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.. | 0 | |||||
| 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.") . | 84,403 | 85,386 | 120,951 | 86,347 | 179,900 | 556,987 |
| 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...... | 3,734 | 19,221 | 4,979 | 30,293 | 11,471 | 69,698 |
| 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. | 88,137 | 104,607 | 125,930 | 116,640 | 191,371 | 626,685 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 14,629 | 9,178 | 8,568 | 3,107 | 108,105 | 143,587 |
| 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. | 10,000 | 16,000 | 48,000 | 15,000 | 40,100 | 129,100 |
| c | Add lines 7a and 7b.. | 24,629 | 25,178 | 56,568 | 18,107 | 148,205 | 272,687 |
| 8 | Public Support (Subtract line 7c from line 6.) | 353,998 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 88,137 | 104,607 | 125,930 | 116,640 | 191,371 | 626,685 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,014 | 1,362 | 775 | 1,624 | 665 | 5,440 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,014 | 1,362 | 775 | 1,624 | 665 | 5,440 |
| 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.) | 5,606 | 6,096 | 6,046 | 6,150 | 6,150 | 30,048 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 662,173 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISC. INCOME; 2007: 56.; 2008: 96.; 2009: 46.; 2010: 150.; 2011: 0.; DESCRIPTION: SIGN RENTAL; 2007: 5550.; 2008: 6000.; 2009: 6000.; 2010: 6000.; 2011: 6150.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 19 | Documents are provided upon request. | |
| Pt VI, Line 11a | The return is prepared by a Board member who is a | |
| Certified Public Accountant. There was not enough | ||
| time to have the return reviewed by the entire | ||
| governing body. All members of the governing body | ||
| may review at any time. | ||
| Form 990, Part IX, Line 24f | MISCELLANEOUS EXPENSE 2711. 903. 904. 904. EXHIBITS EXPENSE 1705. 1705. 0. 0. POSTAGE 385. 128. 129. 128. PRINTING/REPRODUCTION 12. 12. 0. 0. TELEPHONE 1094. 841. 253. 0. |
| Software ID: | 11000175 |
| Software Version: |