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.") .... | 81,600 | 97,050 | 68,136 | 61,029 | 54,620 | 362,435 |
| 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.. | 81,600 | 97,050 | 68,136 | 61,029 | 54,620 | 362,435 |
| 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. | 362,435 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 81,600 | 97,050 | 68,136 | 61,029 | 54,620 | 362,435 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 6,445 | 5,952 | 1,072 | 797 | 937 | 15,203 |
| 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.. | 8,099 | 5,910 | 21,377 | 10,565 | 9,665 | 55,616 |
| 11 | Total support (Add lines 7 through 10). | 433,254 | |||||






| 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 INCOME; 2007: 8099.; 2008: 5910.; 2009: 21377.; 2010: 10565.; 2011: 9665.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | The Form 990 is reviewed annually with the Board of Directors | |
| by the outside CPA. | ||
| Pt VI, Line 12c | All policies are reviewed annually as well as discussed | |
| at regular scheduled board meetings. | ||
| Pt VI, Line 15 | All compensated employees performance is reviewed annually | |
| by the Board of Directors. Pay increases are based upon | ||
| the result of these reviews. | ||
| Pt VI, Line 19 | All policies, procedures, tax returns and financial statements | |
| are available to the public upon request and are maintained | ||
| at the Organizations offices. | ||
| Form 990EZ, Part II, Line 24 | ACCOUNTS RECEIVABLE - NET GRANTS RECEIVABLE - NET INVENTORIES PREPAIDS | |
| Form 990EZ, Part II, Line 26 | ACCOUNTS PAYABLE & ACCRUED EXPENSES BONDS, MORTGAGES & OTHER NOTES ACCRUED SALARIES OTHER ACCRUED EXPENSES | |
| Form 990, Part IX, Line 24f | MEDICAL SERVICES 2438. 2219. 219. 0. VENDING 9706. 8833. 873. 0. COST OF SALES 89406. 89406. 0. 0. TRAINING 1252. 1139. 113. 0. SUPPLIES 18491. 16827. 1664. 0. REPAIRS & MAINTENANCE 18031. 16408. 1623. 0. TELEPHONE & UTILITIES 41959. 38183. 3776. 0. EQUIPMENT LEASE 2265. 2061. 204. 0. BANK CHARGES 2168. 0. 2168. 0. AUDIT 13000. 0. 13000. 0. BAD DEBTS 105. 105. 0. 0. |
| Software ID: | 11000175 |
| Software Version: |