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.") .... | 19,571 | 264,781 | 284,352 | |||
| 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.. | 19,571 | 264,781 | 284,352 | |||
| 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. | 284,352 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 19,571 | 264,781 | 284,352 | |||
| 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). | 284,352 | |||||






| 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 10b | THE FORM 990 WILL BE REVIEVED BY THE FINANCE COMMITTE AND THE ENTIRE BOARD FOR APPROVAL BEFORE FILLING | |
| Pt VI, Line 19 | AVAILABLE TO THE PUBLIC UPON REQUEST | |
| Pt XII, Line 2c | REVIEW | |
| Pt XII, Line 1 | REVIEW BY THE FINANCE COMMITTE | |
| Pt XII, Line 3b | REVIEW BY THE FINANCE COMMITTE | |
| Pt VI, Line 12c | EACH MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST POLICY ON AN ANNUAL BASIS | |
| Pt VII, Col (E) | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Pt VII, Col (E) | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Pt VI, Line 11a | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Pt VI, Line 8a | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Pt VI, Line 7b | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Pt VI, Line 8b | REVIRE BY COMMITTEE AND BOARD OF TRUSTEE | |
| Form 990EZ, Part I, Line 16 | PROGRAM EXPENSES 50139. TRASH BAGS 6999. EQUIPMENT RENTAL 3936. AUTOMOBILE EXPENSES 5497. CLEANING SUPPLIES 1156. STARAGE FACILITY 750. OFFICE EXPENSES 3100. TELEPHONE 1835. BANK SERVICE FEES 1454. INSURANCE 1798. TRAVEL 1136. OFFICE SUPPLIES 1381. FINES AND FEES 685. UTILITIES 350. | |
| Form 990, Part III, Line 4d | PROVIDE ENTRY LEVEL JOBS TO EX-OFFENDERS AND LOW SKILLS MEMBER OF THE COMMUNITIES 0. 0. 0. | |
| Form 990, Part IX, Line 24f | PROGRAM AWARDS 4164. 4164. 0. 0. AUTOMOBILE EXPENSES 5497. 5497. 0. 0. CLEANING SUPPLIES 1156. 1156. 0. 0. STORAGE 750. 750. 0. 0. TELEPHONE 1835. 0. 1835. 0. BANK SERVICE CHARGE 1454. 0. 1454. 0. INSURANCE 1798. 0. 1798. 0. FINES AND FEES 685. 0. 685. 0. UTILITIES 350. 0. 350. 0. SUPPLIES 1381. 0. 1381. 0. |
| Software ID: | 11000175 |
| Software Version: |