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. | ||||||
| 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.. | ||||||
| 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.") . | 208,758 | 222,915 | 230,412 | 241,276 | 277,456 | 1,180,817 |
| 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. | 208,758 | 222,915 | 230,412 | 241,276 | 277,456 | 1,180,817 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 55,645 | 67,667 | 38,078 | 23,213 | 38,632 | 223,235 |
| 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.. | 55,645 | 67,667 | 38,078 | 23,213 | 38,632 | 223,235 |
| 8 | Public Support (Subtract line 7c from line 6.) | 957,582 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 208,758 | 222,915 | 230,412 | 241,276 | 277,456 | 1,180,817 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 44 | 88 | 257 | 359 | 44 | 792 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 44 | 88 | 257 | 359 | 44 | 792 |
| 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.). | 208,802 | 223,003 | 230,669 | 241,635 | 277,500 | 1,181,609 |




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Members or stockholder classes and rights (Part VI, line 6) | The organization has a board of trustees elders The organization has 25 members Members can join without cost or financial investment after attending membership classes and making a commitment to the organization Members can vote on matters of new trustees and budget and other unusual significant projects Neither the trustees nor the members receive benefits as stockholders nor do they benefit on dissolution of the organization which is incorporated as a not-for-profit corporation | |
| 02. Member election for additional members (Part VI, line 7a) | Voting members as a body elect new trustees elders Additional members of the organization are admitted by committing to the organization and attending membership classes | |
| 03. Governing body decisions (Part VI, line 7b) | Large expenditures and significant policy changes are presented to the membership body for approval General expenditures and policy implementation are governed by managment and Elders | |
| 04. Governing body meeting documentation (Part VI, line 8a) | Trustees minutes are documented and subsequently read and approved The trustees do not delegate authority to subcommittees and therefore there are no minutes of committee meetings | |
| 05. Committee meeting documentation (Part VI, line 8b) | Trustees minutes are documented and subsequently read and approved The trustees do not delegate authority to subcommittees and therefore there are no minutes of committee meetings | |
| 06. Form 990 governing body review (Part VI, line 11) | The 990 is electronically transmitted to trustees for review and comments prior to authorizing e-filing of the 990 | |
| 07. Governing documents, etc, available to public (Part VI, line 19) | Public documents including 990 are available on request of the board of trustees |
| Software ID: | |
| Software Version: |