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.") .... | 353,593 | 133,367 | 205,615 | 257,136 | 170,471 | 1,120,182 |
| 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.. | 5,521 | 3,443 | 3,187 | 8,285 | 20,436 | |
| 4 | Total. Add lines 1 through 3.. | 359,114 | 136,810 | 208,802 | 265,421 | 170,471 | 1,140,618 |
| 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. | 1,140,618 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 359,114 | 136,810 | 208,802 | 265,421 | 170,471 | 1,140,618 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 22,997 | 24,262 | 29,542 | 32,039 | 21,050 | 129,890 |
| 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). | 1,270,508 | |||||






| 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 |
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| Explanation |
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| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 6 | The organization has 420 members. The members are boys | |
| and girls ages 6 thru 18. Participants in Boys and | ||
| Girls Club activities are required to hold a membership. | ||
| Pt VI, Line 11a | The form 990 will be presented January 28, 2013 at the | |
| board meeting. As part of the presentation, a copy | ||
| of the form 990 will be distributed to all board members | ||
| for review. | ||
| Pt VI, Line 12c | The organization reviews and monitors the conflict of | |
| interest policy. | ||
| Pt VI, Line 15 | The salaries are reviewed annually. | |
| Pt VI, Line 19 | The organization makes its governing documents, | |
| Conflict of Interest policy, and financial statements | ||
| available upon request. | ||
| Form 990EZ, Part I, Line 16 | MEALS/ STAFF MEETINGS APPRECIATION DINNER MARKETING & PROMOTION WEB PAGE FEES EVENTS CIVIC CLUBS PROGRAMS: BASKETBALL FOOTBALL BASEBALL SOFTBALL SOCCER GAMES, FITNESS, & PROGRAM AIDS FILMS & SPECIAL EVENTS AWARDS MISCELLANEOUS PAYMENTS TO AFFILIATES FEES FOR ENDOWMENT FUND TRANSPORTATION: GAS, OIL, MAINT INSURANCE | |
| Form 990EZ, Part II, Line 24 | SALES TAX REFUND RECEIVABLE DUE FROM HHS GRANT CONCESSIONS INVENTORY SUPPLIES- SPORTING GOODS PREPAID EXPENSES DUE FROM GANG PREVENTION GRANT DUE FROM FAMILY PLUS GRANT DUE FROM ARRA GRANT | |
| Form 990, Part IX, Line 24f | PROGRAM DIRECT EXPENSES 17986. 17986. 0. 0. |
| Software ID: | 11000175 |
| Software Version: |