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. | 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.. | ||||||
| 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.") . | 66,632 | 44,701 | 40,588 | 56,600 | 50,000 | 258,521 |
| 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...... | 106,525 | 139,379 | 134,863 | 138,662 | 137,871 | 657,300 |
| 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. | 173,157 | 184,080 | 175,451 | 195,262 | 187,871 | 915,821 |
| 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.) | 915,821 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 173,157 | 184,080 | 175,451 | 195,262 | 187,871 | 915,821 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 0 | |||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| 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. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 0 | |||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 173,157 | 184,080 | 175,451 | 195,262 | 187,871 | 915,821 |




| 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 8, Other Revenue CREDIT 2,068 Form 990-EZ, Part I, Line 8, Other Revenue TRANSFER 326 Form 990-EZ, Part I, Line 16, Other Expenses Supplies 1,237 Form 990-EZ, Part I, Line 16, Other Expenses Telephone 3,913 Form 990-EZ, Part I, Line 16, Other Expenses MEMBERSHIP DUES 35 Form 990-EZ, Part I, Line 16, Other Expenses CABLE 1,279 Form 990-EZ, Part I, Line 16, Other Expenses BANK FEES 584 Form 990-EZ, Part I, Line 16, Other Expenses CLIENT ALLOWANCE 400 Form 990-EZ, Part I, Line 16, Other Expenses GAS 888 Form 990-EZ, Part I, Line 16, Other Expenses REPAIRS AND MAINTENANCE 951 Form 990-EZ, Part I, Line 16, Other Expenses EXTERMINATING 254 Form 990-EZ, Part I, Line 16, Other Expenses FOOD 3,402 Form 990-EZ, Part I, Line 16, Other Expenses DEPT OF LABOR 271 Form 990-EZ, Part I, Line 16, Other Expenses INSURANCE 6,475 Form 990-EZ, Part I, Line 16, Other Expenses REFUND 231 Form 990-EZ, Part I, Line 16, Other Expenses OFFICE SUPPLIES EXPENSES 600 Form 990-EZ, Part I, Line 16, Other Expenses MISCELLANEOUS 3,940 Form 990-EZ, Part I, Line 16, Other Expenses PAYROLL EXPENSE 14,110 Form 990-EZ, Part I, Line 16, Other Expenses TRAINING 150 Form 990-EZ, Part I, Line 16, Other Expenses PROPERTY TAXES 415 Form 990-EZ, Part I, Line 16, Other Expenses AUTO 7,193 Form 990-EZ, Part I, Line 16, Other Expenses CONTRACTED SERVICES 4,030 Form 990-EZ, Part I, Line 16, Other Expenses COMPUTER REPAIR 40 Form 990-EZ, Part I, Line 16, Other Expenses JANITORIAL SERVICES 169 Form 990-EZ, Part I, Line 16, Other Expenses APPLIANCES 165 Form 990-EZ, Part I, Line 16, Other Expenses POSTAGE 33 Form 990-EZ, Part I, Line 16, Other Expenses WORKERS COMP 70 Form 990-EZ, Part I, Line 16, Other Expenses SPEND DOWN 50 Form 990-EZ, Part I, Line 16, Other Expenses TOBACCO PRODUCTS FOR CLIENTS 139 Form 990-EZ, Part I, Line 16, Other Expenses LAWN CARE 520 Form 990-EZ, Part II, Line 24, Other Assets FURNITURE AND EQUIPMENT Beginning of year 729, End of year 902 |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |