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.") . | 41,902 | 84,230 | 57,494 | 32,299 | 9,283 | 225,208 |
| 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...... | 198,942 | 162,838 | 157,070 | 149,003 | 182,962 | 850,815 |
| 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. | 240,844 | 247,068 | 214,564 | 181,302 | 192,245 | 1,076,023 |
| 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.) | 1,076,023 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 240,844 | 247,068 | 214,564 | 181,302 | 192,245 | 1,076,023 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 6,409 | 13,856 | 12,233 | 11,443 | 6,039 | 49,980 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 6,409 | 13,856 | 12,233 | 11,443 | 6,039 | 49,980 |
| 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.). | 1,126,003 | |||||




| 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 6 | MANAGEMENT POSITIONS ARE NOT PAID POSITIONS | |
| Pt VI-B, Line 11a | BOARD MEMBERS DO NOT REVIEW BEFORE FILING; COPY OF FORM 990 IS AVAILABLE | |
| FOR REVIEW AT THE AMBULANCE BUILDING AT THEIR CONVENIENCE | ||
| Pt VI-C, Line 19 | INFORMATION IS MADE AVAILABLE TO THE PUBLIC AT THE AMBULANCE | |
| BUILDING OFFICE UPON REQUEST | ||
| Pt VI-A, Line 7a | VOLUNTEER BOARD MEMBERS ARE ELECTED TO THE BOARD BY OTHER BOARD | |
| MEMBERS | ||
| Pt VI-A, Line 7b | BOARD MEMBERS VOTE ON MAJOR DECISIONS OF THE ORGANIZATION | |
| Pt VI-A, Line 2 | DIRECTORS JOSEPH AND THERESA D'ANDREA ARE HUSBAND AND WIFE | |
| Pt VI-A, Line 2 | SECRETARY CYNTHIA MEHALKO AND EMPLOYEE STEVEN MEHALKO ARE HUSBAND AND WIFE | |
| VII-A, Line 1d | THIS FIGURE (7,293) IS INCLUDED IN THE TOTAL REPORTED IN | |
| PART IX, Line 7-A AND B - OTHER SALARIES AND WAGES FOR PROGRAM SERVICE | ||
| EXPENSES (76,967) SINCE BOTH DIRECTORS ARE PAID AS | ||
| AMBULANCE DRIVERS/EMTS/PARAMEDICS NOT AS DIRECTORS | ||
| Form 990EZ, Part I, Line 8 | SALE OF BOOKS PREVIOUSLY USED FOR TRAINING RENTAL OF AMBULANCE | |
| Form 990EZ, Part I, Line 16 | AMBULANCE REPAIRS AMBULANCE/MEDICAL SUPPLIES FUEL FOR AMBULANCES PA CHARITABLE REGISTRATION FEE DUES & MEMBERSHIPS MISCELLANEOUS | |
| Form 990EZ, Part II, Line 26 | PAYROLL TAXES 642. | |
| Form 990, Part IX, Line 24f | AMBULANCE EXPENSES 6764. 6764. 0. 0. TOLLS 210. 210. 0. 0. AMBULANCE SUPPLIES 3914. 3914. 0. 0. FUEL 6281. 6281. 0. 0. |
| Software ID: | 10000104 |
| Software Version: |