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. | 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.") . | 605 | 50 | 835 | 50 | 85 | 1,625 |
| 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...... | 236,175 | 234,371 | 230,726 | 248,319 | 236,352 | 1,185,943 |
| 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. | 236,780 | 234,421 | 231,561 | 248,369 | 236,437 | 1,187,568 |
| 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.) | 1,187,568 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 236,780 | 234,421 | 231,561 | 248,369 | 236,437 | 1,187,568 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 491 | 479 | 192 | 20 | 69 | 1,251 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 491 | 479 | 192 | 20 | 69 | 1,251 |
| 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.) | 12 | 624 | 581 | 1,339 | 2,556 | |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 1,191,375 | |||||




| Facts And Circumstances Test |
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| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISCELLAEOUS INCOME; 2006: 12.; 2007: 624.; 2008: 581.; 2009: 1339.; |
| 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 | FORM 990 IS MADE AVAILABLE TO THE BOARD | |
| Pt VI-B, Line 15 | BOARD DETERMINES BASED ON FINANCIAL ABILITY OF THE ORGANIZATION | |
| Pt VI-B, Line 15 | AND EMPLOYEE PERFORMANCE | |
| Form 990EZ, Part I, Line 16 | MANAGEMENT FEE 2414. INSURANCE 21739. OPERATING & MAINT. 2051. CONGREGATE CARE SERVICE 2139. MISC. ADMINISTRATIVE 283. PAYROLL TAXES 11486. CONVENTIONS & MEETINGS 948. OFFICE EXPENSE 4967. ACCOUNTING SERVICES 3930. SUPPLIES 7487. MORTGAGE INTEREST 14250. LOSS ON ASSET DISPOSAL 464. | |
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE - NET 2501. 4290. PREPAIDS 7591. 6708. | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES 22517. 20530. BONDS, MORTGAGES & OTHER NOTES 182146. 171143. | |
| Form 990, Part IX, Line 24f | CONVENTIONS & MEETINGS 948. 0. 948. 0. LOSS ON ASSET DISPOSAL 464. 464. 0. 0. |
| Software ID: | 10000104 |
| Software Version: |