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.") .... | 151,426 | 155,671 | 59,185 | 160,049 | 1,109,182 | 1,635,513 |
| 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.. | 151,426 | 155,671 | 59,185 | 160,049 | 1,109,182 | 1,635,513 |
| 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. | 1,635,513 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 151,426 | 155,671 | 59,185 | 160,049 | 1,109,182 | 1,635,513 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 495 | 122 | 7,252 | 75 | 127 | 8,071 |
| 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). | 1,643,584 | |||||






| 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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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | ALL ACTIONS OF THE ORGANIZATION MUST BE APPROVED BY THE MAJORITY OF THE BOARD | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE BOARD REVIEWS THE RETURN PRIOR TO SIGNING FOR 8453 AUTHORIZING THE ACCOUNTANT TO E-FILE | |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL INFORMATION THE ORGANIZATION HAS IS AVAILABLE FOR INSPECTION BY ANYONE AND THE MAIN OFFICE | |
| CONTACT ADDRESSES FOR OFFICERS, DIRECTORS, ETC | FORM 990, PART VII | ALVIN HOOVER - P O BOX 948, BROOKHAVEN, MS 39601. CHAD NETTERVILLE - P O BOX 639, CENTREVILLE, MS 39631. SEMMES ROSS - P O BOX 788, MONTICELLO, MS 39654. BEN YARBROUGH MD - P O BOX 636, MEADVILLE, MS 39653. RICHARD J FIELDS III MD - P O BOX 639, CENTREVILLE, MS 39631. ANDREA MARSHALL MD - P O BOX 788, MONTICELLO, MS 39654. SONNY DICKEY - P O BOX 636, MEADVILLE, MS 39653. DONALD RENTFRO - P O BOX 1203, NATCHEZ, MS 39121. BILL HEBURN - P O BOX 1488, NATCHEZ, MS 39121. MICHAEL WHEELIS, MD - P O BOX 1203, NATCHEZ, MS 39121. RICHARD WILLIAMS - P O BOX 1307, MCCOMB, MS 39649. JEFFERY ROSS MD - P O BOX 948, BROOKHAVEN, MS 39601. WILLIAM DIXON MD - P O BOX 1307, MCCOMB, MS 39649. CALVIN POOLE MD - P O BOX 1488, NATCHEZ, MS 39121. |
| THE BOARD RECEIVES QUARTERLY COMPLIATION REPORTS AND REVIEW THEM THE MONTHLY MEETING FOLLOWING RECEIPT OF THEM. |
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