Form Schedule B (Form 9 Schedule B (Form 9 Schedule of Contributors

Schedule B

OMB No. 1545-0047

Schedule of Contributors

(Form 990, 990-EZ,
or 990-PF)

2009

 Attach to Form 990, 990-EZ, or 990-PF.

Department of the Treasury
Internal Revenue Service

Name of the organization

Employer identification number

Organization type (check one):
Filers of:
Form 990 or 990-EZ

Section:
501(c)(

) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation
527 political organization
Form 990-PF

501(c)(3) exempt private foundation
4947(a)(1) nonexempt charitable trust treated as a private foundation
501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See
instructions.
General Rule
For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.
Special Rules
For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 331⁄3 % support test of the regulations under
sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the greater
of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h or (ii) Form 990-EZ, line 1. Complete Parts I and
II.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during
the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable, scientific, literary, or
educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and III.
For a section 501(c)(7), (8), or (10) organization filing Form 990 or 990-EZ that received from any one contributor, during
the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did not
aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during the
year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
 $
during the year
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box on line H of its Form 990-EZ,
or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990, 990-EZ, or
990-PF).
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613X

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part I

Name of organization

Part I
(a)
No.

Employer identification number

Contributors (see instructions)
(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

$

(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II if there is
a noncash contribution.)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part I

Name of organization

Part I
(a)
No.

Employer identification number

Contributors (see instructions)
(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

$

(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II if there is
a noncash contribution.)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part I

Name of organization

Part I
(a)
No.

Employer identification number

Contributors (see instructions)
(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

(d)
Type of contribution
Person
Payroll
Noncash

$

(Complete Part II if there is
a noncash contribution.)

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Aggregate contributions

$

(d)
Type of contribution
Person
Payroll
Noncash
(Complete Part II if there is
a noncash contribution.)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part II

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization

Part II
(a) No.
from
Part I

Employer identification number

Noncash Property (see instructions)
(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

$
(a) No.
from
Part I

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

(d)
Date received

/

(d)
Date received

/

/

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part II

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization

Part II
(a) No.
from
Part I

Employer identification number

Noncash Property (see instructions)
(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

$
(a) No.
from
Part I

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$
(a) No.
from
Part I

(see instructions)

$

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

/

(d)
Date received

/
(c)
FMV (or estimate)

(b)
Description of noncash property given

(d)
Date received

/

(d)
Date received

/

/

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part III

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization

Part III

(a) No.
from
Part I

Employer identification number

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.)  $
(b) Purpose of gift

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(d) Description of how gift is held

(c) Use of gift

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(d) Description of how gift is held

(c) Use of gift

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Page _____ of _____ of Part III

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization

Part III

(a) No.
from
Part I

Employer identification number

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.)  $
(b) Purpose of gift

(d) Description of how gift is held

(c) Use of gift

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(d) Description of how gift is held

(c) Use of gift

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

(a) No.
from
Part I

(b) Purpose of gift

Relationship of transferor to transferee

(c) Use of gift

(d) Description of how gift is held

(e) Transfer of gift
Transferee’s name, address, and ZIP + 4

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.
Note. Terms in bold are defined in the
Glossary of the Instructions for Form
990.

Purpose of Schedule
Schedule B (Form 990, 990-EZ, or
990-PF) is used to provide information
on contributions the organization
reported on:
● Form 990-PF, Return of Private
Foundation, line 1;
● Form 990, Return of Organization
Exempt from Income Tax, Part VIII,
Statement of Revenue, line 1; or
● Form 990-EZ, Short Form Return of
Organization Exempt from Income Tax,
line 1.

Who Must File
Every organization must complete and
attach Schedule B to their Form 990,
990-EZ, or 990-PF, unless it certifies
that it does not meet the filing
requirements of this schedule by
answering “No” on Form 990, Part IV,
Checklist of Required Schedules, line 2;
on Form 990-EZ, line H; or on Form
990-PF, line 2. See the separate
instructions for these lines on those
forms.
If an organization is not required to file
Form 990, 990-EZ, or 990-PF but
chooses to do so, it must file a complete
return and provide all of the information
requested, including the required
schedules.

Accounting Method
When completing Schedule B (Form 990,
990-EZ, or 990-PF), the organization
must use the same accounting method it
checked on Form 990, Part XI, Financial
Statements and Reporting, line 1; Form
990-EZ, line G; or Form 990-PF, line J.

Public Inspection
Schedule B is:
● Open to public inspection for an
organization that files Form 990-PF,
● Open to public inspection for a
section 527 political organization that
files Form 990 or 990-EZ, or
● For all other organizations that file
Form 990 or 990-EZ, the names and
addresses of contributors are not
required to be made available for public
inspection. All other information,
including the amount of contributions,
the description of noncash
contributions, and any other
information, is required to be made
available for public inspection unless it
clearly identifies the contributor.

Page

If an organization files a copy of Form
990 or 990-EZ, and attachments, with
any state, it should not include its
Schedule B (Form 990, 990-EZ, or
990-PF) in the attachments for the state,
unless a schedule of contributors is
specifically required by the state. States
that do not require the information might
inadvertently make the schedule
available for public inspection along with
the rest of the Form 990 or 990-EZ.
See the instructions for Form 990,
990-EZ, or 990-PF for information on
telephone assistance and the public
inspection rules for these forms and their
attachments.

Contributors to be
Listed on Part I
A contributor (person) includes
individuals, fiduciaries, partnerships,
corporations, associations, trusts, and
exempt organizations. In addition,
section 509(a)(2), 170(b)(1)(A)(iv), and
170(b)(1)(A)(vi) organizations must also
report governmental units as
contributors.

Contributions
Contributions reportable in Schedule B
(Form 990, 990-EZ, or 990-PF) are
contributions, grants, bequests, devises,
and gifts of money or property, whether
or not for charitable purposes. For
example, political contributions to
section 527 political organizations are
included. Contributions do not include
fees for the performance of services.
See the instructions for Form 990, Part
VIII, line 1, for a fuller discussion of what
constitutes contributions.

General Rule
Unless the organization is covered by
one of the Special Rules below, it must
list in Part I every contributor who,
during the year, gave the organization
directly or indirectly, money, securities,
or any other type of property
aggregating $5,000 or more for the
organization’s tax year. In determining
the aggregate amount, separate and
independent gifts of less than $1,000
can be disregarded.

Special Rules
Section 501(c)(3) organizations that
file Form 990 or 990-EZ. For an
organization described in section
501(c)(3) that meets the 331⁄3 % support
test of the regulations under sections
509(a)(1) and 170(b)(1)(A)(vi), and not just
the 10% support test (whether or not the
organization is otherwise described in
section 170(b)(1)(A)), list in Part I only
those contributors whose contribution of
$5,000 or more during the tax year is
greater than 2% of the amount reported
on Form 990, Part VIII, line 1h or Form
990-EZ, line 1.

9

Example. A section 501(c)(3)
organization, of the type described
above, reported $700,000 in total
contributions, gifts, grants, and similar
amounts received on Form 990, Part VIII,
line 1h. The organization is only required
to list in Parts I and II of its Schedule B
each person who contributed more than
the greater of $5,000 or 2% of $700,000
($14,000) during the tax year. Thus, a
contributor who gave a total of $11,000
would not be reported in Parts I and II
for this section 501(c)(3) organization.
Even though the $11,000 contribution to
the organization was greater than
$5,000, it did not exceed $14,000.
Section 501(c)(7), (8), or (10)
organizations. For contributions to
these social and recreational clubs,
fraternal beneficiary and domestic
fraternal societies, orders, or
associations that were not for an
exclusively religious, charitable, etc.,
purpose, list in Part I each contributor
who contributed $5,000 or more during
the tax year, as described under the
General Rule, earlier.
For contributions to a section
501(c)(7), (8), or (10) organization
received for use exclusively for religious,
charitable, scientific, literary, or
educational purposes, or for the
prevention of cruelty to children or
animals (sections 170(c)(4), 2055(a)(3), or
2522(a)(3)), list in Part I each contributor
whose aggregate contributions for an
exclusively religious, charitable, etc.,
purpose were more than $1,000 during
the tax year. To determine the
more-than-$1,000 amount, total all of a
contributor’s gifts for the tax year
(regardless of amount). For a noncash
contribution, complete Part II.
All section 501(c)(7), (8), or (10)
organizations that listed an exclusively
religious, charitable, etc., contribution in
Part I or II must also complete Part III to
provide further information on such
contributions of more than $1,000 during
the tax year, and show the total amount
received from such contributions that
were for $1,000 or less during the tax
year.
However, if a section 501(c)(7), (8), or
(10) organization did not receive
aggregate contributions of more than
$1,000 from a single contributor during
the tax year for exclusively religious,
charitable, etc., purposes, and
consequently was not required to
complete Parts I through III with respect
to these contributions, it need only
check the third Special Rules box on the
front of Schedule B and enter, in the
space provided, the total contributions it
received during the tax year for an
exclusively religious, charitable, etc.,
purpose.

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Specific Instructions
Note. You can duplicate Parts I through
III if you need more copies. Number
each page of each part.
Part I. In column (a), identify the first
contributor listed as No. 1 and the
second contributor as No. 2, etc.
Number consecutively. In column (b),
enter the contributor’s name, address,
and ZIP code. Identify an “anonymous”
donor if the organization has actual
knowledge of such donor’s identity. In
column (c), enter the amount of
aggregate contributions for the tax year
for the contributor listed.
In column (d), check the type of
contribution. Check all that apply for the
contributor listed. If a cash contribution
came directly from a contributor (other
than through payroll deduction), check
the “Person” box. A cash contribution
includes contributions paid by cash,
credit card, check, money order,
electronic fund or wire transfer, and
other charges against funds on deposit
at a financial institution.
If an employee’s cash contribution
was forwarded by an employer (indirect
contribution), check the “Payroll” box. If
an employer withholds contributions
from employees’ pay and periodically
gives them to the organization, report
only the employer’s name and address
and the total amount given unless you
know that a particular employee gave
enough to be listed separately.
Check the “noncash” box for any
contribution of property other than cash
during the tax year, and complete Part II
of this schedule.
For a section 527 organization that
files a Form 8871, Political Organization
Notice of Section 527 Status, the names
and addresses of contributors that are
not reported on Form 8872, Political
Organization Report of Contributions and

Page

Expenditures do not need to be reported
in Part I if the organization paid the
amount specified by section 527(j)(1). In
this case, enter “Pd. 527(j)(1)” in column
(b) instead of a name, address, and zip
code; but you must enter the amount of
contributions in column (c).
Part II. In column (a), show the number
that corresponds to the contributor’s
number in Part I. In column (b), describe
the noncash contribution received by
the organization during the tax year.
Note the public inspection rules
discussed earlier.
In columns (c) and (d), report property
with readily determinable market value
(for example, marked quotations for
securities) by listing its fair market
value (FMV). If the organization
immediately sells securities contributed
to the organization (including through a
broker or agent), the contribution still
must be reported as a gift of property
(rather than cash) in the amount of the
net proceeds plus the broker’s fees and
expenses. See the instructions to Form
990, Part VIII, line 1g, which provide an
example to illustrate this point. If the
property is not immediately sold,
measure market value of marketable
securities registered and listed on a
recognized securities exchange by the
average of the highest and lowest
quoted selling prices (or the average
between the bona fide bid and asked
prices) on the contribution date. See
Regulations section 20.2031-2 to
determine the value of contributed
stocks and bonds. When FMV cannot be
readily determined, use an appraised or
estimated value. To determine the
amount of a noncash contribution
subject to an outstanding debt, subtract
the debt from the property’s FMV. Enter
the date the property was received by
the organization, if the donor has fully
given up use and enjoyment of the
property at that time.

10

For more information on noncash
contributions, see the instructions for
Schedule M (Form 990), Noncash
Contributions.
If the organization received a partially
completed Form 8283, Noncash
Charitable Contributions, from a donor,
complete it and return it so the donor
can get a charitable contribution
deduction. Keep a copy for your
records.
Original (first) and successor donee
(recipient) organizations must file Form
8282, Donee Information Return, if they
sell, exchange, consume, or otherwise
dispose of (with or without
consideration) charitable deduction
property (property other than money or
certain publicly traded securities) within
3 years after the date the original donee
received the property.
Part III. Section 501(c)(7), (8), or (10)
organizations that received contributions
for use exclusively for religious,
charitable, etc. purposes during the tax
year must complete Parts I through III
for each person whose gifts totaled
more than $1,000 during the tax year.
Show also, in the heading of Part III,
total gifts to these organizations that
were $1,000 or less for the tax year and
were for exclusively religious, charitable,
etc., purposes. Complete this
information only on the first Part III page.
If an amount is set aside for an
exclusively religious, charitable, etc.,
purpose, show in column (d) how the
amount is held (for example, whether it
is commingled with amounts held for
other purposes). If the organization
transferred the gift to another
organization, show the name and
address of the transferee organization in
column (e) and explain the relationship
between the two organizations.