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.") .... | 388,189 | 504,051 | 403,149 | 388,727 | 1,684,116 | |
| 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.. | 388,189 | 504,051 | 403,149 | 388,727 | 1,684,116 | |
| 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. | 1,684,116 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 388,189 | 504,051 | 403,149 | 388,727 | 1,684,116 | |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 718 | 3,360 | 434 | 4,512 | ||
| 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). | 1,688,628 | |||||






| 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: | 11000218 |
| Software Version: | 2011.0.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990 Part VI | 6 | About 50 members of the Company to provide fire/ems services |
| Form 990 Part VI | 7a | Members vote for gov. body on a yearly basis |
| Form 990 Part VI | 7b | Members meet monthly to review activities. Items are brought to the general membership for discussion and voting. |
| Form 990 Part VI | 11-11a | Completed 990 is presented at the regular meeting of the company. |
| Form 990 Part VI | 12c | All conflict of interest issues are directed to the president to monitor and discussed for compliance with the board at a regular meeting. |
| Form 990 Part VI | 19 | The company has policies, financial statements, and 990 available for public inspection at the fire house. |
| Form 990 Part VI | 15a | No one at the company is compensated |
| Form 990 Part XI | 5 | Ladies Aux activity and adjustments to net assets. |
| Form 990 Part VI Section A Line 6 About 50 members of the Company to provide fire/ems services Form 990 Part VI Section A Line 7a Members vote for gov. body on a yearly basis Form 990 Part VI Section A Line 7b Members meet monthly to review activities. Items are brought to the general membership for discussion and voting. Form 990 Part VI Section B Line 11-11a Completed 990 is presented at the regular meeting of the company. Form 990 Part VI Section B Line 12c All conflict of interest issues are directed to the president to monitor and discussed for compliance with the board at a regular meeting. Form 990 Part VI Section C Line 19 The company has policies, financial statements, and 990 available for public inspection at the fire house. Form 990 Part VI Section B Line 15a No one at the company is compensated Form 990 Part XI Line 5 Ladies Aux activity and adjustments to net assets. |
| Software ID: | 11000218 |
| Software Version: | 2011.0.0 |