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) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 116 | 5,618 | 13,283 | 11,926 | 14,818 | 45,761 |
| 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.. | 116 | 5,618 | 13,283 | 11,926 | 14,818 | 45,761 |
| 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. | 45,761 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 116 | 5,618 | 13,283 | 11,926 | 14,818 | 45,761 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 402 | 522 | 338 | -17 | 1,245 | |
| 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.. | 1,351 | 149 | 1,237 | 2,737 | ||
| 11 | Total support (Add lines 7 through 10). | 49,743 | |||||






| Calendar year(or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 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. | ||||||
| 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.) | ||||||
| Calendar year (or fiscal year beginning in) | (a) 2006 | (b) 2007 | (c) 2008 | (d) 2009 | (e) 2010 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| 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.). | ||||||




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | FORM 990 IS DISTRIBUTED TO BOARD MEMBERS IN TENTATIVE FORM PRIOR TO COMPLETION FOR THEIR INPUT AFTER THEIR QUESTIONS ARE ADDRESSED THE COMPLETED 990 IS PREPARED FOR FILING | |
| 02. Conflict of interest policy compliance (Part VI, line 12c) | BOARD MEMBERS ARE REQUESTED THEY PROVIDE THE SECRETARY WRITTEN DISCLOSURE OF ANY CONFLICTS OF INTEREST OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY EACH BOARD MEMBER ACKNOWLEDGES THEIR OBLIGATION TO DISCLOSE TO THE CHAIRMAN A CONFLICT OR THE APPEARANCE OF A CONFLICT AND ABSTAIN FROM ANY VOTE ON THE MATTER INVOLVING THE CONFLICT A CONFLICT OF INTEREST OR APPEARANCE OF A CONFLICT COULD ARISE WHEN A TRANSACTION OR ACTION OF THE BOARD CONFLICTS WITH THE PERSONAL INTERESTS OF THE BOARD MEMBER IMMEDIATE FAMILY MEMBER OF A BOARD MEMBER OR EMPLOYER OF THE BOARD MEMBER | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | COMPENSATION OF THE DIRECTOR AND ASSISTANT DIRECTOR ARE DETERMINED BY THE GOVERNING BOARD | |
| 04. Other officer or key employee compensation (Part VI, line 15b | COMPENSATION OF ALL EMPLOYEES ARE DETERMINED BY THE GOVERNING BOARD TAKING INTO CONSIDERATION THE DUTIES PERFORMED EXPERIENCE AND CUSTOMARY RATES OF PAY IN THE AREA | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | ORGANIZATIONAL DOCUMENTS EXEMPTION LETTER MINUTES TO BOARD MEETINGS FORMS 990 |
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