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.") .... | 251,997 | 282,592 | 252,960 | 261,661 | 232,067 | 1,281,277 |
| 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.. | 18,000 | 18,000 | 18,000 | 18,000 | 18,000 | 90,000 |
| 4 | Total. Add lines 1 through 3.. | 269,997 | 300,592 | 270,960 | 279,661 | 250,067 | 1,371,277 |
| 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. | 1,371,277 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 269,997 | 300,592 | 270,960 | 279,661 | 250,067 | 1,371,277 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 317 | 301 | 80 | 43 | 41 | 782 |
| 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.. | 1,200 | 9,711 | 176 | 340 | 969 | 12,396 |
| 11 | Total support (Add lines 7 through 10). | 1,384,455 | |||||






| 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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: MISCELLANEOUS; 2006: 1200.; 2007: 9711.; 2008: 176.; 2009: 340.; 2010: 969.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | The 990 is prepared by the auditor and reviewed by the | |
| coordinator. Its is then copied and mailed | ||
| Pt VI-C, Line 19 | All forms are available for public inspection upon request | |
| Pt XII, Line 2c | There is NO change on the oversight or selection process | |
| Pt VI-A, Line 8b | There is no committees. This is a small organization | |
| with a small board of directors | ||
| Pt VI-A, Line 2 | The county coordinator is related to a board of director | |
| Form 990EZ, Part I, Line 8 | MISCELLANEOUS 4103. | |
| Form 990EZ, Part I, Line 16 | MISCELLANEOUS TRAVEL INSURANCE SUPPLIES FOOD FRINGE BENEFITS | |
| Form 990EZ, Part II, Line 24 | GRANT & CONTRACT RECEIVABLES 10020. 9085. OTHER RECEIVABLES 300. 300. PREPAID INSURANCE 6276. 6276. | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & OTHER ACCRUALS 10104. 9812. 3 | |
| Form 990, Part III, Line 4d | IN-HOME SERVICES 3823. 0. 0. | |
| Form 990, Part VI, Line 9 | DOWL GODWIN PO BOX 683 SALEM AR 72576 CARROLL BENTON PO 397 SALEM AR 72576 CHARLES WILLETT PO BOX 278 SALEM AR 72576 JERRY HUMPHRY 243 FAIRVIEW ROAD MAMMOTH SPRINGS AR 72554 VRIGINIA MARTIN 286 MUSTAGE TRAIL SALEM AR 72576 |
| Software ID: | 10000104 |
| Software Version: |