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.") .... | 1,515 | 74,574 | 20,974 | 19,188 | 274,519 | 390,770 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 25,209 | 25,209 | ||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | 1,515 | 74,574 | 20,974 | 19,188 | 299,728 | 415,979 |
| 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. | 415,979 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,515 | 74,574 | 20,974 | 19,188 | 299,728 | 415,979 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 4,092 | 560 | 1,358 | 3,154 | 9,164 | |
| 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.. | 6,765 | -3 | -2 | 15,441 | 55 | 22,256 |
| 11 | Total support (Add lines 7 through 10). | 447,399 | |||||






| 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.) | 0 | |||||
| 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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: OTHER INCOME; 2006: 6765.; 2007: -3.; 2008: -2.; 2009: 15441.; 2010: 55.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | FORM 990 IS REVIEWED BY BOARD MEMBER AT REGULAR BOARD MEETING | |
| BEFORE FILING. | ||
| Pt VI-B, Line 12c | CONFLICT OF INTEREST POLICIES ARE INCLUDED IN THE AGENCY'S | |
| EMPLOYEE POLICIES REQUIRING IMMEDIATE AND FULL DISCLOSURE. | ||
| Pt VI-B, Line 15 | THE BOARD PERFORMS AN EVALUATION OF THE PERFORMANCE OF THE OFFICERS | |
| ANNUALLY. THE BOARD SETS COMPENSATION BASED ON AN INFORMAL ANALYSIS | ||
| OF AREA WAGES AND THROUGH DELIBERATION WITH FELLOW BOARD MEMBERS. | ||
| Pt VI-C, Line 19 | THE AGENCY'S GOVERNING DOCUMENTS, POLICIES AND FINANCIALS ARE AVAILABLE | |
| UPON REQUEST. THE AGENCY'S FORM 990 TAX RETURN IS AVAILABLE AT GUIDESTAR.ORG. | ||
| Pt XI | LINE5: ON OCTOBER 9,2009, THE AGENCY ASSUMED OWNERSHIP OF TREASURE MANOR. | |
| TREASURE MANOR' ASSET AND LIABILITY WAS NOT INCLUDED IN ORIGINAL | ||
| 2009 990 FORM. THESE CHANGES INCLUDE AN INCREASE OF CASH $12,112, INCREASE OF | ||
| INVESTMENT OF $593,565, INCREASE OF RESERVED CASH $72,129, | ||
| INCREASE OF NET FIXED ASSETS $650,596, INCREASE OF AP $270, | ||
| INCREASE OF TENANT DEPOSIT $7,752, INCREASE OF LT DEBT $1,359,992, | ||
| ALL OF THE ABOVE CHANGES RESULT IN A DECREASE OF NET ASSET OF 39,612. | ||
| Pt XII, Line 3b | THE AGENCY HAD AN A-133 AUDIT, BUT THE AUDIT WAS CONDUCTED | |
| FOR A PERIOD DIFFERENT FROM THE FORM 990 TAX RETURN PERIOD |
| Software ID: | 10000104 |
| Software Version: |