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.") . | 42,886 | 36,139 | 12,549 | 45,725 | 74,305 | 211,604 |
| 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...... | 8,713 | 60 | 95 | 418 | 5,423 | 14,709 |
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | 0 | 0 | 0 | 0 | 0 | 0 |
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | 0 |
| 6 | Total. Add lines 1 through 5. | 51,599 | 36,199 | 12,644 | 46,143 | 79,728 | 226,313 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 100 | 400 | 381 | 100 | 2,200 | 3,181 |
| 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. | 5,100 | 0 | 0 | 6,150 | 11,250 | |
| c | Add lines 7a and 7b.. | 5,200 | 400 | 381 | 100 | 8,350 | 14,431 |
| 8 | Public Support (Subtract line 7c from line 6.) | 211,882 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 51,599 | 36,199 | 12,644 | 46,143 | 79,728 | 226,313 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 921 | 1,446 | 1,651 | 1,552 | 632 | 6,202 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | 0 | 0 | 0 | 0 | 0 | 0 |
| c | Add lines 10a and 10b. | 921 | 1,446 | 1,651 | 1,552 | 632 | 6,202 |
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | 0 | 0 | 0 | 0 | 0 | 0 |
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) | 0 | 0 | 0 | 0 | 0 | 0 |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 52,520 | 37,645 | 14,295 | 47,695 | 80,360 | 232,515 |




| Facts And Circumstances Test |
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| Explanation |
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| Software ID: | 11000129 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| F990_P04_S00_L11a | Form 990, Part IV, Line 11a | Trailer and Computer Assets |
| F990_P04_S00_L11b | Form 990, Part IV, Line 11b | Trailer and Computer Accum Deprec |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | Reviewed by Board Members at Board Meeting |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | Discussed at board meeting |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | Executive Director, Motion, Dicussion, and vote for approval by the Board of directors, 2009 |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Upon request |
| F990_P11_S00_L05 | Form 990, Part XI, Line 5 | Jasper Co Habitat for Humanity pick up the assets for Powesheik Counties failing Habitat for Humanity Chapter. The Assets transferred were $167,860.55 |
| Software ID: | 11000129 |
| Software Version: | v1.00 |