Attach to Form 990 or Form 990-EZ.
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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 23,046 | 25,000 | 25,888 | 24,892 | 22,130 | 120,956 |
| 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...... | 59,905 | 54,926 | 90,952 | 97,747 | 87,985 | 391,515 |
| 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. | 82,951 | 79,926 | 116,840 | 122,639 | 110,115 | 512,471 |
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | 0 | |||||
| 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. | 0 | |||||
| c | Add lines 7a and 7b.. | 0 | |||||
| 8 | Public support (Subtract line 7c from line 6.) | 512,471 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 82,951 | 79,926 | 116,840 | 122,639 | 110,115 | 512,471 |
| 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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | 82,951 | 79,926 | 116,840 | 122,639 | 110,115 | 512,471 |
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
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-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: AMERICAN LEGION POST 201. DATE OF GIFT: 05/09/15. AMOUNT GIVEN: 1,400. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN YMCA. GRANTEE ADDRESS: 2269 MANN ROAD POWHATAN, VA 23139. DATE OF GIFT: VARIOUS. AMOUNT GIVEN: 5,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN CHRISTMAS MOTHER. GRANTEE ADDRESS: P.O. BOX 461 POWHATAN, VA 23139. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN LEADERSHIP INSTITUTE. GRANTEE ADDRESS: 3887 OLD BUCKINGHAM ROAD POWHATAN, VA 23139. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ROTARY INTERNATIONAL. DATE OF GIFT: 06/17/15. AMOUNT GIVEN: 4,620. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: SCHOLARSHIP. GRANTEE NAME: POWHATAN HIGH SCHOOL - SCHOLARSHIPS. GRANTEE ADDRESS: 2320 SKAGGS ROAD POWHATAN, VA 23139. DATE OF GIFT: 05/19/15. AMOUNT GIVEN: 4,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: BACKPACKS OF LOVE. GRANTEE ADDRESS: 3035 LOWER HILL ROAD POWHATAN, VA 23139. DATE OF GIFT: VARIOUS. AMOUNT GIVEN: 2,600. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: BON AIR ROTARY. DATE OF GIFT: 09/17/14. AMOUNT GIVEN: 1,900. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: HABITAT FOR HUMANITY. GRANTEE ADDRESS: P.O. BOX 416 POWHATAN, VA 23139. DATE OF GIFT: VARIOUS. AMOUNT GIVEN: 2,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN COUNTY. DATE OF GIFT: 04/06/15. AMOUNT GIVEN: 100. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: HAITI OUTREACH. DATE OF GIFT: 10/15/14. AMOUNT GIVEN: 1,440. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN HIGH SCHOOL - FBLA. GRANTEE ADDRESS: 2320 SKAGGS ROAD POWHATAN, VA 23139. DATE OF GIFT: 06/30/15. AMOUNT GIVEN: 1,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: CHILDREN'S FOUNDATION. DATE OF GIFT: 04/23/15. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ALBEMARLE TEEN CHALLENGE. DATE OF GIFT: 09/04/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ALS. DATE OF GIFT: 10/21/14. AMOUNT GIVEN: 384. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ASK. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: BLACKHAWK GYM. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: BON SECOURS CARE FUND. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: HILLARD HOUSE. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: LONESOME DOVE. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: NICARAGUA DENTAL MISSION. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN COALITION OF CHURCHES. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN COUNTY HISTORICAL SOCIETY. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,200. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN COUNTY SERVICES FOR DOMESTIC VIOLENCE. DATE OF GIFT: 02/11/15. AMOUNT GIVEN: 1,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN CRIME SOLVERS. DATE OF GIFT: 02/11/15. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN FIRE AND EMS. DATE OF GIFT: 02/11/15. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: POWHATAN FREE CLINIC. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: RONALD MCDONALD HOUSE. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 1,000. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ROTARY CLUB OF INNSBROOK. DATE OF GIFT: 10/20/14. AMOUNT GIVEN: 225. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: SAFE. DATE OF GIFT: 02/11/14. AMOUNT GIVEN: 250. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: SPECIAL OLYMPICS. DATE OF GIFT: 10/15/14. AMOUNT GIVEN: 250. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: HEN PANTRY. DATE OF GIFT: 12/17/14. AMOUNT GIVEN: 250. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: HENRICUS FOUNDATION. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: ROTARY CLUB OF LILONGWE. DATE OF GIFT: 12/11/14. AMOUNT GIVEN: 1,600. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: TOGETHER FOR TANZANIA. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: VA HOME FOR BOYS AND GIRLS. DATE OF GIFT: 02/11/15. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: WAR MEMORIAL CULTURAL ARTS CENTER. DATE OF GIFT: 10/20/14. AMOUNT GIVEN: 1,500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: WEAR A SMILE SHARE A SMILE. DATE OF GIFT: 06/04/15. AMOUNT GIVEN: 500. |
| FORM 990-EZ, PART I, LINE 10 - GRANTS AND SIMILAR AMOUNTS PAID | ACTIVITY CLASSIFICATION: CHARITABLE. GRANTEE NAME: PYAA. DATE OF GIFT: 11/13/14. AMOUNT GIVEN: 500. TOTAL INCLUDED ON FORM 990-EZ, LINE 10: 46,719. |
| FORM 990-EZ, PART I, LINE 16 - OTHER EXPENSES | DESCRIPTION: POST OFFICE BOX RENTAL. AMOUNT: 42. DESCRIPTION: MEETING MEALS EXPENSE. AMOUNT: 14,276. DESCRIPTION: MEMBER ITEMS AND ROTARY ITEMS. AMOUNT: 549. DESCRIPTION: WEBSITE. AMOUNT: 579. DESCRIPTION: DISTRICT AND INTERNATIONAL DUES. AMOUNT: 5,895. DESCRIPTION: MISCELLANEOUS. AMOUNT: 26. DESCRIPTION: TAXES AND LICENSES. AMOUNT: 25. DESCRIPTION: RYLA. AMOUNT: 1,000. DESCRIPTION: CHARITY NIGHT DINNER. AMOUNT: 1,626. DESCRIPTION: STORAGE RENT. AMOUNT: 600. DESCRIPTION: PETS. AMOUNT: 304. TOTAL TO FORM 990-EZ, LINE 16: 24,922. |
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