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.") .... | ||||||
| 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. | ||||||
| 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.. | ||||||
| 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.") . | 116,690 | 203,379 | 53,576 | 55,453 | 45,716 | 474,814 |
| 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.. | 454,218 | 327,647 | 437,328 | 492,529 | 480,851 | 2,192,573 |
| 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. | 570,908 | 531,026 | 490,904 | 547,982 | 526,567 | 2,667,387 |
| 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.) | 2,667,387 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 570,908 | 531,026 | 490,904 | 547,982 | 526,567 | 2,667,387 |
| 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.). | 570,908 | 531,026 | 490,904 | 547,982 | 526,567 | 2,667,387 |




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | THE ORGANIZATION HAS MEMBERS. |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | MEMBERS ELECT GOVERNING BODY AT THE ANNUAL MEETING EACH YEAR. |
| DOCUMENTATION BY GOVERNING BODY | FORM 990, PAGE 6, PART VI, LINE 8A | NO DOCUMENTATION OF MEETINGS AND ACTIONS TAKEN BY THE GOVERNING BODY. |
| DOCUMENTATION BY COMMITTEE | FORM 990, PAGE 6, PART VI, LINE 8B | NO DOCUMENTATION OF MEETINGS AND ACTIONS TAKEN BY COMMITTES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. |
| POLICIES AND PROCEDURES GOVERNING CHAPTERS | FORM 990, PAGE 6, PART VI, LINE 10B | NO WRITTEN POLICIES AND PROCEDURES GOVERNING THE CHAPTERS |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | EACH MEMBER OF THE GOVERNING BODY REVIEWS THE 990 INDEPENDENTLY BEFORE FILING. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE GOVERNING BODY IS RESPONSIBLE FOR PERIODIC REVIEW TO ASSURE COMPLIANCE TO THE CONFLICT OF INTEREST POLICY. ALL DIRECTORS (THERE ARE NO EMPLOYEES) ARE COVERED UNDER THE POLICY AND MUST SIGN AN ANNUAL STATEMENT AFFIRMING THEY HAVE RECEIVED A COPY OF THE POLICY, HAVE READ AND UNDERSTOOD THE POLICY, AND AGREE TO COMPLY WITH THE POLICY INCLUDING DISCLOSING ANY ACTUAL OR POSSIBLE CONFLICTS OF INTEREST. AN INTERESTED PERSON MAY MAKE A PRESENTATION TO THE BOARD OR TO COMMITTEE MEETINGS BUT MUST EXCUSE HIMSELF FROM THE DISCUSSION AND VOTE ON THE ISSUES INVOLVING THE CONFLICT OF INTEREST. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST. |
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