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.") . | 137,676 | 211,846 | 171,613 | 217,145 | 187,593 | 925,873 |
| 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...... | 6,332 | 14,334 | 12,976 | 22,250 | 55,892 | |
| 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. | 137,676 | 218,178 | 185,947 | 230,121 | 209,843 | 981,765 |
| 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.) | 981,765 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 137,676 | 218,178 | 185,947 | 230,121 | 209,843 | 981,765 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 5,068 | 2,684 | 1,077 | 260 | 80 | 9,169 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 5,068 | 2,684 | 1,077 | 260 | 80 | 9,169 |
| 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.) | 2,404 | 2,404 | ||||
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 145,148 | 220,862 | 187,024 | 230,381 | 209,923 | 993,338 |




| 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) | The chairman of the board and one of the directors are married | |
| 02. Form 990 governing body review (Part VI, line 11) | UPON RECEIVING THE FORM 990 FROM OUR ACCOUNTANT THE BOARD WILL REVIEW IT AND EACH BOARD MEMBER WILL REPLY WITH ASSENT OR DISAGREEMENT THE FORM MAY BE MAILED OR ATTACHED TO AN EMAIL THEIR REPLY WILL BE BY EMAIL | |
| 03. Conflict of interest policy compliance (Part VI, line 12c) | THE BOARD RECENTLY APPROVED A WRITTEN CONFLICT OF INTEREST POLICY | |
| 04. CEO, executive director, top management comp (Part VI, line 15a) | THE BOARD MEETS ANNUALLY TO DETERMINE THE DIRECTORS SALARY BASED ON HIS NEED GRACELIFES INCOME EXPENSES AND COMPARABLE SALARIES IN SIMILAR ORGANIZATIONS | |
| 05. Other officer or key employee compensation (Part VI, line 15b | THE BOARD MEETS ANNUALLY TO DETERMINE SUPPORT STAFF WAGES BASED ON GRACELIFES INCOME EXPENSES AND COMPARABLE WAGES IN SIMILAR ORGANIZATIONS | |
| 06. Governing documents, etc, available to public (Part VI, line 19) | DOCUMENTS ARE AVAILABLE UPON REQUEST SOME DOCUMENTS ARE AVAILABLE AT OUR WEBSITE GRACELIFEORG AND THROUGH GUIDESTARORG | |
| 07. Explanation of other changes in net assets or fund balances (Part XI, line 5) | ADJUSTEMENT OF ACCUMULATED DEPRECIATION AND ROUNDING |
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