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)
![]() |
(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.") .. | 72,131 | 72,146 | 45,938 | 153,453 | 58,799 | 402,467 |
| 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 | 72,131 | 72,146 | 45,938 | 153,453 | 58,799 | 402,467 |
| 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. | 402,467 | |||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | 72,131 | 72,146 | 45,938 | 153,453 | 58,799 | 402,467 |
| 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 | 402,467 | |||||
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.") . | ||||||
| 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) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (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 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 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 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 |
|---|
| Software ID: | 21013178 |
| Software Version: | v1.00 |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| Form 990-EZ, Part I, Line 10 | LastName FirstName GrantAmt ABBOTT SHANIA $390.58 BOHUSLAW LINDA $328.00 BROSKI JENNIFER $286.50 BROUSSARD BRIAN $366.00 CLARK MARY $433.59 CRISLER CATHLEEN $486.22 CROOKER SALWA $277.93 CRUZ REBEKAH $271.76 ELDRIDGE AMANDA $231.52 ENG KATHERINE $336.00 ERCEG JENNIFER $336.26 ESTRADA JAMES $326.69 GILMORE BRANDON $175.00 GREENHALGH RICHARD $354.00 HISCOE JENNIFER $223.00 HODGE SARA $287.17 HUPPE MATTHEW $381.00 JIMENEZ MAYTE $252.00 JUDD KEVIN $437.53 KELLEHER ROBERTA $335.40 KELLEY STEPHEN $333.14 KIMBALL MELODY $262.00 KOBY ALISON $339.80 LUNN MARY $500.00 MANYK MICHAEL $385.34 MARTIN SHANNON $390.00 MCMAHON JENNIFER $261.21 MICHAUD'YOUNG MARISSA $342.04 MOOTE ROSALIN $342.00 NARROW STEPHANIE $156.11 NICHOLSON ANGELA $400.00 PANZIERI RICHARD $129.74 PICOTT KAILEY $468.00 PIEL PETER $500.00 PONTE BAMBI $402.00 PUFFER TRAVIS $300.00 REDMAN VALERIE $158.34 RIVERA SONIA $286.35 ROBINSON MARK $333.00 SCLIRIS CHRISTOPHER $280.00 SMITH CAROLANN $371.31 SOUTHARD DOUGLAS $426.00 TORONTO MARK $355.00 TWOMBLY WILLIAM $400.00 VALLIERES MARK $370.40 VITALI TEAGAN $133.30 WALKER MEGAN $198.00 WARD JERICHO $500.00 WATERSON CHRISTINA $500.00 WELLS TAMMY $400.00 BLACKINGTON DIANA $377.87 BOYCE BLANCHE $500.00 BURKE OLIVIA $301.00 BUZZELL SHELLEY $290.09 BYRNE LYNN $400.00 CLARK ASHLEY $359.39 COLON JOSE $470.00 CREON ELEANOR $750.00 DALTON HEIDI $450.00 DIETZ IRENE $286.00 DREW SHAWN $450.00 ELLIOTT ROBERT $385.58 GERRY CHRISTOPHER $500.00 GREENWELL DIANE $343.00 GREGORY EDWARD $500.00 GRIGG JAMES $750.00 HAFFORD SAMANTHA $475.25 HAMEL JOSEPH $342.00 HORBERT MICHELLE $500.00 JOHNSON DONNA $438.50 KEVLIK CATHERINE $378.02 KLECZEK TAMARA $500.00 KNIPPING SCOTT $474.68 LIBBY CAROLYN $400.02 LISI CATHY $400.00 MANDIGO RUTH $300.65 MURRAY JACOB $331.00 O'CALLAGHAN JASON $460.00 PARIS MARK $476.30 PASQUAROSA DAWN $376.80 PERRY JOSEPH $750.00 PINE RIVER TRUST $471.76 POWELL KANE $300.00 PROVOST LAUREN $307.00 REILLY CAITLIN $455.00 REIS JOSEPH $300.00 RHOADES ROBERT $411.00 ROGERS JEANINE $400.00 SISTI GRACE $431.00 STAPLES TANYA $390.00 STEVENS JOSHUA $529.00 TETLOW AMANDA $346.00 THIBEAULT MARIA $400.00 WEEKS MICHAEL $449.55 WRIGHT DEBORAH $500.00 AVERY LANCE $357.52 CHARLES SAMANTHA $425.87 COLE CAROLIN $332.38 COOPER SUSAN $393.00 COPPOLA ANTHONY $255.32 COY SARAH $400.00 CREASE JEREMY $300.00 DEBOISBRIAND JANET $384.28 DOERINGSFELD SEAN $350.00 DOHERTY DONNA $452.82 FLAGG TRACY $375.96 GOODWIN AMANDA $637.00 GOSSELIN DOROTHY $278.00 HALL CATHERINE $460.02 HAMLIN SARAH $500.00 HILL BRIAN $480.00 HODGE CRYSTAL $333.54 JAY PAULA $466.00 JOYCE JUSTINE $475.33 KEMP ALEXANDER $400.00 KENNESON KAYLA $324.32 LACASSE NADINE $389.07 LISTOVITCH JOHN $549.00 MCEVOY STEPHANIE $300.00 MILLETTE SUEANN $300.00 MITCHELL KATHRYN $345.00 MOLEA MAUREEN $427.72 NASON JOSH $500.00 NELSON TONI $474.00 PILLE CORNELIA $500.00 POWELL SELENA $456.68 ROLLISON THOMAS $224.00 ROYAL ROBIN $500.00 SAUNDERS PETER $479.00 SCHOONMAN ANN $372.00 SEUFERT MICHELLE $400.00 SHEALY CRAIG $158.00 SMITH THOMAS $375.02 TOTTE DEBRA $565.00 WALSH CHRISTINE $273.00 WATERMAN AMANDA $418.03 WHITEHOUSE GABRIEL $277.00 WINSLOW THOMAS $390.00 BERNIER DREW $386.50 BLAKE PATRICIA $344.00 BROWN KENNETH $360.48 CANTERBURY JERRY $439.54 DONALDSON ROBERT $455.00 ELLIS DONNA $297.00 FRECHETTE DOUGLAS $294.48 GALLUP SONJA $463.00 GRAHAM ADRIENNA $354.62 KENDREW-BEAN SHERRY $307.00 KING GAGE $263.00 MACMASTER ROBERT $400.00 MARVIN VERONICA $342.72 PIKE THOMAS $228.31 REINSANT JEFFREY $375.22 REYNOLDS KRISTII $358.59 SMITH ERIC $437.25 ST CLAIR KYLE $368.93 STROUT SANDRA $343.00 UYENO KERRI $314.00 VIEN JAMES $211.73 RIDEOUT ERIN $317.00 BONACCOLTO JOSEPH $273.67 BROSNAHAN KAREN $363.00 CAVESE BRIAN $400.00 CHECHOWITZ MATTHEW $300.00 DOWNS LORRAINE $350.00 DUGUAY ROBYN $308.00 FELLERS BRIAN $360.85 GARFIELD AMANDA $385.00 LABOE KAYLA $426.00 LAMALFA PAUL $409.00 MALO BARBARA $345.00 NIESSEN FRANK $372.00 PAUL ANGELA $300.00 PROVENCHER NICOLE $400.00 REED TRACY $201.36 SANVILLE DAVID $385.17 SILVA PABLO $324.25 SMITH CARMINE $375.00 STANLEY KENNETH $462.00 WARNER ELAINE $369.50 WILSON KARISSA $345.00 BROWN ALFRED $455.92 COOPER SANDRA $408.66 FARRELL ANDREW $380.71 FLETCHER JAMES $400.00 GILBERT CATHERINE $412.76 HAMILTON DAVID $467.50 HANSIS PATRICIA $284.76 HARTFORD CHELSEA $500.00 JOHNSON MARCY $339.00 JONES BUFFI ANN $168.99 KELLEHER SHIRLEY $308.33 PAOLETTI DOMINIC $500.00 PAVLAKOS TINA $410.00 WEAVER DEBBIE $398.00 WEBER ALEXANDRA $387.00 BRUNELLE SHARON $395.46 CANTO ZACHARY $325.70 NOEL VICTORIA $356.00 NUTTING BRIAN $287.00 PHILLIPS DOROTHY $379.00 RIVERA DANIELLE $274.00 BICKFORD DEBORAH $394.62 BROWN STEPHANIE $500.00 CUTTER JENNIFER $500.00 DAVIS LAUREN $140.00 FENNELL BETTY $400.00 FOURNIER BRENDA $245.65 HANCOCK JEANNE $500.00 HANLON BONNIE $320.00 HENRY HERBERT $283.18 JACOBS HEATHER $400.00 KIMBALL JESSICA $281.00 LOPEZ MARINES $275.79 MADORE ERNEST $400.00 MAHMOUD MAHER $300.00 NELSON DANIEL $311.53 O'CONNELL JAYNE $500.00 SCHOOLS THOMAS $400.00 SPENCER KELLY $486.85 STADTMILLER MARK $400.00 WHITE AMY $352.11 MAYLNN HEATHER $358.70 LYNDSEY PHANEUF $217.79 MILBOURN PAULINE $450.00 BROWN SARAH $464.00 EDGE VALERIE $500.00 DAMBRA LISA $500.00 DEMORIA DENISE $363.93 JACKMAN ROBERT $317.52 RICHARDS TOM $403.36 SEDERQUIST JOHN $500.00 GROAT KIMBERLY $750.00 HACKETT PAUL $750.00 HANCOCK MELISSA $150.70 KULACZ TERRI $151.64 MARTY CINDY $276.20 SENECAL SCOTT $290.26 CHAIGNOT CASSIE $446.37 GALANTE PHILIP $297.80 GRAD JESSIE $430.00 GREENWOOD WALTER $400.00 NERDEN TIMOTHY $500.00 PROULX GARY $500.00 WESTERLUND MICHELLE $274.78 KELLEY JOHNETTA $296.38 KUPP LIZA MARIE $350.00 PERREAULT JENNIFER $474.10 SAPIER ANGELA $452.58 STARKEY AMANDA $248.93 SWETT THEODORE $348.88 CARREIRO PAUL $403.00 FRANCE COURTNEY $500.00 HUTCHINS KAREN $500.00 HUTTONCUMMINGS SHARON $307.55 MILLS STEPHANIE $203.89 RAMIREZ KASHA $500.00 DAIGLE ALLISON $366.68 LAMBERT RICHARD $750.00 THOMPSON JENNIFER $480.79 |
| Software ID: | 21013178 |
| Software Version: | v1.00 |