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.") .... | 169,478 | 316,144 | 485,622 | |||
| 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.. | 169,478 | 316,144 | 485,622 | |||
| 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. | 485,622 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 169,478 | 316,144 | 485,622 | |||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 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). | 485,622 | |||||






| 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.) | ||||||
| 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 |
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| Unusual grants Part II or Part III line 1 THE EXPANSION IS FUNDED WITH GRANT FUNDS NOT PREVIOUSLY AVAILABLE |
| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Members or stockholder classes and rights (Part VI, line 6) | MEMBERSHIP IS AVAILABLE TO DOMESTIC VIOLENCE AND SEXUAL ASSAULT ORGANIZATIONS WHICH ARE ORGANIZED PRIMARILY FOR THE PURPOSE OF SERVING TRIBAL COMMUNITIES IN NORTH DAKOTA FOR PURPOSES OF THIS CORPORATION A MEMBER SHALL BE DEFINED AS ANY ORGANIZATION WHICH MEETS THE MINIMUM REQUIREMENTS FOR MEMBERSHIP SET FORTH BY THE CORPORATION AND WHOSE PRIMARY PURPOSE IS TO PROVIDE ALL OF THE FOLLOWING SERVICES TO VICTIMS OF DOMESTIC VIOLENCE ANDOR SEXUAL ASSAULT ADVOCACY PREVENTION EDUCATION INFORMATION REFERRAL SHELTER AND SOCIAL CHANGE WORK AS OUTLINED IN THE MISSION STATEMENT | |
| 02. Member election for additional members (Part VI, line 7a) | EACH MEMBER SHALL BE ENTITLED TO ONE VOTE ON EACH MATTER SUBMITTED TO A VOTE VOTING BY PROXY SHALL BE ALLOWED MEMBERS SHALL ELECT ALL MEMBERS OF THE BOARD OF DIRECTORS | |
| 03. Form 990 governing body review (Part VI, line 11) | TAX RETURN IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS PRIOR TO FILING AT A BOARD OF DIRECTORS REGULAR MEETING | |
| 04. Conflict of interest policy compliance (Part VI, line 12c) | THE BOARD AND EMPLOYEES ARE REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE QUESTIONAIRE AT LEAST ANNUALLY | |
| 05. CEO, executive director, top management comp (Part VI, line 15a) | THE DIRECTORCHIEF OPERATING OFFICERS SALARY WAS DETERMINED BY THE BOARD AFTER REVIEWING WHAT SIMILAR POSITIONS IN THE GENERAL AREA WERE BEING PAID | |
| 06. Other officer or key employee compensation (Part VI, line 15b | THERE ARE NO OTHER EXECUTIVE OFFICERS OR KEY PERSONS EMPLOYED THERE ARE ONLY 6 EMPLOYEES AND THE OTHER 5 ARE NOT MANAGEMENT LEVEL EMPLOYEES | |
| 07. Governing documents, etc, available to public (Part VI, line 19) | GOVERNING DOCUMENTS CONFLICT OF INTEREST STATEMENTS MINUTES AND FINANCIAL RECORDS ARE AVAILABLE FOR REVIEW BY THE PUBLIC DURING NORMAL BUSINESS HOURS AT THE ENTITIES BUSINESS OFFICES | |
| 08. Explanation of other changes in net assets or fund balances (Part XI, line 5) | ROUNDING |
| Software ID: | |
| Software Version: |