Form Schedule B Form 99 Schedule B Form 99 Schedule of Contributors

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Schedule B
Department of the Treasury
Internal Revenue Service

▶

Name of the organization

Form 990 or 990-EZ

2011

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

Employer identification number

Organization type (check one):
Filers of:

OMB No. 1545-0047

Schedule of Contributors

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

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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, total 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 total 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
Part I, 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 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) (2011)

Page 2

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization

Part I
(a)
No.

Employer identification number

Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.

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(b)
Name, address, and ZIP + 4

(c)
Total contributions

$

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Total contributions

$

(a)
No.

(b)
Name, address, and ZIP + 4

(c)
Total contributions

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

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

(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)
Total 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)
Total 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)
Total 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) (2011)

Page 3

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization

Part II
(a) No.
from
Part I

Employer identification number

Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.

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(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$

(a) No.
from
Part I

(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$

(a) No.
from
Part I

(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$
(a) No.
from
Part I

(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$
(a) No.
from
Part I

(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$
(a) No.
from
Part I

(c)
FMV (or estimate)

(b)
Description of noncash property given

(see instructions)

(d)
Date received

$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

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
that total 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.) ▶ $
Use duplicate copies of Part III if additional space is needed.

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(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

(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

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 5

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

General Instructions
Section references are to the Internal
Revenue Code unless otherwise noted.

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, Part I, 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,
Part I, line 1.

Who Must File

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.

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Note. Terms in bold are defined in the
Glossary of the Instructions for Form
990.

Purpose of Schedule

• 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.

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 taking the following
action:
• Answering “No” on Form 990, Part IV,
Checklist of Required Schedules, line 2,
or
• Checking the box on
• Form 990-EZ, line H, or
• Form 990-PF, Part I, Analysis of
Revenue and Expenses, 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 XII, 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.
• Schedule B is open to public
inspection for a section 527 political
organization that files Form 990 or
990-EZ.

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 that total $5,000
or more for the organization’s tax year.
In determining the total amount,
separate and independent gifts of less
than $1,000 can be disregarded.

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.

Page 6

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

However, if a section 501(c)(7), (8), or
(10) organization did not receive total
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.

Specific Instructions

For more information on noncash
contributions, see the instructions for
Schedule M (Form 990), Noncash
Contributions.

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Do not attach substitutes for
Schedule B or attachments to
Schedule B with information
CAUTION
on contributors. Parts I, II,
and III of Schedule B may be duplicated
as needed to provide adequate space for
listing all contributors. Number each
page of each part.

!
▲

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 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 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 a donor as
“anonymous” only if the organization
does not know the donor’s identity. In
column (c), enter the amount of total
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.

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, but only if the donor
has fully given up use and enjoyment of
the property at that time.

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, the total of
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 you use
duplicate copies of Part III.
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.