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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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.") . | 56,513 | 80,138 | 61,099 | 51,653 | 47,300 | 296,703 |
| 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...... | 42,374 | 59,683 | 48,401 | 40,938 | 32,476 | 223,872 |
| 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. | 98,887 | 139,821 | 109,500 | 92,591 | 79,776 | 520,575 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 900 | 100 | 515 | 1,225 | 2,740 | |
| 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. | 5,000 | 5,000 | ||||
| c | Add lines 7a and 7b.. | 5,900 | 100 | 515 | 1,225 | 7,740 | |
| 8 | Public Support (Subtract line 7c from line 6.) | 512,835 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 98,887 | 139,821 | 109,500 | 92,591 | 79,776 | 520,575 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 34 | 16 | 23 | 13 | 1 | 87 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 34 | 16 | 23 | 13 | 1 | 87 |
| 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.) | 616 | 392 | 572 | 1,421 | 3,001 | |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 98,921 | 140,453 | 109,915 | 93,176 | 81,198 | 523,663 |




| Facts And Circumstances Test |
|---|
| FUNDRAISER INCOME-$1268 TAX DISCOUNT INCOME-$2 REFUNDS-$58 MISC INCOME-$60 INSURANCE REFUND-$33 |
| Explanation |
|---|
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| PART 1 LINE 8-REVENUE: TAX DISCOUNT INCOME-$2 REFUNDS-$58 MISC INCOME-$60 INSURANCE REFUND-$33 PART 1 LINE 10-GRANTS MISC HUMANITARIAN ASSISTANCE-$17285 FOOD PANTRY DONATIONS-$259 GOLDEN ECHOES DONATIONS-$289 RUSSELL HOUSE SHELTER-$150 LIFELINE PREGNANCY CENTER-$150 WIDOWS MEETING LUNCHEONS-$1060 PART 1 LINE 10-EXPENSES: GRANTS-ASSISTANCE PD OUT-$19183 FOOD PANTRY DONATIONS-$2063. GOLDEN ECHOES DONATIONS-$2064. RUSSELL HOUSE SHELTER-$600. LIFELINE PREGNANCY SHELTER-$600. MOWING ASSISTANCE-$2700. WIDOWS LUNCHEONS-$1340. LINE 16-OTHER EXPENSES: REGISTER CASH SHORTAGES-$25 FLOWERS/FUNERAL EXPENSE-$25 BANK CHARGES-$116 RETURN CHARGES-$68 SUPPLIES-$1731 TELEPHONE-$820 VEHICLE EXPENSE-$217 GENERAL LIABILITY INS-$482 MILEAGE REIMBURSEMENTS-$163 EQUIPMENT RENTAL-$50 FUNDRAISER EXPENSE-$43 PAYROLL TAX EXPENSE-$894 MISC EXPENSE-$30 DEPRECIATION EXPENSE-$1384 LINE 20-ASSET CHANGES DISPOSITION OF ASSETS-$28 Part II-Line 24 Other assets: EQUIPMENT-$2232 LESS ACCUMULATED DEP-(1913) NONCASH INVENTORY-$9674 Part II-Line 26 Liabilities: FCNB Loan-$31724 Current Liabilities-$1278 Part V-Line 35: ALL ITEMS SOLD THROUGH THE RETAIL STORE ARE DONATED BY THE GENERAL PUBLIC AND ALL PROCEEDS ARE USED TO FUND THE ORGANIZTAIONS PURPOSE. |
| Software ID: | |
| Software Version: |
| Person Name | Explanation |
|---|---|
| DARLA VANCE | SERVED AS MANAGER AND DIRECTOR OF MISSIONS STORE PROGRAM |