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? |
|||
|---|---|---|---|---|---|---|---|---|---|
| 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.") .... | 44,761 | 41,505 | 47,734 | 46,419 | 46,155 | 226,574 |
| 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.. | 44,761 | 41,505 | 47,734 | 46,419 | 46,155 | 226,574 |
| 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. | 226,574 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 44,761 | 41,505 | 47,734 | 46,419 | 46,155 | 226,574 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 102 | 143 | 150 | 148 | 122 | 665 |
| 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). | 227,239 | |||||






| 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 EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE ARE | |
| Pt VI, Line 11a | ASSIGNED THE RESPONSIBILITY FOR THE REVIEW AND APPROVAL | |
| Pt VI, Line 11a | OF ALL INFORMATION AND TAX FILINGS FOR THE FEDERAL | |
| Pt VI, Line 11a | GOVERNMENT AND COMMONWEALTH OF MASSACHUSETTS AT THE | |
| Pt VI, Line 11a | DIRECTIVE OF THE BOARD OF DIRECTORS. | |
| Pt VI, Line 12c | THE DIRECTORS PROVIDES SELF-DECLARATION OF POSSIBLE CONFLICTS | |
| Pt VI, Line 12c | INTEREST AS PART OF THE ANNUAL MEETING RESPONSIBILITIES. | |
| Pt VI, Line 12c | KEY EMPLOYEES PROVIDE AN ANNUAL SELF DECLARATION AS PART OF | |
| Pt VI, Line 12c | THEIR ANNUAL PERFORMANCE EVALUATION PROCESS. POTENTIAL | |
| Pt VI, Line 12c | CONFLICTS IDENTIFIED ARE REVIEWED AND APPROVED IF APPROPRIATE | |
| Pt VI, Line 12c | AS A PART OF THE BOARD OF DIRECTORS' ROUTINE RESPONSIBILITIES. | |
| Pt VI, Line 15 | THE BOARD OF DIRECTORS PERFORMS AN INFORMAL REVIEW OF | |
| Pt VI, Line 15 | SALARIES FOR COMPARABLE RESPONSIBILITIES IN LIKE SIZE | |
| Pt VI, Line 15 | ORGANIZATIONS AND OTHER SIMILAR ORGANIZATIONS WITHIN | |
| Pt VI, Line 15 | THE COMMUNITY. DISCUSSIONS ARE DOCUMENTED AS PART OF THE | |
| Pt VI, Line 15 | RECORDING OF THE MINUTES OF THE BOARD OF TRUSTEES INCLUDING | |
| Pt VI, Line 15 | THEIR FORMAL APPROVAL OF REVISED COMPENSATION AND BENEFITS. | |
| Pt VI, Line 19 | THE ORGANIZATON MAKES ALL FEDERAL AND COMMONWEALTH OF | |
| Pt VI, Line 19 | MASSACHUSETTS FILINGS, AND GOVERNING DOCUMENTS AVAILABLE | |
| Pt VI, Line 19 | UPON FORMAL REQUEST. VARIOUS COMPANIES AND THE | |
| Pt VI, Line 19 | MASSACHUSETTS SECRETARY OF STATE MAKE THESE FILINGS | |
| Pt VI, Line 19 | AND THE AUDITED FINANCIAL STATEMENTS AVAILABLE. | |
| Pt XII, Line 2c | THE BOARD OF DIRECTORS, REVIEWS AND APPROVES THE AUDITOR | |
| Pt XII, Line 2c | SELECTION FOR RECOMMENDATION TO THE FULL BOARD OF | |
| Pt XII, Line 2c | DIRECTORS. | |
| Form 990, Part IX, Line 24f | MEDICAL SUPPLIES 879. 879. 0. 0. DIRECTORS INSURANCE 3435. 0. 3435. 0. LICENSES AND FEES 1017. 0. 1017. 0. COMPLIANCE FILINGS 3600. 0. 3600. 0. TELEPHONE 1888. 0. 1888. 0. FUNDRAISING EXPENSES 2697. 0. 0. 2697. ACCOUNTING 10400. 0. 10400. 0. POSTAGE 489. 489. 0. 0. PAYROLL PROCESSING 3849. 3849. 0. 0. SPECIAL EVENTS 415. 0. 0. 415. MISCELLANEOUS 244. 0. 244. 0. CLASSROOM SUPPLIES 27355. 27355. 0. 0. BAD DEBTS 1007. 0. 1007. 0. ADVERTISING 1663. 0. 1663. 0. PRINTING 1151. 1151. 0. 0. |
| Software ID: | 11000175 |
| Software Version: |