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.") .... | 370,528 | 425,272 | 374,247 | 437,795 | 431,196 | 2,039,038 |
| 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.. | 370,528 | 425,272 | 374,247 | 437,795 | 431,196 | 2,039,038 |
| 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. | 2,039,038 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 370,528 | 425,272 | 374,247 | 437,795 | 431,196 | 2,039,038 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 54,147 | 7,522 | 7,157 | -21,498 | 6,329 | 53,657 |
| 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.. | 151,749 | 147,618 | 157,387 | 170,120 | 285,867 | 912,741 |
| 11 | Total support (Add lines 7 through 10). | 3,005,436 | |||||






| 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 |
|---|
| OTHER INCOME PART II, LINE 10; DESCRIPTION: CLIENT PRIVATE PAY; 2007: 151749.; 2008: 147618.; 2009: 157387.; 2010: 170120.; 2011: 285867.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 12c | All transactions involving the acquisition of goods and services | |
| are monitored to ensure that no conflict of interest arises | ||
| with existing employees and or BOD members. The | ||
| organization has a specifically stated policy regarding | ||
| transactions that may indicate that a conflict of interest | ||
| exists. Should a potential conflict of interest be noted, | ||
| the employee, according to the policy, is required to report | ||
| the potential conflict to his/her immediate supervisor. | ||
| If the potential conflict involves the Executive Director, | ||
| then the BOD President is required to be notified. In | ||
| the case of a potential conflict involving a BOD member, then the | ||
| full BOD will vote on whether or not the potential conflict | ||
| is an actual conflict. The affected BOD member will | ||
| abstain from the vote. An updated conflict of interest | ||
| questionaire is completed by the BOD and key employees | ||
| during the IRS Form 990 review process. | ||
| Pt VI, Line 19 | The Organization has policies and procedures in written and electronic | |
| form and these items are available for public inspection. | ||
| Pt VI, Line 11a | Form 990 is reviewed by the Executive Director and Members | |
| of the BOD prior to release. The Independent Auditor | ||
| and the preparer of the form 990 present, for review, | ||
| each document to the BOD Members for approval. All | ||
| BOD Members and Key Employees complete the conflict of | ||
| interest questionaire as part of the review process. | ||
| Pt VI, Line 8a | The BOD meets, as a general schedule, on a monthly basis. | |
| Meeting minutes are taken related to broad BOD actions | ||
| Form 990, Part IX, Line 24f | RESIDENTIAL AIDE-IN-KIND MANAGEMENT AND FINANCIAL CONSULT EMPLOYEE AND VOLUNTEER RECOGNITION DUES AND PUBLICATIONS CONTINUING EDUCATION UNCOLLECTIBLE ACCOUNTS EXPENSE INSURANCE D&O | |
| and specific committee actions and the related reports. | ||
| Pt VI, Line 8b | Committee reports are presented, as required, at each BOD mtg. | |
| The reporting of the Committee's actions are reported within | ||
| the minutes of the overall BOD meeting. | ||
| Pt XII, Line 2c | The BOD serves as the oversight committee. The BOD decides | |
| upon Independent Auditor selection, requires presentation | ||
| of the audited financial statements and the Form 990, prior | ||
| to finalizing. | ||
| Pt XII, Line 3b | The required Single Audit is performed by a licensed CPA | |
| Pt VI, Line 15 | The Executive Director's salary is approved by the BOD | |
| and reflects consultation related to the compensation for | ||
| similar executive positions in the non profit sector. | ||
| Part XI ln 5 | Other change in net assets. The unrealized gain from | |
| June 30, 2011 has changed to an unrealized loss as of | ||
| June 30, 2012. The net change was a reduction in net | ||
| assets of $15,987. |
| Software ID: | 11000175 |
| Software Version: |