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.") .... | 292 | 14,274 | 36,606 | 144,775 | 26,243 | 222,190 |
| 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.. | 292 | 14,274 | 36,606 | 144,775 | 26,243 | 222,190 |
| 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).. | 403,875 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | -181,685 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 292 | 14,274 | 36,606 | 144,775 | 26,243 | 222,190 |
| 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). | 222,190 | |||||






| 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.) | ||||||
| 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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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Officer, directors, etc. family relationship (Part VI, line 2) | ONE OF THE BOARD OF DIRECTORS MEMBER AND CASE MANAGER IS THE SISTER OF THE EXECUTIVE DIRECTOR AND ASSISTANT TREASURER OF THE BOARD ONE OF THE SHELTER FACILITIES IS LEASED FROM THE SPOUSE OF THE EXECUTIVE DIRECTOR | |
| 02. Form 990 governing body review (Part VI, line 11) | THE GOVERNING BODY CONSISTS OF 7 MEMBERS OF THE BOARD OF DIRECTORS EACH MEMBER OF THE BOARD VIEWS THE 990 FORM | |
| 03. Conflict of interest policy compliance (Part VI, line 12c) | EACH BOARD MEMBER HAD TO APPROVE THE CONFLICT OF INTEREST POLICY AND WAS GIVEN A COPY AFTER THE APPROVAL BY THE BOARD OF DIRECTORS | |
| 04. CEO, executive director, top management comp (Part VI, line 15a) | THE BOARD OF DIRECTORS SET THE SALARY OF THE EXECUTIVE DIRECTOR AND THE EXECUTIVE DIRECTOR SET THE SALARY FOR ALL OTHER EMPLOYEES CURRENTLY THE ORGANIZATION DOES NOT OFFER COMPENSATION OTHER THAN SALARIES PART VII LINE 2 LINDA SEGREST EXECUTIVE DIRECTOR 22475 2011 ANNUAL SALARY JAMES JONES PROGRAM DIRECTOR 13675 2011 ANNUAL SALARY REGINA JOHNSON CASE MANAGER RECEIVED NO COMPENSATION ONLY GAS REIMBURSEMENT NELLIE JOHNSON SHAW FISCAL MANAGER RECEIVED NO COMPENSATION ONLY GAS REIMBURSEMENT | |
| 05. Other officer or key employee compensation (Part VI, line 15b | THE EXECUTIVE DIRECTOR DETERMINES THE SALARY FOR OTHER KEY EMPLOYEES CURRENTLY THE ORGANIZATION DOES NOT OFFER COMPENSATION OTHER THAN SALARIES | |
| 06. Governing documents, etc, available to public (Part VI, line 19) | GOVERNING DOCUMENTS ARE MAINTAINED AT THE ADMINISTRATIVE OFFICES LOCATED AT 425 W PEEBLES ROAD IN MEMPHIS TENNESSEE VIEWING OF THE DOCUMENTS IS AVAILABLE UPON REQUEST | |
| 07. Explanation of other changes in net assets or fund balances (Part XI, line 5) | ORGANIZATION WAS DONATED REAL PROPERTY AND PURCHASED EQUIPMENT IN 2011 THAT INCREASED THE NET ASSETS IN 2011 |
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