Attach to Form 990 or Form 990-EZ.
See separate instructions.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | 281,365 | 152,785 | 206,909 | 156,593 | 174,156 | 971,808 |
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | 0 | 0 | 0 | 0 | 0 | |
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | 0 | 0 | 0 | 0 | 0 | |
| 4 | Total. Add lines 1 through 3 | 281,365 | 152,785 | 206,909 | 156,593 | 174,156 | 971,808 |
| 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. | 971,808 | |||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 281,365 | 152,785 | 206,909 | 156,593 | 174,156 | 971,808 |
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | 0 | 0 | 0 | 0 | 0 | |
| 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.).. | 0 | 0 | 0 | 0 | 0 | |
| 11 | Total support (Add lines 7 through 10). | 971,808 | |||||






Calendar year (or fiscal year beginning in) ![]() |
(a) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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) 2009 | (b) 2010 | (c) 2011 | (d) 2012 | (e) 2013 | (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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| Software ID: | 13000241 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, Line 6 | The organization is based on membership and is guided by 4 Board Members. |
| Form 990, Part VI, Section A, Line 7a | The organization has a Board of Directors that serve specific terms as outlined in organizational documents and are elected and/or appointed positions. |
| Form 990, Part VI, Section B, Line 11b | Once the 990 is completed by CEO, in collaboration with Board Treasurer, it is then reviewed and presented electronically to all Board Members prior to filing with the IRS. The Treasurer may review the return with the Board at the following scheduled Board Meeting if so requested by the active Board. |
| Form 990, Part VI, Section B, Line 12c | Board Members, officers, and all employees review and execute the organizational conflict of interest policy annually including (if applicable) a written statement indicating interests that could give rise to conflicts each year. |
| Form 990, Part VI, Section B, Line 15 | Financial compensation of the CEO, Programs Coordinator and Clinical Director are established and reviewed by the Executive Board of Directors (Volunteers). The process includes securing and evaluating similarly qualified and functionally comparable compensation data information used in the establishment process. Board consideration and approval of compensation is reflected in meeting minutes. |
| Form 990, Part VI, Section C, Line 19 | The Form 1023 application to the IRS and Form 990 for the previous 4 years are made available for public inspection by the public during normal business office hours. The names and address on contributors (if any) on Schedule B are retracted in the forms made available to the public. Copies will be provided for a fee of $1.75/per page plus postage. Other corporate documents, such as bylaws, minutes, financials, and policies and procedures shall be maintained as internal documents and shall not be made available to the public, unless for reason determined by the CEO and approved by the Board of Directors. |
| Software ID: | 13000241 |
| Software Version: | v1.00 |