return of organization exempt from income tax 2017 · 2019-01-11 · form omb no. 1545-0047 return...

Form OMB No. 1545-0047

Form

Return of Organization Exempt From income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

- Do not enter social security numbers on this form a s it may be made public. - Go to www.irs.gov/Form990 for instructions and the latest information.

2017 Department of ttie Treasury Internal Revenue Service

Return of Organization Exempt From income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)

- Do not enter social security numbers on this form a s it may be made public. - Go to www.irs.gov/Form990 for instructions and the latest information.

Open to Public Inspection

A For the 2017 calendar year, or tax year beginning , 2017, and ending B Check If applicable:

Address change

Name change

Initial return

Final return/terminated

Amended return

Application pending

Safe Harbor of NC, I n c . 210 2nd S t r e e t SE Hickory, NC 28602

F Name and address ot principal officer: VlClZ.! Murray Same As C Above

1 Tax-exempt status X 501(c)(3) 501(c) ( ) • • (insert no.) 4947(a)(1) or 527

J Websi te : ' - w w w.safeharbornc.orq

D Employer identification number

57-1215608 Telephone number

(828) 326-7233

G Gross receipts $ 1,548,055. H(a) Is this a group return tor subordinates?

U(b) Are all subordinates included? It 'No,' attach a list, (see instructions)

H(c) Group exemption number •

Yes X No Yes No

K Form ot organization: |X Corporation | Trust Association Other• L Year ot formation: 2004 M State ot legal domicile: NC P a r t i I S u m m a r y

(U

u

£

i a ea CO

it:

1 Briefly describe ttie organization's miss ion or most signif icant activi t ies: ^e£_ S.chedulfi CL

Check this box *" ^ if the organization discontinued its operations or d isposed of more than 2 5 % of its net a s s e t s . Number of voting members of the governing body (Par t V I , line l a ) Number of independent voting members of the governing body (Par t V I , line l b ) Total number of individuals employed in calendar year 2017 (Par t V , line 2a ) Total number of volunteers (est imate if necessa ry )

7 a Total unrelated bus iness revenue from Par t V I I I , column ( C ) , line 12 b Net unrelated bus iness taxable income from Form 99C-T, line 34.

7a 7b

10

29 .200.

-134. -134.

8 9

10 11 12

Contributions and grants P a r t V I I I , line I h ) Program serv ice revenue P a r t V I I I , line 2g) Investment income (Part V I I I , column (A ) , l ines 3 , 4 , and 7d) Other revenue (Par t V I I I , column (A ) , l ines 5, 6d, 8c , 9c , 10c, and l i e ) Total revenue — add l ines 8 through 11 (must equal Par t V I I I , column (A ) , line 12) .

Prior Year Current Year 776,862. 34,981.

1,329,458. 31,321.

170. 24, -29,539. 782,474.

-14,369. 1,346,434,

13 Grants and similar amounts paid (Par t IX, column ( A ) , l ines 1-3)

14 Benef i ts paid to or for members (Par t IX, column ( A ) , line 4 )

15 Sa la r i es , other compensat ion, employee benefits (Par t IX , column (A ) , l ines 5-10)

16a Professional fundraising fees P a r t IX, column ( A ) , line l i e )

b Total fundraising expenses (Par t IX, column (D) , line 25) 127, 765 . 17 Other expenses P a r t IX, column (A ) , l ines l l a - l l d , l l f - 2 4 e )

18 Total expenses . Add l ines 13-17 (must equal Part IX , column ( A ) , line 25)

19 Revenue less expenses . Subtract line 18 from line 12

377,693. 458,934.

215,803. 227,627. 593,496. 686,561. 188,978. 659,873.

Beginning of Current Year End of Year 20 Total asse ts P a r t X , line 16) 21 Total liabilities (Par t X , line 26)

22 Net asse ts or fund ba lances. Subtract line 21 from line 2 0 .

984,410. 1,649,771. 3,715. 9,203.

980,695. 1,640,568. Part II I S ignature B l o c k

Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowrledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.

Sign Here

Signature of officer

^ V i c k i Murray Date

E x e c u t i v e D i r . Type or print name and title

Paid Preparer U s e Only

Print/Type preparer's name

T e r r y W. L a n c a s t e r Preparer's signature Date Check | _ | if

self-employed

PTIN

P00096087 Firm s name • C. DeWltt Foard & Co, PA, CPAs Firm's address "817 E. Morehead s t r e e t , S t e . 100 Firm's EIN 561688300

C h a r l o t t e , NC 28202-2767 Phone no. 704-372-1515 May the I R S d iscuss this return with the preparer shown above? (see instruct ions). Y e s No BAA For Paperwork Reduction Act Notice, see the separate Instructions. TEEA0113L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608 Part HI I Statement of Program S e r v i c e A c c o m p l i s h m e n t s

Check if Schedule O contains a response or note to any line in this Par t I I I . 1 Briefly describe the organization's miss ion:

See Schedule 0

Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 9 9 0 - E Z ? If ' Y e s , ' describe these new serv ices on Schedu le O. Did the organization cease conducting, or make signif icant changes in how it conducts, any program s e r v i c e s ? . If ' Y e s , ' describe these changes on Schedu le O.

Describe the organization's program serv ice accompl ishments for each of its three largest program serv ices , a s measured by expenses . Sect ion 501 (c ) (3) and 501 (c ) (4 ) organizations are required to report the amount of grants and al locations to others, the total expenses , and revenue, if any, for each program serv ice reported.

Y e s X No

Y e s X No

4 a (Code: ) ( E x p e n s e s $ 170, 214 . including grants of $ ) (Revenue $ )

Whol.§_Woman_ R e s i d e n t i a ] ^ iTpgr^ Safe_ Harbor^ PTqyides_ a _one7year_ r e s i d e n t i a ] ^ STpgr^ t h a t _ allows_ u ^ J;o_six_women_ to WOEK_ 9JL ^ b u i l d i n g _ t h e i r _ l i v e s . _ Each_ woman _whq _comes_ through_ this_^rogr_am_r^eceiyes _a_ s t a b l e .environment,_ food, . c l o t h i n g , . case_managemen1;j_otitsourced^ P r o f e s s i o n a l c o u n s e l i n g .and .substance, abuse .treatment^ .career.as_sessjien1^,.Bjl)le .study, .class.es a s s o c i a t e d _with_ pyercoming the . e f f e c t s . o f . s e x u a l . a i y d . g h y s i c a l . v i o l e ^ t r a n s p o r t a t i o n , , outsourced j n e d i c a l and Jienlyal.health.assessmenlySj^.>?ei>tqring,.an_d e diicat ion _qpp g r t un i t i e s .

4 b (Code: ) ( E x p e n s e s $ 149,285. including grants of $ ) (Revenue $ )

New_ pay_ Prqgraiy Ihe_ Day^ S h e l t e p program^ p r o v i d e s , a .saf e_ ancp prqduc-tiye .environment during .daytime hptars.for_women_ and_ children.wlyo.arp.hqmeless^ J?h r e c e i v e ^ care_, .such _as_food, c l o t h i n g , .and.hygiene.rtems,.tq^ n?eet.their Jaasic.human .needs^.They .alscg r e c e i v e I f t l t e c p case.managemenly and_ r e f e r r a l s . t o . ot_her .community, r e s o u r c e s . . They, have . a c c e s s , to J ob s e a r c h .too l s _ and_ mentors_.

4 c (Code: ) ( E x p e n s e s $ 59,660. including grants of $ ) (Revenue $ 9, 900 . ) Greenleaf . ' t r a n s i t i o n a l .Housing .Program T h i s p r o g r a m . allpws_ Whplp.Wpmary praduat^s.'to. l i v e independently w h i l e . s t i l l P§lAta:lpi5.g. .§ccoun1yability . . I t _proyides_ a . s a f e _place. tq^ begin a p p l y i n g the . t o o l s . qf_. recovery, and. h e a l t h f u l . l i v i n g Ipiey Jiave^ p c q u i r e d . over the p r e v i o u s _yeap w h i l e . a l s o p r a c t i c i n g .sound, f i n a n c i a l J)lanning^._Greenleaf . i s . a l s q .for .s i n g l e _vromen/mqtpiers_ whq^ _ need, shqrt-yterin^ a s s i s t a n c e . t p . g e t . t h e i p l i v e s . b a c k .on.a_ p o s i t i v e , t r a c k .

4 d Other program serv ices (Descr ibe in Schedule 0 . ) ( E x p e n s e s $ including grants of $ ) ( R e v e n u e $ )

4 e Total program serv ice expenses *• 379, 159 . BAA TEEA0102L 12/05/17 Form 990 (2017)

F o r m 9 9 0 (2017) Safe Harbor of NC, I n c . 57-1215608 Part IV C h e c k l i s t of Requ i red S c h e d u l e s

Y e s No

1 Is the organization described in sect ion 501 (c ) (3 ) or 4947(a ) (1 ) (other than a private foundation)? If 'Yes,' complete Scfiedule A 1 X

2 Is the organization required to complete Scfiedule B, Sctiedule of Contributors ( see instructions)?. 2 X

3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If 'Yes,' complete Scfiedule C, Pari I

4 Section 501(cX3) organizations. Did the organization engage in lobbying activi t ies, or have a sect ion 501 (h) election in effect during the tax yea r? /( 'Yes,' complete Schedule C, Part II

5 Is the organization a section 501(c ) (4 ) , 501 (c ) (5 ) , or 501(c ) (6 ) organization that rece ives membership dues, assessmen ts , or similar amounts a s defined in Revenue Procedure 98-19? / ( 'Yes,' complete Sctiedule C, Part III.

6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes,' complete Schedule D, Part 1

3 X 3 Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates

for public office? If 'Yes,' complete Scfiedule C, Pari I




4 X





5 X




6 Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If 'Yes,' complete Schedule D, Part 1 6 X

7 Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land a reas , or historic structures? If 'Yes,' complete Schedule D, Part 11 7 X

8 Did the organization maintain col lections of works of art, historical t reasures, or other similar a s s e t s ? If 'Yes,' complete Schedule D, Part III. 8 X

9 Did the organization report an amount in Part X , line 2 1 , for escrow or custodial account liability, serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation serv ices? If 'Yes,' complete Schedule D, Part IV 9 X

10 Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi -endowments? /( 'Yes,' complete Schedule D, Part V. 10 X

11 If the organization's answer to any of the following questions is 'Yes ' , then complete Schedule D, Parts V I , VI I , VII I , IX, or X a s appl icable.

a Did the organization report an amount for land, buildings, and equipment in Part X , line 10? If 'Yes,' complete Schedule D, Part VI 11a X

b Did the organization report an amount for investments - other securities in Part X , line 12 that is 5% or more of its total assets reported in Part X , line 16? If 'Yes,' complete Schedule D, Part VII. l i b X

c Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total asse ts reported in Par t X , line 16? If 'Yes,' complete Schedule D, Part VIII 11c X

d Did the organization report an amount for other assets in Part X , line 15 that is 5% or more of its total assets reported in Part X , line 16? If 'Yes,' complete Schedule D, Part IX l i d X

e Did the organization report an amount for other liabilities in Par t X , line 2 5 ? If 'Yes,' complete Schedule D, Part X

f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under F IN 48 ( A S C 740)? If 'Yes,' complete Schedule D, Part X....

12a Did the organization obtain separate, independent audited financial statements for the tax year? If 'Yes,' complete Schedule D, Parts XI and XII

l i e X e Did the organization report an amount for other liabilities in Par t X , line 2 5 ? If 'Yes,' complete Schedule D, Part X


12a Did the organization obtain separate, independent audited financial statements for the tax year? If 'Yes,' complete Schedule D, Parts XI and XII

11f X

e Did the organization report an amount for other liabilities in Par t X , line 2 5 ? If 'Yes,' complete Schedule D, Part X


12a Did the organization obtain separate, independent audited financial statements for the tax year? If 'Yes,' complete Schedule D, Parts XI and XII 12a X

b W a s the organization included in consolidated, independent audited financial statements for the tax year? If 'Yes,' and if the organization answered 'No' to line 12a, then completing Schedule D, Parts XI and XII is optional 12b X

13 Is the organization a school described in sect ion 170(h) (1) (A) ( i i )? If 'Yes,' complete Schedule E 13 X

14a Did the organization maintain an office, employees, or agents outside of the United S t a t e s ? 14a X

b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If 'Yes,' complete Schedule F, Parts 1 and IV

15 Did the organization report on Par t IX, column ( A ) , line 3, more than $5,000 of grants or other ass i s tance to or for any foreign organization? If 'Yes,' complete Schedule F, Parts II and IV

16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If 'Yes,' complete Schedule F, Parts III and IV

14b X



16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If 'Yes,' complete Schedule F, Parts III and IV

15 X



16 Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If 'Yes,' complete Schedule F, Parts III and IV 16 X

17 Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A ) , l ines 6 and l i e ? / ( 'Yes,' complete Schedule G, Part 1 ( see instructions) 17 X

18 Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VI I I , l ines 1c and 8a? If 'Yes,' complete Schedule G, Part II 18 X

19 Did the organization report more than $15,000 of gross income from gaming activities on Part VII I , line 9a? If 'Yes,' complete Schedule G Part III . 19 X 19

1 BAA TEEA0103L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . C h e c k l i s t of Requ i red S c h e d u l e s (continued)

57-1215608 Part IV

20a Did the organization operate one or more hospital faci l i t ies? / ( ' Y e s , ' complete Schedule H

b If ' Y e s ' to line 20a , did the organization attach a copy of its audited f inancial s tatements to this return? . . . .

21 Did the organization report more than $5,000 of grants or other ass i s tance to any domestic organization or domestic government on Part IX, column (A ) , line 1 ? If 'Yes,' complete Schedule I, Parts I and II

22 Did the organization report more than $5,000 of grants or other ass i s tance to or for domestic individuals on Par t IX , column (A ) , line 2 ? If 'Yes,' complete Schedule I, Parts I and III

23 Did the organization answer 'Yes ' to Part VI I , Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? It 'Yes,' complete Schedule J

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that w a s issued after December 3 1 , 2002? /( 'Yes,' answer lines 24b through 24d and complete Schedule K. If 'No, 'go to line 25a

b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period except ion?

c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds?

d Did the organization act as an 'on behalf of issuer for bonds outstanding at any time during the y e a r ?

25a Section 501(c)(3), 501(cX4), and 501(cX29) organizations. Did the organization engage in an e x c e s s benefit transaction with a disqualif ied person during the yea r? /( 'Yes,' complete Schedule L, Part I

b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If 'Yes,' complete Schedule L, Part I

26 Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former off icers, directors, t rustees, key employees, highest compensated employees, or disqualif ied persons? /( 'Yes,' complete Schedule L, Part II.'.

27 Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If 'Yes,' complete Schedule L, Part III

28 Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for appl icable filing thresholds, conditions, and except ions) :

a A current or former officer, director, trustee, or key employee? If 'Yes,' complete Schedule L, Part IV....

b A family member of a current or former officer, director, trustee, or key employee? If 'Yes,' complete Schedule L, Part IV

c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If 'Yes,' complete Schedule L, Part IV

29 Did the organization receive more than $25,000 in non-cash contributions? If 'Yes,' complete Schedule M

30 Did the organization receive contributions of art, historical t reasures, or other s imi lar a s s e t s , or qualified conservat ion contributions? If 'Yes,' complete Schedule M

31 Did the organization liquidate, terminate, or dissolve and c e a s e operat ions? If 'Yes,' complete Schedule N, Part I.

32 Did the organization sel l , exchange, dispose of, or transfer more than 25% of its net assets? If 'Yes,' complete Schedule N, Part II

33 Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701 -3? If 'Yes,' complete Schedule R, Part I

34 Was the organization related to any tax-exempt or taxable entity? If 'Yes,' complete Schedule R, Part II, III, or IV, and Part V, line I

35a Did the organization have a controlled entity within the meaning of sect ion 512(h ) (13)?

b If ' Y e s ' to line 35a, did the organization receive any payment from or engage in any transact ion with a controlled entity within the meaning of sect ion 512(b) (13)? If 'Yes,' complete Schedule R, Part V, line 2

36 Section 501(cX3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If 'Yes,' complete Schedule R, Part V, line 2

37 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If 'Yes,' complete Schedule R, Part VI

38 Did the organization complete Schedule 0 and provide explanations in Schedule O for Part V I , lines l i b and 19? Note. All Form 990 fi lers are required to complete Schedu le O

Y e s No

20a X

20b

21 X

22 X

23 X

24a X 24b

24c 24d

25a X

25b X

26 X

27 X

28a X

28b X

28c X 29 X

30 X 31 X

32 X

33 X

34 X 35a X

35b

36 X

37 X

38 X BAA Form 990 (2017)

TEEA0104L 08/08/17

F o r m 9 9 0 (2017) Safe Harbor of NC, I n c . 57-1215608 P a g e s

I Part V I S ta tements Regard ing Other I R S F i l i n g s a n d T a x C o m p l i a n c e Check if Schedule O contains a response or note to any line in this Part V

1 a l b

1 a Enter the number reported in Box 3 of Form 1096. Enter -0- if not appl icable

b E n t e r the number of Forms W - 2 G included in line l a . Enter -0- if not appl icable

c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners?.

12 0

2 a 2 a Enter the number of employees reported on Form W-3 , Transmit ta l of Wage and Tax Sta te

ments, filed for the calendar year ending with or within the year covered by this return

b If at least one is reported on line 2 a , did the organization file al l required federal employment tax re tu rns? .

Note. If the sum of l ines l a and 2a is greater than 250, you may he required to e-file ( see instructions)

3 a Did the organization have unrelated bus iness gross income of $1,000 or more during the yea r?

b If 'Yes,' has It filed a Form 990-T for this year? If W to line 3b, provide an explanation in Sctiedule 0.

29

4 a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a f inancial account in a foreign country (such a s a hank account, secur i t ies account, or other f inancial accoun t )? .

b If 'Yes, ' enter the name of the foreign country: See instructions for filing requirements for F inCEN Form 114, Report of Foreign Bank and Financial Accounts ( F B A R ) .

5 a Was the organization a party to a prohibited tax shelter transact ion at any time during the tax y e a r ?

b Did any taxable party notify the organization that it w a s or is a party to a prohibited tax shelter t r ansac t i on? . . .

c If ' Y e s , ' to line 5a or 5h, did the organization file Form 8886 -T?

6 a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?

b If 'Yes, ' did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?

7 Organizations that may receive deductible contributions under section 170(c).

a Did the organization receive a payment in e x c e s s of $75 made partly a s a contribution and partly for goods and serv ices provided to the payor?

b If ' Y e s , ' did the organization notify the donor of the value of the goods or se rv ices provided? c Did the organization sel l , exchange, or otherwise dispose of tangible personal property for which it was required to file

Form 8282?

d If ' Y e s , ' indicate the number of Forms 8282 filed during the year 7 d e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit c o n t r a c t ? . . .

f Did the organization, during the year , pay premiums, directly or indirectly, on a personal benefit contract?.

g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?

h If the organization received a contribution of c a r s , boats, a i rp lanes, or other veh ic les , did the organization file a Form 1098-C?

8 Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have e x c e s s bus iness holdings at any time during the y e a r ?

9 Sponsoring organizations maintaining donor advised funds. a Did the sponsoring organization make any taxable distributions under sect ion 4966? bD id the sponsoring organization make a distribution to a donor, donor advisor, or related person?

10 Section 501(c)(7) organizations. Enter : a Initiation fees and capital contributions included on Par t V I I I , l ine 12

b Gross receipts, included on Form 990, Part V I I I , line 12, for public use of club facil i t ies

11 Section 501(c)02) organizations. Enter :

a Gross income from members or shareholders

10a 10b

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

11a

l i b 12a Sect ion 4947(aX1) non-exempt char i table t rus ts . Is the organization filing Form 990 in lieu of Form 1041 ?.

b If ' Y e s , ' enter the amount of tax-exempt interest received or accrued during the year.

13 Section 501(cX29) qualified nonprofit health insurance i ssuers . a Is the organization l icensed to issue qualified health p lans in more than one state? . .

1 2 b

Note. S e e the instructions for additional information the organization must report on Schedule O.

b Enter the amount of reserves the organization is required to maintain by the s ta tes in which the organization is l icensed to issue qualified health plans

c Enter the amount of reserves on hand 14a Did the organization receive any payments for indoor tanning serv ices during the tax year?.

1 3 b

1 3 c

b If ' Y e s , ' has it filed a Form 720 to report these payments? If 'No,' provide an explanation in Schedule O..

1 c

2 b

3 a

3 b

4 a

5 a 5 b 5 c

6 a

6 b

7 a 7 b

7 c

7 e 7f

7 g

7 h

9 a 9 b

1 2 a

1 3 a

1 4 a

1 4 b

Y e s No

BAA TEEA0105L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608

Part VI G o v e r n a n c e , Management , and D i s c l o s u r e For each Yes' response to lines 2 through 7b below, and for a 'No' response to line 8a, 8b, or I Ob below, describe the circumstances, processes, or changes in Schedule O. See Instructions. Check if Schedule O contains a response or note to any line in this Part VI X

Sect ion A . G o v e r n i n g B o d y and Management

1 a Enter the number of voting members of the governing body at the end of the tax year . . If there are material di f ferences in voting rights among members of the governing body, or if the governing body delegated broad authority to an execut ive committee or similar committee, expla in in Schedu le O.

b Enter the number of voting members included in line l a , above, who are independent .

1 a

l b

10

10 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee?

Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors, or t rustees, or key employees to a management company or other person?

4 Did the organization make any signif icant changes to its governing documents

s ince the prior Form 990 w a s fi led?

5 Did the organization become aware during the year of a signif icant diversion of the organization's a s s e t s ?

6 Did the organization have members or stockholders?

7 a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body?

b Are any governance decis ions of the organization reserved to (or subject to approval by) members , stockholders, or persons other than the governing body?

Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

a The governing body? b E a c h committee with authority to act on behalf of the governing body?

9 Is there any officer, director, trustee, or key employee listed in Par t V I I , Sect ion A, who cannot he reached at the organization's mail ing address? If 'Yes,' provide the names and addresses in Schedule O

8

7 a

7 b

8 a 8 b

Y e s

X X

No

Y_

X

X

X Sect ion B. P o l i c i e s (This Section B reguests information about policies not reguired by the Internal Revenue Code.)

10a Did the organization have local chapters, branches, or aff i l iates?

b If 'Yes,' did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?

11 a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule O the process, if any, used by the organization to review this Form 990. See Schedule 0

12a Did the organization have a written conflict of interest pol icy? /( 'No,' go to line 13 bWere officers, directors, or trustees, and key employees required to disclose annually interests that could give rise

to confl icts?

c Did the organization regularly and consistently monitor and enforce compliance with the policy? If 'Yes,' describe In Schedule O how this was done

Did the organization have a written whistlehlower policy? Did the organization have a written document retention and destruction policy? Did the process for determining compensation of the following persons include a review and approval by independent persons, comparabil ity data, and contemporaneous substantiation of the delitreration and dec is ion?

a The organization's C E O , Execut ive Director, or top management official

b Other officers or key employees of the organization

If ' Y e s ' to line 15a or 15h, describe the process in Schedu le 0 (see instructions).

16a Did the organization invest in, contribute asse t s to, or participate in a joint venture or similar arrangement with a taxable entity during the yea r?

b If 'Yes, ' did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under appl icable federal tax law, and take steps to safeguard the organization's exempt status with respect to such ar rangements?

13 14 15

10a

10b 11a

12a

12b

12c 13 14

15a 15b

16a

16b

Y e s

X

No

Sect ion C . D i s c l o s u r e 17

18

19

20

None List the states with which a copy of this Form 990 is required to he filed

Sect ion 6104 requires an organization to make its Forms 1023 (or 1024 if appl icable) , 990, and 990 -T (Sect ion 501(c ) (3 )s only) avai lable for public inspection. Indicate how you made these available. Check all that apply.

Own website X Another's website Other (explain in Schedule 0) X Upon request

Describe in Schedule 0 whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. See Schedule 0 State the name, address, and telephone number of the person who possesses the organization's hooks and records:

L i z Webster 210 2nd S t r e e t SE Hickory NC 28602 (828) 326-7233 BAA TEEA0106L 08/08/17 Form 990 (2017 )

Form990 (2017) Safe Harbor of NC, I n c . 57-1215608 Part VII I C o m p e n s a t i o n of Of f icers , D i rec tors , T r u s t e e s , K e y E m p l o y e e s , H ighest C o m p e n s a t e d E m p l o y e e s , and

Independent C o n t r a c t o r s Check if Schedule O contains a response or note to any line in this Part VII

Sect ion A. Of f icers , D i rec tors , T r u s t e e s , K e y E m p l o y e e s , a n d H ighest C o m p e n s a t e d E m p l o y e e s 1 a Complete this tahle for all persons required to he listed. Report compensation for the calendar year ending with or within the organization's tax year.

• List all of the organization's current off icers, directors, t rustees (whether individuals or organizat ions), regardless of amount of compensation. Enter -0- in columns (D) , ( E ) , and ( F ) if no compensat ion w a s paid.

• List all of the organization's current key employees, if any. S e e instructions for definition of 'key employee. ' • List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee)

who received reportable compensat ion (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations.

• List all of the organization's former off icers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations.

• List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensat ion from the organization and any related organizat ions.

List persons in the following order: individual trustees or directors; institutional t rustees; off icers; key employees; highest compensated employees; and former such persons.

Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.

(A) Name and Title

(B) Average

hours per

week (list any hours for related

organizations trelow dotted line)

f? ^

s

(C) Position (do not check more than one box, unless person

is both an officer and a director/trustee)

I

(D) Reportable

compensation from the organization (W-2/1099-MISC)

(E ) Reportable

compensation from related organizations

(W-2/1099-MISC)

(F) Estimated

amount of other compensation

from the organization and related

organizations

Sabina Hardy_ D i r e c t o r

(2) Pat Anderson D i r e c t o r

_1_ 0

David _Washco_ C h a i r E l e c t

_ 1 _ 0

Susan _Guest_ D i r e c t o r

_1_ 0 0.

(5) Don M. Wimbish T r e a s u r e r

_2_ 0

John David Rqss_ C h a i r

_2_ 0 0.

_(?>_ P a t r i c i a . R i c e S e c r e t a r y

_2_ 0 X

(8) Frank C o l e t t o D i r e c t o r C h a r l e s . D u r r e t t . D i r e c t o r

30 0 X

0 0 ) . The. Honorable . C l i f t o n Smith. D i r e c t o r

.0. 0

d l L Debbie Haynes Prog. D i r e c t o r

50 0 40,991 4,933.

h.?L y i c j ^ i _MuiLAy_ _ E x e c u t i v e D i r .

03)

50 0 59,784. 4,933.

04)

BAA TEEA0107L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608

Part VH Section^A. Of f icers , D i rec tors , T r u s t e e s , K e y E m p l o y e e s , a n d Highest C o m p e n s a t e d E m p l o y e e s (continued) (B) I (C)

(A) Name and title

Average hours

per week

(list any hours

for related

organiza - tions tie low dotted line)

S- ( S g

Position (do not check more than one box. unless person is both an officer and a director/trustee)

t

g

(D) Reportable

compensation from the organization (W-2/1099-MISC)

(E ) Reportable

compensation from related organizations

(W-2/1059-MISC)

(F) Estimated

amount of other compensation

from the organization and related

organizations

(15)

06)

07)

08)

09)

(20)

(21)

(22)

(23)

(24)

(25)

1 b Sub-total

c Total from continuation sheets to Part VII, Section A .

d Total (add lines l b and 1c)

100,775. 0. 9,866. 0. 0. 0.

100,775. 0. 9,866. 2 Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation

from the organization "" Q

Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line l a ? If 'Yes,' complete Sctiedule J for sucfi Individual.

4 For any individual listed on line l a , is the sum of reportable compensat ion and other compensat ion from the organization and related organizations greater than $150,000? / ( 'Yes,' complete Schedule J for such individual

5 Did any person listed on line l a receive or accrue compensat ion from any unrelated organization or individual for serv ices rendered to the organization? If 'Yes,' complete Schedule J for such person

Sect ion B . Independent C o n t r a c t o r s 1 Complete this tahle for your five highest compensated independent contractors that received more than $100,000 of

compensation from the organization. Report compensation for the calendar year ending with or within the organization's tax year.

Y e s No

X

X

(A) Name and bus iness address

(B) Description of se rv ices

(C) Compensat ion

2 Total number of independent contractors (including but not limited to those listed above) who received more than

$100,000 of compensation from the organization "• Q

BAA TEEA0108L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608 Part VIIII Statement of R e v e n u e

Check if Schedule O contains a response or note to any line in this Par t V I I I .

(A) Total revenue

(B) Related or

exempt function revenue

(C) Unrelated bus iness revenue

(D) Revenue

excluded from tax under sect ions

512-514

1 a b c d e

Federated campaigns Membership dues Fundraising events

Related organizations Government grants (contributions)....

All other contributions, gifts, grants, and similar amounts not included above . . . Noncash contributions included in lines la-lf: Total. Add l ines l a - l f

l a l b 1 c 115,264. I d 1 e

I f 1,214,194.

1,329,458

2 a b c d e f

PTogranL s e r v i c e , rev_enue

All other program serv ice revenue . .

Total. Add l ines 2a-2f

Business Code

31,321. 31,321

31,321 Investment income (including dividends, interest and other similar amounts) ' Income from investment of tax-exempt bond proceeds .'. Royalt ies

24 24.

Gross rents i L e s s : rental expenses

Rental income or ( l o s s ) . . .

6 a b c

d Net rental income or ( loss) ,

7 a

(r) Real (ii) Personal

c d

8 a

Gross amount from sales ot assets other than inventory

Less: cost or other basis and sales expenses Gain or ( loss) Net gain or ( loss)

(i) Securities (li) Ottier

Gross income from fundraising events (not including. $ 115, 264 . of contributions reported on line I c ) .

S e e Part IV, line 18 a L e s s : direct expenses b b

c Net income or ( loss) from fundraising events

9 a

11,655,

Gross income from gaming activi t ies. S e e Part IV, line 19

-11,655. -11,655.

b L e s s : direct expenses b c Net income or ( loss) from gaming activi t ies.

10a Gross sa les of inventory, less returns and a l lowances a

b L e s s : cost of goods sold b c Net income or ( loss) from sa les of inventory

187,252. 189,966.

-2,714. -2,580. -134. Miscellaneous Revenue

11a b c d e

12

All other revenue Total. Add l ines l l a - l l d Total revenue. S e e instruct ions.

Business Code

1,346,434. 28,741. -134. -11,631. BAA TEEA0109L 08/08/17 Form 990 (2017)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608 Part IX Statement of Funct iona l E x p e n s e s Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).

Check if Schedule 0 contains a response or note to any line in this Par t IX

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.

(A) Total e x p e n s e s

(B) Program serv ice

e x p e n s e s

(C) Management and general expenses

(D) Fundraising

expenses 1 Grants and other ass is tance to domestic

organizations and domestic governments. S e e Par t IV, line 21

2 Grants and other ass is tance to domestic individuals. S e e Part IV, line 2 2

3 Grants and other ass is tance to foreign organizations, foreign governments, and foreign individuals. S e e Part IV, l ines 15 and 16

4 Benef i ts paid to or for members 5 Compensat ion of current off icers, directors,

trustees, and key employees 6 Compensat ion not included above, to

disqualified persons (as defined under section 4958( f ) (1) ) and persons described in section 4958(c ) (3 ) (B )

7 Otfier sa lar ies and wages

1 Grants and other ass is tance to domestic organizations and domestic governments. S e e Par t IV, line 21




























100,775. 34,023. 36,860. 29,892.







7 Otfier sa lar ies and wages 0. 0. 0. 0.







7 Otfier sa lar ies and wages 290,962. 167,574. 84,103. 39,285. 8 Pens ion plan accrua ls and contributions

(include section 401 (k) and 403(b) employer contributions)

9 Ottier employee benefits 35,329. 20,688. 7,877. 6,764. 10 Payrol l taxes 31,868. 16,740. 9,790. 5,338. 11 F e e s for serv ices (non-employees) :

a Management

b Legal c Accounting

d Lobbying

e Professional fundraising services. See Part IV, line 17 . . .

f Investment management fees

e Professional fundraising services. See Part IV, line 17 . . .

f Investment management fees g Other. (If line llg amount exceeds 10% of line 25, column

(A) amount list line l lg expenses on Schedule 0.) 15,735. 2,625. 8,759. 4,351. 12 Advertising and promotion

13 Office expenses 41,733. 5,232. 9,624. 26,877. 14 Information technology

15 Royalt ies

16 Occupancy

17 Travel 18 Payments of travel or entertainment

expenses for any federal, state, or local public officials

19 Conferences, conventions, and m e e t i n g s — 20 Interest 19 Conferences, conventions, and m e e t i n g s — 20 Interest

21 Payments to affi l iates 22 Depreciation, depletion, and amort izat ion . . .

23 Insurance 41,512. 28,644. 8,302. 4,566. 22 Depreciation, depletion, and amort izat ion . . .

23 Insurance 25,231. 20,723. 3,141. 1,367. 24 Other expenses . Itemize expenses not

covered above (List miscel laneous expenses in line 24e. If line 24e amount exceeds 10% of line 25 , column (A) amount, list line 24e expenses on Schedule 0 . )

a U t i l i t i e s 29.836. 25.802. 2,013. 2,021. 6 Program Expenses 21.304. 21,304. c Maintenance expense 16.734. 15,328. 1,406.

C l i e n t s e r v i c e s 15.529. 14,605. 847. 77. e All other expenses 20,013. 5,871. 6,915. 7,227.

25 Total functional expenses. Add lines 1 through 24e. . . . 686,561. 379,159. 179,637. 127,765. 26 Jo in t c o s t s . Complete this line only if

the organization reported in column ( B ) joint costs from a combined educational campaign and fundraising solicitation. Check here Q if following S O P 98-2 ( A S C 958-720)

Form 990 (2017) Safe Harbor of NC, I n c . 57-1215608 P a g e l l

Part X B a l a n c e S h e e t Check if Schedule O contains a response or note to any line in this Part X .

Beginning of year (B)

E n d of year

C a s h — non-interest-hearing

Sav ings and temporary cash investments.

P ledges and grants receivable, net

Accounts receivable, net

126,958

1,582 5 Loans and other receivables from current and former off icers, directors,

t rustees, key employees, and highest compensated employees. Complete Par t II of Schedule L

Loans and other receivables from other disqualif ied persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions). Complete Par t II of Schedu le L . . .

7 8 9

10a

Notes and loans receivable, net

Inventories for sa le or use

Prepaid expenses and deferred charges .

11 12 13 14 15 16

Land , buildings, and equipment: cost or other bas is . Complete Par t VI of Schedule D

I L e s s : accumulated depreciation

Investments — publicly traded secur i t ies

Investments - other secur i t ies. S e e Par t IV, line 11 .

Investments — program-related. S e e Par t IV, line 11

Intangible asse ts

e ther asse ts . S e e Par t IV, line 11

10a 10b

1,120,840. 259,494. 855,870. 1 0 c

11 12 13 14 15

Total asse ts . Add l ines 1 through 15 (must equal line 34) . 984,410. 16

787,595.

830.

861,346.

1,649,771. 17 18 19 20 21 22

23 24 25

Accounts payable and accrued expenses Grants payable Deferred revenue Tax-exempt bond liabilities Escrow or custodial account liability. Complete Part IV of Schedu le D Loans and other payables to current and former off icers, directors, t rustees, key employees, highest compensated employees, and disqualif ied persons. Complete Part II of Schedule L

Secured mortgages and notes payable to unrelated third part ies Unsecured notes and loans payable to unrelated third part ies

3,665. 17 18 19 20 21

22 23 24

ether liabilities (including federal income tax, payables to related third part ies, and other liabilities not included on l ines 17-24). Complete Par t X of Schedu le D. 50. 25

26 Total liabilities. Add l ines 17 through 25. 3,715. 26

5,592.

3,611. 9,203.

27 28 29

30 31 32 33 34

Organizations that follow SFAS 117 (ASC 958), check here • lines 27 through 29, and lines 33 and 34. Unrestricted net asse t s Temporari ly restricted net asse t s

Permanent ly restricted net asse t s

Organizations that do not follow S F A S 117 (ASC 958), check here • and complete l ines 30 through 34.

Capital stock or trust principal, or current funds

Paid- in or capital surplus, or land, building, or equipment fund

Retained earnings, endowment, accumulated income, or other funds

Total net asse t s or fund ba lances

Total liabilities and net assets/ fund ba lances

X and complete

935,933. 27

44,762. 28 29

30 31 32

980,695. 33

984,410. 34

924,352. 702,216. 14,000.

1,640,568. 1,649,771.

BAA Form 990 (2017)

TEEA0111L 08/08/17

Form 990 (2017) S a f e H a r b o r o f NC, I n c . 57-1215608 I Part XI I Reconc i l ia t ion of Net A s s e t s

Check if Schedule C contains a response or note to any line in this Part X I .

1 2 3 4 5 6 7 8 9

10

Total revenue (must equal Part V I I I , column (A ) , line 12)

Total expenses (must equal Par t IX, column (A ) , line 25)

Revenue less expenses . Subtract line 2 from line 1

Net asse ts or fund ba lances at beginning of year (must equal Par t X , line 33 , column ( A ) ) . .

Net unreal ized gains ( losses) on investments

Donated serv ices and use of faci l i t ies Investment expenses Prior period adjustments

ether changes in net asse ts or fund ba lances (explain in Schedule C )

Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X , line 33, column (B ) ) 10

1.346.434. 686,561. 659,873. 980,695.

0.

1,640,568. Par tX I l I F inanc ia l S ta tements a n d Report ing

Check if Schedule C contains a response or note to any line in this Par t X I I .

1 Accounting method used to prepare the Form 990: X C a s h Accrual Other

If the organization changed its method of accounting from a prior year or checked 'Other,' expla in in Schedule O.

2 a Were the organization's f inancial s tatements compiled or reviewed by an independent accountant? .

If ' Y e s , ' check a box below to indicate whether the f inancial s tatements for the year were compiled or reviewed on a separate bas is , consolidated bas is , or both:

Separate bas is Consol idated bas is Both consolidated and separate bas is

bWere the organization's f inancial s tatements audited by an independent accountant?.

If ' Y e s , ' check a box below to indicate whether the f inancial s tatements for the year were audited on a separa te bas is , consolidated bas is , or both:

X Separa te bas is Consol idated bas is Both consolidated and separate bas is

c If 'Yes ' to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its f inancial statements and select ion of an independent accountant?

If the organization changed either its oversight process or select ion process during the tax year , expla in in Schedule O.

3 a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A -133?

b If 'Yes, ' did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits

2 a

2 b

2 c

3 a

3 b

Y e s No

X

BAA Form 990 (2017)

TEEA0112L 08/08/17

S C H E D U L E A (Form 990 or 990-EZ)

Department of the Treasury Internal Revenue Service

Public Charity Status and Public Support Complete If the organization is a section 501 (cX3) organization or a section

4947(a)0) nonexempt charitable trust. " Attach to Form 990 or Form 990-EZ.

• Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2017 Open to Public

Inspection

Name of the organization

S a f e H a r b o r o f NC , I n c .

Employer identification number

57-1215608 Part I I R e a s o n for P u b l i c Char i ty S t a t u s (A l l o rgan i za t i ons m u s t comp le te th is par t . ) S e e ins t ruc t ions .

The organization is not a private foundation because it is : (For l ines 1 through 12, check only one box.) 1 2 3 4

6 7

8

9

10

11

12

A church, convention of churches, or association of churches described in section 170(bX1XAXi)-A school described in section 170(b)(1XAXii). (Attach Schedule E (Form 990 or 990-EZ).) A hospital or a cooperative hospital serv ice organization described in section 170(b)OXA)0'')-A medical research organization operated in conjunction with a hospital descr ibed in section 17(Kb)(1XAXiii). Enter the hospital 's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(bX1XAXiv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(bX1XAXv).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(bXlXAXvi). (Complete Part II.)

J A community trust described in section 170(bX1XAXvi). (Complete Part I I .)

An agricultural research organization described in section 170(b)OXAX'x) operated in conjunction with a land-grant college or university or a non-land-grant college of agriculture (see instructions). Enter the name, city, and state of the college or university:

X j An organization that normally receives: (1) more than 33-1/3% of its support from contributions, membership fees, and gross receipts from activit ies related to its exempt functions—subject to certain except ions, and (2) no more than 3 3 - 1 / 3 % of its support from gross investment income and unrelated bus iness taxable income ( less sect ion 511 tax) from bus inesses acquired by the organization after June 30, 1975. S e e section 509(aX2). (Complete Part I I I .) An organization organized and operated exclusively to test for public safety. S e e section 509(aX4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations descr ibed in section 509(a)(1) or section 509(aX2). S e e section 509(aX3). Check the box in

^ l ines 12a through 12d that descr ibes the type of supporting organization and complete l ines 12e, 12f, and 12g. Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sect ions A and B. Type II. A supporting organization supervised or controlled in connection with its supported organizat ion(s) , by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sect ions A and C .

^ Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported ^ organizat ion(s) (see instructions). You must complete Part IV, Sect ions A, D, and E .

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization general ly must satisfy a distribution requirement and an at tent iveness requirement (see instructions). You must complete Part IV, Sect ions A and D, and Part V.

_ Check this box if the organization received a written determination from the I P S that it is a Type I, Type I I , Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations Provide the following information about the supported organizat ion(s) .

(i) Name of supported organization (ii) EIN Oil) Type of organization (described on Tines 1-10 above (see instructions))

Ov) Is ttie organization listed in your governing

document?

(v) Amount of monetary support (see instructions)

(vi) Amount of other support (see instructions)

(i) Name of supported organization (ii) EIN Oil) Type of organization (described on Tines 1-10 above (see instructions))

Y e s No

(v) Amount of monetary support (see instructions)

(vi) Amount of other support (see instructions)

(A)

(B)

(C)

(D)

(E)

Total BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

TEEA0401L 08/10/17 Schedule A (Form 990 or 990-EZ) 2017

Schedule A (Form 990 or 990-EZ) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 2

Part II I Suppor t S c h e d u l e for Organ iza t ions D e s c r i b e d in S e c t i o n s 1 7 0 ( b X l X A X i v ) and 1 7 0 ( b X l X A X v i ) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, p lease complete Par t III.)

Sect ion A . Pub l ic Suppor t

Calendar year (or fiscal year beginning in)

1 Gifts, grants, contributions, and membership fees received. (Do not include any 'unusual grants.)

2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf

3 The value of serv ices or facilit ies furnished by a governmental unit to the organization without charge . . .

4 Total. Add l ines 1 through 3 . . . 5 The portion of total

contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2 % of the amount shown on line 11 , column ( f ) . .

6 Public support. Subtract line 5 from line 4

(a) 2013 (b)2014 (c)2015 (d)2016 (e)2017 (0 Total Calendar year (or fiscal year beginning in)










































Sect ion B. Total Suppor t


7 Amounts from line 4

8 Gross income from interest, dividends, payments received on securi t ies loans, rents, royalt ies, and income from similar sources

(a) 2013 (b)2014 (c)2015 (d)2016 (e)2017 (0 Total Calendar year (or fiscal year beginning in)






9 Net income from unrelated business activit ies, whether or not the business is regularly carried on

10 Other income. Do not include gain or loss from the sa le of capital asse ts (Exp la in in Part V I . )

11 Total support. Add l ines 7 through IQ


11 Total support. Add l ines 7 through IQ

12 Gross receipts from related activi t ies, etc. (see instruct ions). 12

13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501 (c)(3) organization, check this box and stop here

Sect ion C . Computa t ion of P u b l i c Suppor t P e r c e n t a g e 14 Public support percentage for 2017 (line 6, column (f) divided by line 1 1 , column (f)).

15 Public support percentage from 2016 Schedule A, Par t I I , line 14

14 15

16a 33-1/3% support test—2017. If the organization did not check the box on line 13, and line 14 is 3 3 - 1 / 3 % or more, check this box and stop here. The organization qualif ies a s a publicly supported organization

b 33-1/3% support test—2016. If the organization did not check a box on line 13 or 16a, and line 15 is 3 3 - 1 / 3 % or more, check this box and stop here. The organization quali f ies a s a publicly supported organizat ion '

17a 10%-facts-and-circumstances test—2017. If the organization did not check a box on line 13, 16a, or 16h, and line 14 is 10% or more, and if the organization meets the ' fac ts-and-c i rcumstances ' test, check this box and stop here. Exp la in in Part VI how the organization meets the ' facts-and-c i rcumstances ' test. The organization quali f ies a s a publicly supported organization "

b 10%-facts-and-circumstances test—2016. If the organization did not check a box on line 13, 16a, 16h, or 17a, and line 15 is 10% or more, and if the organization meets the ' facts-and-c i rcumstances ' test, check this box and stop here. Exp la in in Part V I how the organization meets the ' facts-and-c i rcumstances ' test. The organization quali f ies a s a publicly supported organization

18 Private foundation. If the organization did not check a box on line 13, 16a, 16h, 17a, or 17h, check this box and see ins t ruc t ions. . .

BAA Schedule A (Form 990 or 990-EZ) 2017

TEEA0402L 08/10/17


Part Ml [Support S c h e d u l e for Organ iza t ions D e s c r i b e d in S e c t i o n 509(aX2) (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part fai ls to qualify under the tests listed below, p lease complete Part II.)

Sect ion A . Pub l ic Suppor t

If the organization

Calendar year (or fiscal year beginning in) 1 Gifts, grants, contributions,

and membership fees received. (Do not include any 'unusual grants. ')

2 Gross receipts from admissions, merchandise sold or services performed, or facil i t ies furnished in any activity that is related to the organization's tax-exempt purpose

3 Gross receipts from activit ies that are not an unrelated trade or business under section 5 1 3 .



6 Total. Add l ines 1 through 5 . . . 7a Amounts included on l ines 1,

2, and 3 received from disqualified persons

(3 )2013 ( b ) 2 0 1 4 ( c ) 2 0 1 5 (d) 2016 (e )2017 (0 Total Calendar year (or fiscal year beginning in) 1 Gifts, grants, contributions,








320,930. 578,185. 608,829. 776,862. 1,214,194. 3,499,000.









0.









0.









0.









0.









320,930. 578,185. 608,829. 776,862. 1,214,194. 3,499,000.








2, and 3 received from disqualified persons 0. 0. 0. 0. 0. 0.

b Amounts included on l ines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1 % of the amount on line 13 for the year.

c Add l ines 7a and 7h

8 Public support. (Subtract line 7c from line 6.)

0. 0. 0. 0. 0. 0.



8 Public support. (Subtract line 7c from line 6.)

0. 0. 0. 0. 0. 0.



8 Public support. (Subtract line 7c from line 6.) 3,499,000.

Sect ion B . Total Suppor t Calendar year (or fiscal year beginning in)

9 Amounts from line 6 (a) 2013 (b ) 2014 ( c ) 2 0 1 5 (d) 2016 (e )2017 (0 Total Calendar year (or fiscal year beginning in)

9 Amounts from line 6 320,930. 578,185. 608,829. 776,862. 1,214,194. 3,499,000. 10a Gross income from interest, dividends,

payments received on securities loans, rents, royalties, and income from similar sources 13. 16. 170. 24. 223.

b Unrelated business taxable income ( less section 511 taxes) from bus inesses acquired after June 30, 1975 . .

c Add lines 10a and 1 Oh 0.

b Unrelated business taxable income ( less section 511 taxes) from bus inesses acquired after June 30, 1975 . .

c Add lines 10a and 1 Oh 0. 13. 16. 170. 24. 223. 11 Net i ncome from unrelated busi ness

activities not included in line 10b, whether or not the business is regularly carried on


0.

11 Net i ncome from unrelated busi ness activities not included in line 10b, whether or not the business is regularly carried on

12 Other income. Do not include gain or loss from the sa le of capital asse ts (Exp la in in Part V I . ) 0.

13 Total support. (Add l ines 9, 10c, 11 , and 12.) 320,930. 578,198. 608,845. 777,032. 1,214,218. 3,499,223.

14 First five years . If the Form 990 organization, check this box and

is for the organization's first, second, third, fourth, or fifth tax year a s a section 501 (c ) (3 ) stop here

Sect ion C . Computa t ion of PubMc Suppor t P e r c e n t a g e 15 Publ ic support percentage for 2017 (line 8, column (0 divided by line 13, column (f)) 16 Public support percentage from 2016 Schedule A, Par t I I I , line 15

15 16

99.99 % 99.99 %

Sect ion D. Computat ion of Investment I n c o m e P e r c e n t a g e 17 Investment income percentage for 2017 (line 10c, column (f) divided by line 13, column (f)) 17 18 Investment income percentage from 2016 Schedule A, Par t I I I , line 17 I 18

0.01 % 0.01 -8

19a 33-1/3% support tests—2017. If the organization did not check the box on line 14, and line 15 is more than 33 -1 /3%, and line 17 IS not more than 33 -1 /3%, check this box and stop here. The organization quali f ies a s a publicly supported organization

b 33-1/3% support tests—2016. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 -1 /3%, and line 18 IS not more than 33 -1 /3%, check this box and stop here. The organization qualif ies a s a publicly supported organization

20 Private foundation. If the organization did not check a box on line 14, 19a, or 19h, check this box and see instructions

BAA TEEA0403L 08/10/17 Schedule A (Form 990 or 990-E2) 2017

Schedule A (Form 990 or 990-EZ) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 4 Part IV I Support ing Organ iza t ions

( C o m p l e t e only if y o u c h e c k e d a box in l ine 12 on P a r t I. If y o u c h e c k e d 12a of P a r t I, comp le te S e c t i o n s A and B . It you c h e c k e d 12b ot P a r t I, comp le te S e c t i o n s A a n d C . It y o u c h e c k e d 12c ot P a r t I, comp le te S e c t i o n s A , D, a n d E . It y o u c h e c k e d 12d ot P a r t I, comp le te S e c t i o n s A a n d D, a n d comp le te P a r t V . )

Sect ion A . All Suppor t ing Organ iza t ions

1 Are all of the organization's supported organizations listed by name In the organization's governing documents? If 'No,' describe in Part VI flow tfie supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain.

2 Did the organization have any supported organization that does not have an IRS determination ot status under section 509(a) (1) or (2)? If 'Yes.' explain in Part W how the organization determined that the supported organization was described In section 509(a)(1) or (2).

3a Did the organization have a supported organization descr ibed in sect ion 501(c ) (4 ) , (5 ) , or (6 )? If 'Yes.' answer (b) and (c) below.

b Did the organization confirm that each supported organization qualified under sect ion 501(c ) (4 ) , (5 ) , or (6) and satisf ied the public support tests under sect ion 509 (a ) (2 )? If 'Yes,' describe in Part VI when and how the organization made the determination.

c Did the organization ensure that all support to such organizations w a s used exclus ively for section 170(c ) (2 ) (B ) purposes? If 'Yes,' explain in Part VI what controls the organization put in place to ensure such use.

4a Was any supported organization not organized in the United S ta tes ('foreign supported organizat ion')? If 'Yes' and if you checked 12a or 12b in Part I. answer (b) and (c) below.

b Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If 'Yes.' describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with Its supported organizations.

c Did the organization support any foreign supported organization that does not have an I P S determination under sect ions 501(c) (3) and 509(a) (1) or (2 )? If 'Yes,' explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

5a Did the organization add, substitute, or remove any supported organizations during the tax year? If 'Yes.' answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

b Type I or Type It only. Was any added or substituted supported organization part of a c l a s s a l ready designated in the organization's organizing document?

c Substitutions only. W a s the substitution the result of an event beyond the organization's control?

6 Did the organization provide support (whether in the form of grants or the provision of serv ices or faci l i t ies) to anyone other than (i) its supported organizat ions, (ii) individuals that are part of the charitable c l a s s benefited by one or more of its supported organizations, or (in) other supporting organizations that also support or benefit one or more of the filing organization's supported organizat ions? If 'Yes,' provide detail In Part VI.

7 Did the organization provide a grant, loan, compensat ion, or other similar payment to a substant ial contributor (defined in section 4958 (c ) (3 ) (C ) ) , a family member of a substant ial contributor, or a 3 5 % controlled entity with regard to a substantial contributor? If 'Yes.' complete Part I of Schedule L (Form 990 or 990-EZ).

8 Did the organization make a loan to a disqualif ied person (as defined in section 4958) not descr ibed in line complete Part I of Schedule L (Form 990 or 990-EZ).

7? If 'Yes.

9a Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons a s defined in section 4946 (other than foundation managers and organizations described in sect ion 509(a ) (1 ) or (2 ) )? /( 'Yes.' provide detail in Part VI.

b Did one or more disqualif ied persons (as defined in line 9a ) hold a controlling interest in any entity in which the supporting organization had an interest? If 'Yes,' provide detail in Part VI.

c Did a disqualified person ( a s defined in line 9a ) have an ownership interest in, or derive any personal benefit from, asse ts in which the supporting organization also had an interest? If 'Yes,' provide detail in Part VI.

10a Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizat ions)? If 'Yes.' answer 10b below.

b Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720. to determine whether the organization had excess business holdings.)

Y e s No

1

2

3a

3b

3c

4a

4b

4c

5a

5b

5c

6

7

8

9a

9b

9c

10a

10b

BAA TEEA0404L 08/10/17 Schedule A (Form 990 or 990-EZ) 2017

Schedule A (Form 990 or 990-EZ) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 5 P a r t l y I Suppor t ing Organ iza t ions (continued)

Y e s No 11 Has the organization accepted a gift or contribution from any of tfie following persons?

a A person who directly or indirectly controls, either alone or together with persons described in (h) and (c) below, the governing body of a supported organizat ion?

b A family member of a person described in (a ) above?

c A 3 5 % controlled entity of a person described in (a ) or (h) above? If 'Yes' to a, b, or c, provide detail in Part VI.

11a

11 Has the organization accepted a gift or contribution from any of tfie following persons?



c A 3 5 % controlled entity of a person described in (a ) or (h) above? If 'Yes' to a, b, or c, provide detail in Part VI.

l i b

11 Has the organization accepted a gift or contribution from any of tfie following persons?



c A 3 5 % controlled entity of a person described in (a ) or (h) above? If 'Yes' to a, b, or c, provide detail in Part VI. 11c

Sect ion B . T y p e 1 Suppor t ing Organ iza t ions Y e s No

1 Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's directors or trustees at all times during the tax year? If 'No.' describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any. applied to such powers during the tax year.

2 Did the organization operate for the benefit of any supported organization other than the supported organizat ion(s) that operated, superv ised, or controlled the supporting organizat ion? /( 'Yes.' explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization.

1

1 Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization's directors or trustees at all times during the tax year? If 'No.' describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization's activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any. applied to such powers during the tax year.

2 Did the organization operate for the benefit of any supported organization other than the supported organizat ion(s) that operated, superv ised, or controlled the supporting organizat ion? /( 'Yes.' explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. 2

Sect ion C . T y p e II Suppor t ing Organ iza t ions Y e s No

1 Were a majority of the organization's directors or trustees during the tax year also a majority of the directors or trustees of each of the organization's supported organizat ion(s)? / ( 'No.' describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). 1

Sect ion D. All T y p e III Suppor t ing Organ iza t ions Yes No

1 Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization's tax year , (i) a written notice describing the type and amount of support provided during the prior tax year, (i i) a copy of the Form 990 that w a s most recently filed a s of the date of notification, and (in) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided?

2 Were any of the organization's off icers, directors, or t rustees either ( i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If 'No,' explain in Part VI how the organization maintained a close and continuous working relationship with the supported organlzation(s).

3 By reason of the relationship described in (2) , did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or asse t s at all t imes during the tax yea r? If 'Yes.' describe in Part VI the role the organization's supported organizations played in this regard.

1



3 By reason of the relationship described in (2) , did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or asse t s at all t imes during the tax yea r? If 'Yes.' describe in Part VI the role the organization's supported organizations played in this regard.

2



3 By reason of the relationship described in (2) , did the organization's supported organizations have a significant voice in the organization's investment policies and in directing the use of the organization's income or asse t s at all t imes during the tax yea r? If 'Yes.' describe in Part VI the role the organization's supported organizations played in this regard. 3

Sect ion E . T y p e III Funct iona l ly Integrated Suppor t ing Organ iza t ions

1 Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions).

a | _ J The organization sat isf ied the Activit ies Tes t . Complete line 2 below.

b The organization is the parent of each of its supported organizat ions. Complete line 3 below.

The organization supported a governmental entity, [describe in Part VI how you supported a government entity (see instructions).

2 Activit ies Test . Answer (a) and (b) below.

a Did substantial ly all of the organization's activit ies during the tax year directly further the exempt purposes of the supported organlzation(s) to which the organization was responsive? If 'Yes.' then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

b Did the activit ies described in (a ) constitute activit ies that, hut for the organization's involvement, one or more of the organization's supported organizat ion(s) would have been engaged in? If 'Yes,' explain in Part VI the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement.

3 Parent of Supported Organizat ions. Answer (a) and (b) below.

a Did the organization have the power to regularly appoint or elect a majority of the off icers, directors, or t rustees of each of the supported organizat ions? Provide details in Part VI.

b Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported organizat ions? If 'Yes.' describe in Part VI the role played by the organization in this regard.

2a

2b

3a

3b

Y e s No



Part V [Type III Non-Funct iona l ly Integrated 509(aX3) Suppor t ing O r g a n i z a t i o n s

Check here if the organization satisf ied the Integral Par t Tes t a s a qualifying trust on Nov. 20 , 1970 (expla instructions. All other Type III non-functionally integrated supporting organizat ions must complete Sect ior

in in ions A

Par t V I ) . See through E .

Sect ion A — A d j u s t e d Net I n c o m e (A) Prior Year (B) Current Year (optional)

1 Net short-term capital gam 1

2 Pecover ies of prior-year distrihutions 2

3 Other gross income (see instructions) 3

4 Add lines 1 through 3 . 4

5 Depreciation and depletion 5

6 Portion of operating expenses paid or incurred for production or collection of gross income or for management , conservat ion, or maintenance of property held for production of income (see instructions) 6

7 Other expenses (see instructions) 7

8 Adjusted Net income (subtract l ines 5, 6, and 7 from line 4) . 8

Sect ion B — Minimum A s s e t A m o u n t (A) Prior Year (B) Current Year (optional)

1 Aggregate fair market value of al l non-exempt-use asse ts ( see instructions for short tax year or asse t s held for part of yea r ) :

a Average monthly value of secur i t ies l a

b Average monthly cash ba lances 1b

c Fair market value of other non-exempt-use asse t s 1c

d Total (add l ines l a , l b , and 1c) I d

e Discount c laimed for blockage or other factors (explain in detail in PartVi) :

2 Acquisition indebtedness appl icable to non-exempt-use asse t s 2

3 Subtract line 2 from line I d . 3

4 C a s h deemed held for exempt use . Enter 1-1/2% of line 3 (for greater amount, see instructions). 4

5 Net value of non-exempt-use asse t s (subtract line 4 from line 3 ) 5

6 Multiply line 5 by .035. 6

7 Pecover ies of prior-year distrihutions 7

8 Minimum Asset Amount (add line 7 to line 6) 8

Sect ion C - Distr ibutable A m o u n t Current Y e a r

1 Adjusted net income for prior year (from Sect ion A, line 8, Column A ) 1

2 Enter 8 5 % of line 1. 2

3 Minimum asset amount for prior year (from Sect ion B , line 8, Column A ) 3

4 Enter greater of line 2 or line 3 . 4

5 Income tax imposed in prior year 5

6 Distributable Amount. Subtract line 5 from line 4, un less subject to emergency temporary reduction (see instructions). 6

7 Check here if the current year is the organization's first a s a non-functionally integrated Type III supporting organization


TEEA0406L 08/10/17

Schedule A (Form 990 or 990-EZ) 2017 Safe Harbor o f NC, I n c . 57-1215608 Page 7

Part V [Type III Non-Funct iona l ly Integrated 509(aX3) Suppor t ing O r g a n i z a t i o n s (continued) Sect ion D - Distr ibut ions Current Year

1 Amounts paid to supported organizations to accompl ish exempt purposes

2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in e x c e s s of income from activity

3 Administrative expenses paid to accompl ish exempt purposes of supported organizat ions

4 Amounts paid to acquire exempt-use asse t s

5 Qualif ied set-aside amounts (prior I R S approval required)

6 Other distrihutions (describe in Part VI). S e e instructions.

7 Total annual distributions. Add l ines 1 through 6.

8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). S e e instructions.

9 Distributable amount for 2017 from Sect ion C , line 6

10 Line 8 amount divided by line 9 amount

Sect ion E — Distr ibution A l loca t ions ( s e e ins t ruc t ions ) (i)

E x c e s s Distributions

(ii) Underdistributions

Pre-2017

(iii) Distributable

Amount for 2017

1 Distributable amount for 2017 from Sect ion C , line 6

2 Underdistrihutions, if any, for yea rs prior to 2017 (reasonable cause required — explain in Par t V I ) . S e e instructions.

3 E x c e s s distrihutions carryover, if any, to 2017

a

b F r o m 2013 c From 2014

d From 2015

e From 2016

f Total of l ines 3a through e

g Applied to underdistrihutions of prior yea rs

h Applied to 2017 distributable amount

i Carryover from 2012 not applied (see instructions)

j Remainder. Subtract l ines 3g, 3h, and 3i from 3f.

4 Distrihutions for 2017 from Sect ion D, line 7: $

a Applied to underdistrihutions of prior yea rs

b Applied to 2017 distributable amount c Remainder. Subtract l ines 4 a and 4h from 4 .

5 Remaining underdistrihutions for yea rs prior to 2017, if any. Subtract l ines 3g and 4 a from line 2. For result greater than zero, explain in Par t V I . S e e instructions.

6 Remaining underdistrihutions for 2017. Subtract l ines 3h and 4h from line 1 . For result greater than zero, explain in Par t V I . S e e instructions.

7 E x c e s s distributions carryover to 2018. Add l ines 3j and 4 c .

8 Breakdown of line 7:

a E x c e s s from 2013. b E x c e s s from 2014.

c E x c e s s from 2015.

d E x c e s s from 2016

e E x c e s s from 2017.


TEEA0407L 08/22/17


Part VI Supp lementa l ln fo rmat ion . Provide the explanations required by Part , , , _ , , Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, % 11a, l ib , and l i e ; Part IV, Section B, lines 1 and 2; Part IV, Section C,

line 10; Part II, line 17a or 17b;Part III, line 12; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1;

Part IV, Section D, lines 2 and 3; Part IV, Section E, lines Ic, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line le; Part V, Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions.)


S C H E D U L E D (Form 990)


Supplemental Financial Statements Complete If the organization answered "Yes" on Form 990,

Part IV, line 6, 7, 8, 9 , 10 ,11a , 11h, 11c, l i d , l i e , l i t , 12a, or 12h. Attach to Form 990.

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2017 Open to Puhiic inspection

Name of the organization

Safe Harbor of NC, I n c .


57-1215608 Part I Organ iza t ions Maintaining Donor A d v i s e d F u n d s or Other S imi la r F u n d s or A c c o u n t s .

C o m p l e t e if tfie o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 6 .

1 Total number at end of year

2 Aggregate value of contributions to (during year)

3 Aggregate value of grants from (during year)

(a) Donor advised funds (h) Funds and other accounts 1 Total number at end of year








3 Aggregate value of grants from (during year) 4 Aggregate value at end of year

Did the organization inform all donors and donor advisors in writing that the asse t s held in donor advised funds are the organization's property, subject to the organization's exc lus ive legal control? [ ] Y e s Q N O

6 Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can he used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Y e s No

Part II I C o n s e r v a t i o n E a s e m e n t s . Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 7 .

1 Purpose(s ) of conservation easements held by the organization (check all that apply) . Preservat ion of a historically important land area

Preservat ion of a certified historic structure Preservat ion of land for puhiic use (e.g . , recreation or education)

Protection of natural habitat

Preservat ion of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.

2 a 2 b 2 c

a Total number of conservat ion easemen ts

b Total acreaqe restricted by conservat ion e a s e m e n t s

c Number of conservation easemen ts on a certified historic structure included in (a)

d Number of conservation easements included in (c ) acquired after 7/25/06, and not on a historic structure listed in the National Reqister.

5 Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year

2 d

Held at the E n d of the Tax Year

4

5

Number of states where property subject to conservation easement is located

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, ^ ^ and enforcement of the conservat ion easements it holds? Y e s No

6 Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year

Amount of expenses incurred in monitoring. Inspecting, handling of violations, and enforcing conservation easements during the year • $

Does each conservation easement reported on line 2(d) above satisfy the requirements of sect ion 170(h) (4 ) (B) ( i ) — and section 170(h) (4) (B) ( i i )? | _

in Part XIII , describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if appl icable, the text of the footnote to the organization's f inancial s tatements that descr ibes the organization's accounting for conservation easements .

Y e s No

Part ill Organ iza t ions Maintaining C o l l e c t i o n s of Art, Histor ical T r e a s u r e s , or Other S imi lar A s s e t s . Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 8 .

1 a If the organization elected, a s permitted under S F A S 116 ( A S C 958) , not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of puhiic service, provide, in Part X I I I , the text of the footnote to its f inancial s tatements that descr ibes these Items.

b If the organization elected, a s permitted under S F A S 116 ( A S C 958) , to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for puhiic exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: (i) Revenue included on Form 990, Part V I I I , line 1 " $

Oi) Asse ts included in Form 990, Par t X * • $

i If the organization received or held works of art, historical treasures, or other similar assets for financial gam, provide the following amounts required to he reported under S F A S 116 ( A S C 958) relating to these i tems:

a Revenue included on Form 990, Par t V I I I , line 1

b Asse ts included in Form 990, Part X " $

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990. TEEA3301L 10/11/17 Schedule D (Form 990) 2017

Schedule D (Form 990) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 2

Part III Organ iza t ions Maintaining C o l l e c t i o n s of Art, Histor ical T r e a s u r e s , or Other S imi lar A s s e t s (continued)

3 Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection Items (check all that apply) ;

Puhi ic exhihition

Scholar ly research

Preservat ion for future generat ions

Loan or exchange programs Other

4 Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Par t X I I I .

5 During the year, did the organization solicit or receive donations of art, historical t reasures, or other similar asse ts |—, to he sold to raise funds rather than to he maintained a s part of the organization's col lection? Y e s No

Part IV E s c r o w and C u s t o d i a l A r r a n g e m e n t s . C o m p l e t e if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 9 , or repor ted a n a m o u n t on F o r m 9 9 0 , P a r t X , l ine 2 1 .

1 a Is the organization an agent, trustee, custodian or other intermediary for contrihutions or other a s s e t s not included — on Form 990, Part X ?

b If ' Y e s , ' explain the arrangement In Par t XIII and complete the following tahle:

Y e s No

I d c Beginning halance

d Additions during the year

e Distrihutions during the year

f Ending halance 2 a Did the organization include an amount on Form 990, Par t X , line 2 1 , for escrow or custodial account liahility?.

b If ' Y e s , ' explain the arrangement in Par t X I I I . Check here if the explanation has heen provided on Par t XII I —

I c

I f

Amount

Y e s No

Part V I E n d o w m e n t F u n d s . C o m p l e t e if the o rgan iza t ion a n s w e r e d ' Y e s ' on Forrr i 9 9 0 , P a r t IV , l ine 10.

1 a Beginning of year halance.

b Contrihutions

c Net investment earnings, ga ins, and losses

d Grants or scholarships

e Other expenditures for facil i t ies and programs

f Administrative expenses g E n d of year ha lance

2 Provide the est imated percentage of the current year end halance (l ine 1g, column (a ) ) held a s ;

a Board designated or quasi-endowment %

b Permanent endowment %

%

(a) Current year (b) Prior year (c) Two years back (d) Tfiree years back (e) Four years back

c Temporari ly restricted endowment

The percentages on lines 2a, 2b, and 2c should equal 100%.

3 a Are there endowment funds not in the possession of the organization that are held and administered for the organization hy: ( i ) unrelated organizat ions

(ii) related organizations b If ' Yes ' on line 3a( i i ) , are the related organizations listed a s required on Schedu le R ?

4 Describe in Part XI I I the intended uses of the organization's endowment funds.

3a(i) 3a(ii)

3b

Y e s No

Part VI I L a n d , B u i l d i n g s , a n d E q u i p m e n t . C o m p l e t e if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 1 l a . S e e F o r m 9 9 0 , P a r t X , l ine 10.

Description of property (a ) Cost or other bas is (b) Cost or other (c) Accumulated (d) Book value ( investment) bas is (other) depreciation

1 a Land 222,239. 222,239. b Buildings 833,781. 221,621. 612,160. c Leasehold improvements d Equipment 49,010. 37,873. 11,137. e Other 15,810. 15,810.

Tota l . Add l ines 1 a through 1 e. (Column (d) must equal Form 990, Part X, column (B), line lOc).. 861,346. BAA Schedule D (Form 990) 2017

TEEA3302L 08/10/17


Part VII I I nves tments - Other S e c u r i t i e s . N/A Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine l i b . S e e F o r m 9 9 0 , P a r t X , l ine 12.

(a) Description of security or category (including name of security) (b) Book value (c) Method of valuation: Cost or end-of-year market value

(1) Financia l derivatives

(2) Closely-held equity interests (3) e ther

W _~ _(B2 (Pl PI ©

^ F ^ _(G)

_(H)

PI Total. (Column (b) must equal Form 990, PartX, column (B) line 12.).

I nves tments — Program Re la ted . N/A Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 11c. S e e F o r m 9 9 0 , P a r t X , l ine 13. (a) Description of investment (b) Book value (c) Method of valuat ion: Cost or end-of-year market value

(1) (2)

(3) (4) (5)

(6) (7) (8) (9)

(10) Total. (Column (b) must equal Form 990, PartX, column (B) line 13.) .. Part IX Other A s s e t s . N/A

(a) Description (b) Book value

(1) (2) (3) (4) (5) (6) (7) (8) (9)

(10)

Total. (Column (b) must equal Form 990, Part X, column (B) line 15.).

Part X Other L iabi l i t ies .

(a) Description of liahility (b) Book value (1) Federal income taxes

(2) C r e d i t c a r d payable 3,611. (3) (4) (5) (6) (7) (8) (9)

(10)

(11) Total. (Column (b) must equal Form 990, PartX, column (B) line 25.) " 3,611. 2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII O

BAA TEEA3303L 08/10/17 Schedule D (Form 990) 2017


Part XI I Reconc i l ia t ion of R e v e n u e per Audi ted F i n a n c i a l S t a t e m e n t s With R e v e n u e per Return . Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 1 2 a .

1 Total revenue, gains, and other support per audited f inancial s tatements

2 Amounts included on line 1 but not on Form 990, Part V I I I , l ine 12: a Net unrealized gams ( losses ) on investments b Donated serv ices and use of facil i t ies c Recover ies of prior year grants d Other (Describe In Part X I I I . ) .. See P a r t X I I I e Add lines 2a througfi 2d

3 Subtract line 2e from line 1 4 Amounts included on Form 990, Part VII I , line 12, but not on line 1:

a Investment expenses not included on Form 990, Par t V I I I , l ine 7b

b Ottier (Describe in Par t XI I I . )

c Add l ines 4a and 4h 5 Total revenue. Add l ines 3 and 4c . (This must equal Form 990, Part I, line 12.).

2 a 2 b 2 c 2 d 164,930.

4 a 4 b

1

2 e

4 c

1,511,364.

164,930. 1,346,434,

1,346,434.

Par tX I l I Reconc i l ia t ion of E x p e n s e s per Audi ted F i n a n c i a l S t a t e m e n t s With E x p e n s e s per Re turn . Comp le te if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 1 2 a .

1 Total expenses and losses per audited f inancial s tatements 2 Amounts included on line 1 but not on Form 990, Par t IX, line 25 :

a Donated serv ices and use of facil i t ies b Prior year adjustments

c Otfier losses. d Ottier (Describe in Par t X I I I . ) .. See . P a r t X I I I e Add l ines 2a tfirough 2d

3 Subtract line 2e from line 1 4 Amounts included on Form 990, Part IX, line 25 , but not on line 1 :

a Investment expenses not included on Form 990, Part V I I I , line 7b b Otfier (Describe in Par t X I I I . ) c Add lines 4a and 4b

5 Total expenses . Add l ines 3 and 4c . (This must equal Form 990, Part I, line 18.).

2 a 2 b 2 c 2 d 164,930.

4 a 4 b

1

2 e

4 c

851,491.

164,930. 686,561.

686,561.

Part Xlli I Supp lementa l Information. Provide the descriptions required for Part I I , l ines 3, 5 , and 9; Part I I I , l ines l a and 4 ; Part IV, l ines I h and 2h; Par t V , line 4 ; Part X , line 2 ; Par t X I , l ines 2d and 4h; and Par t X I I , l ines 2d and 4h . A lso complete this part to provide any additional information.

S c h e d u l e D, Part X I , L ine 2d Other R e v e n u e Inc luded In F / S But Not Inc luded O n F o r m 990

Resource s a l e s r e ported a t n e t $ 160,420. S p e c i a l event expenses 4, 510.

T o t a l $ 164,930.

S c h e d u l e D, Part XII , L i n e 2d Other E x p e n s e s A n d L o s s e s P e r Audi ted F / S

Resource s a l e s r e ported a t n e t $ 160, 420. S p e c i a l event expenses 4, 510.

T o t a l $ 164,930.

BAA Schedu le D (Form 990) 2017

TEEA3304L 08/10/17

S C H E D U L E G (Form 990 or 990-EZ)

Department of ttie Treasury Internal Revenue Service

Supplemental Information Regarding Fundraising or Gaming Activities Complete if the organization answered 'Yes' on Form 990, Part IV, line 17,18, or 19, or if the

organization entered more than $15,000 on Form 990-EZ, line 6a. - Attach to Form 990 or Form 990-EZ.

»• Go to www.irs.gov/Form990 for the latest instructions.

OMB No. 1545-0047

S C H E D U L E G (Form 990 or 990-EZ)




»• Go to www.irs.gov/Form990 for the latest instructions.

2017 S C H E D U L E G (Form 990 or 990-EZ)




»• Go to www.irs.gov/Form990 for the latest instructions. Open to Public Inspection

Name of ttie organization

Safe Harbor of NC, I n c . Employer identification number

57-1215608 p . I—I Fundraising Activities. Complete if the organization answered 'Yes ' on Form 990, Part iV, line 17.

' — I Form 990 -EZ fl iers are not required to complete this part. 1 indicate whether the organization ra ised funds through any of the following act ivi t ies. Check all that apply.

Mail solicitations

b internet and emai l solicitations

c Phone solicitations

d n in-person solicitations

2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or key employees listed in Form 990, Par t V i i ) or entity in connection with professional fundraising se rv i ces?

Soiicitation of non-government grants

f Soiicitation of government grants

Spec ia l fundraising events

^ Y e s [X ]NO

b if ' Y e s , ' list the 10 highest paid individuals or entit ies ( fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization.

( I ) Name and address of individual or entity (fundraiser)

Oi) Activity (i i i) Did fundraiser

have custody or control of contributions?

Y e s No

Ov) Gross receipts from activity

(v) Amount paid to (or retained by)

fundraiser listed in column 0)

(vl) Amount paid to (or retained by)

organization

2

3

4

5

6

7

8

9

10

Total 3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration

or l icensing.

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. TEEA3701L 08/09/17

Schedule G (Form 990 or 990-EZ) 2017

Schedule G (Form 990 or 9 9 0 - E Z ) 2017 Safe Harbor of NC, I n c . 5 7 - 1 2 1 5 6 0 8 Page 2

Part II I F u n d r a i s i n g E v e n t s . C o m p l e t e if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 18, or reported more than $ 1 5 , 0 0 0 of f und ra i s ing even t cont r ibut ions a n d g r o s s i n c o m e on F o r m 9 9 0 - E Z , l i nes 1 and 6b. L i s t e v e n t s wi th g ross rece ip t s g rea te r than $ 5 , 0 0 0 .

(a) Even t #1

F a l l E v e n t

(b) Even t #2

B e d S p r e a d D e r

(c) Other events

None

(d) Total events (add column (a)

through column (c)) R E

(event type) (event type) (total number)

(d) Total events (add column (a)

through column (c))

V E N 1 Gross receipts 9 3 , 8 3 3 . 2 1 , 4 3 1 . 1 1 5 , 2 6 4 . U E

2 L e s s : Contributions 9 3 , 8 3 3 . 2 1 , 4 3 1 . 1 1 5 , 2 6 4 .

3 Gross income (l ine 1 minus line 2 )

4 C a s h pr izes

5 Noncash pr izes 5 6 3 . 5 6 3 . D

R 6 Rent/facil i ty costs 5 0 0 . 5 0 0 . E C T 7 Food and beverages 4 , 1 3 5 . 4 , 1 3 5 . E X p 8 Entertainment E N S 9 Other direct expenses 3 , 6 4 7 . 2 , 8 1 0 . 6 , 4 5 7 . E S

10 Direct expense summary. Add l ines 4 through 9 in column ( d ) . 1 1 , 6 5 5 . 11 Nf>t i n r n m p <;Eimmarv S i i h t r a r t linn ID f rom lino .3 column (d) - 1 1 , 6 5 5 . 11 - 1 1 , 6 5 5 .

Part III G a m i n g . C o m p l e t e if the o rgan iza t ion a n s w e r e d ' Y e s ' on F o r m 9 9 0 , P a r t IV , l ine 19, or repor ted more than

1 Gross revenue.

(a) Bingo (b) Pul l tabs/instant bingo/progressive

bingo (c) Other gaming

(d) Total gaming (add column (a)

through column (c))

E D X I P R E E N C S T E

S

2 C a s h pr izes

3 Noncash pr izes

4 Rent/facil ity costs

5 Other direct expenses . Y e s No 6 Volunteer labor

7 Direct expense summary. Add l ines 2 through 5 in column (d)

8 Net gaming income summary. Subtract line 7 from line 1 , column (d )

Y e s No

Y e s No

9 Enter the s ta te(s) in which the organization conducts gaming act iv i t ies:

a Is the organization l icensed to conduct gaming activit ies in each of these s t a t e s ? .

b If 'No,' expla in:

Y e s No

10a Were any of the organization's gaming l icenses revoked, suspended, or terminated during the tax year?,

b If ' Y e s , ' expla in:

Y e s No

BAA TEEA3702L 09/18/17 Schedule G (Form 990 or 990-EZ) 2017

Schedule G (Form 990 or 9 9 0 - E Z ) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 3 11 Does the organization conduct gaming activit ies with nonmembers?.

12 Is the organization a grantor, beneficiary or trustee of a trust, or a member of a partnership or other entity formed to administer charitable gaming?

Y e s No

Y e s No

13 Indicate the percentage of gaming activity conducted in:

a The organization's facility.

b An outside facility 14 Enter the name and address of the person who prepares the organization's gaming/special events books and records:

13a 13b

Name

Address -

15a Does the organization have a contract with a third party from whom the organization rece ives gaming revenue?

b If ' Y e s , ' enter the amount of gaming revenue received by the o r g a n i z a t i o n $ and the amount

of gaming revenue retained by the third party - $

c If ' Y e s , ' enter name and address of the third party:

Y e s No

Name

Address *•

16 Gaming manager information:

Name

Gaming manager compensat ion *•

Description of serv ices provided *•

~P Director/officer

17 Mandatory distributions:

Employee [ Independent contractor

a Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming l icense?

b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the

organization's own exempt activit ies during the tax year $

^ Y e s Q N O

Part IV I Supp lementa l Information. P r o v i d e the e x p l a n a t i o n s requ i red by P a r t I, l ine 2b , c o l u m n s ( i l l ) a n d ( v ) ; and P a r t I I I , l i nes 9 , 9b , 10b, 15b, 15c , 16, a n d 17b, a s app l i cab le . A l s o provide a n y addi t ional in format ion. S e e ins t ruc t ions .

BAA TEEA3703L 09/18/17 Schedule G (Form 990 or 990-EZ) 2017

S C H E D U L E L (Form 990 or 990-EZ)


Transactions With Interested Persons *- Complete if the organization answered 'Yes ' on Form 990, Part iV, iine 25a, 25b, 26, 27, 28a,

28b, or 28c, or Form 990-EZ, Part V, iine 38a or 40b. «• Attach to Form 990 or Form 990-EZ.

*- Go to www.irs.gov/Form990 for Instructions and the latest Information.

OMB No. 1545-0047 S C H E D U L E L (Form 990 or 990-EZ)




*- Go to www.irs.gov/Form990 for Instructions and the latest Information.

2017 S C H E D U L E L (Form 990 or 990-EZ)




*- Go to www.irs.gov/Form990 for Instructions and the latest Information. Open To Public

Inspection Name ot the organization

S a f e H a r b o r o f N C , I n c .


5 7 - 1 2 1 5 6 0 8

Part 1 E x c e s s Benef i t T r a n s a c t i o n s ( sec t i on 501 ( c ) ( 3 ) , sec t i on 501 ( c ) ( 4 ) , a n d 501 ( c ) ( 2 9 ) o rgan iza t i ons on l y ) . Complete if the organization answered ' Y e s ' on Form 990, Part IV, line 25a or 25b, or Form 9 9 0 - E Z , Part V , line 40b.

1 (a) Name ot disqualified person (b) Relationship hetviieen disqualified

person and organization (c) Description ot transaction (d) Corrected?

1 (a) Name ot disqualified person (b) Relationship hetviieen disqualified

person and organization (c) Description ot transaction Yes No

(1) (2) (3) (4) (5) (6)

2 Enter the amount of tax incurred by the organization managers or disqualif ied persons during the year under section 4958 " $

3 Enter the amount of tax, if any, on line 2. above, reimbursed by the organization " $

Part II L o a n s to and/or F r o m Interested P e r s o n s . Complete if the organization answered 'Yes' on Form 990-EZ, Part V, line 38a or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22.

(a) Name of interested person (b) Relationship with organization

(c) Purpose ot loan

(d) Loan to or from the

organization?

(e) Original principal amount

(0 Balance due (g) In default? (h) Approved hy hoard or committee?

0) Written agreement?

(a) Name of interested person (b) Relationship with organization

(c) Purpose ot loan

To From

(e) Original principal amount

(0 Balance due

Y«s No Yes No Yes No

0 ) (2) (3) (4) (5) (6) (7) (8)

(9) 00)

Total *-$ Part III G r a n t s or A s s i s t a n c e Benef i t ing Interested P e r s o n s .

Complete if the organization answered 'Yes' on Form 990, Part IV, line 27.

(a) Name of interested person (b) Relationship between interested person and the organization

(c) Amount of assistance (d) Type of assistance (e) Purpose of assistance

(1) (2) (3) (4) (5) (6) (7) (8) (9)

OO) BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Schedule L (Form 990 or 990-EZ) 2017

TEEA4501L 08/09/17

Schedule L (Form 990 or 9 9 0 - E Z ) 2017 Safe Harbor of NC, I n c . 57-1215608 Page 2

Part i V I B u s i n e s s T r a n s a c t i o n s Involving Interested P e r s o n s . Complete if the organization answered 'Yes' on Form 990, Part IV, line 28a, 28b, or 28c. (a) Name of interested person (b) Relationstiip tietween

interested person and ttie organization

(c) Amount ot transaction

(d) Description of transaction (e)St i j organi2

rever

Yes

ring of ation's ues?

No

(1) J e s s i c a Haynes Daughter of Bd. Mem. (2) 26,289. Employment X (3) (4) (5) (6) (7) (8) (9)

(10) P a r t V Supplementa l Information

Provide additional information for responses to questions on Schedule L (see instructions).

TEEA4501L 08/09/17

Schedule L (Form 990 or 990-EZ) 2017

S C H E D U L E 0 (Form 990 or 990-EZ)


Supplemental Information to Form 990 or 990-EZ Complete to provide information for responses to specif ic questions on

Form 990 or 990-EZ or to provide any additional information. • Attach to Form 990 or 990-EZ.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047 S C H E D U L E 0 (Form 990 or 990-EZ)




Go to www.irs.gov/Form990 for the latest information.

2017 S C H E D U L E 0 (Form 990 or 990-EZ)




Go to www.irs.gov/Form990 for the latest information. Open to Public Inspection

Name ot the organization

Safe Harbor of NC, I n c . Employer identitication number

57-1215608

Form 990, Part I, L i n e 1 - Organizat ion M iss ion or Signi f icant Act iv i t ies

Safe Harbor provides a s a f e environment where women can work on r e b u i l d i n g t h e i r

l i v e s . We focus on two primary components: (1) A one-year r e s i d e n t i a l program f o r

women r e c o v e r i n g from i s s u e s such as mental i l l n e s s , substance abuse, or domestic

v i o l e n c e , (2) A day s h e l t e r f o r homeless women and c h i l d r e n who need a s a f e p l a c e to

st a y .

Form 990, Part III, L i n e 1 - Organizat ion M i s s i o n

Safe Harbor provides a s a f e environment where women can work on r e b u i l d i n g t h e i r

l i v e s . We focus on two primary components: (1) A one-year r e s i d e n t i a l program f o r

women r e c o v e r i n g from i s s u e s such as mental i l l n e s s , substance abuse, or domestic

v i o l e n c e , (2) A day s h e l t e r f o r homeless women and c h i l d r e n who need a s a f e p l a c e to

st a y .

F o r m 990, Part V I , L i n e l i b - F o r m 990 R e v i e w P r o c e s s

Reviewed by t r e a s u r e r , board c h a i r and exec d i r e c t o r before f i l i n g .

Form 990, Part V I , L ine 19 - Ottier Organizat ion D o c u m e n t s Publ ic ly Ava i lab le

They are a v a i l a b l e to the p u b l i c upon req u e s t . Copies of these documents can be

mailed, emailed, or viewed a t our o f f i c e by the p u b l i c a t any time.

BAA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. TEEA4901L 08/09/17 Schedule 0 (Form 990 or 990-EZ) (2017)

return of organization exempt from income tax 2017 · 2019-01-11 · form omb no. 1545-0047 return...

Documents