OMB No. 1545-0047

Public Charity Status and Public Support SCHEDULE A

© Attach to Form 990 or Form 990-EZ. © See separate instructions. Department of the Treasury

Internal Revenue Service

Name of the organization Employer identification number

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

(v) Did you notify

the organization in

col. (i) of your

support?

(ii) EIN (iii) Type of organization

(described on lines 1–9

above or IRC section

(see instructions))

(i) Name of supported

organization

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Schedule A (Form 990 or 990-EZ) 2009

Form 990 or 990-EZ.

Part I

Cat. No. 11285F

(Form 990 or 990-EZ)

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

1

2

3

6

4

5

7

8

9

10

11

a b c d

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the

hospital’s name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in 

section 170(b)(1)(A)(iv). (Complete Part II.)

An organization that normally receives a substantial part of its support from a governmental unit or from the general public 

described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331⁄3% of its support from contributions, membership fees, and gross 

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331⁄3% of its

support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

Since August 17, 2006, has the organization accepted any gift or contribution from any of the

following persons?

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the

purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 

509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting

organization, check this box

Type I Type II Type III–Functionally integrated Type III–Other

A person who directly or indirectly controls, either alone or together with persons described in (ii)

and (iii) below, the governing body of the supported organization?

A family member of a person described in (i) above?

Provide the following information about the supported organization(s).

(i)

(ii)

(vi) Is the

organization in col.

(i) organized in the

U.S.?

(vii) Amount of

support

(iv) Is the organization

in col. (i) listed in your

governing document?

Open to Public

Inspection

e By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified

persons other than foundation managers and other than one or more publicly supported organizations described in section 

509(a)(1) or section 509(a)(2).

(iii) A 35% controlled entity of a person described in (i) or (ii) above?

Total

f

g

h

Complete if the organization is a section 501(c)(3) organization or a section 2009

4947(a)(1) nonexempt charitable trust.

Yes No Yes No Yes No

Yes No

11g(ii)

11g(i)

11g(iii)
Schedule A (Form 990 or 990-EZ) 2009 Page 2

Part II

14 Public support percentage for 2009 (line 6, column (f) divided by line 11, column (f))

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)

(Complete only if you checked the box on line 5, 7, or 8 of Part I.)

Calendar year (or fiscal year beginning in) © (a) 2005 (b) 2006 (c) 2007 (d) 2008 (f) Total

1

The portion of total contributions by each

person (other than a governmental unit or

publicly supported organization) included

on line 1 that exceeds 2% of the amount

shown on line 11, column (f)

2

3

4

Tax revenues levied for the organization’s 

benefit and either paid to or expended on 

its behalf

5

The value of services or facilities

furnished by a governmental unit to the

organization without charge

Total. Add lines 1 through 3

6 Public support. Subtract line 5 from line 4.

Gifts, grants, contributions, and

membership fees received. (Do not

include any "unusual grants.")

Schedule A (Form 990 or 990-EZ) 2009

Section A. Public Support

(e) 2009

(a) 2005 (b) 2006 (c) 2007 (d) 2008 (f) Total

7

Gross income from interest, dividends,

payments received on securities loans,

rents, royalties and income from similar 

sources

8

9

10

Net income from unrelated business

activities, whether or not the business is 

regularly carried on

Other income. Do not include gain or

loss from the sale of capital assets

(Explain in Part IV.)

11

12

Amounts from line 4

Section B. Total Support

(e) 2009

Total support. Add lines 7 through 10

Section C. Computation of Public Support Percentage

15 Public support percentage from 2008 Schedule A, Part II, line 14

12

14

15

16a 331⁄3 % support test—2009. If the organization did not check the box on line 13, and line 14 is 331⁄3% or more, check this box

and stop here. The organization qualifies as a publicly supported organization ©

b

17a

18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions ©

Gross receipts from related activities, etc. (see instructions)

Calendar year (or fiscal year beginning in) ©

13 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3)

organization, check this box and stop here ©

331⁄3 % support test—2008. If the organization did not check a box on line 13 or 16a, and line 15 is 331⁄3% or more, check this 

box and stop here. The organization qualifies as a publicly supported organization ©

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or 

more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the 

organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization ©

b 10%-facts-and-circumstances test—2008. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or

more, and if the organization meets the “facts-and-circumstances” test, check this box and stop here. Explain in Part IV how the

organization meets the “facts-and-circumstances” test. The organization qualifies as a publicly supported organization ©

%

%
Schedule A (Form 990 or 990-EZ) 2009 Page 3

Part III

14 First five years. If the Form 990 is for the organization’s first, second, third, fourth, or fifth tax year as a section 501(c)(3) 

organization, check this box and stop here ©

Support Schedule for Organizations Described in Section 509(a)(2)

(Complete only if you checked the box on line 9 of Part I.)

Calendar year (or fiscal year beginning in) © (a) 2005 (b) 2006 (c) 2007 (d) 2008 (f) Total

1

Gross receipts from admissions, merchandise 

sold or services performed, or facilities

furnished in any activity that is related to the

organization’s tax-exempt purpose

2

3 Gross receipts from activities that are not an

unrelated trade or business under section 513

4 Tax revenues levied for the organization’s 

benefit and either paid to or expended on 

its behalf

5 The value of services or facilities

furnished by a governmental unit to the

organization without charge

6 Total. Add lines 1 through 5

Amounts included on lines 1, 2, and 3

received from disqualified persons

7a

Amounts included on lines 2 and 3 received 

from other than disqualified persons that

exceed the greater of $5,000 or 1% of the 

amount on line 13 for the year

b

Add lines 7a and 7b

Public support (Subtract line 7c from

line 6.)

8

Gifts, grants, contributions, and

membership fees received. (Do not include 

any "unusual grants.")

c

Section A. Public Support

(e) 2009

Calendar year (or fiscal year beginning in) © (a) 2005 (b) 2006 (c) 2007 (d) 2008 (f) Total

9

Gross income from interest, dividends,

payments received on securities loans,

rents, royalties and income from similar

sources

10a

b Unrelated business taxable income (less 

section 511 taxes) from businesses

acquired after June 30, 1975

c Add lines 10a and 10b

11 Net income from unrelated business

activities not included in line 10b,

whether or not the business is regularly 

carried on

Other income. Do not include gain or

loss from the sale of capital assets

(Explain in Part IV.)

12

13

Amounts from line 6

Section B. Total Support

(e) 2009

Total support. (Add lines 9, 10c, 11,

and 12.)

15 Public support percentage for 2009 (line 8, column (f) divided by line 13, column (f))

Section C. Computation of Public Support Percentage

16 Public support percentage from 2008 Schedule A, Part III, line 15

15

16

17 Investment income percentage for 2009 (line 10c, column (f) divided by line 13, column (f))

18 Investment income percentage from 2008 Schedule A, Part III, line 17

19a 331⁄3 % support tests—2009. If the organization did not check the box on line 14, and line 15 is more than 331⁄3%, and line 

17 is not more than 331⁄3%, check this box and stop here. The organization qualifies as a publicly supported organization ©

331⁄3 % support tests—2008. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 331⁄3 %, and

line 18 is not more than 331⁄3%, check this box and stop here. The organization qualifies as a publicly supported organization ©

Section D. Computation of Investment Income Percentage

17

%

%

18

%

%

b

20 Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions ©
Schedule A (Form 990 or 990-EZ) 2009 Page 4

Supplemental Information. Complete this part to provide the explanations required by Part II, line 10;

Part II, line 17a or 17b; and Part III, line 12. Provide any other additional information. See instructions.

Schedule A (Form 990 or 990-EZ) 2009

Part IV