Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (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 |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | 0 | 0 | 0 | 9,415 | 15,917 | 25,332 |
| 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 | 0 | 0 | 0 | 9,415 | 15,917 | 25,332 |
| 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.) | 25,332 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | 0 | 0 | 0 | 9,415 | 15,917 | 25,332 |
| 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 on 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.).. | 0 | 0 | 0 | 9,415 | 15,917 | 25,332 |
| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
|---|
| Return Reference | Explanation |
|---|---|
| Part III - Line 1, Unusual Grant Lists | | Name of the Contributor:, Date of Grant:, Year:, Amount:, Description:| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| Donor, "2021", $0, Check| |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Part I, line 16 | | Other Expenses:, Amount:| Gasoline, $45.99| Gasoline, $44.88| Gasoline, $60.13| Gasoline, $30.05| Gasoline, $70.00| Gasoline, $363.50| Gasoline, $2.50| Office Supplies, $38.96| Office Supplies, $21.04| Office Supplies, $61.21| Office Supplies, $24.92| Accounting Software Subscription, $29.50| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Accounting Software Subscription, $59.00| Gasoline, $40.06| Gasoline, $15.41| Gasoline, $50.37| Gasoline, $50.35| Gasoline, $60.55| Gasoline, $60.40| Gasoline, $18.57| Gasoline, $30.37| Gasoline, $25.38| Gasoline, $30.37| Gasoline, $50.42| Gasoline, $80.36| Gasoline, $44.07| Gasoline, $25.35| Gasoline, $40.35| Gasoline, $31.22| Gasoline, $50.36| Gasoline, $50.35| Gasoline, $30.35| Gasoline, $89.69| Gasoline, $50.58| Gasoline, $65.35| Gasoline, $34.34| Gasoline, $50.37| Gasoline, $51.40| Gasoline, $70.36| Gasoline, $25.42| Gasoline, $40.56| Gasoline, $60.35| Gasoline, $65.37| Gasoline, $70.35| Gasoline, $40.36| Gasoline, $80.40| Gasoline, $30.35| Gasoline, $40.43| Gasoline, $25.41| Gasoline, $45.35| Gasoline, $38.35| Gasoline, $50.56| Gasoline, $51.57| Gasoline, $40.47| Gasoline, $40.40| Gasoline, $60.35| Gasoline, $51.04| Gasoline, $30.37| Gasoline, $40.36| Gasoline, $15.35| Gasoline, $60.36| Gasoline, $30.44| Gasoline, $50.35| Gasoline, $35.44| Gasoline, $35.37| Gasoline, $50.37| Gasoline, $45.63| Gasoline, $40.52| Gasoline, $35.41| Gasoline, $45.40| Gasoline, $40.35| Gasoline, $30.36| Auto Parts Repair, $16.23| Auto Parts Repair, $23.28| Auto Parts Repair, $30.33| Auto Parts Repair, $102.95| Auto Parts Repair, $31.85| Auto Parts Repair, $23.73| Auto Parts Repair, $8.12| Auto Parts Repair, $62.72| Home Furnishing Purchase, $22.76| Office Supplies, $162.55| Furniture Cleaning, $214.00| Mechanic Services, $303.25| ATM Fee, $2.50| Gasoline, $30.45| Gasoline, $50.37| Website Email Services, $71.88| Gasoline, $35.45| Website Email Services, $71.88| Mechanic Services, $50.00| Gasoline, $50.36| Gasoline, $25.42| Gasoline, $20.36| Gasoline, $50.00| Gasoline, $25.42| Gasoline, $30.36| Website Email Services, $71.88| Website Email Services, $93.48| Gasoline, $30.40| Gasoline, $60.02| Volunteer Appreciation Lunch, $64.97| Rental Truck, $51.00| Gasoline, $113.14| Office Supplies, $52.74| Gasoline, $118.07| Rental Truck, $26.61| Gasoline, $101.74| Awards Trophies, $74.78| Gasoline, $300.00| Gasoline, $35.39| Gasoline, $25.40| Gasoline, $11.48| Website Email Services, $40.37| Gasoline, $3.99| Gasoline, $40.04| Gasoline, $33.46| Gasoline, $60.05| Gasoline, $55.28| Gasoline, $70.09| Gasoline, $50.00| Gasoline, $50.14| Gasoline, $51.88| Gasoline, $46.00| Gasoline, $50.21| Website Email Services, $25.09| Auto Parts Repair, $83.88| Vehicle Maintenance, $1212.85| Vehicle Maintenance, $205.20| Gasoline, $419.28| Equipment, $50.07| Office Supplies, $51.96| Home Furnishing Purchase, $127.86| Home Furnishing Purchase, $269.82| Home Furnishing Purchase, $329.81| Gasoline, $237.91| Furniture Repair, $40.08| Municipal Fee, $107.27| Municipal Fee, $15.00| Auto Parts Repair, $50.00| Auto Parts Repair, $21.65| Auto Parts Repair, $149.32| Auto Parts Repair, $33.42| Auto Parts Repair, $9.73| Auto Parts Repair, $5.40| Volunteer Reimbersements, $130.03| Mechanic Services, $162.50| ATM Fee, $202.50| Mechanic Services, $2.50| ATM Fee, $402.50| Volunteer Reimbersements, $2.50| ATM Fee, $22.50| Volunteer Reimbersements, $2.50| ATM Fee, $202.50| Volunteer Reimbersements, $2.50| ATM Fee, $22.50| Auto Parts Repair, $2.50| Program Supplies, $63.93| Gasoline, $284.81| Gasoline, $67.33| Gasoline, $51.54| Gasoline, $73.20| Furniture Cleaning, $83.98| Furniture Cleaning, $430.00| Furniture Cleaning, $367.00| Gasoline, $322.00| Office Supplies, $37.78| Office Supplies, $215.66| Office Supplies, $137.60| Office Supplies, $36.85| Office Supplies, $54.55| Office Supplies, $14.09| Gasoline, $116.47| Gasoline, $50.06| Furniture Repair, $40.09| Furniture Repair, $34.61| Rental Truck, $30.26| Gasoline, $98.89| Gasoline, $128.67| Municipal Fee, $137.41| Website Email Services, $3.99| Website Email Services, $3.99| Website Email Services, $12.00| Website Email Services, $3.99| Website Email Services, $12.00| Website Email Services, $3.99| Website Email Services, $12.00| Website Email Services, $3.99| Website Email Services, $12.00| Website Email Services, $3.99| Website Email Services, $12.00| Website Email Services, $3.99| Website Email Services, $3.99| Furniture Repair, $20.46| Furniture Repair, $64.87| |
| Part II, line 24 | | Asset Name:, BOY Amount:, EOY Amount:| 5, $6995, $7957| |
| Software ID: | |
| Software Version: |