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.") .... | 80,596 | 80,596 | ||||
| 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.. | 80,596 | 80,596 | ||||
| 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. | 80,596 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 80,596 | 80,596 | ||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 848 | 848 | ||||
| 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.. | 150 | 150 | ||||
| 11 | Total support (Add lines 7 through 10). | 81,594 | |||||






| 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 |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | TO PROVIDE EMERGENCY ASSISTANCE INCLUDING FOOD, SHELTER, CLOTHING, MEDICINE, GASOLINE OR OTHER SUPPORT. THE CORPORATION MAINTAINS A PARTICULAR INTEREST IN SERVING THE SPECIAL NEEDS OF COMMUNITY MEMBERS. "SPECIAL NEEDS" IS DEFINED AS THOSE NEEDS NOT MET OR FUFILLED BY OTHER COMMUNITY RESOURCES. |
| MATERIAL DIFFERENCES IN VOTING RIGHTS EXPLANATION | FORM 990, PAGE 6, PART VI | THE EXECUTIVE DIRECTOR AND ONE LIASON POSITION DO NOT HAVE VOTING RIGHTS. THESE MEMBERS VOTING WOULD NOT BE CONSISTENT WITH THE BY LAWS AND CONFLICT OF INTEREST POLICY. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | BOARD MEMBERS ARE ELECTED AT AN ANNUAL MEETING EVERY SPRING, OR AT INTERIM DATES IF A POSITION IS VACANT. |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | THE DECISIONS SUBJECT TO APPROVAL OF BOARD MEMBERS INCLUDE: BUDGET, EMPLOYMENT, INVESTMENTS, MAJOR PURCHASES, AND BOARD MEMBERS TERMS AND AMENDMENTS. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE 990 IS TO BE REVIEWD AT A BOARD MEETING, ENTERED INTO THE MINUTES THAT IT WAS ACKNOWLEDGED AS WRITTEN. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | AN INDIVIDUAL SERVING AS A BOARD MEMBER MUST DISCLOSE ANY PERSONAL OR FINANCIAL INTEREST IN CONTRACTS OR AGREEMENTS WHICH MIGHT LEAD TO OR BE PERCEIVED AS LEADING TO PERSONAL GAIN AND OR PROFIT. IF A BOARD MEMBER IS AN EMPLOYEE OR INDEPENDENT CONTRACTOR WITH AN AGENCY WITH WHICH THE BOARD IS CONSIDERING ENTERING INTO A CONTRACT, THE AGREEMENT OR CONTRACT SHALL NOT BE APPROVED UNLESS ALL OF THE FOLLOWING REQUIREMENTS ARE MET: A. THE BOARD MEMBER SHALL PROMPTLY DISCLOSE HIS OR HER INTEREST IN THE CONTRACT TO THE BOARD. B. THE CONTRACT SHALL BE APPROVED BY A VOTE OF NOT LESS THAN TWO THIRDS OF THE MEMBERS OF THE BOARD WHO ARE PRESENT AND VOTING IN AN OPEN MEETING WITHOUT THE VOTE OF THE BOARD MEMBER IN QUESTION. THE BOARD MEMBER SHALL BE EXCUSED FROM THE ROOM PRIOR TO VOTING. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE EXECUTIVE DIRECTORS SALARY IS SUBJECT TO BOARD APPROVAL. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| OTHER EXPENSES | FORM 990, PART IX, LINE 24E | CO - TRANSPORTATION 2,810 FUNDRAISER GOLF OUTING 2,199 CO - MEDICAL 2,164 CO - TRANSPORTATION - GAS 2,139 CO - HOUSEHOLD 1,415 CO - AUTO SERVICE 843 CO - MORTGATE 800 COMMUNITY OUTREACH-AUTO 590 CO - LODGING - MOTEL 466 CO - STUDENT FEES 458 CO - AUTO INSURANCE 326 CO - INSURANCE 118 CO - GROCERIES 83 CO - BUS TICKETS 49 CO - CLOTHING 49 LICENSES 40 |
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