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. | 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.") . | 15,016 | 21,542 | 14,550 | 785 | 51,893 | |
| 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...... | 505,806 | 499,805 | 499,481 | 500,088 | 580,251 | 2,585,431 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 10,654 | 10,952 | 10,195 | 8,193 | 12,799 | 52,793 |
| 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. | 516,460 | 525,773 | 531,218 | 522,831 | 593,835 | 2,690,117 |
| 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.) | 2,690,117 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 516,460 | 525,773 | 531,218 | 522,831 | 593,835 | 2,690,117 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 98 | 124 | 413 | 165 | 63 | 863 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 98 | 124 | 413 | 165 | 63 | 863 |
| 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.) | 208 | 459 | 645 | 2,418 | 516 | 4,246 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 2,695,226 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISC. INCOME; 2007: 208.; 2008: 459.; 2009: 645.; 2010: 2418.; 2011: 516.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | A COPY OF THE FORM 990 IS TO BE PROVIDED TO EACH | |
| BOARD MEMBER FOR REVIEW AND APPROVAL PRIOR TO IT'S | ||
| FILING. | ||
| Pt VI, Line 12c | THE CENTER HAS ADOPTED A CONFLICT OF INTEREST | |
| POLICY THAT REQUIRES ALL BOARD MEMBERS TO REVIEW | ||
| THE CONFLICT OF INTEREST POLICY ANNUALLY AND TO | ||
| DISCLOSE ANY CONFLICTS OR POTENTIAL CONFLICTS OF | ||
| INTEREST TO THE PRESIDENT OF THE BOARD OF DIRECTORS. | ||
| BASED UPON THE NATURE OF THE DISCLOSED CONFLICTS, THE | ||
| BOARD OF DIRECTORS WILL MONITOR THE SITUATION AND | ||
| DETERMINE THE APPROPORATE COURSE OF ACTION. | ||
| Pt VI, Line 15 | THE EXECUTIVE DIRECTOR HAS AN ANNUAL REVIEW BY THE | |
| BOARD OF DIRECTORS. AT THAT TIME, SALARY AND BENEFITS | ||
| ARE ANALYZED BASED UPON JOB PERFORMANCE, MARKET | ||
| CONDITIONS, AND COMPARABLE POSITIONS THROUGHOUT THE | ||
| REGION. | ||
| Pt VI, Line 19 | THE CENTER'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST | |
| POLICY AND FINANCIAL STATEMENTS ARE KEPT AT THE | ||
| CENTER'S ADMINISTRATIVE OFFICES AND ARE AVAILABLE FOR | ||
| PUBLIC INSPECTION UPON REQUEST. | ||
| Pt XII, Line 2c | THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR THE | |
| SELECTION OF AN INDEPENDENT AUDITOR AND OVERSIGHT OF | ||
| THE AUDIT. | ||
| Pt XI | OTHER CHANGES IN NET ASSETS: | |
| PRIOR PERIOD ADJUSTMENT DUE TO FIRST YEAR AUDIT OF | ||
| FINANCIAL STATEMENTS | ||
| Form 990, Part IX, Line 24f | CAMPS/ACTIVITIES 2245. 2245. STAFF DEVELOPMENT 401. 401. EQUIPMENT EXPENSE 118. 118. LICENSE FEES 546. 546. MISC 1898. 1898. KITCHEN CLEANING 7671. 7671. GRANT EXPENSES 2227. 2227. |
| Software ID: | 11000175 |
| Software Version: |