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.") .... | ||||||
| 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) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.).. | ||||||
| 11 | Total support (Add lines 7 through 10). | ||||||






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.") . | 4,210 | 3,000 | 7,210 | |||
| 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...... | 78,500 | 78,500 | ||||
| 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. | 4,210 | 81,500 | 85,710 | |||
| 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.) | 85,710 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2008 | (b) 2009 | (c) 2010 | (d) 2011 | (e) 2012 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 4,210 | 81,500 | 85,710 | |||
| 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.).. | 4,210 | 81,500 | 85,710 | |||




| Facts And Circumstances Test |
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Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990 - ORGANIZATION'S MISSION | 1. TO ACT AS A REGIONAL EMS ADVISORY BODY, KEEPING MEMBERS INFORMED ABOUT STATE AND NATIONAL ISSUES WHICH IMPACT EMS. 2. TO PROMOTE REGIONAL COORDINATION AND COOPERATION OF EMS SERVICES. 3. TO ACT AS A LIASION BODY BETWEEN THE STATE BUREAU OF EMS, AND THE STATE EMS ADVISORY COUNCIL. 4. TO PROVIDE A FORUM TO DISCUSS THE COMMON PROBLEMS AND CONCERNS SHARED BY EMS PROVIDERS SERVING THE FIRST COAST. 5. TO PROMOTE TRAINING AND EDUCATION OF THE PROFESSIONAL PROVIDER AND MEMBERS OF THE GENERAL PUBLIC IN THE PROVIDING OF EMERGENCY MEDICAL CARE. 6. TO PROMOTE OPTIMAL PERFORMANCE STANDARDS. 7. TO RECOMMEND TO THE RESPECTIVE COUNTY LEGISLATIVE BODIES THE ADOPTION OF SUCH RESOLUTIONS, OR PASSAGE OF SUCH ORDINANCES, AS MAY BE REQUIRED TO ENSURE THE ACCOMPLISHMENT OF THE PURPOSES STATED WITHIN. 8. TO ENGAGE IN THE PLANNING, DEVELOPMENT, AND IMPLEMENTATION OF SUCH ACTIVITIES AND PROGRAMS AS DEEMED DESIRABLE IN ORDER TO ACCOMPLISH THE COUNCIL'S GENERAL OBJECTIVES OR PURPOSES. THIS CAN BE DONE BY THE COUNCIL ALONE, OR IN CONJUNCTION WITH OTHER PERSONS, GROUPS, FIRMS, CORPORATIONS, OR ORGANIZATIONS. |
| EXPLANATION ON VOLUNTEERS AND TYPES OF SERVICES OR BENEFITS | FORM 990, PAGE 1, PART I, LINE 6 | THE MEMBERS OF THE COUNCIL ARE ALL VOLUNTEER. NO BENEFITS OR SERVICES RECEIVED IN EXCHANGE FOR VOLUNTEERING. |
| CLASSES OF MEMBERS OR STOCKHOLDERS | FORM 990, PAGE 6, PART VI, LINE 6 | YES |
| ELECTION OF MEMBERS AND THEIR RIGHTS | FORM 990, PAGE 6, PART VI, LINE 7A | YES |
| DECISIONS SUBJECT TO APPROVAL OF MEMBERS | FORM 990, PAGE 6, PART VI, LINE 7B | ALL DECISIONS ARE SUBJECT TO APPROVAL BY THE MEMBERS. |
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | INFORMED GOVERNING BODY MEMBERS THAT A COPY IS AVAILABLE UPON REQUEST. OFFICERS WILL REVIEW FORM 990 PRIOR TO FILING. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | PROVIDE COPIES ON REQUEST |
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