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Form 990 Schedule J Compensation Information 990 - Official Federal Forms
| Form 990 Schedule J Compensation Information Form. This is a national form and can be used in Department Of Treasury . |
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SCHEDULE J (Form 990) Department of the Treasury Internal Revenue Service Name of the organization For certain Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees Complete if the organization answered "Yes" to Form 990, Part IV, line 23. Attach to Form 990. See separate instructions. Compensation Information OMB No. 1545-0047 Open to Public Inspection 2012 Employer identification number Part I 1a Questions Regarding Compensation Yes No Check the appropriate box(es) if the organization provided any of the following to or for a person listed in Form 990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items. First-class or charter travel Travel for companions Tax indemnification and gross-up payments Discretionary spending account Housing allowance or residence for personal use Payments for business use of personal residence Health or social club dues or initiation fees Personal services (e.g., maid, chauffeur, chef) b If any of the boxes on line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? . . . . . Indicate which, if any, of the following the filing organization used to establish the compensation of the organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III. Compensation committee Independent compensation consultant Form 990 of other organizations 4 Written employment contract Compensation survey or study Approval by the board or compensation committee 1b 2 3 During the year, did any person listed in Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization: a Receive a severance payment or change-of-control payment? . . . . . . . . . . . . . . . b Participate in, or receive payment from, a supplemental nonqualified retirement plan? . . . . . . . c Participate in, or receive payment from, an equity-based compensation arrangement? . . . . . . . If "Yes" to any of lines 4ac, list the persons and provide the applicable amounts for each item in Part III. Only section 501(c)(3) and 501(c)(4) organizations must complete lines 59. For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any compensation contingent on the revenues of: . . . . . . 5a 5b 4a 4b 4c 5 a The organization? . . . . . . . . . . . . . . . . . . . . . . . . . . . b Any related organization? . . . . . . . . . . . . . . . . . . . . . . . . If "Yes" to line 5a or 5b, describe in Part III. For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any 6 compensation contingent on the net earnings of: a The organization? . . . . . . . . . . . . . . . . . . b Any related organization? . . . . . . . . . . . . . . . If "Yes" to line 6a or 6b, describe in Part III. 7 For persons listed in Form 990, Part VII, Section A, line 1a, did the payments not described in lines 5 and 6? If "Yes," describe in Part III . 8 . . . . . . . . . . . . . . . . . . . . . . . . 6a 6b organization provide any non-fixed ............ 7 9 Were any amounts reported in Form 990, Part VII, paid or accrued pursuant to a contract that was subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe in Part III . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? ........................ Cat. No. 50053T 8 9 For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule J (Form 990) 2012 American LegalNet, Inc. www.FormsWorkFlow.com Schedule J (Form 990) 2012 Page 2 Part II Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed. For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII. Note. The sum of columns (B)(i)(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual. (B) Breakdown of W-2 and/or 1099-MISC compensation (i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation (C) Retirement and other deferred compensation (D) Nontaxable benefits (E) Total of columns (B)(i)(D) (F) Compensation reported as deferred in prior Form 990 (A) Name and Title 1 2 (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) (i) (ii) 3 4 5 6 7 8 9 10 11 12 13 14 American LegalNet, Inc. www.FormsWorkFlow.com 15 16 Schedule J (Form 990) 2012 Page 3 Part III Supplemental Information Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information. Schedule J (Form 990) 2012 American LegalNet, Inc. www.FormsWorkFlow.com Schedule J (Form 990) 2012
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