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.") .... | 871,607 | 310,329 | 330,621 | 421,720 | 1,214,248 | 3,148,525 |
| 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.. | 871,607 | 310,329 | 330,621 | 421,720 | 1,214,248 | 3,148,525 |
| 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).. | 1,036,639 | |||||
| 6 | Public Support. Subtract line 5 from line 4. | 2,111,886 | |||||
| Calendar year(or fiscal year beginning in) | (a) 2007 | (b) 2008 | (c) 2009 | (d) 2010 | (e) 2011 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 871,607 | 310,329 | 330,621 | 421,720 | 1,214,248 | 3,148,525 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | 13,184 | 3,131 | 3,030 | 1,501 | 253 | 21,099 |
| 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.. | 10,500 | 13,530 | 13,530 | 13,530 | 51,090 | |
| 11 | Total support (Add lines 7 through 10). | 3,220,714 | |||||






| 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.) | ||||||
| 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 |
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| Explanation |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| 01. Form 990 governing body review (Part VI, line 11) | A COPY OF THE 990 AND ALL OF ITS ATTACHED SCHEDULES ARE REVIEWED FIRST BY THE EXECUTIVE DIRECTIOR AND THEN BY THE TREASURER FOR ACCURACY FULL DISCLOSURE AND CONTENT BEFORE THE RETURN IS MAILED TO THE IRS AND NCDOR | |
| 02. Conflict of interest policy compliance (Part VI, line 12c) | BEFORE ANY MEETING OF THE BOARD OF DIRECTORS AN AGENDA WILL BE CIRCULATED TO EACH DIRECTOR WITH AGENDA ITEMS DESCRIBED IN SUFFICIENT DETAIL TO ALLOW MEMBERS OF THE BOARD TO IDENTIFY POSSIBLE CONFLICTS OF INTEREST A MEMBER OF THE BOARD OF DIRECTORS WITH A CONFLICT OF INTEREST WILL DECLARE SAME TO THE CHAIR OF THE MEETING PRIOR TO THE INTRODUCTION OF THE AGENDA ITEM IN QUESTION STATE THE CONFLICT IN THE MINUTES IF THEIR IS A CONFLICT THAT MEMBER WILL REFRAIN FROM PARTICIPATING IN DISCUSSIONS AND VOTING ON THE ITEM | |
| 03. CEO, executive director, top management comp (Part VI, line 15a) | THE FINANCE COMMITTEE APPROVES THE PAY OF THE EXECUTIVE DIRECTOR AND ANY BONUS OR BENEFITS THAT HE MAY RECIEVE | |
| 04. Other officer or key employee compensation (Part VI, line 15b | THE FINANCE COMMITTEE APPROVES ALL PAY RECIEVED BY ANY OFFICER OF THE ORGANIZATION | |
| 05. Governing documents, etc, available to public (Part VI, line 19) | POLICIES AND PROCEDURES ARE AVAILABLE ON THE ORGANIZATIONS WEBSITE ALONG WITH THE ANNUAL REPORT A COPY OF THE POLICY MANUAL IS ALSO AVAILABLE IN THE FRONT AREA ALONG WITH A COPY OF THE AUDIT AND ANNUAL REPORT | |
| 06. Significant program services not listed on prior year return (Part III, line 2) | BEGINNING JULY 1 2011 THE CENTER TOOK OVER THE ELDERLY NUTRITION EMPLOYMENT TITLE V AND INFORMATION AND ASSISTANCE PROGRAMS FROM ROWAN COUNTY | |
| 07. Explanation of other changes in net assets or fund balances (Part XI, line 5) | DIFFERENCE IN REALIZED LOSSES AND UNREALIZED GAINS FOR THE YEAR |
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