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.") .... | 9,519 | 9,521 | 19,040 | |||
| 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.. | 9,519 | 9,521 | 19,040 | |||
| 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. | 19,040 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 9,519 | 9,521 | 19,040 | |||
| 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). | 19,040 | |||||






| 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 VI-A, Line 8a | OFFICERS HOLD MEETINGS CONCERNING OPERATING DECISIONS | |
| Pt VI-B, Line 11a | TAX RETURN REVIEWED & DISCUSSED WITH OFFICERS | |
| Form 990EZ, Part I, Line 8 | BANK OF OAK RIDGE INTEREST INCOME 37. | |
| Form 990EZ, Part I, Line 16 | ADVERTISING 1370. BANK SERVICE CHGS 2000. CONTINUING EDUC 0. DUES 95. FOOD PROGRAM 9521. FOOD SUPPLIES 389. INSPECTIONS 50. BUSINESS INSURANCE & WORKMANS COMP 3922. LICENSES 523. MISC SUPPLIES & TOYS 54479. OFFICE SUPPLIES 47. PAYROLL TAXES 12714. PROFESSIONAL SERVICES 1782. RECREATIONAL EXP 21413. SECURITY PROPERTY TAXES 5292. AUTO EXPENSES (FUEL, MAINTENANCE, INS, TAGS) 20891. GIFTS 46. MEALS & ENTERTAINMENT (50%) 44. TRASH PICKUP 594. | |
| Form 990EZ, Part II, Line 24 | ASSETS LESS DEPRECIATION 38136. 28391. | |
| Form 990EZ, Part II, Line 26 | 08 KIA SPORTAGE 10200. 200. KUBOTA MOWER 14599. 599. 941 MATCH 1464. 2083. STATE W/H 525. 501. NCUI 62. 0. CC PAYMENT 6441. 2161. LOAN PAYMENT 3826. 6395. | |
| Form 990, Part IX, Line 24f | FOOD SUPPLIES 9910. 9910. 0. 0. MATERIALS/SUPPLIES/TOYS 54479. 54479. RECREATIONAL EXP 21413. 21413. 0. 0. PROPERTY TAXES 5292. 5292. 0. 0. UTILITIES 9837. 9837. 0. 0. BUILDING RENT 24000. 24000. 0. 0. PLAYGROUND MAINT 5197. 5197. 0. 0. CONTINUING EDUC 0. EQUIPMENT RENTAL 12000. 12000. EQUIPMENT REPAIRS INSPECTIONS 50. 50. MEETING EXP 88. 88. 0. GIFTS & FLOWERS 46. 46. 0. 0. DUES 95. 95. 0. 0. PAYROLL TAXES 8730. 8730. 0. 0. |
| Software ID: | 10000104 |
| Software Version: |