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.") .... | 240,033 | 377,610 | 507,876 | 501,199 | 473,318 | 2,100,036 |
| 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.. | 240,033 | 377,610 | 507,876 | 501,199 | 473,318 | 2,100,036 |
| 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. | 2,100,036 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 240,033 | 377,610 | 507,876 | 501,199 | 473,318 | 2,100,036 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 660 | 1,228 | 1,346 | 1,765 | 1,628 | 6,627 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | -956 | -956 | ||||
| 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). | 2,105,707 | |||||






| 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.) | ||||||
| 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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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Members or stockholder classes and rights (Part VI, line 6) | ORGANIZATION HAS 8 MEMBERS WHO ARE ALSO THE BOARD OF DIRECTORS | |
| 02. Member election for additional members (Part VI, line 7a) | BOARD OF DIRECTORS WHO ARE ALSO THE MEMBERS ARE NOMINATED AND VOTED TO THE BOARD BY THE OTHER BOARD OF DIRECTORS | |
| 03. Governing body decisions (Part VI, line 7b) | SECRETARY OF THE BOARD OF DIRECTORS RECORDS MONTHLY MEETING MINUTES | |
| 04. Governing body meeting documentation (Part VI, line 8a) | MINUTES OF MONTHLY MEETING | |
| 05. Form 990 governing body review (Part VI, line 11) | COPIES OF FORM 990 PROVIDED UPON REQUEST TO PRINCIPLE OFFICERS TO REVIEW AT MONTHLY MEETING | |
| 06. Officer, director, etc mailing address (Part VI, line 9) | PAT SCHWARTZ LARRY BRIGGEMAN 1020 W 9TH 50441 NORTH 281 STATE HIWAY PRATT KS 67124 IUKA KS 67066 DOROTHY FURGASON RON SIBLEY 416 HOWARD 1332 E 5TH ST PRATT KS 67124 PRATT KS 67124 CL MEIGS VICKIE DAVIS 20400 SE GRANDVIEW 1506 RIVERVIEW PRATT KS 67124 PRATT KS 67124 SHIRLEY LAWTON 507 WELTON PRATT KS 67124 CARTER BARKER 118 SE 25TH AVE PRATT KS 67124 | |
| 07. Conflict of interest policy compliance (Part VI, line 12c) | POLICY IS REVIEWED RANDOMLY AT MONTHLY BOARD MEETINGS | |
| 08. CEO, executive director, top management comp (Part VI, line 15a) | OTHER GROUP HOMES IN SURROUNDING TOWNS WERE CONTACTED COLA RAISES ARE COMPARABLE TO THE STATE OF KANSAS POLICY | |
| 09. Other officer or key employee compensation (Part VI, line 15b | SAME AS 15A | |
| 10. Governing documents, etc, available to public (Part VI, line 19) | GOVERNING DOCUMENTS ARE PUBLIC RECORD THOUGH THE STATE OF KANSAS CONFLICT OF INTEREST POLICY OTHER BYLAWS AND FINANCIAL STATEMENTS AVAILABLE UPON REQUEST | |
| 11. Explanation of other changes in net assets or fund balances (Part XI, line 5) | NON-CASH CONTRIBUTIONS RECEIVED DURING 2010 WERE 1467 |
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