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.") .... | 11,788 | 11,785 | 19,619 | 12,563 | 6,868 | 62,623 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 9,134 | 11,093 | 14,032 | 34,259 | ||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3.. | 11,788 | 11,785 | 28,753 | 23,656 | 20,900 | 96,882 |
| 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. | 96,882 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 11,788 | 11,785 | 28,753 | 23,656 | 20,900 | 96,882 |
| 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.. | 480 | 240 | 720 | |||
| 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). | 97,602 | |||||






| 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. Members or stockholder classes and rights (Part VI, line 6) | THE MEMBERS ARE ACTIVE ABLE-BODIED INDIVIDUALS WHO HAVE THE RIGHT TO VOTE ANNUALLY FOR THE BOARD OF DIRECTORS AND OFFICERS OF THE ORGANIZATION | |
| 02. Member election for additional members (Part VI, line 7a) | ACTIVE MEMBERS VOTE ANNUALLY TO ELECT THE DIRECTORS AND OFFICERS OF THE ORGANIZATION | |
| 03. Governing body decisions (Part VI, line 7b) | THE BOARD OF DIRECTORS MUST APPROVE ANY VENTURE THAT REQUIRES THE ORGANIZATION TO BORROW MONEY OR SPEND AN EXCESS OF 10000 | |
| 04. Form 990 governing body review (Part VI, line 11) | A COPY OF FORM 990 HAS BEEN GIVEN TO THE MEMBERS OF THE ORGANIZATION TO BE REVIEWED AT THE NEXT MEETING | |
| 05. Conflict of interest policy compliance (Part VI, line 12c) | IN THE EVENT OF A POSSIBLE OR REAL CONFLICT OF INTEREST ALL INTERESTED PARTIES WILL BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OF DIRECTORS AND ACTIVE MEMBERS OF THE DEPARTMENT IF A CONFLICT OF INTEREST IS DETERMINED THE INTERESTED PERSON MAY MAKE A PRESENTATION TO THE GOVERNING BODY AND THEN LEAVE THE MEETING ALTERNATIVES TO THE PROPOSED TRANSACTIONS WILL BE INVESTIGATED THE DEPARTMENT WILL DETERMINE IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT CAN BE OBTAINED THAT WILL NOT CREATE A CONFLICT OF INTEREST IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE WITHOUT A CONFLICT OF INTEREST THEN THE GOVERNING BODY SHALL DETERMINE BY A MAJORITY VOTE WHETHER ENTERING INTO THE TRANSACTION IS IN THE BEST INTEREST OF THE DEPARTMENT | |
| 06. Governing documents, etc, available to public (Part VI, line 19) | FORM 990 WILL BE MADE AVAILABLE TO THE PUBLIC BY REQUEST |
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