Form Schedule I (Form 9 Schedule I (Form 9 Grants and Other Assistance to Organizations, Government

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SCHEDULE I
(Form 990)
Department of the Treasury
Internal Revenue Service

Name of the organization

Part I
1
2

DRAFT AS OF
November 20, 2012
DO NOT FILE
Complete if the organization answered “Yes” to Form 990, Part IV, line 21 or 22.

Open to Public
Inspection

▶ Attach

to Form 990.

2012

Employer identification number

General Information on Grants and Assistance

Yes

No

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered “Yes” to Form 990,
Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.

1 (a) Name and address of organization
or government

(2)

OMB No. 1545-0047

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

Part II

(1)

Grants and Other Assistance to Organizations,
Governments, and Individuals in the United States

(b) EIN

(c) IRC section
if applicable

(d) Amount of cash
grant

(e) Amount of noncash assistance

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

(g) Description of
non-cash assistance

(h) Purpose of grant
or assistance

(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
(11)
(12)
2
3

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table .
Enter total number of other organizations listed in the line 1 table . . . . . . . . . .

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

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Cat. No. 50055P

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▶
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Schedule I (Form 990) (2012)

DRAFT AS OF
November 20, 2012
DO NOT FILE

Schedule I (Form 990) (2012)

Part III

(a) Type of grant or assistance

1
2
3
4
5
6
7

Part IV

Page 2

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered “Yes” to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(b) Number of
recipients

(c) Amount of
cash grant

(d) Amount of
non-cash assistance

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

(f) Description of non-cash assistance

Supplemental Information. Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional
information.

Schedule I (Form 990) (2012)

Page 3

Schedule I (Form 990) (2012)

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

General Instructions
Future developments. For the latest
information about developments related to
Schedule I (Form 990), such as legislation
enacted after the schedule and its instructions
were published, go to www.irs.gov/form990.
Note. Terms in bold are defined in the
Glossary of the Instructions for Form 990.

Parts II and III of this schedule may be
duplicated to list additional grantees (Part II)
or types of grants/assistance (Part III) that do
not fit on the first page of these parts. Number
each page of each part.
Do not report foreign grants or assistance,
including grants or assistance provided to
U.S. organizations or individuals for foreign
activity, on this schedule. Instead, report
them on Schedule F (Form 990), Statement of
Activities Outside the United States.

Column (a). Enter the full legal name and
mailing address of each recipient organization
or government entity.
Column (b). Enter the employer
identification number (EIN) of the grant
recipient.
Column (c). Enter the section of the
Internal Revenue Code under which the
organization receiving the assistance is
tax-exempt, if applicable (for example, a
school described in section 501(c)(3) or a
social club described in section 501(c)(7)). If a
recipient is a government entity, enter the
name of the government entity. If a recipient
is neither a tax-exempt nor a government
entity, leave column (c) blank.
Column (d). Enter the total dollar amount of
cash grants to each recipient organization or
entity for the tax year. Cash grants include
grants and allocations paid by cash, check,
money order, electronic fund or wire transfer,
and other charges against funds on deposit at
a financial institution.
Columns (e) and (f). Enter the fair market
value of noncash property. Describe the
method of valuation. Report property with a
readily determinable market value (for
example, market quotations for securities) at
its fair market value. For marketable securities
registered and listed on a recognized
securities exchange, measure market value
on the date the property is distributed to the
grantee by the average of the highest and
lowest quoted selling prices or the average
between the bona fide bid and asked prices.
When fair market value cannot be readily
determined, use an appraised or estimated
value.
Column (g). For noncash property or
assistance, enter a description of the property
or assistance. List all that apply. Examples of
noncash assistance include medical supplies
or equipment, pharmaceuticals, blankets, and
books or other educational supplies.
Column (h). Describe the purpose or
ultimate use of the grant funds or other
assistance. Do not use general terms such as
charitable, educational, religious, or scientific.
Use more specific descriptions such as
general support, payments for nursing
services, or laboratory construction. Enter the
type of assistance, such as medical, dental, or
free care for indigent hospital patients. In the
case of disaster assistance, include a
description of the disaster and the assistance
provided (for example, “Food, shelter, and
clothing for Organization A’s assistance to
victims of Colorado wildfires”). Use Part IV if
additional space is needed for descriptions.

DRAFT AS OF
November 20, 2012
DO NOT FILE
Purpose of Schedule

Schedule I (Form 990) is used by an
organization that files Form 990 to provide
information on grants and other assistance
made by the filing organization during the tax
year to organizations, governments, and
individuals in the United States. Report
activities conducted by the organization
directly. Also, report activities conducted by
the organization indirectly through a
disregarded entity or a joint venture treated
as a partnership.
Grants and other assistance include
awards, prizes, contributions, non-cash
assistance, cash allocations, stipends,
scholarships, fellowships, research grants,
and similar payments and distributions made
by the organization during the tax year. For
purposes of Schedule I, grants and other
assistance do not include:
• Salaries or other compensation to
employees, or payments to independent
contractors if the primary purpose of such
payments is to serve the direct and immediate
needs of the organization (such as legal,
accounting, or fundraising services).
• The payment of any benefit by a 501(c)(9)
voluntary employees' beneficiary association
(VEBA) to employees of a sponsoring
organization or contributing employer, if such
payment is made under the terms of the
VEBA trust and in compliance with section
505.
• Grants to affiliates that are not organized as
legal entities separate from the filing
organization, or payments made to branch
offices, accounts, or employees of the
organization located in the United States.
Organizations in the United States include
nonprofits or other exempt organizations,
partnerships, corporations, or other business
entities that are created or organized in the
United States or under the laws of the United
States or any state, the District of Columbia,
the Commonwealth of Puerto Rico, the
Commonwealth of the Northern Mariana
Islands, Guam, American Samoa, the United
States Virgin Islands, and an estate or trust
other than a foreign estate or trust.
Governments in the United States include
the U.S. government and the government of
any state, the District of Columbia, or any
possession of the United States, or political
subdivision thereof. A grant to a U.S.
government agency must be included on this
schedule regardless of where the agency is
located or operated.
Individuals in the United States include
persons who are U.S. citizens or residents of
the United States but do not include U.S.
citizens or residents of the United States living
or residing outside the United States at the
time the grant is paid or distributed.

Who Must File

An organization that answered “Yes” to Form
990, Part IV, Checklist of Required Schedules,
line 21 or 22, must complete Part I and either
Part II or Part III of this schedule and attach it
to Form 990.
If an organization is not required to file
Form 990 but chooses to do so, it must file a
complete return and provide all of the
information requested, including the required
schedules.

Specific Instructions

Part I. General Information on
Grants and Assistance

Complete this part if the organization
answered “Yes” on Form 990, Part IV, line 21
or 22.
Lines 1 and 2. On line 1, indicate “Yes” or
“No” regarding whether the organization
maintains records to substantiate amounts,
eligibility, and selection criteria used for
grants. In general terms, describe how the
organization monitors its grants to ensure that
such grants are used for proper purposes and
are not otherwise diverted from the intended
use. For example, the organization can
describe the periodic reports required or field
investigations conducted. Use Part IV for the
organization’s narrative response to line 2.

Part II. Grants and Other
Assistance to Governments and
Organizations in the United States
Line 1. Complete line 1 if the organization
answered “Yes” on Form 990, Part IV, line 21.
A “Yes” response means that the organization
reported more than $5,000 on Form 990, Part
IX, line 1, column (A). Enter information only
for each recipient U.S. organization or
government entity that received more than
$5,000 aggregate of grants or assistance from
the organization during the tax year.
Enter the details of each organization or
entity on a separate line of Part II. If there are
more organizations or entities to report in Part
II than space available, report the additional
organizations or entities on duplicate copies
of Part II. Use as many duplicate copies as
needed, and number each page. Use Part IV if
additional space is needed for descriptions of
particular column entries.

If the organization checks
“Accrual” on Form 990, Part XII,
TIP line 1, follows SFAS 116 (ASC
958) (see Instructions for Form
990, Part IX), and makes a grant during the
tax year to be paid in future years to an
organization or government in the United
States, it should report the grant's present
value in Part II, line 1, column (d) or (e), and
report any accruals of present value
increments in future years.

Page 4

Schedule I (Form 990) (2012)

Line 2. Add the number of recipient
organizations listed on Schedule I (Form 990),
Part II, line 1, that (a) have been recognized by
the Internal Revenue Service as exempt from
federal income tax as described in section
501(c)(3), (b) are churches, including
synagogues, temples, and mosques, (c) are
integrated auxiliaries of churches and
conventions or association of churches, or (d)
are governmental units or other government
entities in the United States. Enter the total.
Line 3. Add the number of recipient
organizations listed on Schedule I (Form 990),
Part II, line 1, that are not described on line 2.
This number should include both
organizations that are not tax-exempt and
organizations that are tax-exempt under
section 501(c) but not section 501(c)(3).

Enter the details of each type of assistance
to individuals on a separate line of Part III. If
there are more types of assistance than space
available, report the types of assistance on
duplicate copies of Part III. Use as many
duplicate copies as needed, and number each
page. Use Part IV if additional space is
needed for descriptions of particular column
entries.
Column (a). Specify type(s) of assistance
provided, or describe the purpose or use of
grant funds. Do not use general terms such as
charitable, educational, religious, or scientific.
Use more specific descriptions, such as
scholarships for students attending a
particular school; provision of books or other
educational supplies; food, clothing, and
shelter for indigents, or direct cash assistance
to indigents; etc. In the case of specific
disaster assistance, include a description of
the type of assistance provided and identify
the disaster (for example, “Food, shelter, and
clothing for immediate relief for victims of
Colorado wildfires”).
Column (b). Enter the number of recipients
for each type of assistance. If the organization
is unable to determine the actual number,
provide an estimate of the number. Explain in
Part IV how the organization arrived at the
estimate.
Column (c). Enter the aggregate dollar
amount of cash grants for each type of grant
or assistance. Cash grants include grants and
allocations paid by cash, check, money order,
electronic fund or wire transfer, and other
charges against funds on deposit at a
financial institution.
Columns (d) and (e). Enter the fair market
value of noncash property. Describe the
method of valuation. Report property with a
readily determinable market value (for
example, market quotations for securities) at
its fair market value. For marketable securities
registered and listed on a recognized

securities exchange, measure market value by
the average of the highest and lowest quoted
selling prices or the average between the
bona fide bid and asked prices, on the date
the property is distributed to the grantee.
When fair market value cannot be readily
determined, use an appraised or estimated
value.
Column (f). For noncash grants or assistance,
enter descriptions of property. List all that
apply. Examples of noncash assistance
include medical supplies or equipment,
pharmaceuticals, blankets, and books or
other educational supplies.

DRAFT AS OF
November 20, 2012
DO NOT FILE
Part III. Grants and Other
Assistance to Individuals in the
United States

Complete Part III if the organization answered
“Yes” on Form 990, Part IV, line 22. A “Yes”
response means that the organization
reported more than $5,000 on Form 990, Part
IX, line 2, column (A).
Enter information for grants and other
assistance made to or for the benefit of
individual recipients. Do not complete Part III
for grants or assistance provided to
individuals through another organization or
entity, unless the grant or assistance is
earmarked by the filing organization for the
benefit of one or more specific individuals in
the United States. Instead, complete Part II,
earlier. For example, report a payment to a
hospital designated to cover the medical
expenses of particular U.S. individuals in Part
III and report a contribution to a hospital
designated to provide some service to the
general public or to unspecified U.S. charity
patients in Part II.

If the organization checks
“Accrual” on Form 990, Part XII,
TIP line 1, follows SFAS 116 (ASC
958) (see instructions for Form
990, Part IX), and makes a grant during the
tax year to be paid in future years to an
individual in the United States, it should report
the grant's present value in Part III, column (c)
or (d), and report any accruals of present value
increments in future years.

Part IV. Supplemental Information

Use Part IV to provide narrative information
required in Part I, line 2 regarding monitoring
of funds, and in Part III, column (b) regarding
how the organization estimated the number of
recipients for each type of grant or
assistance. Also use Part IV to provide other
narrative explanations and descriptions, as
needed. Identify the specific part and line(s)
that the response supports. Part IV can be
duplicated if more space is needed.