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.") . | 1,729 | 10,751 | 3,091 | 8,966 | 4,705 | 29,242 |
| 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...... | 428,410 | 409,057 | 372,883 | 389,124 | 382,452 | 1,981,926 |
| 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. | 430,139 | 419,808 | 375,974 | 398,090 | 387,157 | 2,011,168 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 6,194 | 7,872 | 4,285 | 6,546 | 5,365 | 30,262 |
| 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. | 2,825 | 6,325 | 9,150 | |||
| c | Add lines 7a and 7b.. | 9,019 | 7,872 | 10,610 | 6,546 | 5,365 | 39,412 |
| 8 | Public Support (Subtract line 7c from line 6.) | 1,971,756 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 430,139 | 419,808 | 375,974 | 398,090 | 387,157 | 2,011,168 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 5 | 5 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 5 | 5 | ||||
| 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.) | 100 | 100 | ||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 2,011,273 | |||||




| Facts And Circumstances Test |
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| HONORARIA FOR COMPLETING SURVEY; OTHER INCOME PART III, LINE 12; DESCRIPTION: HONORARIA; 2010: 100.; |
| 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 Form 990 is distributed to each member at a | |
| regular meeting of the board of directors. Important | ||
| aspects of the return are discussed and members | ||
| given an opportunity to ask questions. The Form 990 | ||
| is also emailed to all board members. | ||
| Pt VI, Line 12c | The executive director and the treasurer annually | |
| review the conflict of interest statements. At the time | ||
| the Form 990 is discussed by the board, the conflict | ||
| of interest policy is also discussed. Board members | ||
| are encouraged to contact the Board Chair or the | ||
| executive director about any potential conflicts of | ||
| interest. Board Members and officers have a duty to disclose | ||
| any potential conflict. The person may make a presentation | ||
| to the board but must leave the meeting during the | ||
| discussion of and vote on the transaction in question. | ||
| Pt VI, Line 19 | Copies of the organizations governing documents, financial | |
| statements and conflict of interest policy are available | ||
| upon request from the executive director by contacting | ||
| the store. | ||
| Pt VI, Line 15 | Members of the executive committee of the board obtained | |
| information about comparable compensation arrangements | ||
| from Form 990 filed by similar organizations. | ||
| The entire board discusses and approves the compensation | ||
| of the executive director in conjunction with the approval | ||
| of the budget. The board meeting minutes reflect this | ||
| this process. | ||
| Form 990, Part IX, Line 24f | TELEPHONE | |
| Pt VI, Line 2 | Bruce Pitner and Jessica Pitner-family relationship |
| Software ID: | 11000175 |
| Software Version: |