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.") . | 14,266 | 27,920 | 28,671 | 51,068 | 38,057 | 159,982 |
| 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...... | 7,092 | 7,863 | 6,360 | 6,477 | 6,178 | 33,970 |
| 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. | 21,358 | 35,783 | 35,031 | 57,545 | 44,235 | 193,952 |
| 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.) | 193,952 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 21,358 | 35,783 | 35,031 | 57,545 | 44,235 | 193,952 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 18,384 | 7,355 | 11,045 | 7,814 | 9,053 | 53,651 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 18,384 | 7,355 | 11,045 | 7,814 | 9,053 | 53,651 |
| 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.). | 247,603 | |||||




| 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 11a | FEDERAL FORM 990 IS REVIEWED AND APPROVED BY THE BOARD OF MANAGERS PRIOR TO FILING. | |
| Pt VI, Line 12c | BOARD MEMBERS SIGN A CONFLICT OF INTEREST DOCUMENT AND DISCLOSE ANY INFORMATION. | |
| A. AWARENESS AND DISCLOSURE | ||
| DIRECTORS WILL MAINTAIN A HIGH SENSITIVITY TO POSSIBLE CONFLICT OF INTEREST WHICH MAY | ||
| EXIST IN EXERCISING CORPORATE DECISIONS. THE DIRECTOR WILL IMMEDIATELY AND PUBLICLY | ||
| RAISE THE POTENTIAL CONFLICT AT THE COMMITTEE OR BOARD MEETING. THE MEMBER SHALL | ||
| IDENTIFY THE CONFLICT OF INTEREST SITUATION PRIOR TO DISCUSSION BEING HELD BY THE | ||
| BOARD OR COMMITTEE. ANY MEMBER WHO SEES A POTENTIAL CONFLICT OF INTEREST | ||
| WITH ANOTHER BOARD MEMBER MUST DISCUSS SAID CONFLICT WITH THE MEMBER, | ||
| WITH THE BOARD PRESIDENT, OR RAISE THE ISSUE DURING A BOARD MEETING. | ||
| B. PROCEDURES | ||
| 1]. ALL PROSPECTIVE BOARD DIRECTORS WILL BE PROVIDED A COPY OF THE CONFICT OF | ||
| INTEREST POLICY. PERSONS WILL SIGN A BOARD RESPONSIBILITY COMMITMENT | ||
| FORM WHICH WILL INCLUDE AN IDENTIFICATION OF ANY POSSIBLE CONFLICT OF INTEREST. | ||
| 2]. UPON THE IDENTIFICATION OF A POTENTIAL CONFLICT OF INTEREST OF A DIRECTOR, | ||
| THAT DIRECTOR WILL IMMEDIATELY WITHDRAW FROM ANY DISCUSSION OF THE SUBJECT AND | ||
| WILL ABSTAIN FROM THE VOTE. THE DIRECTOR MAY FIND IT PRUDENT TO REMOVE HIM OR HERSELF | ||
| FROM THE MEETING IF A DISCUSSION OF HOW TO RESOLVE THE CONFLICT IS NEEDED. | ||
| 3]. THE BOARD WILL IMMEDIATELY PROCEED TO INSURE A DISINTERESTED REVIEW OF THE MATTER. | ||
| THE BOARD WILL CONSIDER THE MOST APPROPRIATE ACTION, WHICH MAY INCLUDE THE FOLLOWING: | ||
| - INSURE THE DIRECTOR WITHDRAWS FROM DISCUSSION AND VOTE ON THE ISSUE. | ||
| - DETERMINE THAT AN ON-GOING CONFLICT EXISTS WHICH WILL CONSISTENTLY | ||
| LIMIT THE DIRECTOR'S FIDUCIARY RESPONSIBILITY TO SERVE THE ORGANIZATION. | ||
| - REQUEST A SOLICITOR OPINION TO GUIDE BOARD ACTION. | ||
| 4]. THE BOARD WILL INSURE THAT THE BOARD MINUTES REFLECT IDENTIFICATION | ||
| OF THE CONFLICT, ANY DIRECTOR'S WITHDRAWAL FROM DISCUSSION AND VOTING, | ||
| Form 990, Part IX, Line 24f | MISCELLANEOUS EXPENSES | |
| AND HOW THE BEST INTEREST OF THE ORGANIZATION WAS SERVED. | ||
| Pt VI, Line 15 | THE BOARD OF MANAGERS REVIEWS AND APPROVES ANY AND ALL EXECUTIVE COMPENSATION. | |
| Pt VI, Line 19 | THESE AND OTHER DOCUMENTS ARE AVAILABLE AT THE ORGANIZATION'S ADMINISTRATIVE OFFICES. | |
| Pt XII, Line 2c | THE BOARD OF MANAGERS REVIEWS AND APPROVES THE REVIEWED FINANCIAL STATEMENTS. | |
| Pt XI | LINE 5 OTHER CHANGES OF $(28,087) REPRESENT INVESTMENT APPRECIATION (DEPRECIATION). |
| Software ID: | 11000175 |
| Software Version: |