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.. | ||||||
| 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.") . | 61,525 | 94,664 | 43,968 | 200,157 | ||
| 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. | 61,525 | 94,664 | 43,968 | 200,157 | ||
| 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.) | 200,157 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 61,525 | 94,664 | 43,968 | 200,157 | ||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| 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. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 0 | |||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 61,525 | 94,664 | 43,968 | 200,157 | ||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 10000149 |
| Software Version: | 2010.2.15 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990-EZ, Part I, Line 10, Grants Paid Activity Scholarships, Grantee 11 Students, Cash | ||
| Grant 20,256, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity Student Awards, Grantee 18 Students - | ||
| Eagle Scouts, Cash Grant 5,360, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Elks National Foundation 2750 | ||
| N. Lakeview Ave. Chicago IL 60614, Cash Grant 6,300, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Lima Exchange Club 302 W. | ||
| North St. Lima OH 45801, Cash Grant 5,000, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Lima Symphony Orchestra 133 N. | ||
| Elizabeth St. Lima OH 45802, Cash Grant 5,000, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Ohio Cerebral Palsey Fund 995 | ||
| Goodale Blvd, Suite 2 Columbus OH 43212, Cash Grant 5,000, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Pheasants Forever 1783 Buerkle | ||
| Circle St Paul MN 55110, Cash Grant 8,000, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee W.O.A.L. 3020 Lake Shore Dr. | ||
| Lima OH 45806, Cash Grant 2,000, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee CP Bowling League 721 N. Cable | ||
| Rd. Lima OH 45805, Cash Grant 1,800, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Ohio Elks Association 302 W. | ||
| North St. Lima OH 45801, Cash Grant 915, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Lima Junior Golf Assoc. 525 N. | ||
| Stevick Rd. Lima OH 45807, Cash Grant 700, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Horses for Heroes 33532 | ||
| Bowsher Rd. Cridersville OH 45806, Cash Grant 500, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee DARE Program 333 N. Main St. | ||
| Lima OH 45801, Cash Grant 400, Relationship None | ||
| Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Miscellaneous Charities, Cash | ||
| Grant 2,074, Relationship None | ||
| Form 990-EZ, Part I, Line 16, Other Expenses Supplies 11 | ||
| Form 990-EZ, Part I, Line 16, Other Expenses Advertising 140 | ||
| Form 990-EZ, Part I, Line 16, Other Expenses Bank fees 64 | ||
| Form 990-EZ, Part I, Line 16, Other Expenses Insurance / Bonding 201 | ||
| Form 990-EZ, Part I, Line 16, Other Expenses Ohio Charitable Organization registration 200 |
| Software ID: | 10000149 |
| Software Version: | 2010.2.15 |