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.") .... | 144,605 | 325,877 | 470,482 | |||
| 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.. | 144,605 | 325,877 | 470,482 | |||
| 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).. | 139,441 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | 331,041 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 144,605 | 325,877 | 470,482 | |||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 316 | 1,650 | 1,966 | |||
| 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.. | -402 | -402 | ||||
| 11 | Total support (Add lines 7 through 10). | 472,046 | |||||






| 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 |
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| Explanation |
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| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The form is reviewed by the Board Treasurer and other | |
| members of the Board. All questions are reviewed to make | ||
| certain that there are no incorrect answers. | ||
| Pt VI, Line 19 | Upon request, they are provided to grantors, contributors, | |
| and Board members. | ||
| Pt XI | Changes In Net Assets: | |
| Prior Period Adjustment At 1/1/11 - 102 | ||
| Unrealized gain on securities held at 12/31/11 - 829 | ||
| TOTAL 931 | ||
| Pt XII, Line 1 | Reason for change in accounting method - The Organization | |
| is now having an annual audit. They are required to be | ||
| on the accrual basis beginning in 2011. | ||
| Pt VI, Line 4 | Amended by-laws were enacted during 2011.The number and | |
| terms of the members of the Board of Directors were | ||
| changed, and a provision was added regarding how a | ||
| deadlock should be managed if Board members cannot reach a | ||
| decision about important Organization matters. | ||
| Pt VI, Line 6 | The Organization has members that pay a fee and are | |
| entitled to serve on special advisory Boards and | ||
| committees. | ||
| Pt VI, Line 12c | Questionnaires are required to be completed by all | |
| Board members annually. Should there be reasons for | ||
| concern, there is a detailed review of all | ||
| transactions that appear to be a cause for concern. | ||
| Form 990EZ, Part I, Line 16 | BANK FEES FEDERAL FEES ACCOUNTING FEES STATE REGISTRATION FEES OFFICE EXPENSE | |
| Form 990, Part IX, Line 24f | PRINTING 17. 17. 0. 0. TELEPHONE 21. 21. 0. 0. VOLUNTEER EXPENSES 171. 171. 0. 0. PROFESSIONAL FEES 485. 485. 0. 0. OPERATIONS 252. 252. 0. 0. |
| Software ID: | 11000175 |
| Software Version: |