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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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.. | 0 | |||||
| 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.") . | 51,872 | 22,589 | 35,587 | 31,974 | 27,164 | 169,186 |
| 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...... | 4,529 | 547 | 1,615 | 11,933 | 1,667 | 20,291 |
| 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. | 56,401 | 23,136 | 37,202 | 43,907 | 28,831 | 189,477 |
| 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.) | 189,477 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 56,401 | 23,136 | 37,202 | 43,907 | 28,831 | 189,477 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 13,969 | 9,147 | 11,724 | 6,235 | 18,330 | 59,405 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 13,969 | 9,147 | 11,724 | 6,235 | 18,330 | 59,405 |
| 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.). | 248,882 | |||||




| Facts And Circumstances Test |
|---|
| OTHER ADDL INFO: PART III, LINE 1 UNUSUAL GRANT 2011 - $165,278; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 2 | CHESTER RILEY, JOHN RILEY - FAMILY RELATIONSHIP | |
| Pt VI, Line 2 | AIMEE TOOKER, DUANE JAHANNSEN - FAMILY RELATIONSHIP | |
| Pt VI, Line 6 | ALL INDIVIDUALS IN THE ORGANIZATION ARE EITHER | |
| PROBATIONARY OR ACTIVE MEMBERS. | ||
| Pt VI, Line 7a | AN ACTIVE MEMBER SHALL BE ENTITLED TO ONE VOTE AT | |
| MEETINGS. AN ACTIVE MEMBER SHALL BE ENTITLED TO | ||
| NOMINATE MEMBERS FOR ELECTED POSITIONS. THE DIRECTORS | ||
| AND OFFICERS SHALL BE ELECTED AT THE ANNUAL MEETING. | ||
| Pt VI, Line 7b | A MEMBER DIRECTOR MAY BE REMOVED WITH OR WITHOUT CAUSE | |
| BY A MAJORITY VOTE OF THE MEMBERSHIP ONLY AT A | ||
| SPECIAL MEETING CALLED FOR THE PURPOSE OF REMOVING | ||
| THAT MEMBER. | ||
| Pt VI, Line 11a | THE FORM 990 IS REVIEWED BY THE FINANCE COMMITTEE OF | |
| THE ORGANIZATION. THE FORM 990 IS THEN SENT TO THE | ||
| BOARD OF DIRECTORS FOR THEIR REVIEW AND APPROVAL | ||
| PRIOR TO FILING. | ||
| Pt VI, Line 19 | A COPY OF THE FORM 990 FOR PUBLIC INSPECTION IS ON | |
| FILE AT THE BUSINESS OFFICE OF THE ORGANIZATION. A | ||
| COPY OF THE BYLAWS, CONFLICT OF INTEREST POLICY, | ||
| POLICY & PROCEDURES MANUAL AND FINANCIAL STATEMENTS | ||
| ARE ON FILE AT THE BUSINESS OFFICE OF THE ORGANIZATION | ||
| FOR PUBLIC INSPECTION. |
| Software ID: | 11000175 |
| Software Version: |