (A)) Other changes in net assets or fund balances (attach explanation) Net assets orfund balances at end of year Combine lines 18,19, and 20 LHA For Privacy Act and Paperwork Reduction Act Notice, see the separate instruclions.
STMT 2
RCEiV3D
D C 1 9 2008 E
10c 11 12 13
14
15 15 17 18 19 20 21
CGDEN, UT
723001 12-27-07
6065
Form 990(5007)
SAVE A L I F E
FOUNDATION
36-3869459
a
bl b2 b3
page 5
Part IV-A
a b 1 2 3
\lith Reconciliation of Revenue per Audited Financial Statements W i Revenue per Return (Seethe instructions)
Total revenue, gams, and other support per audited financial statements A m o u n t s included on line a but not on Part 1, tine 12: Net unrealized gains on investments Donated services a n d use of facilities Recoveries of prior year grants SEE STATEMENT 7
1,003,158.
375,790. 7,814.
b
A Other ( s p e c i M :
hi
A d d lines b1 through b4 c d 1 2 Subtract line b from line a A m o u n t s included o n Part I, line 12, but not on line a: Investment expenses not included on Part I, line 6 b Other (specify). A d d lines d 1 a n d d 2
c m
d2
383,604. 619,554.
0. d 619,554. e Part IV-B Reconciliation of Expenses per Audited Financial Statements Will Expenses per Return 1,109,654. a Total expenses a n d losses per audrted financial statements a
T o t a l r e v e n u e (Part I, line 12). A d d lines c a n d d A m o u n t s included o n line a but not on Part 1, line 17 Donated services a n d use of facilities Pnor year adjustments reported on Part I, line 2 0 Losses reported on Part I, line 20 01 1 2 3
rj
375,790.
b2 b3
b4
4 Other (specrfvlc d 1
SEE STATEMENT 8
7,814.
b c
A d d lines b 1 through W Subtract line b from line a A m o u n t s included on Part 1, line 17, but not on line a: Investment expenses not included on Part 1, line 6 b dl
383,604. 726,050.
jffi
d
>
(B) Tiile and aavragg hours (C) Compensation per week devoted to (II not paid, enter position PRESIDENT & C EO
0. 726,050.
(E)Expense account and other allowances
Part V-A
Current Officers, Directors, Trustees, and Key Employees (List each person w h o was an office r, director, trustee, or key employee at any time d u n n g the year even if they were not c o m p e n s a t e d ) (S ee the instructions)
(A) Name and aadress
{0|Cor>tnnu lions to employee benETit
CAROL S P I Z Z I R I 9 9 5 0 LAWRENCE #3~00 SCHILLER PARK,' I L 6 0 1 7 6 R I T A MULLINS 99S'O" LAWRENCE # 3 0 0 SCHILLER P A R K , " l L 6 0 1 7 6 DOUGLAS BROWNE 99~50 LAWRENCE # 3 0 0 S C H I L L E R PARK, I L 6 0 1 7 6 JOHN DONLEAVY 9 9 5 0 LAWRENCE # 3 0 0 ' S C H I L L E R PARK, I L 6 0 1 7 6 ANDY KNAPP 9 9 5 0 LAWRENCE # 3 0 0 " S C H I L L E R PARK, I L 6 0 1 7 6 ERNESTO A PRETTO 9 9 5 0 LAWRENCE # 3 0 0 ' S C H I L L E R PARK, I L 6 0 1 7 6 MARK MITCHELL 9 9 5 0 " LAWRENCE " # 3 0 0 SCHILLER"PARK, IL 6 0 1 7 6
40.00 SECRETARY 2.00 TREASURER 2.00 DIRECTOR 2.00 DIRECTOR " 2.00 DIRECTOR 2.00 DIRECTOR 2.00
33,380.
2,662.
0.
0.
0.
0.
0.
0.
0.
0. RESISNED
6 / 2 0 08 0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
0.
6065
DIVIDER
SALF
Save A Life Foundation
Page8 2003-2004 SALF National Spokesman- Travis Geisler, NASCAR Driver-Bush Series 2003-2004 SALF State SpokesmanIllinois State Senate President, Emil Jones Executive Board of Directors Ciirol J. Spizzini, President & Founder Save A Life Foundation Doug Browne, Treasurer Deputy Director, National Center for Injury Prevention and Control CDC Rita Mullins, Secretary Mayor of Palatine, Illinois Peggy Trimble, RN, Pennsylvania State EMS Director (retired) Advisory Board Derek Crawford Regional Director of State Government Affairs, Altria, INC. JohnJ.Donleavy Vice President, VELCO Power & Light, VT Robert E. Ryan Vice President, Government Affairs, Comcast Communications Mark Mitchell, D.O. ER Medical Director, St. Joseph Regional Medical Center, Milwaukee, 117 Steve Orebaugh, M.D. Pittsburgh Medical Center Ernesto Pretto, M.D. Professor and Chief. University of Miami. Jackson Memorial Hospital, Department of Anesthesiology, President of IfADEM (former) State Council Ken Alderson Executive Director of Illinois Municipal League Edward Crews, FF/EMT-P I n Bock Mayor of Hanover Park, Illinois Kelly Clancy Corporate Director of External Affairs, Alexian Brothers Martin J. Heffron Business Consultant, U.S. Cellular Medical Board Carol Spizzirri, B.S.N. Peter Safar, M.D., ScD., (Fatherof CPR, deceased) Henry Heimlich, M.D., ScD., (Heimlich maneuver) Steve Orebaugh, M.D. EmestoA. Pretto, M.D. Mark Mitchell, D.O.
Save A Life Foundation National Headquarters O'Hare Aerospace Center 9950 West Lawrence Ave. Suite # 300 Schiller Park, Illinois 60176 Illinois Branch Offices: SALF State Office. Springfield Alexian Brothers Medical Center, Hanover Park Anderson Hospital, Maryville St. James Hospital, Pontiac Joliet Fire Department, Joliet Indiana Walnut Township Volunteer Fire Department Florida OlTice of the Mayor Fire & Rescue Department, Miami Pennsylvania American Trauma Society, Mechanicsburg Wisconsin St. Joseph Regional Medical Center, Milwaukee
Major Sponsors
*Ronald McDonald House Charities-Global *Ronald McDonald House Charities Chicagoland and Northwest Regions Altna, INC. Blue Cross Blue Shield of Illinois Chicago Public Schools Comcast Communications ComEd-Exelon Company Daily Herald Publications Kimball Hill Homes Pace Transportation Rider Dickerson, Inc.
Illinois State Representattve Louii Lang SALF has saved the lives of countless numbers of people. It is truly the gift that keeps giving. From small beginnings, this organization has become very significant and with our attention and help can become a modelfor 1000s around the country to follow. The lessons learned bv so many children will do much to lead us to a safer and more' aware citizenry and I am proud to stand with Carol and her legions to do whatever I am able to bring this message and these lessons to more and more people."
SALF
rr
^\
Treasurer Douglas R. Browne. Treasurer DBMD, Centers for Disease Control & Prevention - GA Secretary Honorable Rita Mullins, Secretary Mayor Palatine. IL. Exec. Bd. * U.S. Conference of Mayors, Illinois Municipal League Senior Advisor Andrew Knapp, Executive Board Member Vice Pres of Govt Relations Magellan Health Services - D.C. Illinois SALF Spokesperson
John Urvilcivv. I'rcMiiim.Lii.lCl-IJ V E I A D - V T Mark Friedman, MD, FACEP FACP - I L Dancll Pancrson Safe Kids Coordinator - tL Bob Ruin Vice President Gov'1 Affairs Comcast - IL Icllrey Schwartz, D O - I L Dick Stiver Retired Assistant School Superintendent - IL
IllinotscnalcPrcsidcnt
v*.
Sponsors
Abbott Laboratories*AdolphKiefer and Assoc * Ahlbeck & Company Air Quality Maintenance * Alan and Sourixat Thavisouk * Albert Fernando Contemporary Marketing * Albrecht Enterprises * Alexian Brothers Health System, Inc *Allstate Foundation Altria Corporate Services, Inc. *Amencan College of Osteopathic Emergency Physicians * Associated Fire Fighters of Illinois* Bank One * Blue Cross Blue Shield * Bnskman & Briskman * Browning Ferris Industries * Cambridge Homes * Caraher Management * Charlotte-MecWenberg Police * Chicago Cubs* Chicago Wolves Pro Hockey * Chicagoland Speedway * Cisco Systems* City of Concord * City of Des Plains * CLTV * ComCast * Commonwealth Edison Co * Competition Telecom Inc * Corporate Treats * Cremation Services Inc * Cunie Motors * Daily Herald * Dave Pateand Son's * Degen & Rosato Consbuction Co. * Elkay * ESPNs RPM Tonight * Exelon - ComEd and PECO * Floran Technologies * GO ARMY Racing * Guru Electric * H & H Electric *Hilton Hotels World Headquarters*Household- HELP Charity Committee *IL State Rep., Lee Daniels*Irwin Andrew Porter Foundation * Italian American War Veterans #5 * JadeGurss *Jay Howard Enterpnses * John O. Brill* John Spot/Tim Lmtner* Kimball Hill Homes * Kmtetsu Inll Travel Consultants * Kraft Racing * Krispy Kreme * Legends in Stone * Lowes Motor Speedway * McDonalds Corporation * Midv*st Equipment Rentals * Motorola *NEXTEL Communications * North Carolina CERT * North Carolina Citizens Corps ' North Carolina Governors Office *Northwest Display Corp* OCTAGON Marketing * PACTIV Corporation *Parkway Bank andTrust* Pro Star *R Carrozza Plumbing Co., Inc. *Racing Reflections* Red Bull Cheever Racing* Richard Petty Driving Experience * Ronald McDonald Global *Ronald McDonald House Charities Chicago/Northern Indiana * Rosemont Exposition Services * Rosemont Suites * Ryan and Ryan * SBC Communications * Stoffel Seals Corporation * Stormo. Ramello & Durkin *TCF Bank * United Airlines Foundation * Vahey Construction Co. Inc * West Cook Municipal League * Westpoint Stevens* William A McGinty Company
SALF
rr
^\
Treasurer Douglas R. Browne. Treasurer DBMD, Centers for Disease Control & Prevention - GA Secretary Honorable Rita Mullins, Secretary Mayor Palatine. IL. Exec. Bd. * U.S. Conference of Mayors, Illinois Municipal League Senior Advisor Andrew Knapp, Executive Board Member Vice Pres of Govt Relations Magellan Health Services - D.C. Illinois SALF Spokesperson
John Urvilcivv. I'rcMiiim.Lii.lCl-IJ V E I A D - V T Mark Friedman, MD, FACEP FACP - I L Dancll Pancrson Safe Kids Coordinator - tL Bob Ruin Vice President Gov'1 Affairs Comcast - IL Icllrey Schwartz, D O - I L Dick Stiver Retired Assistant School Superintendent - IL
IllinotscnalcPrcsidcnt
v*.
Sponsors
Abbott Laboratories*AdolphKiefer and Assoc * Ahlbeck & Company Air Quality Maintenance * Alan and Sourixat Thavisouk * Albert Fernando Contemporary Marketing * Albrecht Enterprises * Alexian Brothers Health System, Inc *Allstate Foundation Altria Corporate Services, Inc. *Amencan College of Osteopathic Emergency Physicians * Associated Fire Fighters of Illinois* Bank One * Blue Cross Blue Shield * Bnskman & Briskman * Browning Ferris Industries * Cambridge Homes * Caraher Management * Charlotte-MecWenberg Police * Chicago Cubs* Chicago Wolves Pro Hockey * Chicagoland Speedway * Cisco Systems* City of Concord * City of Des Plains * CLTV * ComCast * Commonwealth Edison Co * Competition Telecom Inc * Corporate Treats * Cremation Services Inc * Cunie Motors * Daily Herald * Dave Pateand Son's * Degen & Rosato Consbuction Co. * Elkay * ESPNs RPM Tonight * Exelon - ComEd and PECO * Floran Technologies * GO ARMY Racing * Guru Electric * H & H Electric *Hilton Hotels World Headquarters*Household- HELP Charity Committee *IL State Rep., Lee Daniels*Irwin Andrew Porter Foundation * Italian American War Veterans #5 * JadeGurss *Jay Howard Enterpnses * John O. Brill* John Spot/Tim Lmtner* Kimball Hill Homes * Kmtetsu Inll Travel Consultants * Kraft Racing * Krispy Kreme * Legends in Stone * Lowes Motor Speedway * McDonalds Corporation * Midv*st Equipment Rentals * Motorola *NEXTEL Communications * North Carolina CERT * North Carolina Citizens Corps ' North Carolina Governors Office *Northwest Display Corp* OCTAGON Marketing * PACTIV Corporation *Parkway Bank andTrust* Pro Star *R Carrozza Plumbing Co., Inc. *Racing Reflections* Red Bull Cheever Racing* Richard Petty Driving Experience * Ronald McDonald Global *Ronald McDonald House Charities Chicago/Northern Indiana * Rosemont Exposition Services * Rosemont Suites * Ryan and Ryan * SBC Communications * Stoffel Seals Corporation * Stormo. Ramello & Durkin *TCF Bank * United Airlines Foundation * Vahey Construction Co. Inc * West Cook Municipal League * Westpoint Stevens* William A McGinty Company
SALF
Annual Report
2007-2008
rr
Q
Executive Board
I'trairknl
CarolJ. Spizzim,
l',.,d_-i,l;.,d|,ui.i;i
Board of Directors
>
Advisor} Board
^ \
K m A l d e r s lirrr. Ex Director, tUinois Municipal League Derek L. Crawford, Regional Director Ijnll - IL
Treasurer
I j..ijuii.-R l'r,ti=,
Darrell Pancrson Safe Kids Coordinator -I1. Bob Ryan Vtcc President Gov'1 Affairs Comcast - IL
Jefliey Schwartz, D O - I L Dick Supher Retired Assistant School Supanmendeffl - IL
Treasmn
Secretary
Honorable Rita Mull LIB, Secretary
Bob Kenny
ChiefMcHaniv Gary Taylor
I.ii.alI.
IT,.in i;\
mil'
Anne Johnson, M D
Greg Scott
Mayor Steve Stocklcn
V.
K,n
., K Wcbli
Sponsors
Abbott Laboratories * Adolph Kiefer and Assoc * Ahlbeck & Company Air Quality Maintenance * Alan and Sourixat Thavisouk* Albert Fernando Contemporary Marketing * Albrecht Enterprises * Alexian Brothers Health System, Inc *Allstate Foundation* Altria Corporate Services, Inc. *American College of Osteopathic Emergency Physicians * Associated Fire Fighters of Illinois* Bank One * Blue Cross Blue Shield * Snskman & Briskman * Browning Ferris Industries * Bulklift* Cambridge Homes * Caraher Management * Charlotte-Mecklenberg Police * Chicago Cubs* Chicago Wolves Pro Hockey * Chicagoland Speedway * Cisco Systems * City of Concord * City of Des Plaines* CLTy" ComCast*Commonwealth Edison Co *Competrbon Telecom Inc * Corporate Treats* Cremation Services Inc *Cross Containers *Curne Motors *Daily Herald *Dave Pate and S o n s * Degen & Rosato Construcbon Co. * Dundee Landscape*Bkay *ESPNs RPM Tonight * Exelon -ComEdand PECO *Floran Technologies*GO ARMY Racing * Gurtz Electnc * Hexion * H & H Electric* Hilton Hotels World Headquarters* Household - HELP Charrty Committee *IL State Rep, Lee Daniels * liwin Andrew Porter Foundation *Italian American War Veterans #5 *Jade Gurss * Jay Howard Enterprises *John O. Brill * John Spot/Tim Lintner * Kimball Hill Homes * Kintetsu Intr Travel Consultants* Kraft Racing* Krispy Kreme * Legends in Stone* Lowes Motor Speedway* McDonalds Corporation * Midwest Equipment Rentals *Motorola * NEXTEL Communications* North Carolina CERT* North Carolina Citizens Corps.* North Carolina Governors Office * Northwest Display Corp * OCTAGON Marketing * Otto Engineering * Partner of R H Partners 1, LLC * PACTIV Corporation * Performance Stamping * Parkway Bankand Trust* Pro Star *Quiltmaster*R Carrozza Plumbing Co , Inc * Racing Relictions* Red Bull Cheever Racing*Richard Petty Driving Experience * Ronald McDonald Global *Ronald McDonald House Charities Chicago/Northern Indiana * Rosemom Exposition Services* Rosemont Suites * Ryan and Ryan * SBC Communications* Spring Hill Center CCII* Stanley Machine * Stoffel Seals Corporation * Stonno, Ramello & Durkin * TCF Bank * United Airlines Foundabon * Vahey Construction Co., Inc * West Cook Municipal League * Westpant Stevens* Wil1iam A McGmty Company
DIVIDER
Lisa Madigan
A ITuKNi;y CiEKKKAt.
Ms. Carol Spizzirri, President Save A Life Foundation, Suite 300 Schiller Park, Illinois 60176 Re: Save A Life Foundation CO# 06498102 . Our Fileff99-99,0088
DearMs.Spizzirri: The financial reports filed with this office indicate that you have made one or more variahle rai* loans to the Save A Life Foundation. Please provide us any and all information reZiZirniwct respecting said Joan(s) including the following: 1. 2. 3. 4. 5. 6. Each loan agreement, loan note and any amendments thereto; A schedule of all said loan(s) for each year and the current balance of each loan; A schedule of all accrued interest payable on said loan(s) for each year; A schedule of all interest and or principle payments made to you on said loan(s); The IRS Code Section and a description of the IRS Applicable Federal Rates used to determine the interest accrued annually on said loan(s); and All board minutes approving and/or discussing said loan(s).
, ^ T ^ r ^ 3 1 1 ^ ^ ^
Sincerely, jT
ioo
West Randolph Street, 11* Floor, Chicago, Illinois 60601-3175 by June 27, 2007 Thank you for vour assistance; if you have any questions, please contact me at (312) 814-3849.
CBIZ
June 27,2007
Ms. Elaine M. Johnson Illinois Attorney General's Office 100 W.Randolph St. 11* Floor Chicago, IL 60601-3175 Re: Save a Life Foundation CO H: 06498102 File No.: 99-99,0088
Dear Ms. Johnson: On behalf of the above-named organization and its President, Carol Spizzirri, we as the accountants are responding to your letter dated June 5, 2007 (photocopy enclosed). Your letter requests certain information concerning loan transactions between this organization and its founder, Ms. Spizzirrii Please be advised that Ms. Spizzirri began lending operating funds to Save A Life Foundation (SALF) since its inception in 1993. Since that time, the outstanding loan balance and accrued interest have been recorded on the organization's books with adjustments for reimbursements. In response to each of the points mentioned in your letter, please be advised of the following: 1. No formal loan agreement or note exists.
2 4 . See attached Exhibit A which reflects the loan activity since 2000. 5. This loan originated in February 1993 as it was memorialized in the board minutes attached. Since there is no formal loan agreement, it could be characterized as a demand note. As such, the Internal Revenue Code Section 1274 applicable federal - / _ short term rate was 4.23m. rTj r.;:? The enclosed Exhibit B presents the organization's accrued interest calculation forthe years 2000-2006. Jr & ~ 6. Enclosed as Exhibit C please find photocopies of board minutes apprpving "and/or discussing said loan.
SSL
CtyZ'
Ms. Elaine M. Johnson June 27, 2007 Page 2 of2
If you have further questions concerning this matter, you may contact the undersigned. Very truly yours, CBIZ ACCOUNTING, TAX & ADVISORY SERVICES, LLC
( /
K^ieri\MBUCab\nat1u]\]o)iiuantLAliGtn.Savi:alircF<l<.S07(faK
mMLu^immmAAu
,1
Discussion
Welcomed and thanked all attendees for participating. Secretary Mullins read Board minutes of January 26,2007
Action
Approved as read
DSSSSSU
Treasurer report was approved as read Treasurer Browne noted Spizzirri's Mullins motioned that organization start up loan and loan Spizzirri's start up loan and 2004 loan be retumed to to SALF in 2004 to maintain trie Spizzirri with interest no later organization during a financial then September 1,2008. shortage is still out standing and Motion was seconded by needs to be reimbursed to her Browne and motion carried. with the agreed upon interest of 5% to clear SALF's books no later then next FYOB Spizzlni has not requestedfundsinorderto conduct business, such as this Sst year when a marketlng MmDaionTexpededlylost 2 sponsorTSoizzini stated hat thlre was no rush to return undsuil SALF waS financiilly sound thatIrainini^ children was more important. Browne stated that SAL?booksTust be clear of all outstanding debts to demonstrate the organization is sound, if that means not
Secretary Mullins
SALFs Bylaws allows for compensation to Executive Board members for time consideration. Sec Mullins purposes SALF considers compensating those Executive Board members with Board leadership responsibilities i.e. President, Vice President, Treasurer. Secretary, Chairman S r ^ c ^ ouraosed that a sum be based on me am^unonime spent in doing S^LF business for various SALF relatedI meeHngs, paperwork and soedal 3 Members need S rf J j c h Ex Members
BSS
reimburse Mullins motioned to compensate Executive Board President for her duties at $75,500. Motion ' w3seconded by Treasurer Browne and carried. Motion was made by Spizzini to compensate Treasurer for
his duties at $40,000 a year.
Motion was secondedby cecrl?ary Mullins and compensate Secretary Mullins for Secretary duties at $40,000 per year. Motion was s e e d e d b y President
i.p')Tin7>;s i
have to pay. Spizzini purposed to post-pond this compensation until mid September 2007 when SALF would be financially sound to afford this compensation. It was further purposed by Browne that compensation should be reviewed yearly based on the increased demands and out of pocket expenses of that appointment. SDizztrri purposed a special EXBCUdwBMrd meeting between U s u r e r , Secretary and President should be held Auaust 2M7 to purpose graduatina retirementbenefit ortionsfor whoVe been on the Boa^dfor SWHfor moreyeare
Spizzirri and carried. Treasurer Browne motioned that compensation for all existing Executive positions would begin September 1, 2007, orTL soon as Foundation was financially sound to execute these compensations (what ever comes first). Motion was seconded bv Secretary Mullins and carried Mullins motioned that all Executive board members would be reviewed vearly and by S^artaooraval could qualify
fori^reaVwrSnsation
u D t o l 0 ? Browne secondedI the motton Motion cannedTraasurerarowne
S^i^bllBhedfo?
existing Executive members
SSErsSi33SS
Executive member, i.e. Chairman, Vice Chairman, for approval at the June, 2007 meeting.motion, motion Mulling seconded seconoea the moron, Motion to accept Andy Knapp Carol Spfczlrri nominated Andy as a member of the SALF Knapp to the SALF Executive Executive Board was made by Board. Mr. Andy Knapp feels as Executive Board as former aide to Rita Mullins. Motion was seconded by Browne and Health and Human Services carried. (HHS) Secretary Tommy Thompson. Knapp he understands the growing need of SALF's "PreEMS"mission and feels he could serve as a liaison to those agencies and individuals who
Sfi^eareTu'irhs58
directly and indirectly could benefit He feels he can additionally strengthen SALF's image nationally, both in board development at the state and national level and generate revenue with his contacts.
DIVIDER
hility
h
Department of Commerce
find
Search By Entity Name By AK Entity # By Officer Name By Registered Agent Verify Verify Certification Biennial Report File Online LLC File Online Business Corporation File On Online Orders Register for Online Orders Order Good Standing Name Registration Register a Business Name Online
Date: 4/1/2007 Filed Documents (Click above to view filed documents that are available.) Entity Name History Name Save A Life Foundation, Inc. Save A Life Foundation, Inc. Nonprofit Corporation Information AK Entity #: Status: Entity Effective Date: Primary NAiCS Code: Home State: Principal Office Address: Expiration Date: Last Biennial Report Filed Date: Last Biennial Report Filed: Registered Agent Agent Name: Office Address: Mailing Address: Principal Office Address: BUSINESS FILINGS INCORPORATED 9360 Glacier Hwy, Ste-202 Juneau AK 99801 No Address Name Type Legal Home State
106734
Active- Good Standing 02/22/2007 624190: Other Individual and Family Services IL N/A Perpetual
Officers, Directors, 5% or more Shareholders, Members or Managers Name: Address: Title: Owner Pet: Carol Spizzini 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 President 0
[-miiv
Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet: Name: Address: Title: Owner Pet:
Carol Spizzini 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Director 0 Peggy Trimble 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Vice President 0 Peggy Trimble 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Director 0 Rita Mullins 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Secretary 0 Rita Mullins 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Director 0 Douglas Browne 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Treasurer 0 Douglas Browne 9950 W Lawrence Ave Ste 300 Schiller Park IL 60176 Director 0
b^iBV&At&te&S&imBtBtot&Caipj&ttX&f
C o f 2)4'I'301)7 I k:iS:53 TM
State of Arizona Public Access Svstem J u m p To... Annual Reports Scanned Documents
2:10 PM
Corporate Inquiry File Number: F-L286511-2 Corp. Name: SAVE A LIFE FOUNDATION, INC. Domestic Address 9950 W LAWRENCE A\"E STE. 300 SCHILLER PARK, IL 60176 Foreign Address :394ECAMELBACKRD PHOENIX, AI S5016 Statutory- A s e n t Information Agent Name: BUSINESS FILINGS INCORPORATED Check Corporate Status
Agent Status: APPOINTED 01 24 200" Agent Last Updated: 04 04 200" Additional C o r p o r a t e Information Corporation Type: NON-PROFIT Incorporation Date: 01 24 200" Domicile: ILLINOIS Approval Date: 03 212007 Business Type: Corporate Life Period: PERPETUAL County: M4RICOPA Original Poblish Date: 04 16 2007 Officer Information CAROL J S P I Z Z I R R I PRESIDENT 9 9 5 0 W LAWRENCE AVE STE. 300 SCHILLER PARKf~L 60176 Date of Taking Office: 01/24/2007 Last Updated: 03/21/2007 RITA MULLINS SECRETARY 9 9 5 0 W LAWRENCE AVE STE. 300 SCHILLER P A R K , I L 60176 Date of Taking Office: 01/24/2007 Last Updated: 03/21/2007
DOUGLAS BROWN TREASURER 9 9 5 0 W LAWRENCE AVE STE. 300 SCHILLER P A R K , I L 60176 Date of Taking O f f i c e : 01/24/2007 Last Updated: 06/17/200B
Director Information ANDREW KNAPE DIRECTOR 9 9 5 0 W LAWRENCE AVE STE. 300 SCHILLER P A R E , I L 60176 Date of Taking Office: 01/24/2007 Last Updated: 06/17/2008
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| Document Number | C1G4G334 f 01963442 02413532 Back To Top APPLICATION FOR AUTHORITY PUB OF APPL FOR AUTHORITY OS ANNUAL REPORT
Date Received
FILED SecJrueUr1yof0S6tate
Current Principal Place of Business: 9950 W LAWRENCE AVE., SUITE 300 SCHILLERPARK.IL 60176 Current Mailing Address: 9950 W LAWRENCE AVE, SUITE 300 SCHILLERPARK.IL 60176
FEI Number: 36-3869459 FEI Number Applied For ( ) FEI Number Not Applicable ( ) Certificate of Status Desired ( ) In accordance with s. 607.193(2)(b), F.S., the corporation did not receive die prior notice, Name and Address of Current Registered Agent: N a m e and Address of New Registered Agent:
BUSINESS FILINGS INCORPORATED 1203 GOVERNORS SQUARE BLVD. STE. 101 TALLAHASSEE, FL 323012960 US The above named entity submits this statement for the purpose of changing its registered office or registered agent, or both, in the State of Florida. SIGNATURE Electronic Signature of Registered Agent OFFICERS AND DIRECTORS:
Title: Name: Address: City-St-Zip: Title: Name Address: Clty-St-Zip Title: Name Address: City-St-Zip: Title: Name: Address: City-St-Zip: Title: Name: Address: City-St-Zip: P ( ) Delete SPIZZIRRI, CAROL J 17479 W DARTMOOR DRIVE GRAYSLAKE IL 60030 SD ( ) Delete LEVICK. NADINE 137 WEST 110TH STREET. APT 7B NEW YORK, NY 10026 TD ( ) Delete BROWNE, DOUG 4770 BUFORD HIGHWAY ATLANTA, GA 30340 C ( ) Delete MULLINS, RITA 123NBROCKWAY PALATINE, IL 60057 VC (X) Delete TRIMBLE, PEGGY P.O. BOX 90 HARRIS8URG. PA 17108
TD (X)Change ( (Addition BROWNE, DOUG 4770 BUFORD HIGHWAY ATLANTA. GA 30340 C (X) Change ( ) Addition MULLINS, RITA 123NBROCKWAY PALATINE, IL 60067 D (X) Change ( ) Addition KNAPP.ANDY 601 PENNSYLVANIA AVE, NW 9TH FL, SOUTH BLD WASHINGTON. DC 2D004 ! ) Change ( ) Addition
I hereby certify that the information supplied with this filing does not qualify for the for the exemption stated in Chapter 119, Florida Statutes I further certify that the information indicated on this report or supplemental report is true and accurate and that my electronic signature shall have the same legal effect as if made under oath: that I am an officer or director of the corporation or the receiver or trustee empowered to execute this report as required by Chapter 617, Florida Statutes and that my name appears above, or on an attachment with an address, with all other like empowered. SIGNATURE: CAROL J SPIZZIRRI Electronic Signature of Signing Officer or Director
07H1/2006
Date
Control No: 07021498 Date Filed: 02/23/2007 12:00 AM Karen C Handel Secretary of State
CATHY COX
Secretary of State
N O T I C E TO A P P L I C A N T :
P R I N T P L A I N L Y OR T Y P E R E M A I N D E R OF T H I S
FORM
2.
Mark Schiff
Name of filing person {certificate will be mailed to this person, at address below)
Madison
City
Wl
State
53717
Zip Code
60176
Zip Code
Atlanta
Cifr Circle ONE
Fulton
County Jurisdiction {Home State or Country)
GA
30361
Zip Code
State
Illinois
6.
Carol Spizzirri
Officer/ CEO
IL
State
60176
Zip Code
Douglas Browne
Officer / CFO
Schiller Park
City
IL
State
60176
Zip Cade
Rita Mullins
Officer / SEC
Schiller Park
City
IL
State
60176
Zip Code
7. NOTICE: Mail or deliver the following items to the &&He$Mfffittaat,thB above address i I (1) Original and one copy of this application TJ M f f J y ' j , * ? , L ' - i ^ i / 0 d i / 0 3 (2) An ORIGINAL certificate of existence or gooo* l a n d i n g , not mo'rVihlrl ,9*-d*ys old, certified by the home state or country. Certificate from horne state may not be more than 90 days old. (Copy of articles of incorporation from home state should MOT be submitted) ays old. (Copy of articles of incorporation tf o (3) Filing fee of 225.00 payable to oSecretaryWtatt'"fF U n g f e ^ a r e N O N - r e t u i S e c r e t a r y ^ & t ^ J ' j Filing Jeits aje_NON-rsfundable.
2-I3-Q-?
ized S
'resident zirri, Pre and obtain entity information via the Internet: http://www.georgiacorporations.org
F0RM 236
Business Information
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General Information
Name Master Name Business Type File Number Status Pface Incorporated Formation Date Mailing Address Value SAVE A LIFE FOUNDATION, INC. Foreign Nonprofit Corporation 36645 F2 Active Illinois UNITED STATES Feb 26, 2007
mgm
9950 W
LAWRENCE AVE STE 300 SCHILLER PARK Illinois60176 United States of America BUSINESS FILINGS INTERNATIONAL, INC. 900 FORT ST MALL STE 1800 HONOLULU Hawaii 96813 United States of America
Agent Name
Agent Address
Officers
Name SPIZZIRRl.CAROL TRIMBLE ,PEGGY MULLINS.RITA BROWNE,DOUGLAS Office P/D V/D S/D T/D
Transactions
Date Code Remarks
MiHR-0S-23a7
APPUCATION FOR MICHAEL A. MAURO CERTIFICATE OF AUTHORITY Secretary of State State of Iowa , ^ W N O N P R O F I T )
15:37
P. 02
TO THE SECRETARY OF STATE OF THE STATE OF IOWA: Pursuant to the Revised Iowa Nonprofit Corporation Act, the undersigned corporation applies for a certificate of authority to transact business in Iowa, and states:
o
1. Thenameofthecorporationis Save A Life Foundation, Inc. 1A. [See Note 5] The name the corporation will use in Iowa, if different than the legal name of the corporation is [[[inois
2.
The corporation is incorporated under the Saws of the state [orforeign country] of _ 2/9/1993
3. The date of incorporation of.the corporation was 4. The duration of the corporation is Perpetual
$ 5. The street address of its principal office is Address 9950 West Lawrence Ave Suite 300
Park H fifilTfi
rt o
6. The street address of its registered office in towa and the name of its registered agent at that office Name Address Business Filings Incorporated 7777 nrenri AvPn,.* DesMoines. IA 50312 k^The corporation has no members. [^Jri.
8. The names and usual business or home addresses of its current directors and officers Name Address Carol J. Spizzirri. Director and President 9950 West Lawrence Ave Suite 300 Schiller Park. IL 176
J
RECEDED TIME MAS. $, 3:45FM
HNS
I1P.R-06-2007
'_5:37
p . S3
Name Address
Douglas Browne. Director and Treasurer S950 West Lawrence Ave Suite 300 s ^ i i w P g r k II fioi7fi
please attach aaditional pages as necessary]
9. A certificate of existence, or a document of similar import, duly authenticated within 90 days prior to the date of this application, by the official having custody of corporate records in the state or country of incorporation^ accompanies this application.
tftft
NOTES; 1. Thefilingfeeis$25.00. Make checks payable to SECRETARY OF STATE. 2. The document is to be signed by the chairperson of the board, the president, or other officer of the corporation. if directors have not been selected, the document is to be signed by an incorporator. If the corporation is In the hands of a court appointed fiduciary, the document is to be signed by the fiduciary. A copy of a signature is acceptable forfiling. Verification is not required.
3. One copy of the document is to be delivered to the Secretary of State for filing. 4. The effective time and date of the document is the laterof the following: a. the time of filing on the date it is filed; b. the time specified in the document on the date it is filed; c. the time and date specified In the document, not later than 90 days after the date it is filed.
5. If the name of the corporation does not satisfy the requirements of secfion 1506 of the Revised Iowa Nonprofit CorporafconActtherjorporationmayuseafictitiousn^ is unavailable and the corporation delivers to the secretary of statefor filing a copy of the resolution of its boardof directors, certified by its secretary, adopting the fictitious name.
SECRETARYOFSTATE Business Services Division Lucas Building, 1st Floor DesMoines, Iowa 50319 Phone:(515)281-5204 FAX:(515)281-7142or(515) 242-5953 Website: www.sos.state.ia.Us
lE&eiVEfi TIME m.
i,
3:45?M
MflR-e?-2007 203
15:59
P.03/05
FILED EFFECTIVE
2007MAR-7 PM 3= U3
SELUEfARY Of STATE STATE OF IDAHO
The name which ft shall use fn Idaho Is: It is incorporated under the laws ofIts date of Incorporation is:
2/9/1993
The street address of its principal office is; 9950 West Lawrence Ave., Suite 300, Schiller Park, IL 00176
6.
The address to which correspondence should be addressed, If different than Item 5, Is:
7.
The street address of Its registered office In Idaho is: 5527 Kendall St., Boise, ID 83706 and its registered agent In Idaho at that address is: B u a ( n f l S S Filings Incorporated
8. 9.
Yes
ED No
The names and respective addresses of its directors and officers are: Name Office Dfrector, President 9950 West Lawrence Ave., Suite 300. Schiller Park, IL 60176 Director, V P 9950 West L s w e n c e Ave., Suite 300, Schiller Park, IL 60176 Director, Secretary " 3 9 5 0 West Lawrence Ave., Suite; Director. Treasurer Her Park, IL6017E Address 9950 West Lawrence Ave., Suite 300, Schiller Park. IL 60176
Dated:
3/7/07
03/07/8007
155fl
C??/?fc7
0658500.09 ""KEf
Received and Filed 02/27/2007 1:52:45 PM Fee Receipt; $40.00
4. Illinois 5. _2/aL1993_
!.!!:
js the state or country under whose law the corporation is incorporated. is the date of incorporation and the period of duration is Perpetual
7 ^ n a ^ ^ T f e ' ^ j g l Z i ^ g l ^ 422 00
!>'.-i City Suit rip Codl
9950 W. Lawrence Ave., Suite 300, Schiller Park, IL 60176 _995_Q.W- Lawrence Ave., Suite 300, Schiller Park, IL 60176 9950 W . l a w r e n c e Ave., Suite 300, Schiller Park, IL 60176 9950 W. Lawrence Ave., Suite 300, Schiller Park, IL 60176 " 9 5 0 W* Lawrence Ave., Suit300<, Schiller ParkI IL 60176 ~ ^ ~ ^ " 9 5 0 W' U w r e n c e A v e T s i i i t e 300. SchilleT PaTkJL 60176
{Attach a continuation sheet, if nacessary)
Secretary Treasurer
Douglas Browne
ft If a professional service corporation, all the individual shareholders, not less th3n one half of the directors, and all of the officers other than the secretary and treasurer are licensed in one or more states or territories of the United States or District of Columbia to render a professional service described in the statement of purposes of the corporation. 10. A certificate of existence duly authenticated by the Secretary of State accompanies this application. 11. This application will be effective upon filing, unless a delayed effective date and/or time is specified: _
(OMaynJ M ) M data Una)
_CarolSpi
Date;
ident
TypaOf FnntNami a Till*
Z-lS
-Q7
.20 0 7
U.,Tftj.7
MarkSchimAVPl 7
Typa or P: T or p vn N s -* & TJDa (See attached sheet (or instructions)
SSC101 {7/98)
F
P r H ^ P W
(1) Exact name of the corporation, including any words or abbreviarions indicating incorporation: Savft A Liffi Fnnnriatinn Inr.
(2) Name under which rhe corporarion will transact business in the commonwealth that satisfies the requirements ol'C.L. Chap ter 156D, Section 15.06:
an agreement to refrain from use of the unavailable name in the commonwealth; and . a copy of the doing business certificate filed in the city or town where it maintains its registered office; and * a copy of the resolution of the corporations board of directors, certified by its secretary, the name under which the corpora tion will transact business in the commonwealth pursuant to 950 CMR 113.50(4).
(4) Street address of principal office: 9P,50 W I a w r R n m AVP , Suits ann, firfifflpr Park, Illinnk fjm7fi (number, street, city or town, state, zip code)
(5) Street address of registered office in the commonwealth: 101 Federal Street, Boston, M a s s a c h u s e t t s 0 2 1 1 0 (number, Urea, city or town, state, zip code)
I. Business Filings incog; registered agent of the above corporation consent to my appointment as registered agent pursuant to G. L Chapter 156D, Section 5-02.*
PC.
ti wwianiotwuwwia
(8) Names and business addresses o f its current officers and directors:
NAME President: Carol Spizzirri VLcc-presidem: Peggy Trimble Treasurer: Douglas Browne Secretary: Rita Mullins
Assistant M O C K M :
BUSINESS ADDRESS
9950 W. Lawrence Ave., Suite 300r Schltter Park, Illinois 60176 9950 W. Lawrence Ave.. Suite 300. Schiller Park, Illinois 601 9950 W. Lawrence Ave.r Suite 300. Schiller Park, Illinois 60176 9950 W. Lawrence Ave.f Suite 300, Schiller Park, Illinois 601:
Director^ ; -
pe
Carol J. Spizzirri, 9950 W. Lawrence Ave., Suite 300. Schiller Park, Illinois 60176 9 9 * Tumble. 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 Rita Mullins, 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176
I f the Orrtificate is in a fordism laftouaee u rra.Klarioi, rh(>t,F" nnJrr rh n f rUr , r t | , J t , | | I,,.
'Ihis certificate is effective at the rime and on die date approved by the Division, unless a later effective date not more than 90 days Irom the date offilingis specified:
State of Missouri
Robin C a r n a h a n , Secretary of State
Corporations Division P.O. Box 778 / 600 W. Main Street, Rm 322 Jefferson City, MO 65102
File Number: 200705711211 Date Filed: 02/22/2007 Robin Carnahan Secretary of State
(i)
and it is organized and existing under the laws of Illinois (2) (3) (4) (5) If the corporation's name is unavailable, the name it will use in Missouri is The date of its incorporation was 2/9/1993 The address of its principal place of
Address businessTs^QSO W. Lawrence Ave., Suite 300 Schiller Park, CitylStuiv/Zip Illinois 60176 The name and physical address of its registered agent and office in the State of Missouri is
(6)
The names of its officers and directors and their business or home addresses are as follows (attach additional sheets as necessary); Name President Carol Spizzirri Vice President Secretary Peggy Trimble "50
w
Address
City/State/Zip
9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176 To educate and train children and adults in basic llfe supporting first
Rita Mullins
Treasurer Dou9 l as Browne Director C a r 0 ' J l Spizzirii Director Pegg^Trimble (?) The specific purpose(s) of its business in Missouri: aid skills and emergency preparedness.
(8)
No.
.y (9) If incorporated in Missouri would the corporation be a public benefit. Corporation? or mutual benefit
Name and address to return filed document: Name: Business Filings Incorporated Address: 8025 Excelsior Dr. S u t e 200 City, State, and Zip Code: Madison, W l 53717
T0705401174
Corp. 55A(Ul/U:M
F0002-Pagelof3
ii ii inn l in i mi ii
1. Type of Corporation Profit 2. Name of the Corporation
OFFICE OF THE MISSISSIPPI SI P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333 Application for Certificate of Authority
The undersigned corporation, pursuant to Section 79-4-15.03 (if a profit corporation) or Section 79-11-367 (if a nonprofit corporation) of the Mississippi Code of 1972, hereby executes the following document and sets forth:
Nonprofit
Illinois
5. Street Address of the corporation's principal office
IL
Period of duration
60176 Perpetual
CD
07
7. Name, Street and Mailing Address of the Registered Agent and Registered Office are Name
Business Filings International, Inc. 645 Lakeland East Drive, Suite 101
IS
P.O. Box
Flowood
MS
39232
Rev. 01/96
F0002-Page2of3
Title
Carol Spizzirri
Business Address City, State, ZIP5, ZIP4 Name
Peggy Trimble
Business Address City, State, ZIP5, ZIP4 Name
en
n
S3
07
Rita Mullins
Business Address City, State, ZIP5, ZIP4 9. Directors Name
Title
Carol J. Spizzirri
Business Address City, State, ZIP5, ZIP4
Rev. 01/96
F0002-Page3of3
OFFICE OF THE MISSISSIPPI SECRETARY OF STATE P.O. BOX 136, JACKSON, MS 39205-0136 (601) 359-1333 Application for Certificate of Authority Title Director
Name
Peggy Trimble
Business Address City, State, ZIP5,ZIP4 Name
IL
60176
Rita Mullins
Business Address City, State, ZIP5, ZIP4
10. FOR NONPROFIT ONLY (Check appropriate box) The corporation has members
CO \>
has no members.
So
01
(U\^ ^ \^
Printed Name Carol Spizzirri Title President
Rev. 01/96
Douglas Browne, 9950 W. Lawrence Ave., Suite 300, Schiller Park, Illinois 60176
?5
^o -n n
ZJ3
ro 07
Address 2: State: NV Phone: Mailing Address 1: Mailing City: Mailing Zip Code:
Status: Active
Financial Information
No Par Share Count: 0 Capital Amount: $0
Filed Date Filed: 03/02/2007 Business ID: 573375 William M.Gardner Secretary of State
PURSUANT TO THE PROVISIONS OF VOLUNTARY CORPORATIONS AND ASSOCIATIONS AND THE N W HAMPSHIRE BUSINESS CORPORATIONS ACT, THE UNDERSIGNED CORPORATION HEREBY E APPLIES FOR A CERTIFICATE OF REGISTRATION IN NEW HAMPSHIRE, AND FOR THAT PURPOSE SUBMITS THE FOLLOWING STATEMENT:
FIRST:
SECOND:
Illinois
THIRD:
an
e perio FOURTH:
Office
FIFTH:
The name of its registered agent in New Hampshire is and the complete address (including
Zip code) of its proposed registered office in New Hampshire is (agent's business address) 9 Capitol Street, Concord, New Hampshire 03301
(Note 1)
SIXTH:
the transaction of business in New Hampshire are To educate and train children and adults in basic life supporting first aid skills and emergency preparedness.
State of New Hampshire
Form FNP 1 - Foreign Nonprofit Application 5 Page(s)
11i1i11niBi
Page 1 of 3
CD Miec, FNP-l Pg 1 v - i . o
APPLICATION FOR REGISTRATION OF A FOREIGN NONPROFIT CORPORATION Save A Life Foundation, Inc. [corporate aane)
SEVENTH: The names and usual business addresses of its current officers and directors are: {If there are additional officers or directors, attach additional sheet.) Name OFFICERS Carol Spiz2lrrl President 9950 W. Lawrence Avc, Suite 300 Schiller Park, Illinois 60176
Peg
Office
Address
Trimble
Vice-president
Rita Mullins
Secretary
Douglas Browne
Treasurer
DIRECTORS Carol J. Spizzirri Director 9950 W, Lawrence Ave., Suite 300 Schiller Park, Illinois 60176 Peg Trimble Director 9950 W, Lawrence Avc, Suite 300 Schiller Park, Illinois 60176 Rita Mullins Director 9950 W, Lawrence Ave., Suite 300 Schiller Park, Illinois 6QI76 Douglas Browne Director 9950 W. Lawrence Ave., Suite 300 Schiller Park, Illinois 60176
Page 2 of 3
CD M i a c .
FHP-l Pg 2 V - 1 . 0
S0S1D: 72841(1 Date Filed: 6/2/2004 4:18:00 PM Elaine F. Matshall North Carolina Secretary of State C2004H300421
APPLICATION FOR CERTIFICATE OF AUTHORITY FOR NONPROFIT CORPORATION Pursuant to 55A-15-03 of the General Statutes of North Carolina, the undersigned corporation hereby applies for a Certificate of Authority to conduct affairs in the State of North Carolina, and for that purpose submits the following: 1. The name of the corporation is Save A Liie Foundation^ Jflfl. and if that name is unavailable for use in the State of North Carolina, the name the corporation wishes to use is: 2. The state or country under whose laws the corporation was organized is: I"'nois 3. The date of incorporation was 4. ; its period of duration is: TCRf>TU ft) . .
The street address of the principal office of the corporation is: Number and Street O'Hare Aerospace Center 9950 West Lawrence Ave Ste#300 City, Stale, Zip Code Schiller Park, Illinois 60176
5,
The mailing address if different from the street address of the principal office of the corporation is:
6. The street address and county of the registered office in the State of North Carolina is: Number and Street 808 Lighthouse Drive City, State, Zip Code Corolla, North Carolina, 27927 252-453-6079 County: Currituck
7. The mailing address if different from the street address of the registered office in the State of North Carolina is:
8. The name of the registered agent in the State of North Carolina is: John J. Donleavy 9. The names and usual business addresses of the current officers of the corporation are: Name Title Business Address
Carol J, Spizzirri Mark Mitchell, DO John J. Donleavy Alan Thavisouk William Kling Esq Doug Brown Steve Orebuagh,M.D Hon. Rila Multilns President/Founder Vice Chair Secretary Treasurer Member Member Member Member OHare Aerospace Ctr 9950 W. Lawrence Ave #300. Schiller Pk, IL 60176 10619 North Augusta Ct. Mequon, Wl 53092 808 Lighthouse Drive Corolla, North Carolina 1126 Longford Ct. Hoffman Estates, IL 60194 140 South Dearborn. Chicago. IL 60603 4770 Bufford Hwy, Atlanta, GA 30340 2000 Mary Street Pittsburgh, PA 15203-2095 123 North Brockway, Palatine, IL 60067
fe / ^ ^
Secretary of State
S
a> to
'IP
'ECSpt,Av,
Pierre SD 57501
RECEIVED
CCD 2 6 >UMI
CT*
S-O.SEC,OFSTATE
J^
J2& dztf T (A Foreign Corporation) Pursuann a ib<4wferi 1 s'ofSDCL 47-27-1, the undersigned corporation hereby applies for a Non-Stock Certificate of Authority to S n s l j S ^ n a & ' l i ffe State of South Dakota and for that purpose submits the following:
ii)L^Sfrt*$$m
?V C
'
and the address of its principal office in the state or country under the laws of which it is incorporated is 9950 W. Lawrence Ave, Suite 300, Schiller Park. Illinois 60176 (Mailing address if different from above) (3) The date of incorporation is 2 / 9 / n 9 9 3 ^ _ _ ^ _ and the period of duration is
Per
Pehjal
(4) The street address, or a statement that there ts no street address, of its proposed registered office in the State of South Dakota is 319 S. Coteau St., Pierre, South Dakota 57501 and the name of the proposed registered agent in the State of South Dakota at that address is , , . Business Filings International, IIUL (5) The purposes of the corporation in engaging in business in this state
To educate and train children and adults In basic life supporting first aid skills and emergency preparedness.
(6) The names and respective addresses of its directors and officers: NAME Carol J. Spizzirri
Peggy Trimble Rita Mullins Carol Spizzirri Peggy Trimble Rita Mullins Douglas Browne Treasurer Douglas Browne "950 W. Lawrence Ave., Suite 300. Schiller Park, IL 60176
OFFICE Director
Director Director
995
STREET ADDRESS
CITY
STATE
ZIP
" "
5 0 w
5 0 W
President
Sui,
300 0 >
Schiller p a r k
>IL
5 0 w
Director
*f\\
<A
L.
ELECTIONS
Markowltz
OTHER FRO &RAMS PROFESSIONAL REGULATIONS SECRETARY'S DESK
Corporation Information Corporation Name SAVE A LIFE FOUNDATION, INC. Corporation Status Active File No N-25450-0 Vermont Type Incorporation Date 12/06/2005 Corporation Description TEACHES BASIC BYSTANDER CPR IL State of Incorporation Fiscal Month End 12 Registered Agent BUSINESS FILINGS INCORPORATED Address 400 CORNERSTONE DR ST240 City State Zip WILLISTONVT 05495 Officer 1 CAROL J.SPIZZIRRJ Officer 3 RITAMULLINS Officer 4 DOUGLAS R. BROWNE Officer 5 ANDREW KNAPP JOHN DONLEARY Officer 6 Principal Street Address 9950 W. LAWRENCE AVE#300 City State Zip SCHILLER PARK IL 60176
:
Last Biennial Report filed 02/29/2008 Above accurate as of: 09/26/2008 Information Contaci
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SAVE A LIFE FOUNDATION, INC. Eff Date Fil Date: 2/23/2007 2/23/2007 Ch Type: Class' F N Term Date: Term Reas:
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Officer Information
Incorporator
Secretary
PITA M U L L I N S 9950 W L A W R E N C E A V E , S U I T E 300
City
State/Pr
Country
Zip
City SCHILLER
PARK
State/Pr
""
Country
USA
Zip
6176
Incorporator
City
State/Pr
Country
Zip
State/Pr
IL
Country
USA
Zip
60176
President CAROL JSPIZZIRRI 9950 W LAWRENCE AVE, SUITE 300 City DAo!/ L L E R PARK Vice-President
PEGGY TRIMBLE 9950 W L A W R E N C E A V E , S U I T E 300
Director CAROL JSPIZZIRRI 9950 W LAWRENCE AVE, SUITE 300 Zip 60176 City SCHILLER PARK Director
PEGGY TRIMBLE + 2 OTHERS 9950 W L A W R E N C E A V E , S U I T E 300
State/Pr IL
Country USA
State/Pr
|L
Country USA
Zip 6Q176
City PARKLER
State/Pr IL
Country USA
Zip 6176
City PARKLER
State/Pr
lL
Country USA
Zip 6176
DIVIDER
Form NFP
Articles of Dissolution
White Secretary of State Department of Bosbess Sendees SpringRetd, IL 62756 217-7824961 www.cybenirfreI|8RofMoni Remit payment In tin form of a money order or check made payable to Secretary of State.
MP 17 2009
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| Submit in duplicate-J-^-. -Type-or.print.clearly.inbiack.hik_j^-g===.;ItojHrtjMjtoJ^eJh&fiTO^ 1. The name of the corporation is **v* * ^ f : 2. The post office address to which' may be mailed a copy'of any process against the corporation that may,be
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served on the Secretary of State is c, KARAS, J-W "**; AUGUS :_ 3. The dissolution of the corporation was duly authorized on _ : ^ ^2^' in the Wanner indicated below: ("X" one box only) 0 By a majority of the board of the directors, in accordance with Section 112.05. ~ By written consent signed by all directors entitled to vote.pn dissolution, iri accordance with Section J 108.45 of this Act. '" ' i By written consent signed by all members entitled to vote on'dissolution, in accordance with Section 112.10, board of director action not being required: O By the members in accordance with Section 112.15, resolution having been duly adopted and submitted to the members. At a meeting of members, not less than the minimum number of votes required by statute and by the Articles of Incorporation were voted in favor of the dissolution; D By the members, in accordance with Sections 112.10 and 107.10, a resolution having been duly adopted and submitted to the members. A consent in writing has been signed by members having not less than the minimum number of votes required by statute and bythe Articles of Incorporation. Members who have-not consented m-writing have been given notice in accordance with Section. 107.10. 4. a) The undersigned corporation has caused these articles to be signed by a duly authorized officer* who affirms, under penalties of perjury, that the facts stated'herein are true. (All signatures must be in BLACK INK.)
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* If there are no officers and the dissolution is authorized by the board of directors, a majority of the directors must SIGN BELOW; and type or print their names. 4. b) The undersigned affirms, under penalties of perjury that the facts stated herein a re true:-:
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SCM 7.2009
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