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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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. | 0 | |||||
| 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.. | 0 | |||||
| 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.") . | 108,158 | 141,461 | 168,785 | 151,319 | 166,337 | 736,060 |
| 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...... | 105,122 | 75,346 | 55,976 | 86,648 | 77,919 | 401,011 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | 213,280 | 216,807 | 224,761 | 237,967 | 244,256 | 1,137,071 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 10,000 | 10,000 | ||||
| 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. | 6,034 | 11,389 | 17,423 | |||
| c | Add lines 7a and 7b.. | 6,034 | 21,389 | 27,423 | |||
| 8 | Public Support (Subtract line 7c from line 6.) | 1,109,648 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 213,280 | 216,807 | 224,761 | 237,967 | 244,256 | 1,137,071 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,032 | 795 | 1,172 | 369 | 418 | 3,786 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,032 | 795 | 1,172 | 369 | 418 | 3,786 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | ||||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 1,140,857 | |||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | The Executive Director and officers review the tax return | |
| and a copy is sent to all board members before filing. | ||
| Pt VI-B, Line 12c | The Organization asks all board members to review the | |
| policy at least annually and report and conflicts to | ||
| the board. | ||
| Pt VI-B, Line 15 | The executive board reviews all salaries annually. They | |
| use the CareNet National Recommendations as guidelines and | ||
| make their decisions which are presented to the Board. | ||
| Form 990EZ, Part I, Line 8 | MISCELLANEOUS | |
| Form 990EZ, Part I, Line 16 | INSURANCE CLIENT SERVICES VOLUNTEER TRAINING ADVERTISING GOODWILL GENERAL OFFICE EXPENSE MISCELLANEOUS MEETINGS AND TRAVEL | |
| Form 990EZ, Part II, Line 26 | PAYROLL TAXES 2534. | |
| Form 990, Part VI, Line 9 | TINA CLARK 3263 FARM LANE MANCHESTER MD 21102 JAMES FORSBERG 9997 GREEN VALLEY ROAD UNION BRIDGE MD 21791 SEAN FOLEY 5068 WERTZ ROAD HAMPSTEAD MD 21074 JEFF ODEM 5 WILLIAMS COURT OWINGS MILLS MD 21117 BOB ROBERTSON 260 EAST MAIN STREET WESTMINSTER MD 21157 SUE REISIG 828 HUGHES SHOP ROAD WESTMINSTER MD 21158 | |
| Form 990, Part IX, Line 24f | MMISCELLANEOUS 342. 0. 342. 0. PRINTING 4048. 3644. 202. 202. POSTAGE 5967. 5370. 299. 298. |
| Software ID: | 10000104 |
| Software Version: |