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 | 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. | 0 | |||||
| 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.. | 0 | |||||
| 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.") . | 441,874 | 180,586 | 308,679 | 201,786 | 79,474 | 1,212,399 |
| 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...... | 219,463 | 254,623 | 247,188 | 272,482 | 993,756 | |
| 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. | 441,874 | 400,049 | 563,302 | 448,974 | 351,956 | 2,206,155 |
| 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.) | 2,206,155 | |||||
| Calendar year (or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 441,874 | 400,049 | 563,302 | 448,974 | 351,956 | 2,206,155 |
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 541 | 1,033 | 157 | 712 | 571 | 3,014 |
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | 541 | 1,033 | 157 | 712 | 571 | 3,014 |
| 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.) | 347 | 264 | 4,667 | 1,707 | 6,985 | |
| 13 | Total support (Add lines 9, 10c, 11 and 12.). | 2,216,154 | |||||




| Facts And Circumstances Test |
|---|
| OTHER INCOME PART III, LINE 12; DESCRIPTION: MISCELLANEOUS INCOME; 2007: 0.; 2008: 347.; 2009: 264.; 2010: 4667.; 2011: 1707.; |
| Explanation |
|---|
| Software ID: | 11000175 |
| Software Version: |
Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| Pt VI, Line 11a | DRAFT COPY OF 990 IS PROVIDED TO BOARD MEMBERS VIA EMAIL | |
| PRIOR TO SUBMISSION OF FINAL RETURN. | ||
| Pt VI, Line 12c | THE BOARD MEMBERS SIGN A CONFLICT OF INTEREST STATEMENT ANNUALLY. | |
| Pt VI, Line 15 | THE BOARD OF DIRECTORS EVALUATES THE EXECUTIVE DIRECTOR'S PERFORMANCE | |
| IN THE PREVIOUS YEAR ALONG WITH CONSIDERATION FOR COST OF LIVING DETERMINES | ||
| IF AN INCREASE IN SALARY IS ADVISIBLE. | ||
| Pt VI, Line 19 | THESE DOCUMENTS ARE AVAILABLE TO THE PUBLIC AT THE FRONT DESK | |
| OF THE FACILITY UPON REQUEST. | ||
| Item B | THIS RETURN WAS AMENDED DUE TO AUDIT ADJUSTMENTS MADE DURING THE | |
| AUDIT FOR THIS FISCAL YEAR THAT WAS CONDUCTED AFTER THE DUE DATE | ||
| OF THIS RETURN. TOTAL ASSETS, LIABILITES, REVENUES AND EXPENSES WERE | ||
| CHANGED DUE TO UNCOLLECTIBILITY OF PLEDGES RECEIVABLE AND | ||
| UNDER ACCRUAL OF PAYROLL AND RELATED LIABILITIES. TOTAL REVENUES | ||
| DECREASED $250. TOTAL EXPENSES INCREASED $16,865. | ||
| PART XI | THESE FIGURES CHANGED DUE TO THE CHANGES MADE TO THE FINANCIAL STATEMENTS | |
| DUE TO THE ADJUSTMENTS. | ||
| PART XII, LINE 2 | THE ANSWERS TO THESE QUESTIONS CHANGED BECAUSE AN AUDIT WAS | |
| CONDUCTED AFTER THE ORIGINAL FILING OF THE RETURN. | ||
| Form 990EZ, Part I, Line 8 | 2% TIMELY | |
| Form 990EZ, Part I, Line 16 | ADVERTISING BANK CHARGES CHILD CARE FOOD, TOYS, BEDDING, BOOKS, SUPPLIES BAD DEBTS EMPLOYER TAXES POSTAGE & DELIVERY LIABILITY INSURANCE LICENSES & PERMITS MISCELLANEOUS OFFICE MINOR EQUIPMENT OFFICE SUPPLIES STAFF IMMUNIZATIONS STAFF TRAINING SUPPLIES MEALS | |
| Form 990, Part IX, Line 24f | STAFF TRAINING 3093. 3093. 0. 0. MISCELLANEOUS 3667. 3667. 0. FUNDRAISING 3495. 0. 0. 3495. WEBSITE DEVELOPMENT 5200. 0. 5200. 0. UNCOLLECTIBLE PLEDGES 3000. 0. 0. 3000. |
| Software ID: | 11000175 |
| Software Version: |