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.") .... | ||||||
| 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.") . | 28,365 | 59,927 | 36,769 | 18,994 | 27,309 | 171,364 |
| 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...... | 784,201 | 807,088 | 821,694 | 744,215 | 700,694 | 3,857,892 |
| 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. | 812,566 | 867,015 | 858,463 | 763,209 | 728,003 | 4,029,256 |
| 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. | 17,500 | 9,000 | 4,446 | 595 | 12,978 | 44,519 |
| c | Add lines 7a and 7b.. | 17,500 | 9,000 | 4,446 | 595 | 12,978 | 44,519 |
| 8 | Public Support (Subtract line 7c from line 6.) | 3,984,737 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 812,566 | 867,015 | 858,463 | 763,209 | 728,003 | 4,029,256 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 13,136 | 12,610 | 8,247 | 4,502 | 728 | 39,223 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 13,136 | 12,610 | 8,247 | 4,502 | 728 | 39,223 |
| 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.) | 750 | 2,186 | 98 | 1,965 | 1,921 | 6,920 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 4,075,399 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: REBATES & VENDING; 2006: 750.; 2007: 2186.; 2008: 98.; 2009: 1965.; 2010: 1921.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | Form 990 reviewed by Chairman of the Board and by | |
| Treasurer. Sent to entire Board for inspection and information. | ||
| Pt VI-A, Line 3 | A management company was employed to replace the | |
| Oragnization's previous administrator. | ||
| Pt VI-C, Line 19 | Review of documentation is available upon request. | |
| Form 990, Part IX, Line 24f | DIETARY 56727. 56727. 0. 0. LAUNDRY 8244. 8244. 0. 0. LAWN CARE 3300. 3300. 0. 0. MEDICAL SUPPLIES 5989. 5989. 0. 0. KITCHEN/LAUNDRY/HOUSEHOLD SUPPLIES 6949. 6949. 0. 0. REPAIRS & MAINTENANCE 3755. 3755. 0. 0. SECURITY & INSPECTIONS 2800. 2800. 0. 0. TELEPHONE 4572. 0. 4572. 0. TAXES & LICENSES 410. 0. 410. 0. TELEVISION 6235. 6235. 0. 0. UTILITIES 62677. 61110. 1567. 0. PENALTIES 5186. 0. 5186. 0. MISCELLANEOUS 321. 0. 321. 0. |
| Software ID: | 10000104 |
| Software Version: |