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.") . | ||||||
| 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...... | 748,469 | 736,913 | 681,134 | 720,479 | 642,073 | 3,529,068 |
| 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. | 748,469 | 736,913 | 681,134 | 720,479 | 642,073 | 3,529,068 |
| 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.) | 3,529,068 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 748,469 | 736,913 | 681,134 | 720,479 | 642,073 | 3,529,068 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 53 | 16 | 5 | 5 | 4 | 83 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 53 | 16 | 5 | 5 | 4 | 83 |
| 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.). | 3,529,151 | |||||




| Facts And Circumstances Test |
|---|
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 2 | In order to accomplish its mission, the Organization rents | |
| facilities from an entity owned by the directors of the | ||
| Organization. The total paid to the entity for rent | ||
| was $40,600. | ||
| Pt VI, Line 11a | A copy of the Form 990 is provided to all board members | |
| before it is filed. Comments are solicited from board | ||
| members and the return is approved. | ||
| Pt VI, Line 15 | In setting compensation the organization (1) reviews and | |
| approves all amounts, (2) uses data to compare compensation | ||
| amounts, and (3) uses contemporaneous documentation and | ||
| recordkeeping for all compensation data and discussions. | ||
| Pt VI, Line 19 | The organization has copes of all governing documents and | |
| financial statements at their offices for anybody who | ||
| comes in and requests such documents. If the request for | ||
| the documents is mailed, the organization mails the copies to | ||
| the requestor within the time required by law. | ||
| Form 990EZ, Part II, Line 26 | PAYROLL TAXES PAYABLE | |
| Form 990, Part IX, Line 24f | ACTIVITES CHARGES 887. 887. 0. 0. BANK CHARGES 141. 141. 0. 0. BUILDING & VEHICLE INSURANCE 14200. 14200. 0. 0. BUILDING REPAIRS 2940. 2940. 0. 0. CHILDREN'S INSURANCE 270. 270. 0. 0. CONTINUING EDUCATION 935. 935. 0. 0. CORPORATE FILING FEES 61. 61. 0. 0. DENTAL INSURANCE 5932. 5932. 0. 0. DONATIONS 581. 581. 0. 0. ELECTRIC 7830. 7830. 0. 0. GARNISHMENT REIMBURSEMENT 352. 352. 0. 0. GAS FOR VEHICLES 5175. 5175. 0. 0. GROCERIES 60519. 60519. 0. 0. HEALTH INSURANCE 33721. 33721. 0. 0. JANITORIAL |
| Software ID: | 11000175 |
| Software Version: |