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.") .... | 53,171 | 73,015 | 156,000 | 50,387 | 58,764 | 391,337 |
| 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.. | 15,390 | 15,390 | 30,780 | |||
| 4 | Total. Add lines 1 through 3.. | 53,171 | 73,015 | 156,000 | 65,777 | 74,154 | 422,117 |
| 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. | 422,117 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 53,171 | 73,015 | 156,000 | 65,777 | 74,154 | 422,117 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 31 | 24 | 22 | 77 | ||
| 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). | 422,194 | |||||






| 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.") . | 53,171 | 73,015 | 156,000 | 50,387 | 58,764 | 391,337 |
| 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.. | 15,390 | 30,780 | ||||
| 6 | Total. Add lines 1 through 5. | 53,171 | 73,015 | 156,000 | 65,777 | 74,154 | 422,117 |
| 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.) | 422,117 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 53,171 | 73,015 | 156,000 | 65,777 | 74,154 | 422,117 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 31 | 24 | 22 | 77 | ||
| 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.). | 422,194 | |||||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Qestion 16 Books Subscriptions and reference $596 Postage $88 Printing and copying $111 Supplies $2305.00 Telephone $1526 Camp Fees ect $600 Other Cost $214 Program Expense $56 Travel Expense $436 Van Expense $6617 Pass thur Grant $150 SVC Charge $11 990EZ pg 2 Question 24 See asset Schedule $4958 Loan to Jacqueline Hives $966 CD @ TCNB $1636 990EZ pg 2 Question 26 Payroll Liability $526 990 Primary Exempt Purpose The mission of the orginazation is to improve the well being emotionally, and physically, of youth by combining structured life skills, educational and recreational activities, developing and promoting leadership and involvement of youth and their parents, and by providing life skills to prevent sustance abuse and other harmful activities. 990 Program Service Accomplishment Youth have shown increased self awareness of pro social behavior. They can verbilize the characteristics of positive role models and can begin seeing their lives move in a direction to be able to immolate those role models. One 13 year old female stated recently that she is now able to ignore fellow students who treat her badly and can then go on to be nice to them, indicating a higher tolerance. They are also able to speak openly about things that are affecting them at school, at home and in their enviroment. Participants have been observed demonstrating acceptable behavior and encouraging others to demonstrate positive behavior. Pg 2 Part IV List of Officers Jacqueline Hives 306 Bridgeport Rd Camden AL 36726 Activities Coordinator 30 hours per week salary $20883.00 Sheryl Threadgill 141 Hillview Estates Camden AL 36726 Director 40 hours per week no salary Darryl Perryman P O Box 402 Camden AL 36726 Vice President 1 Hour per Week No salary Joann Williams 1882 Highway 28W Camden AL 36726 Secretary 1 hour per week no salary Janice Robinson 796 K P Thomas Rd Camden AL 36726 Treasure 1 Hour per Week no salary Alicia Foster P O Box 370 Camden AL 36726 Chairperson 1 hour per week no salary Books in Care Of Gina Wood Business Services LLC 102 Broad St Camden AL 36726 334-682-9123 |
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