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. | 0 | |||||
| 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.") . | 78,907 | 408,541 | 505,162 | 701,320 | 662,223 | 2,356,153 |
| 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...... | 3,845,536 | 3,222,735 | 2,334,906 | 1,880,969 | 2,327,785 | 13,611,931 |
| 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. | 3,924,443 | 3,631,276 | 2,840,068 | 2,582,289 | 2,990,008 | 15,968,084 |
| 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.) | 15,968,084 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 3,924,443 | 3,631,276 | 2,840,068 | 2,582,289 | 2,990,008 | 15,968,084 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 22,152 | 8,105 | 4,445 | 3,217 | 1,866 | 39,785 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | |||||
| c | Add lines 10a and 10b. | 22,152 | 8,105 | 4,445 | 3,217 | 1,866 | 39,785 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | |||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 12,223 | 10,684 | 8,384 | 9,116 | 14,543 | 54,950 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 3,958,818 | 3,650,065 | 2,852,897 | 2,594,622 | 3,006,417 | 16,062,819 |




| Facts And Circumstances Test |
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| Part III Line 12 The line includes vending income and miscellaneous income |
| Explanation |
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| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 11b | The executive director reviews the form when it is signed |
| Form 990 Part VI | 12c | Reviewed annually at board meeting |
| Form 990 Part VI | 15b | Determined by the board of directors |
| Form 990 Part III Program Service Accomplishments | Line 4d Other Activities | Program Service Expenses 154,166, Grants and allocations 0, Revenue 0 Participated in a study to evaluate whether concurrent smoking cessation treatment improves, worsens, or has no effect on stimulant-use outcomes in smokers who are in outpatient substance abuse treatment for cocaine or methamphetamine dependence |
| Form 990, Part III, Line 4d Program Service Expenses 154,166, Grants and allocations 0, Revenue 0 Participated in a study to evaluate whether concurrent smoking cessation treatment improves, worsens, or has no effect on stimulant-use outcomes in smokers who are in outpatient substance abuse treatment for cocaine or methamphetamine dependence Form 990 Part VI Section B Line 11b The executive director reviews the form when it is signed Form 990 Part VI Section B Line 12c Reviewed annually at board meeting Form 990 Part VI Section B Line 15b Determined by the board of directors |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |