Form Schedule G (Form 9 Schedule G (Form 9 Supplemental Information Regarding Fundraising or Gaming

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Date

I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE G (FORM 990), PAGE 1 of 4
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 835 mm (327⁄8 ),
PERFORATE: ON FOLD
FOLDED TO: 216 mm (81⁄2 ") x 279 mm (11")

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

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1

Signature

O.K. to print
Revised proofs
requested

OMB No. 1545-0047

Must be completed by organizations that answer “Yes” to Form 990, Part IV, lines 17, 18, or
19, and by organizations that enter more than $15,000 on Form 990-EZ, line 6a.

Name of the organization

Part I

Date

Supplemental Information Regarding
Fundraising or Gaming Activities

SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service

Action

2008
Open To Public
Inspection

Employer identification number

Fundraising Activities. Complete if the organization answered “Yes” to Form 990, Part IV, line 17.

Indicate whether the organization raised funds through any of the following activities. (Check all that apply)
mail solicitations
solicitation of non-government grants
email solicitations
solicitation of government grants
phone solicitations
special fundraising events
in-person solicitations

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2a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees
or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising activities?

Yes

No

b If “Yes,” list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization. Form 990-EZ filers are not required to complete this table.
(i) Name of individual
or entity (fundraiser)

(ii) Activity

(iii) Did fundraiser have
custody or control of
contributions?

Yes

Total

(iv) Gross receipts
from activity

(v) Amount paid to
(or retained by)
fundraiser listed in (i)

(vi) Amount paid to
(or retained by)
organization

No

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3 List all states in which the organization is registered or licensed to solicit funds or has been notified it is exempt from
registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2008

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I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE D (FORM 990), PAGE 2 of 4
PRINTS: HEAD to HEAD
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 835 mm (327⁄8 "),
PERFORATE: ON FOLD
FOLD TO: 216 mm (81⁄2 ") x 279 mm (11")

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Schedule G (Form 990 or 990-EZ) 2008

Part II

Page

2

Events. Complete if the organization answered “Yes” to Form 990, Part IV, line 18, or reported more than
$15,000 on Form 990-EZ, line 6a. List events with gross receipts greater than $5,000.
(a) Event #1

(c) Other Events

(b) Event #2

(d) Total Events
(sum of (a)-(c))

Revenue

(event name)

1

Gross receipts

2

Less: (Charitable
contributions)
Gross revenue (line 1
minus line 2)

Direct Expenses

3

4

Cash prizes

5

Non-cash prizes

6

Rent/Facility costs

7

Other direct expenses

8
9

Direct expense summary (Sum lines 4-7, column (d))
Net Income Summary. (Enter the difference between lines 3(d) and 8(d))

Revenue

Part III

Direct Expenses

(event name)

(total number)

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Gaming. Complete if the organization answered “Yes” to Form 990, Part IV, line 19, or reported more
than $15,000 on Form 990-EZ, line 6a.
(b) Pull tabs/Instant
bingo/progressive bingo

(a) Bingo

(d) Total gaming (sum
of (a)-(c))

(c) Other gaming

1

Gross Revenue

2

Cash Prizes

3

Non-Cash Prizes

4

Rent/Facility Costs

5

Other Direct Expenses

6

Volunteer Labor

7

Direct expense summary (Sum lines 2-5, column (d))

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8

Net gaming income summary (Enter the difference between lines 1(d) and 7(d))

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Yes
No

%

Yes
No

%

Yes
No

%

Yes No
9 Enter the state(s) in which the organization operates gaming activities:
a Is the organization licensed to operate gaming activities in each of these states?
b If “No,” Explain:

9a

10a Were any of the organization’s gaming licenses revoked, suspended or terminated during the tax year?
b If “Yes,” Explain:

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12

Does the organization operate gaming activities with nonmembers?
Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity
formed to administer charitable gaming?

10a

11
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Schedule G (Form 990 or 990-EZ) 2008

1
I.R.S. SPECIFICATIONS

TO BE REMOVED BEFORE PRINTING

INSTRUCTIONS TO PRINTERS
SCHEDULE G (FORM 990), PAGE 3 of 4 (PAGE 4 IS BLANK)
MARGINS: TOP 13 mm (1⁄2 "), CENTER SIDES.
PRINTS: HEAD to HEAD
PAPER: WHITE WRITING, SUB. 20.
INK: BLACK
FLAT SIZE: 216 mm (81⁄2 ") x 835 mm (327⁄8 "),
PERFORATE: ON FOLD
FOLD TO: 216 mm (81⁄2 ") x 279 mm (11")

DO NOT PRINT — DO NOT PRINT — DO NOT PRINT — DO NOT PRINT

Schedule G (Form 990 or 990-EZ) 2008

Page

3

Yes No
13
a
b
14

Indicate the percentage of gaming activity operated in:
%
13a
The organization’s facility
%
13b
An outside facility
Provide the name and address of the person who prepares the organization’s gaming/special events books
and records:
Name:
Address:

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15a Does the organization have a contract with a third party from whom the organization receives gaming
revenue?
b If “Yes,” enter the amount of gaming revenue received by the organization $
and the amount
of gaming revenue retained by the third party $
.
c If “Yes,” enter name and address:
Name:
Address:
16

15a

Gaming Manager Information
Name:

Gaming Manager Compensation $
Description of Services Provided:
Director/Officer

Employee

Independent Contractor

17 Mandatory Distributions
a Is the organization required under state law to make charitable distributions from the gaming proceeds to
retain the state gaming license?
b Enter the amount of distributions required under state law distributed to other exempt organizations or spent
in the organization’s own exempt activities during the tax year: $

17a

Schedule G (Form 990 or 990-EZ) 2008