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.") .... | 184,961 | 227,520 | 418,033 | 451,262 | 637,933 | 1,919,709 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | 0 | 0 | 0 | 0 | 0 |
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Total. Add lines 1 through 3.. | 184,961 | 227,520 | 418,033 | 451,262 | 637,933 | 1,919,709 |
| 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).. | 1,107,071 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | 812,638 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 184,961 | 227,520 | 418,033 | 451,262 | 637,933 | 1,919,709 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 1,616 | 2,888 | 1,849 | 1,023 | 712 | 8,088 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 11 | Total support (Add lines 7 through 10). | 1,927,797 | |||||






| 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 |
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| Explanation |
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| Software ID: | 11000129 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | Process to review Form 990 before submission as follows: Prior to review by Board of Directors, Form 990 and schedules are reviewed and approved for submission by the Finance Committee. Upon approval, Form 990 is presented to the Board via email for review and discussion as needed. Consensus approval from the Board is reached and Form 990 is filed. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Process to monitor and enforce compliance with conflict of interest polict as follows: Each Board Member Commitment form states the conflict of interest policy. Any business decision involving a Board member is reviewed and any benefits to the Board member are disclosed before decisions are made. Any Board member with a conflict of interest is excluded from voting on the matter. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | Process to determine compensation of organization's CEO reviewed and approved as follows: Representatives from the Board of Directors gather annual information including salary history, completion of performance objectives, and substantiation of industry norms for compensation of CEO of similar non-profits. Data is reviewed and a recommendation made to the Board without attendance of CEO. Recommendation is voted on and approved by Board of Directors annually. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Process to make governing documents, conflict of interest policy, and financial statements available to the public is as follows: Above mentioned documents are made available upon request and annual financial statements are published in reports to funders. |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | Increase/(Decrease) in net assets as follows: Unrealized loss on investment ($310), Donated services $31,977, Donated use of facilities $6,110. |
| Software ID: | 11000129 |
| Software Version: | v1.00 |