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 | ||||
| (1)
TERRELL STATE HOSPITAL |
320113643 | MHMR State Hospital | Yes | Yes | Yes | 238,081 | |||
| Total | 238,081 | ||||||||
| 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.") . | ||||||
| 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.) | 0 | |||||
| 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: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt III, Line 2 | N/A | |
| Pt III, Line 3 | N/A | |
| Pt V, Line 3b | N/A | |
| Pt VI-A, Line 2 | N/A | |
| Pt VI-A, Line 3 | N/A | |
| Pt VI-A, Line 4 | N/A | |
| Pt VI-A, Line 5 | N/A | |
| Pt VI-A, Line 6 | N/A | |
| Pt VI-A, Line 7a | N/A | |
| Pt VI-A, Line 7b | GOVERNING BODY DECISIONS MUST BE APPROVED BY THE BOARD OF DIRECTORS | |
| Pt VI-A, Line 8a | ALL GOVERNING BODY DECISIONS ARE RECORDED IN THE MEETING MINUTES | |
| Pt VI-A, Line 8b | ALL COMMITTEE ACTIONS ARE RECORDED IN THE MEETING MINUTES | |
| Pt VI-B, Line 10b | N/A | |
| Pt VI-B, Line 11a | REVIEWED BY THE GOVERNING BODY AS PRESENTED BY OUTSIDE CPA | |
| Pt VI-B, Line 12c | COMPLIANCE IS REVIEWED BY THE BOARD CHAIRMAN AND COMM. REALATIONS DIRECTOR | |
| Pt VI-B, Line 15 | N/A NO ONE RECEIVES ANY COMPENSATION | |
| Pt VI-C, Line 19 | AVAILABLE UPON REQUEST | |
| Pt XII, Line 1 | CASH BASIS OF ACCOUNTING IS USED FOR BOOKS AND TAX PURPOSES | |
| Pt XII, Line 2c | THE BOARD ITSELF PERFORMS THE AUDIT OVERSIGHT FUNCTION | |
| Pt XII, Line 3b | N/A | |
| Form 990EZ, Part I, Line 16 | INSURANCE LODGING MEALS REGISTRATION MEMBERSHIPS | |
| Form 990, Part IX, Line 24f | ENTERTAINMENT/ADMISSIONS 7412. 7412. 0. 0. FOOD FOR PATIENTS 6460. 6460. 0. 0. FURNITURE & FIXTURES 1100. 1100. 0. 0. IN-KIND GOODS & SERVICES 166046. 166046. INSURANCE 897. 0. 897. 0. PROF. CONSULTING FEE 617. 0. 617. 0. OFFICE SUPPLIES 6240. 0. 6240. 0. POSTAGE 5048. 0. 5048. 0. PRINTING 532. 0. 532. 0. MEMBERSHIP DUES 110. 0. 110. 0. SALES TAX - RUMMAGE ROOM 1465. 0. 1465. 0. WILDWOOD CEMETARY 3500. 0. 3500. 0. LAKE TAWAKONI 0. 0. 0. 0. CINEMA 1004. 0. 1004. 0. GENERAL 10722. 0. 10722. 0. PUB |
| Software ID: | 10000104 |
| Software Version: |