OMB No 1545 00C7 Return of Organization Exempt from Income Tax Under Section 501(c), 527, or 4947(axl) of the Internal Revenue Code

(except black lung benefit trust or private foundation)

izadon may have to use a copy of this return to satisfy state reporting requirements earb loom Jun 1 . 2007 . and endma Mav 31

Open to Public Inspection Internal Revenue Service ~ I

A Forthe2001calendar' B Check d applicable

R~~

2002 Employer Identification Number 52-1860379 Telephone number

(410) 651-9852

y tax eg p ' Name of organization

Address change IRSIaEN Three Lower Counties Community Services Inc or P ~M

street (or P O box ,f mail .s not delivered to street addr RooMSUita orryp~ Name change

Number Initial ieluen spcl0c 12179 Elm Street-P 0 Box 191 FinalieWm Uon~ Ciy,TOwnorCountry State ZIP CCEe+<

Amended return Princess Anne MD 218$3 Other

Applufation Pending 9 Section S0l(CX3) organizations and 4947(axl) nonexempt H and l ale not applicable ro Section 577 apanmGOns charitable trusts must attach a completed Schedule A H (a) Is this a group return ion aniiiates7 ~ r.. X~ No

G Web site . (Forth 990 or 990.F4

~ H (b) II yes enter number of attihaies ll~

H (C) Are all affiliates ncluded!7 Yes No J Organization ty e (u no attach a list see instructions)

check onl one ~ 0 sui(c) 3 " Uosen m ) 11 aga7(,)(i)or sn K Check here s" i( the organizations gross receipts are normally not more than

H (d) is this a separate return mica by an

$25,000 the organization need not file a return with the IRS, but d the organization aQa~~sai~ m~e~ed by a on" ruling' Yes X Na

rou GEN received a Form 990 Package in the mail, it should file a return without financial data I Enter 4 ]I!?, Some states require a complete return . M Check " f the organization is not required

L Gross recei p ts Add lines 6b, 8b, 9b, and 10b to line 12 ~ 4, 703, 966 to attach Schedule B (Form 990, 990 E2, or 990 PF)

Part I Revenue Expenses, and Changes m Net Assets or Fund Balances see instructions ) 1 Contributions, gifts, grants, and similar amounts received a Direct public support 1 a b Indirect public support 1 b c Government contributions (grants) 1 c 1,146,666 d Total tic) (cash ~ 1 , 146, 066 noncash Id 1 . 146 , 066

2 Program service revenue including government tees and contracts (from Part VII, line 93) 2 3 , 224 , 972 3 Membership dues and assessments 3 4 Interest on savings and temporary cash investments 4 10 746 5 Dividends and interest from securities 5 6a Gross rents 6a b Less rental expenses 6b c Net rental income or (loss) (subtract line 6b from line 6a) 6c

7 Other investment income (describe ~ 7

Sa Gross amount from sales of assets other (A) Securities (B) Other

than inventory Ba o E b Less cost or other basis and sales expenses Bb c~ -j c Gain or (loss) (attach schedule) Sc CD d Net gain or (loss) (combine line Sc, columns (A) and (B)) Bd

9 Special events and activities (attach schedule) a Gross revenue (not including $ of contributions

reported on line la) 9a b Less direct expenses other than fundraising expenses 9b c Net income or (loss) from special events (subtract line 9b from line 9a) 9c

10a Gross sales of inventory, less returns and allowances 10a Q b Less cost of goods sold nlip

t Gross profit or (loss) from sales of inventory (attach schedule) (subtract line 1 e~~~ V I C ` ~v 11 Other revenue (from Part VII, line 103) yn~ L.~ ~ lY ~ 1 322, 182 1 12 Total revenue (add lines ld, 2, 3, 4, 5, 6c, 7, Sd, 9c, lOc, an 11) LSU 12 4 703, 966 13 Program services (from line 44, column (B)) 203 13 3 , 099 , 044 14 Management and general (from line 44, column (C))

f

1 4 74 838,932 v 15 Fundraising (from line 44, column (D)) 15 0 16 Payments to affiliates (attach schedule) 16 E V

- 17 Total expenses add lines 76 and 44, column A) P1; pIC17 3 , 937 , 976

A 18 Excess or (deficit) for the year (subtract line 17 from line 12) -V8- 765 990 w 5 ~ 19 Net assets or fund balances at beginning of year (from line 73, co mn (A)) `1` 19 223 , 917 n r T 20 Other changes in net assets or fund balances (attach explanation) 20

S 21 Net assets or fund balances at end of ear combine lines 18, 19, and 20) 21 989 , 907 BAA For Paperwork Reduction Act Notice, see the separate instructions TEEnoioi ovivoz Form 990 (2001)

011 RES0,rtT FEB 1 9 203 ~.~

Form 990 2001

F m.lned""x` I I Cash IX I Accrual

's Community Services, Inc 52-1860379 Page 2 ln585 All organizations must complete column (A) Columns (B), (C), and (D) are organizations and section 4947(a)(1) nonexempt charitable trusts but optional for others

(A) Total (B) Program (C) Management (D) Fundraising services and general

required for section 501(c)(3) and

Do not include amounts reported on line 66, 86, 96 106, or 16 of Part 1

22 Grants and allocations (att sch) (cash $ non cash $ )

23 Spenfic assistance to individuals (at: sch) 24 Benefits paid to or far members (act sch) 25 Compensation Of Officers, directors, etc 26 Other salaries and wages 27 Pension plan contributions 28 Other employee benefits 29 Payroll taxes 30 Professional fundraising fees 31 Accounting fees 32 Legal fees 33 Supplies 34 Telephone 35 Postage and shipping 36 Occupancy 37 Equipment rental and maintenance 38 Printing and publications 39 Travel 40 Conferences, conventions, and meetings 41 Interest 42 Depreciation, depletion, etc (attach schedule) 43 Other expenses not covered above (itemize)

a see attached schedule b t d e

44 Total functional expenses (add lines 22 43) 0 al I t I mns (B) (D)

129 , 215 46,608 126,125 64,583

0 0 51,559 22 , 096

0 16 , 244 153,672 18,864 42 , 088 18,656 9,636 2,773

79,291 0 15,435 15,325

0 0 3,681 7,889 13,192 8,102 63 , 562 17 , 643 104 , 685 25,044

482 .675 142 .681

129 .729

0

b Medical Services-provided - Pediatrics -------------------------------------------------------------------------------------------------------------

(Grants and allocations $

cMedical Services-provided - Dental ______-_-_-__-________________ ------------------------------------------------------------------------------------------------------------

(Grants and allocations $ ) Medical Services- provided - Chesapeake-Health - -____________________ ------------------------------------------------------------------------------------------------------------

(Grants and allocations $ )

e Other program services

f Total of Program Servo

Bl~ Form 990 (2001) TEEA0102 01/01/02

172

w~aUPSelotalsmoiioesi3~15 44 3,937,976 3,099 044 838 , 932 Joint Costs. Check ~U ii you are following SOP 98 2 Are any point costs from a combined educational campaign and fundraising solicitation reported in (B) Program services? ~0 Yes E] No If 'Yes,' enter (i) the aggregate amount of these joint costs $ , (u) the amount allocated to program services $ , piQ the amount allocated to management and general $ ,and (iv) the amount allocated

to fundraisino $

What is the organization's primary exempt purposes " to p=o.id- medical s=r.ic-_to tne.=eey--inr-ecounties _t n_ryt �@ropram Service ed( 5011 All organizations must describe their exempt purpose achievements in a clear and concise manner Stale the number of ~`q orpanvzboi clients served, publications issued, etc Discuss achievements that are not measurable (Section 501(c)(3) & (4) organ ~ a~(,) Sig�,s �.~~~nc R carnnn 19671a1n1 nnnoxemN chantahlP. Imsts must also enter the amount of oranls & allOtalions t0 others ) ootiona of

a Medical Services-provided-Adult Medicine-____-_--______________ ------------------------------------------------------ ------------------------------------------------------

Grants and allocations $ 758 194

allocations 462 .765

TEEA0103 03/25/01

-rorm99o(2oot) Three Lower Counties Community Services, Inc 52-1860379 Page 3

Pact IV Balance Sheets (see instructions)

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

45 Cash - non-interest-bearing 878 45 236 .4

C F-46 Savings and temporary cash investments 56,858 46 972,2 -

47a Accounts receivable 47a 846, 594 b Less allowance for doubtful accounts 47b 125 . 499 652,466 47c 721 .095

48a Pledges receivable 48a b Less allowance for doubtful accounts 48b q8c

49 Grants receivable 49 364,615

p 50 Recervables from officers, directors, trustees, and key s employees (attach schedule) 50 s e 51 a Other notes & loans receivable (attach sch) 51 a s b Less allowance for doubtful accounts 51 b 51 c

52 Inventories for sale or use 52 26,030 53 Prepaid expenses and deferred charges 42 , 744 53 12,413 54 Investments - securities (attach schedule) 11~[] Cost E] FMV 54 SSa Investments - land, buildings, & equipment basis SSa

b Less accumulated depreciation (attach schedule) SSb SSc

56 Investments - other (attach schedule) 100 56 56,399 57a Land, buildings, and equipment basis 57a 1,828 . 410

b Less accumulated depreciation (attach schedule) 57b 502,075 1,402,555 57c 1 1 326 . .335

58 Other assets (describe " a/r third party payors ) 198,266 58 1,565 59 Total assets (add lines 45 throug h 58) (must equal line 74) 2 , 353, 867 59 3,717 , 149 60 Accounts payable and accrued expenses 301 579 60 2$4 576 61 Grants payable 61 62 Deferred revenue 433, 811 62 1 , 151 999 63 Loans from officers, directors, trustees, and key employees (attach schedule) 63 64a Tax-exempt bond liabilities (attach schedule) 64a

b Mortgages and other notes payable (attach schedule) 1 , 394 560 64b 1 303 972 s 65 Other liabilities (describe " ) 65

66 Total liabilities (add lines 62'h2, h 65 2, 129, 950 66 2 , 740, 547

N Organizations that follow SFAS 117, check here " U and complete lines 67

through 69 and lines 73 and 74 67 Unrestricted -136,083 67 616, 602 68 Temporarily restricted 68 69 Permanently restricted 360,000 69 360 000

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

70 Capital stock, trust principal, or current funds 70 71 Paid-in or capital surplus, or land, building, and equipment fund 71 72 Retained earnings, endowment, accumulated income, or other funds 72

73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72, column (A) must equal line 19 and column (B) must equal line 27) 223,917 73 976,602

74 Total liabilities and net assets/fund balances (add lines 66 and 73) 2 , 353 .867 74 3,717 , 149

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization How the 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 accurate and fully describes, in Part III, the organizations programs and accomplishments

BAA

-1860379 Services, P

'Form 990 2001) Three Lower lounges lommunt Part IV-A Reconciliation of Revenue per Audited

Financial Statements with Revenue per Return (See instructions )

of Expenses per Audited Financial Statements with Expenses per Return

a Total expenses and losses per audited financial statements

b Amounts included on line a but not on line 17, Form 990

(1) Donated serv-ices and use of facilities $

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

(3) Losses reported on line 20, Farm 990 $

(4) Other (specify)

Add amounts on lines (1) Through (4) c Line a minus line b

d Amounts included an line 77, Form 990 but not on line a :

(1) Investment expenses not included on line 6b, form 990 $

(2) Other (specify)

Add amounts on lines (1) and (2)

e Total expenses per line 17, Form 990 (line c plus line d)

a Total revenue, gains, and other support per audited financial statements

b Amounts included on line a but not an line 12, Form 990

(1) Net unrealized gains on investments $

('2) Donated serv ices and use of facilities $

(3) Recoveries of poor year grants $

(4) Other (specify)

-----

Add amount on lines (1) through (4) c Line a minus line b

d Amounts included an line 12, Form 990 but not on line a .

(1) investment expenses not included on line 6b, Form 990 $

(2) Other (specify)

-----

Add amounts on lines (1) and (2)

e Total revenue per line 12, Form 990 (line c plus hoe d)

3 . 937,976

3,937,976 ed, see instructions )

(E) Expense account and other

allowances

0

0

0

0 i

0

(B) Title and average hours (C) Compensation (D) Contributions to

(A) Name and address per week devoted (f not paid, employee benefit to position enter-0.) plans and deferred

comoensahon

3

Robert Fitzg_eraLd--____-__ FitzRerald Rd Princess Anne, Eldon-Willing--___-_-____ 10652 Haines Point Rd-Chance, Brenda Hooks Princess Anne, Md

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

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

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

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

ce-Pres

0

0

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 organizations7 ~ []Yes X~ No

If 'Yes ; attach schedule - see instructions gqq TEEA01041 10/18101 Form 990 (2001)

Joan- G - Robbins 27288 Heritage Ct -Salisbury,M Mahmaud Shirazi 5671 Roval Mile Blvd,Salisbury .

LaRue erector

resident

401 108 .167

0

0

nties Community Services, Inc 52-1860379

X

to 501(c)(3) and 501(c~(4) organizations Did the organization engage in any Section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year7 If 'Yes,' attach a statement explaining each transaction

c Enter Amount of tax imposed on the organization managers or disqualified persons during the year under Sections 4912, 4955, and 4958 0

d Enter Amount of tax on line 89c, above, reimbursed by the organization 0 90 a List the states with which a copy of this return is filed -

- M a ryj a gcL - - - - - - - - - - - - - - - - -

- - - - - - ri b~ - - - - b Number of employees employed in the pay period that includes March 12, 200T (see instructions) 91 The books are in care of - Scott Tawes

- and Associates, CPA,

- PKeleptione number (410)651-3620 - - - - - -

Located at - 11760 Some rset Avenq!~, _tr~i Ep;j~s2 nne MD ZIP+ 4- 21853 - - - - - - - - - - - - -

_L - - - - - - - - - - - - - - - - - - - - - - - - - -92 Section 49~7Fa~(I) nonexempt charitable trusts filing Form 990 in lieu of Form 1041 - Check here

and enter the amount of tax-exempt interest received or accrued during the tax year 92 BAA Form 990 (2001)

TEEAOID5 01/01/02

76 Did the organization engage in any activity not previously reported to the IRS7 If 'Yes,' attach a detailed description of each activity 6

77 Were any changes made in the organizing or governing documents but not reported to the IRS? If 'Yes,' attach a conformed copy of the changes

78a Did the organization have unrelated business gross income of $1,000 or more during the year covered by this return? 78 b If 'Yes,' has it filed a tax return on Form 990-T for this year7 78

79 Was there a liquidation, dissolution, termination . or substantial contraction during the year? If 'Yes,' attach a statement

80a Is the organization related (other than by association with a statewide of nationwide organization) through common membership, governing bodies, trustees, officers, etc, to any other exempt or nonexempt organization7 80a

to If 'Yes,' enter the name of the organization . . . . . . . . . . . . . . . . . . . - - - - 0 n - - - - - - - - - - - - - - - - - - - - - - - - - - - - and check whether it is -0-exempt or onexempt

81 a Enter direct or indirect political expenditures See line 81 instructions I 81al 0 b Did the organization file Form 1120-POL for this year? 81 to

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

b If Yes.' you may indicate the value of these items here Do not include this amount as revenue in Part I or as an expense in Part 11 (See instructions in Part III ) I 82bj

83a Did the organization comply with file public inspection requirements for returns and exemption applications? to Did the organization comply with the disclosure requirements relating to quid pro quo contributions?

84a Did the organization solicit any contributions or gifts that were not tax deductible7

b It 'Yes,' did the or anization include with every solicitation an express statement that such contributions or gifts were not tax clecluctible'R

85 501(c)(4) (5), or (6) organizations a Were substantially all dues nondeductible by members? b Did the organization make only in house lobbying expenditures of $2,000 or less7

If 'Yes' was answered to either 85a or 851b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year

c: Dues, assessments, and similar amounts from members 85cl d Section 162(e) lobbying and political expenditures 85d e Aggregate nondeductible amount of Section 6033(e)(1)(A) dues notices

'5! f Taxable amount of lobbying and political expenditures (line 85d less 85e) i5f g Does the organization elect to pay the Section 6033(e) tax on the amount on line 85f7

In If Section 6033(eXIXA) dues notices were sent does the organization agree to add the amount on line 85f to its reasonable estimate of dues allouble to nondeductible lobbying and political expenditures for the followng tax year?

86 501(c)(7) organizations Enter a Initiation fees and capital contributions included on line 12

Is Gross receipts, included on line 12, for public use of club facilities 87 501(c)(12) organizations Enter a Gross income from members or shareholders

IoGross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them )

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 301 7701-2 and 301 7701-37 if 'Yes,'complete Part IX

89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under Section 4911 - 0 , Section 4912 - 0 , Section 4955

Form990(2001) Three Lower Counties Communitv Services . In 6

Unrelated business income Note Enter gross amounts unless (A) (B) otherwise indicated Business code Amount

93 Program service revenue a Patient charges less contr ad ; to c d e f Medicare/Medicaid payments 9 Fees & contracts from government agencies

94 Membership dues and assessments 95 Interest on savings & temporary cash inymnts 96 Dividends & interest from securities 97 Net rental income or (loss) from real estate

a debt financed property b not debt financed property

98 Net rental income or (loss) from pets prop 99 Other investment income 100 Gain or (loss) from sales of assets

other than inventory 101 Not income or (loss) from special events 102 Gross profit or (loss) from sales of unientory 103 Other revenue a

to Mi sc Income c Priority Ptnrs d Management Fees I I Q,

104 Subtotal (add columns (B), (D), and (Q) 105 Total (add line 104, columns (B), (D), and (Q)

Excluded by section 51 (C)

xclusion code

'art Vill I Relationship of Activities to the Accomplishment of Exempt PurposeS (See instructions) Line No Explain how each activity for which income is reported in column (E) of Part VII contributed importantly to the accomplishment

I of the organization's exempt purposes (other than by providing funds for such purposes)

(A) address, and EIN of corporation, nership, or disregarded entity

(a) (C) T(,OD) (E) Percentage of Nature of activities 3tal End of-year marship interest Income assets

X % %

a Did the organization, during the year, receive any funds, directly or indirectly, to pay to Did the organization, during the year, pay premiums, directly or inc Note : If 'Yes'to (b), file Form 8870 andForm 4720 (see instructions)

Tnalties jifrf - p .1fra. garrugir fg., mgi, mcItV Unde . pie 16 ., fuepe el

to in .

icer) is C rr

10" 1 e se Sign Sonatu~!Lroff",

Here 1i

Paid Preparer s

Pre- Signature 1i

arer'S Firm's name (or 5co Gse = if -1-em 11, 17 Only nd adT11e0YeM T-1 :nd ZIP .7

8AA

Tawes & Associates

52-1860379

2, 513, or 514 (E) (D) Related or exempt

Amount I function income

I

Organization Exempt Under Section 501(cX3)

(Except Private Foundation) and Section 501(e), 501(f), 501(k), 501(n), or Section 4947(aXI) Nonexempt Charitable Trust Supplementary Information - (See separate instructions

Supplementary Information - (see separate instructions) Must be completed by the above organizations and attached to their Form 990 or 990-EZ.

----r- . . .

Department of the Treasury Internal Re~mje Sen,,ce

Name of ft Orgmeation

Three Lower Cc ieS Lommunitv ~,ervices . in

(e) Expense account and other

allowances

-~21~.JlYarL Crawford

Maria-Guevera - - - - - - - - - - - - - - - -

1534-B Sharen Drive, Salisbury,Md Dentist 40 82,295 7,916 Total number of other employees paid over $50,000 l* 71

1 Part 11 Compensation of the Five Highest Paid Independent Contractors for Professional Services (See instructions List each one (whether individuals or firms) It there are none, enter 'None ')

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

counting/Consulting 1 54

of others receiving over

Schedule A (Form 990 or 990-EZ) 2001

TEEAD401 01/24102

Schedule A (Form 990 or 990-EZ)

(See instructions List each one If there are none, enter 'None ')

(a) Name and address of each (b) Title and average (c) Compensation employee paid more hours per week

than $50.000 1 devoted to position

_~Lftr~em -D a n 1 e I - - - - - - - - - - - - - - - -

4658 Piney Ridge Ct , alisbury,Md Pediatrician 40 122 .283 10,298

Than Than-Nu - - - - - - - - - - - - - - - -

903 Emerel Ct, Salisbury,11d Pediatrician 40 108,857 7,916

S,2Lqly~. Paras - - - - - - - -

- - - - - - - IPsvchiatrist 401 102 .234 4 .198 802 Longwharf Rd . Salisburv,Md

OMB No 1545 0047

2001

Scott-Tawes and Associates,CPA,-PA - - - - - - - - - - - - - -

11760 Somerset Avenue . Princess Anne . Md 21853

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

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BAA For Paperwork Reduction Act Notice, see the instructions for Form 990 and Form 990-EZ

FP-a-rt Statements About Activities (See instructions ) No

Note Attach a statement to explain how the organization determines that individuals or organizations receiving

and state 10 11 An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(A)(iv)

(Also complete the Support Schedule in Part IV A

11 a LK J An organization that normally receives a substantial part of its support from a governmental unit or from the general public Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV A )

11 b FIA community trust Section 170(b)(1)(A)(vi) (Also complete the Support Schedule in Part IV-A

12 An organization that normally receives (1) mom than 33-1/3% of its support from contributions, membership fees, and gross 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 An organization that is not controlled by any disqualified ersons (other than foundation managers) and supports organizations described in (11 lines 5 through 12 above, or (2) section M (c)(4), (5), or (6), if they meet the test of section 509(a)(2) (See section 50 , , % )

the following information about the instructions

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

14 F1 An organization organized and operated to test for public safety Section 509(a)(4) (See instructions )

BAA TEEAD402 01121102 Schedule A (Form 990 or Form 990 EZ) 2001

or

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 referendum? If 'Yes,' enter the total expenses paid or incurred in connection with the lobbying activities W S 0 0 (Must equal amounts on line 38, Part VI-A, or line i of Part VI-B )

Organizations that made an election under section 501 (h) by tiling Form 5768 must complete Part VI A Other organizations checking 'Yes, must complete Part VI B 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 following acts with any substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority owner, or principal beneficiary7 Of the answer to any question is 'Yes,'attach a detailed statement explaining the transactions )

a Sale, exchange, or leasing of property?

b Lending of money or other extension of cred1t7

c Furnishing of goods, services, or facilities? See Pt V, Fm 990

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)7

e Transfer of any part of its income or assets?

3 Does the organization make grants for scholarships, fellowships, student loans, etc7 (See Note below 4 Do you have a section 403(b) annuity plan for your employees7

FP-a-rt- Reason for Non-Private Foundation Status (See instructions )

The organization is not a private foundation because it is (please check only One applicable box) 5 A church, convention of churches, or association of churches Section 1 70(b)(1 )(A)(1) 6 A school Section 170(b)(1)(A)(n) (Also complete Part V ) 7 A hospital or a cooperafive hospital service organization Section 170(b)(1)(A)(111) 8 A federal, state, or local government or governmental unit Section 170(b)(1)(A)(v) 9 A medical research organization operated in conjunction with a hospital Section 170(b)(1)(A)(iii) Enter the hospital's name, city,

Schedule A (Form 990 or 990 EZ) 2001 Three Lower Counties Community Services, Inc 52-1860379 Part IV-A ) Support Schedule (Complete only if you checked a box on line 10, 11, or 12 ) Use cash methodof accounting. Note: You may use the worksheet in the (nstructrons, for conve" from the accrual to the cash method of accounting

3

Calendar year (or fiscal year (a) beginning in) -L_ 00 1 R A Total

146 .066 1 917 .763 1 872 .763 1 795 .703 1 3 .732

0

Organizations described on line 12. a For amounts included in lines 15, 16, and 77 that were received from a 'disqualified 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 (2000) (1999) (1998) (1997)

bFor an amount included in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records to show L 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 this list with your return After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year (2000) (1999) . . . . . (1998) . . . . . . . . . . . (1997) . . . . . . . . . .

c Add Amounts from column (e) for lines 15 16 17 20 21 -1 27cI

d Add Line 27a total and line 271b total e Public support (line 27c total minus line 27d total) f Total support for section 509(a)(2) test Enter amount from line 23, column (e) g Public support percentage (line 27e (numerator) divided by line 27f (denominator))

28 Unusual Grants For an organization described in line 10, 11, or 12 that received any unusual grants during 1997 through 2000, prepare a list for

our records

to show,,

for each yeatr, the name of the contributor, the date and amount of the grant, and a brief description of the

y g t ot is list

nature of the ran Do n le In IM your return Do not include these grants in line 15 Schedule A (Form 990 or 990-EZ) 2001 BAA TEEA0403 12131/01

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

Gross income from interest dividends, amounts received from payments on secunbes loans (Secbon 512(aX5)), rents, royalties, and unrelated business taxable income (less Section 511 taxes) from businesses acquired by the organ

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

20 Tax revenues levied for the organization's benefit and either paid to it or expended -- - -1-11

21 The value of services or facilities furnished to the organization by a governmental unit without charge Do not include the value of services or facilities generally furnished to the public without charge 0 0 0 0 0

22 Other income Attach a schedule Do not include gain or (loss) from sale of capital assets 288,182 393,367 511,045 52,029 1,244,623

23 Total of lines 15 through 22 3,875,682 1 3,392 179 2,970,041 2,287,945 12-1-52-518-47 24 Line 23 minus line 17 1,444,994 1 , 312 1515 1,384,389 848,516 4,990,414 25 Enter I% of line 23 38,757 33,922 29,700 22,879 26 Organizations descnbed on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 26a 99,808

to Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental Unit or publicly supported organization) whose total gifts for 1997 through 2000 exceeded the amount shown in line 26a Do not file this list with your return Enter the total of all these excess amounts

c Total support for Section 509(a)(1) test Enter line 24, column (e) 26c 4,990,414 d Add Amounts from column (e) for lines 18 13,496 ig 0

22 1,244,623 26b 26d 1,258, 119 . e Public support (line 26c minus line 26d total) 26e 3,732,295 If Public support percentage Qine 26e (numerator) divided by line 26c (denominator)) 26f 74 79 %

Inc 52-1860379 Page 4

N/A IYes FRo

Schedule A (Form 990 or 990 EZ) 2001 Three Lower Counties Community Servic Part V Private School Questionnaire (See instructions )

tio be completed Only by schools that checked the box online G in Part IV)

31

b Has the organization's right to such aid ever been revoked or suspended? If you answered 'Yes' to either 34a or b, please explain using an attached statement

35 Does the organization certify that it has complied with the a licable requirements of sections 4 01 through 4 05 of Rev Proc 75-50, 1975-2 C B M, covering racial

TEEA0404 09M/01 or

29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, other governing instrument, or in a resolution of its governing body7

30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues . and other written communications with the public dealing with student admissions, programs, and scholarships'

31 Has the organization publicized its racially nondiscriminatory policy through newspa er or broadcast media during the period of solicitation for students, or during the registration period if it has no sofilcitation program, in a way that makes the policy known to all parts of the general community it serves' If 'Yes,' please describe, it 'No, please explain (If you need more space, attach a separate statement

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

32 Does the organization maintain the following a Records indicating the racial composition of the student body, faculty, and administrative staff 7

b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory basis?

c Copies of all catalogues . brochures, announcements, and other written communications to the public dealing with student admissions, programs, and scholarships?

d Copies of all material used by the organization or on its behalf to solicit contributions7

If you answered 'No' to any of the above, please explain (if you need more 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 policies7

c Employment of faculty or administrative staff 7

d Scholarships or other financial assistance7

e Educational policies?

f Use of facilities?

g Athletic programs7

h Other extracurricular activities?

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

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

34a Does the organization receive any financial aid or assistance from a governmental agency'

29

Schedule A (Form 990 or 990 EZ) 2001 Three Lower Counties Community Services, Inc 52-1860379 Page 5 jPart VI-A I Lobbying Expenditures by Electing Public Charities (see instructions)

CFo be completed Only by an eligible organization that filed Form 5768) 'a' and 'limited control' provisions apply

(a) (b) Affiliated group To be completed

totals I for all electing

C a if the organization belongs to an affiliated group Check ~ b if you chec Check

Limits on Lobbying Expenditures

O'he term 'expenditures' means amounts paid or incurred

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

If the amount on line 40 is - The lobbying nontaxable amount is - Not over $500,000 20% of the amount on line 40

-

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000 Over $1,000,00) but not over $1,500,0W $775,000 plus 10% of the excess over $1,000,000 41 Dver $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,5WODO Over $17,000.000 $1,000,000

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

Caution- If there is an amount on either line 43 or line 44 . vou must file Form 4720 0

Lobbying Expenditures Dunng 4 -Year Averaging Period

(b) W (d) (e) 2000 1999 1998 Total

50 Grassroots lobbying

TEFA0405 12131/01

4 -Year Averaging Period Under Section 501(h) (Some organizations that made a section 501 (h) election do not have to complete all of the five columns below

See the instructions for lines 45 through 50 )

Calendar year (a) (or fiscalyear 2001 hPninninn inli ~ I

45 Lobbying nontaxable

46 Lobtrimit ceilma amount

47 Total

48 Grassroots, non-taxable arnount

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

Ir-drE VI-D LOoDying Activity Dy Noneiecting vuwic unarnies (For reporting only by organizations that crid not complete Part VI-A) (See instructions N/A

During the year, did the organization attempt to influence national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of Yes No Amount

a Volunteers b Paid staff or management (include compensation in expenses reported on lines c through h.) c Media advertisements d Mailings to members, legislators, or the public a Publications, or published or broadcast statements I Grants to other organizations for lobbying purposes g Direct 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 lines c through h )

If 'Yes' to any of the above, also attach a statement giving a detailed description of if BAA Schedule A (Form 990 or 990-EZ) 2001

8chedule A Transfers To and Transactions and Relationships With Noncharitable

51 Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501 (c) of the Code (other than section 501 (c)(3) onlanizations) or in section 527, relating to political organizations7

52a 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 5277 - El Yes El No

BAA TEEAD406 0912.5101 Schedule A (Form 990 or 990-EZ) 2001

Related Partv Tr

Total

Three Lower Counties Community Services, Inc 52-1860379

Miscellaneous Statement

Part III Question 2b

- Organization borrowed money from Executive Director's

father The lender holds notes at competive interest rates

Form 990 p 3/1-ine 64b, column (A)

Amount Description

Peninsula Bank-Equipment 3,803 Pen i nsul a Bank-Van Loan 10,152 Peninsula Bank-Working Capital Loan 189,829 Peninsula Bank-Equipment Loan 93,907 Peninsula Bank-Mortgage 245,923 N/P-Gillis 55,000 Rural Development-Mortgage 786,066 Capital leases 9,880

Form 990 p 3/1-ine 64b, column (8)

Description Amount

Peninsula Bank-equipment 0 Peninsula Bank-Van Loan 0 Peninsula Bank-Working Capital Loan 165,449 Peninsula Bank-Equipment Loan 78,907 Peninsula Bank-Mortgage 238,113 Rural Development-Mortgage 778,500 N/P-Gillis 35,000 Capital Leases 8,003

Sch A, 990 p 3/1-ine 22-a

Description Amount

Misc income 1,715 Priority Partners 286,467

288, 182 Total

Three Lower Counties Community Services, Inc 52-1860379

Supporting Statement of:

Total 1,394,560

Supporting Statement of :

Total 1,303,972

Supporting Statement of:

Totals 625,356.00 482,675.00 142,681 .00

Three Lower Counties Community Services, Inc # 52-1860379 Form 990 FYE 5/31/02

(A) (B) (C) Schedule of Other Functional Expenses: Total Program Service Mat & General Form 990-Part II-Line 43b:

Bad Debts 180,00000 180,00000 Contracted Labor 70,05900 70,05900 - Janitorial 59,97000 46,29000 13,68000 Lab Fees 53,51900 53,46200 5700 Computer Expense 36,67800 23,25800 13,42000 Management Fees 32,56500 - 32,56500 Fees and Licenses 30,87300 23,24500 7,62800 Utilities 28,90700 23,66900 5,23800 MedBank 27,94300 - 27,94300 Miscellaneous 26,31500 16,54200 9,77300 Minor Equipment 20,86000 11,97600 8,88400 Insurance 15,13900 7,011 00 8,12800 Human Resourses Expense 14,76100 4,94900 9,81200 Consultant Fees 27,76700 22,21400 5,55300

Form 990 FYE 5/31/02 Page 3-Question 57

Depreciation and amortization expense for the years ending May 31,2002 was $129,729

Three Lower Counties Community Services, Inc # 52-1860379 Schedule of Land, Buildings and Equipment

Property and Equipment

Property and equipment as of May 31,2002, consisted of the following

Land 80,00000 Buildings 195,00000 Building Improvements 916,95900 Furniture and Equipment 354,65200 Vehichles 12,64800 Medical Equipment 269,15100

1,828,410 00 Less accumulated depreciation (502,07500

Net Property and equipment

Check type of return to be filed (rile a separate application for each return) XX Form 990 0 Form 990-T (corporation) 0 Form 4720 D Form 990-BL 0 Form 990-T (sec 401(a) or 408(a) trust) El Form 5227 C1 Form 990-EZ 0 Form 990-T (trust other than above) 0 Form 6069 El Form 990-PF 0 Form 1041-A 0 Form 8870 " If the organization does not have an office or place of business in the United States, check this box . . . . . . " If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) - If this is for the whole group, check this box lll~ [3 If it IS for Part Of the group, Check this box b, M and attach a list VAth the names and EINs of all members the extension will cover

I request an automatic 3-month (6-month, for 990-T corporation) extension of time until . ..Jan . . . 1 .5 . . . . . . . . 200-3. to file the exempt organization return for the organization named above The extension is for the organization's return for Is, Q calendar year 20 . . or 02 . . . . . . . . . . . . . . . . . . . . . . . . . 20PA. and ending .14ay 31 11.~ 29xtax year beginning . . . . . ~Nne 1 . . . . .. . . . . . . . . . . . . . . . . . . . . . . 20 . . .

)-T, ente Fanyrefundable credits and estima all s

a

i I clucle ur;TmeKt5Mth2 for . or, if nq EFTP (Electronic Federal Tax ayme

Urides pettafties of perfury I declare trim I have ennlMed th it is true . ocriect, and complete arid that I am autrMZ&d to

Farm 8868 (112-20M For Paperwork Reduction Act Notice, see instruction CaL Ift 279160_

Form 8868 Application for Extension of Time To File an (Decembe 20M Exempt Organization Return OMB No 1545-1709 DePaWent of the Treasixy Internal Reverim Servicit ll~ File a separate applicatton for each return

" If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box . - III. W " If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 (on page 2 of this form) Note- Do not complete Part 11 unless you have already been granted an automatic 3-month extension an a previously riled Form 8868, JIM Automatic 3-Month Extension of Time-Only submit original (no copies needed) Note Form 990.7coiporations requesting an automatic 6-month extension-check this box and complete Part I only IN. E] Ali other corporations (including Form 990-C fiffers) must use Form 7004 to request an extension of time to file income tax returns PartnershrDs, REMICs and trusts must use Form 8736 to request an extension of time to rile Form 7065, 1066, or 1041 Type or Name of Exempt Organization Employer identification i print Three Lower Counties Connunity Servicesir Inc .1 52 :1860379 File %tthe Number street and room cr suite no If a P 0 box, see instructions this

C, 12179 Elm Street - P .O . Box 191

M51suctions City, town or post office state. and ZIP code For a foreign address. see instructions Princess Anne, MD 21853

2 If this tax year is for less than 12

Its If this application is for Form 990-BL. 1 nonrefundable credits See instructions

b If this application is for Form 990-PF or made Include any prior year overpayme

c Balance Due Subtract line 3b from line ,Anth FTD coupon or, if required, by i

ue

P-e.- I. C-P

1 0 Change in accounting period

tax.less any

tax payments

to ft best of My knowledge and belief.

-/1:5-0