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.") .... | 50,948 | 43,525 | 4,377 | 802 | 2,104 | 101,756 |
| 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.. | 50,948 | 43,525 | 4,377 | 802 | 2,104 | 101,756 |
| 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. | 101,756 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 50,948 | 43,525 | 4,377 | 802 | 2,104 | 101,756 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 9,477 | 7,995 | 4,190 | 920 | 2,297 | 24,879 |
| 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.. | 5,758 | 912 | 10,531 | 3,828 | 21,029 | |
| 11 | Total support (Add lines 7 through 10). | 147,664 | |||||






| 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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| Other income Part II line 10 or Part III line 12 General Explanation - Line 10 2006 5758 2007 912 XXX-XX-XXXX 2009and 3828 2010 are sales of inventory less cost of goods sold and miscellaneous income Insurance proceeds related to fire damage of 150602 in 2009 was not included in support due to the fact it is considered to be gain from disposition of property capital assets |
| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | Form 990 Part VI Section B Line 11 - A final draft version of 990 is provided by email to the Board of Directors for review feedback and comments prior to approval and filing with the IRS Form 990 Part VI Section B Line 15 - The Board of Directors and the Executive Director develop goals annually Employee performance is compared to set goals before pay increases are implemented | |
| 02. Conflict of interest policy compliance (Part VI, line 12c) | Form 990 Part VI Section B Line 12c - Compliance to conflict of interest policy is monitored by annually providing a list of major organization members to Board of Directors and requesting their review The policy covers all Board Members the Executive Director and Key Employees If a Board Member stands to economically benefit from agreements or contracts implemented by the organization then that Board member may not participate in deliberations and decisions regarding the transaction | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | The process for determing compensation for the top management official is based upon the Board Members review of competitive compensation for similar postions and the compensation deliberation and decision is made by the Board | |
| 04. Other officer or key employee compensation (Part VI, line 15b | The process for determining compensation for officers or key employees other than the top management official is based upon the Board Members review of oompetitive compensation for similar positions and the compensation deliberation and decision is made by the Board | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | The organization govening documents conflict of interest policy and financial statements are available for review upon request | |
| 06. Explanation of other changes in net assets or fund balances (Part XI, line 5) | Other changes line as part of reconciliation of net assets is changes in liabilities adjustment |
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