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.") .... | 3,250 | 4,959 | 6,880 | 15,089 | ||
| 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.. | 3,250 | 4,959 | 6,880 | 15,089 | ||
| 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. | 15,089 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 3,250 | 4,959 | 6,880 | 15,089 | ||
| 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). | 15,089 | |||||






| 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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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | Article 9 Committees Section 4 Audit Committee Paragraph 5 - The Audit Committee shall confer with the auditor to satisfy its members that the corporations financial affairs are in order and shall review and determine whether to accept the audit Article 12 Records and Reports Section 5 Reports The Board shall cause an annual report to be sent to all directors within 120 days after the end of the corporations fiscal year | |
| 02. Conflict of interest policy compliance (Part VI, line 12c) | Article 8 Standard of Care Section 3 Conflict of Interest To protect the corporations interest when it is contemplating entering into a transaction or arrangement that might benefit the private interest of one of its officers or directors or that might otherwise result in a possible excess benefit transaction This policy is intended to supplement but not replace any applicable California and federal laws governing conflict of interest applicable to nonprofit and charitable corporations and is not intended as an exclusive statement of responsibilities | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | Article 8 Standard of Care Section 5 Compensation Review The Board shall review the fairness of compensation including benefits paid to the Chairperson of the Board and the Treasurer upon the occurrence of the following events a The officer is hired b The officers term of employment is extended or renewed or c The officers compensation is modified unless such modification occurs pursuant to a general modification of compensation that extends to all employees Section 6 Periodic Reviews Periodic reviews shall be conducted to ensure the Corporation operate in a manner consistent with charitable pruposes and oes not engage in activities that could jeopardize its tax exempt status | |
| 04. Other officer or key employee compensation (Part VI, line 15b | Article 8 Standard of Care Section 5 Compensation Review The Board shall review the fairness of compensation including benefits paid to the Chairperson of the Board and the Treasurer upon the occurrence of the following events a The officer is hired b The officers term of employment is extended or renewed or c The officers compensation is modified unless such modification occurs pursuant to a general modification of compensation that extends to all employees | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | Article 12 Records and Reports Section 2 The corporation shall keep at its principal officea copy of its federal tax exemption application and its annual information returns for three years from their date of filing which shall be open to public inspection and copying to the extent required by law |
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