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 monetary support | |||
|---|---|---|---|---|---|---|---|---|---|
| Yes | No | Yes | No | Yes | No | ||||
| Total | |||||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 4,575 | 16,676 | 21,251 | |||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | |||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | |||||
| 4 | Total. Add lines 1 through 3 | 4,575 | 16,676 | 21,251 | |||
| 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).. | 0 | |||||
| 6 | Public support. Subtract line 5 from line 4. | 21,251 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 4,575 | 16,676 | 21,251 | |||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 11,205 | 6,037 | 2,217 | 422 | 4 | 19,885 |
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | 0 | |||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. | 4,788 | 3,417 | 1,663 | 9,868 | ||
| 11 | Total support (Add lines 7 through 10). | 51,004 | |||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (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 |
|---|
| Part II, Line 10--EQUIPMENT LOST IN FIRE. NET VALUE-$1,312. |
| Explanation |
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| Software ID: | 12000229 |
| Software Version: | 2012v2.0 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Form 990-EZ, Part II, Line 24.1003 | Other Assets.1003 | Machinery and Equipment - Beginning $2015 Machinery and Equipment - Ending $0 |
| Form 990-EZ, Part I, Line 16.3 | Other Expenses.3 | LEGAL NOTICE $105 |
| Form 990-EZ, Part I, Line 16.2 | Other Expenses.2 | GOVT FILING FEES $120 |
| Form 990-EZ, Part I, Line 16.1 | Other Expenses.1 | BANK FEES $195 |
| Form 990-EZ, Part I, Line 16.1012 | Other Expenses.1012 | Insurance $1230 |
| Form 990-EZ, Part I, Line 16.1009 | Other Expenses.1009 | Depreciation $703 |
| Form 990-EZ, Part I, Line 16.1002 | Other Expenses.1002 | Office Expenses $153 |
| Form 990-EZ, Part I, Line 10.28 | Grants and Similar Amounts Paid In Excess of $5,000.28 | | Donee's Name: ALL WASHED UP LAUNDRY | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.27 | Grants and Similar Amounts Paid In Excess of $5,000.27 | | Donee's Name: WATSON CHIROPRACTIC | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.26 | Grants and Similar Amounts Paid In Excess of $5,000.26 | | Donee's Name: SPYHOUSE COFFEE-EAST ISLES | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.25 | Grants and Similar Amounts Paid In Excess of $5,000.25 | | Donee's Name: PUMPHOUSE CREAMERY | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.24 | Grants and Similar Amounts Paid In Excess of $5,000.24 | | Donee's Name: PAPA'S RESTAURANT | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.23 | Grants and Similar Amounts Paid In Excess of $5,000.23 | | Donee's Name: OLD TOWN FANCY | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.22 | Grants and Similar Amounts Paid In Excess of $5,000.22 | | Donee's Name: OLD ARIZONA | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.21 | Grants and Similar Amounts Paid In Excess of $5,000.21 | | Donee's Name: NORTH PRAIRE TILEWORKS | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.20 | Grants and Similar Amounts Paid In Excess of $5,000.20 | | Donee's Name: INTEGRITY HOME HEALTH | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.19 | Grants and Similar Amounts Paid In Excess of $5,000.19 | | Donee's Name: GIVING TREE GARDENS | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.18 | Grants and Similar Amounts Paid In Excess of $5,000.18 | | Donee's Name: CORAZON INC | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.11 | Grants and Similar Amounts Paid In Excess of $5,000.11 | | Donee's Name: CAMDEN MUSIC SCHOOL | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.10 | Grants and Similar Amounts Paid In Excess of $5,000.10 | | Donee's Name: CAFE FINSPANG | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.9 | Grants and Similar Amounts Paid In Excess of $5,000.9 | | Donee's Name: BRIAN D'S OLD SCHOOL | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.8 | Grants and Similar Amounts Paid In Excess of $5,000.8 | | Donee's Name: BUTTER BAKERY CAFE | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.7 | Grants and Similar Amounts Paid In Excess of $5,000.7 | | Donee's Name: BLASTED ART INC | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.6 | Grants and Similar Amounts Paid In Excess of $5,000.6 | | Donee's Name: BIKES & PIECES LLC | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.5 | Grants and Similar Amounts Paid In Excess of $5,000.5 | | Donee's Name: ARTE HISPANO LLC | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.3 | Grants and Similar Amounts Paid In Excess of $5,000.3 | | Donee's Name: AFRO DELI & COFFEE | Cash Amount Given: $7500 |
| Form 990-EZ, Part I, Line 10.2 | Grants and Similar Amounts Paid In Excess of $5,000.2 | | Donee's Name: 1050 DESIGN LLC | Cash Amount Given: $7500 |
| Software ID: | 12000229 |
| Software Version: | 2012v2.0 |