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.") . | 925 | 800 | 800 | 800 | 3,325 | |
| 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.. | 153,639 | 158,313 | 198,749 | 193,302 | 100,906 | 804,909 |
| 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. | 154,564 | 159,113 | 199,549 | 194,102 | 100,906 | 808,234 |
| 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.) | 808,234 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 154,564 | 159,113 | 199,549 | 194,102 | 100,906 | 808,234 |
| 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. | 11,714 | 11,714 | ||||
| 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.). | 154,564 | 159,113 | 199,549 | 194,102 | 112,620 | 819,948 |




| Facts And Circumstances Test |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Officer, directors, etc. family relationship (Part VI, line 2) | RICHARD SALTER IS NOT RELATED TO CHRYSTAL OSBORNE BUT HAS RAISED HER IN HIS HOUSEHOLD AS HIS DAUGHTER SINCE SHE WAS A CHILD | |
| 02. Members or stockholder classes and rights (Part VI, line 6) | WE HAVE MEMBERS WHO JOIN EACH YEAR THE MEMBERSHIP ALLOWS MEMBERS TO HAVE DISCOUNTS ON THEIR DRINKS | |
| 03. Governing body meeting documentation (Part VI, line 8a) | GOVERNING BODY MEETINGS ARE NOT DOCUMENTED THERE ARE ONLY TWO OFFICERS BOTH ARE ACTIVE IN THE DAILY OPERATIONS OF THE ORGANIZATION ALL DECISIONS ARE MADE JOINTLY AND ARE NOT THEREFORE DOCUMENTED | |
| 04. Committee meeting documentation (Part VI, line 8b) | COMMITTEE MEETINGS ARE VERBALLY CONDUCTED BY THE TWO OFFICERS AND ARE NOT DOCUMENTED AND ARE HELD AS NEEDED DURING DAILY OPERATIONS | |
| 05. Form 990 governing body review (Part VI, line 11) | TAX RETURNS ARE PRESENTED TO THE OFFICERS FOR SIGNING AND REVIEW BEFORE THEY ARE MAILED | |
| 06. Governing documents, etc, available to public (Part VI, line 19) | GOVERNING BODY DOCUMENTS ARE MADE AVAILABLE TO THE GENERAL PUBLIC UPON REQUEST COPIES ARE HELD AT THE BUSINESS AND AT THE OFFICE OF THE ACCOUNTANT | |
| 07. Cessation of, or significant change to, any program service (Part III, line 3) | EFFECTIVE JULY 1 2011 THE ORGANIZATION CEASED OPERATION AS A NON-PROFIT THE ASSETS WERE DISTRIBUTED TO SATISFY THE DEBT OWED TO OFFICERS SEE SCHEDULE N | |
| 08. Explanation of other changes in net assets or fund balances (Part XI, line 5) | DUE TO THE CESSATION OF OPERATIONS 6561 IS LOSS ON BOOK VALUE OF ASSETS |
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