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.") . | 5,413 | 5,413 | ||||
| 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...... | 1,405,856 | 1,781,519 | 1,912,826 | 1,802,904 | 1,829,130 | 8,732,235 |
| 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. | 1,405,856 | 1,781,519 | 1,912,826 | 1,802,904 | 1,834,543 | 8,737,648 |
| 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.) | 8,737,648 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,405,856 | 1,781,519 | 1,912,826 | 1,802,904 | 1,834,543 | 8,737,648 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 316 | 13 | 1,528 | 5,235 | 2,142 | 9,234 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 316 | 13 | 1,528 | 5,235 | 2,142 | 9,234 |
| 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.). | 8,746,882 | |||||




| 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 | DRAFT OF FORM 990 PROVIDED TO BOARD PRIOR TO AUGUST | |
| BOARD MEETING FOR THEIR REVIEW. ACTUAL FORM | ||
| REVIEWED IN DETAIL BY OUTSIDE CPA WITH BOARD | ||
| AT AUGUST MEETING. BOARD MAKES FORMAL MOTION TO | ||
| APPROVE THE RETURN AS PRESENTED AND FILED. | ||
| Pt VI-B, Line 12c | ORGANIZATION HAS CONFLICT OF INTEREST POLICY IN FORCE | |
| THAT ALL EMPLOYEES ARE REQUIRED TO COMPLY WITH. | ||
| TRUSTEES DO NOT COMPLETE A CONFLICT OF INTEREST | ||
| STATEMENT. | ||
| Pt VI-B, Line 15 | COMPENSATION FOR OPERATIONS MANAGER IS REVIEWED, | |
| DETERMINED, AND AUTHORIZED BY FULL BOARD. | ||
| DETERMINATION OF AMOUNT PAID IS BASED ON LEVEL OF | ||
| EXPERIENCE, TIME WITH THE ORGANIZATION, AND A | ||
| REVIEW OF COMPARABLE PAY SCALES USED BY LOCAL EMS | ||
| SERVICE PORIVIDERS IN THE LOCAL AREA. | ||
| Pt VI-C, Line 19 | ORGANIZATIONS GOVERNING DOCUMENTS, FINANCIAL | |
| STATEMENTS, AND TAX REURN ARE AVAILABLE FOR | ||
| INSPECTION UPON REQUEST IN THE ORGANIZATIONS | ||
| BUSINESS OFFICE. THE ORGANIZATION DOES NOT | ||
| CURRENTLY HAVE A FORMAL "CONFLICT OF INTEREST" | ||
| POLICY. | ||
| Pt XI | PRIOR PERIOD ADJUSTMENT TO CORRECT FOR OLD UNCOLLECTIBLE | |
| RECEIVABLES DATING BACK TO 2007. ORGANIZATION HAS | ||
| FORMALIZED BILLING AND COLLECTIONS IN HOUSE. | ||
| Form 990, Part IX, Line 24f | SUPPLIES AND SMALL EQUIPMENT 5398. 5398. 0. 0. MISCELLANEOUS 2031. 2031. 0. 0. SEMINARS AND CONTINUING EDUCATION 11428. 11428. 0. 0. BILLING DEPARTMENT EXPENSES 3538. 0. 3538. 0. PROPERTY TAX 3341. 0. 3341. 0. DONATIONS 5028. 5028. 0. 0. |
| Software ID: | 10000104 |
| Software Version: |