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.") . | 2,411 | 2 | 2,413 | |||
| 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...... | 26,995 | 18,847 | 22,015 | 33,910 | 34 | 101,801 |
| 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. | 26,995 | 18,847 | 22,015 | 36,321 | 36 | 104,214 |
| 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.) | 104,214 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 26,995 | 18,847 | 22,015 | 36,321 | 36 | 104,214 |
| 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.). | 26,995 | 18,847 | 22,015 | 36,321 | 36 | 104,214 |




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ALL OTHER ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4D | CIVIC ORGANIZATION FORMED TO RAISE FUNDS FOR CHARITIES AND SCHOLARSHIPS. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 WAS EMAILED TO EVERY BOARD MEMBER. THE BOARD MEMBERS WERE REQUESTED IN THE EMAIL TRANSMISSION TO ACKNOWLEDGE RECEIPT OF THE FORM 990. ADDITIONALLY, THEY WERE REQUESTED TO REVIEW THE FORM AND CONTACT THE PRESIDENT AND/OR TREASURER CONCERNING ANY QUESTIONS THEY HAVE BEFORE THE BOARD MEETING WHEN THE FORM 990 IS REVIEWED IN ITS ENTIRETY. THE BOARD MEMBERS WERE INSTRUCTED THAT FORM 990 INSTRUCTIONS ARE AVAILABLE ONLINE AT WWW.IRS.GOV. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | THE BOARD MEMBERS OF THE ORGANIZATION DISCUSS THE CONFLICT OF INTEREST POLICY AT LEAST ANNUALLY. AT A BOARD MEETING, NEW CONFLICT OF INTEREST STATEMENTS ARE SIGNED BY EACH BOARD MEMBER. THE SIGNED STATEMENTS ARE MAINTAINED BY THE SECRETARY AND ARE AVAILABLE FOR INSPECTION UPON REQUEST TO THE GENERAL PUBLIC. THE STATEMENTS ARE UPDATED ANNUALLY. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | UPON REQUEST. |
| OTHER EXPENSES | FORM 990, PART IX, LINE 24E | BINGO EXPENSES 1,763 GREEN HAT 1,500 MEALS 1,008 GOLF SHIRTS WHITE / LOGO 616 STUDENT/TEACHER OF THE MO 600 DELRAY AFFAIR EXPENSES 500 RYLA 400 4TH OF JULY CONTEST EXPEN 338 WREATH EXPENSE 320 STORAGE RENTSL 254 SUPPLIES 86 LICENSES AND TAXES 75 |
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