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. | ||||||
| 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.") . | 48,725 | 30,591 | 29,773 | 27,483 | 44,464 | 181,036 |
| 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...... | 8,016 | 3,812 | 6,301 | 3,027 | 4,242 | 25,398 |
| 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. | 56,741 | 34,403 | 36,074 | 30,510 | 48,706 | 206,434 |
| 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.) | 206,434 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 56,741 | 34,403 | 36,074 | 30,510 | 48,706 | 206,434 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 2,718 | 3,257 | 971 | 505 | 297 | 7,748 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 2,718 | 3,257 | 971 | 505 | 297 | 7,748 |
| 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.). | 59,459 | 37,660 | 37,045 | 31,015 | 49,003 | 214,182 |




| Facts And Circumstances Test |
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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) | THERE IS ONE CLASS OF MEMBERS THE MEMBERS DO NOT HAVE VOTING RIGHTS | |
| 02. Form 990 governing body review (Part VI, line 11) | BOARD WILL REVIEW AT NEXT BOARD MEETING | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | THE BOARD OF DIRECTORS HIRE EMPLOYEES AND DETERMINE SALARIES FOR SUCH THERE IS NO EXECUTIVE DIRECTOR BOARD MEMBERS DO NOT RECEIVE COMPENSATION | |
| 04. Other officer or key employee compensation (Part VI, line 15b | OFFICERS DO NOT RECEIVE COMPENSATION THERE ARE NO KEY EMPLOYEES NOR IS THERE AN EXECUTIVE DIRECTOR | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | ALL REPORTS AND DOCUMENTS ARE PUBLIC RECORD AND CAN BE VIEWED AT THE HUMANE SOCIETY UPON REQUEST | |
| 06. General explanation attachment | A COPY OF THE 990 IS MADE AVAILABLE TO THE BOARD OF DIRECTORS FOR REVIEW AT THE HUMANE SOCIETY AT THE BOARD MEMBERS CONVENIENCE |
| Software ID: | |
| Software Version: |