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.") .... | 343,796 | 326,751 | 351,239 | 344,020 | 141,256 | 1,507,062 |
| 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.. | 343,796 | 326,751 | 351,239 | 344,020 | 141,256 | 1,507,062 |
| 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. | 1,507,062 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 343,796 | 326,751 | 351,239 | 344,020 | 141,256 | 1,507,062 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 626 | 626 | ||||
| 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.. | 1,932 | 1,932 | ||||
| 11 | Total support (Add lines 7 through 10). | 1,509,620 | |||||






| 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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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
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| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE EXECUTIVE BOARD IS PRESENTED COPIES OF THE MONTHLY, QUARTERLY, AND END OF YEAR FINANCIAL STATEMENTS AND SERVICE REPORTS FOR THE REVIEW OF THE 990. AFTER THE 990 IS REVIEWED, THE DIRECTOR IS RESPONSIBLE TO SIGN AND SUBMIT. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | EMPLOYEES AND THE EXECUTIVE BOARD MEMBERS ARE TO DISCLOSE TO THE DIRECTOR, IN WRITING, ANY EMPLOYMENT OR FINANCIAL OPPORTUNITY THAT COULD BE IN VIOLATION OF THE ENTITY'S CONFLICT OF INTEREST POLICY OR THAT COULD ADVERSELY AFFECT THE AGENCY. ANY TIME THIS OCCURS, IT IS THE RESPONSIBILITY OF THE DIRECTOR TO FOLLOW THE GUIDLINES AND COLLECT NECESSARY DATA TO DETERMINE IF THERE IS A POSSIBLE CONFILICT OF INTEREST. INFORMATION WOULD THEN BE PRESENTED TO THE EXECUTIVE BOARD FOR DETERMINATION. THE PERSON FILING THE DISCLOSURE IS ALWAYS ALLOWED TO PRESENT HIS/HER CASE TO THE EXECUTIVE BOARD. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | THE ORGANIZATION POSTS WRITTEN PROCEDURE THAT DEFINES THE STEPS FOR THE PUBLIC TO TAKE TO OBTAIN INFORMATION REGARDING THE CONFLICT OF INTEREST POLICY, GRIEVANCE POLICY, FINANCIAL STATUS, NAMES OF THE EXECUTIVE BOARD, AND BY-LAWS ON A BULLETING BOARD INSIDE THE CENTER. ALL REQUESTS MUST BE IN WRITING. THE WRITTEN REQUESTS ARE MADE AVAILABLE AT THE ORGANIZATION'S EXPENSE. |
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