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.") .... | 148,666 | 57,841 | 45,686 | 26,269 | 66,764 | 345,226 |
| 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.. | 148,666 | 57,841 | 45,686 | 26,269 | 66,764 | 345,226 |
| 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. | 345,226 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 148,666 | 57,841 | 45,686 | 26,269 | 66,764 | 345,226 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 131 | 6 | 248 | 220 | 460 | 1,065 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | 12,068 | 12,728 | 24,796 | |||
| 10 | Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets.. | 2,200 | 1,600 | 5,016 | 8,816 | ||
| 11 | Total support (Add lines 7 through 10). | 379,903 | |||||






| 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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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Officer, directors, etc. family relationship (Part VI, line 2) | VICE PRESIDENT RYAN FETZER AND SECRETARY REBECCA FETZER ARE RELATED BY MARRIAGE | |
| 02. Members or stockholder classes and rights (Part VI, line 6) | THE ENTITY IS ORGANIZED AS A VOLUNTEER FIRE DEPARTMENT INDIVIDUALS MAY APPLY FOR MEMBERSHIP AND ARE APPROVED BY CURRENT MEMBERS | |
| 03. Member election for additional members (Part VI, line 7a) | THE GOVERNING BOARD IS ELECTED FROM AMONG THE MEMBERS IN GOOD STANDING OF THE ORGANIZATION | |
| 04. Governing body decisions (Part VI, line 7b) | THE MEMBERS OF THE ORGANIZATION APPROVE SIGNIFICANT DECISIONS OR ACTIONS OF THE GOVERNING BOARD | |
| 05. Governing body meeting documentation (Part VI, line 8a) | THE SECRETARY OR ANOTHER DESIGNATED MEMBER IS RESPONSIBLE FOR PREPARING WRITTEN RECORDS OF THE ACTIONS OF THE GOVERNING BOARD AND THE MEMBERS AT LARGE | |
| 06. Form 990 governing body review (Part VI, line 11) | FORM 990 IS PREPARED BY AN INDEPENDANT PREPARER THE GOVERNING BOARD DESIGNATES A MEMBER OR MEMBERS OF THE BOARD TO ACT AS LIASON AND THAT MEMBERS REVIEW THE RETURN WITH THE PREPARER BEFORE SUBMISSION TO THE BOARD FOR APPROVAL AND FILING | |
| 07. Governing documents, etc, available to public (Part VI, line 19) | THE GOVERNING DOCUMENTS AND FORM 990 MAY BE INSPECTED BY ANY MEMBER OF THE GENERAL PUBLIC UPON REQUEST TO THE BOARD OF DIRECTORS REQUESTS BY ANY INDIVIDUAL OR ORGANZATION TO INSPECT FINANCIAL AND OTHER INTERNAL DOCUMENTS ARE GRANTED OR DENIED BY THE BOARD OF DIRECTORS ON A CASE-BY-CASE BASIS | |
| 08. Explanation of other changes in net assets or fund balances (Part XI, line 5) | ROUNDING ADJUSTMENT |
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