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 990-EZ 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
2016
Open to Public
Inspection
Name of the organization
SAM ACTION INC
 
Employer identification number

47-3688463
Return Reference Explanation
FORM 990, PART VI, SECTION B, LINE 11B 990 IS REVIEWED BY THE ORGANIZATION'S PRESIDENT, OFFICERS AND THE CPA FIRM.
FORM 990, PART VI, SECTION B, LINE 12C ALL DIRECTORS ARE REQUIRED TO SIGN A CONFLICT OF INTEREST STATEMENT.
FORM 990, PART VI, SECTION C, LINE 18 FORM 990 IS AVAILABLE UPON REQUEST.
FORM 990, PART VI, SECTION C, LINE 19 DOCUMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2016


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