Short Form. Return of Organization Exempt From Income Tax 0016

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1 I-q S Form 99-EZ Short Form OMB No Return of Organization Exempt From Inome Tax 16 Under setion 51(), 527, or 4947(a)(1) of the Internal Revenue Code (exept private foundations) F- C`am' UA Department of the Treasury intema! Revenue Servie I Do not enter soial seurity numers on this form as it may e made puli. Information aout Form 99-EZ and its instrutions is at wwwrrs.gov1forrn99. A For the 216 alendar year, or tax year eginning, 216, and ending, 2 B Chek it apprlale: C Name of organization D Employer identifiation numer q Address hangs Citizens for St. Simons and Sea Island, In q Name harge Numer and street (or P.O. ox, if mail is not delivered to street address) Roo suite E Telephone numer o initial return P.O. Box o Final ret unftermir,ated amered return City or town, state or provine, ountry, and ZIP or foreign postal ode F Group Exemption ApPi1eatio p nd4v t Simons Island, Georgia Numer G Aounting Method: H Cash Arual Other (speify) H Chek H if the organization is not 1 Wesite: required to attah Shedule B fi J Tax-exempt status (hek only one) - 51 (9)(3) q 51 (insert no.) q 4947 (a)( 1 ) or 527 (Form 99, 99-EZ, or 99-PF). K Form of organization: 21 Corporation q Trust q Assoiation q Other L Add lines 5, 6, and 7 to line 9 to determine gross reeipts. If gross reeipts are $2, or more, or if total assets (Part 11, olumn (B) elow) are $5, or more, file Form 99 instead of Form 99-Q $ Revenue, Expenses, and Changes in Net Assets or Fund Balanes (see the instrutions for Part I) Q Chek if the organization used Shedule to respond to any question in this Part I. q 1 Contriutions, gifts, grants, and similar amounts reeived ,525 Q 2 Program servie revenue inluding government fees and ontrats Memership dues and assessments Investment inome a Gross amount from sale of assets other than inventory.... 5a Less : ost or other asis and sales expenses Gain or (loss) from sale of assets other than inventory (Sutrat line 5 from line 5a).... S 6 Gaming and fundraising events a Gross inome from gaming (attah Shedule G if greater than $15, ) a Gross inome from fundraising events (not inluding $ of ontriutions e from fundraising events reported on line 1 ) (attah Shedule G if the sum of suh gross inome and ontriutions exeeds $ 15,). 6 Less : diret expenses from gaming and fundraising events... 6 d Net inome or (loss) from gaming and fundraising events (add lines 6a and 6 and sutrat line 6) d 7a Gross sales of inventory, less returns and allowanes a Less : ost of goods sold Gross profit or (loss) from sales of inventory (Sutrat line 7 from line 7a) Other revenue (desrie in Shedule ) Total revenue. Add lines 1, 2, 3, 4, 5, 6d, 7, and ,525 1 Grants and similar amounts paid (list in Shedule ) Benefits paid to or for memers Lai RE ECE IVED Salaries, other ompensation, and employee enefits Professional fees and other payments to independent ontra. u 13 31,843 (D 14 Oupany, rent, trtdities, and maintenane 17 Y W 15 Printing, puliations, postage, and shipping , Other expenses (desrie in Shedule O ) Total expenses. Add lines 1 through 16. J T 17 33,81 18 Exess or (defiit ) for the year (Sutrat line 17 from tine 9) (32,285) y 19 Net assets or fund alanes at eginning of year (from line 27, olumn (A)) (must agree with end-of-year figure reported on prior year ' s return) ,33 2 Z 2 Other hanges in net assets or fund alanes (explain in Shedule ) Net assets or fund alanes at end of year. Comine lines 18 throug h 2. X? - 21,47 For Paperwork Redution At Notie, see the separate instrutions. Cat. No Form 99-EZ f2o16y

2 Q Form 99-EZ (216) Page 2 Balane Sheets (see the instrutions for Part II) Chek if the organization used Shedule to respond to any question in this Part II.. q (A) Beginning of year (B) End of year 22 Cash, savings, and investments , ,47 23 Land and uildings Other assets (desrie in Shedule ) Total assets , ,47 26 Total liail ities (desrie in Shedule ) Net assets or fund alanes ine 27 of olumn (B) must agree with line 21 ) 53, ,47 Statement of Program Servie Aomplishments (see the instrutions for Part III) Chek if the organization used Shedule to respond to any question in this Part III. q Expenses What is the organization's primary exempt purpose? See Shedule. Desrie the organization's program servie aomplishments for eah of its three largest program servies, as measured y expenses. In a lear and onise manner, desrie the servies provided, the numer of persons enefited, and other relevant information for eah program title Grants $ If this amount inludes forei g n g rants, hek here. q (Grants $ ) If this amount inludes foreign grants, hek here (Grants $ ) If this amount inludes foreig n grants, hek here. 31 Other program servies (desrie in Shedule ) q (Required for 51()n 51()(3) and 51()(4) organizations; optional for others.) 8a 9a q 4.. (Grants $ If this amount inludes foreign g rants, hek here. q Total program servie expenses (add lines 28a throug h 31 a). 32 George Ragsdale List of Offiers, Diretors, Trustees, and Key Employees (list eah one even if not ompensated-see the instrutions for Part IV) ChPrk if tha nrnani7ntinn risen SrhMriula f-) to rpsnnnrf to any nuestion in this Part IV (1 (a) Name and title () Average hours per week devoted to k () Reportale (d) Health enefits, ompensation ontnutions to employ (Forms W-2/199-MISC) enefit plans, and (if not paid, enter --) deferred ompensation (e) Estimated amount of other ompensation President Cesar Rodriguez Treasurer James Foster Seretary Form 99-EZ (216)

3 Form 99-EZ (216) Page 3 J^M Other Information (Note the Shedule A and personal enefit ontrat statement requirements in the instrutions for Part V) Chek if the organization used Shedule to res pond to any question in this Part V.. q 33 Did the organization engage in any signifiant ativity not previously reported to the IRS? If "Yes," provide a detailed desription of eah ativity in Shedule a 36 37a 38a 39 a 4a d e 41 42a 43 44a d 45a Were any signifiant hanges made to the organizing or governing douments? If "Yes," attah a onformed opy of the amended douments if they reflet a hange to the organization's name. Otherwise, explain the hange on Shedule (see instrutions) Did the organization have unrelated usiness gross inome of $1, or more during the year from usiness ativities (suh as those reported on lines 2, 6a, and 7a, among others)? a 3 If "Yes," to line 35a, has the organization filed a Form 99-T for the year? If "No," provide an explanation in Shedule 35 Was the organization a setion 51 ()(4), 51()(5). or 51 ()(6) organization sujet to setion 633(e) notie, reporting, and proxy tax requirements during the year? If "Yes," omplete Shedule C, Part III Did the organization undergo a liquidation, dissolution, termination, or signifiant disposition of net assets during the year? If "Yes," omplete appliale parts of Shedule N Enter amount of politial expenditures, diret or indiret, as desried in the instrutions 37a Did the organization file Form 112-POL for this year? Did the organization orrow from, or make any loans to, any offier, diretor, trustee, or key employee or were any suh loans made in a prior year and still outstanding at the end of the tax year overed y this return? 38a 3 If "Yes," omplete Shedule L, Part II and enter the total amount involved Setion 51 ()(7) organizations. Enter: Initiation fees and apital ontriutions inluded on line a Gross reeipts, inluded on line 9, for puli use of lu failities Setion 51 ()(3) organizations. Enter amount of tax imposed on the organization during the year under: setion 4911 ; setion 4912 ; setion 4955 Setion 51()(3), 51()(4), and 51()(29) organizations. Did the organization engage in any setion 4958 exess enefit transation during the year, or did it engage in an exess enefit transation in a prior year that has not een reported on any of its prior Forms 99 or 99-EZ? If "Yes," omplete Shedule L, Part I 4 3 Setion 51()(3), 51()(4), and 51()(29) organizations. Enter amount of tax imposed on organization managers or disqualified persons during the year under setions 4912, 4955, and Setion 51()(3), 51()(4), and 51()(29) organizations. Enter amount of tax on line 4 reimursed y the organization All organizations. At any time during the tax year, was the organization a party to a prohiited tax shelter transation? If "Yes," omplete Form 8886-T e 3 List the states with whih a opy of this return is filed The organization's ooks are in are of Citizens for-st Simons and Sea Island, In. Telephone no , Loated at P.O. Box 285 ZIP x At any time during the alendar year, did the organization have an interest in or a signature or other authority over a finanial aount in a foreign ountry (suh as a ank aount, seurities aount, or other finanial aount)? 42 3 If "Yes," enter the name of the foreign ountry: See the instrutions for exeptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Finanial Aounts (FBAR). At any time during the alendar year, did the organization maintain an offie outside the United States? 42 3 If "Yes," enter the name of the foreign ountry: - Setion 4947(a)(1) nonexempt haritale trusts filing Form 99-EZ in lieu of Form 141-Chek here... q and enter the amount of tax-exempt interest reeived or arued during the tax year Did the organization maintain any donor advised funds during the year? If "Yes," Form 99 must e ompleted instead of Form 99-EZ Did the organization operate one or more hospital failities during the year? If "Yes," Form 99 must e ompleted instead of Form 99-EZ Did the organization reeive any payments for indoor tanning servies during the year?.. If "Yes' to line 44, has the organization filed a Form 72 to report these payments? If "No, " provide an explanation in Shedule Did the organization have a ontrolled entity within the meaning of setion 512()(13)? Did the organization reeive any payment from or engage in any transation with a ontrolled entity within the meaning of setion 512()(13)? If "Yes," Form 99 and Shedule R may need to e ompleted instead of Form 99-EZ (see instrutions) Yes No 44a I I d 3 45a 3 I45I I 3 Form 99-EZ (216) a

Form 99 -E7 (216) page 4 46 Did the organization engage, diretly or indiretly, in politial ampaign ativities on ehalf of or in opposition to andidates for puli offie?

4 Form 99 -E7 (216) page 4 46 Did the organization engage, diretly or indiretly, in politial ampaign ativities on ehalf of or in opposition to andidates for puli offie? If "Yes," omplete Shedule C, Part I Setion 51 ()(3) organizations only All setion 51 ()(3) organizations must answer questions and 52, and omplete the tales for lines 5 and 51. Chek if the organization used Shedule to respond to any question in this Part V{. q 47 Did the organization engage in loying ativities or have a setion 51(h) eletion in effet during the tax year? If "Yes," omplete Shedule C, Part II Is the organization a shool as desried in setion 17 ()(1)(A)(i)? If "Yes," omplete Shedule E a Did the organization make any transfers to an exempt non-haritale related organization? a 3 If "Yes," was the related organization a setion 527 organization? Complete this tale for the organization 's five highest ompensated employees (other than offiers, diretors, trustees, and key emnlovees) who eah reeived more than $1. of ompensation from the orianization. If there is none, enter " None." (a) Name and title of eah employee None () Average hours per week devoted to position () Reportale ompensation (Forms W-2/199-MISC) (d) Health enefits, ontriutions to employee enefit plans, and deferred ompensation (e) Estimated amount of other ompensation f Total numer of other employees paid over $1, Complete this tale for the organization's five highest ompensated independent ontrators who eah reeived more than $1, of ompensation from the organization. If there is none, enter "None." (a) Name and usiness address of eah independent ontrator..,.,.a 1-1-F v, vurr,,nj 1JCnUCnL wnuawrs earn reeiv 52 Did the organization omplete Shedule A? Note: All Under penalties of perjury, I delare that I have examined this return. inluding true, orret, and omplete, eiaration of premier (other than offier) is ase Sign Here Paid Preparer Use Only

5 SCHEDULE I Supplemental Information to Form 99 or 99-EZ (Form 99 or 99-EZ)I Complete to provide information for responses to speifi questions on Form 99 or 99-EZ or to provide any additional information. Department of the T-SLOY Attah to Form 99 or 99-EL I -1 no o.,,o e e I Information aout Shedule (Form 99 or 99 -EZI and its instrutions is at Name of the organization OMB No Employer identifiation numer Cirizens for St. Simons and Sea Island, In Form 99-EZ, Part III, - Primary Exempt Purpose The organization's mission Is to eduate the itizenry regarding governane in the areas of planning, zoning and ode enforement for St Simons Island and Sea Island Form 99-EZ, Part Aomplishments During 216, the organization onduted a numer of invitation only workshops and a numer of Town Hall Meetings for St. Simons Island, I Sea Island and other uninorporated Glynn County itizens. Funds were used during 116 to fund a door-to-door poll and telephone polls; to engage onsultants to assist In developing eduational materials and develop legislative strategies; to support the organization's wesite and to pay for expenses related to the workshops and Town Hall meetings, inluding opying/printing osts and fees for rental of meeting spae. Approximately 15 other loal organizations partiipated in the workshops and hundreds of itizens attended the Town Hall meetings. For Paperwork Redution At Notie, see the Instrutions for Form 99 or 99-EL Cat. No. 5156K Shedule (Form 99 or 99-EZ) (216)

. Short Form OMB No

. Short Form OMB No ^. Short Form OMB. 1545-1150 Form 990-EZ Return of Organization Exempt From Inome Tax 2@16 Under setion 501 (), 527, or 4947(a)(1) of the Internal Revenue Code (exept private foundations) 1v2 ^SZ Uv Do