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.") .... | 1,091,062 | 1,122,380 | 1,119,150 | 1,366,937 | 1,322,028 | 6,021,557 |
| 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.. | 1,091,062 | 1,122,380 | 1,119,150 | 1,366,937 | 1,322,028 | 6,021,557 |
| 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. | 6,021,557 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 1,091,062 | 1,122,380 | 1,119,150 | 1,366,937 | 1,322,028 | 6,021,557 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 144 | 99 | 243 | |||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | 160 | 160 | ||||
| 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). | 6,021,960 | |||||






| 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 |
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| Explanation |
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| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The 990 is maintained in the finance office and a copy is kept at the fron desk of each location for review by anyone requesting the information. The 990 is also available on line for board members for review . | |
| Pt VI, Line 12c | The finance director presents the policy annualy at board meetings or at given board meetings where a conflict is probable | |
| Pt VI, Line 15 | The board of directors has a personnel committee to review the process of selection of a CEO and the related salary associated with the position as well as similar positions held at satellite offices | |
| Pt VI, Line 19 | currently a copy is maintained at the front desk of each location and in the finance office. Efforts are underway to place the forms via PDF format on the website. | |
| Form 990, Part III, Line 4d | INDEPENDENT CARE WAIVER PROGRAM, IMMAGRANT SERVICES, 309655. 0. 255728. | |
| Form 990, Part IX, Line 24f | PARKING 6728. 6728. PEER SUPPORT 3238. 3238. POSTAGE 5688. 5688. PRINTING 2270. 2270. TRANSITION SERVICES 8077. 8077. VEHICLE EXPENSES 71. 71. COMPUTER EXPENSES 10566. 10566. AUDIT AND PAYROLL FEES 9265. 9265. HOME MODIFICATION MATERIALS 1344. 1344. JOB ACCESIBILITY 3129. 3129. TELEPHONE 18806. 18806. VTAP VOUCHER PAYMENTS 45694. 45694. ADAPT EXPENSES 5658. 5658. |
| Software ID: | 11000175 |
| Software Version: |