Part II Declaration and Signature Authorization of …€¦ · Part II Declaration and Signature...
Transcript of Part II Declaration and Signature Authorization of …€¦ · Part II Declaration and Signature...
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IRS e-file Signature Authorizationfor an Exempt Organization
OMB No. 1545-1878Form 8879-EOFor calendar year 2011, or fiscal year beginning , 2011, and ending , 20
I Do not send to the IRS. Keep for your records.
See instructions on back.Department of the Treasury
Internal Revenue Service I À¾µµName of exempt organization
Name and title of officer
Employer identification number
Type of Return and Return Information (Whole Dollars Only) Part I
Check the box for the return for which you are using this Form 8879-E0 and enter the applicable amount, if any, from the return. If youcheck the box on line 1a, 2a, 3a, 4a, or 5a, below, and the amount on that line for the return being filed with this form was blank, thenleave line 1b, 2b, 3b, 4b, or 5b, whichever is applicable, blank (do not enter -0-). But, if you entered -0- on the return, then enter -0-on the applicable line below. Do not complete more than 1 line in Part I.
I1a
2a
3a
4a
5a
Form 990 check here
Form 990-EZ check here
Form 1120-POL check here
Form 990-PF check here
Form 8868 check here
b Total revenue, if any (Form 990, Part VIII, column (A), line 12) 1b
2b
3b
4b
5b
mmmI b Total revenue, if any (Form 990-EZ, line 9) mmmmmmmmmmmI b Total tax (Form 1120-POL, line 22)mmmmmmmmmmmmmI b Tax based on investment income (Form 990-PF, Part VI, line 5) mI b Balance Due (Form 8868, Part I, line 3c or Part II, line 8c) mmmmm
Declaration and Signature Authorization of Officer Part II
Under penalties of perjury, I declare that I am an officer of the above organization and that I have examined a copy of theorganization's 2011 electronic return and accompanying schedules and statements and to the best of my knowledge and belief, theyare true, correct, and complete. I further declare that the amount in Part I above is the amount shown on the copy of theorganization's electronic return. I consent to allow my intermediate service provider, transmitter, or electronic return originator (ERO)to send the organization's return to the IRS and to receive from the IRS (a) an acknowledgement of receipt or reason for rejection ofthe transmission, (b) the reason for any delay in processing the return or refund, and (c) the date of any refund. If applicable, Iauthorize the U.S. Treasury and its designated Financial Agent to initiate an electronic funds withdrawal (direct debit) entry to thefinancial institution account indicated in the tax preparation software for payment of the organization's federal taxes owed on thisreturn, and the financial institution to debit the entry to this account. To revoke a payment, I must contact the U.S. Treasury FinancialAgent at 1-888-353-4537 no later than 2 business days prior to the payment (settlement) date. I also authorize the financial institutionsinvolved in the processing of the electronic payment of taxes to receive confidential information necessary to answer inquiries andresolve issues related to the payment. I have selected a personal identification number (PIN) as my signature for the organization'selectronic return and, if applicable, the organization's consent to electronic funds withdrawal.
Officer's PIN: check one box only
to enter my PIN as my signatureI authorizeERO firm name Enter five numbers, but
do not enter all zeros
on the organization's tax year 2011 electronically filed return. If I have indicated within this return that a copy of the return isbeing filed with a state agency(ies) regulating charities as part of the IRS Fed/State program, I also authorize the aforementionedERO to enter my PIN on the return's disclosure consent screen.
As an officer of the organization, I will enter my PIN as my signature on the organization's tax year 2011 electronically filed return.If I have indicated within this return that a copy of the return is being filed with a state agency(ies) regulating charities as part ofthe IRS Fed/State program, I will enter my PIN on the return's disclosure consent screen.
I IOfficer's signature Date
Certification and Authentication Part III
ERO's EFIN/PIN. Enter your six-digit electronic filing identification
number (EFIN) followed by your five-digit self-selected PIN.do not enter all zeros
I certify that the above numeric entry is my PIN, which is my signature on the 2011 electronically filed return for the organizationindicated above. I confirm that I am submitting this return in accordance with the requirements of Pub. 4163, Modernized e-File (MeF)Information for Authorized IRS e-file Providers for Business Returns.
I IERO's signature Date
ERO Must Retain This Form - See InstructionsDo Not Submit This Form To the IRS Unless Requested To Do So
For Paperwork Reduction Act Notice, see back of form. Form 8879-EO (2011)
JSA
1E1676 1.000
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PALISADES CHARTER HIGH SCHOOL 92-0184898
DR. PAMELA MAGEE, EXECUTIVE DIRECTOR
X 24178365.
9 9 0 1 1X WILKINSON HADLEY KING & C
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9139BJ 577A V 11-6.5
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OMB No. 1545-0047
Return of Organization Exempt From Income TaxForm ½½́
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lungbenefit trust or private foundation)
À¾µµ Open to Public
Department of the Treasury
Internal Revenue Service IThe organization may have to use a copy of this return to satisfy state reporting requirements. Inspection
, 2011, and ending , 20A For the 2011 calendar year, or tax year beginningD Employer identification numberC Name of organization
B Check if applicable:
Addresschange Doing Business As
E Telephone numberNumber and street (or P.O. box if mail is not delivered to street address) Room/suiteName change
Initial return
Terminated City or town, state or country, and ZIP + 4
Amendedreturn
G Gross receipts $
Applicationpending
H(a) Is this a group return foraffiliates?
F Name and address of principal officer: Yes No
Are all affiliates included? Yes NoH(b)
If "No," attach a list. (see instructions)Tax-exempt status:I J501(c) ( ) (insert no.) 4947(a)(1) or 527501(c)(3)
I IWebsite:J H(c) Group exemption number
IK Form of organization: Corporation Trust Association Other L Year of formation: M State of legal domicile:
SummaryPart I
1 Briefly describe the organization's mission or most significant activities:
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Check this box
Number of voting members of the governing body (Part VI, line 1a)
Number of independent voting members of the governing body (Part VI, line 1b)
Total number of individuals employed in calendar year 2011 (Part V, line 2a)
Total number of volunteers (estimate if necessary)
Total unrelated business revenue from Part VIII, column (C), line 12
Net unrelated business taxable income from Form 990-T, line 34
if the organization discontinued its operations or disposed of more than 25% of its net assets.
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Prior Year Current Year
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Contributions and grants (Part VIII, line 1h)
Program service revenue (Part VIII, line 2g)
Investment income (Part VIII, column (A), lines 3, 4, and 7d)
Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)
Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12)
Grants and similar amounts paid (Part IX, column (A), lines 1-3)
Benefits paid to or for members (Part IX, column (A), line 4)
Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10)
Professional fundraising fees (Part IX, column (A), line 11e)
Total fundraising expenses (Part IX, column (D), line 25)
Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e)
Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25)
Revenue less expenses. Subtract line 18 from line 12
Total assets (Part X, line 16)
Total liabilities (Part X, line 26)
Net assets or fund balances. Subtract line 21 from line 20
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Signature BlockPart II 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.
SignHere
MSignature of officer Date
MType or print name and title
Print/Type preparer's name Preparer's signature Date PTINCheck ifPaid
Preparer
Use Only
self-employed
II
IFirm's name
Firm's address
Firm's EIN
Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) Yes NommmmmmmmmmmmmmmmmmmmmmmmmFor Paperwork Reduction Act Notice, see the separate instructions. Form 990 (2011)JSA
1E1010 1.000
1207/01 06/30
PALISADES CHARTER HIGH SCHOOL 92-0184898
15777 BOWDOIN STREET (310) 459-0310
PACIFIC PALISADES, CA 90272 24,178,365.X
XWWW.PALIHIGH.ORG
X 2003 CA
PALISADES CHARTER HIGH SCHOOL WILL EMPOWER OUR DIVERSE STUDENTPOPULATION TO MAKE POSITIVE CONTRIBUTIONS TO THE GLOBAL COMMUNITY BYDEDICATING OUR RESOURCES TO ENSURE EDUCATIONAL EXCELLENCE AND GROWTH.
11.6.
351.32.
-2,840.-2,840.
23,112,894. 23,556,532.184,388. 588,282.63,374. 36,391.
-210,289. -2,840.23,150,367. 24,178,365.
9,000. 22,000.0 0
17,304,786. 17,487,479.0 0
05,351,487. 5,296,388.
22,665,273. 22,805,867.485,094. 1,372,498.
15,070,045. 16,577,146.5,886,503. 6,024,845.9,183,542. 10,552,301.
P00067183WILKINSON HADLEY KING & CO., LLP 52-2354566218 W. DOUGLAS AVENUE EL CAJON, CA 92020 619-447-6700
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9139BJ 577A V 11-6.5
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Form 990 (2011) Page 2Statement of Program Service Accomplishments Part III Check if Schedule O contains a response to any question in this Part III mmmmmmmmmmmmmmmmmmmmmmmm
1 Briefly describe the organization's mission:
2 Did the organization undertake any significant program services during the year which were not listed on theprior Form 990 or 990-EZ? Yes NommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," describe these new services on Schedule O.
3 Did the organization cease conducting, or make significant changes in how it conducts, any programservices? Yes NommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," describe these changes on Schedule O.
4 Describe the organization's program service accomplishments for each of its three largest program services, as measured by
expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of
grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code: ) (Expenses $ including grants of $ ) (Revenue $ )
4b (Code: ) (Expenses $ including grants of $ ) (Revenue $ )
4c (Code: ) (Expenses $ including grants of $ ) (Revenue $ )
4d Other program services (Describe in Schedule O.)
(Expenses $ including grants of $ ) (Revenue $ )
I4e Total program service expenses JSA Form 990 (2011)1E1020 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
PALISADES CHARTER HIGH SCHOOL WILL EMPOWER OUR DIVERSE STUDENTPOPULATION TO MAKE POSITIVE CONTRIBUTIONS TO THE GLOBAL COMMUNITY BYDEDICATING OUR RESOURCES TO ENSURE EDUCATIONAL EXCELLENCE, CIVICRESPONSABILITY, AND PERSONAL GROWTH.
X
X
16,886,220. 22,000. 588,282.
A CHARTER SCHOOL PROVIDING EDUCATIONAL OPPORTUNITIES TO THESURROUNDING COMMUNITY.
16,886,220.
9139BJ 577A V 11-6.5
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Form 990 (2011) Page 3
Checklist of Required Schedules Part IV Yes No
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Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes,"
complete Schedule A 1
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11a
11b
11c
11d
11e
11f
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20b
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIs the organization required to complete Schedule B, Schedule of Contributors (see instructions)? mmmmmmmmmDid the organization engage in direct or indirect political campaign activities on behalf of or in opposition to
candidates for public office? If "Yes," complete Schedule C, Part ImmmmmmmmmmmmmmmmmmmmmmmmmmmSection 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h)
election in effect during the tax year? If "Yes," complete Schedule C, Part IImmmmmmmmmmmmmmmmmmmmmmIs the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues,
assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C,
Part III mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization maintain any donor advised funds or any similar funds or accounts for which donors
have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If
"Yes," complete Schedule D, Part I mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IImmmmmmmmmmDid the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part
X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes,"
complete Schedule D, Part IV mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization, directly or through a related organization, hold assets in temporarily restricted
endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V mmmmmmmIf the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI,
VII, VIII, IX, or X as applicable.
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Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIImmmmmmmmmmmmmmmmmDid the organization report an amount for investments-program related in Part X, line 13 that is 5% or more
of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIIImmmmmmmmmmmmmmmmmDid the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets
reported in Part X, line 16? If "Yes," complete Schedule D, Part IX mmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses
the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X mmmmmmDid the organization obtain separate, independent audited financial statements for the tax year? If "Yes,"
complete Schedule D, Parts XI, XII, and XIIImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmb
a
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Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if
the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optionalmmmmmmmmmmmmIs the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E mmmmmmmmmmDid the organization maintain an office, employees, or agents outside of the United States?mmmmmmmmmmmmmDid the organization have aggregate revenues or expenses of more than $10,000 from grantmaking,
fundraising, business, investment, and program service activities outside the United States, or aggregate
foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IVmmmmmmmmmmmDid the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any
organization or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV mmmmmmmDid the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance
to individuals located outside the United States? If "Yes," complete Schedule F, Parts III and IV mmmmmmmmmmmDid the organization report a total of more than $15,000 of expenses for professional fundraising services
on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I (see instructions)mmmmmmmmmmmDid the organization report more than $15,000 total of fundraising event gross income and contributions on
Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II mmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a?
If "Yes," complete Schedule G, Part IIImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization operate one or more hospital facilities? If "Yes," complete Schedule H
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?
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Form 990 (2011)JSA
1E1021 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
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9139BJ 577A V 11-6.5
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Form 990 (2011) Page 4
Checklist of Required Schedules (continued) Part IV Yes No
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Did the organization report more than $5,000 of grants and other assistance to any government or organization
in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II 21
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24a
24b
24c
24d
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25b
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mmmmmmmmmmmmDid the organization report more than $5,000 of grants and other assistance to individuals in the United States
on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III mmmmmmmmmmmmmmmmmmmmmmDid the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the
organization's current and former officers, directors, trustees, key employees, and highest compensated
employees? If "Yes," complete Schedule J mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmma
b
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Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than
$100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b
through 24d and complete Schedule K. If “No,” go to line 25mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?mmmmmmmDid the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?mmmmmmmSection 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction
with a disqualified person during the year? If "Yes," complete Schedule L, Part I mmmmmmmmmmmmmmmmmmmIs the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior
year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ?
If "Yes," complete Schedule L, Part ImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmWas a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or
disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part IImDid the organization provide a grant or other assistance to an officer, director, trustee, key employee,
substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled
entity or family member of any of these persons? If "Yes," complete Schedule L, Part III mmmmmmmmmmmmmmmWas the organization a party to a business transaction with one of the following parties (see Schedule L,
Part IV instructions for applicable filing thresholds, conditions, and exceptions):
A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IVmmmmmmmmA family member of a current or former officer, director, trustee, or key employee? If "Yes," complete
Schedule L, Part IVmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmAn entity of which a current or former officer, director, trustee, or key employee (or a family member thereof)
was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV mmmmmmmmmDid the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified
conservation contributions? If "Yes," complete Schedule M mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N,
Part ImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes,"
complete Schedule N, Part IImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization own 100% of an entity disregarded as separate from the organization under Regulations
sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part ImmmmmmmmmmmmmmmmmmmmmWas the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III,
IV, and V, line 1 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmma
b
Did the organization have a controlled entity within the meaning of section 512(b)(13)? mmmmmmmmmmmmmmDid 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," complete Schedule R, Part V, line 2mmmmmmmmmmmmmmmmmmmmmSection 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable
related organization? If "Yes," complete Schedule R, Part V, line 2mmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization conduct more than 5% of its activities through an entity that is not a related organization
and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R,
Part VI mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and
19? Note. All Form 990 filers are required to complete Schedule O.mmmmmmmmmmmmmmmmmmmmmmmmmForm 990 (2011)
JSA
1E1030 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
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9139BJ 577A V 11-6.5
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Form 990 (2011) Page 5
Statements Regarding Other IRS Filings and Tax ComplianceCheck if Schedule O contains a response to any question in this Part V
Part V mmmmmmmmmmmmmmmmmmmmmmmYes No
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7d
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Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicablemmmmmmmmmmEnter the number of Forms W-2G included in line 1a. Enter -0- if not applicablemmmmmmmmmDid the organization comply with backup withholding rules for reportable payments to vendors and
reportable gaming (gambling) winnings to prize winners? 1c
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mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmEnter the number of employees reported on Form W-3, Transmittal of Wage and Tax
Statements, filed for the calendar year ending with or within the year covered by this return mIf at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)mmmmmmmDid the organization have unrelated business gross income of $1,000 or more during the year? mmmmmmmmmmIf "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule OmmmmmmmmmmmmmAt 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)? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIIf “Yes,” enter the name of the foreign country:
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? mmmmmmmmDid any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
If "Yes" to line 5a or 5b, did the organization file Form 8886-T? mmmmmmmmmmmmmmmmmmmmmmmmmmmmDoes the organization have annual gross receipts that are normally greater than $100,000, and did the
organization solicit any contributions that were not tax deductible?mmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," did the organization include with every solicitation an express statement that such contributions or
gifts were not tax deductible? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmOrganizations that may receive deductible contributions under section 170(c).
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods
and services provided to the payor?mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," did the organization notify the donor of the value of the goods or services provided? mmmmmmmmmmmmDid the organization sell, exchange, or otherwise dispose of tangible personal property for which it was
required to file Form 8282? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," indicate the number of Forms 8282 filed during the yearmmmmmmmmmmmmmmmmDid the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?mmmDid the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?mmmIf the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting
organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring
organization, have excess business holdings at any time during the year?mmmmmmmmmmmmmmmmmmmmmmmSponsoring organizations maintaining donor advised funds.
Did the organization make any taxable distributions under section 4966?
Did the organization make a distribution to a donor, donor advisor, or related person?
Section 501(c)(7) organizations. Enter:
Initiation fees and capital contributions included on Part VIII, line 12
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
Section 501(c)(12) organizations. Enter:
Gross income from members or shareholders
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
10a
10b
11a
11b
12b
13b
13c
mmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmGross income from other sources (Do not net amounts due or paid to other sources
against amounts due or received from them.)mmmmmmmmmmmmmmmmmmmmmmmmmmmSection 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
If "Yes," enter the amount of tax-exempt interest received or accrued during the year mmmmmSection 501(c)(29) qualified nonprofit health insurance issuers.
Is the organization licensed to issue qualified health plans in more than one state?mmmmmmmmmmmmmmmmmmNote. See the instructions for additional information the organization must report on Schedule O.
Enter the amount of reserves the organization is required to maintain by the states in which
the organization is licensed to issue qualified health plansmmmmmmmmmmmmmmmmmmmmEnter the amount of reserves on handmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization receive any payments for indoor tanning services during the tax year? mmmmmmmmmmmmmIf "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O mmmmmm
JSAForm 990 (2011)1E1040 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X
00
X
351X
XX
X
X X
X
X
X
X X X X
X
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 6
Governance, Management, and Disclosure For each "Yes" response to lines 2 through 7b below, and for a"No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in ScheduleO. See instructions.
Part VI
mmmmmmmmmmmmmmmmmmmmmmmmmmCheck if Schedule O contains a response to any question in this Part VI
Section A. Governing Body and ManagementYes No
1a
1b
mmmmmm1
2
3
4
5
6
7
8
a
b
a
b
a
b
Enter the number of voting members of the governing body at the end of the tax year. If there are
material differences in voting rights among members of the governing body, or if the governing body
delegated broad authority to an executive committee or similar committee, explain in Schedule O.
Enter the number of voting members included in line 1a, above, who are independentmmmmmm2
3
4
5
6
7a
7b
8a
8b
9
10a
10b
11a
12a
12b
12c
13
14
15a
15b
16a
16b
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with
any other officer, director, trustee, or key employee? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization delegate control over management duties customarily performed by or under the direct
supervision of officers, directors, or trustees, or key employees to a management company or other person? mmmDid the organization make any significant changes to its governing documents since the prior Form 990 was filed?
Did the organization become aware during the year of a significant diversion of the organization's assets?
Did the organization have members or stockholders?
mmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization have members, stockholders, or other persons who had the power to elect or appoint
one or more members of the governing body?mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmAre any governance decisions of the organization reserved to (or subject to approval by) members,
stockholders, or persons other than the governing body?mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization contemporaneously document the meetings held or written actions undertaken during
the year by the following:
The governing body?
Each committee with authority to act on behalf of the governing body?
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
9 Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached atthe organization's mailing address? If "Yes," provide the names and addresses in Schedule O mmmmmmmmmmmm
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)Yes No
10
11
12
13
14
15
16
a
b
a
b
a
b
c
a
b
a
b
Did the organization have local chapters, branches, or affiliates? mmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," did the organization have written policies and procedures governing the activities of such chapters,
affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?mmmmHas the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?mmDescribe in Schedule O the process, if any, used by the organization to review this Form 990.
Did the organization have a written conflict of interest policy? If "No," go to line 13 mmmmmmmmmmmmmmmmmWere officers, directors, or trustees, and key employees required to disclose annually interests that could give
rise to conflicts? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes,"
describe in Schedule O how this was done mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmDid the organization have a written whistleblower policy?
Did the organization have a written document retention and destruction policy?
Did the process for determining compensation of the following persons include a review and approval by
independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
The organization's CEO, Executive Director, or top management official
Other officers or key employees of the organization
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions.)
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement
with a taxable entity during the year?mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIf "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its
participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard theorganization's exempt status with respect to such arrangements? mmmmmmmmmmmmmmmmmmmmmmmmmm
Section C. Disclosure
I17
18
19
20
List the states with which a copy of this Form 990 is required to be filed
Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only)available for public inspection. Indicate how you made these available. Check all that apply.
Own website Another's website Upon request
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy,
and financial statements available to the public during the tax year.
State the name, physical address, and telephone number of the person who possesses the books and records of the
Iorganization:JSA Form 990 (2011)
1E1042 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X
11
6
X
X X X X
X
X
X X
X
X
X
X
X
XXX
XX
X
CA,
X
GREGORY WOOD 15777 BOWDOIN STREET PACIFIC PALISADES, CA 90272 310-230-6650
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 7
Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, andIndependent Contractors
Part VII
Check if Schedule O contains a response to any question in this Part VII mmmmmmmmmmmmmmmmmmmmSection A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within theorganization's tax year.
%%%
%%
List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amountof compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.
List all of the organization's current key employees, if any. See instructions for definition of "key employee."
List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from theorganization and any related organizations.
List all of the organization's former officers, key employees, and highest compensated employees who received more than$100,000 of reportable compensation from the organization and any related organizations.
List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of theorganization, more than $10,000 of reportable compensation from the organization and any related organizations.
List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highestcompensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A) (B) (C) (D) (E) (F)
Name and Title Averagehours per
week
Position
(do not check more than one
box, unless person is both an
officer and a director/trustee)
Reportablecompensation
fromthe
organization(W-2/1099-MISC)
Reportablecompensation from
relatedorganizations
(W-2/1099-MISC)
Estimatedamount of
othercompensation
from theorganizationand related
organizations
(describe
hours for
related
organizations
in Schedule
O)
Ind
ividu
al tru
stee
or d
irecto
r
Institu
tion
al tru
stee
Office
r
Key e
mp
loye
e
Hig
he
st com
pe
nsa
ted
em
plo
yee
Fo
rme
r
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
(13)
(14)
Form 990 (2011)JSA
1E1041 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
MARIKE ANDERSON-DAMTEACHER REPRESENTATIVE 30.00 X 55,911. 0 15,599.JUDI FIRTHCLASSIFIED REPRESENTATIVE 40.00 X 46,996. 0 16,000.WENDY HAGENTEACHER 30.00 X 60,437. 0 15,885.MONICA IANNESSAADMINISTRATIVE REPRESENTATIVE 40.00 X 102,545. 0 19,564.CHRIS LEETEACHER 30.00 X 72,705. 0 17,649.LISA KAAS-BOYLECOMMUNITY REPRESENTATIVE 0 X 0 0 0MARK EPSTEINPARENT REPRESENTATIVE 0 X 0 0 0ALLISON HOLDORFF-POHILLPARENT REPRESENTATIVE 0 X 0 0 0STEPHANIE INYAMAPARENT REPRESENTATIVE 0 X 0 0 0JASON CUTLERCOMMUNITY REPRESENTATIVE 0 X 0 0 0MATTHEW WUNDERCOMMUNITY REPRESENTATIVE 0 X 0 0 0EEMAN KHORRAMIANSTUDENT REPRESENTATIVE 0 X 0 0 0GREGORY WOODCHIEF BUSINESS OFFICER 40.00 X 116,931. 0 24,943.PAMELA MAGEEEXECUTIVE DIRECTOR/PRINCIPAL 40.00 X 67,438. 0 10,815.
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 8
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) Part VII
(A) (B) (C) (D) (E) (F)
Estimated
amount of
other
compensation
from the
organization
and related
organizations
Name and title Average
hours per
week
(describe
hours for
related
organizations
in Schedule
O)
Position
(do not check more than one
box, unless person is both an
officer and a director/trustee)
Reportablecompensation
fromthe
organization(W-2/1099-MISC)
Reportablecompensation from
relatedorganizations
(W-2/1099-MISC)
Ind
ividu
al tru
stee
or d
irecto
r
Institu
tion
al tru
stee
Office
r
Key e
mp
loye
e
Hig
he
st com
pe
nsa
ted
em
plo
yee
Fo
rme
r
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI1b Sub-total
mmmmmmmmmmmmmIc Total from continuation sheets to Part VII, Section AmmmmmmmmmmmmmmmmmmmmmmmmmmmmId Total (add lines 1b and 1c)
2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 ofreportable compensation from the organization I
Yes No
3 Did the organization list any former officer, director, or trustee, key employee, or highest compensatedemployee on line 1a? If "Yes," complete Schedule J for such individual 3mmmmmmmmmmmmmmmmmmmmmmmmmm
4 For any individual listed on line 1a, is the sum of reportable compensation and other compensation from theorganization and related organizations greater than $150,000? If “Yes,” complete Schedule J for suchindividual 4mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
5 Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individualfor services rendered to the organization? If “Yes,” complete Schedule J for such person 5mmmmmmmmmmmmmmmm
Section B. Independent Contractors
1 Complete this table for your five highest compensated independent contractors that received more than $100,000 ofcompensation from the organization. Report compensation for the calendar year ending with or within the organization's taxyear.
(A)Name and business address
(B)Description of services
(C)Compensation
2 Total number of independent contractors (including but not limited to those listed above) who receivedmore than $100,000 in compensation from the organizationI
JSA Form 990 (2011)1E1055 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
( 15) RUSSELL HOWARDASSISTANT PRINCIPAL 40.00 X 108,509. 0 19,939.
( 16) ALEXANDER SHUHGALTERTEACHER 30.00 X 112,297. 0 20,251.
( 17) JAMES PALENOTEACHER 30.00 X 112,020. 0 19,046.
( 18) MARY BUSHASSISTANT PRINCIPAL 40.00 X 109,178. 0 20,005.
( 19) JOHN RAUSCHUBERTEACHER 30.00 X 107,766. 0 19,878.
522,963. 0 120,455.549,770. 0 99,119.
1,072,733. 0 219,574.
15
X
X
X
ATTACHMENT 1
5
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 9
Statement of Revenue(C)
Unrelatedbusinessrevenue
Part VIII (B)
Related orexemptfunctionrevenue
(D)Revenue
excluded from taxunder sections
512, 513, or 514
(A)
Total revenue
1a
1b
1c
1d
1e
1f
1a
b
c
d
e
f
g
2a
b
c
d
e
f
6a
b
c
b
c
8a
b
9a
b
10a
b
11a
b
c
d
e
Federated campaigns
Membership dues
Fundraising events
Related organizations
Government grants (contributions)
All other contributions, gifts, grants,
and similar amounts not included above
Noncash contributions included in lines 1a-1f:
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmm
$
Co
ntr
ibu
tio
ns,
Gif
ts,
Gra
nts
an
d O
the
r S
imil
ar
Am
ou
nts
Ih Total. Add lines 1a-1fmmmmmmmmmmmmmmmmmmmBusiness Code
All other program service revenuemmmmmIg Total. Add lines 2a-2fP
rog
ram
Serv
ice R
even
ue
mmmmmmmmmmmmmmmmmmm3
4
5
Investment income (including dividends, interest, and
other similar amounts)
Income from investment of tax-exempt bond proceeds
Royalties
III
I
I
I
I
I
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
(i) Real (ii) Personal
Gross rents
Less: rental expenses
Rental income or (loss)
mmmmmmmmmmmmm
d Net rental income or (loss)mmmmmmmmmmmmmmmmm(i) Securities (ii) Other
7a Gross amount from sales ofassets other than inventory
Less: cost or other basis
and sales expenses
Gain or (loss)
mmmmmmmmmmm
d Net gain or (loss) mmmmmmmmmmmmmmmmmmmmmGross income from fundraising
events (not including $
of contributions reported on line 1c).
See Part IV, line 18
Less: direct expenses
mmmmmmmmmmma
b
a
b
a
b
mmmmmmmmmmc Net income or (loss) from fundraising eventsmmmmmmmmO
the
r R
even
ue
Gross income from gaming activities.
See Part IV, line 19 mmmmmmmmmmmLess: direct expenses mmmmmmmmmm
c Net income or (loss) from gaming activitiesmmmmmmmmmGross sales of inventory, less
returns and allowances mmmmmmmmmLess: cost of goods soldmmmmmmmmm
c Net income or (loss) from sales of inventorymmmmmmmmmMiscellaneous Revenue Business Code
All other revenue
Total. Add lines 11a-11d
mmmmmmmmmmmmmImmmmmmmmmmmmmmmmmI12 mmmmmmmmmmmmmmTotal revenue. See instructions
Form 990 (2011)
JSA
1E1051 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
1,747.
153,691.
22,170,488.
1,230,606.
23,556,532.
FOOD SERVICE SALES 224,491. 224,491.
ASSOCIATED STUDENT BODY REVENUE 363,791. 363,791.
588,282.
ATTACHMENT 2 36,391. 36,391.
0
0
0
0
0
0
0
FACILITY PERMITS, NET 713990 -2,840. -2,840.
-2,840.
24,178,365. 588,282. -2,840. 36,391.
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 10
Statement of Functional Expenses Part IX
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IXmmmmmmmmmmmmmmmmmmmmmmmmmm(A) (B) (C) (D)Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.Total expenses Program service
expensesManagement andgeneral expenses
Fundraisingexpenses
Grants and other assistance to governments and
organizations in the United States. See Part IV, line 2 1
1 mGrants and other assistance to individuals in
the United States. See Part IV, line 22
2 mmmmmm3 Grants and other assistance to governments,
organizations, and individuals outside the
United States. See Part IV, lines 15 and 16mmmmBenefits paid to or for members4 mmmmmmmmm
5 Compensation of current officers, directors,
trustees, and key employees mmmmmmmmmm6 Compensation not included above, to disqualified
persons (as defined under section 4958(f)(1)) and
persons described in section 4958(c)(3)(B)mmmmmmOther salaries and wages7 mmmmmmmmmmmm
8 Pension plan accruals and contributions (include section
401(k) and 403(b) employer contributions)mmmmmm9 Other employee benefits
Payroll taxes
Fees for services (non-employees):
Management
Legal
Accounting
Lobbying
mmmmmmmmmmmm10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
mmmmmmmmmmmmmmmmmma
b
c
d
e
f
g
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Professional fundraising services. See Part IV, line 1 7
Investment management fees mmmmmmmmmOther
Advertising and promotion
Office expenses
Information technology
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Royalties
Occupancy
Travel
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Payments of travel or entertainment expenses
for any federal, state, or local public officials
Conferences, conventions, and meetings
Interest
Payments to affiliates
Depreciation, depletion, and amortization
Insurance
mmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmOther expenses. Itemize expenses not covered
above (List miscellaneous expenses in line 24e. If
line 24e amount exceeds 10% of line 25, column
(A) amount, list line 24e expenses on Schedule O.)
a
b
c
d
e All other expenses
25 Total functional expenses. Add lines 1 through 24e
26 Joint costs. Complete this line only if theorganization reported in column (B) joint costsfrom a combined educational campaign and
Ifundraising solicitation. Check here iffollowing SOP 98-2 (ASC 958-720) mmmmmmm
JSA Form 990 (2011)1E1052 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
0
22,000. 22,000.
00
283,494. 161,994. 121,500.
012,739,227. 10,933,283. 1,805,944.
1,082,702. 854,571. 228,131.3,023,869. 2,130,451. 893,418.
358,187. 172,730. 185,457.
0179,574. 179,574.
5,490. 5,490.000
2,745,612. 684,434. 2,061,178.10,238. 10,238.68,093. 68,093.30,943. 30,943.
00
1,079. 1,079.
023,644. 18,915. 4,729.37,307. 37,307.
0215,581. 201,618. 13,963.129,547. 23,611. 105,936.
ASSOCIATED STUDENT BODY 359,439. 359,439.TEXTBOOKS, MATERIALS, SUPPLI 258,013. 224,225. 33,788.NONCAPITALIZED EQUIPMENT 124,077. 99,262. 24,815.FOOD 359,985. 359,985.
747,766. 571,452. 176,314.22,805,867. 16,886,220. 5,919,647.
0
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 11
Balance SheetPart X (A)
Beginning of year(B)
End of year
Cash - non-interest-bearing
Savings and temporary cash investments
Pledges and grants receivable, net
Accounts receivable, net
1
2
3
4
5
1
2
3
4
5
6
7
8
9
10c
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Receivables from current and former officers, directors, trustees, key
employees, and highest compensated employees. Complete Part II of
Schedule LmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmReceivables from other disqualified persons (as defined under section4958(f)(1)), persons described in section 4958(c)(3)(B), and contributingemployers and sponsoring organizations of section 501(c)(9) voluntaryemployees' beneficiary organizations (see instructions)
6
mmmmmmmmmmmmNotes and loans receivable, net
Inventories for sale or use
Prepaid expenses and deferred charges
7
8
9
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmm10a
10b
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
a Land, buildings, and equipment: cost or
other basis. Complete Part VI of Schedule D
Less: accumulated depreciationb
Investments - publicly traded securities
Investments - other securities. See Part IV, line 11
Investments - program-related. See Part IV, line 11
Intangible assets
Other assets. See Part IV, line 11
Total assets. Add lines 1 through 15 (must equal line 34)
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
As
se
ts
Accounts payable and accrued expenses
Grants payable
Deferred revenue
Tax-exempt bond liabilities
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Escrow or custodial account liability. Complete Part IV of Schedule D
Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified persons.
Complete Part II of Schedule LLia
bil
itie
s
mmmmmmmmmmmmmmmmmmmmmmmmmSecured mortgages and notes payable to unrelated third parties
Unsecured notes and loans payable to unrelated third partiesmmmmmmmmmmmmmmmm
Other liabilities (including federal income tax, payables to related third
parties, and other liabilities not included on lines 17-24). Complete Part X
of Schedule D mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI
Total liabilities. Add lines 17 through 25mmmmmmmmmmmmmmmmmmmmand completeOrganizations that follow SFAS 117, check here
lines 27 through 29, and lines 33 and 34.
27
28
29
30
31
32
33
34
Unrestricted net assets
Temporarily restricted net assets
Permanently restricted net assets
Capital stock or trust principal, or current funds
Paid-in or capital surplus, or land, building, or equipment fund
Retained earnings, endowment, accumulated income, or other funds
Total net assets or fund balances
Total liabilities and net assets/fund balances
27
28
29
30
31
32
33
34
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Immmmmmmmmmmmmmmmmmmmmmmm
andOrganizations that do not follow SFAS 117, check herecomplete lines 30 through 34.
mmmmmmmmmmmmmmmmmmmmmmmmmmmm
Ne
t A
ss
ets
or
Fu
nd
Bala
nces
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmForm 990 (2011)
JSA
1E1053 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
2,983,772. 1,871,183.809,791. 3,080,876.
0 05,088,780. 5,860,286.
0 0
0 00 00 8,246.
ATCH 3 45,645. 69,609.
9,045,145.3,358,199. 6,113,628. 5,686,946.
0 00 00 00 0
28,429. 015,070,045. 16,577,146.3,110,586. 4,185,124.
0 0
ATCH 4ATCH 7,381. 2,700.0 00 0
0 0
ATCH 5 1,930,509. 1,586,783.0 0
838,027. 250,238.5,886,503. 6,024,845.
X
8,681,792. 8,764,747.281,750. 1,401,579.220,000. 385,975.
9,183,542. 10,552,301.15,070,045. 16,577,146.
9139BJ 577A V 11-6.5
DRAFT
Form 990 (2011) Page 12Reconciliation of Net Assets Part XI Check if Schedule O contains a response to any question in this Part XI mmmmmmmmmmmmmmmmmmmmmmm
1
2
3
4
5
1
2
3
4
5
6
Total revenue (must equal Part VIII, column (A), line 12) mmmmmmmmmmmmmmmmmmmmmmmmmmTotal expenses (must equal Part IX, column (A), line 25) mmmmmmmmmmmmmmmmmmmmmmmmmmRevenue less expenses. Subtract line 2 from line 1 mmmmmmmmmmmmmmmmmmmmmmmmmmmmNet assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) mmmmmmmmOther changes in net assets or fund balances (explain in Schedule O) mmmmmmmmmmmmmmmmmmNet assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33,
column (B)) mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm6
Financial Statements and Reporting Part XII Check if Schedule O contains a response to any question in this Part XII mmmmmmmmmmmmmmmmmmmmmm
Yes No
1
2
3
Accounting method used to prepare the Form 990: Cash Accrual Other
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
mmmmmmmmmmmmmmmmmmmmmmmm
mmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
2a
2b
2c
3a
3b
a
b
c
d
a
b
Were the organization's financial statements compiled or reviewed by an independent accountant?
Were the organization's financial statements audited by an independent accountant?
If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight
of the audit, review, or compilation of its financial statements and selection of an independent accountant?
If the organization changed either its oversight process or selection process during the tax year, explain in
Schedule O.
If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were
issued on a separate basis, consolidated basis, or both:Both consolidated and separate basisSeparate basis Consolidated basis
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in
the Single Audit Act and OMB Circular A-133?
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the
required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
Form 990 (2011)
JSA
1E1054 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X
24,178,365.22,805,867.1,372,498.9,183,542.
-3,739.
10,552,301.
X
XX
X
X
X
X
9139BJ 577A V 11-6.5
DRAFT
OMB No. 1545-0047SCHEDULE A Public Charity Status and Public Support(Form 990 or 990-EZ)
Complete if the organization is a section 501(c)(3) organization or a section4947(a)(1) nonexempt charitable trust.
À¾µµDepartment of the Treasury
Open to Public Inspection I IAttach to Form 990 or Form 990-EZ. See separate instructions.Internal Revenue Service
Name of the organization Employer identification number
Reason for Public Charity Status (All organizations must complete this part.) See instructions. Part I The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the
hospital's name, city, and state:
An organization operated for the benefit of a college or university owned or operated by a governmental unit described in
section 170(b)(1)(A)(iv). (Complete Part II.)
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
An organization that normally receives a substantial part of its support from a governmental unit or from the general public
described in section 170(b)(1)(A)(vi). (Complete Part II.)
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
An organization that normally receives: (1) more than 331/3 % of its support from contributions, membership fees, and gross
receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 331/3% of its
support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
An organization organized and operated exclusively to test for public safety. See section 509(a)(4).
An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the
purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section
509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.
a Type I b Type II c Type III - Functionally integrated d Type III - Other
e
f
g
h
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified
persons other than foundation managers and other than one or more publicly supported organizations described in section
509(a)(1) or section 509(a)(2).
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting
organization, check this boxmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSince August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?Yes No(i)
(ii)
(iii)
A person who directly or indirectly controls, either alone or together with persons described in (ii)
and (iii) below, the governing body of the supported organization? 11g(i)
11g(ii)
11g(iii)
mmmmmmmmmmmmmmmmmmmmmA family member of a person described in (i) above?
A 35% controlled entity of a person described in (i) or (ii) above?mmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmProvide the following information about the supported organization(s).
(i) Name of supportedorganization
(ii) EIN (iii) Type of organization(described on lines 1-9above or IRC section(see instructions))
(iv) Is theorganization incol. (i) listed inyour governing
document?
(v) Did you notifythe organization
in col. (i) ofyour support?
(vi) Is theorganization in
col. (i) organizedin the U.S.?
(vii) Amount of support
Yes No Yes No Yes No
(A)
(B)
(C)
(D)
(E)
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Schedule A (Form 990 or 990-EZ) 2011
JSA
1E1210 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X
9139BJ 577A V 11-6.5
DRAFT
Schedule A (Form 990 or 990-EZ) 2011 Page 2
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(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 qualify underPart III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Part II
Section A. Public Support(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) TotalICalendar year (or fiscal year beginning in)
1 Gifts, grants, contributions, andmembership fees received. (Do notinclude any "unusual grants.")mmmmmm
2 Tax revenues levied for theorganization's benefit and either paidto or expended on its behalfmmmmmmm
3 The value of services or facilitiesfurnished by a governmental unit to theorganization without chargemmmmmmm
4 Total. Add lines 1 through 3mmmmmmm5 The portion of total contributions by
each person (other than agovernmental unit or publiclysupported organization) included online 1 that exceeds 2% of the amountshown on line 11, column (f)mmmmmmm
6 Public support. Subtract line 5 from line 4.
Section B. Total Support(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) TotalICalendar year (or fiscal year beginning in)
7 Amounts from line 4 mmmmmmmmmm8 Gross income from interest, dividends,
payments received on securities loans,rents, royalties and income from similarsourcesmmmmmmmmmmmmmmmmm
9 Net income from unrelated businessactivities, whether or not the businessis regularly carried onmmmmmmmmmm
10 Other income. Do not include gain orloss from the sale of capital assets(Explain in Part IV.) mmmmmmmmmmm
11 Total support. Add lines 7 through 10
Gross receipts from related activities, etc. (see instructions)
mm12
14
15
12 mmmmmmmmmmmmmmmmmmmmmmmmmm13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
I
II
I
II
organization, check this box and stop here mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSection C. Computation of Public Support Percentage
%
%
14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f))
Public support percentage from 2010 Schedule A, Part II, line 14
mmmmmmmm15 mmmmmmmmmmmmmmmmmmm16a 331/3 % support test - 2011. If the organization did not check the box on line 13, and line 14 is 331/3 % or more, check
this box and stop here. The organization qualifies as a publicly supported organization mmmmmmmmmmmmmmmmmmmmb 331/3 % support test - 2010. If the organization did not check a box on line 13 or 16a, and line 15 is 331/3 % or more,
check this box and stop here. The organization qualifies as a publicly supported organizationmmmmmmmmmmmmmmmmm17a 10%-facts-and-circumstances test - 2011. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is
10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in
Part IV how the organization meets the "facts-and-circumstances” test. The organization qualifies as a publicly supported
organizationmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmb 10%-facts-and-circumstances test - 2010. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organzation meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organizationmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructionsmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSchedule A (Form 990 or 990-EZ) 2011
JSA
1E1220 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
Schedule A (Form 990 or 990-EZ) 2011 Page 3
Support Schedule for Organizations Described in Section 509(a)(2)(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II.If the organization fails to qualify under the tests listed below, please complete Part II.)
Part III
Section A. Public Support(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) TotalICalendar year (or fiscal year beginning in)
1 Gifts, grants, contributions, and membership fees
received. (Do not include any "unusual grants.")
2 Gross receipts from admissions, merchandise
sold or services performed, or facilities
furnished in any activity that is related to the
organization's tax-exempt purposemmmmmm3 Gross receipts from activities that are not an
unrelated trade or business under section 513m4 Tax revenues levied for the
organization's benefit and either paid
to or expended on its behalfmmmmmmm5 The value of services or facilities
furnished by a governmental unit to the
organization without chargemmmmmmm6 Total. Add lines 1 through 5mmmmmmm7a Amounts included on lines 1, 2, and 3
received from disqualified personsmmmmb Amounts included on lines 2 and 3
received from other than disqualified
persons that exceed the greater of $5,000
or 1% of the amount on line 13 for the year
c Add lines 7a and 7bmmmmmmmmmmm8 Public support (Subtract line 7c from
line 6.) mmmmmmmmmmmmmmmmmSection B. Total Support
(a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) TotalICalendar year (or fiscal year beginning in)
9 Amounts from line 6mmmmmmmmmmm10a Gross income from interest, dividends,
payments received on securities loans,rents, royalties and income from similarsourcesmmmmmmmmmmmmmmmmm
b Unrelated business taxable income (less
section 511 taxes) from businesses
acquired after June 30, 1975 mmmmmmc Add lines 10a and 10b mmmmmmmmm
11 Net income from unrelated businessactivities not included in line 10b,whether or not the business is regularlycarried on mmmmmmmmmmmmmmm
12 Other income. Do not include gain or
loss from the sale of capital assets
(Explain in Part IV.) mmmmmmmmmmm13 Total support. (Add lines 9, 10c, 11,
and 12.) mmmmmmmmmmmmmmmm14 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3)
organization, check this box and stop here ImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSection C. Computation of Public Support Percentage15
16
Public support percentage for 2011 (line 8, column (f) divided by line 13, column (f))
Public support percentage from 2010 Schedule A, Part III, line 15
15
16
17
18
%
%
%
%
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSection D. Computation of Investment Income Percentage17
18
19
20
Investment income percentage for 2011 (line 10c, column (f) divided by line 13, column (f))
Investment income percentage from 2010 Schedule A, Part III, line 17
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
a
b
331/3 % support tests - 2011. If the organization did not check the box on line 14, and line 15 is more than 331/3 %, and line
I17 is not more than 331/3 %, check this box and stop here. The organization qualifies as a publicly supported organization
331/3 % support tests - 2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 331/3 %, and
Iline 18 is not more than 331/3 %, check this box and stop here. The organization qualifies as a publicly supported organization
IPrivate foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructionsJSA Schedule A (Form 990 or 990-EZ) 20111E1221 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
Schedule A (Form 990 or 990-EZ) 2011 Page 4
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (Seeinstructions).
Part IV
Schedule A (Form 990 or 990-EZ) 2011JSA
1E1225 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
OMB No. 1545-0047Schedule B Schedule of Contributors
À¾µµ(Form 990, 990-EZ,or 990-PF) IDepartment of the TreasuryInternal Revenue Service
Attach to Form 990, Form 990-EZ, or Form 990-PF.
Name of the organization Employer identification number
Organization type (check one):
Filers of:
Form 990 or 990-EZ
Section:
501(c)( ) (enter number) organization
4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation
Form 990-PF
Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See
instructions.
General Rule
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.
Special Rules
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33 1/3 % support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi) and received from any one contributor, during the year, a contribution of
the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1.
Complete Parts I and II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary,
or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during the
year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or
more during the year I$mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmCaution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on
Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions for Form 990, 990-EZ, or 990-PF. Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
JSA
1E1251 1.000
PALISADES CHARTER HIGH SCHOOL92-0184898
X 3
X
9139BJ 577A V 11-6.5
DRAFT
Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 2
Name of organization Employer identification number
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. Part I
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)JSA
1E1253 1.000
PALISADES CHARTER HIGH SCHOOL92-0184898
1 CALIFORNIA DEPT OF EDUCATION X
17,227,472.
2 US DEPT OF EDUCATION X
796,318.
3 COUNTY OF LOS ANGELES-TAXES X
3,708,184.
4 PACIFIC PALISADES BOOSTER CLUB X
107,000.
5 THE SAM AND ROSE GILBERT TRUST A X
1,170,000.
6 US DEPARTMENT OF AGRICULTURE X
438,514.
9139BJ 577A V 11-6.5
DRAFT
Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 2
Name of organization Employer identification number
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed. Part I
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
(a)No.
(b)Name, address, and ZIP + 4
(c)Total contributions
(d)Type of contribution
Person
Payroll
Noncash$
(Complete Part II if there isa noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)JSA
1E1253 1.000
PALISADES CHARTER HIGH SCHOOL92-0184898
7 PCHS - ASB X
46,691.
8 KATHLEEN KENNEDY & FRANK MARSHALL X
5,000.
9 TITLE FOUNDATION X
5,000.
10 OTHER CONTRIBUTORS <$5000 X
50,606.
9139BJ 577A V 11-6.5
DRAFT
Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 3Name of organization Employer identification number
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed. Part II
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
(a) No.
from
Part I
(c)
FMV (or estimate)
(see instructions)
(b)
Description of noncash property given
(d)
Date received
$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)JSA
1E1254 1.000
PALISADES CHARTER HIGH SCHOOL92-0184898
9139BJ 577A V 11-6.5
DRAFT
Schedule B (Form 990, 990-EZ, or 990-PF) (2011) Page 4Name of organization Employer identification number
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizationsthat total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
Part III
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,contributions of $1,000 or less for the year. (Enter this information once. See instructions.) I$Use duplicate copies of Part III if additional space is needed.
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
(a) No.fromPart I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
(e) Transfer of gift
Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)JSA
1E1255 1.000
PALISADES CHARTER HIGH SCHOOL92-0184898
9139BJ 577A V 11-6.5
DRAFT
OMB No. 1545-0047SCHEDULE DSupplemental Financial Statements
(Form 990)
IComplete if the organization answered "Yes," to Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
À¾µµ Open to Public Department of the Treasury I IAttach to Form 990. See separate instructions.Internal Revenue Service Inspection
Name of the organization Employer identification number
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if theorganization answered "Yes" to Form 990, Part IV, line 6.
Part I
(a) Donor advised funds (b) Funds and other accounts
1
2
3
4
5
6
Total number at end of year
Aggregate contributions to (during year)
Aggregate grants from (during year)
Aggregate value at end of year
mmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmm
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization’s property, subject to the organization's exclusive legal control? mmmmmmmmmmm Yes No
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used
only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose
conferring impermissible private benefit? mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Yes No
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7. Part II 1 Purpose(s) of conservation easements held by the organization (check all that apply).
Preservation of land for public use (e.g., recreation or education)
Protection of natural habitat
Preservation of open space
Preservation of an historically important land area
Preservation of a certified historic structure
2
3
4
5
6
7
8
9
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservationeasement on the last day of the tax year.
Held at the End of the Tax Year
2a
2b
2c
2d
a
b
c
d
Total number of conservation easements
Total acreage restricted by conservation easements
Number of conservation easements on a certified historic structure included in (a)
Number of conservation easements included in (c) acquired after 8/17/06, and not on a
historic structure listed in the National Register
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year
Number of states where property subject to conservation easement is located
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of
violations, and enforcement of the conservation easements it holds?
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)
(i) and section 170(h)(4)(B)(ii)?
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
II
mmmmmmmmmmmmmmmmmmmmmmm Yes No
II$
Yes NommmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmIn Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes theorganization’s accounting for conservation easements.
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
Part III
1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheetworks of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheetworks of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance ofpublic service, provide the following amounts relating to these items:
I(i)
(ii)
Revenues included in Form 990, Part VIII, line 1
Assets included in Form 990, Part X
mmmmmmmmmmmmmmmmmmmmmmmmmmmmm $
$Immmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm2 If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
Ia Revenues included in Form 990, Part VIII, line 1Assets included in Form 990, Part X
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm $$b mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule D (Form 990) 2011JSA
1E1268 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
Schedule D (Form 990) 2011 Page 2
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued) Part III
Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its
Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part
XIV.
3
4
5
collection items (check all that apply):
Public exhibition
Scholarly research
Preservation for future generations
Loan or exchange programs
Other
a
b
c
d
e
During the year, did the organization solicit or receive donations of art, historical treasures, or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization's collection?mmmmmm Yes No
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990, Part IV,line 9, or reported an amount on Form 990, Part X, line 21.
Part IV
1a
b
c
d
e
f
2a
b
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X?
If "Yes," explain the arrangement in Part XIV and complete the following table:
Beginning balance
Additions during the year
Distributions during the year
Ending balance
Did the organization include an amount on Form 990, Part X, line 21?
If "Yes," explain the arrangement in Part XIV.
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Yes No
Amount
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
1c
1d
1e
1f
Yes NommmmmmmmmmmmmmmmmmmmmmEndowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10. Part V
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
mmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmm
mmmmmmmmmmmmmmmm
mmmmmmmm
1a
b
c
d
e
f
g
a
b
c
3a
b
Beginning of year balance
Contributions
Net investment earnings, gains,
and losses
Grants or scholarships
Other expenditures for facilities
and programs
Administrative expenses
End of year balance
I2
4
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
Board designated or quasi-endowment %
Permanent endowment %
Temporarily restricted endowment %
The percentages in lines 2a, 2b, and 2c should equal 100%.
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:
(i) unrelated organizations
(ii) related organizations
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R?
Describe in Part XIV the intended uses of the organization's endowment funds.
II
Yes No
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm3a(i)
3a(ii)
3b
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Land, Buildings, and Equipment. See Form 990, Part X, line 10. Part VI Description of property (a) Cost or other basis
(investment)(b) Cost or other basis
(other)(c) Accumulated
depreciation(d) Book value
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmm
1a
b
c
d
e
Land
Buildings
Leasehold improvements
Equipment
Other
mmmmmmITotal. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)
Schedule D (Form 990) 2011
JSA
1E1269 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
220,000. 170,000. 170,000. 170,000.187,975. 59,000.
22,000. 9,000.
385,975. 220,000. 170,000. 170,000.
100.0000
XX
8,345,686. 2,726,967. 5,618,719.
699,459. 631,232. 68,227.1,504,964. 703,484. 801,480.
6,488,426.
9139BJ 577A V 11-6.5
DRAFT
Schedule D (Form 990) 2011 Page 3
Investments - Other Securities. See Form 990, Part X, line 12. Part VII (a) Description of security or category
(including name of security)(b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives
(2) Closely-held equity interests
(3) Other
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
ITotal. (Column (b) must equal Form 990, Part X, col. (B) line 12.)
Investments - Program Related. See Form 990, Part X, line 13. Part VIII (a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
ITotal. (Column (b) must equal Form 990, Part X, col. (B) line 13.)
Other Assets. See Form 990, Part X, line 15. Part IX (a) Description (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
ITotal. (Column (b) must equal Form 990, Part X, col. (B) line 15.)mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmOther Liabilities. See Form 990, Part X, line 25. Part X
1. (a) Description of liability (b) Book value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
Federal income taxes
ITotal. (Column (b) must equal Form 990, Part X, col. (B) line 25.)
2. FIN 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports theorganization's liability for uncertain tax positions under FIN 48 (ASC 740).JSA Schedule D (Form 990) 20111E1270 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
DUE TO SPONSORING DISTRICT 250,238.
250,238.
9139BJ 577A V 11-6.5
DRAFT
Schedule D (Form 990) 2011 Page 4
Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements Part XI 1
2
3
4
5
6
7
8
9
10
Total revenue (Form 990, Part VIII, column (A), line 12)
Total expenses (Form 990, Part IX, column (A), line 25)
Excess or (deficit) for the year. Subtract line 2 from line 1
Net unrealized gains (losses) on investments
Donated services and use of facilities
Investment expenses
Prior period adjustments
Other (Describe in Part XIV.)
Total adjustments (net). Add lines 4 through 8
Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9
1
2
3
4
5
6
7
8
9
10
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmReconciliation of Revenue per Audited Financial Statements With Revenue per Return Part XII
1
2
3
4
5
Total revenue, gains, and other support per audited financial statements
Amounts included on line 1 but not on Form 990, Part VIII, line 12:
Net unrealized gains on investments
Donated services and use of facilities
Recoveries of prior year grants
Other (Describe in Part XIV.)
Add lines 2a through 2d
Subtract line 2e from line 1
Amounts included on Form 990, Part VIII, line 12, but not on line 1 :
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIV.)
Add lines 4a and 4b
Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.)
1
2e
3
4c
5
mmmmmmmmmmmmmmmmma
b
c
d
e
a
b
c
2a
2b
2c
2d
4a
4b
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmReconciliation of Expenses per Audited Financial Statements With Expenses per Return Part XIII
1
2
3
4
5
1
2
3
4
5
Total expenses and losses per audited financial statements
Amounts included on line 1 but not on Form 990, Part IX, line 25:
Donated services and use of facilities
Prior year adjustments
Other losses
Other (Describe in Part XIV.)
Add lines 2a through 2d
Subtract line 2e from line 1
Amounts included on Form 990, Part IX, line 25, but not on line 1:
Investment expenses not included on Form 990, Part VIII, line 7b
Other (Describe in Part XIV.)
Add lines 4a and 4b
Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.)
1
2e
3
4c
5
mmmmmmmmmmmmmmmmmmmmmmmma
b
c
d
e
a
b
c
2a
2b
2c
2d
4a
4b
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSupplemental Information Part XIV
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b;Part V, line 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provideany additional information.
Schedule D (Form 990) 2011
JSA
1E1271 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
24,178,365.22,805,867.1,372,498.
1,372,498.
24,821,706.
643,341.643,341.
24,178,365.
24,178,365.
23,449,208.
643,341.643,341.
22,805,867.
22,805,867.
OTHER REVENUE & EXPENSES
SCHEDULE D XII & XIII
AMOUNTS REPORTED ON THE STATEMENT OF REVENUE ON THE TAX RETURN (FORM 990
PART VIII)REPORT FACILITY PERMITS NET OF DIRECTLY RELATED EXPENSES. AS A
RESULT $643,341 OF DIRECTLY RELATED EXPENDITURES ARE REPORTED ON FORM 990
PART VIII RATHER THAN PART IX.
9139BJ 577A V 11-6.5
DRAFT
Schedule D (Form 990) 2011 Page 5
Supplemental Information (continued) Part XIV
Schedule D (Form 990) 2011
JSA
1E1226 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
OMB No. 1545-0047SCHEDULE I(Form 990)
Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States À¾µµComplete if the organization answered "Yes" to Form 990, Part IV, line 21 or 22.
Attach to Form 990.
Open to Public Department of the Treasury
Internal Revenue Service I Inspection
Name of the organization Employer identification number
General Information on Grants and Assistance Part I
1
2
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance?
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm Yes No
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes"to Form 990, Part IV, line 21, for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000.Part II can be duplicated if additional space is needed
Part II
Immmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm(a) Name and address of organization
or government
(f) Method of valuation(book, FMV, appraisal,
other)
(c) IRC section
if applicable
(d) Amount of cashgrant
(e) Amount of non-cash assistance
(g) Description of non-cash assistance
(h) Purpose of grantor assistance
(b) EIN1
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
II
2
3
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table
Enter total number of other organizations listed in the line 1 tablemmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule I (Form 990) (2011)
JSA
1E1288 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X
9139BJ 577A V 11-6.5
DRAFT
Schedule I (Form 990) (2011) Page 2
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.Part III can be duplicated if additional space is needed.
Part III
(f) Description of non-cash assistance(a) Type of grant or assistance (e) Method of valuation (book,
FMV, appraisal, other)
(b) Number ofrecipients
(d) Amount of
non-cash assistance
(c) Amount of cash grant
1
2
3
4
5
6
7
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information. Part IV
Schedule I (Form 990) (2011)
JSA
1E1504 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
GABRIEL KAUFMAN - COLLEGE SCHOLARSHIP 2,000.
HEEJAE YANG - COLLEGE SCHOLARSHIP 4,000.
ERNST SCHMID - COLLEGE SCHOLARSHIP 1,000.
ALANA CORRE - COLLEGE SCHOLARSHIP 3,000.
SOHEILA KAMJOU - COLLEGE SCHOLARSHIP 2,000.
MIRAE DONG - COLLEGE SCHOLARSHIP 2,000.
MARITZA SANCHEZ - COLLEGE SCHOLARSHIP 2,000.
9139BJ 577A V 11-6.5
DRAFT
Schedule I (Form 990) (2011) Page 2
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.Part III can be duplicated if additional space is needed.
Part III
(f) Description of non-cash assistance(a) Type of grant or assistance (e) Method of valuation (book,
FMV, appraisal, other)
(b) Number ofrecipients
(d) Amount of
non-cash assistance
(c) Amount of cash grant
1
2
3
4
5
6
7
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information. Part IV
Schedule I (Form 990) (2011)
JSA
1E1504 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
ETHAN GARBER - COLLEGE SCHOLARSHIP 2,000.
LUA MACHADO - COLLEGE SCHOLARSHIP 2,000.
JESSICA CONTRERAS - COLLEGE SCHOLARSHIP 2,000.
9139BJ 577A V 11-6.5
DRAFT
Supplemental Information to Form 990 or 990-EZOMB No. 1545-0047SCHEDULE O
(Form 990 or 990-EZ)
Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
À¾µµ Open to Public Inspection
Department of the TreasuryInternal Revenue Service IName of the organization Employer identification number
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule O (Form 990 or 990-EZ) (2011)
JSA1E1227 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
HOW DOES THE ORGANIZATION MONITOR AND ENFORCE CONFLICT OF INTEREST POLICY?
FORM 990 PART VI GOVERNANCE, MANAGEMENT, DISCLOSURE
PALISADES CHARTER HIGH SCHOOL REQUIRES ALL KEY EMPLOYEES AND MEMBERS OF
THE BOARD OF TRUSTEES TO COMPLETE A CALIFORNIA FORM 700 "ANNUAL STATEMENT
OF ECONOMIC INTEREST".
PALISADES POLICY'S AND FINANCIAL STATEMENTS
THE ORGANIZATIONS DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL
STATEMENTS CAN BE FOUND EITHER ON THE SCHOOLS WEBSITE, IN THE GOVERNING
MINUTES, OR UPON REQUEST AT THE OFFICE OF THE EXECUTIVE DIRECTOR OR CHIEF
BUSINESS OFFICER.
DETERMINATION OF COMPENSATION
FORM 990 PART VI GOVERNANCE, MANAGEMENT, DISCLOSURE
BOARD OF TRUSTEES REVIEW/APPROVE COMPENSATION LEVELS BY ALL
EXECUTIVE/MANAGEMENT-LEVEL EMPLOYEES.
HOW IS FORM 990 MADE AVAILABLE TO THE PUBLIC
IN BOARD MEETING MINUTES AND ON WEBSITE (WWW.PALIHIGH.ORG)
OTHER CHANGES IN NET ASSETS OR FUND BALANCE
FORM 990 PART XI LINE 5
INCLUSION OF ASSOCIATED STUDENT BODY ACCOUNTS FOR THE FIRST TIME IN THE
AUDIT AND TAX RETURN RESULTED IN A CHANGE IN BEGINNING NET ASSETS OF
9139BJ 577A V 11-6.5
DRAFT
Schedule O (Form 990 or 990-EZ) 2011 Page 2
Name of the organization Employer identification number
Schedule O (Form 990 or 990-EZ) 2011JSA
1E1228 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
$(3,739).ATTACHMENT 1
990, PART VII- COMPENSATION OF THE FIVE HIGHEST PAID IND. CONTRACTORS
NAME AND ADDRESS DESCRIPTION OF SERVICES COMPENSATION
GLOBAL TRANSPORTATION SERVICES PUPIL TRANSPORTATION 484,383.200 E GARDENA BLVDGARDENA, CA 90248
TUMBLEWEED TRANSPORTATION PUPIL TRANSPORTATION 289,683.1024 HANLEY AVELOS ANGELES, CA 90049
SODEXO, INC FOOD MANAGEMENT 198,702.DEPT 43283LOS ANGELES, CA 90011
MIDDLETON YOUNG & MINNEY LEGAL SERVICES 144,552.701 UNIVERSITY AVE STE 150SACRAMENTO, CA 95825
SARLAN BUILDERS INC CONSTRUCTION 411,697.9903 SANTA MONICA BLVDBEVERLY HILLS, CA 90212
TOTAL COMPENSATION 1,529,017.
ATTACHMENT 2FORM 990, PART VIII - INVESTMENT INCOME
(A) (B) (C) (D) TOTAL RELATED OR UNRELATED EXCLUDED
DESCRIPTION REVENUE EXEMPT REVENUE BUSINESS REV. REVENUE
INTEREST INCOME 36,391. 36,391.
TOTALS 36,391. 36,391.
9139BJ 577A V 11-6.5
DRAFT
Schedule O (Form 990 or 990-EZ) 2011 Page 2
Name of the organization Employer identification number
Schedule O (Form 990 or 990-EZ) 2011JSA
1E1228 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898ATTACHMENT 3
FORM 990, PART X - PREPAID EXPENSES AND DEFERRED CHARGES
ENDINGDESCRIPTION BOOK VALUE
PREPAID EXPENSE 69,609.
TOTALS 69,609.
ATTACHMENT 4FORM 990, PART X - DEFERRED REVENUE
ENDINGDESCRIPTION BOOK VALUE
DEFERRED REVENUE 2,700.
TOTALS 2,700.
ATTACHMENT 5FORM 990, PART X - SECURED MORTGAGES AND NOTES PAYABLE
LENDER: GILBERT LOANORIGINAL AMOUNT: 783,835.INTEREST RATE: 5.600000DATE OF NOTE: 02/01/2010MATURITY DATE: 10/31/2018REPAYMENT TERMS: QUARTERLY PAYMENTS THROUGH OCTOBER 2018SECURITY PROVIDED: POOLPURPOSE OF LOAN: POOL PROJECT
BEGINNING BALANCE DUE ........................................ 714,890.ENDING BALANCE DUE ........................................... 566,015.
LENDER: BANK OF THE WESTORIGINAL AMOUNT: 354,580.INTEREST RATE: 5.690000DATE OF NOTE: 08/31/2010MATURITY DATE: 08/31/2013REPAYMENT TERMS: 3 YEAR FULLY AMORTIZING TERM LOANSECURITY PROVIDED: TRACK & FIELDPURPOSE OF LOAN: PAY BALOON PAYMENT FOR TRACK & FIELD LOAN
9139BJ 577A V 11-6.5
DRAFT
Schedule O (Form 990 or 990-EZ) 2011 Page 2
Name of the organization Employer identification number
Schedule O (Form 990 or 990-EZ) 2011JSA
1E1228 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898ATTACHMENT 5 (CONT'D)
BEGINNING BALANCE DUE ........................................ 252,199.ENDING BALANCE DUE ........................................... 134,679.
LENDER: BANK OF THE WESTORIGINAL AMOUNT: 1,000,000.INTEREST RATE: 5.690000DATE OF NOTE: 09/30/2010MATURITY DATE: 03/31/2016REPAYMENT TERMS: 60 MONTH REPAYMENT PLUS BALOON PAYMENT AT MATURITYSECURITY PROVIDED: TRACK & FIELDPURPOSE OF LOAN: REPAYMENT OF LOAN FOR TRACK & FIELD PROJECT
BEGINNING BALANCE DUE ........................................ 963,420.ENDING BALANCE DUE ........................................... 886,089.
TOTAL BEGINNING MORTGAGES AND OTHER NOTES PAYABLE 1,930,509.
TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE 1,586,783.
9139BJ 577A V 11-6.5
DRAFT
OMB No. 1545-0687Exempt Organization Business Income Tax Return (and proxy tax under section 6033(e))
Form 990-TFor calendar year 2011 or other tax year beginning , 2011, and
Department of the TreasuryÀ¾µµ
Open to Public Inspection for501(c)(3) Organizations OnlyIending , 20 . See separate instructions.Internal Revenue Service
D Employer identification number(Employees' trust, see instructions.)
Name of organization ( Check box if name changed and see instructions.)Check box ifA
address changed
B Exempt under section
Printor
Type
Number, street, and room or suite no. If a P.O. box, see instructions.501( )( )
E Unrelated business activity codes(See instructions.)
408(e) 220(e)
408A 530(a)
City or town, state, and ZIP code529(a)
C Book value of all assetsat end of year IF Group exemption number (See instructions.)
IG Check organization type 501(c) corporation 501(c) trust 401(a) trust Other trust
IH Describe the organization's primary unrelated business activity.
II During the tax year, was the corporation a subsidiary in an affiliated group or a parent-subsidiary controlled group? Yes NommmmmmmIIf "Yes," enter the name and identifying number of the parent corporation.
I IJ The books are in care of Telephone number
(A) Income (B) Expenses (C) NetUnrelated Trade or Business Income Part I 1
2
3
4
5
6
7
8
9
10
11
12
13
a
b
a
b
c
Gross receipts or sales
Less returns and allowances
Cost of goods sold (Schedule A, line 7)
Gross profit. Subtract line 2 from line 1c
Capital gain net income (attach Schedule D)
Net gain (loss) (Form 4797, Part II, line 17) (attach Form 4797)
Capital loss deduction for trusts
Income (loss) from partnerships and S corporations (attach statement)
Rent income (Schedule C)
Unrelated debt-financed income (Schedule E)
Interest, annuities, royalties, and rents from controlled
organizations (Schedule F)
Investment income of a section 501(c)(7), (9), or (17)
organization (Schedule G)
Exploited exempt activity income (Schedule I)
Advertising income (Schedule J)
Other income (See instructions; attach schedule.)
Total. Combine lines 3 through 12
Ic Balance 1c
2
3
4a
4b
4c
5
6
7
8
9
10
11
12
13
mmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmDeductions Not Taken Elsewhere (See instructions for limitations on deductions.) (Except for contributions, Part II deductions must be directly connected with the unrelated business income.)
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Compensation of officers, directors, and trustees (Schedule K)
Salaries and wages
Repairs and maintenance
Bad debts
Interest (attach schedule)
Taxes and licenses
Charitable contributions (See instructions for limitation rules.)
Depreciation (attach Form 4562)
Less depreciation claimed on Schedule A and elsewhere on return
Depletion
Contributions to deferred compensation plans
Employee benefit programs
Excess exempt expenses (Schedule I)
Excess readership costs (Schedule J)
Other deductions (attach schedule)
Total deductions. Add lines 14 through 28
Unrelated business taxable income before net operating loss deduction. Subtract line 29 from line 13
Net operating loss deduction (limited to the amount on line 30)
Unrelated business taxable income before specific deduction. Subtract line 31 from line 30
Specific deduction (Generally $1,000, but see line 33 instructions for exceptions.)
Unrelated business taxable income. Subtract line 33 from line 32. If line 33 is greater than line 32,
enter the smaller of zero or line 32
14
15
16
17
18
19
20
22b
23
24
25
26
27
28
29
30
31
32
33
34
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm21
22a
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmJSA For Paperwork Reduction Act Notice, see instructions. Form 990-T (2011)1E1610 2.000
07/011206/30
PALISADES CHARTER HIGH SCHOOLX C 03 92-0184898
15777 BOWDOIN STREET
PACIFIC PALISADES, CA 90272 713990
16,577,146. XFACILITY PERMITS FOR USE OF SCHOOL FACILITIES.
X
GREGORY WOOD 310-230-6650
640,501.640,501.
640,501. 640,501.
640,501. 640,501.
190,288.
ATTACHMENT 1 63,523.
248,197.248,197.
37,223.
ATTACHMENT 2 104,110.643,341.-2,840.
-2,840.1,000.
-2,840.
9139BJ 577A V 11-6.5
DRAFT
Form 990-T (2011) Page 2
Tax Computation Part III
35 Organizations Taxable as Corporations. See instructions for tax computation. Controlled group
Imembers (sections 1561 and 1563) check here See instructions and:
a Enter your share of the $50,000, $25,000, and $9,925,000 taxable income brackets (in that order):
$ $ $(1) (2) (3)
$b Enter organization's share of: (1) Additional 5% tax (not more than $11,750)mmmmmmm$(2) Additional 3% tax (not more than $100,000) mmmmmmmmmmmmmmmmmmmm
Ic Income tax on the amount on line 34 35cmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm36 Trusts Taxable at Trust Rates. See instructions for tax computation. Income tax on
ITax rate schedule or Schedule D (Form 1041) 36the amount on line 34 from: mmmmmmmmmmmmI3737 Proxy tax. See instructions mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Alternative minimum tax38 38
39
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm39 Total. Add lines 37 and 38 to line 35c or 36, whichever appliesmmmmmmmmmmmmmmmmmmmmmmmmmm
Tax and Payments Part IV a40 Foreign tax credit (corporations attach Form 1118; trusts attach Form 1116) 40ammmmb Other credits (see instructions) 40bmmmmmmmmmmmmmmmmmmmmmmmmmmmc General business credit. Attach Form 3800 (see instructions) 40cmmmmmmmmmmmmd Credit for prior year minimum tax (attach Form 8801 or 8827) 40dmmmmmmmmmmmme Total credits. Add lines 40a through 40d 40emmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
41 Subtract line 40e from line 39mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm41
Other taxes. Check if from: Form 4255 Form 8611 Form 8697 Form 8866 Other (attach schedule)42 42mTotal tax. Add lines 41 and 42 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm4343
a Payments: A 2010 overpayment credited to 2011 44a44 mmmmmmmmmmmmmmmmmb 2011 estimated tax payments 44bmmmmmmmmmmmmmmmmmmmmmmmmmmmc Tax deposited with Form 8868 44cmmmmmmmmmmmmmmmmmmmmmmmmmmd Foreign organizations: Tax paid or withheld at source (see instructions) 44dmmmmmmmmmmmmmmmmmmmmmmmmmmmmmme Backup withholding (see instructions) 44e
Credit for small employer health insurance premiums (Attach Form 8941)f 44fmmmmmmg Other credits and payments: Form 2439
Other 44gITotalForm 4136
4545 Total payments. Add lines 44a through 44gmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmI 4646 Estimated tax penalty (see instructions). Check if Form 2220 is attachedmmmmmmmmmmmmmmmmmmI4747 Tax due. If line 45 is less than the total of lines 43 and 46, enter amount owed mmmmmmmmmmmmmmmmmI4848 Overpayment. If line 45 is larger than the total of lines 43 and 46, enter amount overpaidmmmmmmmmmmmmI IEnter the amount of line 48 you want: Credited to 2012 estimated tax Refunded49 49
Statements Regarding Certain Activities and Other Information (see instructions) Part V 1 At any time during the 2011 calendar year, did the organization have an interest in or a signature or other authority over a financial
account (bank, securities, or other) in a foreign country? If YES, the organization may have to file Form TD F 90-22.1, Report of Foreign
Bank and Financial Accounts. If YES, enter the name of the foreign country here
Yes No
I2 During the tax year, did the organization receive a distribution from, or was it the grantor of, or transferor to, a foreign trust?
If YES, see instructions for other forms the organization may have to file.
mmmmIEnter the amount of tax-exempt interest received or accrued during the tax year $3
ISchedule A - Cost of Goods Sold. Enter method of inventory valuation
1 Inventory at beginning of year 1 6 Inventory at end of year 6m mmmmmmmmm2 Purchases 2 7 Cost of goods sold. Subtract linemmmmmmmmmm3 Cost of labor 3 6 from line 5. Enter here and inmmmmmmmmm4 a Additional section 263A costs Part I, line 2 7mmmmmmmmmmmmmmm
(attach schedule) 4a 8 Do the rules of section 263A (with respect to Yes Nommmmmmm4b property produced or acquired for resale) applyb Other costs (attach schedule) mm5 Total. Add lines 1 through 4b to the organization?5 mmmmmmmmmmmmmmmmmmmm
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 taxpayer) is based on all information of which preparer has any knowledge.
SignMay the IRS discuss this return
with the preparer shown belowMMHere(see instructions)?Signature of officer Date Title Yes No
Print/Type preparer's name Preparer's signature Date PTINCheck if
Paidself-employed
PreparerFirm's name
Firm's addressII
IFirm's EINUse Only
Phone no.
Form 990-T (2011)
JSA
1E1620 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
X X
X
X
P00067183WILKINSON HADLEY KING & CO., LLP 52-2354566218 W. DOUGLAS AVENUE 619-447-6700EL CAJON, CA 92020
9139BJ 577A V 11-6.5
DRAFT
Form 990-T (2011) Page 3
Schedule C - Rent Income (From Real Property and Personal Property Leased With Real Property)(see instructions)
1. Description of property
(1)
(2)
(3)
(4)
2. Rent received or accrued
(a) From personal property (if the percentage of rentfor personal property is more than 10% but not
more than 50%)
(b) From real and personal property (if thepercentage of rent for personal property exceeds50% or if the rent is based on profit or income)
3(a) Deductions directly connected with the incomein columns 2(a) and 2(b) (attach schedule)
(1)
(2)
(3)
(4)
TotalTotal(b) Total deductions.Enter here and on page 1,Part I, line 6, column (B)
(c) Total income. Add totals of columns 2(a) and 2(b). Enter
here and on page 1, Part I, line 6, column (A) I ImmmmmSchedule E - Unrelated Debt-Financed Income (see instructions)
3. Deductions directly connected with or allocable todebt-financed property2. Gross income from or
allocable to debt-financedproperty
1. Description of debt-financed property(a) Straight line depreciation
(attach schedule)(b) Other deductions
(attach schedule)
(1)
(2)
(3)
(4)
4. Amount of averageacquisition debt on or
allocable to debt-financedproperty (attach schedule)
5. Average adjusted basisof or allocable to
debt-financed property(attach schedule)
6. Column4 divided
by column 5
8. Allocable deductions(column 6 x total of columns
3(a) and 3(b))
7. Gross income reportable(column 2 x column 6)
(1) %
(2) %
(3) %
(4) %
Enter here and on page 1,Part I, line 7, column (A).
Enter here and on page 1,Part I, line 7, column (B).
Totals ImmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmITotal dividends-received deductions included in column 8mmmmmmmmmmmmmmmmmmmmmmmmmmmm
Schedule F - Interest, Annuities, Royalties, and Rents From Controlled Organizations (see instructions)
Exempt Controlled Organizations
1. Name of controlledorganization
2. Employer identification number
5. Part of column 4 that is included in the controlling
organization's gross income
6. Deductions directlyconnected with income
in column 5
3. Net unrelated income
(loss) (see instructions)
4. Total of specified
payments made
(1)
(2)
(3)
(4)
Nonexempt Controlled Organizations11. Deductions directly
connected with income incolumn 10
10. Part of column 9 that isincluded in the controlling
organization's gross income
8. Net unrelated income(loss) (see instructions)
9. Total of specifiedpayments made
7. Taxable Income
(1)
(2)
(3)
(4)
Add columns 5 and 10. Enter here and on page 1, Part I, line 8, column (A).
Add columns 6 and 11. Enter here and on page 1, Part I, line 8, column (B).
ITotals mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmForm 990-T (2011)JSA
1E1630 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
9139BJ 577A V 11-6.5
DRAFT
Form 990-T (2011) Page 4
Investment Income of a Section 501(c)(7), (9), or (17) Organization (see instructions)Schedule G - 3. Deductions
directly connected(attach schedule)
5. Total deductionsand set-asides (col. 3
plus col. 4)
4. Set-asides(attach schedule)1. Description of income 2. Amount of income
(1)
(2)
(3)
(4)
Enter here and on page 1,Part I, line 9, column (A).
Enter here and on page 1,Part I, line 9, column (B).
ITotalsmmmmmmmmmmmmSchedule I - Exploited Exempt Activity Income, Other Than Advertising Income (see instructions)
4. Net income(loss) from
unrelated trade orbusiness (column2 minus column
3). If a gain,compute cols. 5
through 7.
3. Expensesdirectly
connected withproduction of
unrelatedbusiness income
7. Excess exemptexpenses
(column 6 minuscolumn 5, but not
more thancolumn 4).
2. Grossunrelated
business incomefrom trade or
business
5. Gross incomefrom activity thatis not unrelatedbusiness income
6. Expensesattributable to
column 51. Description of exploited activity
(1)
(2)
(3)
(4)
Enter here and onpage 1, Part I,
line 10, col. (A).
Enter here and onpage 1, Part I,
line 10, col. (B).
Enter here andon page 1,
Part II, line 26.
ITotals mmmmmmmmmmmmSchedule J - Advertising Income (see instructions)
Income From Periodicals Reported on a Consolidated Basis Part I
4. Advertisinggain or (loss) (col.2 minus col. 3). Ifa gain, compute
cols. 5 through 7.
7. Excess readershipcosts (column 6
minus column 5, butnot more than
column 4).
2. Grossadvertising
income
3. Directadvertising costs
5. Circulationincome
6. Readershipcosts
1. Name of periodical
(1)
(2)
(3)
(4)
ITotals (carry to Part II, line (5)) mmIncome From Periodicals Reported on a Separate Basis (For each periodical listed in Part II, fill in columns Part II 2 through 7 on a line-by-line basis.)
4. Advertisinggain or (loss) (col.2 minus col. 3). Ifa gain, compute
cols. 5 through 7.
7. Excess readershipcosts (column 6
minus column 5, butnot more than
column 4).
2. Grossadvertising
income
3. Directadvertising costs
5. Circulationincome
6. Readershipcosts
1. Name of periodical
(1)
(2)
(3)
(4)
Totals from Part I(5)Enter here and on
page 1, Part I,line 11, col. (A).
Enter here and onpage 1, Part I
line 11, col. (B).
Enter here andon page 1,
Part II, line 27.
ITotals, Part II (lines 1-5)mmmmSchedule K - Compensation of Officers, Directors, and Trustees (see instructions)
3. Percent oftime devoted to
business
4. Compensation attributable tounrelated business
1. Name 2. Title
(1) %
(2) %
(3) %
(4) %
ITotal. Enter here and on page 1, Part II, line 14mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmForm 990-T (2011)JSA
1E1640 2.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATCH 3
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 1
FORM 990T - PART II - LINE 18 - INTEREST
LONG TERM DEBT INTEREST EXPENSE 63,523.
PART II - LINE 18 - INTEREST 63,523.
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 2
FORM 990T - PART II - LINE 28 - TOTAL OTHER DEDUCTIONS
CUSTODIAL SUPPORT - CONSULTING 6,000.UTILITIES 40,000.INSURANCE 3,000.SUPPLIES 55,110.
PART II - LINE 28 - OTHER DEDUCTIONS 104,110.
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 3
SCHD. K, FORM 990-T, COMPENSATION OF OFFICERS, DIRECTORS, & TRUSTEES
BUSINESSNAME AND ADDRESS TITLE PERCENT COMPENSATION
GREGORY WOOD CHIEF BUSINESS OFFICER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
PAMELA MAGEE EXECUTIVE DIRECTOR/PRINCIPAL 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
MARIKE ANDERSON-DAM TEACHER REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
JUDI FIRTH CLASSIFIED REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
WENDY HAGEN TEACHER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
MONICA IANNESSA ADMINISTRATIVE REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
CHRIS LEE TEACHER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
LISA KAAS-BOYLE COMMUNITY REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
MARK EPSTEIN PARENT REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
ALLISON HOLDORFF-POHILL PARENT REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 3 (CONT'D)
SCHD. K, FORM 990-T, COMPENSATION OF OFFICERS, DIRECTORS, & TRUSTEES
BUSINESSNAME AND ADDRESS TITLE PERCENT COMPENSATION
STEPHANIE INYAMA PARENT REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
JASON CUTLER COMMUNITY REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
MATTHEW WUNDER COMMUNITY REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
EEMAN KHORRAMIAN STUDENT REPRESENTATIVE 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
RUSSELL HOWARD ASSISTANT PRINCIPAL 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
ALEXANDER SHUHGALTER TEACHER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
JAMES PALENO TEACHER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
MARY BUSH ASSISTANT PRINCIPAL 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
JOHN RAUSCHUBER TEACHER 0 015777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
TOTAL COMPENSATION 0
9139BJ 577A V 11-6.5
DRAFT
2011Description of Property
DEPRECIATIONDate Unadjusted 179 exp. M A Current-yearBeginning Ending
Bus. Basis for Current-yearplaced in Cost reduction Basis Accumulated ACRS CRS 179Accumulated Me-Asset description service or basis % in basis Reduction depreciation depreciation depreciation Life class class expense depreciationConv.thod
Less: Retired AssetsmmmmmmmmmmmmSubtotalsmmmmmmmmmmmmmmmmmListed Property
Less: Retired Assets mmmmmmmmmmmmSubtotalsmmmmmmmmmmmmmmmmmTOTALSmmmmmmmmmmmmmmmmmmAMORTIZATION
Date Cost EndingCurrent-yearplaced in or Accumulated Accumulated
amortizationAsset description service basis amortization Code Life amortization
TOTALSmmmmmmmmmmmmmmmmmm*Assets RetiredJSA1X9024 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
POOL VARIOUS 5,494,540. 63.000 3,461,560. 94,406. 220,281. SL 27.500 125,875.
TRACK & FIELD VARIOUS 1,504,964. 63.000 948,127. 581,162. 703,484. SL 7.000 122,322.
4,409,687. 675,568. 923,765. 248,197.
6,999,504. 4,409,687. 675,568. 923,765. 248,197.
9139BJ 577A V 11-6.5
6,999,504.
DRAFT
TAXABLE YEAR California Exempt Organization FORM
Annual Information Return2011 199.Calendar Year 2011 or fiscal year beginning month day year , and ending month day year
Corporation/Organization Name California corporation number
FEINAddress (suite, room, or PMB no.)
City State ZIP Code
%No
No
No
No
Yes
Yes
Yes
Yes
J If exempt under R&TC Section 23701d, has the organization
during the year: (1) participated in any political campaign,
or (2) attempted to influence legislation or any ballot measure,
or (3) made an election under R&TC Section 23704.5
(relating to lobbying by public charities)?
If "Yes," complete and attach form FTB 3509.
A First Return mmmmmmmmmmmmmmmmmmmmmmmmmB Amended Return mmmmmmmmmmmmmmmmmmmmmC IRC Section 4947(a)(1) trust mmmmmmmmmmmmmmmmmmD Final Returnmmmmmmmmmmmmmmmmmmmmmmmmm
%% % Yes NoDissolved Surrendered (Withdrawn) mmmmmm%Enter date:% Merged/Reorganized
K Is the organization exempt under R&TC Section 23701g?%E Check accounting method: Yes No
If "Yes," enter the gross receipts from nonmember
sources
(1) Cash (2) Accrual (3) Other
% % %Federal return filed?F mmmmmmmmmmmmmmmmmmmmm$
%L If organization is exempt under R&TC Section 23701d and is
exclusively religious, educational, or charitable, and is
supported primarily (50% or more) by public contributions,
check box. No filing fee is required
(1) 990T (2) 990(PF) (3) Sch H (990)
NoYesG Is this a group filing for the subordinates/affiliates?
If "Yes," attach a roster, See instructions
Is this organization in a group exemption?
If "Yes," what is the parent's name?
mmmmmmm%mmmmmmmmm
H M Is the organization a Limited Liability Company? %Yes No Yes Nommmmmmmmmmmmm mmmN Did the organization file Form 100 or Form 109 to report
taxable income? % Yes NommmmmmmmmmmmmmmmmI ODid the organization have any changes in its activities,
governing instrument, articles of incorporation, or bylaws
that have not been reported to the Franchise Tax Board?
If "Yes," explain, and attach copies of revised documents.
Is the organization under audit by the IRS or has the
IRS audited in a prior year?
%% Yes Nommmmmmmmmmmm
Yes NommmmmComplete Part I unless not required to file this form. See General Instructions B and C.Part I
1 Gross sales or receipts from other sources. From Side 2, Part II, line 8
Gross dues and assessments from members and affiliates
Gross contributions, gifts, grants, and similar amounts received.
Total gross receipts for filing requirement test. Add line 1 through line 3.
This line must be completed. If the result is less than $25,000, see General Instruction B
%%%%
1 000000
00
000000000000000000
mmmmmmmmmmmmm2 2mmmmmmmmmmmmmmmmmmm
Receiptsand
Revenues
3 3mmmmmmmmmmmmmmmm4
mmm 4
%5 Cost of goods sold
Cost or other basis, and sales expenses of assets sold
Total costs. Add line 5 and line 6
Total gross income. Subtract line 7 from line 4
0000
5mmmmmmmmmmmmmmmm6 %6
%%%
%
7 7mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm8 8
9 Total expenses and disbursements. From Side 2, Part II, line 18
Excess of receipts over expenses and disbursements. Subtract line 9 from line 8
9mmmmmmmmmmmmmmmmExpenses10 mmmmmmmm10
11
12
13
14
15
11
12
13
14
15
Filing fee $10 or $25. See General Instruction F
Total payments
Penalties and Interest. See General Instruction J
Use tax. See General Instruction K
Balance due. Add line 11, line 13, and line 14. Then subtract line 12 from the result
mmmmmmmmmmmmmmmmmmmmmmmmFilingFee
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
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 istrue, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Sign %TelephoneTitle DateSignature
of officerHere I
%Date PTINCheck if self-Preparer's
signaturePaid II employedPreparer's %FEIN
Firm's name (or yours,Use Onlyif self-employed)I %and address Telephone
%May the FTB discuss this return with the preparer shown above? See instructionsmmmmmmmmmmmmmmmmmmmmm Yes No
027 3651114 Form 199 C1 2011 Side 1For Privacy Notice, get form FTB 1131.
1Y0527 1.000
07 01 11 06 30 2012
PALISADES CHARTER HIGH SCHOOL
15777 BOWDOIN STREET 92-0184898
PACIFIC PALISADES CA 90272XXXX
X
XX
XX
XX X
X
XX
621,833.
ATCH 1 23,556,532.
24,178,365.
24,178,365.22,805,867.1,372,498.
P00067183WILKINSON HADLEY KING & CO., LLP218 W. DOUGLAS AVENUE 52-2354566
EL CAJON, CA 92020619-447-6700
X
9139BJ 577A V 11-6.5
DRAFT
Organizations with gross receipts of more than $25,000 and private foundations regardless of amount of gross receipts -complete Part II or furnish substitute information. See Specific Line Instructions.
Part II
%%%%%%%
1 Gross sales or receipts from all business activities. See instructions 1 00000000000000
0000000000000000000000
mmmmmmmmmmmmmmmmm2 Interest 2mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm3 Dividends 3mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmReceipts
from
Other
Sources
4 Gross rents 4mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm5 Gross royalties 5mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm6 Gross amount received from sale of assets (See Instructions) 6mmmmmmmmmmmmmmmmmmmm7 Other income. Attach schedule 7mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm8 Total gross sales or receipts from other sources. Add line 1 through line 7.
%%%%%%%%%
Enter here and on Side 1, Part I, line 1 8mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm9 Contributions, gifts, grants, and similar amounts paid. Attach schedule 9mmmmmmmmmmmmmmm
10 Disbursements to or for members 10mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm11 Compensation of officers, directors, and trustees. Attach schedule 11mmmmmmmmmmmmmmmmm
Expenses
and
Disburse-
ments
12 Other salaries and wages 12mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm13 Interest 13mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm14 Taxes 14mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm15 Rents 15mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm16 Depreciation and depletion (See instructions) 16mmmmmmmmmmmmmmmmmmmmmmmmmmmm17 Other Expenses and Disbursements. Attach schedule. 17mmmmmmmmmmmmmmmmmmmmmmm18 Total expenses and disbursements. Add line 9 through line 17. Enter here and on Side 1, Part I, line 9 m18
Schedule L Balance Sheets Beginning of taxable year End of taxable year
%%%%%%%%%
%%
%%%%%%%
(a) (b) (c) (d)Assets
1 Cashmmmmmmmmmmmmmmmmmmmmm2 Net accounts receivablemmmmmmmmmmmm3 Net notes receivable. mmmmmmmmmmmmm4 Inventories mmmmmmmmmmmmmmmmmm5 Federal and state government obligations mmm6 Investments in other bonds.mmmmmmmmmm7 Investments in stock. mmmmmmmmmmmmm8 Mortgage loansmmmmmmmmmmmmmmmm9 Other investments. Attach schedulemmmmmm
a10 Depreciable assets mmmmmmmmmmmmm( ) ( )b Less accumulated depreciation mmmmmmm
11 Landmmmmmmmmmmmmmmmmmmmmm12 Other assets. Attach schedulemmmmmmmmm13 Total assetsmmmmmmmmmmmmmmmmmmLiabilities and net worth
Accounts payable14 mmmmmmmmmmmmmmmContributions, gifts, or grants payable15 mmmmmBonds and notes payable16 mmmmmmmmmmmMortgages payable17 mmmmmmmmmmmmmmOther liabilities. Attach schedule18 mmmmmmmmCapital stock or principle fund19 mmmmmmmmmPaid-in or capital surplus. Attach reconciliation20 mRetained earnings or income fund21 mmmmmmmTotal liabilities and net worth22 mmmmmmmmm
Schedule M-1 Reconciliation of income per books with income per return
%Do not complete this schedule if the amount on Schedule L, line 13, column (d), is less than $25,000
%1 Net income per books 7 Income recorded on books this yearmmmmmmmmmmmmmmmmmm
% %2 Federal income tax not included in this return.mmmmmmmmmmmmmmmmmmm3 Excess of capital losses over capital gains Attach schedulemmmmmmmmmmmmmmmmmm
%4 Income not recorded on books this 8 Deductions in this return not charged
%year. Attach schedule against book income this year.mmmmmmmmmmmmmmmmmm
%5 Expenses recorded on books this year not Attach schedulemmmmmmmmmm
deducted in this return. Attach schedule 9 Total. Add line 7 and line 8mmmmmmmmmmmmmm6 Total. 10 Net income per return.mmmmmmmmmmmmmmmm mmmmmAdd line 1 through line 5 Subtract line 9 from line 6
027 3652114Form 199 C1 2011Side 2
1Y0528 1.000
588,282.36,391.
-2,840.
621,833.ATCH 2 22,000.
ATCH 3 283,494.12,739,227.
37,307.358,187.
215,581.ATCH 4 9,150,071.
22,805,867.
3,793,563. 4,952,059.5,088,780. 5,860,286.
8,246.
9,008,049. 9,045,145.2,894,421. 6,113,628. 3,358,199. 5,686,946.
ATCH 5 74,074. 69,609.15,070,045. 16,577,146.
3,110,586. 4,185,124.
1,930,509. 1,586,783.ATCH 6ATCH 845,408. 252,938.
9,183,542. 10,552,301.15,070,045. 16,577,146.
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
FORM 199, PART I, LINE 3 - LIST OF CONTRIBUTORS ATTACHMENT 1
DIRECTPUBLIC GOVERNMENT
NAME AND ADDRESS DATE SUPPORT GRANTS
CALIFORNIA DEPT OF EDUCATION 06/30/2012 17,227,472.1430 N STREETSACRAMENTO, CA 95814
US DEPT OF EDUCATION 06/30/2012 796,318.400 MARYLAND AVEWASHINGTON DC, WA 20202
COUNTY OF LOS ANGELES-TAXES 06/30/2012 3,708,184.500 W TEMPLE STLOS ANGELES, CA 90012
PACIFIC PALISADES BOOSTER CLUB 06/30/2012 107,000.15777 BOWDOIN STREETPACIFIC PALISADES, CA 90272
THE SAM AND ROSE GILBERT TRUST A 06/30/2012 1,170,000.17965 SEABREEZE DRIVEPACIFIC PALISADES, CA 90272
US DEPARTMENT OF AGRICULTURE 06/30/2012 438,514.1400 INDEPENDENCE AVE SWWASHINGTON, DC 20250
PCHS - ASB 06/30/2012 46,691.15777 BOWDOIN STPACIFIC PALISADES, CA 90272
KATHLEEN KENNEDY & FRANK MARSHALL 06/30/2012 5,000.16055 VENTURA BLVD #535ENCINO, CA 91436
ATTACHMENT 19139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
FORM 199, PART I, LINE 3 - LIST OF CONTRIBUTORS ATTACHMENT 1 (CONT'D)
DIRECTPUBLIC GOVERNMENT
NAME AND ADDRESS DATE SUPPORT GRANTS
TITLE FOUNDATION 06/30/2012 5,000.577 CHAPALA DRPACIFIC PALISADES, CA 90272
OTHER CONTRIBUTORS <$5000 06/30/2012 50,606.15777 BOWDOIN STPACIFIC PALISADES, CA 90272
FUNDRAISING CONTRIBUTIONS 06/30/2012 1,747.15777 BOWDOIN STPACIFIC PALISADES, CA 90272
TOTAL CONTRIBUTION AMOUNTS 1,386,044. 22,170,488.
ATTACHMENT 19139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
FORM 990, PART II - GRANTS AND ALLOCATIONS PAID DURING THE YEAR ATTACHMENT 2
RELATIONSHIP TO SUBSTANTIAL CONTRIBUTOR
AND
RECIPIENT NAME AND ADDRESS FOUNDATION STATUS OF RECIPIENT PURPOSE OF GRANT OR CONTRIBUTION AMOUNT
GRANTS PAID
GABRIEL KAUFMAN - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
HEEJAE YANG - COLLEGE SCHOLARSHIP STUDENT 4,000.COLLEGE SCHOLARSHIP
ERNST SCHMID - COLLEGE SCHOLARSHIP STUDENT 1,000.COLLEGE SCHOLARSHIP
ALANA CORRE - COLLEGE SCHOLARSHIP STUDENT 3,000.COLLEGE SCHOLARSHIP
SOHEILA KAMJOU - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
MIRAE DONG - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
MARITZA SANCHEZ - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
ETHAN GARBER - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLAGE SCHOLARSHIP
LUA MACHADO - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
JESSICA CONTRERAS - COLLEGE SCHOLARSHIP STUDENT 2,000.COLLEGE SCHOLARSHIP
TOTAL CONTRIBUTIONS PAID 22,000.
ATTACHMENT 2
9139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 3
COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES
NAME TITLE COMPENSATION
PAMELA MAGEE EXECUTIVE DIRECTOR/PRINCIPAL 161,994.GREGORY WOOD CHIEF BUSINESS OFFICIAL 121,500.
TOTAL COMPENSATION OF OFFICERS, DIRECTORS, AND TRUSTEES 283,494.
ATTACHMENT 39139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 4
PART II - OTHER EXPENSES
ASSOCIATED STUDENT BODY 359,439.TEXTBOOKS, MATERIALS, SUPPLIES 258,013.NONCAPITALIZED EQUIPMENT 124,077.FOOD 359,985.DUES AND MEMBERSHIPS 33,453.NATURAL GAS SERVICES 347,007.RENTALS, LEASES AND REPAIRS 138,737.COMMUNICATIONS 44,363.OTHER EXPENDITURES 184,206.PENSION EXPENSE 1,082,702.EMPLOYEE BENEFITS 3,023,869.LEGAL EXPENSES 179,574.ACCOUNTING EXPENSE 5,490.OTHER FEES FOR SVCS 2,745,612.ADVERTISING 10,238.OFFICE EXPENSES 68,093.INFO. TECHNOLOGY 30,943.TRAVEL EXPENSES 1,079.CONFERENCES 23,644.INSURANCE 129,547.
TOTAL OTHER EXPENSES 9,150,071.
ATTACHMENT 49139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 5
SCHEDULE L - OTHER ASSETS
DESCRIPTION BEG. OF YEAR END OF YEAR
PREPAID EXPENSES 45,645. 69,609.OTHER ASSETS 28,429.
TOTAL OTHER ASSETS 74,074. 69,609.
ATTACHMENT 59139BJ 577A V 11-6.5
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
CA 199 SCHEDULE L - OTHER LIABILITIESATTACHMENT 6
ENDINGDESCRIPTION BOOK VALUE
DUE TO SPONSORING DISTRICT 250,238.
TOTALS 250,238.
ATTACHMENT 69139BJ 577A V 11-6.5
DRAFT
FORMTAXABLE YEAR California Exempt Organization2011 109Business Income Tax Return
Calendar Year 2011 or fiscal year beginning month day year , and ending month day year .CORP #
FEIN
A BFirst Return Filed? Is this an education IRA within the meaning ofR&TC Section 23712?Yes No Yes No
Corporation/Organization Name
Address
City State ZIP Code
C
D
Is the organization under audit by the IRS or has the IRS audited
in a prior year?.
H
I
J
K
Is the organization a non-exempt charitable trust as described
in IRC Section 4947(a)(1)?.%mmmmmmmmmmmmmmmm Yes No mmmmmmmmmmmmm Yes No
Final Return? Is this organization claiming any Enterprise Zone (EZ), Los Angeles
Revitalization Zone (LARZ), Local Agency Military Base Recovery Area
(LAMBRA), Targeted Tax Area (TTA), or Manufacturing Enhancement
Area (MEA) tax benefits?
Is this organization a qualified pension, profit-sharing, or stock
bonus plan as described in IRC Section 401(a)?
Unrelated Business Activity (UBA) Code
% %Dissolved
Merged/Reorganized (attach explanation)
Surrendered (Withdrawn)
%%%If a box is checked, enter date
Accounting Method Used:
Nature of trade or business
mmmmmmmmmmmmmmm Yes No
%mmmmmmmmmmmmmmmm Yes NoE Amended Return
F
G
(1) Cash (2) Accrual (3) Other Yes Nommmmmm%
00
0000000000000000000000
%%%%%%%%%%%%
1
2
3
4
5
6
7
8
9
1
2
3
4
5
6
7
8
9
Unrelated business taxable income from Side 2, Part II, line 30
Multiply line 1 by the average apportionment percentage
Apportionment Formula Worksheet, Part A, line 6 or Part B, line 2. See instructions
Enter the lesser amount from line 1 or line 2. If line 2 is zero, enter the amount from line 1
mmmmmmmmmmmmmmmmmmmmTaxableCorpora-tion
% from the Schedule R,
mmmmmmmmmmmmmmmmTaxableTrust mmmmmmmmmmmmmmmmmmmUnrelated business taxable income from Side 2, Part II, line 30
Unrelated business taxable income from line 3 or line 4
Enterprise zone, LAMBRA, LARZ, TTA, or Pierce’s disease losses
Net Operating Loss deduction. See General Information N
Add line 6 and line 7
Net unrelated business taxable income. Subtract line 8 from line 5
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmTaxCompu-tation
mmmmmmmmmmmmmmmmmm10
11b
11c
10
11
12
13
Tax % x line 9. See General Information J mmmmmmmmmmmmmmmmmmmmmmmma New jobs credit, amount generated.
c Tax credits from Schedule B. See instructions%a) 11 b) Amount claimedmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
d Total Credits. Add line 11b and 11cmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm%%%
%%%%%%
11d
12
13
14
19
20
21
22
23
24
25
27
00000000
000000000000
00
00
Balance. Subtract line 11d from line 10. If line 11d is greater than line 10, enter -0-
Alternative minimum tax. See General Information O
mmmmmmmmmmTotalTax mmmmmmmmmmmmmmmmmmmmmmmmm
14 Total tax. Add line 12 and line 13mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm00000000
%%%%
15
16
17
18
19
Overpayment from a prior year allowed as a credit
2011 estimated tax payments. See instructions
2011 withholding (Form 592-B and/or 593.) See instructions
Amount paid with extension (form FTB 3539)
Total payments and credits. Add line 15 through line 18
15
16
17
18
mmmmmmmmmmmmmmmmmmmPayments mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
20
21
22
Tax due. Subtract line 19 from line 14. Pay entire amount with return. See instructions
Overpayment. Subtract line 14 from line 19. See instructions
Enter amount of line 21 to be applied to 2012 estimate tax
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Refund(DirectDeposit ofRefund) orAmountDue
23 Use tax. See instructionsmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm24 Refund. If the sum of line 22 and line 23 is less than line 21, then subtract the total from line 2124a
24c%a Fill in the account information to have the refund directly deposited. Routing numbermmmm%b Type: Checking% Savings% c Account Number mmmmmmmmmmmmm
25 Penalties and interest. See General Information M %mmmmmmmmmmmmmmmmmmmmmmmmmm%26 Check if estimate penalty computed using Exception B or C and attach form FTB 5806.
27 Total amount due. Add line 20, line 22, line 23, and line 25, then subtract line 21 from the resultmmmm
027 3641114For Privacy Notice, get form FTB 1131. Form 109 C1 2011 Side 1
1J0514 1.000
11 127 1 6 30X X
PALISADES CHARTER HIGH SCHOOL 92-0184898
15777 BOWDOIN STREET
PACIFIC PALISADES CA 90272
X X
XX
X XSALE OF PERMITS 713990
-2,840.
8.84
9139BJ 577A V 11-6.5
DRAFT
Unrelated Business Taxable IncomePart I Unrelated Trade or Business Income
%%%%%%%%%%%%%%%%%%%%%%
%
%%%%%
1c
2
3
4a
4b
4c
5
6
7
8
9
1
2
3
4
5
6
7
8
9
a Gross receipts or gross sales
Cost of goods sold and/or operations (Schedule A, line 7)
Gross profit. Subtract line 2 from line 1c
a Capital gain net income. See Specific Line Instructions - Trusts attach Schedule D (541)
b Net gain (loss) from Part II, Schedule D-1
c Capital loss deduction for trusts
Income (or loss) from partnerships, limited liability companies, or S corporations. See specific line instructions.
Attach Schedule K-1 (565, 568, or 100S) or similar schedule
Rental income (Schedule C)
Unrelated debt-financed income (Schedule D)
Investment income of an R&TC Section 23701g, 23701i, or 23701n organization (Schedule E)
Interest, Annuities, Royalties, and Rents from controlled organizations (Schedule F)
Exploited exempt activity income (Schedule G)
Advertising income (Schedule H, Part III, Column A)
Other income. Attach schedule
Total unrelated trade or business income. Add line 3 through line 12
b Less returns and allowances 000000000000
000000000000000000
00000000000000
0000000000000000000000
Balance
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmm
10
11
12
13
10
11
12
13
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmPart II Deductions Not Taken Elsewhere (Except for contributions, deductions must be directly connected with the unrelated business income.)
14
15
16
17
18
19
20
14
15
16
17
18
19
20
21
Compensation of officers, directors, and trustees from Schedule I
Salaries and wages
Repairs
Bad debts
Interest. Attach schedule
Taxes. Attach schedule
Contributions. See instructions and attach schedule
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
%mmmmmmmmmmmmmmmmmmmmmmmmmmmm
a Depreciation (Corporations and Associations - Schedule J) (Trusts - form FTB 3885F) 21a 0000
m21
22
23a
23b
24
25
26
27
28
29
30
b Less: depreciation claimed on Schedule A. See instructions 21bmmmmmmm22
23
24
25
26
27
28
29
30
Depletion. Attach schedule mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmma Contributions to deferred compensation plansmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmb Employee benefit programs. See instructions mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmOther deductions. Attach schedule
Total deductions. Add line 14 through line 24
Unrelated business taxable income before allowable excess advertising costs. Subtract line 25 from line 13
Excess advertising costs (Schedule H, Part III, Column B)
Unrelated business taxable income before specific deduction. Subtract line 27 from line 26
Specific deduction. See instructions
Unrelated business taxable income. Subtract line 29 from line 28. If line 28 is a loss, enter line 28
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge andbelief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.Sign
Here %Date Telephone
PTIN
FEIN
Telephone
TitleSignatureof officer
%IDate Check if self-
employedPreparer'ssignature
%Paid
Preparer's
Use Only
I IFirm's name (or yours,if self-employed)and address %I
% Yes NoMay the FTB discuss this return with the preparer shown above? See instructionsmmmmmmmmmmmm
027 3642114Side 2 Form 109 C1 2011
1J0515 1.000
640,501. 640,501.
640,501.
640,501.
190,288.
ATCH 7 63,523.
248,197.248,197.
37,223.ATCH 8 104,110.
643,341.-2,840.
-2,840.1,000.-2,840.
P00067183
WILKINSON HADLEY KING & CO., LLP 52-2354566
218 W. DOUGLAS AVENUE 619-447-6700EL CAJON, CA 92020
X
9139BJ 577A V 11-6.5
DRAFT
Schedule A Cost of Goods Sold and/or Operations. Method of inventory valuation (specify)
1
2
3
4a
4b
5
6
7
1
2
3
4
5
6
7
Inventory at beginning of year
Purchases
Cost of labor
a Additional IRC Section 263A costs. Attach schedule
b Other costs. Attach schedule.
Total. Add line 1 through line 4b.
Inventory at end of year
0000000000000000
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm%%
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmCost of goods sold and/or operations. Subtract line 6 from line 5. Enter here and on Side 2, Part I, line 2
Do the rules of IRC Section 263A (with respect to property produced or acquired for resale) apply to this organization?
mmmmNoYes
00
Schedule B Tax Credits. Do not claim the New Jobs Credit on Schedule B.
%%%
1
2
3
000000
1
2
3
Enter credit name code no. mEnter credit name code no. mEnter credit name code no. m
4 Total. Add line 1 through line 3. If claiming more than 3 credits, enter the total of all claimed credits,
except New Jobs Credit, on line 4. Enter here and on Side 1, line 11c 4mmmmmmmmmmmmmmmmmmmmmSchedule K Add-On Taxes or Recapture of Tax. See instructions.
1
2
3
4
5
Interest computation under the look-back method for completed long-term contracts. Attach form FTB 3834
Interest on tax attributable to installment:
IRC Section 197(f)(9)(B)(ii) election to recognize gain on the disposition of intangibles
Credit recapture. Credit name
Total. Combine the amounts on line 1 through line 4. See instructions
000000000000
%%%%%
1
2a
2b
3
4
5
ma Sales of certain timeshares or residential lots
b Method for non-dealer installment obligations
mmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
Schedule R Apportionment Formula Worksheet
Is this organization electing the Alternate Method - Single-Sales Factor Formula?
If "Yes," skip Part A and complete Part B. If "No," complete Part A and skip Part B.% Yes Nommmmmmmmmmmmmmmmmmmmmmmmmm
Part A. Standard Method - Three Factor Formula. Complete this part only if the corporation uses the three-factor formula. (The three-factor formula
includes the double-weighted sales factor.)
Use only for unrelated trade or business amounts (a) Total within and
outside California
(b) Total within California (c) Percent within
California (b) (a)(Property factor: See instructions
Payroll factor: Wages and other compensation of employees
Sales factor: Gross sales and/or receipts less returns and allowances
Multiply the factor on line 3, column (c) by 2.
Total percentage: Add the percentages in column (c), line 1, line 2, and line 4
Average apportionment percentage: Divide the factor on line 5 by 4 and enter the
1
2
3
4
5
6
%%%
%%%
%%%
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmm
result here and on Form 109, Side 1, line 2. See instructions for exceptionsmmmmPart B. Alternate Method - Single-Sales Factor Formula. Complete this part only if the corporation elects the single-sales factor formula.
(c) Percent within
California (b) (a)
(b) Total within California
This is an irrevocable annual election.
(a) Total within and
outside California
Use only for unrelated trade or business amounts (% %1 Total Sales mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
2 Apportionment percentage. Divide total sales column (b) by total sales column (a)
and enter result here and on Form 109, Side 1, line 2. %mmmmmmmmmmmmmmRental Income from Real Property and Personal Property Leased with Real PropertySchedule C
For rental income from debt-financed property, use Schedule D, R&TC Section 23701g, Section 23701i, and Section 23701n organizations. See instructions for exceptions.1 Description of property 2 Rent received
or accrued3 Percentage of rent attributable
to personal property
%
%%
4 Complete if any item in column 3 is more than 50%, or for any itemif the rent is determined on the basis of profit or income
5 Complete if any item in column 3 is more than 10%, but not more than 50%
(a) Deductions directly connected (attach schedule)
(b) Income includible, column 2 less column 4(a)
(a) Gross income reportable, column 2 x column 3
(b) Deductions directly connected with personal property (attach schedule)
(c) Net income includible, column 5(a) less column 5(b)
Add columns 4(b) and column 5(c). Enter here and on Side 2, Part I, line 6mmmmmmmmmmmmmmmmmmmmmmmm
027 3643114 Form 109 C1 2011 Side 3
1J0516 1.000
X
9139BJ 577A V 11-6.5
DRAFT
Schedule D Unrelated Debt-Financed Income1 Description of debt-financed property 3 Deductions directly connected with or allocable to debt-financed property2 Gross income from or
allocable to debt-financedproperty
(b) Other deductions (attachschedule)
(a) Straight-line depreciation(attach schedule)
Amount of average acquisitionindebtedness on or allocableto debt-financed property(attach schedule)
8 Allocable deductions,total of columns 3(a) and3(b) x column 6
4 5 Average adjusted basis of orallocable to debt-financedproperty (attach schedule)
6 Debt basis percentage, column 4 column 5
7 Gross income reportable,column 2 x column 6
9 Net income (or loss) includible, column 7 less column 8(
%
%
%
Total. Enter here and on Side 2, Part I, line 7mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSchedule E Investment Income of an R&TC Section 23701g, Section 23701i, or Section 23701n Organization
Set-asides
(attach schedule)
51 Description Deductions directly connected
(attach schedule)
Net investment income,
column 2 less column 3
Balance of investment income,
column 4 less column 5
2 Amount 3 4 6
Total. Enter here and on Side 2, Part I, line 8mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmEnter gross income from members (dues, fees, charges, or similar amounts) mmmmmmmmmmmmmmmmmmmmmmmmSchedule F Interest, Annuities, Royalties and Rents from Controlled Organizations
Exempt Controlled Organizations
EmployerIdentificationNumber
21 Name of controlled organizations 3 Net unrelatedincome (loss)
Deductions directlyconnected with incomein column (5)
64 Total of specifiedpayments made
5 Part of column (4) that isincluded in the controllingorganization's grossincome
1
2
3
Nonexempt Controlled Organizations
7 Taxable Income 8 Net unrelatedincome (loss)
Deductions directlyconnected with incomein column (10)
1 19 Total of specifiedpayments made
1 0 Part of column (9) that isincluded in the controllingorganization's grossincome
1
2
3
4
5
6
Add columns 5 and 10
Add columns 6 and 11
Subtract line 5 from line 4. Enter here and on Side 2, Part 1, line 9
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmSchedule G Exploited Exempt Activity Income, other than Advertising Income1 Description of exploited activity (attach schedule
if more than one unrelated activity is exploiting the same exempt activity)
2 Gross unrelatedbusiness incomefrom trade orbusiness
3 Expenses directlyconnected withproduction ofunrelatedbusiness income
4 Net income fromunrelated tradeor business,column 2 lesscolumn 3
5 Gross incomefrom activity that isnot unrelatedbusiness income
6 Expensesattributableto column 5
7 Excess exemptexpense,column 6 lesscolumn 5 but notmore thancolumn 4
8 Net incomeincludible,column 4 lesscolumn 7 butnot less thanzero
Total. Enter here and on Side 2, Part I, line 10 mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
027 3644114Side 4 Form 109 C1 2011
1J0517 1.000
9139BJ 577A V 11-6.5
DRAFT
Schedule H Advertising Income and Excess Advertising Costs
Part I Income from Periodicals Reported on a Consolidated Basis1 2 3 5 6Name of periodical Gross
advertisingincome
Directadvertisingcosts
Circulationincome
Readershipcosts
If column 5 is greater thancolumn 6, enter the incomeshown in column 4, inPart III, column A(b). Ifcolumn 6 is greater thancolumn 5, subtract the sumof column 6 and column 3from the sum of column 5and column 2. Enter amountin Part III, column A(b). If theamount is less than zero,enter -0-.
74 Advertising incomeor excess advertisingcosts. If column 2 isgreater than column 3,complete columns 5,6, and 7. If column 3is greater thancolumn 2, enter theexcess in Part III,column B(b). Do notcomplete columns 5,6, and 7.
TotalsmmmmmmmmmmmmmPart II Income from Periodicals Reported on a Separate Basis
Part III Column A - Net Advertising Income Part III Column B - Excess Advertising Costs
(a) Enter "consolidated periodical" and/ornames of non-consolidated periodicals
(b) Enter total amount from Part I, column 4 or7, and amounts listed in Part II, cols. 4 and 7
(a) Enter "consolidated periodical" and/ornames of non-consolidated periodicals
(b) Enter total amount from Part I, column 4,and amounts listed in Part II, column 4
Enter total here and on Side 2, Part I, line 11 Enter total here and on Side 2, Part II, line 27
Schedule I Compensation of Officers, Directors, and Trustees
1 Name of Officer 2 SSN or ITIN 3 Title 4 Percent of time devotedto business
5 Compensation attributableto unrelated business
6 Expense account allowances
%
%
%
%
%
Total. Enter here and on Side 2, Part II, line 14mmmmmmmmmmmmmmmmmmmmmmmmmmmmSchedule J Depreciation (Corporations and Associations only. Trusts use form FTB 3885F.)
1 Group and guideline class or descriptionof property
2 Date acquired 3 Cost or other basis 4 Depreciation allowedor allowable in prioryears
5 Method of computingdepreciation
6 Life or rate 7 Depreciation forthis year
1
2
3
4
5
6
Total additional first-year depreciation (do not include in items below)
Other depreciation:
Buildings
Furniture and fixtures
Transportation equipment
Machinery and other equipment
Other (specify)
Other depreciation
Total
Amount of depreciation claimed elsewhere on return
Balance. Subtract line 5 from line 4. Enter here and on Side 2, Part II, line 21a
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
mmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm
027 3645114 Form 109 C1 2011 Side 5
1J0518 1.000
ATTACHMENT 9
1,072,733.
248,197.248,197.
248,197.
9139BJ 577A V 11-6.5
DRAFT
2011Description of Property
DEPRECIATIONDate Unadjusted 179 exp. M A Current-yearBeginning Ending
Bus. Basis for Current-yearplaced in Cost reduction Basis Accumulated ACRS CRS 179Accumulated Me-Asset description service or basis % in basis Reduction depreciation depreciation depreciation Life class class expense depreciationConv.thod
Less: Retired AssetsmmmmmmmmmmmmSubtotalsmmmmmmmmmmmmmmmmmListed Property
Less: Retired Assets mmmmmmmmmmmmSubtotalsmmmmmmmmmmmmmmmmmTOTALSmmmmmmmmmmmmmmmmmmAMORTIZATION
Date Cost EndingCurrent-yearplaced in or Accumulated Accumulated
amortizationAsset description service basis amortization Code Life amortization
TOTALSmmmmmmmmmmmmmmmmmm*Assets RetiredJSA1X9024 1.000
PALISADES CHARTER HIGH SCHOOL 92-0184898
POOL VARIOUS 5,494,540. 63.000 3,461,560. 94,406. 220,281. SL 27.500 125,875.
TRACK & FIELD VARIOUS 1,504,964. 63.000 948,127. 581,162. 703,484. SL 7.000 122,322.
4,409,687. 675,568. 923,765. 248,197.
6,999,504. 4,409,687. 675,568. 923,765. 248,197.
9139BJ 577A V 11-6.5
6,999,504.
DRAFT
PALISADES CHARTER HIGH SCHOOL 92-0184898
ATTACHMENT 7
FORM 109, PART II, LINE 18 - INTEREST
LONG TERM DEBT INTEREST EXPENSE 63,523.
FORM 109, PART II, LINE 18 - INTEREST 63,523.
ATTACHMENT 79139BJ 577A V 11-6.5