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.") .... | ||||||
| 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.") . | 71,820 | 72,735 | 63,950 | 106,850 | 145,629 | 460,984 |
| 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...... | 27,539 | 27,539 | ||||
| 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. | 71,820 | 72,735 | 63,950 | 106,850 | 173,168 | 488,523 |
| 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.) | 488,523 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 71,820 | 72,735 | 63,950 | 106,850 | 173,168 | 488,523 |
| 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.). | 71,820 | 72,735 | 63,950 | 106,850 | 173,168 | 488,523 |




| 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 Part VI | 11a | The executive director reviews the tax return for completeness and correctness. The executive director reviews the return and makes any necessary correction. The management approved return is then sent out via email to all of the board members for their information and review. If no response from any board member is received during a stated time the tax return is then filed with the IRS. |
| Form 990 Part VI | 12C | The organization completes a conflict of interest statement at the start of each year. During the year when discussing and voting on major items a question is asked concerning conflict of interst so that any board member has the ability to excuse themself from the vote if a conflict has arisen. |
| Form 990 Part VI | 15 | The compensation of the executive director is approved and monitored by the Board of Directors. The Board uses published survey information from like organizations to establish base line as well as average salay and benefit amounts. The executive director salary is reviewed on a yearly basis by the board. |
| Form 990 Part VI Section B. Policies Line 11a The executive director reviews the tax return for completeness and correctness. The executive director reviews the return and makes any necessary correction. The management approved return is then sent out via email to all of the board members for their information and review. If no response from any board member is received during a stated time the tax return is then filed with the IRS. Form 990 Part VI Section B. Policies Line 12C The organization completes a conflict of interest statement at the start of each year. During the year when discussing and voting on major items a question is asked concerning conflict of interst so that any board member has the ability to excuse themself from the vote if a conflict has arisen. Form 990 Part VI Section B. Policies Line 15 The compensation of the executive director is approved and monitored by the Board of Directors. The Board uses published survey information from like organizations to establish base line as well as average salay and benefit amounts. The executive director salary is reviewed on a yearly basis by the board. |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |