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 | ||||
| (1)
YMCA OF WAYNESBORO VA INC |
540633243 | 501(c)(3) | Yes | Yes | Yes | 25,000 | |||
| Total | 25,000 | ||||||||
| 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. | 0 | |||||
| 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.. | 0 | |||||
| 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.") . | ||||||
| 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.) | 0 | |||||
| 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 |
|---|
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 8a | THE BOARD OF TRUSTEES OF THE WAYNESBORO YMCA | |
| FOUNDATION MET FOUR TIMES DURING 2011, AND | ||
| ALL MEETINGS WERE CONTEMPORANEOUSLY DOCUMENTED | ||
| IN MINUTES OF MEETINGS OF THE BOARD OF | ||
| TRUSTEES. | ||
| Pt VI, Line 8b | THE BOARD OF TRUSTEES OF THE WAYNESBORO YMCA | |
| FOUNDATION CONSISTS OF SIX BOARD MEMBERS, WITH | ||
| NO SPECIFIC SUB-COMMITTEES. | ||
| Pt VI, Line 11a | A DRAFT OF FORM 990 WAS PREPARED AND DELIVERED TO | |
| THE EXECUTIVE DIRECTOR PRIOR TO FILING, AND THE | ||
| EXECUTIVE DIRECTOR REVIEWED THE DRAFT FORM 990 | ||
| IN DETAIL WITH THE MEMBERS OF THE WAYNESBORO YMCA | ||
| FOUNDATION BOARD OF TRUSTEES. | ||
| Pt VI, Line 12c | IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT | |
| OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE | ||
| EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE | ||
| OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE | ||
| DIRECTORS/TRUSTEES AND MEMBERS OF COMMITTEES WITH | ||
| GOVERNING BOARD DELEGATED POWERS CONSIDERING THE | ||
| TRANSACTION OR ARRANGEMENT. EACH DIRECTOR/TRUSTEE, | ||
| PRINCIPAL OFFICER, AND MEMBER OF A COMMITTEE WITH | ||
| GOVERNING BOARD DELEGATED POWERS SHALL ANNUALLY | ||
| SIGN A STATEMENT WHICH AFFIRMS THAT SUCH PERSON HAS | ||
| RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; | ||
| HAS READ AND UNDERSTANDS THE POLICY; HAS AGREED TO | ||
| COMPLY WITH THE POLICY; AND UNDERSTANDS THE | ||
| ORGANIZATION IS CHARITABLE AND, IN ORDER TO MAINTAIN ITS | ||
| FEDERAL TAX EXEMPTION, MUST ENGAGE PRIMARILY IN | ||
| ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS | ||
| TAX-EXEMPT PURPOSES. | ||
| Pt VI, Line 15 | JEFFERY D. FIFE SERVES AS THE EXECUTIVE DIRECTOR OF | |
| THE YMCA OF WAYNESBORO VA, INC. ("YMCA"), AND ALSO | ||
| AS THE EXECUTIVE DIRECTOR OF THE WAYNESBORO YMCA | ||
| FOUNDATION, A TYPE I SUPPORTING ORGANIZATION | ||
| CONTROLLED BY THE YMCA. MR. FIFE IS COMPENSATED | ||
| BY THE YMCA FOR HIS SERVICES TO BOTH ORGANIZATIONS, | ||
| AND HIS COMPENSATION IS DETERMINED AND MONITORED | ||
| BY THE YMCA'S BOARD OF DIRECTORS AS A PART OF ITS | ||
| ANNUAL BUDGETING PROCESS. | ||
| Pt VI, Line 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, | |
| CONFLICT OF INTEREST POLICY, WHISTLEBLOWER POLICY, | ||
| AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC | ||
| UPON REQUEST AT THE ORGANIZATION OFFICES IN | ||
| WAYNESBORO, VIRGINIA. |
| Software ID: | 11000175 |
| Software Version: |