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2021-571-E-AMS-Chapel Hill-Carrboro Branch of the NAACP-Community climate grant project
Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 1 of 11 COMMUNITY CLIMATE ACTION GRANT PERFORMANCE AGREEMENT THIS AGREEMENT, made and entered into this 6th day of October 2021, (“Effective Date”) by and between the County of Orange, a political subdivision of the State of North Carolina, 200 South Cameron Street, Hillsborough, North Carolina, 27278, ("County") and Chapel Hill-Carrboro Branch of the NAACP, a legal entity located at 891 Willow Drive Suite #7, Chapel Hill, NC 27514 (“Provider”). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community equity and climate action need, as identified by the Board of Commissioners; NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth, the County and Provider agree as follows: 1. Term of the Agreement. The term of this Agreement shall be two years beginning - October 1, 2021 to September 30, 2023. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Community Climate Action Grant Program Application and any amendments or revision thereto which is attached as Exhibit “A” and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means, methods, techniques, sequence, safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, the Community Climate Action Grant Program Performance Application, Exhibit B, the Revised, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of $122,100.00. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in installments in the amount of $15,263 to be paid as follows: See Exhibit C. The first payment is contingent upon receipt of the agency’s performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement, related supporting documentation and performance outlined in the Revised Scope of Services and Project Budget in Exhibit B. If the project described in Exhibit A requires funds to be provided on a different or more accelerated schedule, the Provider may request an alternate payment schedule, which if approved, will be attached to this Agreement as Exhibit C, Alternative Payment Schedule. Should an Alternative Payment DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 2 of 11 Schedule be approved, the Provider will still be required to submit quarterly Progress Reports for the duration of the Term of the Agreement. The County’s obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Exhibits B and C. d. Once Provider has satisfied its obligations as provided in (c) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. e. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Exhibit B, Revised Scope of Services. Progress Report dates are: October 1 – December 31, January 1 – March 31, April 1 - June 30, and July 1 – September 30. Reports are due on January 14, April 15, July 15 and October 15, of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services, upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below (hereinafter referred to as “default”), the County may immediately terminate this Agreement, in whole or in part, and from time to time. Notice of termination must be in writing, state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings, be declared insolvent, or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above, the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance, incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider, the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten (10) business days DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 3 of 11 from written notice of default. The County may (but shall not be required to) grant the Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County’s remedies in law or in equity. c. Notwithstanding the foregoing, either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain, during the period of performance of this Agreement, insurance: i. Worker’s Compensation. For protection from claims under workers' or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance, including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance, covering personal injury, bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A - Statutory State NC & Coverage B - Employers Liability $500,000 each accident, $500,000 Bodily Injury by Disease (BID) for each employee. $500,000 for BID limit • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $1,000,000 Each Occurrence • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate • Sexual Abuse & Molestation $1,000,000 Each Occurrence $2,000,000 Aggregate • Cyber Liability $1,000,000 Each Occurrence $2,000,000 Aggregate DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 4 of 11 • Environmental/Pollution $1 million Each Occurrence Liability (Required if demolition, use of hazardous material or environmentally sensitive) c. All insurance policies (with the exception of Worker's Compensation and Professional Liability) required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough, NC 27278 d. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement, including the rights to payment, to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend, indemnify, and hold harmless the County, for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County’s sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 5 of 11 on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County’s living wage is $15.40 per hour. To the extent possible, Orange County recommends that Provider provides a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice, mailed or delivered, to the last known address shall constitute sufficient notice to the County and the Provider. All notices required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance & Administrative Services Orange County Post Office Box 8181 Hillsborough, NC 27278 Provider: Chapel Hill-Carrboro Branch of the NAACP PO Box 1236 Carrboro, NC 27510 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede, replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms, and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States, the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part, term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified, and has not utilized the services of any agent or subcontractor, on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article 11A and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF, the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. For and on behalf of the Provider Dawna Jones, President Date DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 10/12/2021 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 6 of 11 For and on behalf of Orange County Government Bonnie Hammersley, County Manager Date DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 10/14/2021 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 7 of 11 ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Chapel Hill-Carrboro Branch of the NAACP Party/Vendor Contact Person: Bill Ward Contact Phone: 919-960-2587 Party/Vendor Address: PO Box 1236 City: Carrboro State: NC Zip: 27510 Department: Asset Management Services Amount: $122,100 Purpose: Community Climate Grant Project FY20-21 – Water Heater Replacement Budget Code(s): 61370035-803060-30052 Vendor # N/A (N/A if new vendor) Vendor is a BOCC consultant? Yes No X Contract Type: (Check one) New X Renewal Amendment Effective Date October 1, 2021 Approved by Board: Yes X No Agenda Date: February 2, 2021 This agreement is approved as to technical form and content: Department Director’s Signature Date: Information Technologies (Applicable only to hardware/software purchases or related services) This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficiency of insurance standards, specifications, and requirements: Office of the Risk Management Officer Date: Financial Services This instrument has been pre-audited in the manner required by the Local Government Budget and Fiscal Control Act: Office of the Chief Financial Officer Date: Legal Services This agreement is approved as to legal form and sufficiency: Office of the County Attorney Date: Clerk to the Board Received for record retention: All Docusign contracts must be copied to the Clerk upon completion: occlerkdocs@orangecountync.gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 10/7/2021 10/12/2021 10/13/2021 10/14/2021 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 8 of 11 Exhibit A Community Climate Action Grant Program Application See the following appended application documents: • NAACP Climate Action Fund Application FY20-21 • Signed pages of NAACP Application • NAACP#1 FY 2020-21Agency and Project Budget Worksheets • NAACP#2 and #5 Letter regarding Taxes and COI • NAACP#3 Executive Committee • NAACP#4 Solid Waste Program Fee Verification • Habitat#1 Agency Budget - FY21 • Habitat#2 990 • Habitat#3 Board • Habitat#4 Solid Waste Program Fee (SWPF) Verification • Habitat COI Orange County exp 2022.04.01 • Rebuilding#1 Agency Budget Worskheet • Rebuilding#2 990 • Rebuilding#3 Board • Rebuilding#4 SWPF Explanation Letter_20201104 • Orange-County-Housi_Rebuilding-Toge_2021-22_COI • Commercial Auto - COI- Rebuilding Together of the Triangle DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 9 of 11 Exhibit B Community Climate Action Grant Program’s Revised Scope of Services and Program Budget No revisions requested DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 10 of 11 Exhibit C Community Climate Action Grant Program’s Alternative Payment Schedule From a needs assessment of Orange County Home Preservation Coalition applicants, the NAACP team has identified candidates for hot water heater replacement and developed a retrofit plan. Based on this retrofit plan the NAACP team proposes an alternative payment schedule. The payment for the first quarter occurs upon County approval of the performance agreement. The County makes subsequent quarterly payments upon receipt of the quarter's Progress Report, which shows satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in this exhibit and Exhibit B. Performance Period Quarter Requested Funding 1 20,350 2 16,280 3 16,280 4 16,280 5 16,280 6 16,280 7 16,280 8 4,070 Total 122,100 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Chapel Hill-Carrboro Branch of the NAACP Orange County Community Climate Action Grant Program Performance Agreement Rev. 2/21 Page 11 of 11 ATTACHMENT “A” Orange County Certifications – FY 2020-21 Community Climate Action Grant Program Performance Agreement Primary Contact, Chief Executive Officer / Executive Director, and Chief Financial Officer I certify that I have provided the primary contact and chief executive officer or executive director, and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name, title, phone and email address and if possible, fax number. Board of Directors and Officers of the Board I certify that I have provided a current list of the Board of Directors and Officers of the Board with this Agreement and that we will continue to update the list as changes occur. The list should be in writing, with the name, physical address, mailing address and if possible, phone, fax and email address. Project Budget Submission I certify that I have provided a project budget for the period to be covered by Orange County funding, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Agency Budget Submission I certify that I have provided the requested information from the latest budget adopted by the agency for the fiscal years encompassing this Agreement. If not, please explain on a separate sheet of paper. Alignment with Organization’s Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. Certified by: (Provider’s Signature) Title: Date: DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 10/12/2021 President, Chapel Hill-Carrboro Branch of the NAACP 891 Community Climate Action Grant Program Application and Instructions FY 2020-21 Thank you for your interest in Orange County’s Community Climate Action Grant Program! Climate Action Fund Background: As part of the FY20 budget, the Board of Orange County Commissioners created the Orange County Climate Action Fund dedicated to accelerating climate change mitigation actions in Orange County. This decision was motivated in part to help the County meet the climate change mitigation goals set by the Commissioners in recent years. The first round of Climate Action Fund projects were proposed by the Commission for the Environment last year and approved by the Commissioners. These include funding for solar projects for each of the school districts, a LED lighting campaign for lower-income residents, and additional funding to weatherize and preserve affordable housing. The process for soliciting and selecting projects to receive funding this year is being conducted through a formal grant program. For the 2020-21 funding cycle, an estimated $478,657 funding will be provided to support an expansion of climate change mitigation and resilience projects that build on Orange County’s long history of sustainable actions. Following the direction of the Board of Orange County Commissioners, the Orange County Commission for the Environment is seeking applications for the FY20-21 funding cycle. Grant Program Process Key Dates FY20-21: DATE ACTIVITY September 18, 2020 Grant Application Opens September 2020 – October 2020 Applications are Prepared* Monday, October 19th, 5pm Deadline for questions and technical assistance requests Monday, November 9th, noon Application Deadline November – December 2020 Application Review by Orange County Commission for the Environment and Human Relations Commission December 2020 Commission for the Environment scoring complete and sent to Board of Orange County Commissioners January 2021 Agency Funding Review and Approval by Board Spring 2021 Contracts Executed & Projects Begin *Please be sure to check the Grant Project website regularly for updates and for notice about participating in Application Q&A Sessions (to be recorded). Eligibility: All public and non‐profit entities are eligible to apply as well as small businesses whose gross revenues do not exceed $3 million annually. All proposed projects must demonstrate a positive impact on Orange County’s residents and environment as described in the scoring criteria. All funds awarded through this grant program should be spent in Orange County. Before funds can be distributed, successful applicants P a g e 1 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 must have the legal standing to enter into a contractual funding agreement with Orange County. Such legal standing is not required at the time of application. The Board of Orange County Commissioners (BOCC) intends to use the Climate Action Fund to support projects that would not be completed without funding assistance. Existing projects and programs may be eligible if the applicant can demonstrate that Climate Action Funding would significantly accelerate the pace or amplify the scope of the project or program. Projects that contain repairs and replacement of necessary technology or infrastructure must show both energy efficiency improvements and demonstrate that the project is unlikely to be funded through another funding mechanism within the next 5 years. Scoring Process and Technical Assistance: For the FY 20‐21 funding round, there will be a single open application period during the Fall of 2020 with project awards announced by the end of the January 2021. In addition to the guidance and online impact estimation tools provided, the Orange County Commission for the Environment (CFE) and supporting staff will respond to applicants’ requests for clarification or technical assistance if submitted before the posted deadline for questions. Applicants are encouraged to ask for clarification and technical assistance as early as possible. Questions and requests for Technical Assistance should be directed to the Orange County Sustainability Coordinator, Brennan Bouma (bbouma@orangecountync.gov). Once the FY 2021 application period closes, the CFE will review and score all eligible projects using a formula that prioritizes social justice and racial equity. The CFE will consult with other experts or advisory boards on any or all submitted applications for the purposes of ensuring diversity and inclusion and to reinforce their scoring decisions. Upon request, comments from the reviewers on an application will be made available to the Board of Orange County Commissioners and/or to the party who submitted the application. The CFE will deliver a rank‐ordered list of their recommended projects and scores to the Board of Orange County Commissioners who will make the final funding decisions. In this process, the CFE may recommend full or partial funding for their recommended projects. Scoring Criteria: Projects will be assessed by the CFE based primarily on the following criteria. Example metrics that can be used to assign scores under the criteria are listed below each one. Not all example metrics will apply to each project. Application reviewers will pay close attention to any objective and authoritative evidence supporting a proposed project. As you complete your application, please describe how your proposed programs align with evidence-based approaches to addressing climate change. 1. Social Justice and Racial Equity (0 to 5pts): Low‐income households have fewer resources to help them avoid or adapt to the impacts of climate change, and communities of color are often most‐heavily impacted by the disruptions of climate change. Both socioeconomic status and racial identity are key factors that will be used to target and track the positive impacts of these programs. It should be noted that socio‐economic status and race should be tracked separately since it should not be assumed that County residents below the poverty line are people of color. Example metrics: P a g e 2 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Low‐income or marginalized communities/households were engaged in the creation of this project. Low‐income or marginalized communities/households benefit most directly. Racial minorities will be hired and/or are essential to the completion of the project. Any negative side effects of the project do not impact any low‐income or marginalized communities/households. 2. Emissions reduced (0 to 4 pts): This criterion rewards projects which reduce the most emissions as well as those that reduce emissions within Orange County (e.g.‐ transportation, carbon farming), instead of at a power plant as all of these are outside of the County except for UNC’s co‐gen plant which regularly only powers a portion of the UNC campus. Example metrics: A significant amount of Greenhouse gas emissions will be reduced within Orange County as a result of this project. Greenhouse gas emissions reductions are directly attributable to the project. 3. Efficient use of Funds (0 to 4 pts): This criterion measures the relative impact per dollar of investment from the Climate Action Fund, as well as how. Some example metrics include: Example metrics: Impact per grant dollar. Generated cost savings over a reasonable payback period. Acceleration or expansion of existing programs that already show positive impact. Leveraging other funding sources. The proposed project positions the applicant for future funding from other sources. 4. Capacity of Applicant (0 to 3 pts): Example metrics: Applicant has the expertise to complete the project, and shows understanding of what is needed to accomplish the project goals. Applicant has done similar projects or has collaborators with direct experience in the project field. 5. Local Economic Development (0 to 3 pts): Reducing climate change impacts can also increase and diversify local economic development. Transitioning to renewable energy and clean technologies is a huge market opportunity and the County Commissioners want to reward projects that emphasize local investment. Some example metrics include: Example metrics: Number of Orange County residents employed by the applicant organization. % of project materials that are sourced within Orange County/The Triangle/North Carolina. 6. Amount and Duration of Engagement (0 to 3 pts): This criterion measures the extent to which projects effectively educate on climate change impacts, mitigation, and/or resilience, and increase community awareness and engagement with climate change efforts. Some example metrics include: Example metrics: Number of people reached. P a g e 3 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Retention of new knowledge or attitude after project completion. Likelihood of impacted audience continuing engagement with climate change efforts. 7. Time to complete (0 to 3 pts): Example metric: Project can be completed or show clear positive impacts within two years or less. Reporting and Monitoring Applicants that receive funding are required to submit written progress reports. Funded projects will be monitored for progress and performance, financial and administrative management, and compliance with the terms of Performance or Funding Agreement(s). Monitoring may involve site and/or office visit(s). During the first year of implementation of the grant program, staff may make changes to the appropriate frequency of measurement and reporting. P a g e 4 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 SUBMISSION CHECKLIST Primary Applicant Organization Chapel Hill-Carrboro Branch of the NAACP _ Project Name(s) ___Water Heater Replacement _________ Section Subsection Cover Page Applicant and Collaborator/Partner Contact Information Funding Requests Signed Application Cover Page Signed Disclosure of Conflicts of Interest and Clause Applicant Information Applicant organization’s Date of Incorporation Applicant organization’s Purpose/Mission (if applicable) Living Wage Schedule of Positions (if applicable) Project Information Project Name Project Description Strategic Objective Target Population Performance Indicators Project Budget Summary Attachments (A description of these items is available on page 15: “Description of Required Attachments.” Please contact us if it will not be possible to provide any of these required attachments at the time of application: bbouma@orangecountyn c.gov) Applicant Organization’s Annual Budget and Proposed Project Budget (Use template provided) Applicable Financial Records to prove eligibility: IRS Federal Form 990 or Applicant Organization’s Tax Returns from 2019 Applicable Financial Records to prove eligibility of collaborator/partner (if they are receiving project funds): IRS Federal Form 990 or Tax Returns from 2019 List of members of organization’s Governing Board (if Board exists) Solid Waste Program Fee (SWPF) Verification (for commercial property owners and renters) Certificate of Insurance P a g e 5 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 COVER PAGE Applicant Contact Information Applicant Organization’s Legal Name: Chapel Hill-Carrboro Branch of the NAACP Applicant Organization’s Physical Address: 891 Willow Drive Suite #7, Chapel Hll, NC 27514 Applicant Organization’s Mailing Address: PO Box 1236, Carrboro, NC 27510 Applicant Organization’s Web Address: https://www.chapelhillcarrboronaacp.com Executive Director (if applicable): Not applicable Telephone Number: 206-954-4273 E-Mail: naacp5689@gmail.com Tax ID Number: 45-3323968 Funding Request Summary Please list all Fiscal Year 2021 Community Climate Action Grant funding requested for all projects you are proposing and the proposed use of funds (please list program name only). Applicants will be asked to provide more details on their proposed program budget in the Budget Worksheets attachment. Project Equipment Operations Personnel Total Water Heater Replacement $37,088.00 $67,912.00 $17,100.00 $122,100.00 Totals $37,088.00 $67,912.00 $17,100.00 $122,100.00 Briefly explain your proposed use of funds ( 2-4 sentences ): The purchase of 30 heat- pump water heaters at $1,236 each yields $37088. 30 home assessments to determine feasibility and installation details for $6000. Cost for balance of system and labor for installation is $67,912. Administrative costs at 10% of project cost is $11,100. To the best of my knowledge and belief all information and data in this application is true and current. Signature: Applicant’s Authorized Signatory Date P a g e 6 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON- DISCRIMINATION CLAUSE Are any of the Board Members or employees of the organization which will be carrying out this project or their named project collaborators/partners or members of their immediate families, or their business associates… YES NO X a) Employees of or closely related to employees of Orange County? X b) Members of or closely related to members of the governing bodies of Orange County? X c) Current beneficiaries of the program for which funds are being requested? X d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question or know of any other potential conflict of interest regarding your application, please provide a full explanation here: NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender, national origin, age, handicap, religion, sexual orientation, gender identity/expression, familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding, but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signature: Applicant’s Authorized Signatory Date P a g e 7 o f 23 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Applicant Organization & Collaborator Information Please provide the following information about the primary applicant organization: 1.Date of Incorporation (Month/Year): February, 1909 2.Applicant organization’s Purpose/Mission (no more than 2-4 sentences): The mission of the National Association for the Advancement of Colored People is to ensure the political, educational, social, and economic equality of rights of all persons and to eliminate race- based discrimination. 3.Please provide a brief description of your organization’s past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables (no more than 2-4 sentences). Since 1909 the NAACP has successfully restored and expanded social justice and racial equity for countless individuals. More recently t he NAACP has initiated the Environmental and Climate Justice Program that creates resources and leadership for reducing greenhouse gas emissions through building retrofits in under-served communities. Although the NAACP is new to retrofitting buildings, they have built a partnership that includes two organizations with a proven track record for economical and timely retrofits: Rebuilding Together of the Triangle and Habitat for Humanity of Orange County. 4.Living Wage: Does this organization pay permanent employees a minimum living wage? (Yes / No) The Chapel Hill-Carrboro branch of the NAACP does not have any paid employees. If yes, is this organization an Orange County Living Wage Certified Employer ? If no, please briefly explain. 5.Schedule of Positions: a.Number of Full-Time Paid Positons: _0_ b.Number of Part-Time Paid Positions: _0_ c.Number of volunteers 25 and average hours worked per volunteer per month_5_. Please provide the following information about all significant collaborators and partners whether or not they will be receiving grant funding for this project . Feel free to copy and paste Questions “a” through ”e” as needed if you have more than one significant collaborator/partner: For this project two members of the Orange County Home Preservation Coalition are significant collaborators: Rebuilding Together of the Triangle and Habitat for Humanity of Orange County. Orange County Home Preservation Coalition also contributes by providing information on our target population. P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Rebuilding Together of the Triangle (RTT) a)Date of Incorporation (Month/Year): January, 1996 b)Applicant organization’s Purpose/Mission (no more than a few sentences): Rebuilding Together of the Triangle (RTT) believes that everyone deserves to live in a safe healthy home, and we work to achieve this by repairing homes, revitalizing communities and rebuilding lives. RTT completes repairs, safety modifications and home performance upgrades for low-income homeowners in Orange, Chatham, Durham and Wake counties. c)Please provide a brief description of your organization’s past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables (no more than 100 words). RTT has served over 750 Triangle families over the last decade, with projects ranging from simple appliance replacements to full-scale home rehabilitation. We have worked with dozens of public and private funding partners, managing a complex matrix of budgets, timetables and funding priorities to ensure that our clients are able to access the services they need. Most of our projects include at least 3 funding sources, and are completed in careful collaboration with other repair and weatherization partners in this sector. d)Living Wage: Does this organization pay permanent employees a minimum living wage? (Yes / No) Yes a.i.If yes, is this organization an Orange County Living Wage Certified Employer? a.ii.If no, please briefly explain. RTT is not based in Orange County, so while we are committed to paying a living wage, we are not certified by the county as a Living Wage Employer. e) Schedule of Positions: a.Number of Full-Time Paid Positions: 8 b.Number of Part-Time Paid Positions: 4 c.Number of volunteers _25__ and average hours worked per volunteer per month_4_ P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Habitat for Humanity of Orange County (HH) f)Date of Incorporation (Month/Year): April, 1984 g)Applicant organization’s Purpose/Mission (no more than a few sentences): Seeking to put God’s love into action, Habitat for Humanity of Orange County brings people together to build homes, communities, and hope. Our vision is an Orange County where everyone has a decent place to live. h)Please provide a brief description of your organization’s past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables (no more than 100 words). The requested project funding falls under Habitat’s Home Preservation / Repair program. Habitat’s Home Preservation Program serves low-income homeowners who struggle to maintain the interior and exterior of their homes. The program is designed to help preserve affordable home ownership and assist homeowners to live in safe, accessible, and sustainable homes. Since 2010, Habitat has successfully completed 186 affordable home repair projects in Orange County. These projects were subject to grant funding restrictions and reporting. Habitat has received government funding for these projects and has proven its ability to successfully complete and report on the agreed upon work. i)Living Wage: Does this organization pay permanent employees a minimum living wage? (Yes / No) Yes a.i.If yes, is this organization an Orange County Living Wage Certified Employer? Yes a.ii.If no, please briefly explain. j) Schedule of Positions: a.Number of Full-Time Paid Positions: 19 b.Number of Part-Time Paid Positions: 1 c.Number of volunteers 2,023/year___ and average hours worked per volunteer per month_0.44_. Project Information *Please submit for each project if applying for funding for more than one project. 6.Project Name: Water Heater Replacement Project Primary Contact and Title: Project Liaison Bill Ward Telephone Number: 919-960-2587 E-Mail: sandbward@mindspring.com P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 7.Please briefly describe the proposed program and the target population to benefit from the program. (100 words or less) This project was designed to help low-income, Orange County households to transition from inefficient, greenhouse gas generating water heaters to highly efficient, greenhouse gas minimizing water heaters. Applicants to the Orange County Home Preservation Coalition(OCHCP) for weatherization, energy efficiency, urgent repair, or other related services constitute the target population for this project. During application intake the applicant's house is evaluated for potential benefit from this project. Benefits of this project, lower utility bills and lower greenhouse gas emissions, are then explained to the chosen applicants. With agreement of the chosen applicant appropriate modifications are made to the house to transition from an inefficient to an efficient water heater. This project was also designed to cost effectively reduce greenhouse gas emissions. The cost for each pound of yearly CO 2e emissions reduction by a $25k electric automobile is about $5. The cost for each pound of yearly CO 2e emissions reduction by rooftop solar is about $4. The cost for each pound of yearly CO2e emissions reduction by a heat-pump water heater is about $2. 8.Please choose the best description for the type of project: ☐ Infrastructure/Clean Tech: New ☐ Infrastructure/Clean Tech: Repair X Infrastructure/Clean Tech: Replacement ☐ Communication/Education ☐ Natural Systems Management/Restoration ☐ Circular Economy/Waste reduction ☐ Analysis/Plan ☐ Other (Please describe): 9.Please choose the primary climate change mitigation focus for this project (select all that apply): X Energy Efficiency ☐ Renewable Energy X Beneficial Electrification ☐ Carbon Sequestration ☐ Other (Please describe): 10.Has your organization or have your collaborators/partners completed projects of this type in the past? If so, what funds were used? X Yes X Funding used (Please describe): Both RTT and HH have used multiple sources of public and private funds. ☐ No P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 11.If this project is not selected for funding in this round, what other funding might be used to support it within the next 5 years? ☐ Other capital or operational funds X None. This is a unique opportunity. ☐ Unknown (please describe below): 12.Please select the jurisdiction(s) where your project is focused and briefly state how your project aligns with the relevant Climate Action Plans (no more than 2-4 sentences). X Carrboro: https://townofcarrboro.org/928/Community-Climate-Action-Plan X Chapel Hill: In progress, please refer to the website to show alignment. X Orange County: In progress, please instead show alignment with the Orange County BOCC Goals and Priorities. ☐ North Carolina: Clean Energy Plan o Zero Emission Vehicle Plan o Motor Fleet Zero Emission Vehicle Plan o Clean Energy and Clean Transportation Workforce Assessment Extracts from Orange County jurisdiction climate action plans with which this project's goals allign: Carrboro: Recommendations are provided around the themes of community integration, energy efficiency of buildings, transportation, renewable energy, ecosystem protection and restoration, and food choices. Chapel Hill: Climate action is any activity that reduces our greenhouse gas emissions, or that helps us respond to our changing climate by making Chapel Hill a stronger and more resilient community. Orange County: Create, preserve, and protect a natural environment that includes clean water, clean air, wildlife, important natural lands, and sustainable energy for present and future generations . Energy efficiency and beneficial electrification are primary objectives of the previously identified climate action plans. This project contributes significantly to energy efficiency by replacing electric water heaters (uniform energy factor of 0.9) with more highly energy efficient heat-pump water heaters (uniform energy factor greater than 3). This project contributes significantly to beneficial electrification by replacing gas water heaters(uniform energy factor of 0.6) with heat-pump water heaters. Collaborators and Partners In some projects, collaborators and partners provide essential capacity and connections. If collaborators or partners are an essential part of your project whether or not they are receiving grant funds, please use this section to provide more details. If you are not working with collaborators or partners, please feel free to write N/A in this section and move to the Social Justice and Racial Equity section. 13.Please describe one to three key partnerships/collaborations that add the most value to the success of the proposed project. P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Both RTT and HH are critical to the success of this project. They have the expertise and experience to assess the needs of a household, plan the modifications, and efficiently implement the desired changes. Although not a formal partner, the Orange County Home Preservation Coalition identifies target households, connects these households with the appropriate provider, and helps educate their clients about the benefits that OCHPC providers can deliver. Social Justice and Racial Equity 14.How many people will directly or indirectly benefit from your project? Please be as specific as possible on the estimated number and characteristics of those who will benefit including, gender, race, age, socio-economic status and geographic location. Please also state for each group whether the benefits will be direct or indirect. Please fill out the tables below as applicable. The following table represents the demographics for the current applicants to the Orange County Home Preservation Coalition for repair and energy efficiency services. This pool of applicants is continually increasing. Upon grant award this project will select households that can benefit from a water heater replacement – prioritizing those households that have gas water heaters since that will lead to the largest reduction in greenhouse gas emissions. This project has requested funds to replace 30 water heaters and based on our experience we anticipate selecting 20 households with electric water heaters and 10 households with gas water heaters. We believe that each selected household will directly benefit from reduced utility bills and reduced greenhouse gas emissions. Project Target Population Demographics Group Characteristic Project ed 2020- 21 Will the benefits of your project be direct or indirect for this group? Gender Men 24 Women 73 Nonbinary/Genderqueer Self-Describe Total 97 Race and Ethnicity Black or African-American 73 American Indian or Alaska Native 0 Asian 1 White 13 P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Native Hawaiian or other Pacific Islander Two or more races Some other race 10 Total 97 Of the above, how many Hispanic/Latino 6 Of the above, how many non-Hispanic/Latino 91 Total 97 Age 0-5 years 4 6-18 years 22 19-50 years 31 51+ years 112 Total 181 Note that 12 have unknown age Geographic Location Town of Chapel Hill 21 Town of Carrboro 13 Orange County (Outside of Chapel Hill/Carrboro) 63 Outside of Orange County Total 97 Income Low-income (80% of the Area Median Income and Below) Please see income table in the appendix 97 Total 0 15.Please describe any ways in which low‐income or marginalized communities/households were engaged in the creation of this project proposal. The creation of this project was highly dependent on the foundation established by the Orange County Home Preservation Coalition (OCHPC). The OCHPC is a collaborative of 12 local government and community organizations that provide home repairs and modifications to Orange County residents primarily low-income or marginalized households. These households actively apply for energy efficiency services that they could not provide for themselves. The relationship that the OCHPC developed with these marginalized households was a critical stepping stone to helping these households reduce their utility bills. P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 16.Please describe any potential negative side effects of the project and describe the steps you are taking/will take to eliminate or minimize these impacts to any low‐income or marginalized communities/households. We do not anticipate any negative side effects of the project to the households that we serve. 17.Are the impacted residents already aware of the potential positive and negative impacts of your project and the steps you are taking? If not, please describe your plan to engage with them and how you will act based on their input. Clients of this project will most likely not be aware of the benefits of a heat-pump water heater. When we introduce the project to them, we will explain with prepared literature and a socially-distanced dialog not only the benefits to them but to the community. We will patiently answer any questions they may have about the project. If they have any residual reservations, we will not proceed. 18.Please describe any other aspect of your project that is relevant to Social Justice and Racial Equity. This project relies heavily on the participation of the Orange County Home Preservation Coalition (OCHPC). The OCHPC seeks to increase communication and collaboration among home repair organizations to decrease burden on clients and service seekers. Going beyond direct repair service, the OCHPC seeks to advocate for solutions that address the mechanisms that cause or perpetuate racial disparities in access to home repair and modifications in Orange County (including tax assessments, zoning, and mobile home ownership.) Emissions Reduced 19.How many tons of greenhouse gas emissions will your project reduce/avoid each year? This project should reduce greenhouse gas emissions by about 29 short tons/year assuming a grid-supplied electricity emissions of 0.5 pounds CO 2e/kwh. As grid supplied electricity emissions subside with a greener grid, yearly GHG emissions reduction against a 2020 baseline will increase. 20.For how many years will this emissions reduction take place as a result of your project? Please consider the expected lifetime of the technology/program/impact etc. It depends on the lifetime of the heat-pump water heater which can vary dramatically. A reasonable average lifetime for a heat-pump water heater is about 15 years. 21.Please describe the location of the emissions reduction. Where would fossil fuels have been burned if not for your project? For projects creating electricity usage reductions, it can be difficult to determine the location of the power produced. Please feel free to state “Grid-tied electricity reduction” For each electric water heater replaced greenhouse gas emissions from electricity generation (most likely outside Orange County) will be reduced by about 1800 pounds CO 2e/year (assuming P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 0.5 pounds/kwh). For each gas water heater replaced greenhouse gas emissions within Orange County will be reduced by about 2300 pounds CO 2e/year. 22.Please describe any other aspect of your project that is relevant to the amount of emissions that it will reduce or avoid. Efficient use of Funds 23.Please estimate the impact of your project per grant dollar requested. This cost per unit of impact must reflect the total program budget divided by the total impact of the project described in this application. If the proposed project is new, please write N/A in the first column of the table below, and just fill out the second column. The greenhouse gas reductions are based on formulas and uniform energy factors for water heaters obtained from the United States Energy Star program as well as the electricity emission factor (Duke Energy Carolinas) of 0.5 pounds CO 2e/kwh and the emission factor for natural gas of 11.7 pounds CO2/therm (www.eia.gov/environment/emissions/co2_vol_mass.php). Actual 2019-20 Project Costs (If your proposed project expands or accelerates an ongoing effort) Projected Project Costs Total Cost of Project N/A $122,100.00 Unit of Impact: Total # of tons of greenhouse gases reduced N/A 29.48 Cost Per Ton of GHG’s Reduced N/A $4142 Unit of Impact: Total # of individuals served/benefited N/A 60 Cost Per Individual Served/Benefited N/A $2,035.00 Other Unit of Impact: Yearly Utility Bill Savings N/A $8,240.00 Cost Per Unit of Impact N/A $14.80 Other Unit of Impact: Please describe here N/A Cost Per Unit of Impact N/A (Please feel free to add rows if necessary to show any additional units of impact.) P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 24.Please describe any avoided financial costs or savings related to the project and over what period of time those costs will be avoided/reduced. A reasonable expected lifetime for a heat-pump water heater is about 15 years. During this time if the heat-pump water heater replaces an electric water heater the expected savings in the utility bill is $360/year – if the heat-pump water heater replaces a gas water heater the expected savings in the utility bill is $104/year. These savings assume about 65 gallons per day of hot water is used by the household, the cost of electricity is $0.10/kwh, and the cost of natural gas is $0.90/therm. 25.Does your project accelerate or expand on existing programs that already show positive impact? This program is carefully designed to utilize the program infrastructure pioneered by the Orange County Home Preservation Collaborative. The existing home repair and weatherization programming, and the shared intake and assessment process that under-girds it, provide this program with a pipeline of qualified homeowners, a system for evaluating and prioritizing projects, and a model for sharing resources to allow multiple agencies to invest in repairs in a comprehensive, efficient way. So, while this is a new program, it is an expansion of services within this existing framework. 26.Does your project also take advantage of other funding sources? This project does not have a large percentage of matching funds but we have identified a couple of key sources of funding leverage we expect to utilize. The first source is an existing rebate program with Duke Energy; this program is designed to provide owners with a $350 rebate for installing an efficient heat-pump water heater. We have shared this program proposal with Duke Energy, and they have expressed full support. We plan to treat Duke rebates as program income. If we receive the rebate for all 30 homes, we could serve an additional three households. The second source is the existing work of the Orange County Home Preservation Coalition (OCHPC). The group has secured funding from various sources to help support the process involving application intake, home assessment and shared work write up. This has created the pipeline of evaluated, prepared projects that allow this program to very efficiently identify candidates for water heater upgrades. The OCHPC cost of assessment per home is about $500. Typically a project with a specific intervention like this requires assessment of 3-4 homes to identify an appropriate client. Thus, on average, it takes about $2000 for assessment to select and prepare a client for this project. However, since we have built this project upon the existing OCHPC framework, we are only budgeting $200 for assessment per home. 27.Would your proposed project help you to take advantage of funding from other sources besides this grant in the future? At this time, we do not have other sources of funding identified that would replace the Climate Action Funding that Orange County has made available. The leadership that Orange County is exercising in this space is exceptional, but that means there are not large numbers of funders working on these issues directly – yet. That said, we are pursuing funds to assist with beneficial P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 electrification and energy efficiency work around water heater replacement, and we are hopeful that this demonstration project will unlock future funding from other sources focused on the shared benefit this program will provide to our economically vulnerable neighbors, as well as our climate. 28.Please describe any other aspect of your project that is relevant to the efficient use of grant funds. Capacity of Applicant 29.Please describe any projects that you have completed successfully in the past which are similar to the project you are proposing. Rebuilding Together of the Triangle and Habitat for Humanity have an expansive, proven, and well-known track record of completing quality and affordable repairs for Orange County residents. 30.If you are proposing to collaborate with other organizations on this project, please briefly describe their relevant experience to the project and/or the target population. A key collaboration is with the Orange County Home Preservation Coalition. The OCHPC maintains a comprehensive, online, homeowner database that constitutes the target population for this project. RTT and HH will select project clients from this database. The OCHPC will also track the energy efficiency services that RTT and HH provide to project clients. At monthly OCHPC meetings RTT and HH will provide progress updates and will discuss any service issues with the OCHPC. 31.Please describe any other relevant expertise or capacity to carry out the project in your application. Local Economic Development 32.How many Orange County residents are employed by your organization? Habitat for Humanity of Orange County, NC directly employs 13 Orange County residents. Rebuilding Together directly employs 2 Orange County residents. Both organizations prioritize working with local businesses and contractors within Orange County to complete our repair services. 33.What percent of project materials will be purchased from sources within Orange County or North Carolina? P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Both Habitat for Humanity of Orange County and Rebuilding Together prioritize purchasing goods and services locally. We expect that 100% of project materials will be purchased from a local retailer in Orange County, NC. 34.Please describe any other aspect of your project that is relevant to local economic development. This project strives to utilize local, minority subcontractors when possible. Amount and Duration of Engagement 35.Please describe how you will engage with and/or educate project participants. The OCHPC Outreach and Education Committee, which is composed of OCHPC members and recommended community partners, is currently implementing a home maintenance curriculum targeting our service population. Current plans include hosting a monthly one-hour workshop exploring a specific home maintenance topic. Workshop planning emphasizes involving community members in the process. In the springtime, a long-term Northside resident with construction experience will be co-facilitating the monthly workshops alongside a OCHPC partner. With support of Orange County Government, we intend to incorporate an energy conservation and climate impact topics into the workshop curriculum. Specific to this initiative, we will seek to educate homeowners on the benefits of installing a new water heater. An informational handout will be provided to homeowners during the assessment stage of the repair process. Afterwards, a Habitat or Rebuilding Together staff member will meet individually with homeowners to discuss the costs and benefits and climate impact associated with different types of water heaters. 36.How will you measure the success of that engagement or educational effort? We will utilize existing OCHPC evaluation methods to effectively measure the quantitative and qualitative outcomes in the educational efforts of this initiative. Measures include number of homeowners receiving information, change in behaviors, and knowledge gained. 37.Please describe any other aspect of your project that is relevant to the amount, or quality, or length of engagement and education that your project will produce. P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Time to Complete 38.How much time will your project require to demonstrate the positive impacts you describe? Households should see reduced utility bills within weeks of installation of the heat- pump water heater. All proposed water heater replacements should be complete within 18 months of grant funding but could extend to two years depending on circumstances. Submission Guidance Applications are to be submitted as email attachments to Orange County Sustainability Coordinator, Brennan Bouma at bbouma@orangecountync.gov. Please also CC the lead staff member supporting the Commission of the Environment, Wesley Poole at wpoole@orangecountync.gov. The Application Submittal Deadline for the Fiscal Year 2021 round of the Community Climate Action Grant is Monday, November 9th 2020 at 12pm (noon). Please note that late, handwritten, or incomplete applications will not be accepted. Accommodations for applicants with disabilities are available upon request. Please contact the Orange County Sustainability Coordinator, Brennan Bouma (919-245-2626, bbouma@orangecountync,gov) to discuss what is needed. Submit all documents including attachments in both PDF form and in their original editable format (Word and Excel documents). This will ensure the original content and formatting is preserved and will facilitate project scoring and comment. ATTACHMENTS Description of Required Attachments a)Applicant Organization’s Budget and Project Budget Please complete the provided budget template for your organization and your proposed project or submit your own budget file (as long as it contains the same information, and in a similar format, as requested in the provided template. Please explain other in your budget). Budget Template is listed on the Town’s and County website here. Please submit the budget in PDF form as well as in the original editable Excel format. b)IRS Federal Form 990 or 2019 Tax Returns A copy of the applicant organization’s 2018 Form 990 or 2019 Tax Returns is required to determine eligibility. The specific form depends upon the applicant organization’s financial activity. Review the IRS’ table guide, for more details. For Form 990-N (e- postcard) filers, include a copy of the postcard, with the organization’s application materials. P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 c)List of Board of Directors (if applicable) Provide the following information about each board of director’s member: name, telephone number, address, occupation or affiliation of each member and the list must identify the principal officers of the governing body, and length of term. d)Solid Waste Program Fee (SWPF) Verification This fee finances Orange County's recycling and waste reduction program. Submit either a.) proof of payment of the applicant organization’s FY 2018-19 Solid Waste Program Fee, OR b.) a statement on the applicant organization’s letterhead indicating exemption and specify the person(s), business, etc. that is responsible for paying this fee. e)Certificate of Liability Insurance A copy of the applicant organization’s current certificate, from the organization’s insurance carrier. Table 1 below outlines insurance types and minimums required, for each jurisdiction. If exempt from Worker’s Compensation compliance, include a statement explaining why, with the applicant organization’s application materials. NOTE: Proof of insurance is not required at the time of application submission. If your agency is approved for funding, documentation of insurance must be provided to the jurisdiction awarding the funding when the contract is awarded. The insurance certificate should reflect the funding jurisdiction as an additional insured party and certificate holder and provide coverage for the duration of the funding period (as early as February 1, 2021 through January 30, 2023). If proof of insurance can only be written for one year, an update will be required for all ongoing projects. Renewal certificates must be sent to the jurisdiction 30 days prior to any expiration date, cancellation or modification of any stipulated insurance coverage. NOTE: Upon request, insurance requirements may be reviewed on a case by case basis by the County. Please contact the staff identified on the Submission Requirements on Page 15 if you have questions or would like to request a review of your insurance requirements. APPENDIX Table 1. Forms of Liability Insurance and Minimum Policy Amounts Required INSURANCE ORANGE COUNTY3 P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Worker's Compensatio n1 Limits for Coverage A - Statutory State NC, for each employee Limits for Coverage B - Employers Liability of: $500,000 each accident, $500,000 BID for each employee $500,000 for BID limit Commercial General Liability $1 million Each Occurrence $2 million Aggregate Automobile Liability $1 million Each Occurrence Professional Liability $1 million Each Occurrence $2 million Aggregate Sexual Abuse & Molestation $1 million Each Occurrence $2 million Aggregate Cyber Liability $1 million Each Occurrence $2 million Aggregate Visit the NC Industrial Commission’s website for more information regarding Coverage A. Also, note that if an agency uses subcontractors, it must require subcontractors to have workmen’s compensation insurance. Bodily Injury by Disease (BID). Please visit Orange County’s Risk Management page for more information about the County’s Minimum Insurance Requirements. For additional information regarding the Town of Chapel Hill’s Minimum Insurance Requirements, please contact the Office of Risk Management or Business Management. Town of Chapel Hill At- your-Service. Table 2. 2020 Income Limits - US Department of Housing and Urban Development (HUD) Durham-Chapel Hill Metropolitan Statistical Area (Durham, Orange, and Chatham Counties) Source: https://www.huduser.gov/portal/datasets/il/il2020/2020summary.odn P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Income Level 1 person 2 people 3 people 4 people 5 people 6 people 7 people 8 people 30% area median income $19,100 $21,800 $24,550 $27,250 $30,680 $35,160 $39,640 $44,120 50% area median income $31,850 $36,400 $40,950 $45,450 $49,100 $52,750 $56,400 $60,000 80% area median income $50,900 $58,200 $65,450 $72,700 $78,550 $84,350 $90,150 $96,000 P.O. Box 8181 * Hillsborough, North Carolina 27278 Telephone: 919 245-2626 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 FY 2018-19 Agency Budget Applicant Organization's Budget (Most recent complete calendar year or fiscal year) Starting date: January, 2019 Ending Date: December, 2021 ORGANIZATION NAME: ORGANIZATION REVENUE Private Donations $39,000 $32,000 $30,000 -6% Generated Revenue (fees, sales, etc) $40,000 $20,000 $40,000 100% $- $- $- 0 $- $- $- 0 $- $- $- 0 Other Government Grants Triangle United Way $- $- $- 0 State Government $- $- $- 0 Federal Government (CDBG/HOME/etc.) $- $- $- 0 Private Foundation Grants $- $- $- 0 $- $- $- 0 Total Organization Revenue $79,000 $52,000 $70,000 35% AGENCY EXPENSES Compensation $- $- $- 0 Insurance $- $800 $800 0% Rent & Utilities $900 $231 $900 290% Supplies & Equipment $6,000 $2,500 $4,000 60% Travel & Training $10,000 $1,000 $8,000 700% Fundraising $20,000 $5,000 $20,000 300% Community Support $10,000 $7,000 $10,000 43% Scholarships $7,500 $12,000 $17,000 42% Total Agency Expenses $54,400 $28,531 $43,700 53% SURPLUS/(DEFICIT) FOR PERIOD: $24,600 $23,469 $26,300 12% Chapel Hill-Carrboro Chapel Hill-Carrboro Branch of the NAACP Actual Total for Previous Year Estimated Total for Current Year Projected Total for Next Year Percent Change Local Government Grants (Please list separately): Other Revenue: please briefly explain here DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 FY 2018-19 Program Budget Proposed Project Budget PROJECT NAME:Water Heater Replacement Use only if project is ongoing Use for all projects PROJECT REVENUE Private Donations $- $- $- 0 Project Generated Revenue: $- $- $- 0 Orange County Community Climate Action Grant $- $- $122,100 0 $- $- $- 0 $- $- $- 0 $- $- $- 0 Other Government Grants Triangle United Way $- $- $- 0 State Government $- $- $- 0 Federal Government (CDBG/HOME/etc.) $- $- $- 0 Private Foundation Grants $- $- $- 0 $- $- $- 0 Total Project Revenue $- $- $122,100 0 PROJECT EXPENSES Compensation $- $- $67,100 0 Rent & Utilities $- $- $- 0 Supplies & Equipment $- $- $55,000 0 Travel & Training $- $- $- 0 $- $- $- 0 Total Project Expenses $- $- $122,100 0 SURPLUS/(DEFICIT) FOR PERIOD: $- $- $- 0 Actual Total for Previous Year Estimated Total for Current Year Projected Total for Next Year Percent Change Local Government Grants (Please list separately): Other Revenue: please briefly explain here Other Expenses: please briefly explain here DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 NATIONAL ASSOCIATION FOR THE ADVANCEMENT OF COLORED PEOPLE CHAPEL HILL-CARRBORO Branch #5689. P.O. Box 1236 Carrboro, N.C. 27510 Officers Anna L. Richards President James E. Williams , Jr. 1st Vice President 2nd Vice President Joal Hall Broun 3rd Vice President Dawna Jones Secretary Margaret Krome-Lukens Assistant Secretary Malcolm Tye Hunter Treasurer Herman Foushee Assistant Treasurer Officers Term 2 years Jan 2019 – Jan 2021 Anna Richards (Retired) 205 Copper Beech Court Chapel Hill,NC. 206 954-4273 James Williams (Retired) 415 Waterside Drive Carrboro, NC 919 932-3553 Joal Broun ( State of NC) 107 Creekview Circle Carrboro, NC 919 357-3647 Dawna Jones ( UNC ) 114 Finley Forest Drive Chapel Hill, NC 201 726-6916 Margaret Krome-Lukens (Non-Profit Program Mgr) 117 Cole St Chapel Hill, NC 757 206-0911 Malcolm Tye Hunter ( Retired) 817 Old Mill Rd Chapel Hill, NC 919 536-9224 Herman Foushee ( Accountant) 39 White Oak Trail Chapel Hill, NC 202 256-0980 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 HOUSEHOLDS IMPACTED New Home Construction Starts 12 Home Preservation Repair Starts 31 International Houses through Tithe 11 TOTAL HOUSEHOLDS IMPACTED 54 REVENUES Donations 1,344,750$ NC Housing Finance Agency 560,000$ HOME & FHLB Funds 222,000$ Other Restricted Grants, Government Funds 194,312$ Homeowner Mortgage Payments 715,000$ ReStore Proceeds 150,000$ Other Miscellaneous Income 359,590$ Subtotal - Operating Revenue 3,545,652$ Capital Projects Revenue 2,500,692$ Capital Campaign Revenue 688,000$ TOTAL SOURCES OF FUNDS 6,734,344$ EXPENSES Salaries 1,122,903$ Benefits 290,650$ Office Rent 83,167$ Tithe to Habitat for Humanity International 60,000$ Home Preservation 171,500$ Other Program 209,374$ Other Administrative 156,088$ Other Fundraising 79,050$ Construction and Rehab Costs 1,154,000$ Other Cash Outflows 185,898$ Subtotal - Operating Expenses 3,512,630$ Capital Projects Expenses 3,702,000$ Capital Campaign Expenses 124,500$ TOTAL USES OF FUNDS 7,339,130$ NET SOURCES/(USES) OF FUNDS (604,786)$ Our FY21 budget includes significantly higher capital expenses than in prior years due to increased capital spending as we develop the infrastructure for Weavers Grove, our future community in Chapel Hill of 236 homes. Our budget shows a negative cash impact at this time. This budget is conservative and does not include several potential sources of funding that we are actively pursuing. We have also established multiple short-term financing options with favorable rates for use if needed. We currently maintain a cash balance of 4-5 months of operating expenses. Habitat for Humanity of Orange County FY21 Budget DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 PUBLIC DISCLOSURE COPY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Expenses $including grants of $Revenue $ 832002 12-31-18 1 2 3 4 Yes No Yes No 4a 4b 4c 4d 4e Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part III Briefly describe the organization's mission: Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? If "Yes," describe these new services on Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "Yes," describe these changes on Schedule O. ~~~~~~ Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. () ()() () ()() () ()() Other program services (Describe in Schedule O.) ()() Total program service expenses | Form (2018) 2 Statement of Program Service AccomplishmentsPart III 990 HABITAT FOR HUMANITY OF ORANGE COUNTY CHANGES LIVES BY BRINGING X X TOGETHER GOD'S PEOPLE AND RESOURCES TO HELP FAMILIES IN NEED BUILD AND 2,971,703.49,883.2,219,628. HEALTHIER, MORE FINANCIALLY STABLE LIVES. WITH OUR HELP, HABITAT NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY OWN QUALITY AFFORDABLE HOMES IN SAFE AND SUPPORTIVE COMMUNITIES. HABITAT FOR HUMANITY PARTNERS WITH FAMILIES TO CREATE BETTER, HOMEOWNERS ACHIEVE THE STRENGTH, STABILITY, AND INDEPENDENCE THEY NEED TO BUILD A BETTER FUTURE FOR THEMSELVES AND THEIR FAMILIES. THROUGH THE USE OF VOLUNTEER LABOR AND DONATIONS OF MONEY AND MATERIALS, HABITAT BUILDS HOMES FOR FAMILIES IN NEED, AND HOMES ARE SOLD WITH AFFORDABLE 366,348.173,986. HABITAT FOR HUMANITY'S "HOME PRESERVATION" PROGRAM IS FOR HOMEOWNERS MORTGAGES. HOMEOWNERS MAKE MONTHLY PAYMENTS, WHICH ARE SET AT 30% OR LESS OF THEIR INCOME, MAKING HOMEOWNERSHIP AN AFFORDABLE REALITY. DURING THIS FISCAL YEAR, SEVEN NEW HOUSES WERE SOLD. IN ADDITION, THERE WERE ELEVEN HOMES BUILT OUTSIDE THE US WITH THE $49,883 TITHE GRANT MADE TO HABITAT INTERNATIONAL. IN CARRYING OUT ITS AFFORDABLE HOUSING AND COMMUNITY STRENGTHENING ACTIVITIES, HABITAT SEEKS TO EDUCATE AND WHO STRUGGLE TO MAINTAIN THEIR HOMES DUE TO THEIR AGE, DISABILITY, AND/OR FAMILY CIRCUMSTANCES. THIS PROGRAM SUPPORTS THE ORGANIZATION'S MISSION OF AFFORDABLE HOUSING AND COMMUNITY STRENGTHENING BY HELPING HOMEOWNERS RECLAIM THEIR HOMES WITH PRIDE AND DIGNITY. INCLUDES BOTH 307,754. THE HABITAT FOR HUMANITY RESTORE IS A NONPROFIT HOME IMPROVEMENT STORE EXTERIOR AND INTERIOR SERVICES (ROOF, PAINTING, LANDSCAPING, HVAC, WEATHER STRIPPING, PORCH/DECK, HANDICAP ACCESS, FLOOR, CEILING, AND OTHER REPAIR SERVICES). 27 FAMILIES SERVED. AND DONATION CENTER THAT SELLS NEW AND GENTLY USED FURNITURE, HOME ACCESSORIES, BUILDING MATERIALS, AND APPLIANCES TO THE PUBLIC AT A FRACTION OF THE RETAIL PRICE. THE HABITAT FOR HUMANITY RESTORE IS PROUDLY OWNED AND OPERATED BY LOCAL HABITAT FOR HUMANITY AFFILIATES IN DURHAM AND ORANGE COUNTIES. PROCEEDS ARE USED TO BUILD HOMES, 3,338,051. COMMUNITY, AND HOPE LOCALLY AND AROUND THE WORLD. X SEE SCHEDULE O FOR CONTINUATION(S) DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832003 12-31-18 Yes No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 Section 501(c)(3) organizations. a b c d e f a b 11a 11b 11c 11d 11e 11f 12a 12b 13 14a 14b 15 16 17 18 19 20a 20b 21 a b 20 21 a b If "Yes," complete Schedule A Schedule B, Schedule of Contributors If "Yes," complete Schedule C, Part I If "Yes," complete Schedule C, Part II If "Yes," complete Schedule C, Part III If "Yes," complete Schedule D, Part I If "Yes," complete Schedule D, Part II If "Yes," complete Schedule D, Part III If "Yes," complete Schedule D, Part IV If "Yes," complete Schedule D, Part V If "Yes," complete Schedule D, Part VI If "Yes," complete Schedule D, Part VII If "Yes," complete Schedule D, Part VIII If "Yes," complete Schedule D, Part IX If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Parts XI and XII If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional If "Yes," complete Schedule E If "Yes," complete Schedule F, Parts I and IV If "Yes," complete Schedule F, Parts II and IV If "Yes," complete Schedule F, Parts III and IV If "Yes," complete Schedule G, Part I If "Yes," complete Schedule G, Part II If "Yes," complete Schedule G, Part III If "Yes," complete Schedule H If "Yes," complete Schedule I, Parts I and II Form 990 (2018)Page Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to complete ? Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ 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? Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? Did the organization maintain collections of works of art, historical treasures, or other similar assets? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part X, line 21, 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 services? Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~ If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. Did the organization report an amount for land, buildings, and equipment in Part X, line 10? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Did the organization report an amount for other liabilities in Part X, line 25? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? Did the organization obtain separate, independent audited financial statements for the tax year? ~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization included in consolidated, independent audited financial statements for the tax year? ~~~~~ Is the organization a school described in section 170(b)(1)(A)(ii)? Did the organization maintain an office, employees, or agents outside of the United States? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~ If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?~~~~~~~~~~ Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? ~~~~~~~~~~~~~~ Form (2018) 3 Part IV Checklist of Required Schedules 990 X X X X X X X X X X X X X X X X X X X X X X HABITAT FOR HUMANITY, ORANGE COUNTY X X X X X X NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832004 12-31-18 Yes No 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 22 23 24a 24b 24c 24d 25a 25b 26 27 28a 28b 28c 29 30 31 32 33 34 35a 35b 36 37 38 a b c d a b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. a b c a b Section 501(c)(3) organizations. Note. Yes No 1 a b c 1a 1b 1c (continued) If "Yes," complete Schedule I, Parts I and III If "Yes," complete Schedule J If "Yes," answer lines 24b through 24d and complete Schedule K. If "No," go to line 25a If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part II If "Yes," complete Schedule L, Part III If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule M If "Yes," complete Schedule M If "Yes," complete Schedule N, Part I If "Yes," complete Schedule N, Part II If "Yes," complete Schedule R, Part I If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part VI Form 990 (2018)Page Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~ Did the organization engage in an excess benefit transaction with a disqualified person during the year? 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? ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, or key employee? ~~~~~~~~~~~ A family member of a current or former officer, director, trustee, or key employee? 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? ~~ ~~~~~~~~~~~~~~~~~~~~~ Did the organization receive more than $25,000 in non-cash contributions? Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and cease operations? Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? Was the organization related to any tax-exempt or taxable entity? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a controlled entity within the meaning of section 512(b)(13)? If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ Did the organization make any transfers to an exempt non-charitable related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? ~~~~~~~~ Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? All Form 990 filers are required to complete Schedule O Check if Schedule O contains a response or note to any line in this Part V Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~ Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~ Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? Form (2018) 4 Part IV Checklist of Required Schedules Part V Statements Regarding Other IRS Filings and Tax Compliance 990 X X X X X X X X X X X X NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY 16 0 X X X X X X X X X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832005 12-31-18 Yes No 2 3 4 5 6 7 a b 2a Note. 2b 3a 3b 4a 5a 5b 5c 6a 6b 7a 7b 7c 7e 7f 7g 7h 8 9a 9b a b a b a b c a b Organizations that may receive deductible contributions under section 170(c). a b c d e f g h 7d 8 9 10 11 12 13 14 15 16 Sponsoring organizations maintaining donor advised funds. Sponsoring organizations maintaining donor advised funds. a b Section 501(c)(7) organizations. a b 10a 10b Section 501(c)(12) organizations. a b 11a 11b a b Section 4947(a)(1) non-exempt charitable trusts. 12a 12b Section 501(c)(29) qualified nonprofit health insurance issuers. Note. a b c a b 13a 13b 13c 14a 14b 15 16 (continued) e-file If "No" to line 3b, provide an explanation in Schedule O If "No," provide an explanation in Schedule O Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? Form (2018) Form 990 (2018)Page Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~ If at least one is reported on line 2a, did the organization file all required federal employment tax returns? If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions) ~~~~~~~~~~ ~~~~~~~~~~~ Did the organization have unrelated business gross income of $1,000 or more during the year? If "Yes," has it filed a Form 990-T for this year? ~~~~~~~~~~~~~~ ~~~~~~~~~~~ At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~ If "Yes," enter the name of the foreign country: See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? ~~~~~~~~~~~~ ~~~~~~~~~ If "Yes" to line 5a or 5b, did the organization file Form 8886-T?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? ~~~~~~~~~~~~~~~ If "Yes," indicate the number of Forms 8282 filed during the year Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~~~~~~~~~~ ~~~~~~~ ~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ~ Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?~~~~~~~~~~~~~~~~~~~ Did the sponsoring organization make any taxable distributions under section 4966? Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Enter: Initiation fees and capital contributions included on Part VIII, line 12 Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~~~~~~~~~~ ~~~~~~ Enter: Gross income from members or shareholders Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization filing Form 990 in lieu of Form 1041? If "Yes," enter the amount of tax-exempt interest received or accrued during the year Is the organization licensed to issue qualified health plans in more than one state? See the instructions for additional information the organization must report on Schedule O. ~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization receive any payments for indoor tanning services during the tax year? If "Yes," has it filed a Form 720 to report these payments? ~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N. Is the organization an educational institution subject to the section 4968 excise tax on net investment income? If "Yes," complete Form 4720, Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ 5 Part V Statements Regarding Other IRS Filings and Tax Compliance 990 J X X X X X X X X X X X X X 23 NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832006 12-31-18 Yes No 1a 1b 1 2 3 4 5 6 7 8 9 a b 2 3 4 5 6 7a 7b 8a 8b 9 a b a b Yes No 10 11 a b 10a 10b 11a 12a 12b 12c 13 14 15a 15b 16a 16b a b 12a b c 13 14 15 a b 16a b 17 18 19 20 For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions. If "Yes," provide the names and addresses in Schedule O (This Section B requests information about policies not required by the Internal Revenue Code.) If "No," go to line 13 If "Yes," describe in Schedule O how this was done (explain in Schedule O) If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O. Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? Form (2018) Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part VI Enter the number of voting members of the governing body at the end of the tax year Enter the number of voting members included in line 1a, above, who are independent ~~~~~~ ~~~~~~ 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 trustees, or key employees to a management company or other person?~~~~~~~~~~~~~~ Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? Did the organization become aware during the year of a significant diversion of the organization's assets? Did the organization have members or stockholders? ~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The governing body? Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? Did the organization have local chapters, branches, or affiliates? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? Describe in Schedule O the process, if any, used by the organization to review this Form 990. Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization regularly and consistently monitor and enforce compliance with the policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written whistleblower policy? Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? The organization's CEO, Executive Director, or top management official Other officers or key employees of the organization If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? List the states with which a copy of this Form 990 is required to be filed Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A if applicable), 990, and 990-T (Section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. Own website Another's website Upon request Other Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. State the name, address, and telephone number of the person who possesses the organization's books and records | 6 Part VI Governance, Management, and Disclosure Section A. Governing Body and Management Section B. Policies Section C. Disclosure 990 J 15 15 X X X X X X X X X X X X X X X X X X X X X RANDY MCNEILL - 919-932-7077 88 VILCOM CENTER DRIVE #L110, CHAPEL HILL, NC 27514 X X NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY X NC X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Individual trustee or directorInstitutional trusteeOfficerKey employeeHighest compensatedemployeeFormer(do not check more than one box, unless person is both an officer and a director/trustee) 832007 12-31-18 current Section A.Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a current current former former directors or trustees (A)(B)(C)(D)(E)(F) Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part VII Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. ¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation.Enter -0- in columns (D), (E), and (F) if no compensation was paid. ¥ List all of the organization's key employees, if any. See instructions for definition of "key employee." ¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received report- able compensation (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 officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. ¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; 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. PositionName and Title Average hours per week (list any hours for related organizations below line) Reportable compensation from the organization (W-2/1099-MISC) Reportable compensation from related organizations (W-2/1099-MISC) Estimated amount of other compensation from the organization and related organizations Form (2018) 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors 990 (1) SUKI NEWTON CHAIRMAN (2) ELAM HALL (3) TAYLOR LUDLAM (4) KATHY ATWATER (5) JOAN PHARR (6) SUE HARVIN (7) BETSY BLACKWELL (8) CATHY BRYSON (9) ANDREW BURNS (10) DOUG CALL (11) SHANNON KENNEDY (12) DEONDRA ROSE (13) CAMI SCHUPP (14) JOY STEINBERG (15) KELLI THOMAS (16) JENNIFER PLAYER (17) RANDY MCNEILL VICE CHAIRMAN 2ND VICE CHAIRMAN SECRETARY TREASURER FORMER PRESIDENT BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER CEO/PRESIDENT FINANCE DIRECTOR 1.00 2.00 1.00 1.00 2.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 40.00 32.00 X X X X X X X X X X X X X X X X X X X X X X 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 73,367. 56,199. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 10,905. 9,486. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 FormerIndividual trustee or directorInstitutional trusteeOfficerHighest compensatedemployeeKey employee(do not check more than one box, unless person is both an officer and a director/trustee) 832008 12-31-18 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (B)(C)(A)(D)(E)(F) 1 b c d Sub-total Total from continuation sheets to Part VII, Section A Total (add lines 1b and 1c) 2 Yes No 3 4 5 former 3 4 5 Section B. Independent Contractors 1 (A)(B)(C) 2 (continued) If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such person Page Form 990 (2018) PositionAverage hours per week (list any hours for related organizations below line) Name and title Reportable compensation from the organization (W-2/1099-MISC) Reportable compensation from related organizations (W-2/1099-MISC) Estimated amount of other compensation from the organization and related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| ~~~~~~~~~~| | Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization | Did the organization list any officer, director, or trustee, key employee, or highest compensated employee on line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? ~~~~~~~~~~~~~ Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? Complete this table 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. Name and business address Description of services Compensation Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization | Form (2018) 8 Part VII 990 129,566.0.20,391. 0.0.0. PO BOX 4710, CHAPEL HILL, NC 27515-4710 BURLINGTON, NC 27217 0 2 129,566.0.20,391. NC, INC. X X X 58-1603427 HANNAH UTILITIES, INC. HABITAT FOR HUMANITY, ORANGE COUNTY OWEN'S PLUMBING, 2432 HOLLY BROOK DRIVE, DEVELOPMT/INFRASTRUC LAND PLUMBING 521,348. 114,146. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Noncash contributions included in lines 1a-1f: $ 832009 12-31-18 Total revenue. (A)(B)(C)(D) 1 a b c d e f g h 1 1 1 1 1 1 a b c d e f Contributions, Gifts, Grantsand Other Similar AmountsTotal. Business Code a b c d e f g 2 Program ServiceRevenueTotal. 3 4 5 6 a b c d a b c d 7 a b c 8 a b 9 a b c a b 10 a b c a b Business Code 11 a b c d e Total. Other Revenue12 Revenue excludedfrom tax undersections512 - 514 All other contributions, gifts, grants, and similar amounts not included above See instructions Form (2018) Page Form 990 (2018) Check if Schedule O contains a response or note to any line in this Part VIII Total revenue Related or exempt functionrevenue Unrelated businessrevenue Federated campaigns Membership dues ~~~~~~ ~~~~~~~~ Fundraising events Related organizations ~~~~~~~~ ~~~~~~ Government grants (contributions) ~~ Add lines 1a-1f | All other program service revenue ~~~~~ Add lines 2a-2f | Investment income (including dividends, interest, and other similar amounts) Income from investment of tax-exempt bond proceeds ~~~~~~~~~~~~~~~~~| | Royalties | (i) Real (ii) Personal Gross rents Less: rental expenses Rental income or (loss) Net rental income or (loss) ~~~~~~~ ~~~ ~~ | Gross amount from sales of assets other than inventory (i) Securities (ii) Other Less: cost or other basis and sales expenses Gain or (loss) ~~~ ~~~~~~~ Net gain or (loss)| Gross income from fundraising events (not including $of contributions reported on line 1c). See Part IV, line 18 ~~~~~~~~~~~~~ Less: direct expenses ~~~~~~~~~~ Net income or (loss) from fundraising events | Gross income from gaming activities. See Part IV, line 19 ~~~~~~~~~~~~~ Less: direct expenses Net income or (loss) from gaming activities ~~~~~~~~~ | Gross sales of inventory, less returns and allowances ~~~~~~~~~~~~~ Less: cost of goods sold Net income or (loss) from sales of inventory ~~~~~~~~ | Miscellaneous Revenue All other revenue ~~~~~~~~~~~~~ Add lines 11a-11d ~~~~~~~~~~~~~~~| | 9 Part VIII Statement of Revenue 990 203,414. 250,215. 1,448,375. 1,315,811. 1,769,440. 85,941. 2,701,368. 599,923. 371,046. 263,345. 18,679. 4,483,074.2,701,368.0.12,266. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY HOME SALES 900099 1,448,375. RESTORE NET SALES 900099 599,923. MORTGAGE DISCOUNT AMOR 900099 21,142.21,142. 25,822. 0. 25,822. 25,822.25,822. 371,046. DISCOUNT ON NOTES PAYA 900099 4,970. 39,668. -34,698.-34,698. 203,414. 263,345. OTHER FEES 900099 18,679. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Check here if following SOP 98-2 (ASC 958-720) 832010 12-31-18 Total functional expenses. Joint costs. (A)(B)(C)(D) 1 2 3 4 5 6 7 8 9 10 11 a b c d e f g 12 13 14 15 16 17 18 19 20 21 22 23 24 a b c d e 25 26 Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) Professional fundraising services. See Part IV, line 17 (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Sch O.) Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.) Add lines 1 through 24e Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part IX Total expenses Program serviceexpenses Management andgeneral expenses Fundraisingexpenses ~ Grants and other assistance to domestic individuals. See Part IV, line 22 ~~~~~~~ Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ~~~ Benefits paid to or for members ~~~~~~~ Compensation of current officers, directors, trustees, and key employees ~~~~~~~~ ~~~ Other salaries and wages ~~~~~~~~~~ Other employee benefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~ Fees for services (non-employees): Management Legal Accounting Lobbying ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Investment management fees Other. ~~~~~~~~ Advertising and promotion Office expenses Information technology Royalties ~~~~~~~~~ ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Occupancy ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~Travel Payments of travel or entertainment expenses for any federal, state, or local public officials ~ Conferences, conventions, and meetings ~~ Interest Payments to affiliates ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ Depreciation, depletion, and amortization Insurance ~~ ~~~~~~~~~~~~~~~~~ All other expenses | Form (2018) Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII. 10 Statement of Functional ExpensesPart IX 990 49,883. 173,957. 804,737. 45,529. 116,152. 80,933. 43,014. 21,725. 27,698. 13,265. 4,602. 129,955. 90,148. 11,870. 10,417. 24,342. 53,087. 1,583,421. 489,673. 122,919. 121,696. 4,019,023. 49,883. 61,533.87,110.25,314. 528,713.47,332.228,692. 27,459.6,254.11,816. 70,392.14,795.30,965. 47,099.11,076.22,758. 43,014. 21,725. 27,698. 2,741.10,524. 2,761.690.1,151. 77,070.8,774.44,111. 56,896.10,903.22,349. 7,729.1,870.2,271. 2,626.2,929.4,862. 22,966.425.951. 33,243.19,844. 1,583,421. 489,673. 122,919. 107,913.6,476.7,307. 3,338,051.250,727.430,245. CONSTRUCTION COSTS INTEREST AMORT - MORT R INTEREST AMORT - NOTE P NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832011 12-31-18 (A)(B) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 1 2 3 4 5 6 7 8 9 10c 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 a b 10a 10bAssets Total assets. LiabilitiesTotal liabilities. Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34. 27 28 29 Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34. 30 31 32 33 34Net Assets or Fund Balances Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part X Beginning of year End of year Cash - non-interest-bearing Savings and temporary cash investments Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other receivables from other disqualified 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 instr). Complete Part II of Sch L ~~ Notes and loans receivable, net Inventories for sale or use Prepaid expenses and deferred charges ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D Less: accumulated depreciation ~~~ ~~~~~~ Investments - publicly traded securities Investments - other securities. See Part IV, line 11 Investments - program-related. See Part IV, line 11 Intangible assets ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~ Add lines 1 through 15 (must equal line 34) Accounts payable and accrued expenses Grants payable Deferred revenue ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax-exempt bond liabilities Escrow or custodial account liability. Complete Part IV of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~ Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~ Secured mortgages and notes payable to unrelated third parties ~~~~~~ Unsecured notes and loans payable to unrelated third parties ~~~~~~~~ Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines 17 through 25 | Unrestricted net assets Temporarily restricted net assets Permanently restricted net assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ | Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, building, or equipment fund Retained earnings, endowment, accumulated income, or other funds ~~~~~~~~~~~~~~~ ~~~~~~~~ ~~~~ Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~ Total liabilities and net assets/fund balances Form (2018) 11 Balance SheetPart X 990 34,469.46,890. 348,694.235,414. 37,861.79,449. 6,205,816.6,115,742. 511,005. 184,261.332,515.326,744. 37,000. 3,070,132.4,878,646. 12,115,219.13,226,223. 2,085,732.1,543,338. 46,856. 251,766.273,679. 83,499.68,194. 1,439,613.2,060,833. 2,133,922.2,143,191. 3,945,800.4,592,753. X 8,114,497.8,469,409. 54,922.164,061. 8,169,419.8,633,470. 12,115,219.13,226,223. 58-1603427NC, INC. HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832012 12-31-18 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Yes No 1 2 3 a b c 2a 2b 2c a b 3a 3b Form 990 (2018)Page Check if Schedule O contains a response or note to any line in this Part XI Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other changes in net assets or fund balances (explain in Schedule O) Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B)) ~~~~~~~~~~~~~~~~~~~ Check if Schedule O contains a response or note to any line in this Part XII Accounting method used to prepare the Form 990:Cash Accrual Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. Were the organization's financial statements compiled or reviewed by an independent accountant?~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis Were the organization's financial statements audited by an independent accountant?~~~~~~~~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~ If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits Form (2018) 12 Part XI Reconciliation of Net Assets Part XII Financial Statements and Reporting 990 X NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY 4,483,074. 4,019,023. 464,051. 8,169,419. 0. 8,633,470. X X X X X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (iv) Is the organization listedin your governing document? OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 832021 10-11-18 (i)(iii)(v)(vi)(ii) Name of supported organization Type of organization (described on lines 1-10 above (see instructions)) Amount of monetary support (see instructions) Amount of other support (see instructions) EIN (Form 990 or 990-EZ)Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. | Attach to Form 990 or Form 990-EZ. | Go to www.irs.gov/Form990 for instructions and the latest information. Open to Public Inspection Name of the organization Employer identification number 1 2 3 4 5 6 7 8 9 10 11 12 section 170(b)(1)(A)(i). section 170(b)(1)(A)(ii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iv). section 170(b)(1)(A)(v). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(ix) section 509(a)(2). section 509(a)(4). section 509(a)(1)section 509(a)(2)section 509(a)(3). a b c d e f g Type I. You must complete Part IV, Sections A and B. Type II. You must complete Part IV, Sections A and C. Type III functionally integrated. You must complete Part IV, Sections A, D, and E. Type III non-functionally integrated. You must complete Part IV, Sections A and D, and Part V. Yes No Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule A (Form 990 or 990-EZ) 2018 (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) A church, convention of churches, or association of churches described in A school described in (Attach Schedule E (Form 990 or 990-EZ).) A hospital or a cooperative hospital service organization described in A medical research organization operated in conjunction with a hospital described in 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 (Complete Part II.) A federal, state, or local government or governmental unit described in An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in (Complete Part II.) A community trust described in (Complete Part II.) An agricultural research organization described in 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: An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See (Complete Part III.) An organization organized and operated exclusively to test for public safety. See An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in or . See Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. 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. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, 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 organization(s). LHA SCHEDULE A Part I Reason for Public Charity Status Public Charity Status and Public Support 2018 X HABITAT FOR HUMANITY, ORANGE COUNTY 58-1603427NC, INC. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Subtract line 5 from line 4. 832022 10-11-18 Calendar year (or fiscal year beginning in) Calendar year (or fiscal year beginning in) | 2 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 Total. 6 Public support. (a) (b) (c) (d) (e) (f) 7 8 9 10 11 12 13 Total support. 12 First five years. stop here 14 15 14 15 16 17 18 a b a b 33 1/3% support test - 2018. stop here. 33 1/3% support test - 2017. stop here. 10% -facts-and-circumstances test - 2018. stop here. 10% -facts-and-circumstances test - 2017. stop here. Private foundation. Schedule A (Form 990 or 990-EZ) 2018 | Add lines 7 through 10 Schedule A (Form 990 or 990-EZ) 2018 Page (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, please complete Part III.) 2014 2015 2016 2017 2018 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ Add lines 1 through 3 ~~~ 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)~~~~~~~~~~~~ 2014 2015 2016 2017 2018 Total Amounts from line 4 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ Net income from unrelated business activities, whether or not the business is regularly carried on ~ Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)~~~~ Gross receipts from related activities, etc. (see instructions)~~~~~~~~~~~~~~~~~~~~~~~ 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 | ~~~~~~~~~~~~Public support percentage for 2018 (line 6, column (f) divided by line 11, column (f)) Public support percentage from 2017 Schedule A, Part II, line 14 % %~~~~~~~~~~~~~~~~~~~~~ If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~| If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~| If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions | Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage 1404726. 1404726. 1620596. 1620596. 1800400.1394475.1769440.7989637. 1800400.1394475.1769440.7989637. 312,265. 7677372. 1404726.1620596.1800400.1394475.1769440.7989637. 11,369.13,525.25,521.50,143.46,964.147,522. 335,022.337,728.320,064.992,814. 9129973. 11,352,935. 84.09 78.58 X NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (Subtract line 7c from line 6.) Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year (Add lines 9, 10c, 11, and 12.) 832023 10-11-18 Calendar year (or fiscal year beginning in) | Calendar year (or fiscal year beginning in) | Total support. 3 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 6 7 Total. a b c 8 Public support. (a) (b) (c) (d) (e) (f) 9 10 a b c 11 12 13 14 First five years. stop here 15 16 15 16 17 18 19 20 2018 2017 17 18 a b 33 1/3% support tests - 2018. stop here. 33 1/3% support tests - 2017. stop here. Private foundation. Schedule A (Form 990 or 990-EZ) 2018 Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 Schedule A (Form 990 or 990-EZ) 2018 Page (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) 2014 2015 2016 2017 2018 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Gross receipts from admissions, merchandise sold or services per- formed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose Gross receipts from activities that are not an unrelated trade or bus- iness under section 513 ~~~~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ ~~~ Add lines 1 through 5 Amounts included on lines 1, 2, and 3 received from disqualified persons ~~~~~~ Add lines 7a and 7b ~~~~~~~ 2014 2015 2016 2017 2018 Total Amounts from line 6 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ ~~~~ Add lines 10a and 10b ~~~~~~ Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~ Other income. Do not include gainor loss from the sale of capital assets (Explain in Part VI.)~~~~ 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 | Public support percentage for 2018 (line 8, column (f), divided by line 13, column (f)) Public support percentage from 2017 Schedule A, Part III, line 15 ~~~~~~~~~~~% % Investment income percentage for (line 10c, column (f), divided by line 13, column (f)) Investment income percentage from Schedule A, Part III, line 17 ~~~~~~~~% %~~~~~~~~~~~~~~~~~~ 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 The organization qualifies as a publicly supported organization ~~~~~~~~~~| 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 The organization qualifies as a publicly supported organization ~~~~| If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions | Part III Support Schedule for Organizations Described in Section 509(a)(2) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage Section D. Computation of Investment Income Percentage NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832024 10-11-18 4 Yes No 1 2 3 4 5 6 7 8 9 10 Part VI 1 2 3a 3b 3c 4a 4b 4c 5a 5b 5c 6 7 8 9a 9b 9c 10a 10b Part VI a b c a b c a b c a b c a b Part VI Part VI Part VI Part VI Part VI, Type I or Type II only. Substitutions only. Part VI. Part VI. Part VI. Part VI. Schedule A (Form 990 or 990-EZ) 2018 If "No," describe in how the supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain. If "Yes," explain in how the organization determined that the supported organization was described in section 509(a)(1) or (2). If "Yes," answer (b) and (c) below. If "Yes," describe in when and how the organization made the determination. If "Yes," explain in what controls the organization put in place to ensure such use. If "Yes," and if you checked 12a or 12b in Part I, answer (b) and (c) below. If "Yes," describe in how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. If "Yes," explain in 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. If "Yes," answer (b) and (c) below (if applicable). Also, provide detail in 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). If "Yes," provide detail in If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). If "Yes," provide detail in If "Yes," provide detail in If "Yes," provide detail in If "Yes," answer 10b below. (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings.) Schedule A (Form 990 or 990-EZ) 2018 Page (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.) Are all of the organization's supported organizations listed by name in the organization's governing documents? Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? Was any supported organization not organized in the United States ("foreign supported organization")? Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? Did the organization add, substitute, or remove any supported organizations during the tax year? Was any added or substituted supported organization part of a class already designated in the organization's organizing document? Was the substitution the result of an event beyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? 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 organizations)? Did the organization have any excess business holdings in the tax year? Part IV Supporting Organizations Section A. All Supporting Organizations NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832025 10-11-18 5 Yes No 11 a b c 11a 11b 11cPart VI. Yes No 1 2 Part VI 1 2 Part VI Yes No 1 Part VI 1 Yes No 1 2 3 1 2 3 Part VI Part VI 1 2 3 (see instructions). a b c line 2 line 3 Part VI Answer (a) and (b) below.Yes No a b a b Part VI identify those supported organizations and explain 2a 2b 3a 3b Part VI Answer (a) and (b) below. Part VI. Part VI Schedule A (Form 990 or 990-EZ) 2018 If "Yes" to a, b, or c, provide detail in If "No," describe in 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. If "Yes," explain in how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. If "No," describe in how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). If "No," explain in how the organization maintained a close and continuous working relationship with the supported organization(s). If "Yes," describe in the role the organization's supported organizations played in this regard. Check the box next to the method that the organization used to satisfy the Integral Part Test during the year Complete below. Complete below. Describe in how you supported a government entity (see instructions). If "Yes," then in 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. If "Yes," explain in the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement. Provide details in If "Yes," describe in the role played by the organization in this regard. Schedule A (Form 990 or 990-EZ) 2018 Page Has the organization accepted a gift or contribution from any of the following persons? A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization? A family member of a person described in (a) above? A 35% controlled entity of a person described in (a) or (b) above? 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? Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? 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 organization(s)? 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, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? 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 assets at all times during the tax year? The organization satisfied the Activities Test. The organization is the parent of each of its supported organizations. The organization supported a governmental entity. Activities Test. Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? Did the activities described in (a) constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? Parent of Supported Organizations. Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported organizations? (continued)Part IV Supporting Organizations Section B. Type I Supporting Organizations Section C. Type II Supporting Organizations Section D. All Type III Supporting Organizations Section E. Type III Functionally Integrated Supporting Organizations NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832026 10-11-18 6 1 See instructions. Section A - Adjusted Net Income 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8Adjusted Net Income Section B - Minimum Asset Amount 1 2 3 4 5 6 7 8 a b c d e 1a 1b 1c 1d 2 3 4 5 6 7 8 Total Discount Part VI Minimum Asset Amount Section C - Distributable Amount 1 2 3 4 5 6 7 1 2 3 4 5 6 Distributable Amount. Schedule A (Form 990 or 990-EZ) 2018 Schedule A (Form 990 or 990-EZ) 2018 Page Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI.) All other Type III non-functionally integrated supporting organizations must complete Sections A through E. (B) Current Year (optional)(A) Prior Year Net short-term capital gain Recoveries of prior-year distributions Other gross income (see instructions) Add lines 1 through 3 Depreciation and depletion Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) Other expenses (see instructions) (subtract lines 5, 6, and 7 from line 4) (B) Current Year (optional)(A) Prior Year Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): Average monthly value of securities Average monthly cash balances Fair market value of other non-exempt-use assets (add lines 1a, 1b, and 1c) claimed for blockage or other factors (explain in detail in ): Acquisition indebtedness applicable to non-exempt-use assets Subtract line 2 from line 1d Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions) Net value of non-exempt-use assets (subtract line 4 from line 3) Multiply line 5 by .035 Recoveries of prior-year distributions (add line 7 to line 6) Current Year Adjusted net income for prior year (from Section A, line 8, Column A) Enter 85% of line 1 Minimum asset amount for prior year (from Section B, line 8, Column A) Enter greater of line 2 or line 3 Income tax imposed in prior year Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see instructions). Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832027 10-11-18 7 Section D - Distributions Current Year 1 2 3 4 5 6 7 8 9 10 Part VI Total annual distributions. Part VI (i) Excess Distributions (ii) Underdistributions Pre-2018 (iii) Distributable Amount for 2018Section E - Distribution Allocations 1 2 3 4 5 6 7 8 Part VI a b c d e f g h i j Total a b c Part VI. Part VI Excess distributions carryover to 2019. a b c d e Schedule A (Form 990 or 990-EZ) 2018 Schedule A (Form 990 or 990-EZ) 2018 Page Amounts paid to supported organizations to accomplish exempt purposes Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity Administrative expenses paid to accomplish exempt purposes of supported organizations Amounts paid to acquire exempt-use assets Qualified set-aside amounts (prior IRS approval required) Other distributions (describe in ). See instructions. Add lines 1 through 6. Distributions to attentive supported organizations to which the organization is responsive (provide details in ). See instructions. Distributable amount for 2018 from Section C, line 6 Line 8 amount divided by line 9 amount (see instructions) Distributable amount for 2018 from Section C, line 6 Underdistributions, if any, for years prior to 2018 (reason- able cause required- explain in ). See instructions. Excess distributions carryover, if any, to 2018 From 2013 From 2014 From 2015 From 2016 From 2017 of lines 3a through e Applied to underdistributions of prior years Applied to 2018 distributable amount Carryover from 2013 not applied (see instructions) Remainder. Subtract lines 3g, 3h, and 3i from 3f. Distributions for 2018 from Section D, line 7:$ Applied to underdistributions of prior years Applied to 2018 distributable amount Remainder. Subtract lines 4a and 4b from 4. Remaining underdistributions for years prior to 2018, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, explain in See instructions. Remaining underdistributions for 2018. Subtract lines 3h and 4b from line 1. For result greater than zero, explain in . See instructions. Add lines 3j and 4c. Breakdown of line 7: Excess from 2014 Excess from 2015 Excess from 2016 Excess from 2017 Excess from 2018 (continued) Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832028 10-11-18 8 Schedule A (Form 990 or 990-EZ) 2018 Schedule A (Form 990 or 990-EZ) 2018 Page Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; 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 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; 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.) Part VI Supplemental Information. REIMBURSEMENTS OF FEES 2014 AMOUNT: $ 335,022. 2015 AMOUNT: $ 337,728. 2016 AMOUNT: $ 320,064. NC, INC. SCHEDULE A, PART II, LINE 10, EXPLANATION FOR OTHER INCOME: 58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Department of the Treasury Internal Revenue Service 823451 11-08-18 For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF.Schedule B (Form 990, 990-EZ, or 990-PF) (2018) OMB No. 1545-0047 (Form 990, 990-EZ,or 990-PF)| Attach to Form 990, Form 990-EZ, or Form 990-PF. | Go to www.irs.gov/Form990 for the latest information. Employer identification number Organization type Filers of:Section: not General Rule Special Rule. Note: General Rule Special Rules (1) (2) General Rule Caution: must exclusively exclusively exclusively nonexclusively Name of the organization (check one): Form 990 or 990-EZ 501(c)() (enter number) organization 4947(a)(1) nonexempt charitable trust treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the or a Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions. For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of $5,000; or 2% of the amount on (i) Form 990, Part VIII, line 1h; or (ii) Form 990-EZ, line 1. Complete Parts I and II. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1,000 for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I (entering "N/A" in column (b) instead of the contributor name and address), II, and III. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an religious, charitable, etc., purpose. Don't complete any of the parts unless the applies to this organization because it received religious, charitable, etc., contributions totaling $5,000 or more during the year ~~~~~~~~~~~~~~~|$ An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF), but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). LHA Schedule B Schedule of Contributors 2018 NC, INC.58-1603427 X 3 X ** PUBLIC DISCLOSURE COPY ** HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 823452 11-08-18 Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990, 990-EZ, or 990-PF) (2018)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors 1 X 75,000. 2 X 50,000. 3 X 50,000. 4 X 100,000. 5 X 42,759. 6 X 50,000. HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 823452 11-08-18 Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990, 990-EZ, or 990-PF) (2018)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors 7 X 50,000. 8 X 40,000. 9 X 76,713. 10 X 50,000. HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 823453 11-08-18 Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Employer identification number (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received Schedule B (Form 990, 990-EZ, or 990-PF) (2018)Page Name of organization (see instructions). Use duplicate copies of Part II if additional space is needed. (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ 3 Part II Noncash Property HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (Enter this info. once.)completing Part III, enter the total of exclusively religious,charitable, etc., contributions of for the year. 823454 11-08-18 Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor.(a)(e) and $1,000 or less Schedule B (Form 990, 990-EZ, or 990-PF) (2018) Complete columns through the following line entry. For organizations Employer identification number (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee Schedule B (Form 990, 990-EZ, or 990-PF) (2018)Page Name of organization | $ Use duplicate copies of Part III if additional space is needed. 4 Part III HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 832051 10-29-18 Held at the End of the Tax Year (Form 990)| Complete if the organization answered "Yes" on Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.| Attach to Form 990.|Go to www.irs.gov/Form990 for instructions and the latest information. Open to PublicInspection Name of the organization Employer identification number (a) (b) 1 2 3 4 5 6 Yes No Yes No 1 2 3 4 5 6 7 8 9 a b c d 2a 2b 2c 2d Yes No Yes No 1 2 a b (i) (ii) a b For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule D (Form 990) 2018 Complete if the organization answered "Yes" on Form 990, Part IV, line 6. Donor advised funds Funds and other accounts Total number at end of year Aggregate value of contributions to (during year) Aggregate value of grants from (during year) Aggregate value at end of year ~~~~~~~~~~~~~~~ ~~~~ ~~~~~~ ~~~~~~~~~~~~~ Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control?~~~~~~~~~~~~~~~~~~ Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Complete if the organization answered "Yes" on Form 990, Part IV, line 7. Purpose(s) of conservation easements held by the organization (check all that apply). Preservation of land for public use (e.g., recreation or education) Protection of natural habitat Preservation of open space Preservation of a historically important land area Preservation of a certified historic structure 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. Total number of conservation easements Total acreage restricted by conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements on a certified historic structure included in (a) Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year | Number of states where property subject to conservation easement is located | Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds?~~~~~~~~~~~~~~~~~~~~~~~~~ Staff and volunteer hours devoted to monitoring, inspecting, 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 section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. If the organization elected, as permitted under SFAS 116 (ASC 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 public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items. If the organization elected, as permitted under SFAS 116 (ASC 958), 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 public service, provide the following amounts relating to these items: Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$ $~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items: Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$ $| LHA Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Part II Conservation Easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. SCHEDULE D Supplemental Financial Statements 2018 HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832052 10-29-18 3 4 5 a b c d e Yes No 1 2 a b c d e f a b Yes No 1c 1d 1e 1f Yes No (a) (b) (c) (d) (e) 1 2 3 4 a b c d e f g a b c a b Yes No (i) (ii) 3a(i) 3a(ii) 3b (a) (b) (c) (d) 1a b c d e Total. Schedule D (Form 990) 2018 (continued) (Column (d) must equal Form 990, Part X, column (B), line 10c.) Two years back Three years back Four years back Schedule D (Form 990) 2018 Page 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): Public exhibition Scholarly research Preservation for future generations Loan or exchange programs Other Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? If "Yes," explain the arrangement in Part XIII and complete the following table: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amount Beginning balance Additions during the year Distributions during the year Ending balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII ~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 10. Current year Prior year Beginning of year balance Contributions Net investment earnings, gains, and losses Grants or scholarships ~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~ Other expenditures for facilities and programs Administrative expenses End of year balance ~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~ Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: Board designated or quasi-endowment Permanent endowment Temporarily restricted endowment The percentages on lines 2a, 2b, and 2c should equal 100%. |% |% |% Are there endowment funds not in the possession of the organization that are held and administered for the organization by: unrelated organizations related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R? Describe in Part XIII the intended uses of the organization's endowment funds. ~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10. Description of property Cost or other basis (investment) Cost or other basis (other) Accumulated depreciation Book value Land Buildings Leasehold improvements ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Equipment Other ~~~~~~~~~~~~~~~~~ Add lines 1a through 1e. | 2 Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets Part IV Escrow and Custodial Arrangements. Part V Endowment Funds. Part VI Land, Buildings, and Equipment. X X 283,943. 15,000. 94,793. 117,269. 15,000. 80,115. 89,146. 283,943. 0. 14,678. 28,123. 326,744. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (including name of security) 832053 10-29-18 Total. Total. (a) (b) (c) (1) (2) (3) (a) (b) (c) (1) (2) (3) (4) (5) (6) (7) (8) (9) (a) (b) (1) (2) (3) (4) (5) (6) (7) (8) (9) Total. (a) (b) 1. Total. 2. Schedule D (Form 990) 2018 (Column (b) must equal Form 990, Part X, col. (B) line 15.) (Column (b) must equal Form 990, Part X, col. (B) line 25.) Description of security or category (Col. (b) must equal Form 990, Part X, col. (B) line 12.) | (Col. (b) must equal Form 990, Part X, col. (B) line 13.) | Schedule D (Form 990) 2018 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Book value Method of valuation: Cost or end-of-year market value Financial derivatives Closely-held equity interests Other ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ (A) (B) (C) (D) (E) (F) (G) (H) Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13. Description of investment Book value Method of valuation: Cost or end-of-year market value Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15. Description Book value | Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25. Description of liability Book value (1) (2) (3) (4) (5) (6) (7) (8) (9) Federal income taxes | 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 3 Part VII Investments - Other Securities. Part VIII Investments - Program Related. Part IX Other Assets. Part X Other Liabilities. NC, INC. NON-INTEREST BEARING MORTGAGES RECEIVABLE NMTC JOINT VENTURE DEPOSITS- RENT SECURITY LAND HELD FOR HOMESITES HOMES UNDER CONSTRUCTION HOMES HELD FOR SALE DUE TO JOINT VENTURE DEFERRED RENT 58-1603427 4,656,140. 1,459,602. 6,115,742. 3,887. 3,483,119. 1,034,223. 357,417. 4,878,646. 2,133,922. 9,269. 2,143,191. HABITAT FOR HUMANITY, ORANGE COUNTY END-OF-YEAR MARKET VALUE END-OF-YEAR MARKET VALUE X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832054 10-29-18 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 32e 1 a b c 4a 4b 4a 4b 3 4c. 4c 5 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 1 2e 3 a b c 4a 4b 4a 4b 3 4c. 4c 5 Schedule D (Form 990) 2018 (This must equal Form 990, Part I, line 12.) (This must equal Form 990, Part I, line 18.) Schedule D (Form 990) 2018 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total revenue, gains, and other support per audited financial statements Amounts included on line 1 but not on Form 990, Part VIII, line 12: ~~~~~~~~~~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Recoveries of prior year grants Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part VIII, line 12, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total revenue. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total expenses and losses per audited financial statements Amounts included on line 1 but not on Form 990, Part IX, line 25: ~~~~~~~~~~~~~~~~~~~~~~~~~~ Donated services and use of facilities Prior year adjustments Other losses Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total expenses. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Part XIII Supplemental Information. PRIMARILY RELATED TO 5 HOMEOWNERS' ASSOCIATIONS (HOAS) FOR HABITAT NEIGHBORHOODS FOR WHICH HABITAT MANAGES THE COLLECTION OF DUES AND PAYMENT OF HOA EXPENSES. A SMALL PORTION ALSO EXISTS FOR ONE HOMEOWNER IN BANKRUPTCY FOR WHICH HABITAT COLLECTS AMOUNTS MONTHLY INTO AN ESCROW ACCOUNT IN ORDER TO PAY FOR ITEMS SUCH AS PROPERTY TAXES AND INSURANCE. PART X, LINE 2: 4,530,411. 7,669. 7,669. 4,522,742. -39,668. -39,668. 4,483,074. 4,066,360. 7,669. 39,668. 47,337. 4,019,023. 0. 4,019,023. PART IV, LINE 2B: NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY INCOME TAX STATUS - THE ORGANIZATION IS EXEMPT FROM FEDERAL AND STATE INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND THE APPLICABLE STATE TAX STATUTES. IN ADDITION, THE ORGANIZATION QUALIFIES FOR THE CHARITABLE CONTRIBUTION DEDUCTION UNDER SECTION 170(B)(1)(A) AND HAS DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832055 10-29-18 5 Schedule D (Form 990) 2018 (continued) Schedule D (Form 990) 2018 Page Part XIII Supplemental Information BEEN QUALIFIED AS AN ORGANIZATION THAT IS NOT A PRIVATE FOUNDATION UNDER SECTION 509(A)(2) OF THE INTERNAL REVENUE CODE. MANAGEMENT HAS EVALUATED THE EFFECT OF THE GUIDANCE PROVIDED BY GAAP ON ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. MANAGEMENT BELIEVES THAT THE ORGANIZATION CONTINUES TO SATISFY THE REQUIREMENTS OF A TAX-EXEMPT ORGANIZATION AT JUNE 30, 2019. PART XI, LINE 4B - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EVENT EXPENSES -39,668. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT FUNDRAISING EVENT EXPENSES 39,668. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service Didfundraiserhave custodyor control ofcontributions? 832081 10-03-18 Go to (Form 990 or 990-EZ)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. Open to Public Inspection | Attach to Form 990 or Form 990-EZ. | www.irs.gov/Form990 for instructions and the latest information. Employer identification number 1 a b c d a b e f g 2 Yes No (i) (ii) (iii) (iv) (v) (i) (vi) Yes No Total 3 For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule G (Form 990 or 990-EZ) 2018 Name of the organization Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990-EZ filers are not required to complete this part. Indicate whether the organization raised funds through any of the following activities. Check all that apply. Mail solicitations Internet and email solicitations Phone solicitations In-person solicitations Solicitation of non-government grants Solicitation of government grants Special fundraising events Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. Name and address of individual or entity (fundraiser)Activity Gross receipts from activity Amount paidto (or retained by)fundraiserlisted in col. Amount paidto (or retained by)organization | List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing. LHA Supplemental Information Regarding Fundraising or Gaming ActivitiesSCHEDULE G Part I Fundraising Activities. 2018 HABITAT FOR HUMANITY, ORANGE COUNTY 58-1603427 X X X X X X X X NC MOSS & ROSS - 4102 WESTFIELD X 27,698. 27,698.0.DRIVE, DURHAM, NC 27705 0. NC, INC. FUNDRAISING CONSULTING DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832082 10-03-18 2 (d) (a) (c) (a) (b) (c) 1 2 3 4 5 6 7 8 9 10 11 (a) (b) (c) (d) (a) (c) 1 2 3 4 5 6 7 8 Yes Yes Yes No No No 9 10 a b Yes No a b Yes No Schedule G (Form 990 or 990-EZ) 2018 Pull tabs/instant bingo/progressive bingo Schedule G (Form 990 or 990-EZ) 2018 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. Total events (add col. through col. )RevenueEvent #1 Event #2 Other events (event type)(event type)(total number) Gross receipts Less: Contributions ~~~~~~~~~~~~~~ ~~~~~~~~~~~ Gross income (line 1 minus line 2)Direct Expenses Cash prizes Noncash prizes ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Rent/facility costs ~~~~~~~~~~~~ Food and beverages Entertainment ~~~~~~~~~~ ~~~~~~~~~~~~~~ Other direct expenses ~~~~~~~~~~ Direct expense summary. Add lines 4 through 9 in column (d) Net income summary. Subtract line 10 from line 3, column (d) ~~~~~~~~~~~~~~~~~~~~~~~~| | Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.RevenueBingo Other gaming Total gaming (add col. through col. )Direct ExpensesGross revenue Cash prizes Noncash prizes ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Rent/facility costs Other direct expenses ~~~~~~~~~~~~ %%% Volunteer labor ~~~~~~~~~~~~~ Direct expense summary. Add lines 2 through 5 in column (d) Net gaming income summary. Subtract line 7 from line 1, column (d) ~~~~~~~~~~~~~~~~~~~~~~~~| | Enter the state(s) in which the organization conducts gaming activities: Is the organization licensed to conduct gaming activities in each of these states? If "No," explain: ~~~~~~~~~~~~~~~~~~~~ Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year? If "Yes," explain: ~~~~~~~~~ Part II Fundraising Events. Part III Gaming. 118,308. 118,308. 10,238. 90,076. 85,106. 4,970. 1,000. 749. 23,489. 87. 208,384. 203,414. 4,970. 1,000. 749. 23,489. 10,325. 39,668. -34,698. HOUSE PARTY FASHION SHOW NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY NONE 250. 595. 1,214. 2,046.2,641. 1,464. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832083 10-03-18 3 11 12 13 14 15 Yes No Yes No a b 13a 13b Yes Noa b c 16 17 a b Yes No Schedule G (Form 990 or 990-EZ) 2018 Schedule G (Form 990 or 990-EZ) 2018 Page Does the organization conduct gaming activities with nonmembers? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Indicate the percentage of gaming activity conducted in: The organization's facility An outside facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~% %~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the name and address of the person who prepares the organization's gaming/special events books and records: Name | Address | Does the organization have a contract with a third party from whom the organization receives gaming revenue? If "Yes," enter the amount of gaming revenue received by the organization | ~~~~~~ $and the amount of gaming revenue retained by the third party | $ If "Yes," enter name and address of the third party: Name | Address | Gaming manager information: Name | Gaming manager compensation | Description of services provided | $ Director/officer Employee Independent contractor Mandatory distributions: Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year |$ Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions. Part IV Supplemental Information. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832084 04-01-18 4 Schedule G (Form 990 or 990-EZ) (continued) Schedule G (Form 990 or 990-EZ)Page Part IV Supplemental Information NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 832101 11-02-18 SCHEDULE I (Form 990) Complete if the organization answered "Yes" on Form 990, Part IV, line 21 or 22. | Attach to Form 990. | Go to www.irs.gov/Form990 for the latest information. Open to Public Inspection Employer identification number General Information on Grants and AssistancePart I 1 2 Yes No Part II Grants and Other Assistance to Domestic Organizations and Domestic Governments. (f) 1 (a) (b) (c) (d) (e) (g) (h) 2 3 For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule I (Form 990) (2018) Name of the organization Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award the grants or assistance?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.Method ofvaluation (book, FMV, appraisal,other) Name and address of organization or government EIN IRC section (if applicable) Amount of cash grant Amount of non-cash assistance Description of noncash assistance Purpose of grant or assistance Enter total number of section 501(c)(3) and government organizations listed in the line 1 table Enter total number of other organizations listed in the line 1 table ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| | LHA Grants and Other Assistance to Organizations, Governments, and Individuals in the United States 2018 HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC. HABITAT FOR HUMANITY INTERNATIONAL ASSISTANCE WITH HOUSING 91-1914868 501(C)(3)49,883.0.PROGRAMS 1. 0. X 322 W LAMAR STREET 58-1603427 AMERICUS, GA 31709 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832102 11-02-18 2 Part III Grants and Other Assistance to Domestic Individuals. (e) (a) (b) (c) (d) (f) Part IV Supplemental Information. Schedule I (Form 990) (2018) Schedule I (Form 990) (2018)Page Complete if the organization answered "Yes" on Form 990, Part IV, line 22. Part III can be duplicated if additional space is needed. Method of valuation(book, FMV, appraisal, other)Type of grant or assistance Number of recipients Amount of cash grant Amount of non- cash assistance Description of noncash assistance Provide the information required in Part I, line 2; Part III, column (b); and any other additional information. PART I, LINE 2: THE ORGANIZATION MAKES TITHE CONTRIBUTIONS TO HABITAT FOR HUMANITY INTERNATIONAL TO PROVIDE FUNDING TO INTERNATIONAL AFFILIATES. THE TITHE IS DIRECTED TO HONDURAS AND MYANMAR. HABITAT FOR HUMANITY INTERNATIONAL ENSURES THAT EACH AFFILIATE PROVIDES REPORTING AND ACCOUNTABILITY TO REMAIN AN AFFILIATE IN GOOD STANDING. IN ADDITION, PERIODIC REPORTS ARE RECEIVED THAT DETAIL THE ACTIVITIES AND THE USE OF FUNDS BY EACH INTERNATIONAL PARTNER. HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 832141 10-18-18 Open to Public Inspection Complete if the organizations answered "Yes" on Form 990, Part IV, lines 29 or 30. Attach to Form 990. Go to www.irs.gov/Form990 for instructions and the latest information. Employer identification number (a)(b)(c)(d) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 29 Yes No 30 31 32 33 a b 30a 31 32a a b For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule M (Form 990) 2018 Name of the organization Check if applicable Number of contributions or items contributed Noncash contribution amounts reported on Form 990, Part VIII, line 1g Method of determining noncash contribution amounts Art - Works of art Art - Historical treasures Art - Fractional interests ~~~~~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~ Books and publications Clothing and household goods ~~~~~~~~~~ ~~~~~~ Cars and other vehicles Boats and planes Intellectual property ~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~ Securities - Publicly traded Securities - Closely held stock ~~~~~~~~ ~~~~~~~ Securities - Partnership, LLC, or trust interests Securities - Miscellaneous ~~~~~~~~~~~~~~ ~~~~~~~~ Qualified conservation contribution - Historic structures Qualified conservation contribution - Other ~~~~~~~~~~~~ ~ Real estate - Residential Real estate - Commercial Real estate - Other ~~~~~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~ Collectibles Food inventory Drugs and medical supplies Taxidermy ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~~~~~~~ Historical artifacts Scientific specimens Archeological artifacts ~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~ Other () Other () Other () Other () Number of Forms 8283 received by the organization during the tax year for contributions for which the organization completed Form 8283, Part IV, Donee Acknowledgement ~~~~ During the year, did the organization receive by contribution any property reported in Part I, lines 1 through 28, that it must hold for at least three years from the date of the initial contribution, and which isn't required to be used for exempt purposes for the entire holding period?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," describe the arrangement in Part II. Does the organization have a gift acceptance policy that requires the review of any nonstandard contributions?~~~~~~ Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash contributions?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," describe in Part II. If the organization didn't report an amount in column (c) for a type of property for which column (a) is checked, describe in Part II. LHA SCHEDULE M (Form 990) Part I Types of Property Noncash Contributions 2018J J J J J J J HABITAT FOR HUMANITY, ORANGE COUNTY 58-1603427 750. 6,032. 79,159. 2 18 FMV FMV MARKET COST X X XCONSTRUCTION X X X 0 NC, INC. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832142 10-18-18 2 Schedule M (Form 990) 2018 Schedule M (Form 990) 2018 Page Provide the information required by Part I, lines 30b, 32b, and 33, and whether the organization is reporting in Part I, column (b), the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information. Part II Supplemental Information. SCHEDULE M, LINE 32B: THE ORGANIZATION USES WELLS FARGO INVESTMENT ADVISORS TO RECEIVE AND IMMEDIATELY SELL ALL SECURITIES RECEIVED AS A CONTRIBUTION. HABITAT FOR HUMANITY, ORANGE COUNTY NC, INC.58-1603427 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 832211 10-10-18 Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information. | Attach to Form 990 or 990-EZ.| Go to www.irs.gov/Form990 for the latest information. (Form 990 or 990-EZ) Open to Public Inspection Employer identification number For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule O (Form 990 or 990-EZ) (2018) Name of the organization LHA SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2018 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: RESOURCES. FORM 990, PART III, LINE 4A, PROGRAM SERVICE ACCOMPLISHMENTS: EMPOWER ITS HOMEBUYERS THROUGH A SERIES OF RELEVANT WORKSHOPS AND ONE-ON-ONE TRAININGS. HABITAT ALSO STRIVES TO EDUCATE THE BROADER COMMUNITY ABOUT THE CRISIS IN AFFORDABLE HOUSING BY INTRODUCING AND INVOLVING HUNDREDS OF NEW VOLUNTEERS FROM ALL WALKS OF LIFE INTO ITS WORK EACH YEAR. HABITAT PROMOTES THE POSITIVE VALUE OF DIVERSITY BY UNITING PEOPLE OF VARIED ECONOMIC, RELIGIOUS, SOCIAL, AND RACIAL BACKGROUNDS TO WORK TOGETHER TOWARD A COMMON GOAL BUILDING AND REPAIRING DECENT HOMES IN PARTNERSHIP WITH FAMILIES IN NEED. FORM 990, PART VI, SECTION A, LINE 4: THE ORGANIZATION'S BYLAWS WERE REVISED TO REFLECT THE GROWTH AND EXPANSION THAT HAS OCCURRED SINCE INCEPTION, AND TO CLARIFY RESPONSIBILITIES OF SOME TITLES AND HOW THOSE ARE CURRENTLY REFLECTED IN THE BYLAWS. THE REVISIONS ADD SPECIFIC DUTIES OF THE NEWLY NAMED CEO/PRESIDENT (FORMERLY CALLED EXECUTIVE DIRECTOR), BOARD CHAIR (FORMERLY BOARD PRESIDENT) AND SUCCESSIVE OFFICES OF VICE-CHAIR AND SECOND VICE CHAIR. FORM 990, PART VI, SECTION B, LINE 11B: THE FINANCE DIRECTOR AND THE EXECUTIVE DIRECTOR PRESENT THE FULL 990 TO THE TREASURER AND FINANCE COMMITTEE. UPON THEIR REVIEW AND APPROVAL, THE FINANCE COMMITTEE PRESENTS THE FULL 990 TO THE FULL BOARD FOR THEIR REVIEW PRIOR TO FILING THE 990. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 832212 10-10-18 2 Employer identification number Schedule O (Form 990 or 990-EZ) (2018) Schedule O (Form 990 or 990-EZ) (2018)Page Name of the organization FORM 990, PART VI, SECTION B, LINE 12C: WHEN ANY SUCH CONFLICT OF INTEREST CONCERNING A BOARD MEMBER IS RELEVANT TO A MATTER REQUIRING BOARD ACTION, THE INTERESTED BOARD MEMBER SHALL CALL IT TO THE ATTENTION OF THE BOARD PRESIDENT, AND THE INTERESTED MEMBER SHALL NOT ACT OR VOTE ON THE MATTER. THE MINUTES OF THE MEETING SHALL REFLECT THAT THE CONFLICT OF INTEREST WAS DISCLOSED AND THAT THE INTERESTED PERSON DID NOT VOTE. FORM 990, PART VI, SECTION B, LINE 15: THE EXECUTIVE DIRECTOR'S SALARY IS REVIEWED ANUALLY BY THE INDEPENDENT EXECUTIVE COMMITTEE. INCREASES ARE BASED ON MERIT AND AN ANNUAL SALARY SURVEY PROVIDED BY HABITAT INTERNATIONAL. THE TOTAL SALARY INCREASE FOR ALL STAFF FOR EACH FISCAL YEAR IS APPROVED BY THE BOARD PRIOR TO THE START OF EACH FISCAL YEAR (MAY), AND ALL SALARY INCREASES, EXCLUDING THE EXECUTIVE COMMITTEE'S-APPROVED EXECUTIVE DIRECTOR SALARY, FOR THE FISCAL YEAR ARE INTERNALLY DISCUSSED BY DEPARTMENT HEADS, APPROVED BY THE FINANCE DIRECTOR AND EXECUTIVE DIRECTOR, AND ARE WITHIN THE BUDGETED TOTAL. ALL INCREASES ARE BASED ON MERIT, AND AN ANNUAL SALARY SURVEY FROM HABITAT INTERNATIONAL AND/OR SALARY INFORMATION FROM AN EXTERNAL SOURCE OR SOURCES. FORM 990, PART VI, SECTION C, LINE 19: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, FORM 990 AND 1023 ARE AVAILABLE TO THE PUBLIC UPON REQUEST. NC, INC.58-1603427 HABITAT FOR HUMANITY, ORANGE COUNTY DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Habitat for Humanity of Orange County | 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 tel (919) 932-7077 info@orangehabitat.org orangehabitat.org We build strength, stability, self-reliance and shelter. Board of Directors Betsy Blackwell (First Vice Chair), Community Volunteer 604 East Franklin Street, Chapel Hill, NC 27514, (704) 816-9446, watwell@aol.com Ethnicity: Caucasian, Term: 2017-2020 Cathy Bryson (Secretary), Community Volunteer 7923 Morrow Mill Road, Chapel Hill, NC 27516, (310) 592-2382, bryson.cathy@gmail.com Ethnicity: Caucasian, Term: 2017-2020 Doug Call, Community Volunteer 139 South Fields Circle, Chapel Hill, NC 27516, (919) 240-4524, dwc@douglascall.com Ethnicity: Caucasian, Term: 2018-2021 Sharon Davis, Retired, Nursing 107 Bel Arbor Lane, Carrboro, NC 27510, (919) 967-2078, shardvs@yahoo.com Ethnicity: African-American, Term: 2019-2022 Elam Hall (Chair), DHI Communities 618 Wells Court, Chapel Hill, NC 27514, (704) 516-1177, elam_hall@uncbusiness.net Ethnicity: Caucasian, Term: 2019-2022 Sue Harvin, Retired, Social and Scientific Systems 2438 Kornegay Place, Chapel Hill, NC 27514, (919) 932-9640, harvinsue@gmail.com Ethnicity: Caucasian, Term: 2017-2020 Shannon Kennedy, Hodge & Kittrell Sotheby's International Realty 306 Laurel Hill Road, Chapel Hill, NC 27514, (919) 448-6664, kennedy.shannon@outlook.com Ethnicity: Caucasian, Term: 2019-2022 Taylor Ludlam (Second Vice Chair), Kilpatrick Townsend & Stockton LLP 9 Saint James Place, Chapel Hill, NC 27514, (404) 735-3043, taludlam@kilpatricktownsend.com Ethnicity: Caucasian, Term: 2019-2022 Suki Newton (Past Chair), b invited 405 Tramore Drive, Chapel Hill, NC 27516, (919) 247-4148, snewton405@aol.com Ethnicity: Caucasian, Term: 2018-2021 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Habitat for Humanity of Orange County | 88 Vilcom Center Drive, Suite L110, Chapel Hill, NC 27514 tel (919) 932-7077 info@orangehabitat.org orangehabitat.org We build strength, stability, self-reliance and shelter. Board of Directors, cont’d Joan Pharr (Treasurer), Blackman & Sloop 1414 Raleigh Road #300, Chapel Hill, NC 27517, (919) 869-3566, joan@b-scpa.com Ethnicity: Caucasian, Term: 2017-2020 Hassan Pinto, GreatestFan LLC 4903 Glendarion Drive, Durham, NC 27713, (919) 219-3753, hassan.pinto@gmail.com Ethnicity: Afro-Brazilian, Term: 2019-2022 Cami Schupp, Alexander Miller & Schupp 1526 East Franklin Street #202, Chapel Hill, NC 27514, (919) 929-1984, cami@ams-lawyer.com Ethnicity: Caucasian, Term: 2018-2021 Joy Steinberg, JSI Marketing 22 Banbury Lane, Chapel Hill, NC 27517, (214) 535-9524, joy.steinberg@gmail.com Ethnicity: Caucasian, Term: 2018-2021 Anna Wu, University of North Carolina at Chapel Hill 921 Monmouth Avenue, Durham, NC 27701, (919) 962-2748, annaw@fac.unc.edu Ethnicity: Asian-American, Term: 2019-2022 Michael Zuber, Investors Trust PO Box 1064, Chapel Hill, NC 27514, (919) 945-2600, mzuber@invtrust.com Ethnicity: Caucasian, Term: 2019-2022 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 1/14/2020 Bill Detail https://web.co.orange.nc.us/publicwebaccess/BillDetails.aspx?BillPk=2124754 1/2 Bill Search Special Assessment Search Delinquent Bill Search Personal Property Search Value Real $3,224,800 Deferred $0 Use $3,224,800 Personal $0 Exempt & Exclusion $0 Total Assessed Value $3,224,800 Last Payment Date : 11/14/2019 Disclaimer: Orange County Tax Office provides property tax information as a public service. This information is date sensitive. Any data obtained from this site should not be construed as an official receipt or as legal proof of property ownership. Vehicle Property Taxes paid to the North Carolina Division of Motor Vehicles (NCDMV) are not available on this website. To obtain a vehicle property tax statement from NCDMV, call 919-814-1779 or email NCDMV. By North Carolina statute, real and personal property taxes are due annually on September 1st of the tax year and are current if paid by January 5th of the following year. Solid Waste Programs and Stormwater Fees do not constitute a lien on the real property. To pay by mail, search for and print your bill, then mail it with your check or money order to: Orange County Tax Office, PO Box 8181, Hillsborough, NC 27278-8181. Contact Orange County Tax to verify current payment status. Beginning with 2016 taxes, Orange County is billing and collecting Mebane City Taxes for properties located within Orange County. For prior year taxes, contact the City of Mebane at 919-563-5901. Mebane offers a 0.5% discount for Mebane City Taxes paid by August 31st each year and is the only jurisdiction offering a discount in Orange County. Partial payments submitted by August 31st are applied proportionately between the Mebane City and Orange County taxes. Only the portion applied to Mebane City taxes is eligible for the discount. Research Property GIS Go To Abstract New Search Return Property Tax Collections Bill Detail VILCOM INVESTMENT LLC Description:BLDG 4 CAMPUS ON VILCOM P96/142- 143 Location:88 4 VILCOM CENTER DR CHAPEL HILL NC 27514 Mailing Address:85 4TH AVE STE 2G NEW YORK NY 10003 Parcel #:9880465246 Lender:537 Property Tax Real Property Bill Status:PAID Bill Flag: Bill #:0000296628-2019-2019-0000-00 Old Bill #: Old Account #: Due Date:9/1/2019 Interest Begins:1/7/2020 Rate Tax Districts Description Amount .8679 ORANGE Tax $27,988.04 ORANGE Orange County Solid Waste Programs Fee $2,130.00 .5440 CHAPEL HILL Tax $17,542.91 CHAPEL HILL Chapel Hill Stormwater Fee $1,258.92 .2018 CH-CARR SCHOOL Tax $6,507.65 Interest: $0.00 Total Billed: $55,427.52 Current Due: $0.00 0000000000020192019000000002966287 Correct if paid by Select A Date Recalculate Interest Pay Tax On-line Printable Version HELPFUL HINTS FOR SEARCH BY OPTIONS: OLD BILL NUMBER: Bills received prior to September 30, 2010 have bill numbers in the OLD BILL NUMBER format. These bill numbers are 5-10 digits long and begin with the year of the bill. Enter the entire bill number like this: 2009102456 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 04/07/2021 Summit Insurance Group Inc. PO Box 2485 Huntersville, NC 28070-2485 License #: 7638156 Nicole R. Talbert (704)659-2141 (704)659-2148 nicole@sumins.com 00008390-2445808 14 Habitat For Humanity Orange County, NC, Inc. 88 Vilcom Center Dr. Ste L110 Chapel Hill, NC 27514 Builders Mutual Insurance Company A CPP 0058155 08 04/01/2021 04/01/2022X X X 1,000,000 100,000 5,000 1,000,000 2,000,000 2,000,000 Builders Premier Insurance Company B PCA 0009233 08 04/01/2021 04/01/2022 X 1,000,000 Builders Mutual Insurance Company A MUB 0001005 04 04/01/2021 04/01/2022XX X 10,000 5,000,000 5,000,000 Builders Premier Insurance Company B PWC 1011231 08 04/01/2021 04/01/2022 X 1,000,000 1,000,000 1,000,000 Travelers Casualty & Surety Company Of America C 107048172 04/01/2019 04/01/2022Financial Services 1,000,000 Additional insured status applies to the certificate holder under General Liability when required by written contract. Orange County PO Box 8181 Hillsborough, NC 27278 (NRT) Printed by NRT on April 07, 2021 at 01:16PM ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACTNAME: FAXPHONE(A/C, No):(A/C, No, Ext): E-MAILADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ PER OTH-STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 FY 2018-19 Agency Budget Applicant Organization's Budget (Most recent complete calendar year or fiscal year) Starting date: 1/1/2020 Ending Date: 12/31/2020 ORGANIZATION NAME:Rebuilding Together of the Triangle, Inc. ORGANIZATION REVENUE Private Donations $970,626 $1,049,000 $877,000 -16% Generated Revenue (fees, sales, etc) $- $- $- 0 Town of Cary - Rehab Program $- $200,000 $300,000 50% $100,000 $145,000 $200,000 38% Durham City/County $- $30,000 $80,000 167% $24,000 $65,000 $40,000 -38% Town of Apex $- $- $250,000 0 Other Government Grants Triangle United Way $- $- $- 0 State Government $167,896.00 $252,000.00 $300,000.00 $0.19 Federal Government (CDBG/HOME/etc.) $222,000.00 $245,000.00 $520,000.00 $1.12 Private Foundation Grants $78,600.00 $98,000.00 $128,000.00 $0.31 $20,320 $- $- 0 Profit from sale of donated home in Burlington NC Total Organization Revenue $1,583,442 $2,084,000 $2,695,000 29% AGENCY EXPENSES Compensation $401,732 $537,500 $590,000 10% Rent & Utilities $47,483 $55,000 $58,000 5% Supplies & Equipment $861,078 $1,474,000 $2,035,000 38% Travel & Training $7,473 $17,500 $12,000 -31% $- $- $- 0 Total Agency Expenses $1,317,766 $2,084,000 $2,695,000 29% SURPLUS/(DEFICIT) FOR PERIOD: $265,676 $- $- 0 Actual Total for Previous Year Estimated Total for Current Year Projected Total for Next Year Percent Change Local Government Grants (Please list separately): Chatham County Town of Carrboro Other Revenue: please briefly explain here Other Expenses: please briefly explain here DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Check if self-employed OMB No. 1545-0047 Department of the TreasuryInternal Revenue Service Check ifapplicable: Addresschange Namechange Initialreturn Finalreturn/termin-ated Gross receipts $ Amendedreturn Applica-tionpending Are all subordinates included? 932001 01-20-20 Beginning of Current Year Paid Preparer Use Only 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 as it may be made public.Open to Public Inspection| Go to www.irs.gov/Form990 for instructions and the latest information. A For the 2019 calendar year, or tax year beginning and ending B C D Employer identification number E G H(a) H(b) H(c) F Yes No Yes No I J K Website: | L M 1 2 3 4 5 6 7 3 4 5 6 7a 7b a bActivities & GovernancePrior Year Current Year 8 9 10 11 12 13 14 15 16 17 18 19Revenuea bExpenses End of Year 20 21 22 Sign Here Yes No For Paperwork Reduction Act Notice, see the separate instructions. (or P.O. box if mail is not delivered to street address) Room/suite )501(c)(3) 501(c) ((insert no.) 4947(a)(1) or 527 |Corporation Trust Association Other Form of organization:Year of formation:State of legal domicile: | |Net Assets orFund BalancesUnder penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. Signature of officer Date Type or print name and title Date PTINPrint/Type preparer's name Preparer's signature Firm's name Firm's EIN Firm's address Phone no. Form (Rev. January 2020) Name of organization Doing business as Number and street Telephone number City or town, state or province, country, and ZIP or foreign postal code Is this a group return for subordinates?Name and address of principal officer:~~ If "No," attach a list. (see instructions) Group exemption number | Tax-exempt status: Briefly describe the organization's mission or most significant activities: Check this box if the organization discontinued its operations or disposed of more than 25% of its net assets. Number of voting members of the governing body (Part VI, line 1a) Number of independent voting members of the governing body (Part VI, line 1b) Total number of individuals employed in calendar year 2019 (Part V, line 2a) ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ Total number of volunteers (estimate if necessary) Total unrelated business revenue from Part VIII, column (C), line 12 Net unrelated business taxable income from Form 990-T, line 39 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~ Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~Investment income (Part VIII, column (A), lines 3, 4, and 7d) Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)~~~~~~~~ Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) Grants and similar amounts paid (Part IX, column (A), lines 1-3) Benefits paid to or for members (Part IX, column (A), line 4) Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~ Professional fundraising fees (Part IX, column (A), line 11e) Total fundraising expenses (Part IX, column (D), line 25) ~~~~~~~~~~~~~~ Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 18 from line 12 ~~~~~~~~~~~~~ ~~~~~~~ Total assets (Part X, line 16) Total liabilities (Part X, line 26) Net assets or fund balances. Subtract line 21 from line 20 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ May the IRS discuss this return with the preparer shown above? (see instructions) LHA Form (2019) Part I Summary Signature BlockPart II 990 Return of Organization Exempt From Income Tax990 2019 § == 999 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 919-341-5980200 TRANS AIR DRIVE 200 1,793,122. MORRISVILLE, NC 27560 XDAN SARGENT WWW.RTTRIANGLE.ORG X 1995 NC SEEKS TO MAKE A SUSTAINABLE 14 14 17 963 0. 0. 1,525,987. 0. 20,320. 28,285. 906,125. 1,574,592. 0. 0. 401,732. 0. 48,303. 907,184. 926,542. 1,308,916. -20,417. 265,676. 270,514. 330,259. 324,332. 118,401. -53,818. 211,858. DAN SARGENT, EXECUTIVE DIRECTOR P01368646DAVID BOYCE 56-0517823KOONCE, WOOTEN & HAYWOOD, LLP P. O. BOX 17806 RALEIGH, NC 27619-7806 919-782-9265 X 200 TRANS AIR DRIVE, SUITE 200, MORRISVILLE, IMPACT ON PRESERVING AND REVITALIZING HOMES AND COMMUNITIES, SEE SCHEDULE O FOR ORGANIZATION MISSION STATEMENT CONTINUATION X 896,099. 0. 0. 10,026. 0. 0. 360,330. 0. 566,212. 10/22/2020 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Code:Expenses $including grants of $Revenue $ Expenses $including grants of $Revenue $ 932002 01-20-20 1 2 3 4 Yes No Yes No 4a 4b 4c 4d 4e Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part III Briefly describe the organization's mission: Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? If "Yes," describe these new services on Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization cease conducting, or make significant changes in how it conducts, any program services? If "Yes," describe these changes on Schedule O. ~~~~~~ Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported. () ()() () ()() () ()() Other program services (Describe on Schedule O.) ()() Total program service expenses | Form (2019) 2 Statement of Program Service AccomplishmentsPart III 990 SEEKS TO MAKE A SUSTAINABLE IMPACT ON PRESERVING AND REVITALIZING X X HOMES AND COMMUNITIES, ASSURING THAT LOW-INCOME HOMEOWNERS, FROM THE 1,192,637. ELDERLY, DISABLED AND FAMILIES WITH CHILDREN. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 ELDERLY AND DISABLED TO FAMILIES WITH CHILDREN, LIVE IN WARMTH, SAFETY AND INDEPENDENCE. REBUILDING, REPAIRING AND REVITALIZING LOW-INCOME HOUSING FOR THE 1,192,637. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932003 01-20-20 Yes No 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 1 2 3 4 5 6 7 8 9 10 Section 501(c)(3) organizations. a b c d e f a b 11a 11b 11c 11d 11e 11f 12a 12b 13 14a 14b 15 16 17 18 19 20a 20b 21 a b 20 21 a b If "Yes," complete Schedule A Schedule B, Schedule of Contributors If "Yes," complete Schedule C, Part I If "Yes," complete Schedule C, Part II If "Yes," complete Schedule C, Part III If "Yes," complete Schedule D, Part I If "Yes," complete Schedule D, Part II If "Yes," complete Schedule D, Part III If "Yes," complete Schedule D, Part IV If "Yes," complete Schedule D, Part V If "Yes," complete Schedule D, Part VI If "Yes," complete Schedule D, Part VII If "Yes," complete Schedule D, Part VIII If "Yes," complete Schedule D, Part IX If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Part X If "Yes," complete Schedule D, Parts XI and XII If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional If "Yes," complete Schedule E If "Yes," complete Schedule F, Parts I and IV If "Yes," complete Schedule F, Parts II and IV If "Yes," complete Schedule F, Parts III and IV If "Yes," complete Schedule G, Part I If "Yes," complete Schedule G, Part II If "Yes," complete Schedule G, Part III If "Yes," complete Schedule H If "Yes," complete Schedule I, Parts I and II Form 990 (2019)Page Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to complete ? Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ 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? Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? Did the organization maintain collections of works of art, historical treasures, or other similar assets? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part X, line 21, 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 services? Did the organization, directly or through a related organization, hold assets in donor-restricted endowments or in quasi endowments? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable. Did the organization report an amount for land, buildings, and equipment in Part X, line 10? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Did the organization report an amount for investments - program related in Part X, line 13, that is 5% or more of its total assets reported in Part X, line 16? ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Did the organization report an amount for other liabilities in Part X, line 25? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? Did the organization obtain separate, independent audited financial statements for the tax year? ~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization included in consolidated, independent audited financial statements for the tax year? ~~~~~ Is the organization a school described in section 170(b)(1)(A)(ii)? Did the organization maintain an office, employees, or agents outside of the United States? ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~ 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization operate one or more hospital facilities? ~~~~~~~~~~~~~~~~~ If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?~~~~~~~~~~ Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? ~~~~~~~~~~~~~~ Form (2019) 3 Part IV Checklist of Required Schedules 990 X X X X X X X X X X X X X X X X X X X X X X X X X X X X REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932004 01-20-20 Yes No 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 22 23 24a 24b 24c 24d 25a 25b 26 27 28a 28b 28c 29 30 31 32 33 34 35a 35b 36 37 38 a b c d a b Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. a b c a b Section 501(c)(3) organizations. Note: Yes No 1 a b c 1a 1b 1c (continued) If "Yes," complete Schedule I, Parts I and III If "Yes," complete Schedule J If "Yes," answer lines 24b through 24d and complete Schedule K. If "No," go to line 25a If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part I If "Yes," complete Schedule L, Part II If "Yes," complete Schedule L, Part III If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule L, Part IV If "Yes," complete Schedule M If "Yes," complete Schedule M If "Yes," complete Schedule N, Part I If "Yes," complete Schedule N, Part II If "Yes," complete Schedule R, Part I If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part V, line 2 If "Yes," complete Schedule R, Part VI Form 990 (2019)Page Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? ~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~ Did the organization engage in an excess benefit transaction with a disqualified person during the year? 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? ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report any amount on Part X, line 5 or 22, for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons?~~~~~~~~~~~~~ Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons? ~~~ Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions, for applicable filing thresholds, conditions, and exceptions): A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ A family member of any individual described in line 28a? A 35% controlled entity of one or more individuals and/or organizations described in lines 28a or 28b? ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization receive more than $25,000 in non-cash contributions? Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and cease operations? Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? ~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? Was the organization related to any tax-exempt or taxable entity? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a controlled entity within the meaning of section 512(b)(13)? If "Yes" to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~ Did the organization make any transfers to an exempt non-charitable related organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? ~~~~~~~~ Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? All Form 990 filers are required to complete Schedule O Check if Schedule O contains a response or note to any line in this Part V Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~ Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~ Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? Form (2019) 4 Part IV Checklist of Required Schedules Part V Statements Regarding Other IRS Filings and Tax Compliance 990 X X X X X X X X X X X X REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 6 0 X X X X X X X X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932005 01-20-20 Yes No 2 3 4 5 6 7 a b 2a Note: 2b 3a 3b 4a 5a 5b 5c 6a 6b 7a 7b 7c 7e 7f 7g 7h 8 9a 9b a b a b a b c a b Organizations that may receive deductible contributions under section 170(c). a b c d e f g h 7d 8 9 10 11 12 13 14 15 16 Sponsoring organizations maintaining donor advised funds. Sponsoring organizations maintaining donor advised funds. a b Section 501(c)(7) organizations. a b 10a 10b Section 501(c)(12) organizations. a b 11a 11b a b Section 4947(a)(1) non-exempt charitable trusts. 12a 12b Section 501(c)(29) qualified nonprofit health insurance issuers. Note: a b c a b 13a 13b 13c 14a 14b 15 16 (continued) e-file If "No" to line 3b, provide an explanation on Schedule O If "No," provide an explanation on Schedule O Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? Form (2019) Form 990 (2019)Page Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements, filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~ If at least one is reported on line 2a, did the organization file all required federal employment tax returns? If the sum of lines 1a and 2a is greater than 250, you may be required to (see instructions) ~~~~~~~~~~ ~~~~~~~~~~~ Did the organization have unrelated business gross income of $1,000 or more during the year? If "Yes," has it filed a Form 990-T for this year? ~~~~~~~~~~~~~~ ~~~~~~~~~~ At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~ If "Yes," enter the name of the foreign country See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction? ~~~~~~~~~~~~ ~~~~~~~~~ If "Yes" to line 5a or 5b, did the organization file Form 8886-T?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization notify the donor of the value of the goods or services provided? Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? ~~~~~~~~~~~~~~~ If "Yes," indicate the number of Forms 8282 filed during the year Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~~~~~~~~~~ ~~~~~~~ ~~~~~~~~~Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ~ Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year?~~~~~~~~~~~~~~~~~~~ Did the sponsoring organization make any taxable distributions under section 4966? Did the sponsoring organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Enter: Initiation fees and capital contributions included on Part VIII, line 12 Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~~~~~~~~~~ ~~~~~~ Enter: Gross income from members or shareholders Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization filing Form 990 in lieu of Form 1041? If "Yes," enter the amount of tax-exempt interest received or accrued during the year Is the organization licensed to issue qualified health plans in more than one state? See the instructions for additional information the organization must report on Schedule O. ~~~~~~~~~~~~~~~~~~~~~ Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization receive any payments for indoor tanning services during the tax year? If "Yes," has it filed a Form 720 to report these payments? ~~~~~~~~~~~~~~~~ ~~~~~~~~~ Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? If "Yes," see instructions and file Form 4720, Schedule N. Is the organization an educational institution subject to the section 4968 excise tax on net investment income? If "Yes," complete Form 4720, Schedule O. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ 5 Part V Statements Regarding Other IRS Filings and Tax Compliance 990 J X X X X X X X X X X 17 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932006 01-20-20 Yes No 1a 1b 1 2 3 4 5 6 7 8 9 a b 2 3 4 5 6 7a 7b 8a 8b 9 a b a b Yes No 10 11 a b 10a 10b 11a 12a 12b 12c 13 14 15a 15b 16a 16b a b 12a b c 13 14 15 a b 16a b 17 18 19 20 For each "Yes" response to lines 2 through 7b below, and for a "No" response to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes on Schedule O. See instructions. If "Yes," provide the names and addresses on Schedule O (This Section B requests information about policies not required by the Internal Revenue Code.) If "No," go to line 13 If "Yes," describe in Schedule O how this was done (explain on Schedule O) If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain on Schedule O. Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following: Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? Form (2019) Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part VI Enter the number of voting members of the governing body at the end of the tax year Enter the number of voting members included on line 1a, above, who are independent ~~~~~~ ~~~~~~ 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, trustees, or key employees to a management company or other person?~~~~~~~~~~~~~~~ Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? Did the organization become aware during the year of a significant diversion of the organization's assets? Did the organization have members or stockholders? ~~~~~ ~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 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? Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The governing body? Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? Did the organization have local chapters, branches, or affiliates? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? Describe in Schedule O the process, if any, used by the organization to review this Form 990. Did the organization have a written conflict of interest policy? ~~~~~~~~~~~~~~~~~~~~~ ~~~~~~ Did the organization regularly and consistently monitor and enforce compliance with the policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written whistleblower policy? Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision? The organization's CEO, Executive Director, or top management official Other officers or key employees of the organization If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements? List the states with which a copy of this Form 990 is required to be filed Section 6104 requires an organization to make its Forms 1023 (1024 or 1024-A, if applicable), 990, and 990-T (Section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply. Own website Another's website Upon request Other Describe on Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year. State the name, address, and telephone number of the person who possesses the organization's books and records | 6 Part VI Governance, Management, and Disclosure Section A. Governing Body and Management Section B. Policies Section C. Disclosure 990 J 14 14 X X X X X X X X X X X X X X X X X X X X LAUREN JOYCE - 919-341-5980 200 TRANS AIR DRIVE, SUITE 200, MORRISVILLE, NC 27560 NONE REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 X X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Individual trustee or directorInstitutional trusteeOfficerKey employeeHighest compensatedemployeeFormer(do not check more than one box, unless person is both an officer and a director/trustee) 932007 01-20-20 current Section A.Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a current current former former directors or trustees (A)(B)(C)(D)(E)(F) Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part VII Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. ¥ List all of the organization's officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. ¥ List all of the organization's key employees, if any. See instructions for definition of "key employee." ¥ List the organization's five highest compensated employees (other than an officer, director, trustee, or key employee) who received report- able compensation (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 officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. ¥ List all of the organization's that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. See instructions for the order in which to list the persons above. Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. PositionName and title Average hours per week (list any hours for related organizations below line) Reportable compensation from the organization (W-2/1099-MISC) Reportable compensation from related organizations (W-2/1099-MISC) Estimated amount of other compensation from the organization and related organizations Form (2019) 7 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors 990 (1) KATY PATTON CHAIR (2) RON COHN (3) BRIAN O'HAVER (4) LAUREN JOYCE (5) CAMERON BOIVIN (6) ANNE STODDARD (7) TODD JONES (8) MICHAEL BYERS (9) BRANDON MOOREFIELD (10) TYLER GRIMES (11) TIM WILSON (12) DAN CROSLEY (13) MATTHEW DUNCAN (14) MARCELLE THOMAS (15) DAN SARGENT VICE CHAIR SECRETARY TREASURER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER BOARD MEMBER EXECUTIVE DIRECTOR 2.00 1.00 1.00 4.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 40.00 X X X X X X X X X X X X X X X X X X X 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 71,776. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 0. 10,479. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 FormerIndividual trustee or directorInstitutional trusteeOfficerHighest compensatedemployeeKey employee(do not check more than one box, unless person is both an officer and a director/trustee) 932008 01-20-20 Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (B)(C)(A)(D)(E)(F) 1 b c d Subtotal Total from continuation sheets to Part VII, Section A Total (add lines 1b and 1c) 2 Yes No 3 4 5 former 3 4 5 Section B. Independent Contractors 1 (A)(B)(C) 2 (continued) If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such individual If "Yes," complete Schedule J for such person Page Form 990 (2019) PositionAverage hours per week (list any hours for related organizations below line) Name and title Reportable compensation from the organization (W-2/1099-MISC) Reportable compensation from related organizations (W-2/1099-MISC) Estimated amount of other compensation from the organization and related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| ~~~~~~~~~~| | Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization | Did the organization list any officer, director, trustee, key employee, or highest compensated employee on line 1a? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? ~~~~~~~~~~~~~ Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? Complete this table 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. Name and business address Description of services Compensation Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization | Form (2019) 8 Part VII 990 71,776.0.10,479. 0.0.0. 0 0 NONE 71,776.0.10,479. REBUILDING TOGETHER OF THE TRIANGLE X X X 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Noncash contributions included in lines 1a-1f 932009 01-20-20 Business Code Business Code Total revenue. (A)(B)(C)(D) 1 a b c d e f 1 1 1 1 1 1 1 a b c d e f ggContributions, Gifts, Grantsand Other Similar Amountsh Total. a b c d e f g 2 Program ServiceRevenueTotal. 3 4 5 6 a b c d 6a 6b 6c 7 a 7a 7b 7c b c d a b c 8 8a 8b 9 a b c 9a 9b 10 a b c 10a 10bOther Revenue11 a b c d eMiscellaneousRevenue Total. 12 Revenue excluded from tax undersections 512 - 514 All other contributions, gifts, grants, and similar amounts not included above Gross amount from sales of assets other than inventory cost or other basis and sales expenses Gross income from fundraising events See instructions Form (2019) Page Form 990 (2019) Check if Schedule O contains a response or note to any line in this Part VIII Total revenue Related or exempt function revenue Unrelated business revenue Federated campaigns Membership dues ~~~~~ ~~~~~~~ Fundraising events Related organizations ~~~~~~~ ~~~~~ Government grants (contributions) ~ $ Add lines 1a-1f | All other program service revenue ~~~~~ Add lines 2a-2f | Investment income (including dividends, interest, and other similar amounts) Income from investment of tax-exempt bond proceeds ~~~~~~~~~~~~~~~~~| | Royalties | (i) Real (ii) Personal Gross rents Less: rental expenses Rental income or (loss) Net rental income or (loss) ~~~~~ ~ | (i) Securities (ii) Other Less: Gain or (loss) ~~~ ~~~~~ Net gain or (loss)| (not including $of contributions reported on line 1c). See Part IV, line 18 ~~~~~~~~~~~~ Less: direct expenses ~~~~~~~~~ Net income or (loss) from fundraising events | Gross income from gaming activities. See Part IV, line 19 ~~~~~~~~~~~~ Less: direct expenses Net income or (loss) from gaming activities ~~~~~~~~ | Gross sales of inventory, less returns and allowances ~~~~~~~~~~~~ Less: cost of goods sold Net income or (loss) from sales of inventory ~~~~~~~ | All other revenue ~~~~~~~~~~~~~ Add lines 11a-11d | | 9 Part VIII Statement of Revenue 990 191,367. 513,896. 820,724. 1,525,987. 21,446. 1,574,592.20,320.0.28,285. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 230,000. 209,680. 20,320. 20,320.20,320. 37,135. 8,850. 28,285.28,285. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Check here if following SOP 98-2 (ASC 958-720) 932010 01-20-20 Total functional expenses. Joint costs. (A)(B)(C)(D) 1 2 3 4 5 6 7 8 9 10 11 a b c d e f g 12 13 14 15 16 17 18 19 20 21 22 23 24 a b c d e 25 26 Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A). Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 Compensation not included above to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) Professional fundraising services. See Part IV, line 17 (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Sch O.) Other expenses. Itemize expenses not covered above (List miscellaneous expenses on line 24e. Ifline 24e amount exceeds 10% of line 25, column (A)amount, list line 24e expenses on Schedule O.) Add lines 1 through 24e Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part IX Total expenses Program serviceexpenses Management andgeneral expenses Fundraisingexpenses ~ Grants and other assistance to domestic individuals. See Part IV, line 22 ~~~~~~~ Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ~~~ Benefits paid to or for members ~~~~~~~ Compensation of current officers, directors, trustees, and key employees ~~~~~~~~ ~~~ Other salaries and wages ~~~~~~~~~~ Other employee benefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~ Fees for services (nonemployees): Management Legal Accounting Lobbying ~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Investment management fees Other. ~~~~~~~~ Advertising and promotion Office expenses Information technology Royalties ~~~~~~~~~ ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Occupancy ~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~Travel Payments of travel or entertainment expenses for any federal, state, or local public officials ~ Conferences, conventions, and meetings ~~ Interest Payments to affiliates ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~ Depreciation, depletion, and amortization Insurance ~~ ~~~~~~~~~~~~~~~~~ All other expenses | Form (2019) Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII. 10 Statement of Functional ExpensesPart IX 990 82,255. 288,830. 30,647. 7,100. 6,676. 9,790. 3,041. 40,606. 398. 4,707. 59,453. 441,410. 204,439. 73,245. 21,939. 34,380. 1,308,916. 41,128.16,451.24,676. 260,756.24,948.3,126. 24,824.3,371.2,452. 7,100. 6,676. 5,300.4,028.462. 2,585.152.304. 34,515.2,030.4,061. 208.152.38. 4,707. 50,535.2,973.5,945. 441,410. 204,439. 73,245. 21,681.129.129. 27,304.6,642.434. 1,192,637.67,976.48,303. CONTRACT LABOR BUILDING MATERIALS BUILDING SITE INCIDENTA DUES, LICENSES, & MEMBE REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932011 01-20-20 (A)(B) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 1 2 3 4 5 6 7 8 9 10c 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 a b 10a 10bAssets Total assets. LiabilitiesTotal liabilities. Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33. 27 28 Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33. 29 30 31 32 33Net Assets or Fund Balances Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part X Beginning of year End of year Cash - non-interest-bearing Savings and temporary cash investments Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~ Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons ~~~~~~~~~ Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B)~~ Notes and loans receivable, net Inventories for sale or use Prepaid expenses and deferred charges ~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D Less: accumulated depreciation ~~~ ~~~~~~ Investments - publicly traded securities Investments - other securities. See Part IV, line 11 Investments - program-related. See Part IV, line 11 Intangible assets ~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~ Add lines 1 through 15 (must equal line 33) Accounts payable and accrued expenses Grants payable Deferred revenue ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax-exempt bond liabilities Escrow or custodial account liability. Complete Part IV of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~ Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons ~~~~~~~~~ Secured mortgages and notes payable to unrelated third parties ~~~~~~ Unsecured notes and loans payable to unrelated third parties ~~~~~~~~ Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines 17 through 25 | Net assets without donor restrictions Net assets with donor restrictions ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ | Capital stock or trust principal, or current funds Paid-in or capital surplus, or land, building, or equipment fund Retained earnings, endowment, accumulated income, or other funds ~~~~~~~~~~~~~~~ ~~~~~~~~ ~~~~ Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~ Total liabilities and net assets/fund balances Form (2019) 11 Balance SheetPart X 990 50,908.116,527. 50,231.177,256. 9,928.19,325. 27,657. 17,106.159,447.10,551. 6,600. 270,514.330,259. 204,332.115,068. 3,333. 120,000. 324,332.118,401. X -53,818.118,766. 93,092. -53,818.211,858. 270,514.330,259. 56-1955629REBUILDING TOGETHER OF THE TRIANGLE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932012 01-20-20 1 2 3 4 5 6 7 8 9 10 1 2 3 4 5 6 7 8 9 10 Yes No 1 2 3 a b c 2a 2b 2c a b 3a 3b Form 990 (2019)Page Check if Schedule O contains a response or note to any line in this Part XI Total revenue (must equal Part VIII, column (A), line 12) Total expenses (must equal Part IX, column (A), line 25) Revenue less expenses. Subtract line 2 from line 1 Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Investment expenses Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other changes in net assets or fund balances (explain on Schedule O) Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B)) ~~~~~~~~~~~~~~~~~~ Check if Schedule O contains a response or note to any line in this Part XII Accounting method used to prepare the Form 990:Cash Accrual Other If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. Were the organization's financial statements compiled or reviewed by an independent accountant?~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis Were the organization's financial statements audited by an independent accountant?~~~~~~~~~~~~~~~~~~~ If "Yes," check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both: Separate basis Consolidated basis Both consolidated and separate basis If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?~~~~~~~~~~~~~~~ If the organization changed either its oversight process or selection process during the tax year, explain on Schedule O. As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why on Schedule O and describe any steps taken to undergo such audits Form (2019) 12 Part XI Reconciliation of Net Assets Part XII Financial Statements and Reporting 990 X REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 1,574,592. 1,308,916. 265,676. -53,818. 0. 211,858. X X X X X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (iv) Is the organization listedin your governing document? OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 932021 09-25-19 (i)(iii)(v)(vi)(ii) Name of supported organization Type of organization (described on lines 1-10 above (see instructions)) Amount of monetary support (see instructions) Amount of other support (see instructions) EIN (Form 990 or 990-EZ)Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. | Attach to Form 990 or Form 990-EZ. | Go to www.irs.gov/Form990 for instructions and the latest information. Open to Public Inspection Name of the organization Employer identification number 1 2 3 4 5 6 7 8 9 10 11 12 section 170(b)(1)(A)(i). section 170(b)(1)(A)(ii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iii). section 170(b)(1)(A)(iv). section 170(b)(1)(A)(v). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(vi). section 170(b)(1)(A)(ix) section 509(a)(2). section 509(a)(4). section 509(a)(1)section 509(a)(2)section 509(a)(3). a b c d e f g Type I. You must complete Part IV, Sections A and B. Type II. You must complete Part IV, Sections A and C. Type III functionally integrated. You must complete Part IV, Sections A, D, and E. Type III non-functionally integrated. You must complete Part IV, Sections A and D, and Part V. Yes No Total For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule A (Form 990 or 990-EZ) 2019 (All organizations must complete this part.) See instructions. The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.) A church, convention of churches, or association of churches described in A school described in (Attach Schedule E (Form 990 or 990-EZ).) A hospital or a cooperative hospital service organization described in A medical research organization operated in conjunction with a hospital described in 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 (Complete Part II.) A federal, state, or local government or governmental unit described in An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in (Complete Part II.) A community trust described in (Complete Part II.) An agricultural research organization described in 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: An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See (Complete Part III.) An organization organized and operated exclusively to test for public safety. See An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in or . See Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g. 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. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, 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 organization(s). LHA SCHEDULE A Part I Reason for Public Charity Status Public Charity Status and Public Support 2019 X 56-1955629REBUILDING TOGETHER OF THE TRIANGLE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Subtract line 5 from line 4. 932022 09-25-19 Calendar year (or fiscal year beginning in) Calendar year (or fiscal year beginning in) | 2 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 Total. 6 Public support. (a) (b) (c) (d) (e) (f) 7 8 9 10 11 12 13 Total support. 12 First five years. stop here 14 15 14 15 16 17 18 a b a b 33 1/3% support test - 2019. stop here. 33 1/3% support test - 2018. stop here. 10% -facts-and-circumstances test - 2019. stop here. 10% -facts-and-circumstances test - 2018. stop here. Private foundation. Schedule A (Form 990 or 990-EZ) 2019 | Add lines 7 through 10 Schedule A (Form 990 or 990-EZ) 2019 Page (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, please complete Part III.) 2015 2016 2017 2018 2019 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ Add lines 1 through 3 ~~~ 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)~~~~~~~~~~~~ 2015 2016 2017 2018 2019 Total Amounts from line 4 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ Net income from unrelated business activities, whether or not the business is regularly carried on ~ Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)~~~~ Gross receipts from related activities, etc. (see instructions)~~~~~~~~~~~~~~~~~~~~~~~ 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 | ~~~~~~~~~~~~Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) Public support percentage from 2018 Schedule A, Part II, line 14 % %~~~~~~~~~~~~~~~~~~~~~ If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~| If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~| If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions | Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage 568,296. 568,296. 781,232. 781,232. 1176718.911,699.1563122.5001067. 1176718.911,699.1563122.5001067. 5001067. 568,296.781,232.1176718.911,699.1563122.5001067. 5001067. 98,673. 100.00 100.00 X REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (Subtract line 7c from line 6.) Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year (Add lines 9, 10c, 11, and 12.) 932023 09-25-19 Calendar year (or fiscal year beginning in) | Calendar year (or fiscal year beginning in) | Total support. 3 (a) (b) (c) (d) (e) (f) 1 2 3 4 5 6 7 Total. a b c 8 Public support. (a) (b) (c) (d) (e) (f) 9 10 a b c 11 12 13 14 First five years. stop here 15 16 15 16 17 18 19 20 2019 2018 17 18 a b 33 1/3% support tests - 2019. stop here. 33 1/3% support tests - 2018. stop here. Private foundation. Schedule A (Form 990 or 990-EZ) 2019 Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975 Schedule A (Form 990 or 990-EZ) 2019 Page (Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.) 2015 2016 2017 2018 2019 Total Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.")~~ Gross receipts from admissions, merchandise sold or services per- formed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose Gross receipts from activities that are not an unrelated trade or bus- iness under section 513 ~~~~~ Tax revenues levied for the organ- ization's benefit and either paid to or expended on its behalf ~~~~ The value of services or facilities furnished by a governmental unit to the organization without charge ~ ~~~ Add lines 1 through 5 Amounts included on lines 1, 2, and 3 received from disqualified persons ~~~~~~ Add lines 7a and 7b ~~~~~~~ 2015 2016 2017 2018 2019 Total Amounts from line 6 ~~~~~~~ Gross income from interest, dividends, payments received on securities loans, rents, royalties, and income from similar sources ~ ~~~~ Add lines 10a and 10b ~~~~~~ Net income from unrelated businessactivities not included in line 10b, whether or not the business is regularly carried on ~~~~~~~ Other income. Do not include gainor loss from the sale of capital assets (Explain in Part VI.)~~~~ 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 | Public support percentage for 2019 (line 8, column (f), divided by line 13, column (f)) Public support percentage from 2018 Schedule A, Part III, line 15 ~~~~~~~~~~~% % Investment income percentage for (line 10c, column (f), divided by line 13, column (f)) Investment income percentage from Schedule A, Part III, line 17 ~~~~~~~~% %~~~~~~~~~~~~~~~~~~ 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 The organization qualifies as a publicly supported organization ~~~~~~~~~~| 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 The organization qualifies as a publicly supported organization ~~~~| If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions | Part III Support Schedule for Organizations Described in Section 509(a)(2) Section A. Public Support Section B. Total Support Section C. Computation of Public Support Percentage Section D. Computation of Investment Income Percentage REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932024 09-25-19 4 Yes No 1 2 3 4 5 6 7 8 9 10 Part VI 1 2 3a 3b 3c 4a 4b 4c 5a 5b 5c 6 7 8 9a 9b 9c 10a 10b Part VI a b c a b c a b c a b c a b Part VI Part VI Part VI Part VI Part VI, Type I or Type II only. Substitutions only. Part VI. Part VI. Part VI. Part VI. Schedule A (Form 990 or 990-EZ) 2019 If "No," describe in how the supported organizations are designated. If designated by class or purpose, describe the designation. If historic and continuing relationship, explain. If "Yes," explain in how the organization determined that the supported organization was described in section 509(a)(1) or (2). If "Yes," answer (b) and (c) below. If "Yes," describe in when and how the organization made the determination. If "Yes," explain in what controls the organization put in place to ensure such use. If "Yes," and if you checked 12a or 12b in Part I, answer (b) and (c) below. If "Yes," describe in how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations. If "Yes," explain in 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. If "Yes," answer (b) and (c) below (if applicable). Also, provide detail in 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). If "Yes," provide detail in If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). If "Yes," complete Part I of Schedule L (Form 990 or 990-EZ). If "Yes," provide detail in If "Yes," provide detail in If "Yes," provide detail in If "Yes," answer 10b below. (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings.) Schedule A (Form 990 or 990-EZ) 2019 Page (Complete only if you checked a box in line 12 on Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.) Are all of the organization's supported organizations listed by name in the organization's governing documents? Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? Was any supported organization not organized in the United States ("foreign supported organization")? Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? Did the organization add, substitute, or remove any supported organizations during the tax year? Was any added or substituted supported organization part of a class already designated in the organization's organizing document? Was the substitution the result of an event beyond the organization's control? Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization's supported organizations? Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (as defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? 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 organizations)? Did the organization have any excess business holdings in the tax year? Part IV Supporting Organizations Section A. All Supporting Organizations REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932025 09-25-19 5 Yes No 11 a b c 11a 11b 11cPart VI. Yes No 1 2 Part VI 1 2 Part VI Yes No 1 Part VI 1 Yes No 1 2 3 1 2 3 Part VI Part VI 1 2 3 (see instructions). a b c line 2 line 3 Part VI Answer (a) and (b) below.Yes No a b a b Part VI identify those supported organizations and explain 2a 2b 3a 3b Part VI Answer (a) and (b) below. Part VI. Part VI Schedule A (Form 990 or 990-EZ) 2019 If "Yes" to a, b, or c, provide detail in If "No," describe in 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. If "Yes," explain in how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised, or controlled the supporting organization. If "No," describe in how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s). If "No," explain in how the organization maintained a close and continuous working relationship with the supported organization(s). If "Yes," describe in the role the organization's supported organizations played in this regard. Check the box next to the method that the organization used to satisfy the Integral Part Test during the year Complete below. Complete below. Describe in how you supported a government entity (see instructions). If "Yes," then in 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. If "Yes," explain in the reasons for the organization's position that its supported organization(s) would have engaged in these activities but for the organization's involvement. Provide details in If "Yes," describe in the role played by the organization in this regard. Schedule A (Form 990 or 990-EZ) 2019 Page Has the organization accepted a gift or contribution from any of the following persons? A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization? A family member of a person described in (a) above? A 35% controlled entity of a person described in (a) or (b) above? 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? Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? 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 organization(s)? 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, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization's governing documents in effect on the date of notification, to the extent not previously provided? Were any of the organization's officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? 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 assets at all times during the tax year? The organization satisfied the Activities Test. The organization is the parent of each of its supported organizations. The organization supported a governmental entity. Activities Test. Did substantially all of the organization's activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? Did the activities described in (a) constitute activities that, but for the organization's involvement, one or more of the organization's supported organization(s) would have been engaged in? Parent of Supported Organizations. Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Did the organization exercise a substantial degree of direction over the policies, programs, and activities of each of its supported organizations? (continued)Part IV Supporting Organizations Section B. Type I Supporting Organizations Section C. Type II Supporting Organizations Section D. All Type III Supporting Organizations Section E. Type III Functionally Integrated Supporting Organizations REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932026 09-25-19 6 1 See instructions. Section A - Adjusted Net Income 1 2 3 4 5 6 7 8 1 2 3 4 5 6 7 8Adjusted Net Income Section B - Minimum Asset Amount 1 2 3 4 5 6 7 8 a b c d e 1a 1b 1c 1d 2 3 4 5 6 7 8 Total Discount Part VI Minimum Asset Amount Section C - Distributable Amount 1 2 3 4 5 6 7 1 2 3 4 5 6 Distributable Amount. Schedule A (Form 990 or 990-EZ) 2019 Schedule A (Form 990 or 990-EZ) 2019 Page Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). All other Type III non-functionally integrated supporting organizations must complete Sections A through E. (B) Current Year (optional)(A) Prior Year Net short-term capital gain Recoveries of prior-year distributions Other gross income (see instructions) Add lines 1 through 3. Depreciation and depletion Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) Other expenses (see instructions) (subtract lines 5, 6, and 7 from line 4) (B) Current Year (optional)(A) Prior Year Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): Average monthly value of securities Average monthly cash balances Fair market value of other non-exempt-use assets (add lines 1a, 1b, and 1c) claimed for blockage or other factors (explain in detail in ): Acquisition indebtedness applicable to non-exempt-use assets Subtract line 2 from line 1d. Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). Net value of non-exempt-use assets (subtract line 4 from line 3) Multiply line 5 by .035. Recoveries of prior-year distributions (add line 7 to line 6) Current Year Adjusted net income for prior year (from Section A, line 8, Column A) Enter 85% of line 1. Minimum asset amount for prior year (from Section B, line 8, Column A) Enter greater of line 2 or line 3. Income tax imposed in prior year Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions). Check here if the current year is the organization's first as a non-functionally integrated Type III supporting organization (see instructions). Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932027 09-25-19 7 Section D - Distributions Current Year 1 2 3 4 5 6 7 8 9 10 Part VI Total annual distributions. Part VI (i) Excess Distributions (ii) Underdistributions Pre-2019 (iii) Distributable Amount for 2019Section E - Distribution Allocations 1 2 3 4 5 6 7 8 Part VI a b c d e f g h i j Total a b c Part VI. Part VI Excess distributions carryover to 2020. a b c d e Schedule A (Form 990 or 990-EZ) 2019 Schedule A (Form 990 or 990-EZ) 2019 Page Amounts paid to supported organizations to accomplish exempt purposes Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity Administrative expenses paid to accomplish exempt purposes of supported organizations Amounts paid to acquire exempt-use assets Qualified set-aside amounts (prior IRS approval required) Other distributions (describe in ). See instructions. Add lines 1 through 6. Distributions to attentive supported organizations to which the organization is responsive (provide details in ). See instructions. Distributable amount for 2019 from Section C, line 6 Line 8 amount divided by line 9 amount (see instructions) Distributable amount for 2019 from Section C, line 6 Underdistributions, if any, for years prior to 2019 (reason- able cause required- explain in ). See instructions. Excess distributions carryover, if any, to 2019 From 2014 From 2015 From 2016 From 2017 From 2018 of lines 3a through e Applied to underdistributions of prior years Applied to 2019 distributable amount Carryover from 2014 not applied (see instructions) Remainder. Subtract lines 3g, 3h, and 3i from 3f. Distributions for 2019 from Section D, line 7:$ Applied to underdistributions of prior years Applied to 2019 distributable amount Remainder. Subtract lines 4a and 4b from 4. Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. For result greater than zero, explain in See instructions. Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. For result greater than zero, explain in . See instructions. Add lines 3j and 4c. Breakdown of line 7: Excess from 2015 Excess from 2016 Excess from 2017 Excess from 2018 Excess from 2019 (continued) Part V Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932028 09-25-19 8 Schedule A (Form 990 or 990-EZ) 2019 Schedule A (Form 990 or 990-EZ) 2019 Page Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; 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 1c, 2a, 2b, 3a, and 3b; Part V, line 1; Part V, Section B, line 1e; 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.) Part VI Supplemental Information. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Department of the Treasury Internal Revenue Service 923451 11-06-19 For Paperwork Reduction Act Notice, see the instructions for Form 990, 990-EZ, or 990-PF.Schedule B (Form 990, 990-EZ, or 990-PF) (2019) OMB No. 1545-0047 (Form 990, 990-EZ,or 990-PF)| Attach to Form 990, Form 990-EZ, or Form 990-PF. | Go to www.irs.gov/Form990 for the latest information. Employer identification number Organization type Filers of:Section: not General Rule Special Rule. Note: General Rule Special Rules (1) (2) General Rule Caution: must exclusively exclusively exclusively nonexclusively Name of the organization (check one): Form 990 or 990-EZ 501(c)() (enter number) organization 4947(a)(1) nonexempt charitable trust treated as a private foundation 527 political organization Form 990-PF 501(c)(3) exempt private foundation 4947(a)(1) nonexempt charitable trust treated as a private foundation 501(c)(3) taxable private foundation Check if your organization is covered by the or a Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions. For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions. For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33 1/3% support test of the regulations under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of $5,000; or 2% of the amount on (i) Form 990, Part VIII, line 1h; or (ii) Form 990-EZ, line 1. Complete Parts I and II. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, total contributions of more than $1,000 for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III. For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor, during the year, contributions for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an religious, charitable, etc., purpose. Don't complete any of the parts unless the applies to this organization because it received religious, charitable, etc., contributions totaling $5,000 or more during the year ~~~~~~~~~~~~~~~|$ An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990, 990-EZ, or 990-PF), but it answer "No" on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ or on its Form 990-PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990, 990-EZ, or 990-PF). LHA Schedule B Schedule of Contributors 2019 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 X 3 X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 923452 11-06-19 Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990, 990-EZ, or 990-PF) (2019)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors 1 X 191,367. REBUILDING TOGETHER (NATIONAL) 999 N. CAPITOL STREET NE, SUITE 701 WASHINGTON, DC 20002 2 X 49,897. UNITED WAY OF CHATHAM COUNTY 72 HILLSBORO ST #202 PITTSBORO, NC 27312 3 X 99,090. CHATHAM COUNTY COUNCIL ON AGING 365 NC-87 PITTSBORO, NC 27312 4 X 77,500. TRIANGLE COMMUNITY FOUNDATION 800 PARK OFFICES DRIVE SUITE 201 RESEARCH TRIANGLE PARK, NC 27709 5 X 40,540. RON COHN 114 WINDY RUSH LANE CARY, NC 27518 6 X 160,088. NC HOUSING FINANCE AGENCY 3508 BUSH STREET RALEIGH, NC 27609 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 923452 11-06-19 Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990, 990-EZ, or 990-PF) (2019)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors 7 X 200,000. CENTER FOR DISASTER PHILANTHROPY ONE THOMAS CIRCLE NW SUITE 700 WASHINGTON, DC 20005 8 X 106,249. TRIANGLE J COUNCIL OF GOVERNMENTS 4307 EMPEROR BLVD DURHAM, NC 27703 9 X 65,000. NORTH CAROLINA COMMUNITY FOUNDATION 3737 GLENWOOD AVE #460 RALEIGH, NC 27612 10 X 45,500. WELLS FARGO 420 MONTGOMERY STREET SAN FRANCISCO, CA 94104 11 X 42,952. NCCAA BEAUTIFICATION 4428 LOUISBURG RD STE 101 RALEIGH, NC 27616 12 X 36,000. SPECTRUM 999 N. CAPITAL STREET NE, SUITE 701 WASHINGTON, DC 20002 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 923452 11-06-19 Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Employer identification number (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash (a) No. (b) Name, address, and ZIP + 4 (c) Total contributions (d) Type of contribution Person Payroll Noncash Schedule B (Form 990, 990-EZ, or 990-PF) (2019)Page Name of organization (see instructions). Use duplicate copies of Part I if additional space is needed. $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) $ (Complete Part II for noncash contributions.) 2 Part I Contributors 13 X 32,341. TOWN OF CARY 316 N. ACADEMY ST CARY, NC 27513 14 X 30,938. DUKE HHF 4428 LOUISBURG RD STE 101 RALEIGH, NC 27616 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 923453 11-06-19 Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Employer identification number (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received (a) No. from Part I (c) FMV (or estimate)(b) Description of noncash property given (d) Date received Schedule B (Form 990, 990-EZ, or 990-PF) (2019)Page Name of organization (see instructions). Use duplicate copies of Part II if additional space is needed. (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ (See instructions.) $ 3 Part II Noncash Property REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (Enter this info. once.)completing Part III, enter the total of exclusively religious,charitable, etc., contributions of for the year. 923454 11-06-19 Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor.(a)(e) and $1,000 or less Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Complete columns through the following line entry. For organizations Employer identification number (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee (a) No.fromPart I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held (e) Transfer of gift Transferee's name, address, and ZIP + 4 Relationship of transferor to transferee Schedule B (Form 990, 990-EZ, or 990-PF) (2019)Page Name of organization | $ Use duplicate copies of Part III if additional space is needed. 4 Part III REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 932051 10-02-19 Held at the End of the Tax Year (Form 990)| Complete if the organization answered "Yes" on Form 990,Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.| Attach to Form 990.|Go to www.irs.gov/Form990 for instructions and the latest information. Open to PublicInspection Name of the organization Employer identification number (a) (b) 1 2 3 4 5 6 Yes No Yes No 1 2 3 4 5 6 7 8 9 a b c d 2a 2b 2c 2d Yes No Yes No 1 2 a b (i) (ii) a b For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule D (Form 990) 2019 Complete if the organization answered "Yes" on Form 990, Part IV, line 6. Donor advised funds Funds and other accounts Total number at end of year Aggregate value of contributions to (during year) Aggregate value of grants from (during year) Aggregate value at end of year ~~~~~~~~~~~~~~~ ~~~~ ~~~~~~ ~~~~~~~~~~~~~ Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control?~~~~~~~~~~~~~~~~~~ Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Complete if the organization answered "Yes" on Form 990, Part IV, line 7. Purpose(s) of conservation easements held by the organization (check all that apply). Preservation of land for public use (for example, recreation or education) Protection of natural habitat Preservation of open space Preservation of a historically important land area Preservation of a certified historic structure 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. Total number of conservation easements Total acreage restricted by conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements on a certified historic structure included in (a) Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year | Number of states where property subject to conservation easement is located | Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds?~~~~~~~~~~~~~~~~~~~~~~~~~ Staff and volunteer hours devoted to monitoring, inspecting, 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 section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements. Complete if the organization answered "Yes" on Form 990, Part IV, line 8. If the organization elected, as permitted under FASB ASC 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 public service, provide in Part XIII the text of the footnote to its financial statements that describes these items. If the organization elected, as permitted under FASB ASC 958, 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 public service, provide the following amounts relating to these items: Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$ $~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the following amounts required to be reported under FASB ASC 958 relating to these items: Revenue included on Form 990, Part VIII, line 1 Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~|$ $| LHA Part I Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Part II Conservation Easements. Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets. SCHEDULE D Supplemental Financial Statements 2019 REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932052 10-02-19 3 4 5 a b c d e Yes No 1 2 a b c d e f a b Yes No 1c 1d 1e 1f Yes No (a) (b) (c) (d) (e) 1 2 3 4 a b c d e f g a b c a b Yes No (i) (ii) 3a(i) 3a(ii) 3b (a) (b) (c) (d) 1a b c d e Total. Schedule D (Form 990) 2019 (continued) (Column (d) must equal Form 990, Part X, column (B), line 10c.) Two years back Three years back Four years back Schedule D (Form 990) 2019 Page Using the organization's acquisition, accession, and other records, check any of the following that make significant use of its collection items (check all that apply): Public exhibition Scholarly research Preservation for future generations Loan or exchange program Other Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIII. During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? If "Yes," explain the arrangement in Part XIII and complete the following table: ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amount Beginning balance Additions during the year Distributions during the year Ending balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided on Part XIII ~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 10. Current year Prior year Beginning of year balance Contributions Net investment earnings, gains, and losses Grants or scholarships ~~~~~~~ ~~~~~~~~~~~~~~ ~~~~~~~~~ Other expenditures for facilities and programs Administrative expenses End of year balance ~~~~~~~~~~~~~ ~~~~~~~~ ~~~~~~~~~~ Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: Board designated or quasi-endowment Permanent endowment Term endowment The percentages on lines 2a, 2b, and 2c should equal 100%. |% |% |% Are there endowment funds not in the possession of the organization that are held and administered for the organization by: Unrelated organizations Related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" on line 3a(ii), are the related organizations listed as required on Schedule R? Describe in Part XIII the intended uses of the organization's endowment funds. ~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10. Description of property Cost or other basis (investment) Cost or other basis (other) Accumulated depreciation Book value Land Buildings Leasehold improvements ~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~ Equipment Other ~~~~~~~~~~~~~~~~~ Add lines 1a through 1e. | 2 Part III Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets Part IV Escrow and Custodial Arrangements. Part V Endowment Funds. Part VI Land, Buildings, and Equipment. 27,657.17,106.10,551. 10,551. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 (including name of security) 932053 10-02-19 Total. Total. (a) (b) (c) (1) (2) (3) (a) (b) (c) (1) (2) (3) (4) (5) (6) (7) (8) (9) (a) (b) (1) (2) (3) (4) (5) (6) (7) (8) (9) Total. (a) (b) 1. Total. 2. Schedule D (Form 990) 2019 (Column (b) must equal Form 990, Part X, col. (B) line 15.) (Column (b) must equal Form 990, Part X, col. (B) line 25.) Description of security or category (Col. (b) must equal Form 990, Part X, col. (B) line 12.) | (Col. (b) must equal Form 990, Part X, col. (B) line 13.) | Schedule D (Form 990) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12. Book value Method of valuation: Cost or end-of-year market value Financial derivatives Closely held equity interests Other ~~~~~~~~~~~~~~~ ~~~~~~~~~~~ (A) (B) (C) (D) (E) (F) (G) (H) Complete if the organization answered "Yes" on Form 990, Part IV, line 11c. See Form 990, Part X, line 13. Description of investment Book value Method of valuation: Cost or end-of-year market value Complete if the organization answered "Yes" on Form 990, Part IV, line 11d. See Form 990, Part X, line 15. Description Book value | Complete if the organization answered "Yes" on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25. Description of liability Book value (1) (2) (3) (4) (5) (6) (7) (8) (9) Federal income taxes | 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 FASB ASC 740. Check here if the text of the footnote has been provided in Part XIII 3 Part VII Investments - Other Securities. Part VIII Investments - Program Related. Part IX Other Assets. Part X Other Liabilities. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932054 10-02-19 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 32e 1 a b c 4a 4b 4a 4b 3 4c. 4c 5 1 2 3 4 5 1 a b c d e 2a 2b 2c 2d 2a 2d 2e 1 2e 3 a b c 4a 4b 4a 4b 3 4c. 4c 5 Schedule D (Form 990) 2019 (This must equal Form 990, Part I, line 12.) (This must equal Form 990, Part I, line 18.) Schedule D (Form 990) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total revenue, gains, and other support per audited financial statements Amounts included on line 1 but not on Form 990, Part VIII, line 12: ~~~~~~~~~~~~~~~~~~~ Net unrealized gains (losses) on investments Donated services and use of facilities Recoveries of prior year grants Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part VIII, line 12, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total revenue. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990, Part IV, line 12a. Total expenses and losses per audited financial statements Amounts included on line 1 but not on Form 990, Part IX, line 25: ~~~~~~~~~~~~~~~~~~~~~~~~~~ Donated services and use of facilities Prior year adjustments Other losses Other (Describe in Part XIII.) ~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines through Subtract line from line ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Amounts included on Form 990, Part IX, line 25, but not on line 1: Investment expenses not included on Form 990, Part VIII, line 7b Other (Describe in Part XIII.) ~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~ Add lines and Total expenses. Add lines and ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information. 4 Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Part XIII Supplemental Information. PART XI, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISER EVENTS EXPENSES 8,850. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISER EVENTS EXPENSES 8,850. 1,583,442. 8,850. 8,850. 1,574,592. 0. 1,574,592. 1,317,766. 8,850. 8,850. 1,308,916. 0. 1,308,916. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service Didfundraiserhave custodyor control ofcontributions? 932081 09-11-19 Go to (Form 990 or 990-EZ)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. Open to Public Inspection | Attach to Form 990 or Form 990-EZ. | www.irs.gov/Form990 for instructions and the latest information. Employer identification number 1 a b c d a b e f g 2 Yes No (i) (ii) (iii) (iv) (v) (i) (vi) Yes No Total 3 For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule G (Form 990 or 990-EZ) 2019 Name of the organization Complete if the organization answered "Yes" on Form 990, Part IV, line 17. Form 990-EZ filers are not required to complete this part. Indicate whether the organization raised funds through any of the following activities. Check all that apply. Mail solicitations Internet and email solicitations Phone solicitations In-person solicitations Solicitation of non-government grants Solicitation of government grants Special fundraising events Did the organization have a written or oral agreement with any individual (including officers, directors, trustees, or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. Name and address of individual or entity (fundraiser)Activity Gross receipts from activity Amount paidto (or retained by)fundraiserlisted in col. Amount paidto (or retained by)organization | List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing. LHA Supplemental Information Regarding Fundraising or Gaming ActivitiesSCHEDULE G Part I Fundraising Activities. 2019 56-1955629REBUILDING TOGETHER OF THE TRIANGLE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932082 09-11-19 2 (d) (a) (c) (a) (b) (c) 1 2 3 4 5 6 7 8 9 10 11 (a) (b) (c) (d) (a) (c) 1 2 3 4 5 6 7 8 Yes Yes Yes No No No 9 10 a b Yes No a b Yes No Schedule G (Form 990 or 990-EZ) 2019 Pull tabs/instant bingo/progressive bingo Schedule G (Form 990 or 990-EZ) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000. Total events (add col. through col. )RevenueEvent #1 Event #2 Other events (event type)(event type)(total number) Gross receipts Less: Contributions ~~~~~~~~~~~~~~ ~~~~~~~~~~~ Gross income (line 1 minus line 2)Direct Expenses Cash prizes Noncash prizes ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Rent/facility costs ~~~~~~~~~~~~ Food and beverages Entertainment ~~~~~~~~~~ ~~~~~~~~~~~~~~ Other direct expenses ~~~~~~~~~~ Direct expense summary. Add lines 4 through 9 in column (d) Net income summary. Subtract line 10 from line 3, column (d) ~~~~~~~~~~~~~~~~~~~~~~~~| | Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.RevenueBingo Other gaming Total gaming (add col. through col. )Direct ExpensesGross revenue Cash prizes Noncash prizes ~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~ Rent/facility costs Other direct expenses ~~~~~~~~~~~~ %%% Volunteer labor ~~~~~~~~~~~~~ Direct expense summary. Add lines 2 through 5 in column (d) Net gaming income summary. Subtract line 7 from line 1, column (d) ~~~~~~~~~~~~~~~~~~~~~~~~| | Enter the state(s) in which the organization conducts gaming activities: Is the organization licensed to conduct gaming activities in each of these states? If "No," explain: ~~~~~~~~~~~~~~~~~~~~ Were any of the organization's gaming licenses revoked, suspended, or terminated during the tax year? If "Yes," explain: ~~~~~~~~~ Part II Fundraising Events. Part III Gaming. 37,135. 37,135. 37,135. 37,135. 8,850. 28,285. K SHUCK-N-CLUC REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 NONE 8,850.8,850. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932083 09-11-19 3 11 12 13 14 15 Yes No Yes No a b 13a 13b Yes Noa b c 16 17 a b Yes No Schedule G (Form 990 or 990-EZ) 2019 Schedule G (Form 990 or 990-EZ) 2019 Page Does the organization conduct gaming activities with nonmembers? 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? ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Indicate the percentage of gaming activity conducted in: The organization's facility An outside facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~% %~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the name and address of the person who prepares the organization's gaming/special events books and records: Name | Address | Does the organization have a contract with a third party from whom the organization receives gaming revenue? If "Yes," enter the amount of gaming revenue received by the organization | ~~~~~~ $and the amount of gaming revenue retained by the third party | $ If "Yes," enter name and address of the third party: Name | Address | Gaming manager information: Name | Gaming manager compensation | Description of services provided | $ Director/officer Employee Independent contractor Mandatory distributions: Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license?~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year |$ Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions. Part IV Supplemental Information. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932084 04-01-19 4 Schedule G (Form 990 or 990-EZ) (continued) Schedule G (Form 990 or 990-EZ)Page Part IV Supplemental Information REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service Loan to or from the organization? 932131 10-21-19 (Form 990 or 990-EZ)| Complete if the organization answered "Yes" on Form 990, Part IV, line 25a, 25b, 26, 27, 28a, 28b, or 28c, or Form 990-EZ, Part V, line 38a or 40b. Open To Public Inspection | Attach to Form 990 or Form 990-EZ. | Go to www.irs.gov/Form990 for instructions and the latest information. Employer identification number 1 (b) (d) (a) (c) Yes No 2 3 (a) (c) (e) (g)(h) (i) (d) (b) (f) Yes No Yes No Yes No Total (b) (a) (c) (d) (e) For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule L (Form 990 or 990-EZ) 2019 Approvedby board orcommittee? Written agreement? Relationship with organization Name of the organization (section 501(c)(3), section 501(c)(4), and section 501(c)(29) organizations only). Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b. Relationship between disqualified person and organization Corrected?Name of disqualified person Description of transaction Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~| | $ $Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ~~~~~~~~~~~~~~~~ Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22. Name of interested person Purpose of loan Original principal amount In default? Balance due To From |$ Complete if the organization answered "Yes" on Form 990, Part IV, line 27. Relationship between interested person and the organization Name of interested person Amount of assistance Type of assistance Purpose of assistance LHA SCHEDULE L Part I Excess Benefit Transactions Part II Loans to and/or From Interested Persons. Part III Grants or Assistance Benefiting Interested Persons. Transactions With Interested Persons 2019 56-1955629 X X X X X X X X X X X X X X X X X X X X X X X X 30,000. 30,000. 30,000. 20,000. 10,000. 7,000. 0. 0. 0. 0. 0. 0. BRANDON MOOREFI LAUREN JOYCE TODD JONES RON COHN JOHN SARGENT LAUREN JOYCE BOARD ME REBUILDING TOGETHER OF THE TRIANGLE SEE PART V FOR CONTINUATIONS PROVIDE BOARD ME PROVIDE BOARD ME PROVIDE BOARD ME PROVIDE PARENTS PROVIDE BOARD ME PROVIDE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932132 10-21-19 2 (e) (a) (b) (c) (d) Yes No Schedule L (Form 990 or 990-EZ) 2019 Schedule L (Form 990 or 990-EZ) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.Sharing oforganization'srevenues? Name of interested person Relationship between interested person and the organization Amount of transaction Description of transaction Provide additional information for responses to questions on Schedule L (see instructions). Part IV Business Transactions Involving Interested Persons. Part V Supplemental Information. 56-1955629 SCHEDULE L, PART II, LOANS TO AND FROM INTERESTED PERSONS: (A) NAME OF PERSON: BRANDON MOOREFIELD (B) RELATIONSHIP WITH ORGANIZATION: BOARD MEMBER (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT (A) NAME OF PERSON: LAUREN JOYCE (B) RELATIONSHIP WITH ORGANIZATION: BOARD MEMBER (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT (A) NAME OF PERSON: TODD JONES (B) RELATIONSHIP WITH ORGANIZATION: BOARD MEMBER (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT (A) NAME OF PERSON: RON COHN (B) RELATIONSHIP WITH ORGANIZATION: BOARD MEMBER (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT (A) NAME OF PERSON: JOHN SARGENT (B) RELATIONSHIP WITH ORGANIZATION: PARENTS OF EXECUTIVE DIRECTOR (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT X5,000.DAN SARGENT EXECUTIVE DIRECTOR THE ORGANIZ REBUILDING TOGETHER OF THE TRIANGLE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932461 04-01-19 2 Schedule L (Form 990 or 990-EZ) Schedule L (Form 990 or 990-EZ)Page Complete this part to provide additional information for responses to questions on Schedule L (see instructions). Part V Supplemental Information (A) NAME OF PERSON: LAUREN JOYCE (B) RELATIONSHIP WITH ORGANIZATION: BOARD MEMBER (C) PURPOSE OF LOAN: PROVIDE FUNDING FOR CONSTRUCTION PROJECT SCH L, PART IV, BUSINESS TRANSACTIONS INVOLVING INTERESTED PERSONS: (A) NAME OF PERSON: DAN SARGENT (D) DESCRIPTION OF TRANSACTION: THE ORGANIZATION REPAID THE EXECUTIVE DIRECTOR $5,000 FOR A PRIOR YEAR FUNDING OF THE ORGANIZATION'S ONGOING OPERATIONS. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the Treasury Internal Revenue Service 932211 09-06-19 Complete to provide information for responses to specific questions onForm 990 or 990-EZ or to provide any additional information. | Attach to Form 990 or 990-EZ.| Go to www.irs.gov/Form990 for the latest information. (Form 990 or 990-EZ) Open to Public Inspection Employer identification number For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.Schedule O (Form 990 or 990-EZ) (2019) Name of the organization LHA SCHEDULE O Supplemental Information to Form 990 or 990-EZ 2019 FORM 990, PART I, LINE 1, DESCRIPTION OF ORGANIZATION MISSION: ASSURING THAT LOW-INCOME HOMEOWNERS, FROM THE ELDERLY AND DISABLED TO FAMILIES WITH CHILDREN, LIVE IN WARMTH, SAFETY AND INDEPENDENCE. FORM 990, PART VI, SECTION B, LINE 11B: MANAGEMENT AND THE TREASURER REVIEWS THE 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C: THE ORGANIZATION IS CAREFUL NOT TO ENGAGE IN BUSINESS TRANSACTIONS WITH COMPANIES IN WHICH BOARD MEMBERS AND STAFF HAVE MATERIAL INTERESTS. FORM 990, PART VI, SECTION B, LINE 15A: THE ORGANIZATION USED SALARY DATA FROM THE NC CENTER FOR NON-PROFITS AND OTHER SOURCES TO ENSURE THAT COMPENSATION WAS REASONABLE. FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION'S FORM 990 AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 OMB No. 1545-0047 Department of the TreasuryInternal Revenue Service Section 512(b)(13) controlled entity? 932161 09-10-19 SCHEDULE R (Form 990)Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37. Attach to Form 990. Open to PublicInspection| Go to www.irs.gov/Form990 for instructions and the latest information. Employer identification number Part I Identification of Disregarded Entities. (a)(b)(c)(d)(e)(f) Identification of Related Tax-Exempt Organizations. Part II (a)(b)(c)(d)(e)(f)(g) Yes No For Paperwork Reduction Act Notice, see the Instructions for Form 990.Schedule R (Form 990) 2019 | | Name of the organization Complete if the organization answered "Yes" on Form 990, Part IV, line 33. Name, address, and EIN (if applicable) of disregarded entity Primary activity Legal domicile (state or foreign country) Total income End-of-year assets Direct controlling entity Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related tax-exemptorganizations during the tax year. Name, address, and EIN of related organization Primary activity Legal domicile (state or foreign country) Exempt Code section Public charity status (if section 501(c)(3)) Direct controlling entity LHA Related Organizations and Unrelated Partnerships 2019 REBUILDING TOGETHER OF THE TRIANGLE REBUILDING TOGETHER, INC - 52-1585880 WASHINGTON, DC 20002 999 N. CAPITOL STREET NC SUITE 701 REPAIRING HOMES AND REVITALIZING COMMUNITIES DISTRICT OF COLUMBIA 56-1955629 501(C)(3)X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Disproportionate allocations? Legal domicile (state or foreign country) General or managing partner? Section512(b)(13)controlledentity? Legal domicile (state or foreign country) 932162 09-10-19 2 Identification of Related Organizations Taxable as a Partnership. Part III (a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k) Yes No Yes No Identification of Related Organizations Taxable as a Corporation or Trust. Part IV (a)(b)(c)(d)(e)(f)(g)(h)(i) Yes No Schedule R (Form 990) 2019 Predominant income(related, unrelated,excluded from tax undersections 512-514) Schedule R (Form 990) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a partnership during the tax year. Name, address, and EINof related organization Primary activity Direct controllingentity Share of totalincome Share ofend-of-yearassets Code V-UBIamount in box20 of ScheduleK-1 (Form 1065) Percentageownership Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more relatedorganizations treated as a corporation or trust during the tax year. Name, address, and EINof related organization Primary activity Direct controllingentity Type of entity(C corp, S corp,or trust) Share of totalincome Share ofend-of-yearassets Percentageownership REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932163 09-10-19 3 Part V Transactions With Related Organizations. Note:Yes No 1 a b c d e f g h i j k l m n o p q r s (i) (ii) (iii) (iv) 1a 1b 1c 1d 1e 1f 1g 1h 1i 1j 1k 1l 1m 1n 1o 1p 1q 1r 1s 2 (a)(b)(c)(d) (1) (2) (3) (4) (5) (6) Schedule R (Form 990) 2019 Schedule R (Form 990) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule. During the tax year, did the organization engage in any of the following transactions with one or more related organizations listed in Parts II-IV? Receipt of interest, annuities, royalties, or rent from a controlled entity ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Gift, grant, or capital contribution to related organization(s) Gift, grant, or capital contribution from related organization(s) Loans or loan guarantees to or for related organization(s) Loans or loan guarantees by related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Dividends from related organization(s)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sale of assets to related organization(s) Purchase of assets from related organization(s) Exchange of assets with related organization(s) Lease of facilities, equipment, or other assets to related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Lease of facilities, equipment, or other assets from related organization(s) Performance of services or membership or fundraising solicitations for related organization(s) Performance of services or membership or fundraising solicitations by related organization(s) Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Sharing of paid employees with related organization(s)~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Reimbursement paid to related organization(s) for expenses Reimbursement paid by related organization(s) for expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other transfer of cash or property to related organization(s) Other transfer of cash or property from related organization(s) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds. Name of related organization Transaction type (a-s) Amount involved Method of determining amount involved X X X X X X X X X X X X X X X X X X 191,367.CREBUILDING TOGETHER, INC. 56-1955629REBUILDING TOGETHER OF THE TRIANGLE FAIR MARKET VALUE X DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Are allpartners sec.501(c)(3)orgs.? Dispropor- tionate allocations? General or managing partner? 932164 09-10-19 Yes No Yes No Yes N 4 Part VI Unrelated Organizations Taxable as a Partnership. (a)(b)(c)(d)(e)(f)(g)(h)(i)(j)(k) o Schedule R (Form 990) 2019 Predominant income(related, unrelated,excluded from tax undersections 512-514) Code V-UBIamount in box 20of Schedule K-1(Form 1065) Schedule R (Form 990) 2019 Page Complete if the organization answered "Yes" on Form 990, Part IV, line 37. Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships. Name, address, and EIN of entity Primary activity Legal domicile (state or foreign country) Share of total income Share of end-of-year assets Percentage ownership 56-1955629REBUILDING TOGETHER OF THE TRIANGLE DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 932165 09-10-19 5 Schedule R (Form 990) 2019 Schedule R (Form 990) 2019 Page Provide additional information for responses to questions on Schedule R. See instructions. Part VII Supplemental Information REBUILDING TOGETHER OF THE TRIANGLE 56-1955629 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Department of the Treasury Internal Revenue Service File by the due date for filing your return. See instructions. 923841 12-30-19 | File a separate application for each return. | Go to www.irs.gov/Form8868 for the latest information. Electronic filing (e-file). Type or print Application Is For Return Code Application Is For Return Code 1 2 3a b c 3a 3b 3c $ $ $ Balance due. Caution: For Privacy Act and Paperwork Reduction Act Notice, see instructions.8868 www.irs.gov/e-file-providers/e-file-for-charities-and-non-profits. Form (Rev. January 2020)OMB No. 1545-0047 You can electronically file Form 8868 to request a 6-month automatic extension of time to file any of the forms listed below with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, for which an extension request must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit All corporations required to file an income tax return other than Form 990-T (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns. Name of exempt organization or other filer, see instructions.Taxpayer identification number (TIN) Number, street, and room or suite no. If a P.O. box, see instructions. City, town or post office, state, and ZIP code. For a foreign address, see instructions. Enter the Return Code for the return that this application is for (file a separate application for each return) Form 990 or Form 990-EZ Form 990-BL Form 4720 (individual) Form 990-PF 01 02 03 04 05 06 Form 990-T (corporation)07 08 09 10 11 12 Form 1041-A Form 4720 (other than individual) Form 5227 Form 6069 Form 8870 Form 990-T (sec. 401(a) or 408(a) trust) Form 990-T (trust other than above) ¥The books are in the care of | Telephone No.|Fax No.| ¥If the organization does not have an office or place of business in the United States, check this box ~~~~~~~~~~~~~~~~~| ¥If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN). If this is for the whole group, check this box . If it is for part of the group, check this box and attach a list with the names and TINs of all members the extension is for.|| I request an automatic 6-month extension of time until , to file the exempt organization return for the organization named above. The extension is for the organization's return for: | | calendar year or tax year beginning , and ending . If the tax year entered in line 1 is for less than 12 months, check reason:Initial return Final return Change in accounting period If this application is for Forms 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. If this application is for Forms 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. Subtract line 3b from line 3a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions. If you are going to make an electronic funds withdrawal (direct debit) with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions. LHA Form (Rev. 1-2020) Automatic 6-Month Extension of Time. Only submit original (no copies needed). 8868 Application for Automatic Extension of Time To File anExempt Organization Return 2019 REBUILDING TOGETHER OF THE TRIANGLE LAUREN JOYCE X 0. 0. 0. 919-341-5980 200 TRANS AIR DRIVE, NO. 200 MORRISVILLE, NC 27560 56-1955629 NOVEMBER 16, 2020 200 TRANS AIR DRIVE, SUITE 200 - MORRISVILLE, NC 27560 0 1 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 Rebuilding Together of the Triangle Board of Directors Name Position Email Address Term Katy Patton President 919-597-1992 601 W. Rosemary Street Space 108 Chapel Hill, NC 27516 Exp. 2021 Tyler Grimes Vice President 919-810-6200 Exp. 2022 Michael Byers Board Member 919-272-4285 Exp. 2021 Treasurer 803-369-1811 Exp. 2021 Board Member 919-719-9576 2301 Sugar Bush Rd Suite 600, Raleigh, NC 27612 Exp. 2019 Matthew Duncan Secretary 919-743-7329 100 SAS Campus Dr, Cary, NC 27513 Exp. 2022 Board Member 919-360-5339 Exp. 2022 Tim Wilson Board Member 919-531-3240 100 SAS Campus Dr, Cary, NC 27513 Exp. 2021 Board Member 919-815-4411 401 C Foster Street Durham 27701 Exp. 2022 Board Member 919-614-3214 Exp. 2022 Main Phone Number Physical Address (Street, City, State, ZIP; Must be different from Affiliate Address) pattonkaty@gmail.com grimesT@fnb-corp.com 3600 Glenwood Ave Suite 300 Raleigh, NC 27612 byersM@fnb-corp.com 3600 Glenwood Ave Suite 300 Raleigh, NC 27612 Dan Crosley dcrosley13@gmail.com 100 E. Davie Street Raleigh NC 27601 Brandon Moorefield brandon.moorefield@marshmma.com mdduncanesq@gmail.com Cameron Boivin cameronboivin90@gmail.com 5505 Arco Street Cary, NC 27519 tim.wilson@sas.com Marcelle Thomas marcelle@urbandurhamrealty.com Anne Stoddard astoddard@grubbventures.com 3700 Glenwood Ave Suite 330 Raleigh, NC 27612 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 200 Trans Air Dr. Suite 200 Morrisville, NC 27560 919.341.5980 November 4, 2020 Orange County Financial Services 200 South Cameron Street Hillsborough, NC 27278 Re: 3-R Fee for Rebuilding Together of the Triangle To whom it may concern, Rebuilding Together of the Triangle operates our home repair program throughout the county but does not maintain a facility in Orange County. We are, therefore, not assessed the 3-R fee. Thank you for your attention in this matter. Regards, Daniel Sargent Executive Director Rebuilding Together of the Triangle Repairing Homes. Revitalizing Communities. Rebuilding Lives. DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 3/16/2021 Arthur J.Gallagher &Co. Insurance Brokers of CA.,Inc.LIC#0726293 595 Market Street Suite 2100 San Francisco CA 94105 Darby Hughes Darby_Hughes@ajg.com Tokio Marine Specialty Ins Co 23850 REBUTOG-92 Philadelphia Indemnity Insurance Company 18058RebuildingTogether,Inc.(Affiliates) Rebuilding Together of the Triangle 999 N.Capitol St.,NE,Suite 701 Washington DC 20002 1969155768 B X 1,000,000 X 100,000 5,000 1,000,000 2,000,000 X X STOP GAP LIAB Y PHPK2246006 3/15/2021 3/15/2022 2,000,000 STP GAP/ND OH WA WY 1,000,000 B 1,000,000 X X X PHPK2246006 3/15/2021 3/15/2022 B X X 10,000,000PHUB7590133/15/2021 3/15/2022 10,000,000 X 10,000 A Contractors Environmental/Profess PPK2247500 3/15/2021 3/15/2022 Prof Liab perIncident Env Liab per Incident Policy Aggregate 1,000,000 1,000,000 1,000,000 RE:Operations of the Named Insured -Additional Insured with Primary and Non-Contributory status and Waiver of Subrogation applies to General Liability when required by written contract. Orange County Housing and Community Development are included as additional insured as required by written contract. Orange County Housing and Community Development 300 W Tryon Street Hillsborough NC 27278 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 26 04 13 © Insurance Services Office, Inc., 2012 Page of ADDITIONAL INSURED – DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II – Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III – Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. PHPK2246006 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 03/15/2021 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 PHPK2246006 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134 DocuSign Envelope ID: 674071D6-B48A-4209-80A1-FCDFB6EDB134