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.") .... | 210,102 | 164,908 | 311,469 | 410,063 | 458,729 | 1,555,271 |
| 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.. | 210,102 | 164,908 | 311,469 | 410,063 | 458,729 | 1,555,271 |
| 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. | 1,555,271 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 210,102 | 164,908 | 311,469 | 410,063 | 458,729 | 1,555,271 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 626 | 208 | 3,079 | 2,808 | 497 | 7,218 |
| 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.. | 269 | -998 | 60 | -669 | ||
| 11 | Total support (Add lines 7 through 10). | 1,561,820 | |||||






| 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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| Software ID: | 10000149 |
| Software Version: | 2010.2.13 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 11b | The Organizations management and independent certified public accountant presents the tax return to the Board of Directors for review and discussion at a meeting of the Board of Directors. Additionally, management delivers the final version of the approved tax return to all members of the Board of Directors before the tax return is filed. |
| Form 990 Part VI | 12c | The Organizaton has a written conflict of interest policy that is reviewed annually and a copy of the policy is given to all employees, volunteers, and members of the Board of Directors on an annual basis. The Board of Directors are required to annually disclose any conflicts of interest. The Executive Director monitors the annual disclosure reports and makes the Board of Directors aware of any conflicts that would be relevant to issues discussed or voted on by the Board of Directors. |
| Form 990 Part VI | 15b | The Board of Directors and its Executive Committee approves the salaries of the Executive Director and the Clinical Director/President. No other employees are currently classified as officers or key employees that would require Board of Directors approval of salaries. However, the same process would be used on any such key employees or officers when and if they exist. The Board of Directors considers comparable salaries at similar not for profit organizations in making the decision about the level of compensation paid to the Executive Director and the Clinical Director/President of the Organization. Compensation packages are reviewed and approved by the Board of Directors on an annual basis or as needed during the year for any changes in compensation. |
| Form 990 Part VI | 19 | The Organization makes its Form 990 or 990 EZ, its Form 1023 and its conflcit of interest policy available to the general public on request at their main office during normal business hours. |
| Form 990 Part XII | 2c | The Finance/Audit Committee of the Board of Directors and management of the Organization are responsible for the oversight of the Organizations reviewed financial statements and the selection and approval of the Organizations independent certified public accounting firm performing the review. Reviewed financial statements are presented to the Board of Directors by the independent certified public accounting firm for review, discussion and approval. |
| Software ID: | 10000149 |
| Software Version: | 2010.2.13 |