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.") . | 136,152 | 216,154 | 221,675 | 221,682 | 184,671 | 980,334 |
| 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...... | 164,291 | 121,865 | 176,984 | 218,847 | 681,987 | |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 675 | 8,915 | 9,590 | |||
| 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. | 136,152 | 380,445 | 343,540 | 399,341 | 412,433 | 1,671,911 |
| 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.) | 1,671,911 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 136,152 | 380,445 | 343,540 | 399,341 | 412,433 | 1,671,911 |
| 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. | 6,368 | 50,974 | 57,342 | |||
| 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.). | 1,729,253 | |||||




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 8b | NO INDIVIDUAL COMMITTEES, GOVERNING BODY ONLY | |
| Pt VI, Line 11a | FORM 990 PROVIDED TO GOVERNING BODY FOR REVIEW | |
| PRIOR TO FILING | ||
| Pt VI, Line 15 | COMPENSATION OF EXECUTIVE DIRECTOR AND SHELTER STAFF | |
| WAS DISCUSSED AND APPROVED BY THE GOVERNING BODY BASED | ||
| UPON REASONABLE, COMPARATIVE PAY LEVELS AND BUDGET | ||
| RESTRAINTS. | ||
| Pt VI, Line 19 | DOCUMENTS ARE PROVIDED UPON REQUEST | |
| Form 990, Part IX, Line 24f | TELEPHONE 1151. 921. 173. 57. WEBSITE FEES 40. 40. POSTAGE & MAILING SVC 3239. 810. 2429. PRINTING & COPYING 894. 447. 447. EQUIPMENT RENTAL 477. 119. 358. 0. REPAIRS & MAINTENANCE 3215. 2680. 535. VEHICLE EXPENSES 3406. 2725. 681. BUSINESS LICENSES 500. 410. 90. DUES & MEMBERSHIPS 450. 450. IN-KIND SHELTER SUPPLIES 751. 434. 317. IN-KIND OFFICE SUPPLIES 1648. 492. 1156. IN-KIND PRINTING 554. 554. IN-KIND SUBSCRIPTIONS 437. 107. 330. IN-KIND TRAVEL 1789. 1789. |
| Software ID: | 11000175 |
| Software Version: |