Form 990 or 990-EZ (Sch A) Public Charity Status and Public Support
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This document is an IRS form that provides information about an organization's public charity status and public support. It contains sections for determining if an organization qualifies as publicly supported based on the sources of its revenue, including support tests involving percentages of public support and investment income. The form requires information on an organization's receipts, income sources, and the types of organizations it supports.
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Form 990 or 990-EZ (Sch A) Public Charity Status and Public Support
- 1. SCHEDULE A OMB No. 1545-0047 Public Charity Status and Public Support (Form 990 or 990-EZ) 2008 To be completed by all section 501(c)(3) organizations and section 4947(a)(1) nonexempt charitable trusts. Open to Public Department of the Treasury Attach to Form 990 or Form 990-EZ. See separate instructions. Inspection Internal Revenue Service Name of the organization Employer identification number Part I Reason for Public Charity Status (All organizations must complete this part.) (see instructions) The organization is not a private foundation because it is: (Please check only one organization.) A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 1 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.) 2 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). (Attach Schedule H.) 3 4 A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital’s name, city, and state: An organization operated for the benefit of a college or university owned or operated by a governmental unit described in 5 section 170(b)(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). 6 An organization that normally receives a substantial part of its support from a governmental unit or from the general public 7 described in section 170(b)(1)(A)(vi). (Complete Part II.) A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) 8 9 An organization that normally receives: (1) more than 331⁄ 3 % of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331⁄ 3 % of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) 10 An organization organized and operated exclusively to test for public safety. See section 509(a)(4). (see instructions) 11 An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h. a b c d Type I Type II Type III–Functionally integrated Type III–Other e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). f If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box g Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? Yes No (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) 11g(i) and (iii) below, the governing body of the supported organization? 11g(ii) (ii) A family member of a person described in (i) above? 11g(iii) (iii) A 35% controlled entity of a person described in (i) or (ii) above? h Provide the following information about the organizations the organization supports. (iv) Is the organization (i) Name of supported (ii) EIN (iii) Type of organization (v) Did you notify (vi) Is the (vii) Amount of in col. (i) listed in your organization (described on lines 1–9 the organization in organization in col. support above or IRC section governing document? col. (i) of your (i) organized in the (see instructions)) support? U.S.? Yes No No Yes Yes No Total For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 11285F Schedule A (Form 990 or 990-EZ) 2008
- 2. 2 Schedule A (Form 990 or 990-EZ) 2008 Page Part II Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I.) Section A. Public Support Calendar year (or fiscal year beginning in) (a) 2004 (b) 2005 (c) 2006 (d) 2007 (f) Total (e) 2008 1 Gifts, grants, contributions, and membership fees received. (Do not include any quot;unusual grants.quot;) Tax revenues levied for the organization’s 2 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 1-3 The portion of total contributions by each 5 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) Public support. Subtract line 5 from line 4. 6 Section B. Total Support (a) 2004 (b) 2005 (c) 2006 (d) 2007 (f) Total Calendar year (or fiscal year beginning in) (e) 2008 7 Amounts from line 4 Gross income from interest, dividends, 8 payments received on securities loans, rents, royalties and income from similar sources Net income from unrelated business 9 activities, whether or not the business is regularly carried on Other income. Do not include gain or 10 loss from the sale of capital assets (Explain in Part IV.) 11 Total support. Add lines 7 through 10 12 12 Gross receipts from related activities, etc. (see instructions) 13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here Section C. Computation of Public Support Percentage 14 % 14 Public support percentage for 2008 (line 6, column (f) divided by line 11, column (f)) % 15 15 Public support percentage from 2007 Schedule A, Part IV-A, line 26f 16a 331⁄ 3 % support test—2008. If the organization did not check the box on line 13, and line 14 is 331⁄ 3 % or more, check this box and stop here. The organization qualifies as a publicly supported organization b 331⁄ 3 % support test—2007. If the organization did not check a box on line 13 or 16a, and line 15 is 331⁄ 3 % or more, check this box and stop here. The organization qualifies as a publicly supported organization 17a 10%-facts-and-circumstances test—2008. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization b 10%-facts-and-circumstances test—2007. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions Schedule A (Form 990 or 990-EZ) 2008
- 3. 3 Schedule A (Form 990 or 990-EZ) 2008 Page Part III Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I.) Section A. Public Support Calendar year (or fiscal year beginning in) (a) 2004 (b) 2005 (c) 2006 (d) 2007 (f) Total (e) 2008 1 Gifts, grants, contributions, and membership fees received. (Do not include any quot;unusual grants.quot;) 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 Gross receipts from activities that are not an 3 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 1-5 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 1% of the total of lines 9, 10c, 11, and 12 for the year or $5,000 c Add lines 7a and 7b 8 Public support (Subtract line 7c from line 6.) Section B. Total Support Calendar year (or fiscal year beginning in) (a) 2004 (b) 2005 (c) 2006 (d) 2007 (f) Total (e) 2008 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.) First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3) 14 organization, check this box and stop here Section C. Computation of Public Support Percentage % 15 Public support percentage for 2008 (line 8, column (f) divided by line 13, column (f)) 15 Public support percentage from 2007 Schedule A, Part IV-A, line 27g 16 16 % Section D. Computation of Investment Income Percentage % 17 17 Investment income percentage for 2008 (line 10c, column (f) divided by line 13, column (f)) % 18 18 Investment income percentage from 2007 Schedule A, Part IV-A, line 27h 19a 331⁄ 3 % support tests—2008. If the organization did not check the box on line 14, and line 15 is more than 331⁄ 3 %, and line 17 is not more than 331⁄ 3 %, check this box and stop here. The organization qualifies as a publicly supported organization b 331⁄ 3 % support tests—2007. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 331⁄ 3 %, and line 18 is not more than 331⁄ 3 %, check this box and stop here. The organization qualifies as a publicly supported organization 20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions Schedule A (Form 990 or 990-EZ) 2008
- 4. 4 Schedule A (Form 990 or 990-EZ) 2008 Page Part IV Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Provide any other additional information. (see instructions) Schedule A (Form 990 or 990-EZ) 2008