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.") .... | 40,722 | 536,510 | 809,297 | 1,386,529 | ||
| 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.. | 40,722 | 536,510 | 809,297 | 1,386,529 | ||
| 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. | 1,386,529 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 40,722 | 536,510 | 809,297 | 1,386,529 | ||
| 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). | 1,386,529 | |||||






| 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.) | ||||||
| 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 |
|---|
| Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Member election for additional members (Part VI, line 7a) | The organization does not have members but each director has a singular vote and a disinterested majority of the Board of Directors is required to replace andor vote for a director | |
| 02. Governing body decisions (Part VI, line 7b) | The organization does not have members but each director has a singular vote and a majority decision of the Board of Directors is required for approval of any action taken | |
| 03. Form 990 governing body review (Part VI, line 11) | Form 990 is distributed to all members of the Board of Directors and the officers of the organization to review for completeness and accuracy | |
| 04. Conflict of interest policy compliance (Part VI, line 12c) | The Board of Directors will define who is an interested person and what constitutes a financial interest The Board of Directors will impress on all individuals the duty to disclose any actual or possible conflicts of interest and will give everyone the opportunity to disclose such conflicts The Board of Directors will update conflicts of interest on an annual basis The Board of Directors will review all business deals and approve them by majority vote The Board of Directors will require disclosure of any conflicts before any decision is rendered on any matter | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | All governing documents conflict of policy statements and lists and financial statements of operations including Form 990 Form 1023 and the determination letter are made available at the offices of the organization in the case of personal requests and will be sent to those individuals and organizations making a written request of same within 30 days of the receipt of the request | |
| 06. "Other" or change in accounting method (Part XII, line 1) | The organization erroneously indicated the intial method of accounting was cash not accrual All accounting methods have been consistently applied | |
| 07. Explanation of other changes in net assets or fund balances (Part XI, line 5) | The change of 2382 principally reflects timing differences in the replenishment of ATM transactions which ultimately cancel each other |
| Software ID: | |
| Software Version: |