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.") . | 8,122 | 46,004 | 29,179 | 26,894 | 110,199 | |
| 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. | 0 | 8,122 | 46,004 | 29,179 | 26,894 | 110,199 |
| 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.) | 110,199 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 8,122 | 46,004 | 29,179 | 26,894 | 110,199 |
| 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.). | 0 | 8,122 | 46,004 | 29,179 | 26,894 | 110,199 |




| Facts And Circumstances Test |
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| Explanation |
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| The Purpose of Charity - is to build awareness of childhood cancer, raise funds for pediatric cancer research and to provide resources and neccessities to aid both the child and their family during their cancer journey. |
| Expenses - 1. Backpacks for kids, each newly diagnosed child will receive a backpack with toys and stuff to help entertain them while they are in treatment. In 2011 we created 97 bags. Expense = $6,210.83 2. Necessity bags for families at Sparrow Hospital of newly diagnosed children with cancer or other life threatening illnesses receive a bag that contains toiletries and helpful items needed for an extended hospital stay. In 2011 we distributed 20 bags. 3. Expense = $773.83 Toy box - when a child has a procedure, blood draw, or just needs a little lift while they are at MSU Pediatric Clinic they can choose a toy out of the toy box. We contribute to 25+ children weekly. Expense = $265.06 4. Gas Cards are used to travel back and forth from the clinic and/or hospital several times a month. We provide gas cards for those in need of some assistance with their transportation cost. In 2011 we distributed 100 cards ranging from $5 to $25 each. Expense = $1,900.00 5. Snack Pantry - clinic visits can be long (hours) and we provide a snack box at MSU Pediatric Clinic for patient use. In 2011 we provided snacks for 25+ patients who make weekly visits. Expense = $643.84. 6. Promotional goods and fees to help build awareness to childhood cancer and are used for fundraising events. Total expenses for 2011 = $4,808.74. 7. Christmas wreaths and baskets provided to families that are admitted to Sparrow Hospital over Christmas. These services were provided to 10 families. Total expense for 2011: $227.00 8. Donation made to fund pediatric research. 13,500 children on average are diagnosed with cancer each year. There are currently 30,000-40,000 children fighting cancer in the U.S. Total donations for 2011 = $9,055.00 Total support expenses = $23,884.30 |
| Software ID: | 11000129 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P01_S00_L06 | Form 990, Part I, Line 6 | ALL PROGRAMS ARE RUN AND MAINTAINED BY VOLUNTEERS. WE HAVE VARIOUS VOLUNTEERS THAT WORK DIRECTLY WITH THE PROGRAMS AND SEVERAL EXTRA VOLUNTEERS THAT HELP THROUGHOUT THE YEAR. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | 990 FORMS ARE EMAILED TO BOARD MEMBERS AND A HARD COPY IS PROVIDED AFTER 990 IS FILED. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | ALL INFORMATION IS AVAILABLE UPON REQUEST. |
| Software ID: | 11000129 |
| Software Version: | v1.00 |