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.") .... | 35,856 | 43,268 | 87,715 | 39,345 | 30,407 | 236,591 |
| 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.. | 35,856 | 43,268 | 87,715 | 39,345 | 30,407 | 236,591 |
| 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).. | 10,865 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | 225,726 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 35,856 | 43,268 | 87,715 | 39,345 | 30,407 | 236,591 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 39 | 39 | ||||
| 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.. | 100 | 18,224 | 18,324 | |||
| 11 | Total support (Add lines 7 through 10). | 254,954 | |||||






| 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.) | 0 | |||||
| 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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: FUNDRAISING EVENTS; 2010: 100.; 2011: 18224.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| PART I, LINE 1, ORGANIZATION'S MISSION -SUPPORT AND EDUCATIONAL INSTITUTIONS, | ||
| PROGRAMS, EDUCATION, STAFF AND STUDENTS IN POST-GRAD MEDICAL EDUCATION. | ||
| A)PROVIDE ACCESS TO AT LEAST 4 MEDICAL EDUCATION CONFERENCES ANNUALLY; | ||
| B)PROVIDE ACCESS TO RESEARCH AND NEW TECHNOLOGIES OR PODIATRIC MEDICINE | ||
| INCLUDING WOUND CARE AND DIABETES; C)EXPOSURE TO INDIGENT HEALTH CARE | ||
| AND SURGICAL AND CLINICAL TRAINING IN THESE SURROUNDINGS; D)ENCOURAGE | ||
| PARTICIPATION IN CHARITABLE COMMUNITY OUTREACH CLINICS AND PUBLIC | ||
| HEALTH FAIRS; E)PROVIDE RESOURCES TO COMPLETE POST-GRAD TRAINING | ||
| PROGRAM, I.E. SCHOLARSHIPS FOR MEDICAL RESEARCH PAPERS. | ||
| PART III, LINE 1, ORGANIZATION'S MISSION - SEE ABOVE. | ||
| Pt VI, Line 3 | THE FOUNDATION HIRED KRISTA RICHTER TO PERFORM MANAGEMENT | |
| SERVICES. | ||
| Pt VI, Line 11a | THE FOUNDATION'S EXECUTIVE DIRECTORS REVIEWS THE FORM 990 | |
| WITH ITS CPA AND THE TREASURER. | ||
| Pt VI, Line 15 | THE BOARD REVIEWS AND APPROVES THE CONTRACT WITH KRISTA | |
| RICHTER ANNUALLY. | ||
| Pt VI, Line 19 | THE FOUNDATION'S GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS | |
| ARE AVAILABLE UPON REQUEST. | ||
| Pt XI | PRIOR YEAR REVENUE. |
| Software ID: | 11000175 |
| Software Version: |