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.") .... | 32,027 | 25,045 | 17,555 | 44,330 | 35,672 | 154,629 |
| 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.. | 32,027 | 25,045 | 17,555 | 44,330 | 35,672 | 154,629 |
| 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. | 154,629 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 32,027 | 25,045 | 17,555 | 44,330 | 35,672 | 154,629 |
| 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). | 154,629 | |||||






| 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 |
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| Explanation |
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| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990-EZ, Part I, Line 16, Other Expenses Meals and entertainment 243 Form 990-EZ, Part I, Line 16, Other Expenses Equipment rental and maintenance 1,670 Form 990-EZ, Part I, Line 16, Other Expenses Supplies 3,357 Form 990-EZ, Part I, Line 16, Other Expenses Telephone 2,121 Form 990-EZ, Part I, Line 16, Other Expenses PRINTING 197 Form 990-EZ, Part I, Line 16, Other Expenses SIGNAGE 105 Form 990-EZ, Part I, Line 16, Other Expenses RENOVATIONS 292 Form 990-EZ, Part I, Line 16, Other Expenses WEBSITE MAINT 1,730 Form 990-EZ, Part I, Line 16, Other Expenses OFFICE EXPENSES 1,494 Form 990-EZ, Part I, Line 16, Other Expenses LANDSCAPING 69 Form 990-EZ, Part I, Line 16, Other Expenses INSURANCE-NONEMPLOYEE 1,218 Form 990-EZ, Part I, Line 16, Other Expenses PERMITS AND LICENSE 471 Form 990-EZ, Part I, Line 16, Other Expenses SERVICE CHARGES 1,279 Form 990-EZ, Part I, Line 16, Other Expenses SALES TAX 4 Form 990-EZ, Part I, Line 16, Other Expenses ORGANIZATIONAL EXPENSES 205 Form 990-EZ, Part I, Line 16, Other Expenses OTHER BUSINESS EXPENSES 165 Form 990-EZ, Part I, Line 16, Other Expenses Professional Fees 35 Form 990-EZ, Part I, Line 16, Other Expenses Food and Beverage 604 Form 990-EZ, Part II, Line 24, Other Assets DEPOSITS Beginning of year 1,480, End of year 1,480 Form 990-EZ, Part II, Line 24, Other Assets AIR CONDITIONING SYSTEM Beginning of year 2,755, End of year 2,755 Form 990-EZ, Part II, Line 24, Other Assets INVENTORY Beginning of year 6,036, End of year 5,823 Form 990-EZ, Part II, Line 24, Other Assets Renovations Beginning of year 13,450, End of year 16,204 Form 990-EZ, Part II, Line 24, Other Assets FURNITURE, FIXTURES, EQUIPMENT Beginning of year 7,170, End of year 7,350 Form 990-EZ, Part II, Line 26, Liabilities Loans from Officers Beginning of year 9,499, End of year 8,030 Form 990-EZ, Part II, Line 26, Liabilities Gift Certificates Issued Beginning of year 240, End of year 240 Form 990-EZ, Part II, Line 26, Liabilities SALES TAX Beginning of year 2, End of year 5 |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |