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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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.. | 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). | ||||||






| 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.") . | 403,243 | 486,443 | 452,675 | 419,698 | 419,065 | 2,181,124 |
| 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...... | 551,332 | 504,577 | 466,931 | 553,851 | 485,123 | 2,561,814 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 115,837 | 4,177 | 8,890 | 128,904 | ||
| 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. | 1,070,412 | 995,197 | 928,496 | 973,549 | 904,188 | 4,871,842 |
| 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.) | 4,871,842 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 1,070,412 | 995,197 | 928,496 | 973,549 | 904,188 | 4,871,842 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 472 | 270 | 220 | 853 | 849 | 2,664 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 472 | 270 | 220 | 853 | 849 | 2,664 |
| 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.). | 4,874,506 | |||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The agency's Treasurer or President and the Exec Director review the Form 990 | |
| prior to filing. Printed copies are provided to the entire board at the | ||
| annual meeting in January when new board members are presented. | ||
| Pt VI, Line 15 | The executive board reviews salaries for similar positions at | |
| non-profits in the immediate area when setting salaries for the | ||
| executive director's position. Yearly performance reviews are conducted. | ||
| Pt VI, Line 19 | Financial statements are made available when requested for | |
| grant applications and proposals. | ||
| Pt VI, Line 12c | The agency developed a written Conflict of Interest policy at | |
| the end of 2009. A copy of the policy shall be given to all Board members, | ||
| staff, and volunteers upon commencement of such person's relationship. | ||
| Each person shall sign the policy at the beginning of his/her term of service | ||
| or employment and each year thereafter. | ||
| Form 990EZ, Part II, Line 24 | PLEDGES RECEIVABLE - NET | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES DEFERRED REVENUE BONDS, MORTGAGES & OTHER NOTES | |
| Form 990, Part III, Line 4d | DALTON YOUTH CENTER, PROVIDE AFTER SCHOOL PROGRAMS FOR 41100. 0. 3792. MISC COMMUNITY PROGRAMS - MIDDLE SCHOOL DANCES, 64042. 0. 47550. | |
| Form 990, Part IX, Line 24f | SUBCONTRACT COSTS 42940. 33623. 8624. 693. |
| Software ID: | 11000175 |
| Software Version: |