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.") .... | 412,695 | 454,874 | 463,407 | 542,188 | 532,056 | 2,405,220 |
| 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.. | 412,695 | 454,874 | 463,407 | 542,188 | 532,056 | 2,405,220 |
| 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. | 2,405,220 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 412,695 | 454,874 | 463,407 | 542,188 | 532,056 | 2,405,220 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 15,061 | 5,787 | 11,118 | 2,163 | 1,887 | 36,016 |
| 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.. | 52,621 | 199,664 | 252,285 | |||
| 11 | Total support (Add lines 7 through 10). | 2,693,521 | |||||






| 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 | 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.) | 0 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: HEALTH CARE CREDIT; 2011: 6028.; DESCRIPTION: PROGRAM SERVICES; 2010: 52621.; 2011: 193636.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | Return is distributed at monthly board meeting. | |
| Pt VI, Line 15 | An annual evaluation is done of the executive director | |
| with any changes in salary approved the the board of | ||
| directors. | ||
| Pt VI, Line 19 | The administative assistant maintains a file of the | |
| documents which are available for public review. | ||
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE FURNITURE & EQUIPMENT - NET PREPAIDS | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES | |
| Form 990, Part IX, Line 24f | PROGRAM SUPPLIES 81792. 81754. 38. TELEPHONE 7910. 7674. 236. POSTAGE & DELIVERY 3335. 3169. 166. PRINTING & REPRODUCTION 8877. 8533. 344. CLIENT EXPENSES 1593. 1593. 0. LICENSES & PERMITS 22. 0. 22. FUNDRAISING EXPENSES 1623. 0. 0. 1623. INSURANCE EXPENSE 16952. 14768. 2184. MISCELLANEOUS 989. 410. 579. 0. |
| Software ID: | 11000175 |
| Software Version: |