Form 9 9 0 ' ' E Z

Department of th e Treasury
I nternal Revenue Service
A
B
Sh ort Form
Return of Organization E xempt From I ncome Tax
Under section 50 1 ( c) , 527, or 49 47 ( aXl ) of th e I nternal Revenue Code
( except bl ack l ung benef it trust or private f oundation)
Sponsoring organizations of donor advised f unds, organizations th at operate one or more h ospital f acil ities,
and certain control l ing organizations as def ined in section 512( b) ( 13) must f il e
Form 9 9 0 ( see instructions) Al l oth er organizations w ith gross receipts l ess th an $20 0 , 0 0 0
and total assets l ess th an $50 0 , 0 0 0 at th e end of th e year may use th is f orm
Th e organization may h ave to use a copy of th i s return to sati sf y state reporting requirements
For th e 20 11 cal endar y ear, or tax y ear beginning 6/0 1 , 20 11, and ending 5/31
Ch eck if appl icabl e C
Address ch ange
CLBA
Name ch ange
423 Gal w ay Drive
I nitial return
Cary, I L 60 0 13
Terminated
Amended return
OMB No 1545-1150
20 11
Open to Publ ic
I nspection
20 12
E mpl oyer identif ication number
36-45469 74
E Tel eph one number
847-639 -80 50
F Group E xemption
Number
G Accounting Meth od U Cash U Accrual Oth er, ( specif y) H Ch eck 1, U if th e organization is not
I Website : - WWW. CLHOOPS. COM
required to attach Sch edul e B ( Form
J Tax- exempt status ( ck onl y one) - X 50 1( c) ( 3) 50 1( c) ( ) -( I nsert no) 49 47( a) ( 1) or 527
9 9 0 , 9 9 0 -E Z , or 9 9 0 -PF)
K Ch eck ^
H
I f th e organization is not a section 50 9 ( a) ( 3) supporting organization or a section 527 organization and its gross receipts are
normal l y not more th an $50 , 0 0 0 A Form 9 9 0 -E Z or Form 9 9 0 return is not required th ough Form 9 9 0 -N ( e-postcard) may be required ( see
instructions) But if th e organization ch ooses to f il e a return, be sure to f il e a compl ete return
L Add l ines 5b, 6c, and 7b, to l ine 9 to determine gross receipts I f gross receipts are $20 0 , 0 0 0 or more, or if total
assets ( Part I I , l ine 25, col umn ( B) bel ow ) are $50 0 , 0 0 0 or more, f il e Form 9 9 0 instead of Form 9 9 0 -E Z
b.
$ 85, 9 86.
PArt I Revenue , E xpenses , and Ch anges in Net Assets or Fund Bal ances ( see th e instructions f or Part I )
Ch eck if th e nroanvah nn used Sch edul e 0 to respond to any auestion in th is Part I n
CC 1 Contributions, gif ts, grants, and simil ar amounts received 1 8, 0 9 5.
2 Program service revenue incl uding government f ees and contracts 2 77, 866.
3 Membersh ip dues and assessments 3
4 I nvestment income
4 25 .
5a Gross amount f rom sal e of assets oth er th an inventory 5a
b Less cost or oth er basis and sal es expenses 5b
c Gain or ( l oss) f rom sal e of assets oth er th an inventory ( Subtract l ine 5b f rom l ine 5a) Sc
6 Gaming and f undraising events
, ' E
a Gross income f rom gaming ( attach Sch edul e G if greater th an $15, 0 0 0 ) 6a
OE b Gross income f rom f undraising events ( not incl uding $ of contributions
U f rom f undraising events reported on l ine 1) ( attach Sch edul e G if th e sum
E of such gross income and contributions exceeds $15, 0 0 0 ) 6b
c Less direct expenses f rom gaming and f undraising events 6c
d Net income or ( l oss) f rom gaming and f undraising events ( add l ines 6a and
6b and subtract l ine 6c) 6d
7a Gross sal es of inventory, l ess returns and al l ow ances 7a
b Less cost of goods sol d 7b
c Gross prof it or ( l oss) f rom sal es of inventory ( Subtract l ine 7b f rom l ine 7) 7c
RE CE I VE D 8 Oth er revenue ( describe in Sch edul e 0 ) 8
9 Total revenue . Add l ines 1, 2, 3, 4, 5c, 6d, 7c, and 8 i 9 85, 9 86.
10 Grants and simil ar amounts paid ( l ist in Sch edul e 0 )
DE C 0 3 20 12 O
vj
10
,
11 Benef its paid to or f or members Cl ) 11
x ( ' ^ ` 9 5 12 Sal aries, oth er compensation, and empl oyee benef its. 12 21, 254 .
E
(
13 Prof essional f ees and oth er payments to independent contractors
"GDE N,
UT
13 22, 9 83.
N
S
14 Occupancy, rent, util ities, and maintenance 14 17, 9 50 .
E
S
15 Printing, publ ications, postage, and sh ipping 15 3, 441.
16 Oth er expenses ( describe in Sch edul e 0 ) See Sch edul e 0 16 21, 79 3.
17 Total expenses . Add l ines 10 th rou g h 16 11 17 87, 421,
18 E xcess or ( def icit) f or th e year ( Subtract l ine 17 f rom l ine 9 ) 18 -1, 435.
N S 19 Net assets or f und bal ances at beginning of year ( f rom l ine 27, col umn ( A) ) ( must agree w ith end-of -year
E S f igure reported on prior year' s return) 19 -11, 680 .
T' r 20 Oth er ch anges in net assets or f und bal ances ( expl ain in Sch edul e 0 ) 20
S 21 Net assets or f und bal ances at end of y ear Combine l ines 18 th rough 20 ^ 21 -13, 115.
BAA For Paperw ork Reduction Act Notice, see th e separate instructions.
TE E A0 80 3L 0 8/0 5/11
Form 9 9 0 -E Z ( 20 11)
D"I
Form 990-EZ ( 2 01 1 ) CLBA 36-4546974 Page 2
Part I I Balance Sheets. ( see the instructions f or Part I I . )
Check if the organization used Schedule 0 to respond to any question in this Part I I n
( A) Beginning of year ( B) End of year
2 2 Cash, sav ings, and inv estments -1 7, 383. 2 2 -2 , 691 .
2 3 Land and buildings 2 3
2 4 O ther assets ( describe in Schedule 0) See Schedule 0 6,972 . 2 4 5,562 .
2 5 T otal assets -1 0,41 1 . 2 5 2 , 871 .
2 6 T otal liabilities ( describe in Schedule 0) See Schedule 0 1 ,2 69. 2 6 1 5, 986.
2 7 Net assets or f und ba lances ( line 2 7 of col umn ( B) must agree w ith line 2 1 ) -1 1 , 680. 2 7 -1 3, 1 1 5.
Part I I I Statement o f Program Serv ice Accomplishments ( see the instrs f or Part I I I . )
Check if the organization used Schedule 0 to respond to any q uestion in this Part I I I X
Expenses
( Required f or section
What is the organization' s primary exempt purposes ^qpp
Describe the organization' s program serv ice accomp l is h ment s or each ot its three est program serv ices, as
measured by expenses I n a clear and concise manner, describe the serv ices prov ided, the number of persons
benef ited, and other relev ant inf ormation f or each program title
501 ( c) ( 3) and 501 ( c) ( 4)
organizations and section
4947( a) ( 1 ) trusts, optional
f or others )
2 8 Basketball procf rams and basketball -caps are orQanized-and
- - - - - -
-
c
-d----- ------------
onucted f or boys _and_c^irls f rom kinderyaren thr-ouc^h_eighth grade.
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T hese programs prov ide basketball instruction and competition.
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Grants $ ) I f this amount includes f orei g n g rants, check here 8a 7,1 00.
2 9
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FT ( Grants $ ) I f this amount includes f oreign grants, check here 9a l
30
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( Grants $ ) I f this amount includes f oreign grants, check here 0a
31 O ther program serv ices ( describe in Schedule 0)
( Grants $ ) I f this amount includes f oreign grants, check here 31 a
32 T otal p ro g ram serv ice exenses ( add lines 2 8a through 31 a)
1 1 1 0--
32 77, 1 00.
Part I V List of O f f icers , Directors,
Check if the organization used Sc
T rustees, and Key Employees. List each one ev en if not compensated ( see the instructions f or Part I V )
hedule 0 to respond to any question in this Part I V
( a) Name and address
( b) T itle and av erage
hours per w eek
dev oted to position
( c) Reportable compensation
( Form W -2 /1 099 -MI SC)
( if not paid , enter - 0-)
( d) H ealth benef its,
contributions to employee
benef it plans, and
def erred com p ensation
( a) Estimated amount of
other compensation
Se-e_Schedule-Q----------
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1 9,71 0. 0. 0.
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BAA T EEA081 2 L 02 1 1 41 1 2 I -orrn 990-EZ ( 2 01 1 )
Form 990-EZ ( 2 01 1 ) CLBA 36-4546974 Page 3
Part V Other Information ( Note the Schedule A and p ers onal b enefit contract s tatement req uirements in See Schedule 0
the ins tructions for Part V Check if the or g anization us ed Schedule 0 to res p ond to any q ues tion in this Part V
F
anization en e in an activ it not rev ious l re orted to the IRS? If 'Yes ' rov ide a detailed des cri tion of 33 Did the or a
Yes No
y y , p p g g g y p p
each activ ity in Schedule 0 33 X
34 W ere any s ignificant changes made to the organizing or gov erning documents ? If 'Yes , ' attach a conformed cop y of the amended documents if they reflect
a change to the organization's name Otherw is e, ex p lain the change on Schedule 0 ( s ee ins tructions ) 34 X
35a Did the organization hav e unrelated b us ines s gros s income of $1 , 000 or more during the y ear from b us ines s activ ities
( s uch as thos e rep orted on lines 2 , 6a, and 7a, among others ) ? 35a X
b If 'Yes , ' to line 35a, has the organization filed a Form 990 - T for the y ear? If 'No, ' p rov ide an ex p lanation in Schedule 0 35b
c W as the organization a s ection 501 ( c) ( 4) , 501 ( c) ( 5) , or 501 ( c) ( 6) organization s ub ject to s ection 6033( e) notice,
rep orting , and p rox y tax req uirements during the y ear? If 'Yes , ' comp lete Schedule C, Part III 35c X
36 Did the organization undergo a liq uidation, dis s olution , termination, or s ignificant dis p os ition of net as s ets during the
y ear? If 'Yes , ' comp lete ap p licab le p arts of Schedule N 36 X
37a Enter amount of p olitical ex p enditures , direct or indirect , as des crib ed in the ins tructions I 37a 0.
b Did the organization file Form 1 1 2 0 - POL for this y ear? 37b X
38a Did the organization b orrow from, or make any loans to, any officer, director , trus tee, or key emp loy ee or w ere
any s uch loans made in a p rior y ear and s till outs tanding at the end of the tax y ear cov ered b y this return? 38a X
b If 'Yes , ' com p lete Schedule L, Part II and enter the total
amount inv olv ed 38b N/A
39 Section 501 ( c) ( 7) organizations Enter
a Initiation fees and cap ital contrib utions included on line 9 39a N/A
b Gros s receip ts , included on line 9, for p ub lic us e of club facilities 39b N/A
40a Section 501 ( c) ( 3) organizations Enter amount of tax imp os ed on the organization during the y ear under
s ection 491 1 ^ 0 . , s ection 491 2 ^ 0 . , s ection 4955 ^ 0.
b Section 501 ( c) ( 3) and 501 ( c) ( 4) organizations Did the organization engage in any s ection 4958 ex ces s b enefit
trans action during the y ear or did it engage in an ex ces s b enefit trans action in a p rior y ear that has not b een rep orted
on any of its p rior Forms 990 or 990 - EZ' If 'Yes , ' comp lete Schedule L, Part I 40b X
c Section 501 ( c) ( 3) and 501 ( c) ( 4) or g anizations Enter amount of tax imp os ed on or g anization
managers or dis q ualified p ers ons during the y ear under s ections 491 2 , 4955, and 4958 ^ 0.
d Section 501 ( c) ( 3) and 501 ( c) ( 4) organizations Enter amount of tax on line 40c reimb urs ed
b y the organization 0.
e All organizations At any time during the tax y ear, w as the organization a p arty to a p rohib ited tax
s helter trans action? If 'Yes , ' comp lete Form 8886-T 40e X
41 Lis t the s tates w ith w hich a cop y of this return is filed ^ Non e
42 a The organization's
b ooks are in careof Rob ert-McInty re ------------------------ Telep honeno 847-639-8050
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Galw ay -Dr--Cary IL-------------------------
b At any time during the calendar y ear, did the organization hav e an interes t in or a s ignature or other authority ov er a
Yes No
financial account in a foreign country ( s uch as a b ank account, s ecurities account, or other financial account) ? 42 b X
If 'Yes , ' enter the name of the foreign country ^
See the ins tructions for ex cep tions and filing req uirements for Form TD F 90-2 2 .1 , Rep ort of Foreign Bank and Financial Accounts
c At any time during the calendar y ear, did the organization maintain an office outs ide of the U S ' 42 c X
If 'Yes , ' enter the name of the foreign country
1 0-
43 Section 4947( a) ( 1 ) nonex emp t charitab le trus ts filing Form 990 - EZ in lieu of Form 1 041 - Check here ^ [N/A
and enter the amount of tax -ex emp t interes t receiv ed or accrued during the tax y ear ^ 43 N/A
Yes No
44a Did the or g anization maintain any donor adv is ed funds during the y ear? If 'Yes , ' Form 990 mus t b e comp leted ins tead
of Form 990 - EZ 44a X
b Did the organization op erate one or more hos p ital facilities during the y ear? If 'Yes , ' Form 990 mus t b e comp leted
ins tead of Form 990 - EZ 44b X
c Did the organization receiv e any p ay ments for indoor tanning s erv ices during the y ear? 44c X
d If 'Yes ' to line 44c, has the organization filed a Form 72 0 to rep ort thes e p ay ments ? If 'No, ' p rov ide an ex p lanation in
Schedule 0 44d
45a Did the organization hav e a controlled entity of the organization w ithin the meaning of s ection 51 2 ( b ) ( 1 3) ' 45a X
b Did the organization receiv e any p ay ment from or engage in any trans action w ith a controlled entity w ithin the meaning of s ection 51 2 ( b ) ( 1 3) ? If 'Yes , '
Form 990 and Schedule R may need to b e comp leted ins tead of Form 990-EZ ( s ee ins tructions ) 45b X
Form 990 EZ ( 2 01 1 ' TEEA081 2 L 02 /1 4n2
Form 990-EZ (2011) CLBA 36-4546974 Page 4
s No
46 Did t h e organizat ion engage, direc t l y or indirec t l y , in p ol it ic al c amp aign ac t iv it ies on beh al f of or in op p os it ion t o
c andidat es for p u bl ic offic e' I f ' Y es ,' c omp l et e Sc h edu l e C, Part I 46 X
Part VI Sec t ion 501(c )( 3) organizat ions and s ec t ion 4947( a)(1) nonexemp t c h arit abl e t ru s t s onl y . Al l s ec t ion
501(c )(3) organizat ions and s ec t ion 4947(a)(1) nonexemp t c h arit abl e t ru s t s mu s t ans wer qu es t ions
47-49b and 52, and c omp l et e t h e t abl es for l ines 50 and 51.
Ch ec k if t h e organizat ion u s ed Sc h edu l e 0 t o res p ond t o any qu es t ion in t h is Part VI
Y es No
47 Did t h e organizat ion engage in l obby ing ac t iv it ies or h av e a s ec t ion 501(h ) el ec t ion in effec t du ring t h e t ax y ear? I f ' Y es ,'
c omp l et e Sc h edu l e C, Part I I 47 X
48 I s t h e organizat ion a s c h ool as des c ribed in s ec t ion 170(b)(1)(A)(I I )' I f ' Y es ,' c omp l et e Sc h edu l e E 48 X
49a Did t h e organizat ion make any t rans fers t o an exemp t non-c h arit abl e rel at ed organizat ion? 49a X
b I f ' Y es ,' was t h e rel at ed organizat ion a s ec t ion 527 organizat ion? 49b
50 Comp l et e t h is t abl e for t h e organizat ion' s fiv e h igh es t c omp ens at ed emp l oy ees (ot h er t h an offic ers , direc t ors , t ru s t ees and key
emDl ov ees ) wh o eac h rec eiv ed more t h an $100. 000 of c omoens at l on from t h e oraanl zat l on I f t h ere is none. ent er ' None '
(a) Name and addres s of eac h emp l oy ee
p aid more t h an $100,000
(b) T it l e and av erage
h ou rs p er week
dev ot ed t o p os it ion
(c ) Rep ort abl e c omp ens at ion
(Forms W-2/1099 MI SC)
(d) H eal t h benefit s ,
c ont ribu t ions t o emp l oy ee
benefit p l ans , and
deferred c omp ens at ion
(o) Es t imat ed amou nt of
ot h er c omp ens at ion
None
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e T ot al nu mber of ot h er emp l oy ees p aid ov er $100,000
l l ^
51 Comp l et e t h is t abl e for t h e organizat ion' s fiv e h igh es t c omp ens at ed indep endent c ont rac t ors wh o eac h rec eiv ed more t h an $100,000 of
-
c omp ens at ion from t h e or g anizat ion I f t h ere is none, ent er ' None '
(a) Name and addres s of eac h indep endent c ont rac t or p aid more t h an $100,000 (b) T y p e of s erv ic e (c ) Comp ens at ion
None
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e T ot al nu mber of ot h er indep endent c ont rac t ors eac h rec eiv ing ov
52 Did t h e organizat ion c omp l et e Sc h edu l e A? Not e : Al l s ec t ion 501
c h arit abl e t ru s t s mu s t at t ac h a c omp l et ed Sc h edu l e A
Under p enal t ies of p erj u ry , I dec l are t h at I h av e examined t h is ret u rn, inc l u ding ac c omp any ing
t ru e , c orrec t , and c omp l fFt q Dgp l arat ion Q f p rrp arer ( ot h er t h an offic er) is bas ed on al l informa
Sign
V
Signat u re of of ! c dr / ^ ( 1
H ere
Robert Mc I nt y re V
T y p e or p rint name and t it l e
Print /T y p e p rep arer' s name Prep arer' s
Paid
Robert Dix,CPA Robert Dix, l
Prep arer Firm' s name ^ ARKI N AND DI X, CPA` S
Us e Onl y
Firm' s addres s ^ 800 E NORT H WEST H WY ST E 10-5
PALAT I NE, I L 60074-6580
May t h e I RS dis c u s s t h is ret u rn wit h t h e p rep arer s h own abov e? See i
SCHEDULEA
(Form 990 or 990- EZ )
Department of the Treasury
I nternal Revenue Service
Publ ic Charity Status and Publ ic Support
Compl ete if the organization is a section 501(cX3) organization or a section
4947(aXl ) nonexempt charitabl e trust.
Attach to Form 990 or Form 990- EZ . ^ See separate instruction s.
Open to Publ ic
I nspection
Name of the organization Empl oyer identif ication number
CLBA 36- 4546974
Part I Reason f or Publ ic Charity Status (Al l organizations m us t compl ete this part. ) See instructions.
The organization is not a private f oundation because it is (For l ines 1 through 11, check onl y one box )
1 A church, convention of churches or association of churches described in section 170 ( bx1XAXi) .
2 A school described in section 170 (bx1XAXii) . (Attach Schedul e E )
3 A hospital or a cooperative hospital service organization described in section 170 ( bX1XAXiii) .
4 A medical research organization operated in conjunction w ith a hospital described in section 170 (bX1XAXiii) Enter the hospital ' s
name, city, and state _____
_of _______
________________________________
5 An organization operated f or The- benef it a col l ege or university ow ned or operated by a governmental unit described in section
170(b ) (1XAXiv) . (Compl ete Part I I )
6 BA f ederal , state , or l ocal government or governmental unit described in section 170 ( bX1XAXv) .
7 An organization that normal l y receives a substantial part of its support f rom a governmental unit or f rom the general publ ic described
in section 170(bXl XAXvi ) . (Compl ete Part I I )
8 KA community trust described in section 170 ( bXl XAXvi ) . (Compl ete Part I I )
9 X] An organization that normal l y receives (1) more than 33- 1/3% of its support f rom contributions, membership f ees, and gross receipts
f rom activities rel ated to its exempt f unctions - subject to certain exceptions, and (2) no more than 33- 1/3% of its support f rom gross
investment income and unrel ated business taxabl e income (l ess section 511 tax) f rom businesses acquired by the organization af ter
June 30, 1975 See section 509(aX2 ) . (Compl ete Part I I I )
10
H
An organization organized and operated excl usivel y to test f or publ ic saf ety See section 509(aX4) .
11 An organization organized and operated excl usivel y f or the benef it of , to perf orm the f unctions of , or carry out the purposes of one or
more publ icl y supported organizations described in section 509(a) (1) or section 509(a) (2) See section 509 (aX3) . Check the box that
describes the type of supporting organization and compl ete l ines 11 a through 11 h
a Type I b (Type I I c R Type I I I - Functional l y integrated d Type I I I - Other
e By checking this box, I certif y that the organization is not control l ed directl y or indirectl y by one or more disqual if ied persons
other than f oundation managers and other than one or more publ icl y supported organizations described in section 509(a) (1) or
section 509(a) (2)
f I f the organization received a w ritten determination f rom the I RS that is a Type I , Type I I or Type I I I supporting organization,
check this box
11
g Since August 17, 2006, has the organization accepted any gif t or contribution f rom any of the f ol l ow ing persons
(i) A person w ho directl y or indirectl y control s, either al one or together w ith persons described in (I I ) and (il l )
bel ow , the governing body of the supported organization' '
(ii) A f amil y member of a person described in (I ) above'
(iii) A 35% control l ed entity of a person described in (I ) or (if ) above?
h Provide the f ol l ow ing inf ormation about the supported organization(s)
Yes No
11
g (I )
11g(ii)
11 (iii)
(i) Name of supported
organization
(ii) EI N (ni) Type of organization
(described on l ines 1- 9
above or I RC section
(see instructions ) )
(iv) I s the
organization in
col umn (i) l isted in
your governing
document"
(v) Did you notif y
the organization in
col umn (i) of
your support7
(vi) I s the
organization in
col umn (i)
organized in the
U S
(vu) Amount of support
Yes No Yes No Yes No
( A)
(B
(C)
(D)
(E)
Total
BAA For Paperw ork Reduction Act Notice, see the I nstructions f or Form 990 or 990- EZ . Schedul e A (Form 990 or 990- EZ ) 2011
OMB No 1545- 0047
1 2011
TEEA0401L 09/28/11
Schedule A (Form 990 or 990-EZ) 2 01 1 CLBA 36-4546974 Page 2
Part I I Support Schedule for Organizations Described in Sections 1 70(b)(1 )(A)(iv) and 1 70 ( b)(1 )(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to q ualify under Part I I I I f the
organization fails to q ualify under the tests listed below, please complete Part I I I
Section A. Public Support
Calendar year ( or fiscal year
beginning in)
(a) 2 007 (b) 2 008 (c) 2 009 (d) 2 01 0 (e) 2 01 1 (f) T otal
1 G ifts, grants, contributions, and
membership fees received (Do not
include any ' unusual grants )
2 T ax revenues levied for the
organization' s benefit and
either paid to or expended
on its behalf
3 T he value of services or
facilities furnished by a
governmental unit to the
organization without charge
4 T otal . Add lines 1 through 3
5 T he portion of total
contributions by each person
(other than a governmental
unit or publicly supported
organization) included on line 1
that exceeds 2 % of the amount
shown on line 1 1 , column (f)
6 Public support . Subtract line 5
from line 4
Section B. T otal Support
Calendar year (or fiscal year
beginning in)
7 Amounts from line 4
8 G ross income from interest,
dividends, payments received
on securities loans , rents,
royalties and income from
similar sources
9 Net income from unrelated
business activities , whether or
not the business is regularly
carried on
1 0 Other income Do not include
gain or loss from the sale of
capital assets ( Explain in
Part I V )
1 1 T otal support. Add lines 7
through 1 0
(a) 2 007 (b) 2 008 (c) 2 009 (d) 2 01 0 (e) 2 01 1 (f) T otal
1 2 G ross receipts from related activities, etc (see instructions) 1 2
1 3 First five years . I f the Form 990 is for the organization' s first, second, third, fourth, or fifth tax year as a section 501 (c)(3)
organization, check this box and stop here n
Section C. Com p utation of Public Su pport Percenta g e
1 4 Public support percentage for 2 01 1 (line 6, column (f) divided by line 1 1 , column (f)) 1 4 %
1 5 Public support percentage from 2 01 0 Schedule A, Part I I , line 1 4 1 5 %
1 6a 33- 1 1 3% support test - 2 01 1 . I f the organization did not check the box on line 1 3, and the line 1 4 is 33-1 /3% or more, check this box K
and stop here . T he organization q ualifies as a publicly supported organization
b 33-1 / 3% support test - 2 01 0 . I f the organization did not check a box on line 1 3 or 1 6a, and line 1 5 is 33-1 /3% or more, check this box K
and stop here . T he organization q ualifies as a publicly supported organization
1 1 -
1 7a 1 0 %- facts-and - circumstances test - 2 01 1 . I f the organization did not check a box on line 1 3, 1 6a, or 1 6b, and line 1 4 is 1 0%
or more, and if the organization meets the ' facts-and-circumstances' test, check this box and stop here . Explain in Part I V how K
the organization meets the ' facts-and-circumstances' test T he organization q ualifies as a publicly supported organization
b 1 0%-facts-and - circumstances test - 2 01 0 . I f the organization did not check a box on line 1 3, 1 6a, 1 6b, or 1 7a, and line 1 5 is 1 0%
or more, and if the organization meets the ' facts-and-circumstances' test, check this box and stop here . Explain in Part I V how the
organization meets the ' facts-and-circumstances' test T he organization q ualifies as a publicly supported organization
1 8 Private foundation . I f the organization did not check a box on line 1 3, 1 6a, 1 6b, 1 7a, or 1 7b, check this box and see instructions
BAA Schedule A (Form 990 or 990-EZ) 2 01 1
T EEA0402 L 05/2 5/1 1
Schedule A (Form 990 or 990-EZ) 2 01 1 CLBA 36-4546974 Page 3
Part I I I Support Schedule for Organizations Described in Section 509(a)(2 )
(Complete only if you checked the box on line 9 of Part I or if the organization failed to q ualify under Part I I I f the organization fails
to q ualify under the tests listed below, p l ease compl ete P a r t I I )
Section A. Public Support
Calendar year ( or fiscal yr beginning I n)' , ( a ) 2 007 ( b) 2 008 c 2 009 ( d ) 2 01 0 ( e ) 2 01 1 T otal
1 G ifts, grants, contributions
and membership fees
receiv ed (Do not include
any ' unusual grants' ) 2 1 4, 71 7. 1 79, 2 62 . 1 59, 780. 1 2 1 , 683. 85,961 . 761 , 403.
2 G ross receipts from admis-
sions, merchandise sold or
serv ices performed, or facilities
furnished in any activ ity that is
related to the organization' s
tax-exempt purpose 0.
3 G ross receipts from activ ities
that are not an unrelated trade
or business under section 51 3 0.
4 T ax rev enues lev ied for the
organization' s benefit and
either paid to or expended on
its behalf 0.
5 T he v alue of serv ices or
facilities furnished by a
gov ernmental unit to the
organization without charge 0.
6 T otal . Add lines 1 through 5 2 1 4, 71 7. 1 79, 2 62 . 1 59, 780. 1 2 1 , 683. 851 961 . 761 , 403.
7a Amounts included on lines 1 ,
2 , and 3 receiv ed from
disq ualified persons 0. 0. 0. 0. 0. 0.
b Amounts included on lines 2
and 3 receiv ed from other than
disq ualified persons that
exceed the greater of $5,000 or
1 % of the amount on line 1 3
for the year 0. 0 . 0. 0. 0. 0.
c Add lines 7a and 7b 0. 0. 0. 0. 0. 0.
8 Public support (Subtract line
7c from line 6) 761 ,403.
Section B. T otal Support
Calendar year ( or fiscal yr beginning
9 Amounts from line 6
1 0a G ross income from interest,
div idends, payments receiv ed
on securities loans, rents,
royalties and income from
similar sources
b Unrelated business taxable
income (less section 51 1
taxes) from businesses
acq uired after June 30, 1 975
c Add lines I Oa and 1 Ob
1 1 N et income from unrelated business
activ ities not included in line 1 0b,
whether or not the business is
regularly carried on
1 2 Other income. Do not include
gain or loss from the sale of
capital
l
assets (Explain in
1 3
1 4
Se
T otal support . ( Add ins 9, 1 0c, 1 1 , and 1 2 )
First fiv e years . I f the Form 990 is for the organization ' s first, second, third, fourth, or fifth tax year as a section 501 (c)(3)
organization , check this box and stop here
ion C. Comautation of Public SuDDort Percentage
1 5 Public support percentage for 2 01 1 (line 8, column (f) div ided by line 1 3, column (f)) 1 5 99. 52 %
1 6 Public support percentage from 2 01 0 Schedule A, Part I I I , line 1 5 1 6 99. 59 %
Section D. Com p utation of I nv estment I ncome Percenta g e
1 7 I nv estment income percentage for 2 01 1 (line 1 0c, column (f) div ided by line 1 3, column (f)) 1 7 0. 48 %
1 8 I nv estment income percentage from 2 01 0 Schedule A, Part I I I , line 1 7 1 8 0. 41 %
1 9a 33- 1 /3% support tests - 2 01 1 . I f the organization did not check the box on line 1 4, and line 1 5 is more than 33-1 /3%, and line 1 7
is not more than 33-1 /3%, check this box and stop here . T he organization q ualifies as a publicly supported organization 1
b 33-1 / 3% support tests - 2 01 0 . I f the organization did not check a box on line 1 4 or line 1 9a, and line 1 6 is more than 33-1 /3%, and
line 1 8 is not more than 33-1 /3%, check this box and stop here . T he organization q ualifies as a publicly supported organization
DI .
2 0 Priv ate foundation . I f the organization did not check a box on line 1 4, 1 9a, or 1 9b, check this box and see instructions
( a ) 2 007 ( b) 2 008 ( c ) 2 009 ( d ) 2 01 0 ( e ) 2 01 1 T otal
2 1 4,71 7. 1 79,2 62 . 1 59,780. 1 2 1 ,683. 85,961 . 761 ,403.
646. 2 , 992 . 1 4. 1 5. 2 5. 3,692 .
0.
646. 2 ,992 . 1 4. 1 5. 2 5. 3,692 .
0.
0.
2 1 5,363. 1 82 ,2 54. 1 59,794. 1 2 1 ,698. 85,986. 765,095.
BAA T EEA0403L 05/2 5/1 1 Schedule A (Form 990 or 990-EZ) 2 01 1
Schedule A (Form 990 or 990-EZ) 2 01 1 CLBA 36-4546974 Page 4
Part IV Supplemental Information . Complete this part to provide the explanations required by Part II, line 1 0;
Part II, line 1 7a or 1 7b; and Part III, line 1 2 . Als o complete this part for any additional information.
(See ins tructions ).
BAA Schedule A (Form 990 or 990-EZ) 2 01 1
TEEA0404L 05/2 5/1 1
SCHEDULE 0
Supplemental Information to Form 990 or 990-EZ
OMB No 1 5 4 5 004 7
(Form 990 or 990-EZ)
201 1
Department of th e Treasury
Internal Reve n ue Se rvic e
Name of th e organization
Complete to p rovide information for responses to spec ific questions on
Form 990 or 990-EZ or to provide any additional information.
Attac h to Form 990 or 990-EZ.
Open to Public
Inspec tion
Employer identific ation number
36 -4 5 4 697 4
_ - -Form 990_EZ. Part III =Organization's Primary ExemptPu_ose _ _ _ _ _ _ _ _ _ _ _
-----------------
_
-
CLBA' s-Qrimary_exemut purpose is to provide youth development programs-for
-
--
c h ildren to-learn th e fundamentals-of basketball. _ _Th e_partic ipants -learn th e
- -
-fundamental skills of respec t for oth ers,- disc ipline,- org nizationt -truth . _ _ _ _ _ _ _ _ _ _
_ _ _resppnsibilityt teamwork,-
goal-setting,
-self esteems leadersh ips interpersonal- _ _ _ _ _ _
_ _ -skills-and_h ealth v-ph ysic al ac tivities-th rough _th e_sport of
-
basketball - _
Form 990_EZ, Part V =Regarding Transfers Assoc iated with Personal Benefit Contrac ts -
(a) _ Did th e organization,-during th e year, _rec eive_anV_funds,_direc tly_or__
_indirec tly, to_pay_aremiums on-a personal benefit c ontrac t? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _No
(b) _ Did th e organization,-during th e year, paypremiums, direc tly_or - _ _ - _ _ _ _ _ _ _ _
-
-
-
-indirec tly, on_a personal benefit c ontrac t? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _No _ _ _
BAA For Paperwork Reduc tion Ac t Notic e , see th e Instruc tions for Form 990 or 990-EZ. TEEA4 901 L 07 1 1 4 1 1 1 Sc h edule 0 (Form 990 or 990-EZ) 201 1
2011 . Schedule 0 - Supplemental Information Page 2
CLBA 36- 4546974
Form 990 - EZ, Part I, Line 16
Other Expenses
3 on 3 expenses $ 358.
Advertising and Promotion 700.
Allstar weekend expenses 717.
Apparel
632.
Background check 382.
Boys and girls travel 1,895.
Camp expenses
470.
Depreciation
663.
Insurance
5,008.
License and permits 985.
Miscellaneous
1,130.
Office Expenses
2,604.
Open gym
93.
Other program expenses
100.
Refreshements
551.
Repairs
157.
Tshirts/ equip for program
5,348.
Total $ 21,793.
Form 990 - EZ, Part II, Line 24
Other Assets
Beg inning Ending
Inventory
$ 5,909. $ 5,162.
Machinery and Equipment
896. 400.
Miscellaneous
167. 0.
Total $ 6,972. $ 5,562.
Form 990 - EZ, Part II , Line 26
Total Liab ilities
Beginning Ending
payroll taxes
$ 1,269. $ 642.
Rent /exp payab le
0. 15,344.
Total $ 1,269. $ 15,986.
Form 990- EZ, Part IV
List of Officers , Directors , Trustees , and Key Employees
Health
Benefits & Expense
Title and Contrib - Account &
Average Hours Compen- b ution to Other
Name and Address Per Week Devoted sation EBP & DC Allowances
Rob ert McIntyre President
423 Galway
40 $ 19,705. $ 0. $ 0.
Cary, IL 60013
2011 , Schedule 0 - Supplemental Information Page 3
CLBA 36- 4546974
Form 990- EZ, Part IV (continued)
Lis t of O fficers , Directors , Trus tees , and Key Employees
Health
Benefits & Expens e
Title and Contrib- Account &
Average Hours Compen- bution to other
Name and Addres s Per Week Devoted s ation EBP & DC Allowances
Brooke Parker V ice Pres ident
310 N Grove 15 $ 0. $ 0. $ 0.
Barneveld, WI 53507
Pat Dillon
Treas urer
572 O ak Hollow Rd
10 0. 0. 0.
Crys tal Lake, IL 60014
Jeff Roes s lein
Secretary
1144 Bennington Dr
0 0. 0. 0.
Crys tal Lake, IL 60014
Colin McIntyre
Executive Dir.
423 Galway
0 5. 0. 0.
Cary, IL 60013
Dave Moyer
Board Member
365 Greenview Dr
3 0. 0. 0.
Crys tal Lake, IL 60014
Dennis Wils on
Board Member
5416 Dequoia Tr
1 0. 0. 0.
Crys tal Lake, IL 60014
Rhys McIntyre
Board Member
423 Galway
10 0. 0. 0.
Cary, IL 60013
Jim Bris ka
Board Member
1607 Birmingham Lane 5 0. 0. 0.
Crys tal Lake, IL 60014
Tom Bulger
Board Member
888 Camelot Dr
5 0. 0. 0.
Crys tal Lake, IL 60014
Mark Myers Board Member
1097 Boxwood 5 0. 0. 0.
Crys tal Lake, IL 60014
Marco Bregenzer Board Member
1520 Autumncres t
5 0. 0. 0.
Crys tal Lake, IL 60014
Mark Stephan Board Member
32798 Weathervane Ln 5 0. 0. 0.
Lakemoor, IL 60051
Total $ 19, 710. $ 0. $ 0. I
F o r m 8868
Applicatio n f o r Extensio n o f Tim e To F ile an
(Rev Januar y 2012)
Exem pt Or ganizatio n Retur n
OMB N o 1545-1709
Depar tm ent o f th e Tr easur y
I nter nal Revenue S er vice
F ile a separ ate applicatio n f o r each r etur n.
I f yo u ar e f iling f o r an Auto m atic 3-Mo nth Extensio n , co m plete o nly Par t I and ch eck th is bo x u
I f yo u ar e f iling f o r an Additio nal ( N o t Auto m atic ) 3-Mo nth Extensio n , co m plete o nly Par t I I (o n page 2 o f th is f o r m )
Do no t co m plete Par t//un/essyo u h ave alr eady been gr anted an auto m atic 3-m o nth extensio n o n a pr evio usly f iled F o r m 8868
Electr o nic f iling (e-f ile). Yo u can electr o nically f ile F o r m 8868 if yo u need a 3-m o nth auto m atic extensio n o f tim e to f ile (6 m o nth s f o r a
co r po r atio n r equir ed to f ile F o r m 990-T), o r an additio nal (no t auto m atic) 3-m o nth extensio n o f tim e Yo u can electr o nically f ile F o r m 8868 to
r equest an extensio n o f tim e to f ile any o f th e f o r m s listed in Par t I o r Par t I I w ith th e exceptio n o f F o r m 8870, I nf o r m atio n Retur n f o r Tr ansf er s
Asso ciated With Cer tain Per so nal Benef it Co ntr acts, w h ich m ust be sent to th e I RS in paper f o r m at (see instr uctio ns) F o r m o r e details o n th e
electr o nic f iling o f th is f o r m , visit w w w ir s go v/e f ile and click o n e-f ile f o r Ch ar ities & N o npr o f its
Par t I Auto m atic 3-Mo nth Extensio n o f Tim e. Only subm it o r iginal (no co pies needed).
A co r po r atio n r equir ed to f ile F o r m 990-T and r equesting an auto m atic 6-m o nth extensio n - ch eck th is bo x and co m plete Par t I o nly
All o th er co r po r atio ns (including 1120-C f iler s), par tner sh ips, REMI CS , and tr usts m ust use F o r m 7004 to r equest an extensio n o f tim e to f ile
inco m e tax r etur ns
Enter f iler ' s identif ying num ber , see instr uctio ns
N am e o f exem pt o r gan i zatio n o r o th er f iler , see instr uct i o ns Em plo yer ident i f i catio n num ber ( EI N ) o r
Type o r
pr int
CLBA
X 36-4546974
F ile by th e N um ber , str eet, and r o o m o r suite num ber I f a P o bo x , see instr uctio ns S o cial secur ity num ber (S S N )
due date f o r
f iling yo ur
423 Galw a y Dr ive
r etur n S ee
instr uctio ns City, to w n o r po st o f f ice, state , and ZI P co de F o r a f o r eign addr ess , see instr uctio ns
Car v, I L 60013
Enter th e Retur n co de f o r th e r etur n th at th is applicatio n is f o r (f ile a separ ate applicatio n f o r each r etur n) O1
Ap p licatio n
I s F o r
Retur n
Co de
Applicatio n
I s F o r
Retur n
Co de
F o r m 990
01 F o r m 990-T (co r p o r atio n) 07
F o r m 990-BL
02 F o r m 1041-A 08
F o r m 990-EZ
01 F o r m 4720 09
F o r m 990-PF
04 F o r m 5227 10
F o r m 990-T (sectio n 401(a) o r 408(a) tr ust) 05 F o r m 6069 11
F o r m 990-T (tr ust o th er th an abo ve) 06 F o r m 8870 12
Th e bo o ks ar e in th e car e o f " Ro ber t -McI tyr e _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
-------- --------
Teleph o ne N o ^ 847-639 - 8050 ------ _ F AX N o . 01 -________________
I f th e o r ganizatio n do es no t h ave an o f f ice o r place o f business in th e U nited S tates , ch eck th is bo x
I f th is is f o r a Gr o up Retur n , enter th e o r ganizatio n ' s f o ur digit Gr o up Exem ptio n N um ber (GEN ) I f th is is f o r th e w h o le gr o up,
ch eck th is bo x - F ] if it is f o r par t o f th e gr o up , ch eck th is bo x
F I
and attach a list w ith th e nam es and EI N s o f all m em ber s
th e extensio n is f o r
1 I r equest an auto m atic 3-m o nth ( 6 m o nth s f o r a co r po r atio n r equir ed to f ile F o r m 990-T) extensio n o f tim e
until 1/1 5 , 20 13 , to f ile th e exem pt o r ganizatio n r etur n f o r th e o r ganizatio n nam ed abo ve
Th e extensio n is f o r th e o r ganizatio n ' s r etur n f o r
calendar year 20 o r
0.
X tax year beginning _ 6/0
1-
20 11- , and ending _ 5/31_ - _ , 20 12
2 I f th e tax year enter ed in line 1 is f o r less th an 12 m o nth s , ch eck r easo n I nitial r etur n
F ]
F inal r etur n
F jCh ange in acco unting per io d
3a I f th is applicatio n is f o r F o r m 990-BL, 990-PF , 990-T, 4720, o r 6069, enter th e tentative tax, less any
no nr ef undable cr edits S ee instr uctio ns
0.
b I f th is applicatio n is f o r F o r m 990-PF , 990 -T, 4720 , o r 6069 , enter any r ef undable cr edits and estim ated tax
paym ents m ade I nclude any pr io r year o v e r p aym e nt allo w ed as a cr edit 3b l $ 0.
c Balance due . S ubtr act line 3b f r o m line 3a I nclude yo ur paym ent w ith th is f o r m , if r equir ed, by using
EF TPS (Electr o nic F eder al Tax Paym ent S ystem ) S ee instr uctio ns 0.
Cautio n . I f yo u ar e go ing to m ake an electr o nic f und w ith dr aw al w ith th is F o r m 8868, see F o r m 8453-EO and F o r m 8879-EO f o r
paym ent instr uctio ns
BAA F o r Paper w o r k Reductio n Act N o tice, see I nstr uctio ns . F o r m 8868 (Rev 1-2012)
F I F Z0501L 01/04/12