SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
SURPRISE LAKE CAMP
 
Employer identification number

13-1623869
Return Reference Explanation
FORM 990, PART VI, SECTION A, LINE 2 SOME BOARD MEMBERS HAVE FAMILY RELATIONSHIPS WITH OTHER BOARD MEMBERS.
FORM 990, PART VI, SECTION B, LINE 11 TAX RETURN IS REVIEWED BY EACH BOARD OF TRUSTEE MEMBER BEFORE FILING.
FORM 990, PART VI, SECTION B, LINE 12C ALL BOARD MEMBERS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST DISCLOSURE FORM ONCE EVERY THREE YEARS.
FORM 990, PART VI, SECTION B, LINE 15 ALL SALARIES ARE REVIEWED AND APPROVED BY THE BUDGET AND PERSONEL COMMITTEE.
FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART VII DAVID FLEISCHNER - 250 W. 75TH STREET #5B, NEW YORK, NY 10023. MICHAEL ZBAR - 17 ELDOR AVENUE, NEW CITY, NY 10956. CINDY SHMERLER LEVY - 10 WATCH HILL ROAD, PLEASANTVILLE, NY 10570. MARGERY ARSHAM - 34 VALLEY ROAD, SCARSDALE, NY 10583. DR. JOSEPH GOLDBERG - 166-25 12TH AVENUE # 7C, WHITESTONE, NY 11357. PETER HIRSCH - 40 WEST 86TH STREET #6A, NEW YORK, NY 10024. ALAN HOFFMAN - 100 QUENTIN ROOSEVELT BLVD, GARDEN CITY, NY 11530. ALAN KLEIMAN - 134 EAST 93RD ST, APT 4C, NEW YORK, NY 10128. HOWARD BERK - 86-70 FRANCIS LEWIS BOULEVARD - B25, HOLLISWOOD, NY 11427. MOE BORDWIN - 7 HIGH PINE, GLEN CLOVE, NY 11542. DAYLE HENSHEL - 315 EAST 86TH STREET - 22HE, NEW YORK, NY 10028. JOY HENSHEL - 24 MURRAY HILL ROAD, SCARSDALE, NY 10583. PATTI HENSHEL - 4808 MOORLAND LANE #208, BETHESDA, MD 20814. MICHAEL HERSON - 8709 BURNING TREE ROAD, BETHESDA, MD 20817. JAY JACOBS - 85 CRESCENT BEACH ROAD, GLEN CLOVE, NY 11542. BRUCE JAFFE - 96 MUSTATO ROAD, KATONAH, NY 10536. CHARLES JAINCHILL - 160 WEST 71ST - 12R, NEW YORK, NY 10023. STANLEY JOSEPHSON - 384 WOODLANDS ROAD, HARRISON, NY 10528. LINDA KANE - 1735 YORK AVENUE - 8C, NEW YORK, NY 10128. LEE KAPLAN - 95 NORTHGATE CIRCLE, MELVILLE, NY 11747. MICHAEL MARGULIES - THE CROSSING AT BLIND BROOK, PURCHASE, NY 10577. MIRIAM MESSINGER - 21 COBDEN STREET, ROXBURY, MA 02119. RUTH MESSINGER - 91 CENTRAL PARK WEST - 7A, NEW YORK, NY 10023. JAMES MEYER - 105 BROADHOLLOW ROAD, MELVILLE, NY 11747. JERRY MEYER - 50 OLD QUARRY ROAD, GUILFORD, CT 06437. STEPHEN NITKIN - 1 UNIVERSITY PLACE - 15A, NEW YORK, NY 10003. LAURENCE H. RUBINSTEIN - 38 WHISTLER LANDING, SCARBOROUGH, ME 04074. MARK SEGAL - 21 SHERWOOD DRIVE, LARCHMONT, NY 10538. ELIOT SENOR - 90 NORTH CENTRAL AVENUE, HARTSDALE, NY 10530. SUSAN NAMM SPENCER - 700 SOUTH US HIGHWAY ONE, APT 502, JUPITER, FL 33477. ADELE STERN - 360 CABRINI BLVD, NEW YORK, NY 10040. NELSON BRAFF - 50 ROSS AVE, DEMAREST, NJ 07627. FAITH ALTSCHULER KIRKPATRICK - 4720 CENTER BLVD, APT 615, LONG ISLAND CITY, NY 11109. PETER BAUM - 14 SOUTHDALE ROAD, WHITE PLAINS, NY 10605. AMY GOLDBERG - 215 EAST 68 ST, NEW YORK, NY 10065. MICHELE MARK LEVINE - 175 ADAMS ST, APT 6C, BROOKLYN, NY 11201. LEE MEYER - 29 HOLLAND ROAD, MIDDLETOWN, NJ 07748. EVE RUBINSTEIN PAPERNICK - 120 MYRTLE STREET, APT 1R, WALTHAM, MA 02453. SETH STEIN - 210 EAST BROADWAY, APT H307, NEW YORK, NY 10002. ROBERT ALTABET - 75 JEFFERSON COURT, YORKTOWN HEIGHTS, NY 10598. LINDA MARKOWITZ - 45 KNOLLWOOD ROAD, SUITE 305, ELMSFORD, NY 10523.
FORM 990, PART IX, LINE 24E INSURANCE: PROGRAM SERVICE EXPENSES 91,581. MANAGEMENT AND GENERAL EXPENSES 40,589. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 132,170. ELECTRIC FUEL AND GAS: PROGRAM SERVICE EXPENSES 72,489. MANAGEMENT AND GENERAL EXPENSES 32,128. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 104,617. STAFF AND CAMPER RECRUITMENT: PROGRAM SERVICE EXPENSES 54,174. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 54,174. VEHICLE EXPENSES: PROGRAM SERVICE EXPENSES 47,072. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 47,072. LAUNDRY,LINEN AND BEDDING: PROGRAM SERVICE EXPENSES 42,068. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 42,068. TELEPHONE EXPENSE: PROGRAM SERVICE EXPENSES 26,165. MANAGEMENT AND GENERAL EXPENSES 11,596. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 37,761. HOUSEHOLD SUPPLIES: PROGRAM SERVICE EXPENSES 36,597. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,597. POSTAGE & SHIPPING: PROGRAM SERVICE EXPENSES 12,723. MANAGEMENT AND GENERAL EXPENSES 5,639. FUNDRAISING EXPENSES 2,804. TOTAL EXPENSES 21,166. CAMPER MEDICAL: PROGRAM SERVICE EXPENSES 16,439. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 16,439. SECURITY: PROGRAM SERVICE EXPENSES 10,882. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,882. CLOTHING: PROGRAM SERVICE EXPENSES 7,661. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,661. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 850. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 850.
FORM 990, PART XI, LINE 9: DEPRECIATION NOT ON TAX RETURN -18,761.
FORM 990, PART XI, LINE 2C THE CAMP HAS AN AUDIT COMMITTEE TO OVERSEE ACCOUNTING RULES AND STANDARDS, AND TO REVIEW ANNUAL AUDITED FINANCIAL STATMENTS.
FORM 990, PART III, LINE 1 THE MISSION OF SURPRISE LAKE CAMP IS TO PROVIDE A HIGH QUALITY JEWISH CAMPING EXPERIENCE WHERE CHILDREN AND YOUNG ADULTS WILL BE SAFE, HAVE FUN, AND GROW AS THEY ENGAGE IN PROGRAMS AND ACTIVITIES THAT ENABLE THEM TO LEARN VALUES AND SKILLS THAT WILL HELP THEM LEAD FULFILLING LIVES AND BE ASSETS TO THEIR COMMUNITIES.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

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