efile Public Visual Render
Submission Date - 2013-05-16
TIN: 27-0214989
Form
990-EZ
Department of the Treasury
Internal Revenue Service
Short Form
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code
(except black lung benefit trust or private foundation)
Sponsoring organizations of donor advised funds, organizations that operate one or more hospital facilities, and certain controlling organizations as defined in section 512(b)(13) must file Form 990 (see instructions).
All other organizations with gross receipts less than $200,000 and total assets less than $500,000 at the end of the year may use this form.
The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-1150
20
12
Open to Public
Inspection
A
For the 2012 calendar year, or tax year beginning
01-01-2012
, and ending
12-31-2012
B
Check if applicable:
Address change
Name change
Initial return
Terminated
Amended return
Application pending
C
Name of organization
Vermont Haiti Project
Number and street (or P. O. box, if mail is not delivered to street address)
63 Maple Leaf Lane
Room/suite
City or town, state or country, and ZIP + 4
Shelburne
,
VT
05482
D Employer identification number
27-0214989
E
Telephone number
(802) 860-2233
F
Group Exemption
Number.
.
G
Accounting Method:
Cash
Accrual
Other (specify)
H
Check
required to attach Schedule B
(Form 990, 990-EZ, or 990-PF).
I Website:
www.vermonthaitiproject.org
J Tax-exempt status
(check only one)
501(c)(3)
501(c)
(
)
(insert no.)
4947(a)(1)
or
527
K
Check
if the organization is not a section 509(a)(3) supporting organization or a section 527 organization
and
its gross receipts are normally
not
more than $50,000.
A Form 990-EZ or Form 990 return is not required though Form 990-N (e-postcard) may be required (see instructions). But if the organization chooses to file a return, be sure to file a complete return.
L
Add lines 5b, 6c, and 7b, to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part II, line 25,
column (B) below) are $500,000 or more, file Form 990 instead of Form 990-EZ
.
.
.
.
.
.
.
$
68,428
Part I
Revenue, Expenses, and Changes in Net Assets or Fund Balances
(see the instructions for Part I)
Check if the organization used Schedule O to respond to any question in this Part I
...................
1
Contributions, gifts, grants, and similar amounts received
...............
1
55,649
2
Program service revenue including government fees and contracts
............
2
3
Membership dues and assessments
......................
3
4
Investment income
...........................
4
5a
Gross amount from sale of assets other than inventory
........
5a
6,000
b
Less: cost or other basis and sales expenses
...........
5b
3,655
c
Gain or (loss) from sale of assets other than inventory (Subtract line 5b from line 5a)
......
5c
2,345
6
Gaming and fundraising events
a
Gross income from gaming (attach Schedule G if greater than $15,000)
.
6a
b
Gross income from fundraising events (not including $
of contributions
from fundraising events reported on line 1) (attach Schedule G if the
sum of such gross income and contributions exceeds $15,000)
6b
6,581
c
Less: direct expenses from gaming and fundraising events
.......
6c
2,219
d
Net income or (loss) from gaming and fundraising events (add lines 6a and 6b and subtract line 6c)
6d
4,362
7a
Gross sales of inventory, less returns and allowances
........
7a
b
Less: cost of goods sold
.................
7b
0
c
Gross profit or (loss) from sales of inventory (Subtract line 7b from line 7a)
.........
7c
8
Other revenue (describe in Schedule O)
.....................
8
198
9
Total revenue.
Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8
..............
9
62,554
10
Grants and similar amounts paid (list in Schedule O)
.................
10
11
Benefits paid to or for members
........................
11
12
Salaries, other compensation, and employee benefits
................
12
13
Professional fees and other payments to independent contractors
............
13
8,394
14
Occupancy, rent, utilities, and maintenance
...................
14
15
Printing, publications, postage, and shipping
...................
15
161
16
Other expenses (describe in Schedule O)
....................
16
44,160
17
Total expenses.
Add lines 10 through 16
.................
17
52,715
18
Excess or (deficit) for the year (Subtract line 17 from line 9)
............
18
9,839
19
Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree with
end-of-year figure reported on prior years return)
................
19
15,259
20
Other changes in net assets or fund balances (explain in Schedule O)
..........
20
21
Net assets or fund balances at end of year. Combine lines 18 through 20
.........
21
25,098
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 10642I
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
2
Part II
Balance Sheets
(see the instructions for Part II)
Check if the organization used Schedule O to respond to any question in this Part II
.................
(A)
Beginning of year
(B)
End of year
22
Cash, savings, and investments
................
10,412
22
16,421
23
Land and buildings
....................
23
24
Other assets (describe in Schedule O)
..........
4,847
24
9,963
25
Total assets
......................
15,259
25
26,384
26
Total liabilities
(describe in Schedule O)
.............
26
1,286
27
Net assets or fund balances
(line 27 of column (B)
must
agree with line 21)
..
15,259
27
25,098
Part III
Statement of Program Service Accomplishments
(see the instructions for Part III)
Check if the organization used Schedule O to respond to any question in this Part III
.
Expenses
(Required for section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts; optional for others.)
What is the organization's primary exempt purpose?
To promote and foster sustainability and capacity building through people-to-people partnerships between the people of Vermont and the people of Haiti. Our charitable activities focus on providing support for Haitian partners to build healthier communities and to provide cultural exchange opportunities for all.
Describe the organizations program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title.
28
Water purification$5,135 for Biosand filters, installation and education:This ongoing program operates in Port-au-Prince as well as in mountain villages, with four trained technicians. Five new Bio-sand water filters, which are made and purchased in Haiti, were installed in family homes each month this year. Approximately 20 follow-up service visits were conducted each month. The technicians replaced the diffusion plates on four filters each month, and they replaced two covers each month. They provided education to the family members and reinforced clean water practices. In the village of Duchity, the Baptist Ministers home has a Bio-sand filter and his wife gives out full buckets of water to people, to their great pleasure, as they leave Church on Sundays.
(Grants $
5,135
)
If this amount includes foreign grants, check here
...
28a
29
Ecole Foyer DEspoir (House of Hope School)$11,075 for teachers salaries, supplies and state exams:This Port au Prince elementary school now has 200 students and seven teachers. The home of Ismay Felix and Maria Maude has been changed into classrooms where the living room, dining room and two bedrooms used to be. Maria is the Haitian director; she, along with her staff, provide quality education in a caring and safe environment. The kids in this neighborhood do not have other opportunities for schooling. In addition to the school day, there are educational and recreational activities on weekends for the children. In 2012, four children completed their studies, all successfully passing their government mandated exam.
(Grants $
11,075
)
If this amount includes foreign grants, check here
...
29a
30
Duchity Organization for Vocational and Voluntour Experience (DOVVE)$24,880 for ongoing development of the vocational school:This construction project in the village of Duchity, 125 miles southwest of Port au Prince, has made remarkable progress over the past year, especially considering the tools used are hammers, buckets, wheel barrows and a manual cinder block maker. A foundation for a stone wall around the perimeter of the land has been built, with a commitment for completion in 2013. Construction on the main lodge has continued, and is over half-way completed. Furniture, including several bed frames have been installed. A solar powered lighting system is in place, thanks to donation from a USA-based group, and a joint Haitian-American construction project. Water continues to be piped in from the mountain source and collected in a cistern. A composting toilet and hand washing station, completed in 2011, remain in place. Visitors from the U.S. have been able to stay on the property while volunteering to give classes, provide activities for young and old, collaborate to make a small improvements to the land, and share artistic, musical and social pursuits with the people of the village. For this mountainous region, 2012 was particularly rainy, although no major hurricanes effected development. A plan is in place for the next phase of building, as well as a educational and business plan leading up to when the Vocational School will be ready to start classes.
(Grants $
24,880
)
If this amount includes foreign grants, check here
...
30a
31
Other program services (describe in Schedule O)
(Grants $
)
If this amount includes foreign grants, check here
...
31a
32 Total program service expenses
(add lines 28a through 31a)
..........
32
41,090
Part IV
List of Officers, Directors, Trustees, and Key Employees
List each one even if not compensated (see the instructions for Part IV)
Check if the organization used Schedule O to respond to any question in this Part IV
............
(a)
Name and title
(b)
Average
hours per week
devoted to position
(c)
Reportable compensation
(Forms W-2/1099-MISC)
(if not paid, enter -0-)
(d)
Health benefits, contributions to employee benefit plans,
and deferred compensation
(e)
Estimated amount
of other compensation
Bonnie Rubenstein
Director
0
0
Tim Singer
Secretary
0
0
Augusta Wilson
Treasurer
0
0
Kimball Butler
Vice President
0
0
Donna Thomas
President
0
0
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
3
Part V
Other Information
(Note the Schedule A and personal benefit contract statement requirements in the
instructions for Part V.) Check if the organization used Schedule O to respond to any question in this Part V
.......
Yes
No
33
Did the organization engage in any significant activity not previously reported to the IRS? If "Yes," provide a
detailed description of each activity in Schedule O
...................
33
No
34
Were any significant changes made to the organizing or governing documents? If "Yes," attach a conformed copy
of the amended documents if they reflect a change to the organizations name. Otherwise, explain the change
on Schedule O (see instructions)
..........................
34
No
35a
Did the organization have unrelated business gross income of $1,000 or more during the year from business
activities (such as those reported on lines 2, 6a, and 7a, among others)?
............
35a
No
b
If "Yes," to line 35a, has the organization filed a
Form 990-T
for the year? If "No," provide
an explanation in Schedule O
35b
No
c
Was the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization subject to section 6033(e)
notice, reporting, and proxy tax requirements during the year? If "Yes," complete Schedule C, Part III
35c
No
36
Did the organization undergo a liquidation, dissolution, termination, or significant disposition of net assets during
the year? If Yes, complete applicable parts of Schedule N
................
36
No
37a
Enter amount of political expenditures, direct or indirect, as described in the instructions.
37a
b
Did the organization file
Form 1120-POL
for this year?
...................
37b
No
38a
Did the organization borrow from, or make any loans to, any officer, director, trustee, or key employee
or
were
any such loans made in a prior year and still outstanding at the end of the tax year covered by this return?
..
38a
No
b
If Yes, complete Schedule L, Part II and enter the total amount involved
.
38b
39
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on line 9
.......
39a
0
b
Gross receipts, included on line 9, for public use of club facilities
.....
39b
0
40a
Section 501(c)(3) organizations. Enter amount of tax imposed on the organization during the year under:
section 4911
; section 4912
; section 4955
b
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in any section 4958 excess benefit
transaction during the year, or did it engage in an excess benefit transaction in a prior year that has not been
reported on any of its prior Forms 990 or 990-EZ? If Yes, complete Schedule L, Part I
......
40b
No
c
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax imposed on organization managers or
disqualified persons during the year under sections 4912, 4955, and 4958
...
d
Section 501(c)(3) and 501(c)(4) organizations. Enter amount of tax on line 40c reimbursed by the organization
...........................
e
All organizations. At any time during the tax year, was the organization a party to a prohibited tax shelter
transaction? If "Yes," complete Form 8886-T
......................
40e
No
41
List the states with which a copy of this return is filed.
42a
The organization's books are in care of
Augusta Wilson
Telephone no.
(802) 860-2233
Located at
63 Maple Leaf Lane
Shelburne
,
VT
ZIP + 4
05482
b
At any time during the calendar year, did the organization have an interest in or a signature or other authority over a financial account in a foreign country (such as a bank account, securities account, or other financial account)?
Yes
No
42b
No
If Yes, enter the name of the foreign country:
See the instructions for exceptions and filing requirements for
Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
c
At any time during the calendar year, did the organization maintain an office outside the U.S.?
42c
No
If Yes, enter the name of the foreign country:
43
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-EZ in lieu of
Form 1041
Check here
.......
and enter the amount of tax-exempt interest received or accrued during the tax year
....
43
Yes
No
44a
Did the organization maintain any donor advised funds during the year? If "Yes," Form 990 must be completed instead of
Form 990-EZ
................................
44a
No
b
Did the organization operate one or more hospital facilities during the year?
If "Yes," Form 990 must be completed
instead of Form 990-EZ
.............................
44b
No
c
Did the organization receive any payments for indoor tanning services during the year?
.........
44c
No
d
If "Yes," to line 44c, has the organization filed a Form 720 to report these payments?
If "No," provide an
explanation in Schedule O
............................
44d
No
45a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
.........
45a
No
45b
Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," Form 990 and Schedule R may need to be completed instead of
Form 990-EZ (see instructions)
......................
45b
No
Form
990-EZ
(2012)
Form 990-EZ (2012)
Page
4
Yes
No
46
Did the organization engage, directly or indirectly, in political campaign activities on behalf of or in opposition to
candidates for public office? If Yes, complete Schedule C, Part I.
..............
46
No
Part VI
Section 501(c)(3) organizations only
All section 501(c)(3) organizations must answer questions 47-49b and 52, and complete the tables for lines 50 and 51
Check if the organization used Schedule O to respond to any question in this Part VI
................
Yes
No
47
Did the organization engage in lobbying activities or have a section 501(h) election in effect during the tax year?
If "Yes," complete Schedule C, Part II
.......................
47
No
48
Is the organization a school as described in section 170(b)(1)(A)(ii)?
If "Yes," complete Schedule E
..
48
No
49a
Did the organization make any transfers to an exempt non-charitable related organization?
......
49a
No
b
If "Yes," was the related organization a section 527 organization?
................
49b
No
50
Complete this table for the organization's five highest compensated employees (other than officers, directors, trustees and key employees) who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a)
Name and title of each employee paid more than $100,000
(b)
Average
hours per week
devoted to position
(c)
Reportable compensation
(Forms W-2/1099-MISC)
(d)
Health benefits, contributions to employee benefit plans, and deferred compensation
(e)
Estimated amount of other compensation
NONE
f
Total number of other employees paid over $100,000
.................
51
Complete this table for the organization's five highest compensated independent contractors who each received more than $100,000 of compensation from the organization. If there is none, enter "None."
(a)
Name and address of each independent contractor paid more than $100,000
(b)
Type of service
(c)
Compensation
NONE
d
Total number of other independent contractors each receiving over $100,000
..........
52
Did the organization complete Schedule A?
NOTE:
All Section 501(c)(3) organizations and 4947(a)(1)
nonexempt charitable trusts must attach a completed Schedule A
...............
Yes
No
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
2013-05-16
Signature of officer
Date
Augusta Wilson
Treasurer
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Colleen L Montgomery CPA
Date
Check
if
self-employed
PTIN
P00038392
Firm's name
Montgomery & Merrill PC
Firm's EIN
Firm's address
110 Main Street
Burlington
,
VT
054018451
Phone no.
(802) 864-6565
May the IRS discuss this return with the preparer shown above? See instructions
.........
Yes
No
Form
990-EZ
(2012)
Form 990-EZ, Special Condition Description:
Special Condition Description
Additional Data
Software ID:
12000229
Software Version:
2012v2.0