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.") .... | 41,551 | 51,595 | 24,233 | 26,662 | 16,947 | 160,988 |
| 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.. | 41,551 | 51,595 | 24,233 | 26,662 | 16,947 | 160,988 |
| 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. | 160,988 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 41,551 | 51,595 | 24,233 | 26,662 | 16,947 | 160,988 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 151 | 151 | ||||
| 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.. | 9,213 | 540 | 45 | 172 | 11 | 9,981 |
| 11 | Total support (Add lines 7 through 10). | 171,120 | |||||






| 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 | 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...... | ||||||
| 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. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| 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. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public Support (Subtract line 7c from line 6.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | THE PREPARED FORM 990 IS DELIVERED TO THE EXECUTIVE DIRECTOR OF THE ENTITY PRIOR TO FILING THE TAX RETURN THE EXECUTIVE DIRECTOR REVIEWS THE PREPARED FORM 990 AND MAKES IT AVAILABLE TO THE BOARD OF DIRECTORS FOR THEIR REVIEW IF ANY QUESTIONS ARISE THAT CANNOT BE ANSWERED BY THE EXECUTIVE DIRECTOR THOSE QUESTIONS ARE THEN DIRECTED TO THE FORM 990 PREPARER AND RESPONDED TO PROMPTLY | |
| 02. Conflict of interest policy compliance (Part VI, line 12c) | THE CONFLICT OF INTEREST POLICY IS REVIEWED ANNUALLY BY THE EXECUTIVE DIRECTOR AND THE BOARD OF DIRECTORS ALL PERSONS SERVING AS DIRECTORS ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY STATEMENT AS WELL AS THE EXECUTIVE DIRECTOR ALL DIRECTORS AND EMPLOYEES ARE REQUIRED TO DISCLOSE ANY POTENTIAL CONLICTS OF INTEREST AND THESE ARE REGULARLY REVIEWED BY THE BOARD OF DIRECTORS IF THERE ARE DIRECT OR INDIRECT CONFLICTS OF INTEREST AS DETERMINED BY THE BOARD OF DIRECTORS THE PERSON OR PERSONS MAY BE PROHIBITED FROM PARTICIPATING IN THE DELIBERATIONS AND DECISIONS CENTRAL TO THE CONFLICT | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | CURRENTLY THERE IS ONLY ONE PAID POSITION IN THIS ENTITY THE EXECUTIVE DIRECTOR THE GOVERNING BOARD OF DIRECTORS ANNUALLY PERFORMS A REVIEW OF THE EXECUTIVE DIRECTOR AND DETERMINES THE LEVEL OF FUTURE COMPENSATION BASED ON COMPARABLE DATE OF SURROUNDING COUNTIES PERFORMANCE EVALUATIONS OF THE EXECUTIVE DIRECTOR AND THE HOURS TO BE WORKED CONTEMPORANEOUS DOCUMENTATION IS KEPT CONCERNING THE DETERMINATION OF THE COMPENSATION TO BE PAID THIS WAS LAST UNDERTAKEN IN YEAR 2011 | |
| 04. Other officer or key employee compensation (Part VI, line 15b | CURRENTLY THERE ARE NO OTHER PAID EMPLOYEES OF THIS ENTITY IF THERE WERE OTHER FUTURE PAID OFFICERS OR KEY EMPLOYEES THE COMPENSATION PROCESS WOULD BE CONDUCTED THE SAME AS EXPLAINED FOR THE EXECUTIVE DIRECTOR | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | ALL BYLAWS GOVERNING DOCUMENTS PERSONNEL POLICIES CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC FOR REVIEW AT THE OFFICE OF THE ENTITY WHICH IS 1440 EAST SECOND STREET WEBSTER CITY IOWA THESE DOCUMENTS ARE AVAILABLE DURING REGULAR WORKING HOURS WHICH ARE 900 AM TO 200 PM |
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