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.") . | 117,148 | 18,227 | 22,295 | 23,162 | 17,898 | 198,730 |
| 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. | 117,148 | 18,227 | 22,295 | 23,162 | 17,898 | 198,730 |
| 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.) | 198,730 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 117,148 | 18,227 | 22,295 | 23,162 | 17,898 | 198,730 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 22,368 | 22,368 | ||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 22,368 | 22,368 | ||||
| 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.). | 117,148 | 18,227 | 22,295 | 23,162 | 40,266 | 221,098 |




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | TO RECEIVE BY GIFT, BEQUEST, GRANT, LEASE, TRANSFER OR OTHERWISE, ANY REAL OR PERSONAL PROPERTY, TO HOLD SUCH PROPERTY AND APPLY THE INCOME THERE FROM, OR THE PRINCIPAL WHEN NECESSARY OR PROPER TO DO SO, FOR THE FOLLOWING PURPOSES: 1. RELIGIOUS, CHARITABLE, SCIENTIFIC, TESTING FOR PUBLIC SAFETY, LITERARY OR EDUCATIONAL PURPOSES, OR FOR THE PREVENTION OF CRUELTY TO CHILDREN OR ANIMALS, NO PART OF THE NET EARNINGS OF WHICH INURES TO THE BENEFIT OF ANY PRIVATE MEMBER OR INDIVIDUAL, NO SUBSTANTIAL PART OF WHICH IS THE CARRYING ON OF PROPAGANDA, OR OTHERWISE ATTEMPTING TO INFLUENCE LEGISLATION, AND WHICH DOES NOT ATTEMPT TO PARTICIPATE OR INTERVENE IN ANY POLITICAL CAMPAIGN; 2.TO HOLD IN TRUST ANY PROPERTY RECEIVED BY GIFT OR BEQUEST FOR THE PURPOSES SET FORTH IN THE INSTRUMENT BY WHICH THE SAME IS GIVEN OR BEQUEATHED; 3.THIS ORGANIZATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR PURPOSES DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; 4.IN THE EVENT OF DISSOLUTION, ALL ASSETS, REAL AND PERSONAL, SHALL BE DISTRIBUTED TO SUCH ORGANIZATIONS AS ARE QUALIFIED AS TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; 5.TO OPERATE BY MAKING GRANTS TO EXEMPT ORGANIZATIONS THAT QUALIFY AS SUCH UNDER SECTION(C)(3) OF THE INTERNAL REVENUE CODE, OR THE CORRESPONDING PROVISIONS OF A FUTURE UNITED STATES REVENUE CODE. |
| FIRST ACCOMPLISHMENT DESCRIPTION | FORM 990, PAGE 2, PART III, LINE 4A | 2.TO HOLD IN TRUST ANY PROPERTY RECEIVED BY GIFT OR BEQUEST FOR THE PURPOSES SET FORTH IN THE INSTRUMENT BY WHICH THE SAME IS GIVEN OR BEQUEATHED; 3.THIS ORGANIZATION IS ORGANIZED AND OPERATED EXCLUSIVELY FOR PURPOSES DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; 4.IN THE EVENT OF DISSOLUTION, ALL ASSETS, REAL AND PERSONAL, SHALL BE DISTRIBUTED TO SUCH ORGANIZATIONS AS ARE QUALIFIED AS TAX EXEMPT UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; 5.TO OPERATE BY MAKING GRANTS TO EXEMPT ORGANIZATIONS THAT QUALIFY AS SUCH UNDER SECTION(C)(3) OF THE INTERNAL REVENUE CODE, OR THE CORRESPONDING PROVISIONS OF A FUTURE UNITED STATES REVENUE CODE. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | A REVIEW OF THE PRELIMINARY DRAFT OF THE FORM 990 IS CONDUCTED BY THE BOARD OF DIRECTORS AT A BOARD MEETING. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICTS OF INTEREST ARE MONITORED ON A REGULAR BASIS |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | NO DOCUMENTS AVAILABLE TO THE PUBLIC |
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