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.") . | 17,725 | 9,910 | 15,720 | 14,712 | 15,000 | 73,067 |
| 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.. | 14,844 | 6,020 | 3,534 | 6,489 | 5,851 | 36,738 |
| 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. | 32,569 | 15,930 | 19,254 | 21,201 | 20,851 | 109,805 |
| 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.) | 109,805 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 32,569 | 15,930 | 19,254 | 21,201 | 20,851 | 109,805 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,390 | 137 | 1,527 | |||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 1,793 | 376 | 2,169 | |||
| c | Add lines 10a and 10b. | 1,390 | 137 | 1,793 | 376 | 3,696 | |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 33,126 | 33,126 | ||||
| 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.). | 67,085 | 16,067 | 19,254 | 22,994 | 21,227 | 146,627 |




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Members or stockholder classes and rights (Part VI, line 6) | The members of this corporation shall be those persons groups or corporations who can contribute to the corporation such fees as are required by the directors The corporation shall be composed of active and honorary members Active members shall included all annual members who pay the required dues Honorary members shall not be required to pay dues an may attend all meetings of the corporation Each annual member shall be entitled to one vote on matters submitted to a vote of the members Honorary members shall not have the right to vote | |
| 02. Member election for additional members (Part VI, line 7a) | An annual meeting of the members is held to elect the Directors and for transactions of such other business as may be brought before the meeting | |
| 03. Governing body decisions (Part VI, line 7b) | Gambling expenditures and monthly gambling reports require approval by the membership | |
| 04. Form 990 governing body review (Part VI, line 11) | Board reviews 990 before filing | |
| 05. CEO, executive director, top management comp (Part VI, line 15a) | Compensation is reviewed periodically by the a committee of the Board by making comparisons with other local organizations with lawful purpose gambling operations The committee then makes a recommendation to the Board | |
| 06. Other officer or key employee compensation (Part VI, line 15b | Compensation is reviewed periodically by the a committee of the Board by making comparisons with other local organizations with lawful purpose gambling operations The committee then makes a recommendation to the Board | |
| 07. Governing documents, etc, available to public (Part VI, line 19) | The Form 990 is available to the public upon request Other documents are evaluated by the Board on a case by case basis |
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