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.") . | 45,369 | 30,210 | 30,164 | 9,208 | 9,976 | 124,927 |
| 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.. | 16,830 | 14,537 | 18,095 | 21,574 | 16,018 | 87,054 |
| 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. | 62,199 | 44,747 | 48,259 | 30,782 | 25,994 | 211,981 |
| 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.) | 211,981 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 62,199 | 44,747 | 48,259 | 30,782 | 25,994 | 211,981 |
| 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.). | 62,199 | 44,747 | 48,259 | 30,782 | 25,994 | 211,981 |




| Facts And Circumstances Test |
|---|
| Qualifies for Public Charity Status Multiple Reasons Organization receives greater than 3333 of support from contributions etc Governing Body 15 board members who vote on organizational decisions Board members and officers are voted in annually in January of each year CEO does not have voting rights CEO receives a stipend that was voted on by the board of directors |
| Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Members or stockholder classes and rights (Part VI, line 6) | MEMBERS INCLUDE INDIVIDUALS WHO PAY DUES TO PARTICIPATE IN EVENTS AT A DISCOUNT AND RECEIVE NEWSLETTERS AND INFORMATION ON A REGULAR BASIS ABOUT THE ORGANIZATION AND THE PROGRAMS AND ACTIVITIES | |
| 02. Member election for additional members (Part VI, line 7a) | MEMBERS OF THE BOARD OF DIRECTORS ELECT OFFICERS ON AN ANNUAL BASIS BOARD MEMBERS ARE ALSO ELECTED | |
| 03. Governing body decisions (Part VI, line 7b) | GOVERNING BODY DECISIONS ARE MADE BY THE BOARD OF DIRECTORS WHEN A QUORUM IS PRESENT | |
| 04. Form 990 governing body review (Part VI, line 11) | THE BOARD OF DIRECTORS AND OFFICERS REVIEW AND REITERATE THE RULES REGARDING CONFLICT OF INTEREST POLICIES AT THEIR REGULAR MEETINGS THEY ARE REQUIRED IN THE BY-LAWS TO DISCLOSE ANY INTERESTS THAT COULD GIVE RISE TO CONFLICTS THE ORGANIZATION MONITORS AND ENFORCES COMPLIANCE OF THE POLICY | |
| 05. Conflict of interest policy compliance (Part VI, line 12c) | THE GOVERNING BOARD MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY BY REITERATION AT REGULAR MEETINGS OF THE BYLAWS IN RELATION TO THE CONFLICT OF INTEREST POLICY | |
| 06. CEO, executive director, top management comp (Part VI, line 15a) | THE PROCESS FOR DETERMINING THE STIPEND FOR THE CEO IS REVIEWED AND APPROVED BY THE GOVERNING BOARD | |
| 07. Governing documents, etc, available to public (Part VI, line 19) | ALL GOVERNING DOCUMENTS ARE AVAILABLE UPON REQUEST |
| Software ID: | |
| Software Version: |