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.") . | 72,014 | 31,220 | 24,228 | 64,102 | 71,710 | 263,274 |
| 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...... | 288,238 | 168,989 | 255,832 | 176,958 | 210,526 | 1,100,543 |
| 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. | 360,252 | 200,209 | 280,060 | 241,060 | 282,236 | 1,363,817 |
| 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.) | 1,363,817 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 360,252 | 200,209 | 280,060 | 241,060 | 282,236 | 1,363,817 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 468 | 12,514 | 6,860 | 11,513 | 15,241 | 46,596 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 468 | 12,514 | 6,860 | 11,513 | 15,241 | 46,596 |
| 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.) | 224 | 118 | 342 | |||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 1,410,755 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISCELLANEOUS; 2010: 224.; 2011: 118.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | THE GOVERNING BODY IS PROVIDED A COPY OF THE DRAFT FORM 990 | |
| FOR REVIEW. THE EXECUTIVE DIRECTOR PERFORMS AND IN | ||
| DEPTH REVIEW OF THE FORM 990 PRIOR TO FILING. | ||
| Pt VI, Line 12c | BOARD MEMBERS MUST DISCLOSE IMMEDIATELY ANY SITUATION | |
| IN WHICH A CONFLICT OF INTEREST OR APPARENT CONFLICT | ||
| OF INTEREST ARISES. THE BOARD MEMBER THEN IS EXCUSED | ||
| FROM FURTHER DISCUSSION REGARDING THE ISSUES CREATING THE CONFLICT. | ||
| Pt VI, Line 15 | COMPENSATION IS DETERMINED BY PERFORMANCE OBJECTIVES BEING | |
| MET, PERIODIC SURVEYS OF LIKE AGENCIES IN OUR INDUSTRY, | ||
| ANNUAL COST OF LIVING INCREASES, AND AVAILABILITY OF FUNDS. | ||
| Pt VI, Line 19 | FORM 990 IS AVAILABLE THROUGH GUIDESTAR. GOVERNING | |
| DOCUMENTS ARE AVAILABLE UPON REQUEST AT THE AGENCY'S | ||
| ADMINISTRATIVE OFFICES. | ||
| Pt XI | UNREALIZED LOSS ON INVESTMENTS OF $1,663 |
| Software ID: | 11000175 |
| Software Version: |