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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 257,830 | 286,225 | 322,013 | 328,590 | 325,963 | 1,520,621 |
| 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. | 257,830 | 286,225 | 322,013 | 328,590 | 325,963 | 1,520,621 |
| 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.) | 1,520,621 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 257,830 | 286,225 | 322,013 | 328,590 | 325,963 | 1,520,621 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,015 | -6,279 | 4,976 | 2,673 | 328 | 3,713 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,015 | -6,279 | 4,976 | 2,673 | 328 | 3,713 |
| 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.). | 1,524,334 | |||||




| Facts And Circumstances Test |
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| OTHER ADDL INFO: NO ADDITIONAL INFORMATION; |
| Explanation |
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| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The Board reviews the Financial Information. The Financial | |
| Pt VI, Line 11a | Information becomes the source document for the Returns. | |
| Pt VI, Line 19 | All information is reviewed, approved and available upon request. | |
| Pt VI, Line 19 | Each Board Member reviews the Final Copy of the Form 990. | |
| Pt VI, Line 8a | Minutes are recorded at each meeting. Action items are undertaken. | |
| Pt VI, Line 8b | Each committee performs under the guidance and approval of the Board. | |
| Form 990, Part III, Line 4d | CHARITABLE CHECK-OFF DONATIONS 11077. 0. 0. | |
| Form 990, Part IX, Line 24f | OHSA REGION X MEMBERSHIP 6486. 6486. OHSA/REG X EXE BOARD SUPPORT 17225. 17225. MEETING & TRAINING EXPENSES 100082. 100082. SUPPORT SERVICES 85969. 85969. IT RELATED EXPENSES 447. 447. CHARITABLE CHECK OFF EXPENSES 11077. 11077. STATE FEES 173. 173. PRINTING 4400. 4400. INSURANCE 1768. 1768. PRODUCT LINE 2860. 2860. GRANTS, SCHOLARSHIPS & AWARDS 6000. 6000. RENT & UTILITIES 4590. 4590. DONATIONS TO SUPPORTIVE AGENCIES 1300. 1300. BANK CHARGES 1210. 1210. OTHER 57. 57. ROUNDING -7. -7. |
| Software ID: | 11000175 |
| Software Version: |