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. | ||||||
| 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.") . | 405,651 | 455,860 | 544,029 | 582,977 | 535,802 | 2,524,319 |
| 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...... | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | 0 | 0 | 0 | 0 | 0 |
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 6 | Total. Add lines 1 through 5. | 405,651 | 455,860 | 544,029 | 582,977 | 535,802 | 2,524,319 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | 0 | 0 | 0 | 0 | 0 |
| 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. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 7a and 7b.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 8 | Public Support (Subtract line 7c from line 6.) | 2,524,319 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 405,651 | 455,860 | 544,029 | 582,977 | 535,802 | 2,524,319 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 18,101 | 26,064 | 25,815 | 24,773 | 94,753 | |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 10a and 10b. | 18,101 | 26,064 | 25,815 | 24,773 | 0 | 94,753 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 0 | 0 | 0 | 0 | 0 | |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 423,752 | 481,924 | 569,844 | 607,750 | 535,802 | 2,619,072 |




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 11000129 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P06_S0A_L02 | Form 990, Part VI, Section A, Line 2 | Some of the Trustees are related. They are or their parents grew up in the same small farming community of Armstrong Wisconsin (Fond du Lac County). * Maggie Shea is a cousin * Sam Mueller is married to a cousin. * Michael John Shea is a nephew of Kevin Shea * Barbara O'Brien, R. N., is a cousin. * Attorney Kevin G. Shea is a cousin to O'Brien, uncle to Mike Shea, and a brother-in law to Maggie Shea. There are NO business realations amongst the members of the Board of Trustees. |
| F990_P06_S0A_L06 | Form 990, Part VI, Section A, Line 6 | The founding members elect the trustees. The members can confer membership on addtional members. There are less than25 members. They participate in the annual meeting of the membership. They have No ownership interest in the association. |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | Only as provided for in the articles of association: Elect Trustees. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | It is prepared by the agent/trustee Kevin Shea, reviewed by the Treasuer, Maggie Shea and then transmitted to the Trustees for their comments if any. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | The Trustees discuss their activities at their meetings to ensure that there is no conflicts and that there is full disclosure of all activiites associated with this Charity. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | This question does not allow a N/A. We have no compensation for any employeess or anyone else. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Upon request. We have no website at this time. However we have always furnished whatever documents requested with a very quick turnaround, and always to the satisfaction of the requester. |
| Software ID: | 11000129 |
| Software Version: | v1.00 |