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.") . | 87,402 | 47,043 | 52,945 | 161,399 | 264,266 | 613,055 |
| 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. | 87,402 | 47,043 | 52,945 | 161,399 | 264,266 | 613,055 |
| 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.) | 613,055 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 87,402 | 47,043 | 52,945 | 161,399 | 264,266 | 613,055 |
| 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.) | 34,160 | 75,727 | 35,525 | 145,412 | ||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 758,467 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: SPECIAL EVENTS ACTIVITIES; 2006: 0.; 2007: 17138.; 2008: 46795.; 2009: 11798.; DESCRIPTION: TRAINING; 2006: 0.; 2007: 13124.; 2008: 6420.; 2009: 0.; DESCRIPTION: REIMBURSED EXPENSES; 2006: 0.; 2007: 3898.; 2008: 4183.; 2009: 1243.; DESCRIPTION: MISC PROGRAM INCOME; 2006: 0.; 2007: 0.; 2008: 72.; 2009: 0.; DESCRIPTION: SIBLING PROGRAM REVENEU; 2006: 0.; 2007: 0.; 2008: 18257.; 2009: 22484.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-C, Line 19 | NOTIFICATION PROVIDED FOR ACCESS TO FINANCIALS AND CONFLICT | |
| OF INTEREST POLICY LOCATED ON WEBSITE. REVIEW UPON REQUEST. | ||
| Pt VI-A, Line 2 | DIRECTORS DEB GAUSTAD AND JEAN BARUCH ARE SIBLINGS. | |
| Pt VI-A, Line 6 | MEMBERS ARE LOCAL HOSPITALS THAT HAVE LIMITED MEMBERSHIP | |
| ROLES AND FOLLOW BEADS OF COURAGE GUIDLINES. | ||
| Pt VI-B, Line 10b | MEMBER HOSPITALS ARE PROVIDED A POLICIES AND PROCEDURES | |
| DOCUMENT FOR NONPROFIT ACTIVITIES AND ARE REQUIRED TO | ||
| FOLLOW THESE PROCEDURES FOR MEMBERSHIP. | ||
| Pt VI-B, Line 11a | ALL BOARD MEMBERS ARE PROVIDED AN ADVANCE COPY OF THE | |
| ANNUAL 990. GERMANE ISSUES ARE DISCUSSED IN OPEN FORUM | ||
| VIA EMAIL AND CLOSED FORUM BY DIRECTORS MEETINGS. | ||
| Pt VI-B, Line 12c | ONGOING AND ANNUAL REVIEW IS CONDUCTED TO ENSURE COMPLIANCE. | |
| Pt VI-B, Line 15 | COMPENSATION MODIFICATIONS ARE RECOMMENDED AND PUT ON AGENDA | |
| FOR PERIODIC BOARD OF DIRECTORS MEETING FOR APPROVAL. | ||
| Form 990, Part III, Line 4d | COMPASSION AND COURAGE BEREAVEMENT PROGRAM. SUPPORT AT THE END OF 37914. 0. 62740. | |
| Form 990, Part IX, Line 24f | EVENT EXPENSES DUES AND SUBSCRIPTIONS TELEPHONE EXPENSE FEES AND COMMISSIONS |
| Software ID: | 10000104 |
| Software Version: |