Form Schedule F (Form 9 Schedule F (Form 9 Statement of Activities Outside the United States

Schedule F
(Form 990)

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2009

Complete if the organization answered “Yes” to Form 990,
Part IV, line 14b, 15, or 16.
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Department of the Treasury
Internal Revenue Service

Attach to Form 990.

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Open to Public
Inspection

See separate instructions.

Employer identification number

Name of the organization

Part I

OMB No. 1545-0047

Statement of Activities Outside the United States

General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.

1

For grantmakers. Does the organization maintain records to substantiate the amount of the grants or
assistance, the grantees’ eligibility for the grants or assistance, and the selection criteria used to award
the grants or assistance?

Yes

2

For grantmakers. Describe in Part IV the organization’s procedures for monitoring the use of grant funds outside the
United States.

3

Activities per Region. (Use Schedule F-1 (Form 990) if additional space is needed.)
(a) Region

Totals

(b) Number of
offices in the
region

(c) Number of
employees or
agents in
region

(d) Activities conducted in
region (by type) (i.e.,
fundraising, program services,
grants to recipients located in
the region)

No

(e) If activity listed in (d) is
a program service,
describe specific type of
service(s) in region

(f) Total
expenditures for
region

Cat. No. 50082W

Schedule F (Form 990) 2009

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

Schedule F (Form 990) 2009

Part II

1

2
3

Page

2

Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered “Yes” to Form 990,
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Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000
Use Schedule F-1 (Form 990) if additional space is needed.

(a) Name of organization

(b) IRS code
section and EIN
(if applicable)

(c) Region

(d) Purpose of
grant

(e) Amount of
cash grant

(f) Manner of
cash
disbursement

(g) Amount of
non-cash
assistance

(h) Description
of non-cash
assistance

(i) Method of
valuation
(book, FMV,
appraisal,
other)

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt
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by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter
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Enter total number of other organizations or entities
Schedule F (Form 990) 2009

Schedule F (Form 990) 2009

Part III

Page

3

Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 16.
Use Schedule F-1 (Form 990) if additional space is needed.

(a) Type of grant or assistance

(b) Region

(c) Number of
recipients

(d) Amount of
cash grant

(e) Manner of
cash
disbursement

(f) Amount of
non-cash
assistance

(g) Description
of non-cash
assistance

(h) Method of
valuation
(book, FMV,
appraisal,
other)

Schedule F (Form 990) 2009

Schedule F (Form 990) 2009

Part IV

Page

4

Supplemental Information
Complete this part to provide the information required in Part I, line 2, and any additional information.

Schedule F (Form 990) 2009