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.") .... | 26,539 | 20,961 | 25,697 | 21,987 | 17,070 | 112,254 |
| 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.. | 26,539 | 20,961 | 25,697 | 21,987 | 17,070 | 112,254 |
| 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. | 112,254 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 26,539 | 20,961 | 25,697 | 21,987 | 17,070 | 112,254 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 27,778 | 29,502 | 27,831 | 25,487 | 24,226 | 134,824 |
| 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). | 247,078 | |||||






| 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.) | 0 | |||||
| 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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| 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 | All members of the board of directors receive, annually, | |
| a document "Summary of Significant Financial Figures | ||
| from Form 990." This document shows major Form 990 income/ | ||
| expense figures and balance sheet figures for the | ||
| Form 990 fiscal year and for at least three previous | ||
| years such that comparisons can be made and trends | ||
| can be seen. | ||
| Pt VI-C, Line 19 | The organization's statements of mission and programs | |
| and its bylaws are on the organization's website. | ||
| Financial statements are available on request. | ||
| Pt VI-A, Line 2 | The organization is required to complete Schedule B. | |
| Schedule B is attached | ||
| Pt XI | LIne 5 - Rounding amount $1. | |
| Pt VI-A, Line 2 | In one family, both spouses are directors. | |
| Part III | Program Services expenditures were 46,385. | |
| Line 4b | Services were Back to School Clothing program, | |
| Christmas Baskets program, and other direct | ||
| assistance to individuals. | ||
| The funding sources for the 46,385 expenditures | ||
| were: Back to School Appeal 2793 | ||
| Christmas Basket Appeal 4868 | ||
| Individuals, General Purposes 3645 | ||
| Grants from Other Organizations 31015 | ||
| Interest Income 4064 | ||
| Total 46,385 | ||
| Approximate numbers of persons served: | ||
| Form 990, Part IX, Line 24f | FUNDRAISING 679. 679. MANAGEMENT & GENERAL 2711. 2711. | |
| Back to School Clothing 300 Children | ||
| Christmas Baskets 308 Families, 1200 Indiv. | ||
| Assistance to Individuals | ||
| 276 Families, 267 Individuals | ||
| Part III | Program Services expenditures were 46,327. | |
| Line 4a | Services were grants to other agencies: | |
| St. Vincent de Paul 6000 | ||
| R&R Respite Care 19200 | ||
| Saguaro Janes 10775 | ||
| Ducks in a Row 3000 | ||
| Community Action Program 1000 | ||
| Wise Owl 3800 | ||
| Other 2552 | ||
| Total 46,327 | ||
| The funding sources for the 46,327 expenditures | ||
| were: Grants from Other Organizations 33000 | ||
| Interest Income 13327 | ||
| Total 46,327 |
| Software ID: | 10000104 |
| Software Version: |