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.") .... | 102,249 | 81,600 | 97,050 | 68,136 | 61,029 | 410,064 |
| 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.. | 102,249 | 81,600 | 97,050 | 68,136 | 61,029 | 410,064 |
| 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. | 410,064 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 102,249 | 81,600 | 97,050 | 68,136 | 61,029 | 410,064 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 7,003 | 6,445 | 5,952 | 1,072 | 797 | 21,269 |
| 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.. | 8,099 | 5,910 | 21,377 | 10,565 | 45,951 | |
| 11 | Total support (Add lines 7 through 10). | 477,284 | |||||






| 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: MISCELLANEOUS INCOME; 2006: 0.; 2007: 8099.; 2008: 5910.; 2009: 21377.; 2010: 10565.; |
| Explanation |
|---|
| Software ID: | 10000104 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI-B, Line 11a | The Form 990 is reviewed annually with the Board of Directors | |
| by the outside CPA. | ||
| Pt VI-B, Line 12c | All policies are reviewed annually as well as discussed | |
| at regular scheduled board meetings. | ||
| Pt VI-B, Line 15 | All compensated employees performance is reviewed annually | |
| by the Board of Directors. Pay increases are based upon | ||
| the result of these reviews. | ||
| Pt VI-C, Line 19 | All policies, procedures, tax returns and financial statements | |
| are available to the public upon request and are maintained | ||
| at the Organizations offices. | ||
| Pt XI | Line 5, Other changes to net assets: Correction of error | |
| in prior years - understatement of long-term debt. | ||
| Form 990EZ, Part I, Line 8 | VENDING MISCELLANEOUS | |
| Form 990EZ, Part I, Line 16 | FUEL & OIL PUBLIC RELATIONS INSURANCE DUES & SUBSCRIPTIONS MISCELLANEOUS AUDIT ADVERTISING MEDICAL SERVICES GROCERIES VENDING OUTSIDE TRUCKING COST OF SALES | |
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE - NET GRANTS RECEIVABLE - NET INVENTORIES PREPAIDS | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES BONDS, MORTGAGES & OTHER NOTES ACCRUED SALARIES OTHER ACCRUED EXPENSES | |
| Form 990, Part IX, Line 24f | MEDICAL SERVICES 2584. 2352. 232. 0. VENDING 7226. 6576. 650. 0. COST OF SALES 109773. 109773. 0. 0. TRAINING 59. 54. 5. 0. OTHER TAXES 588. 588. 0. 0. SUPPLIES 13993. 12734. 1259. 0. REPAIRS & MAINTENANCE 17343. 15782. 1561. 0. TELEPHONE & UTILITIES 35741. 32524. 3217. 0. EQUIPMENT LEASE 2421. 2203. 218. 0. BANK CHARGES 1172. 0. 1172. 0. |
| Software ID: | 10000104 |
| Software Version: |