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) 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. | ||||||
| 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.. | ||||||
| 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.") . | ||||||
| 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) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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 |
|---|
| Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | THE GOVERNING BODY REVIEWS THE AUDIT REPORT AND FORM 990 BEFORE SUBMISSION TO THE IRS | |
| 02. Governing documents, etc, available to public (Part VI, line 19) | THE ORGANIZATION MAINTAINS A WEB SITE WITH INFORMATION AVAILABLE TO GENERAL PUBLIC ALSO THE FORM 990 AND AUDIT REPORT ARE AVAILABLE UPON REQUEST FROM ANY INDIVIDUAL BY MAIL EMAIL OR AT THE OFFICE | |
| 03. General explanation attachment | X-1 PHOENIX YOUTH CENTER CONTINUED STUDENTS WERE ABLE TO WORK ON THEIR HOMEWORK IN A QUIET AND SUPPORTIVE ENVIRONMENT IMMEDIATELY AFTER LEAVING SCHOOL STAFF AND VOLUNTEERS PROVIDED SUPPORT WHEN STUDENTS HAD QUESTIONS OR NEEDED EXTRA AID ALSO DURING THE SCHOOL YEAR TWO RECREATIONAL PERIODS WERE HELD MONDAY THROUGH THURSDAY AND ONE ON FRIDAY THE FIRST RECREATIONAL PERIOD WAS FOR MIDDLE SCHOOL STUDENTS ONLY THE SECOND LATER PERIOD COULD BE ATTENDED BY STUDENTS GRADES 4-9 IN ADDITION TO THESE SERVICES THE PHOENIX YOUTH CENTER HOSTED FRIDAY NIGHT FIFTH QUARTER PARTIES AFTER HOME FOOTBALL GAMES THERE WERE ALSO HOLIDAY PARTIES AN ICE CREAM PARTY AND MOVIE NIGHTS THE FACILITIES WERE USED BY THE PALMYRA PUBLIC LIBRARY FOR SOME OF THEIR SUMMER PROGRAMS FOR YOUTH CONT X-2 X-2 -PHOENIX YOUTH CENTER CONTINUED THE PHOENIX YOUTH CENTER ALSO PARTICIPATED IN THE UNITED WAY DAY OF CARING FUNDING FOR THE PHOENIX YOUTH CENTER IS PROVIDED FROM PALMYRA AREA COOPERATING CHURCHES INDIVIDUAL DONATIONS AND UNITED WAY AGENCY FOR LEBANON COUNTY FUNDING FOR THE PHOENIX YOUTH CENTER IS PROVIDED FORM PALMYRA AREA COOPERATING CHURCHES INDIVIDUAL DONATIONS AND THE UNITED WAY AGENCY FOR LEBANON COUNTY X-3 CARING CUPBOARD CONTINUED INCLUDED IN THIS NUMBER ARE NEARLY 600 CHILDREN OUR CLIENTS ARE THE NEAR POOR A NEW TERM THAT INCLUDES THE WORKING POOR THOSE ON DISABILITY THOSE RETIRED AND SINGLE PARENTS OUR CLIENTS RESIDE MOSTLY IN THE HERSHEY TO CLEONA GEOGRAPHICAL AREA BUT WE ALSO SERVE CLIENTS FROM HUMMELSTOWN TO FREDERICKSBURG ESPECIALLY THOSE REFERRED TO US BY NUMEROUS NON-PROFIT OR PUBLIC AGENCIES OUR DOORS ARE OPEN THREE DAYS AND FOUR TIMES A WEEK MONDAY 3-7 WEDNESDAY 10-12 AND 530-730 AND FRIDAY 12-2 WE RECEIVE DONATIONS OF PRODUCT WHEN WE ARE OPEN AND ON MONDAY FROM 9-11 AND WEDNESDAY 9-10 THE PACC CARE MANAGERS RESPONSIBILITIES INCLUDE INTERVIEWING NEW CLIENTS CONTINUED X-4 X-4 CARING CUPBOARD CONTINUED AT THE CARING CUPBOARD FOOD PANTRY AND ENCOURAGING CLIENTS TO UTILIZE OTHER RESOURCES THAT MAY BE AVAILABLE TO THEM OFTEN TIMES LOW INCOME FAMILIES BELIEVE THAT BECAUSE THEY ARE WORKING THEY ARE NOT ELIGIBLE FOR GOVERNMENT FUNDED PROGRAMS MANY FAMILIES ASSISTED HAVE BEEN QUITE SURPRISED TO FIND OUT THEY ARE ELIGIBLE FOR LIHEAP HEATING GRANT AND OTHER GOVERNMENT FUNDED PROGRAMS ANOTHER RESPONSIBILITY OF THE CARE MANAGER IS TO ASSIST THOSE IN THE PALMYRA SCHOOL DISTRICT WHO MAY NEED HELP PAYING THEIR RENT OR UTILITIES ALTHOUGH THE PACC COMMUNITY NEEDS FUND DOES NOT CARRY A HIGH BALANCE WE ARE OFTEN ABLE TO SPLIT THE BILL WITH ANOTHER AGENCY OR CHURCH SUNDAY CLASS ETC CONTINUED X-5 X-5 CARING CUPBOARD CONTINUED AND TWO FAMILIES WITH UTILITIES WE HAVE ALSO HELPED A FAMILY IN A CRISIS SITUATION FOR SEVERAL MONTHS WITH THEIR RENT AND UTILITIES WE HAVE GIVEN OVERNIGHT LODGING AND GROCERIES TO ONE TRANSIENT THIS YEAR AND HAVE PURCHASED A BUS TICKET TO A HOSPITAL AND PROVIDED A MEAL AT A RESTAURANT FOR AN ILL HOMELESS PERSON WE HAVE PROVIDED ONE TIME FOOD ASSISTANCE FOR SEVERAL TRANSIENTS FROM THE CARING CUPBOARD THE CARE MANAGER ALSO OVERSEES THE SPECIAL PROJECTS THAT THE CARING CUPBOARD SPONSORS THESE PROJECTS INCLUDE THANKSGIVING MEALS CHRISTMAS GIFTS AND MEALS EASTER BASKETS AND MEALS AND A SUMMER LUNCH PROGRAM FOR THE SCHOOL AGE CHILDREN OF OUR CLIENTS X-6 PALMYRA COUNSELING CENTER CONTINUED PACC MEMBER CHURCHES INCLUDE BETHANY UNITED METHODIST CAMPBELLTOWN UNITED METHODIST CHURCH OF THE HOLY SPIRIT -ROMAN CATHOLIC FIRST EVANGELICAL CONGREGATIONAL FIRST UNITED METHODIST GRAVEL HILL UNITED METHODIST PALM LUTHERAN PALMYRA CHURCH OF THE BRETHREN SALEM UNITED CHURCH OF CHRIST TRINITY UNITED CHURCH OF CHRIST UNITY CHURCH CONTINUED X-7 X-7 PALMYRA COUNSELING CENTER CONT CLIENT SERVICES ARE PROVIDED BY THERAPISTS AND COUNSELORS EMPLOYED BY COBYS FAMILY SERVICES BASED IN LEOLA PA A SOCIAL SERVICES AGENCY RELATED TO THE CHURCH OF THE BRETHREN THE NUMBER OF CLIENT HOURS IN THE PAST YEAR AREPACC - 1055 COBYS - 108 TOTAL - 2135 THE NUMBER OF CLIENTS SERVED ARE 31 THE CENTERS FISCAL STRUCTURE INCLUDES AN ENDOWMENT FUND WHICH ENABLES SERVICES TO BE RENDERED ON A SLIDING FEE SCALE BASED ON HOUSEHOLD INCOME THE PALMYRA AREA COUNSELING CENTER IS OVERSEEN BY A FIVE-MEMBER BOARD OF DIRECTORS COMPRISED OF MEMBERS OF THE PALMYRA AREA COOPERATING CHURCHES PACC TWO BOARD MEMBERS ARE PASTORS TWO ARE LAITY AND ONE REPRESENTS PALMYRA AREA SCHOOL DISTRICT A COBYS REPRESENTATIVE SERVES AS A LIAISON TO THE BOARD |
| Software ID: | |
| Software Version: |