Attach to Form 990 or Form 990-EZ.
See separate instructions.| (i) Name of supported organization |
(ii) EIN |
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) |
(iv) Is the organization in col. (i) listed in your governing document? |
(v) Did you notify the organization in col. (i) of your support? |
(vi) Is the organization in col. (i) organized in the U.S.? |
(vii) Amount of support? |
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|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public Support. Subtract line 5 from line 4. | ||||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 15,003 | 3,500 | 5,298 | 23,801 | ||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | 0 | |||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | |||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | |||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 6 | Total. Add lines 1 through 5. | 0 | 0 | 15,003 | 3,500 | 5,298 | 23,801 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| b | 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public Support (Subtract line 7c from line 6.) | 23,801 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 0 | 15,003 | 3,500 | 5,298 | 23,801 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 0 | |||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 0 | 0 | 15,003 | 3,500 | 5,298 | 23,801 |




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART III, LINE 4d | BANK FEES, FOOD, FUEL, REPAIRS AND MISCELLANEOUS SUPPLIES. | |
| PART VI, SECTION A | (3)THOMAS MANGIN, TRUSTEE/DIRECTOR AND SYBIL MANGIN,DIRECTOR/CFO ARE HUSBAND AND WIFE. (6)SOMEONE BROKE IN OUR CAMP BUILDING AND STOLE OUR HUNTING AND FISHING EQUIPMENT AND THE HURRICAN AND OIL SPILL IN LA HAS SHUT DOWN OUR FISHING FACILITIES. (7) WE HAVE MEMBERS IN OUR ORGANIZATION. | |
| PART VI, SECTION B, LINE 11 | A COPY OF THE 990 IS GIVEN TO THE TRUSTEE AND HE CALL A MEETING OF THE BOARD MEMBERS TO GO OVER THE FORM PRIOR TO FILING. | |
| PART VI, SECTION B, LINE 12c | ANY MEMBER OF THE BOARD WHO HAS A FINANCIAL, PERSONAL OR AN OFFICIAL INTEREST IN, OR CONFLICT, OR THE APPEARANCE OF A CONFLICT WITH ANY MATTER PENDING BEFORE THE BOARD, OF SUCH NATURE THAT IT PREVENTS OR MAY PREVENT THAT MEMBER FROM ACTING ON THE MATTER IN AN IMPARTIAL MANNER, WILL OFFER TO THE BOARD AND VOLUNTARILY EXCUSE THEMSELVES AND WILL VACATE THEIR SEAT AND REFRAIN FROM DISCUSSION AND VOTING ON SAID | |
| PART VI, SECTION B, LINE 15 | (15) THE ENTIRE STAFF OF OFFICERS AND MEMBERS ARE ALL VOLUNTEER WORKERS. | |
| PART VI, SECTION C, LINE 19 | (19) GOVERNING DOCUMENTS, ETC, ARE AVAILABLE TO THE PUBLIC FOR REVIEW. THIS INCLUDES ANY AND ALL CONTRIBUTIONS AND EXPENSES, ALSOS ALL REVENUES RECEIVED AND USED FOR THE ONGOING OF THIS CHARITABLE ORGANIZATION ARE AVAILABLE FOR PUBLIC REVIEW AT ALL TIMES. | |
| PART VII, COLUMN B, HOURS PER WEEK | THERE ARE NO HOURS WORKED FOR ANY OTHER ORGANIZATION. | |
| PART VII, COLUMN B, HOURS PER WEEK | THERE ARE NO OTHER HOURS WORKED FOR ANOTHER ORGANIZATION. | |
| PART VII, COLUMN B, HOURS PER WEEK | THERE ARE NO OTHER HOURS WORKED FOR ANY OTHER ORGANIZATION. | |
| PART VII, COLUMN B, HOURS PER WEEK | THERE ARE NO OTHER HOURS WORKED FOR ANY OTHER ORGANIZATION. | |
| PART VII, COLUMN B, HOURS PER WEEK | THERE ARE NO OTHER HOURS WORKED FOR ANY OTHER ORGANIZATION. | |
| FORM 990 - SUPPLEMENTAL INFORMATION | 01. FORM 990 GOVERNING BODY REVIEW (PART VI, LINE 11). A PRINTED COPY OF THE FORM 990 WAS FURNISHED TO EACH DIRECTOR AND THE TRUSTEE TO EXAMINE PRIOR TO FILING WITH IRS. 02. CONFLICT OF INTEREST POLICY COMPLIANCE (PART VI, LINE 12C). DESCRIBED IN EARLIER INFORMATION FORMS. 03. GOVERNING DOCUMENTS, ETC, AVAILABLE TO PUBLIC (PART VI,LINE 19) |
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