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.") .... | 2,477 | 23,315 | 1,423 | 2,923 | 250 | 30,388 |
| 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.. | 2,477 | 23,315 | 1,423 | 2,923 | 250 | 30,388 |
| 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. | 30,388 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 2,477 | 23,315 | 1,423 | 2,923 | 250 | 30,388 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 8,638 | 6,768 | 8,479 | 9,228 | 4,195 | 37,308 |
| 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.. | 1,125 | 1,834 | 1,969 | 2,612 | 6,029 | 13,569 |
| 11 | Total support (Add lines 7 through 10). | 81,265 | |||||






| 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: MISCELLANEOUS; 2007: 1125.; 2008: 1834.; 2009: 1969.; 2010: 2612.; 2011: 6029.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | A DRAFT OF THE FORM 990 IS REVIEWED BY THE BOARD OF DIRECTORS | |
| PRIOR TO ITS FILING WITH THE IRS. | ||
| Pt VI, Line 12c | THE BOARD MEMBERS REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY | |
| AND ARE REQUIRED TO SIGN A FORM TO ACKNOWLEDGE READING AND | ||
| UNDERSTANDING CSSD'S CONFLICT OF INTEREST POLICY AND MUST NOTE | ||
| IF ANY CONFLICTS OF INTEREST EXIST. THE EXECUTIVE DIRECTOR REVIEWS | ||
| THE FORMS AND IF CONFLICTS OF INTEREST ARE NOTED, FURTHER ACTIONS | ||
| WOULD BE TAKEN. | ||
| Pt VI, Line 15 | THE BOARD OF DIRECTORS DETERMINES THE CEO'S COMPENSATION ANNUALLY | |
| THROUGH DELIBERATION AND DISCUSSION BASED ON THE ACCHIEVEMENT OF SET | ||
| GOALS AND BASED ON INTERVIEWS WITH OTHER STAFF. THE BOARD OF | ||
| DIRECTORS FOLLOWS THE SAME POLICY FOR INCREASES TO THE CEO AS CSSD | ||
| DOES WITH ALL OTHER STAFF. THE CEO MAY RECEIVE UP TO A CERTAIN | ||
| PERCENTAGE INCREASE BASED ON PERFORMANCE. THE CEO DETERMINES | ||
| THE COMPENSATION OF THE EXECUTIVE DIRECTOR AND ALL OTHER STAFF BASED | ||
| ON THIS SAME POLICY. | ||
| Pt VI, Line 19 | CSSD MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL | |
| STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. | ||
| Form 990, Part III, Line 4d | DAY HABILITATION SERVICES - PROVIDED DAY SERVICES 181326. 0. 180910. | |
| Form 990, Part IX, Line 24f | BAD DEBT EXPENSE 2664. 2664. 0. 0. MISCELLANEOUS 7333. 6439. 894. 0. |
| Software ID: | 11000175 |
| Software Version: |