return of organization exempt from income...

16
Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal l Revenue Code (accept black loop benefit trust or private foundation) " Tie organization may have to use a copy of this return to satisfy state reporting requirements Dap~tolMa7remuy InbmN Revsiua Service A For tie 2002 calem 38-3375365 H end I are not applicable to section 527 organizations H(a) Is this a group return for affiliates? Yes No H(h) It Yes ; enter number of affiliates lo Hoc) Areal] affiliates included? N/A Yes No (If 7J0,' attach a list ) Hid) Is this a separate return filed by an or- K Check here " U it the organization's gross receipts a2 normally not more than $25,000 The organization need not file a return with the IRS, but A the organization received a Farm 990 Package in the mail, R should file a return without financial data Some states require a complete return M Check " LJ A the organization is not required to attach Sch B (Farm 990 . 990-EZ, or 990-PF) L Gross receints Add lines 12 18 Excess or (deficit) for the year (sublet[ line 17 from hoe 12) m m o 19 Net assets or fund balances at beginning of year (from line 73, column (A)) 20 Other changes in net assets or fund balances (attach explanation) a 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20) 01-M-M LHA For Paperwork Reduction Act Notice, see the separate Instructions 1 11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171 Form 990 B cnra a plesse C Name of organization 1VWIraDia ux IRS neap i+wi 0~, w ,n , ARUCH SLS INC . olumue Number and street (or P 0 box it marl is not delivered to street address) E Initial ~= spooiflc11571 E . FULTON god wwa ~ o,m mro City or town, stale or country, and ZIP + 4 0, o°'°° OWELL MI 49331 0Z polling *Section 501(q(3) organizations and 3947(ap1 ) nonexempt chartta6le true mutt attach a completed Schedule A (Form 990 or 990-EZ) G Wehctta tldIA J Otaanlzallon tvoe caea~wvorcl " n 5011c1( 3 11 omew) n 49471x1111 nr D Employer Identification number Hoam/surte E Telephone number I 616 897- F ksaamo mtaa LJ cimm L J reauei 1 Contributions, gAls, proofs, and similar amounts received a Direct public support 12 D Indirect public support 10 t Government contributions (pants) 1c a Total (ado hoes to through lc) (cash $ noncash E 2 Program semce revenue including government fees and contracts (from Part VII, line 93) 3 Membership dues and assessments d Interest on savings and temporary cash investments 5 Dividends and interest from securities 6 a Gross rents Ba h Less rental expenses 66 c Net rental income or (loss) (subtract line 6b from line 6a) m 7 Other investment income (describe '10, c 8 a Gross amount from sale of assets other A Securities ( 111 1 Of 0 m than inventory Be b Less cost or other basis and sales expenses ~ 811 c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) t i L "u 'v ~-~ 9 Special events and activities (attach schedule) r a Gross revenue (not including $ of confab tea¢s1 ~ y pp ~ I reported on line 1a) , m 60 T t79a1 7~UU j C i D Less duect expenses other than fundraising expenses 96 :nl M c Net income or (loss) from special events (subtract line 9b from line Ba) O~ t ~ ' r _ O U 10 a Gross sales o1 inventory, less returns and allowances p D Less cost of goods sold 106 c Grass profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10x) 11 Other revenue (from Part VII, line 103) 0 to 13 Program services (from line 44, column (8)) 14 Management and general (from line 44, column (C)) Z `m 15 Fundrausinp (from line 44, column (D)) ~ n w 18 Payments to affiliates (attach schedule) <Z37,815 .> 0 . Q <144, 305 . > ~p Form 990 (2002)

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Page 1: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal l Revenue Code (accept black loop

benefit trust or private foundation) " Tie organization may have to use a copy of this return to satisfy state reporting requirements

Dap~tolMa7remuy InbmN Revsiua Service

A For tie 2002 calem

38-3375365

H end I are not applicable to section 527 organizations H(a) Is this a group return for affiliates? Yes No H(h) It Yes; enter number of affiliates lo Hoc) Areal] affiliates included? N/A Yes No

(If 7J0,' attach a list ) Hid) Is this a separate return filed by an or- K Check here " U it the organization's gross receipts a2 normally not more than $25,000 The

organization need not file a return with the IRS, but A the organization received a Farm 990 Package in the mail, R should file a return without financial data Some states require a complete return

M Check " LJ A the organization is not required to attach Sch B (Farm 990 . 990-EZ, or 990-PF) L Gross receints Add lines 12

18 Excess or (deficit) for the year (sublet[ line 17 from hoe 12) m m o 19 Net assets or fund balances at beginning of year (from line 73, column (A))

20 Other changes in net assets or fund balances (attach explanation) a 21 Net assets or fund balances at end of year (combine lines 18, 19, and 20)

01-M-M LHA For Paperwork Reduction Act Notice, see the separate Instructions 1

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Form 990

B cnra a plesse C Name of organization 1VWIraDia ux IRS

neap i+wi 0~,�w ,n��, ARUCH SLS INC . olumue Number and street (or P 0 box it marl is not delivered to street address)

E Initial ~= spooiflc11571 E . FULTON god wwa ~�o,m mro City or town, stale or country, and ZIP + 4 0, o°'°° OWELL MI 49331

0Z polling *Section 501(q(3) organizations and 3947(ap1 ) nonexempt chartta6le true mutt attach a completed Schedule A (Form 990 or 990-EZ)

G Wehctta tldIA J Otaanlzallon tvoe caea~wvorcl " n 5011c1( 3 11 omew) n 49471x1111 nr

D Employer Identification number

Hoam/surte E Telephone number I 616 897-

F ksaamo mtaa LJ cimm L J reauei

1 Contributions, gAls, proofs, and similar amounts received a Direct public support 12 D Indirect public support

10 t Government contributions (pants) 1c a Total (ado hoes to through lc) (cash $ noncash E

2 Program semce revenue including government fees and contracts (from Part VII, line 93) 3 Membership dues and assessments d Interest on savings and temporary cash investments 5 Dividends and interest from securities 6 a Gross rents Ba

h Less rental expenses 66 c Net rental income or (loss) (subtract line 6b from line 6a)

m 7 Other investment income (describe '10, c 8 a Gross amount from sale of assets other A Securities ( 111 1 Of 0 m than inventory Be

b Less cost or other basis and sales expenses ~ 811 c Gain or (loss) (attach schedule) 8c d Net gain or (loss) (combine line 8c, columns (A) and (B)) t i L "u 'v ~-~ 9 Special events and activities (attach schedule) r a Gross revenue (not including $ of confab tea¢s1 ~ y pp ~ I

reported on line 1a) , m 60 T t79a1 7~UU j C i

D Less duect expenses other than fundraising expenses 96 :nl M c Net income or (loss) from special events (subtract line 9b from line Ba) O~ t ~ ' r _ O U

10 a Gross sales o1 inventory, less returns and allowances p D Less cost of goods sold 106

c Grass profit or (loss) from sales of inventory (attach schedule) (subtract line 10b from line 10x) 11 Other revenue (from Part VII, line 103)

0 to 13 Program services (from line 44, column (8)) 14 Management and general (from line 44, column (C))

Z ̀m 15 Fundrausinp (from line 44, column (D)) ~

n w 18 Payments to affiliates (attach schedule)

<Z37,815 .> 0 . Q

<144, 305 . > ~p Form 990 (2002)

Page 2: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

What is the organization's primary exempt purposes 10.

mM

t Forth 990 (2002)

973171 2

11461022 759636 97317 2002 .06030 BARUCH SLS INC .

BARUCH SLS INC . 38-3375365

Part 11 dement o All organizations must complete column (A) Columns (B), (C), and (D) are required for section 501(c)(3) Page 2 Functional Expenses and 4) organizations and section 4947 a)(1) nonexempt charitable trusts but optional for others

Do notindudaemounlsreportedonline (p) Total (B) Program (C) Management (D) Fundraising 66 86 96 f06 or76olPoRl services and entire1

22 Grants and allocations (attach schedule) Mn f man s 22

23 Specific assistance to individuals (attach schedule) 23 24 Benefits paid to or for members (attach schedule) 24 25 Compensation of officers, directors, etc 25 0 . 0 . ~ ~ 0 . 0 . 26 Other salaries and wages 26 27 Pension plan contributions 27 28 Other employee benefits 28 29 Payroll taxes 29 30 Professional fundraising fees 30 37 Accounting fees 31 5 740 . 5,740 . 32 Lepaitees 92 22 739 . 22 739 . 33 Supplies 33 50 , 639 . 35,808 . 14 , 831 . 34 Telephone 34 14 779 . 14, 779 . 95 Postage and shipping 35 2 197 . 2 197 . 38 Occupancy 38 181 041 . 181 041 . 37 Equipment rental anCmaintenance 37 22 683 . 19 , 195 . 4,488 . 38 Printing and publicabons 38 39 Travel 39 40 Conferences, conventions, and meetings 40 41 interest 41 769 . 769 . 42 Depreciation, depletion, etc (attach schedule) 42 7 512 . 7, 512 . 09 Other expenses not covered above (itemize) a 43a h 43h c 43c 0 ~43A~ a SEE STATEMENT 1 49e 1,538,309 . 1,150,160 . 388,149 . 22 r~ mme,a,s e4 1,846,408 . 1,385,204 . 461,204 . 0 . to °w ""'°° ot~~

Jolm Costs Check " 0 A you are following SOP 98-2 Are any point costs from a combined ad uwlional campaign and funCraising solicitation reported in (B) Program services? " ED Yes OX No I1 Yes,' enter (I) the aggregate amount of these point costs E , (II) the amount allocated to Program services $

1111 qyntreCOro mph EewlDa MW qvept purpws WMOrvib in a Cav n0 coivfa ~ Stet Ne nunAer of dlmb ~eE, W blkappu fnuaE, atc D!f eC~IHC~~mh 111lI N not lM69uR010 (3Ktbn 501(CX.i)Nq (4) oep41171GOM NO <9d7(a%1) !WlIU"t~h01. OLlb mlat1bo a1 W CI" YnW nt OI Wtnb 1n0 ellonCOna in oVien )

a PROVIDE RETIREMENT HOMES FOR THE ELDERLY WHO CANNOT AFFORD

b

c

d

Total of

449 .334 .

Page 3: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

223021 of azm 3

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Form 99o(2002) BARUCH SLS INC . 38-3375365 Page 9

Part N Balance Sheets

Note Where required. attached schedules end amounts within the desrnpuon column (A) (B) should be for end-of-year amounts only Beginning of year End of year

45 Cash -noninterest-Deannp 353 . 45 <472 , 939 .>

46 Savings andtemporary cash investments 8 , 350* 46 19 , 876 .

47 a accounts receivable e7a 151 , 293 . ~ b Less allowance for Aoubttw accounts 476 211 , 307 . 47o 151 , 293 .

48 a Pledges receivable 48a b Less allowance for doubtful accounts 486 48c

49 Gams receivable 49 50 Recervables from officers. directors, trustees,

and key employees 50 N 0 51 a Other notes and loans receivable 51a 109,527 .

D Less allowance fordoubtful accounts Stb 109 527 . Sic 109,527 . 52 Inventones for sale or use 52 53 Prepaid expenses and deterred charges 14 , 195 .. 53 5 , 621 .

54 Investments -securities 1 E--1 Cost ED FMV 54 55a Investments - land, buildings, and

equipment basis 55a

D Less accumulated depreciation 55b 55c 58 Investments - other 58 57 a Land, buildings, and equipment bass 57a 2 , 457 , 086 .

e less accumulated depreciation 57h 206 734 . 2 , 244 , 754 . 57c 2 , 250 , 352 . 58 Other assets (descnbe " SEE STATEMENT 2 ~ 58 , 070i 58 1 , 370 , 9188

59 Totaiassets addunesa5throu n58 mustequal line74 2 , 646 , 556 . 59 3 434 648 . 60 Accounts payable anaaccrued expenses 318 , 904i 60 249 846 . 61 Grants payable 61 62 Deferred avenue 62

N m 69 Loans from officers, directors, trustees, and key employees 63 a 64 a Tax-exempt bond liabilities 64a

uMortgages andother notes payable 1 , 447 , 843 . 5qo 1 , 406 , 887 . 65 Other ha6ilrties(Oescnbe t SEE STATEMENT 3 ) 1 , 117 , 624 . 65 1 , 922 , 220a

68 Total liabilities addlines 60through 65 2 , 884 , 371a 66 3 , 578 , 953 ._ Organizations that follow SFAS 117, check here ~ ~ and complete lines 67 through

69 and lines 73 and 74 67 Unrestricted 67

.S 68 Temporarily restricted 68 1 m 69 Permanency restricted 69

Organizations that do not follow SFAS 117, check here " ~X and complete lines 70 through 74

,°, 70 Capital stock, trust principal . or current funds 4 . 70 0 . r Paid-in or capital surplus, or land, building, and equipment fund 0 . 71 0 . n Retained eaminps,endowment,accumulated income,orother funds <237 , 815 . 72 <144,305 .> 73 Total not assets or fund balances (add lines 67 through 69 or lines 70 through 72,

<237 , 815 . pn 1 <144,305 . > column (A) must equal line 19, column (B) must equal line 21)

Forth 990 is available for public inspection and, for some people, serves as the primary or sole source of Information about a particular organization Howthe public perceives an organization in such cases may be determined by the information presented on its return Therefore, please make sure the return is complete and actuate and fully describes, in Part III, the organization's programs and accomplishments

Page 4: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

anon oT Revenue per Auaitea Statements with Revenue per

support

Financial Statements with Expenses per Return

a Total expenses and losses per audited financial statements " a m N/A

D Amounts included on line a buff not on line 17, Form 990

(1) Donated services and use o1 facilities i

(2) Prior year adjustments reported on line 20, Form 990 $

(3) Losses reported on line 20, Form 990 i

(4) Other (specify)

a Total revenue, pains, and other peraudited financial statements

h Amounts included on line a but not on line 12, Form 990

(1) Net unrealized gains on investments i

(2) Donated services and use of facilities S

(3) Recoveries of prior year grants $

(4) Other (specify)

G e

Add amounts on lines (1) and (2) a Total expenses per line 17, Form 990

Add amounts on lines (1) and (2) e Total revenue per line 12, Form 990

Iloyees (List each one even d not compeTitle and avenge hours (C) Compensation per week Oevote0 to (if not paid . enter (R) Name and address

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75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related orpan¢ations7 It Yes,' attach schedule lo. E-] Yes M) No Form 990 (2002)

u3mi o,-2zm

s Ado amounts on lines (1) through (4)

o one a minus line D d Amounts included on line 12, Form

990 but not on line a

(1) Investment expenses not included on line 6b, Form 990 f

(2) Other (specify)

38-3375365 Paae4

Add amounts on lines (1) through (e) " 0 c one a minus line b " c d Amounts included an line 17, Form

990 but not on line e

(1) Investment expenses not included on line 6D, Form 990 S

(2) Other (specify)

THOMAS NOBEL RESIDENT 11571 E . FULTON LOWELL MI 49331 10 HRS NEIL KRAAY TREASURER 11571 E . FULTON LOWELL MI 49331 10 HRS ED HAYWOOD ICE PRESIDE & 11571 E . FULTON LOWELL MI 49331 10 HRS --------------------------------- ---------------------------------

--------------------------------- ---------------------------------

Page 5: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

87 501(c)(12) organ2anons Enter a Gross income tram members or shareholders B7a N/A

h Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them ) B76 N/A

88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 3017701-2 and 3017701-31 It Yes; complete Part IX as X

89 a 501(c)(3) orgen¢etions Enter Amount of tax imposed on the organization during the year under section 49111 0 . , section 4912 " 0 . , section 4955 1

D 501(c)(3) end 501(c)(4) organ¢snons Did the organization engage in any section 4958 excess benefit transaction during the year or did rt become aware of an excess benefit transaction from a Onor yeah If Yes,' attach a statement explaining each transaction 89h X

e Enter Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 1111~ 0

d Enter Amount of tax on tine 89c, above, reimbursed by the organization " 0 . 90 a List the states with which a copy of this retain is filed 111" MICHIGAN

h Number of employees employed m the pay period that includes March 12, 2002 906 98 91 Tne books are in care of " THOMAS NOBEL Telephone na " 616 897-1893_

Lowteoat 1 11571 E . FULTON, LOWELL, MI ziP+a " 49331

92 Section 49470(7) nonexempt charitable hush filing Forth 990 in lieu of Form 1041- Check here 10 and enter the amount of tax-exempt interest received or accrued du ring the tax veer " ~ 92 I N/A

Form 223041 990 (2002)

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

3375365

76 Did tie organization engage in any adrvdy not previously reported to the IRS If Yes,' attach a detailed description of each activity 75 A

77 Were any changes made in the organizing or governing documents but not reDOrted to Ne IRS 77 X

If Yes,' attach a conformed copy of the changes 78 a Did the organization have unrelated business gross income of E7,000 or more during the year covered by this return') 7Ba X

6 If Yes,' has it filed a tax retain on Form 990-T for this yeah NBA 78b 79 Was there a liquidation, dissolution, termination, or substantial contraction during the yeah 79

It Yes,' attach a statement 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common membership,

governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? BOa X

b It Yes .' enter the name of the organization " SEE STATEMENT 4 and check whether it re 0 exempt or L-i nonexempt

81 a Enter deed or indirect political expenditures See line 81 instructions I 81a 0 .

h Did the organization file Form 1120-POL for this yeah 81113 X

82 a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge or at substantially less than 82a X fair rental value

6 It 'Yes .' you may indicate the value of these items here Do not include this amount as avenue in Part I or as an expense in Part II (See instructions in Part III ) B2b N/A

83 a Did the organization comply with the public inspection requirements for retains and exemption applications? 83a X

D Did the organization comply with the disclosure requirements relating to quid pro quo contnbutions7 83b X

84 a Did the organization solicit any contributions or gifts that were not tax deductibles 84a X

D If Yes; did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible') N/A 14b

&5 501(c)(4), (5), or (6) organizations a Wee substantially all dues nondeductible by members? N/A 85a D Did the organization make only in-house lobbying expenditures of $2,000 or less N/A BSh

It Yes' was answered to either 85a or BSb, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the poor year

0 Dues, assessments, and similar amounts from members 85C N/A I d Section 162(e) lobbying and political expenditures 85E IN / a

e Aggregate nondeductible amount of section 6033(e)(1)(A) dues notices 850 N/A

f Taxable amount of lobbying and political expenditures (line BSd less 85e) 851 N/A p Does the organization elect to pay the section 6033(e) tax on the amount on line 85f7 N/A h It section 6033(e)(1)(A) dues notices were sent, does tie organization agree to add the amount on line BSf to its reasonable estimate of dues

allocable to nondeductible lobbying and political expenditures for the following fax yeah N/A 86 501(c)(n organizations Enter a Initiation fees and capital contributions included on line 12 B6a N/A

h Gross receipts, included on line 12, for public use of club facilities B6h N/A

Page 6: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

Note Enter gross amounts unless otherwise indicated 93 Program service revenue

a SUPPORTIVE REVENUE h RESPITE REVENUE c ENTRY FEES a ANCILLARY REVENUE B ALZHEIMER'S REVENUE f MechicarelMedicaid payments p Fees and contracts horn government agencies

94 Membership dues and assessments 95 Interest on savings and temporary cash investments 86 Dividends and interest from securities 97 Net rental income or (1055) from gal estate

a debt-financed property b not debt-financed property

98 Net rental income or (loss) from personal property 99 Other investment income 700 Gain or (loss) from ales of assets

other than inventory 101 Net income or (loss) from special evenly 102 Gross profit or (loss) from sales of inventory 103 Other revenue

a b t d e

704 Subtotal (add columns (B), (D), and (E)) 1 05 Tout (add line ion, columns (e), (o), and (e))

Line No I Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment of the organization's exempt purposes (other than by providing funds for such purposes)

of I Nature

N/A

Palo PreParefs' signature

Preparers ~,������ ~a, THE REH GROUP Use Only ym~m '~ '3230 EAGLE PARK DRIVE, o~,~~'~,, a~+GRAND RAPIDS, MI 49525

11461022 759636 97317 2002 .06030

Forth tlvltles See papa 31 of tie mstrucUans

Unrelated business income Ewuaaa ~ sizsiaaI (B) C) (0) Relatedarexempt Business Amount Amount

code function income

(a) Did the organization . during the year, receive any funds, directly or indirectly, ti (G) Did tie organization, during the year, pay premiums, directly or indirectly, on a

Please ""°°°°'°'"°` m~c .na m~c Sign Here ' Si

Page 7: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

SCHEDULER Organization Exempt Under Section 501(c)(3) (Fom, 980 or 89o-EZ) (Except Private Foundation) and Section 501(e), 501(q, 501(k),

501(n), or Section asa7(a)11 1 Nonexempt Charitable Trust

Dep~t of the T~urj Supplementary Information-(See separate instructions.) maw ravmu. s.nno. 1 MUST 6e camp leteA by the shove organizations and attached to the If Form 990 or 990-EZ Name of the organization

BARUCH SLS INC .

OM13 No 154S0047

LOOL

her Identification number

3375365

--------------------------------------------

--------------------------------------------

ToGI number of others receiving over $50,000 for professional services " 0 u3,o,Ai um LHA For Paperwork Reduction Act Notice . see the Instructions for form 990 and Form 990-EZ

7 11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions List each one It there are none, enter None') (a) Name and address of each employee paid (h) Title and avenge hours c ~^amuW ~m ( ) Ezp

more than $50,000 per weak devoted to (c) Compensation pi��~ aaccounet and

er

oosrtion oomo.,~no~ allowanc

NONE

---------------------------------

---------------------------------

---------------------------------

---------------------------------

Total number of other employees paid over $50 ,000 Part It Compensation of the Five Highest Paid Independent Contractors for Professional Services

(See page 2 of the instructions List each one (whether inOrviduals or firms) It there are none, enter 'None I

(a) Name and address of each independent contractor paid more than $50,000 (h) Type of service (c) Compensation

NONE

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--------------------------------------------

Schedule A (Form 990 or 990-EZ) 20D2

Page 8: Return of Organization Exempt From Income Tax990s.foundationcenter.org/990_pdf_archive/383/383375365/383375… · Mn f man s 22 23 Specific assistance to individuals (attach schedule)

3 Does the organization make grants for scholarships, fellowships, student loans, etc ? (See Note below ) 3 X 4 Do you have a section 403(b) annuity plan for your employees 4 X Note Attach a statement to erplan how the organization detamunes that individuals or organizations any grants or loans from it in furtherance of it chentable programs 'quafily' to starve payments °

I Part 1V I Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions

The organization is not a private foundation because it Is (Please check only ONE applicable box ) 5 ~ AchurCh,convention ofchurChes,orassociation oichurches SeCtlon170(D)(1)(A)(i) B ~ A school Section 170(b)(7)(A)(n) (Also complete Part V ) 7 0 A hospital or a cooperative hospital service organization Section 170(b)(1)(A)(ni) B 0 A Federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) 9 0 A medical research organization operated in conjunction with a hospital Section 170(b)(7)(A)(ni) Enter the hospital's name, cKy,

and state 10, 10 0 An organization operated for tie benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(n)

(Also complete the Support Schedule in Past IV-A I 11a 0 M organization that normally receives a substantial part of it support tram a governmental unit or from the general public

Section 170(b)(1)(A)(w) (Also complete the Support Schedule in Part IV-A ) 116 ~ AcommunflytrustSecUan170(b)(1)(A)(h)(AlsocompteteNeSupporlScheOuleinPaAIV-A) 12 OX An organization that normally receives (1) more than 331/x% of it support from contributions, membership fees, and grass

receipts from activities related to its charitable. etc , functions -subject to certain exceptions, and (2) no more than 33 1/3% 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) (Also complete the Support Schedule in Part IV-A )

13 0 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in (1) lines 5lhrouuh 12 above, or (2) section 501 (c)(4), (5) or (6) . d they meet the test of section 509(a1(2) (See section 509(a)(3) 1

Provide tie folloxanp information about the supported organizations (See gape 5 of the instructions )

(a) Name(s) of supported organization(s) (6) Line number from above

14 ED M organization organized and operated to test for public safety Section 509(a)(4) (See gape 5 of the instructions

Schedule R (form 990 or 990-EZ) 2002

223111 o,-2zm

973171 11461022 759636 97317 2002 .06030 BARUCH SLS INC .

Schedule A(Farm990or990-¢)2002 BARUCH SLS INC . 38-3375365 Pape2

Pact 111 Statements About Activities (See papa 2 01 the instructions ~ Yes No

1 During the year, has the organization attempted to influence national, state, or local legislation, Including any attempt to influence public opinion on a legislative matter or referendums It Yes; enter the total expenses paid or incurred in connection with the lobbying adivNes " E E (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B ) 1 X Organizations that made an election under section 501(h) by filing Farm 5768 must complete Pad VI-A Other organizations checking 'Yes,' must complete Part VI-0 AND attach a statement giving a detailed description of the lobbying activities

2 During the year, has the organization . either directly or indirectly, engaged in any of the follovnnq acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of then families, or with any taxable organization with which any such ,' person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary? Of the answer to any question is 'Yes,' attach e detailed statement explaining the transactions) SEE STATEMENT 6

a Sale, exchange, or leasing of properly 2a X~

D Lending of money or other extension of credit'

c Furnishing of goods, services, or facilities?

d Payment of compensation (or payment or reimbursement of expenses d more than E7,000)? 1 2E

e Transfer of any part of its income or assets

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3 A

15 ums,pants,anacontributions received (DO not include unusual

17 Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities in any activity that is related to the organization's charitable, etc, purpose

18 Gross income from interest, dividends, amounts received from payments on securities loans (sec- lion 512(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975

19 Net income from unrelated business activities not included in line 18

pall to it or expended on its behalf 21 The value of services or facilities

furnished to the organization by a governmental unit without carpe Do not include the value of services or facilities generally furnished to the public without charge

pp Other income Attach a schedule Do not include gain or (loss) from sale of capital assets

23 Total of lines 15 through 22 24 one 23 minus line 17 25 Enter 1 % of line 23

n urvCJlmenl mwnrc w~~~~~~ U... e vo, cyiumn ie) InYmerawrl um~ny ey nne u~ ~acny~nwawq~ i ~ uu ~ i-p

28 Unusual Grants For an organization described in line 10, 11, or 12 that received any unusual grants during 1998 through 2001, prepare a list for your records to show, for each year, the name of the contributor, the dale and amount of the grant, and a brief description of the nature of the grant Do not file this lid with your return Do net include these pants in line 15

223121 01-22-m NONE sd,eamen~990 a, e90-EZ) 2002 9

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Support Schedule (Complete only if you checked a box on line 10, 17, a 12 ) U5 Note You me use the worksheet in the instructions for converhn from the eccn

(of fiscal year (a) 2001 M 2000 la) 1999

26 Organizations described on lines 10 or 11 a Enter 2% of amount in column (e), line 24 . 26a N/A b Prepare a list for your records to show the name of and amount contributed by each person (other than a povemmental

unit or publicly supported organization) whose total grits for 1998 through 2007 exceeded the amount shown in line 26a DO not file this list with your return Enter the Sum of 211 these excess amounts 111~ 26h N/A

c Total support for section 509(a)(1) test Enter line 24, column (e) 110- 26c N/A d Add Amounts from column (e) for lines 18 19

22 26b 10- 26a N/A e Public support (line 26c minus line 26G total) 1 ~ 26e N/A

27 Organizations described on line 12 a For amounts included in lines 15, 16, and 17 teal wee received from a'disaualified person ; prepare a list for your records to show the name of, and total amounts received in each year from, each 'disqualified person' Do not file this list with your return Enter the sum of

such amounts for each year (2001) 0 . (2000) 0 . (1999) 0 . (1998) 0 .

h For any amount included in line 17 that was received from each person (other than'disqualifie0 persons'), prepare a list for your records to show the name of,

and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations

described in lines 5 through 11, as well as individuals ) Do not file flits list rtth your return After computing the drfterence between the amount received and the larger amount described in (7) or (2), enter the sum of these differences (the excess amounts) for each year

(2001) 0 . (2000) 0 . (1999) 0 . (1998) 0 .

o Add Amounts from column (e) tar lines 15 16

17 3, 477, 168 . 20 21 1110- 27o 3 , 477 , 168 .

d Add Line 27a total 0 . and line 27b total 0 . " 27d 0 .

. e Public support (line 27c total minus line 27d total) 1 27e 3,477,168 .

f Total support for section 509(a)(2) test Enter amount on line 23, column (e) 1 I 27f I 3,477, 173 .

g Public support percentage Qine 27e (numerator) divided by line 27f (denominator)) 1 27 99 .9999%

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733131 07-22-07

10

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Schedule A(FOrm990or990-¢)2002 BARUCH SLS INC . 38-3375365 Page 4 Part V Private School QuesUonnaire (See page 7 of the instructions ) N/A

(To be completed ONLY by schools that checked the box on line 6 in Part 11~

29 Does the org anization have a racial ly nondiunminato Yes No

y ry policy toward students by statement in its charter, bylaws, oNer poveminp instrument, or in a resolution of its governing body 29

90 Does the organization include a statement at As racially nondiscriminatory poly toward students in all it brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and schoWrships9 "30~`

91 Has the organization publicized it racially nondiscriminatory policy through newspaper or broadcastmedia during the period of solicitation for students, or during the registration period h R has no solicitation program, in a way that makes the policy known , , to ail parts of the general community R serves `31 It Yes,' please describe, d No .' please explain (If you need more space, attach a separate statement )

t f

32 Does the organization maintain the following a Records indicating the racial composition o1 the student body, fatally, and administrative staff? 32a b Records documenting that scholarships and other financial assistance era awarded on a racially nondiscriminatory basis 32b c Copies o1 all catalogues, brochures, announcements, and other written communications to the public dealing with student

admissions, programs, and scholarships 32e U Copies of all material used by the organization or on its behalf to solicit contributions? 92d

If you answered No'to any of the above, please explain (I1 you need mope space, attach a separate statement )

33 Does the organization discriminate by race in any way with respect to a Students' rights or privileges? b Admissions policies c Employment of faculty or admmtstraWe staff? d Scholarships or other financial assisGnce7 e Educational policies f Use of facilities? p Athletic programs?

Other extracurricular admUes7 If you answered 'Yes' to any of the above, please explain (If you need more space, attach a separate statement

30 a Does the organization receive any financial aid or assistance from a governmental apency7 ~qa b Has the organization's right to such aid ever been revoked or suspended? 34b

If you answered 'Yes" to either 34a or b, please explain using an attached statement 95 Does the organization ceAAy that K has complied with the applicable requirements of sections 4 01 through 4 05 of Rev Proc 75-50,

1975-2 C 8 587, covering racial nondiscrimination? It No.' attach an explanation 35 Schedule A (Form 990 or 890-EZ) 2002

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990 or 990-EZ) 2002 BARUCH SLS INC . Lobbying Expenditures by Electing Public Charities (Seepage 9 of the instructions) (To be completed ONLY by an elaible organization that filed Forth 5768)

Schedule A

must file Form

4-Year Averaging Period Under Section 507(n) (Some organizations that made a section 507(h) election do not have to complete all of the five columns

below Sea the instructions tar lines 45 Nrouah 50 on oaae 11 of the instructions 1

Lobbying Expenditures During 4-Year Averaging Period

Ihl 1c1 (it) 2001 2000 1999

N/A (e) Total

0 .

0 .

0 .

0 .

0 .

Calendar year (or (a) fiscal year beginning ln) of . 2002

45 Lobbying nontaxable amount

46 Lobbying ceiling amount 150% of line 45( e ))

47 Total lobbying e xp enditures

48 Grassroots nontaxable amount

49 Grassroots ceiling amount ' 150% of line 48( e ))

50 Graissroots lobbying

I Part VI-H 1 Lobbying Activity by Nonelecting Public Charities (For reporting only by organizations that did not complete Part VI-A) (See papa 11 of the instructions ) N/A

During the year . did the organization attempt to influence national, stale or local legislation, including any attempt to Yes No Amount

influence public opinion on a legislative matter or referendum, through the use at a Volunteers - h Paid stall or management (Include compensation in expenses reported on lines c through A e Media advertisements 0 Mailings to members, legislators, or the public e Publications, or published or broadcast statements 1 Grants to other organizations for IobbNnp purposes p Deed contact with legislators, their staffs, government officials, or a legislative body h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means ~~----~~- I Total lobbying expenditures (Add linese through h ) / ° 0 .

It 'Yes' to any of the above, also attach a statement giving a detailed descnpbon of the lobbying activities

zz~m Schedule A (Form 990 or 990-EZ) 2002 o'" 11

11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

Limits on Lobbying Expenditures

term 'ewendRUres' means amounts paid or incurred

36 Total lobbying expenditures to influence public opinion (grassroots; lobbying) 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 98 Total lobbying expenditures (add lines 36 and 37) 39 Other exempt purpose expenditures 40 Total exempt purpose expenditures (add lines 38 and 39) 41 Lobbying nontaxable amount Enter the amount from the following table -

If the amount on line 40 I: - The lobbying nontaxable amount Is -

No[ we 5500000 20% of Me amount on line CO

Ow f500,000butrotwsf100p,OpD $100 000 plus 15% of Me e=ess over $50D 000

O+aS1,000,000butnotwa31,500,000 f175,000plus 10%o1Ne. waS10m,000

dsf150000DWtnotws577,000,W0 f733,000Pluts 5% of Me excess wv$1,500 000

Over 517000,000 $1,000000

42 Grassroots nontaxable amount (enter 25% of line 41) 43 Subtract line 42 from line 36 Enter- A line 42 a more than line 36 44 Subtract line 41 from line 38 Enter -0- d line 41 is more lean line 38

(8) Affiliated group

totals

N/A

8-3375365 N

(6) To be completed for ALL electing organizations

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52 a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501(c) of the Code (other than section 501(c)(3)) or in section 527 " ~ Yes ~X No

n If Yes .' complete the following schedule N/A

12 2002 .06030 BARUCH SLS INC . 97317 11461022 759636 97317

Schedule A(FOrm 990or990-EC)2002 BARUCH SLS INC . 38-3375365 Page 6 Part VII Information Regarding Transfers To and Transactions and Relationships With Noncharitable

Exempt Organizations (See page 12 a1 the instructions 1 51 Did the reporting organization directly of indirectly engage in any of the following with any other organization described m section

501(c) of the Code (other than section 501(c)(3) organizations) Or m section 527, relating to political organizations') e Transfers from the reporting organization to a nonchantable exempt organization of yes No

51 all) X (I) Cash (II) Other assets alit) X

If Other transactions (I) Sales or exchanges of assets with a nonchantable exempt organization b(l) X (II) Purchases of assets from a nonchantable exempt organization bill) X

(III) Rental oifacildies,eqwpment,orother assets 6111) X (Iv) Reimbursement arrangements (v) Loans or loan guarantees ~1v) X

(vl) Performance of services or membership or Nnd2isinp solicitations b~vl) X e Sharing of facilities, equipment, mailing lists, other assets, or paid employees d lithe answer to any of the above is Yes; complete the following schedule Column (b) should always show tie fair market value of the

goods, other assets, or services given by the reporting organization It the organization received less than fair market value in any transaction or sharing arrangement, show m column (0) the value of the goods . other assets, or services received N/A

(a) (~) (c) (d) Line no Amount involved Name of nonchantable exempt organization Description o1 transfers . transactions, and sharing arrangements

(a) Name of organization

(6) Type of organization

M Description of relationship

Schedule A (Form 990 or B90-EZ) 2002

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BARUCH SLS~INC . 38-3375365

FORM 990 OTHER EXPENSES STATEMENT 1

FUNDRAISING

FOOD 64,174 . 64,174 . CONTRACT LABOR 3,937 . 3,937 . MISCELLANEOUS 459 . 382 . 77 . WORKERS COMP INSURANCE 10,409 . 10,409 . LAUNDRY EXPENSE 2,512 . 2,512 . AUTO OPERATIONS 11,615 . 11,615 . DUES, FEES AND SUBSCRIPTIONS 3,976 . 3,976 . ADVERTISING 10,726 . 10,097 . 629 . PROPERTY INSURANCE 5,028 . 5,028 . PROPERTY TAXES <2,851 .> <2,851 .> MANAGEMENT FEES 76,567 . 76,567 . UTILITIES 35,732 . 35,732 . TRASH 1,694 . 1,694 . INCENTIVES 1,573 . 1,573 . TRAINING/EDUCATION 850 . 850 . PHYSICALS 536 . 536 . GENERAL INSURANCE 30,994 . 30,994 . SERVICE CONTRACTS 4,474 . 4,036 . 438 . AUTO LEASING 58,106 . 58,106 . BAD DEBTS 9,698 . 9,698 . NETWORK CONSULTING 869 . 869 . LEASED EMPLOYEE EXPENSES 1,207,231 . 996,119 . 211,112 .

TOTAL TO FM 990, LN 43 1,538,309 . 1,150,160 . 388,149 .

FORM 990 OTHER ASSETS STATEMENT 2

TOTAL TO FORM 990, PART IV, LINE 58, COLUMN B

STATEMENT S) 1, 2 973171

13 11461022 759636 97317 2002 .06030 SARUCH SLS INC .

(A) (B) (C) PROGRAM MANAGEMENT

DESCRIPTION TOTAL SERVICES AND GENERAL

(D)

DESCRIPTION

INTANGIBLE ASSETS - NET OTHER DEPOSITS INSURANCE ESCROW MISCELLANEOUS RECEIVABLE INTERFACILITY TRANSFER

AMOUNT

59,800 . 3,955 . 2,325 . 17,822 .

1,287,016 .

1,370,918 .

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`BARUCH SLS INC . 38-3375365

FORM 990 OTHER LIABILITIES STATEMENT 3

STATEMENT 5

LINE EXPLANATION OF RELATIONSHIP OF ACTIVITIES

BARUCH BORROWS AND LENDS MONEY TO AND FROM LEISURE LIVING MANAGEMENT .

14 STATEMENT S) 3, 4, 5, 6 11461022 759636 97317 2002 .06030 BARUCH SLS INC . 973171

DESCRIPTION

ACCRUED LIABILITIES INTERFACILITY TRANSFERS RELATED COMPANY PAYABLE INTEREST PAYABLE

TOTAL TO FORM 990, PART IV, LINE 65, COLUMN B

FORM 990 IDENTIFICATION OF RELATED ORGANIZATIONS PART VI, LINE 80B

NAME OF ORGANIZATION

GENESIS COMPANIES,INC ., TJT PROPERTIES INC .

FORM 990 PART VIII - RELATIONSHIP OF ACTIVITIES TO ACCOMPLISHMENT OF EXEMPT PURPOSES

AMOUNT

291,226 . 275,856 .

1,347,100 . 8,038 .

1,922,220 .

STATEMENT 4

EXEMPT NONEXEMPT

X

93A SUPPORTIVE SERVICES REVENUE TO SUPPORT PROGRAM SERVICES 93B RESPITE REVENUE TO SUPPORT PROGRAM SERVICES, ELDERLY ASSISTANCE 93C ENTRY FEES TO SUPPORT PROGRAM SERVICES, ELDERLY ASSISTANCE 93D ANCILLARY REVENUE TO SUPPORT PROGRAM SERVICES, ELDERLY ASSISTANCE 93E ALZHEIMERS REVENUE TO SUPPORT PROGRAM SERVICES, ELDERLY ASSISTANCE 93F REIMBURSEMENTS FROM MEDICAID AND MEDICARE 93G SUPPORT RECEIVED FROM GOVERNMENTAL AGENCIES

SCHEDULE A STATEMENT REGARDING ACTIVITIES WITH STATEMENT 6 SUBSTANTIAL CONTRIBUTORS, TRUSTEES, DIRECTORS,

CREATORS, KEY EMPLOYEES, ETC, . PART III, LINE 2

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tax payments made Include any prior year overpayment allowed as a credit

Balance Due . Subtract line 3b from line 3a Include your payment with this form, a, A required, deposit with FFD coupon w, R required, by using EFfPS (Electronic Federal Tax Payment System) See Instructions N/A

Signature and Verification

e examined this forth, including accompanying schedules and statements, and to the best of my knowledge and belief, onzed to prepare this forth

J- ' Title 1111- Date " Notice, see instruction Forth 8888 (12-2000)

16090513 759636 97317 2002 .05040 BARUCH SLS INC . 973171

8868 I Application for Extension of Time To File an (December 2000) ~ Exempt Organization Return OMB No 1545-1709 oR~nerm.r, ,y bema w. s~ios " File a separate applration for each return

" K you ere filing for an Automatic 3-Month Extension, complete only Port I and check this box 0 H you are filing for en AdMaonal (not automatic) 3-Month Extension, complete only Part II (on page 2 of tam form) Note: Do not complete Part II unless you have already been granted an automaUe 3-morrth extension on a provwusy filed Form 8888.

Part !' Automatic 3-Month Extension of Time - Only suborn original (no copes needed) Note : Farm BBo-T corporations requesting en aitomabc 6-month extension - dix* Mls box and complete Part I only No. AO offer corporations (1nGudlny Form 990-0 films crust use Form 7004 to request en exfenron of Bore to ft income tax ra0ims Pertnrrshys, RFJNICs end trusts nest use Form 8 736 to request en exMnslon of 6me to file Form 1065, 1066, or 1047 Type a Name of Exempt Organhetwn Employer Identification number print

HARUCH SLS INC . 38-3375365 ,F�~', am Number, street . and room w suite no H a P O box, sea Instructions

yw' 11571 E . FULTON ~m 9ee eem. .+iom City, town or post office, state, and LP coda For a foreign address, see instructions

LOWELL MI 49331

Cheek type of return to be filed(file a separate application for each return)

Forth 990 = Form 99o-T (corporation) 0 Forth 4720 Forth 99D-BL 0 Form 990T (sec 4010 or 4080 trust) ~ Form 5227

0 Form 990~Q ~ Forth 990~T (trust other than above) ~ Form 6089 0 Forth 990-PF 0 Forth 1041-A ~ Form 8870

* II the organization does not have an office or place of business in the United States, check this box 1 0 0 M this m fix a Group Return, enter the organization's four digit Group Exemption Number (GEM 7 this is for the whole group, check ihm box " 0 If it is for part of the group, check this box " 0 and attach a list with the names and EINs of ell members the extension will cover

1 I request an automatic 3Yrwntn (6-month, roc 990-t corporation) extension of time until AUGUST 15, 2003 to file the exempt organization return for the organization named above me extension iv for the organization's return for " OX calendar year 2 0 0 2 or " 0 tax year beginning , and ending

2 K this tax year m for less than 12 months, check reason ~ Initial return Final return ~ Change in accounting period

3a If this application is for Form 990 BL, 99o-PF, 99PT, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b I( this application is for Forth 990-PF or 990-T, enter any refundable credits and estimated

rtrs

LHA For

zzaavi 0"i-M

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Under penalties of penury, I declare that I have examined this form, including accompanying schedules and statements, and [o the best of my knowledge and belief, it is trua,correct, and complete, and that I am authonzed to prepare this form

ell i 103 ,--/~ Notice to Applicant - To Be Completed by the IRS

We hav. aooroved this aop4cation Please attach this torte to the ornanizannn's return We have not approved this application However, we have granted a 10-day grace period from the later of the date shown below or the due

By Director Date

Alternate Mailing Address - Enter the address if you want the copy of this application for an additional 3 month extension returned to an address different than the one entered above -- ,; ,

Name THE

.~~

-'

Form 8868 (12-2000)

Type Number and street (include suite, room, or apt no ) Or a P O box number 0'7""t 3230 EAGLE PARK DRIVE, SUITE 201

City or town, province or state, and country (including postal or ZIP code) GRAND RAPIDS, MI 49525

Form 8868 (12-2000) Page 2 If you are filing for an Additional (not automate) 3-Month Extension, complete only Part II and check this box " ~X

Note Only complete Part II if you have already been granted an automatic 3-month extension on a prevrousy filed Form 8868 If you are filing for an Automatic 3-Month Extension, complete only Part I (on page 1)

Part IF Additional not automatic) 3-Month Extension of Time - Must file Onginal and One Copy.

Type or Name of Exempt Organization Employer identification number

print ARUCH SLS INC . 38-3375365 Hie °Y M` .tmaea Number, street, and room or suite no If a P O box, see instructions For IRS use only ati .a.+oror 11571 E . FULTON ROnp Ns '.w. see City . town or post office, state, and ZIP code For a foreign address, see instructions '"'w`°°"' DWELL MI 49331 Check type of return to be filed (File a separate applicatron for each return) ~X Form 990 0 Form 990~EZ ~ Form 990 T (sec 4010 or 408(a) trust) ~ Form 1041 A 0 Form 5227 ~ Form 8870

Forth 990-BL 0 Forth 990 PF 0 Form 99o-7 (trust other than above) El Form 4720 E] Forth 6069

STOP- Do not complete Part II A you were not already granted an automatic 3-month extension on a previously filed Form 8868

" If the organization does not have an once or place of business in the United States, check this box " 0 " If this is !c" a Croup Return, enter the organization's ! :vir diE4 l;"oun Exemption Number (CEN) If this is for the whole pra:~, check this box " E:1 If h is for part of the group, check this box 1 0 and attach a list with the names and EINs of all members the extension is for

4 1 request an additional 3-month extension of time until NOVEMBER 17, 2003 5 For calendar year 2 0 0 2 , or other tan year beginning ~--- ' - " a, id 8 If this tax year is for less than 12 months, check reason ~ Initial return 0 Final return ~ Change in accounting penod 7 State in detail why you need the extension

ADDITIONAL TIME IS REQUIRED TO PREPARE A COMPLETE AND ACCURATE RETURN

8a If this application is for Form 990-BL, 990-PF, 990T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b If this application is for Form 990 PF, 990 T, 4720, or 6069, enter any refundable credits and estimated tax payments made Include any prior year overpayment allowed as a credit and any amount pad previously with Form 8868

e Balance Due Subtract line 8b from line Ba Include your payment wtth this form, or, d required, deposit with FTD coupon or, if required, by using EFfPS (Electronic Federal Tax Payment System) See Instructions $ N/A

Signature and Verification

date of the organization's return Including any pnor extensions) This grace period is considered to be a valid extension of time for elections othervnse required to be made on a ninety return Please attach this forth to the organization's return We have not approved this application After considenng the reasons stated in Mem 7, we cannot grant your request for an extension of time to file We era not granting the 10day grace penod

0 We cannot consider this application because it was filed after the due date of the return for which an extension was requested 0 Other