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.") . | 1,020 | 7,500 | 1,607 | 726 | 507 | 11,360 |
| 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...... | 147,569 | 150,317 | 161,756 | 166,808 | 174,417 | 800,867 |
| 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. | 148,589 | 157,817 | 163,363 | 167,534 | 174,924 | 812,227 |
| 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.) | 812,227 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 148,589 | 157,817 | 163,363 | 167,534 | 174,924 | 812,227 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,212 | 1,226 | 537 | 592 | 273 | 3,840 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 1,212 | 1,226 | 537 | 592 | 273 | 3,840 |
| 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.). | 149,801 | 159,043 | 163,900 | 168,126 | 175,197 | 816,067 |




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | PROVIDE CHILD CARE SERVICES IN A LOW INCOME AND FINANCIALLY DISTRESSED RURAL AREA IN LOWER SOUTHWEST WISCONSIN FOR CHILDREN AGES 6 MONTHS TO 12 YEARS OF AGE |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS DISTRIBUTED AT THE MAY BOARD MEETING, OFFICERS AND MEMBERS ARE ASKED TO REVIEW AND PROVIDE FEEDBACK OF THE TAX RETURN . THE PRESIDENT WILL ASK BOARD FOR A MOTION TO ACCEPT THE CURRENT TAX RETURN. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE MANAGING DAYCARE DIRECTOR MONITORS THE DAILY BUSINESS TRANSACTIONS AND DISCUSSES DAILY WITH THE DAYCARE CENTER'S BOARD OFFICERS IF THERE IS ANY APPEARANCE OF CONFLICT. THE OFFICERS ALSO MONITOR THE DAY CARE'S MANAGING DIRECTOR'S INVOLVEMENT WITH TRANSACTIONS TO AVOID AND IF NEEDED TO REPORT AND RESOLVE CONFLICT OF INTEREST ISSUES. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | THE WAGE INCREASE FOR THE CHILD CARE CENTER MANAGING DIRECTOR ARE REVIEWED BY THE FINANCE COMMITTEE AND RECOMMENDED INCREASES ARE PRESENTED TO THE PRESIDENT WHO THEN PRESENT THESE SAME WAGE INCREASE RECOMMENDATIONS TO THE BOARD AT THE NOVEMBER OR DECEMBER BOARD MEETINGS PRIOR TO THE BUDGET PREPARATION FOR THE NEXT OPERATING YEAR. |
| COMPENSATION PROCESS FOR OFFICERS | FORM 990, PAGE 6, PART VI, LINE 15B | THE WAGE INCREASE FOR THE CHILD CARE CENTER EMPLOYEES ARE REVIEWED BY THE FINANCE COMMITTEE AND RECOMMENDED INCREASES ARE PRESENTED TO THE PRESIDENT WHO THEN PRESENT THESE SAME WAGE INCREASE RECOMMENDATIONS TO THE BOARD AT THE NOVEMBER OR DECEMBER BOARD MEETINGS PRIOR TO THE BUDGET PREPARATION FOR THE NEXT OPERATING YEAR. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | RECORDS AND GENERAL LEDGER DOCUMENTS ARE MAINTAINED AT BUSINESS LOCATION AND MADE AVAILABLE UPON REQUEST |
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