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.") . | 44,672 | 39,081 | 57,192 | 71,747 | 67,340 | 280,032 |
| 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. | 44,672 | 39,081 | 57,192 | 71,747 | 67,340 | 280,032 |
| 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.) | 280,032 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 44,672 | 39,081 | 57,192 | 71,747 | 67,340 | 280,032 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 347 | 511 | 2,413 | 1,495 | 4,766 | |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 347 | 511 | 2,413 | 1,495 | 4,766 | |
| 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.). | 284,798 | |||||




| 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 | THE ORGANIZATION HAS MEMBERS | |
| Pt VI-A, Line 7a | THE ORGANIZATION HAS MEMBERS THAT ELECTS | |
| Pt VI-A, Line 7b | DECISIONS ARE APPROVED BY BOARD OF MEMBERS | |
| Pt VI-B, Line 11a | THE ORGANIZATION HAS PROVIDED A COPY OF FORM 990 TO MEMBERS | |
| Form 990EZ, Part I, Line 16 | BOOTH PROMOTION EXPENSES FOOD EXPENSE CASH BASH EXPENSES OTHER FUNDRAISING EXP VETERINARY CARE-PROGRAM KENNEL SUPPLIES MICRO CHIPS/MEDICINES PET ADOPTIONS ADVERTISING BANK CHARGES EMPLOYEE BENEFITS INSURANCE INTEREST RENT REPAIRS SUPPLIES TAXES-REAL ESTATE TAXES-PAYROLL CASUAL HELP SECURITY & SAFETY EMPLOYEE TRAVEL & ALLOWANCE MISCELLANEOUS & PETTY CASH TIRES FUEL & OIL TOLLS LICENSES, PERMITS CUSTOMER RELATIONS SPAY/NEUTER REFUNDS PET ADOPTION REFUNDS | |
| Form 990EZ, Part II, Line 24 | EQUIPMENT LESS ACC. DEPR. 4017. OFFICE EQUIPMENT LESS ACC. DEPR. 46. VEHICLES LESS ACC. DEPR. 0. AMORITZATION COSTS LESS ACC. AMORT. 1432. | |
| Form 990EZ, Part II, Line 26 | MORTGAGE PAYABLE-ST 2226. ACCRUED PAYROLL TAXES 555. MORTGAGE PAYABLE-LT 42377. | |
| Form 990, Part IX, Line 24f | KENNEL SUPPLIES 6036. 6036. 0. 0. OBEDIENCE TRAINING 390. 390. 0. 0. PET ADOPTION 921. 921. 0. 0. BANK CHARGES 662. 221. 220. 221. DUES & SUBSCRIPTIONS 119. 119. 0. 0. EMPLOYEE BENEFITS 475. 0. 475. 0. REPAIRS 8167. 8167. 0. 0. SUPPLIES 12. 0. 12. 0. CASUAL HELP 302. 151. 151. 0. EMPLOYEE MEDICAL BILLS 60. 30. 30. 0. TIRES 340. 340. 0. 0. FUEL & OIL 400. 400. 0. 0. TOLLS 124. 124. 0. 0. LICENSES, PERMITS 478. 478. 0. 0. CUSTOMER RELATIONS 50. 25. 25. 0. VOLUNTEER APPRECIATION GIFTS 25. 12. 13. 0 |
| Software ID: | 10000104 |
| Software Version: |