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.") . | 61,525 | 94,664 | 43,968 | 57,651 | 257,808 | |
| 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. | 61,525 | 94,664 | 43,968 | 57,651 | 257,808 | |
| 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.) | 257,808 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 61,525 | 94,664 | 43,968 | 57,651 | 257,808 | |
| 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.). | 61,525 | 94,664 | 43,968 | 57,651 | 257,808 | |




| 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-EZ, Part I, Line 10, Grants Paid Activity , Grantee Ohio Cerebral Palsey Fund 995 Goodale Blvd, Suite 2 Columbus OH 43212, Cash Grant 6,650, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee CP Bowling League 721 N. Cable Rd. Lima OH 45805, Cash Grant 2,122, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity Student Awards, Grantee 17 Students, Cash Grant 5,300, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Elks National Foundation 2750 N. Lakeview Ave. Chicago IL 60614, Cash Grant 6,500, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Barbers Giving Bikes 1102 N West St A Lima OH 45801, Cash Grant 7,506, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Girl Scouts 1870 W. Robb Ave. Lima OH 45801, Cash Grant 597, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Ohio Elks Association 302 W. North St. Lima OH 45801, Cash Grant 578, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Lima Junior Golf Assoc. 525 N. Stevick Rd. Lima OH 45807, Cash Grant 700, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Lima Symphony Orchestra 133 N. Elizabeth St. Lima OH 45802, Cash Grant 5,000, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Pheasants Forever 1783 Buerkle Circle St Paul MN 55110, Cash Grant 6,000, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee W.O.A.L. 3020 Lake Shore Dr. Lima OH 45806, Cash Grant 2,000, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Black Swamp Area Council 2100 Broad Ave. Findlay OH 45840, Cash Grant 350, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Equestrian Therapy Program 22532 Bowsher Road Cridersville OH 45806, Cash Grant 250, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity Scholarships, Grantee 12 Students, Cash Grant 18,244, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Veterans Food Pantry P.O. Box 5096 Lima OH 45802, Cash Grant 150, Relationship None Form 990-EZ, Part I, Line 10, Grants Paid Activity , Grantee Red Cross - Allen County 610 S. Collett St. Lima OH 45805, Cash Grant 40, Relationship None Form 990-EZ, Part I, Line 16, Other Expenses Bank fees 66 Form 990-EZ, Part I, Line 16, Other Expenses Insurance / Bonding 201 Form 990-EZ, Part I, Line 16, Other Expenses Ohio Charitable Organization registration 125 |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |