SCHEDULE C 

(Form 990 or 990-EZ)

Department of the Treasury 

Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

▶ Complete if the organization is described below. ▶ Attach to Form 990 or Form 990-EZ. 

▶ See separate instructions.

OMB No. 1545-0047

2012

Open to Public 

Inspection

If the organization answered “Yes,” to Form 990, Part IV, line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then

• Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.

• Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.

• Section 527 organizations: Complete Part I-A only.

If the organization answered “Yes,” to Form 990, Part IV, line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then

• Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.

• Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.

If the organization answered “Yes,” to Form 990, Part IV, line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then

• Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of organization Employer identification number

Part I-A Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1 Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

2 Political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . ▶ $

3 Volunteer hours . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Part I-B Complete if the organization is exempt under section 501(c)(3).

1 Enter the amount of any excise tax incurred by the organization under section 4955 . . . . ▶ $

2 Enter the amount of any excise tax incurred by organization managers under section 4955 . . ▶ $

3 If the organization incurred a section 4955 tax, did it file Form 4720 for this year? . . . . . . . . . Yes No

4a Was a correction made? . . . . . . . . . . . . . . . . . . . . . . . . . . . . Yes No

b If “Yes,” describe in Part IV.

Part I-C Complete if the organization is exempt under section 501(c), except section 501(c)(3).

1 Enter the amount directly expended by the filing organization for section 527 exempt function 

activities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ $ 

2 Enter the amount of the filing organization’s funds contributed to other organizations for section 

527 exempt function activities . . . . . . . . . . . . . . . . . . . . . . ▶ $ 

3 Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, 

line 17b . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶ $ 

4 Did the filing organization file Form 1120-POL for this year? . . . . . . . . . . . . . . . . Yes No

5 Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing 

organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter 

the amount of political contributions received that were promptly and directly delivered to a separate political organization, such 

as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name (b) Address (c) EIN (d) Amount paid from 

filing organization’s 

funds. If none, enter -0-.

(e) Amount of political

contributions received and

promptly and directly 

delivered to a separate 

political organization. If 

none, enter -0-.

(1)

(2)

(3)

(4)

(5)

(6)

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ. Cat. No. 50084S Schedule C (Form 990 or 990-EZ) 2012
Schedule C (Form 990 or 990-EZ) 2012 Page 2

Part II-A Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under 

section 501(h)).

A Check ▶ if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's 

name, address, EIN, expenses, and share of excess lobbying expenditures).

B Check ▶ if the filing organization checked box A and “limited control” provisions apply.

Limits on Lobbying Expenditures 

(The term “expenditures” means amounts paid or incurred.)

(a) Filing

organization’s totals

(b) Affiliated 

group totals

1 a Total lobbying expenditures to influence public opinion (grass roots lobbying) . . . .

b Total lobbying expenditures to influence a legislative body (direct lobbying) . . . . .

c Total lobbying expenditures (add lines 1a and 1b) . . . . . . . . . . . . .

d Other exempt purpose expenditures . . . . . . . . . . . . . . . . . .

e Total exempt purpose expenditures (add lines 1c and 1d) . . . . . . . . . . .

f Lobbying nontaxable amount. Enter the amount from the following table in both

columns.

If the amount on line 1e, column (a) or (b) is: The lobbying nontaxable amount is:

Not over $500,000 20% of the amount on line 1e.

Over $500,000 but not over $1,000,000 $100,000 plus 15% of the excess over $500,000.

Over $1,000,000 but not over $1,500,000 $175,000 plus 10% of the excess over $1,000,000.

Over $1,500,000 but not over $17,000,000 $225,000 plus 5% of the excess over $1,500,000.

Over $17,000,000 $1,000,000.

g Grassroots nontaxable amount (enter 25% of line 1f) . . . . . . . . . . . .

h Subtract line 1g from line 1a. If zero or less, enter -0- . . . . . . . . . . . .

i Subtract line 1f from line 1c. If zero or less, enter -0- . . . . . . . . . . . .

j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 

reporting section 4911 tax for this year? . . . . . . . . . . . . . . . . . . . . . . Yes No

4-Year Averaging Period Under Section 501(h) 

(Some organizations that made a section 501(h) election do not have to complete all of the five 

columns below. See the instructions for lines 2a through 2f on page 4.)

Lobbying Expenditures During 4-Year Averaging Period

Calendar year (or fiscal year 

beginning in)

(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total

2a Lobbying nontaxable amount

b Lobbying ceiling amount 

(150% of line 2a, column (e))

c Total lobbying expenditures

d Grassroots nontaxable amount

e Grassroots ceiling amount 

(150% of line 2d, column (e))

f Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2012
Schedule C (Form 990 or 990-EZ) 2012 Page 3

Part II-B Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 

(election under section 501(h)).

For each “Yes,” response to lines 1a through 1i below, provide in Part IV a detailed 

description of the lobbying activity.

(a) (b)

Yes No Amount

1 During the year, did the filing organization attempt to influence foreign, national, state or local 

legislation, including any attempt to influence public opinion on a legislative matter or 

referendum, through the use of:

a Volunteers? . . . . . . . . . . . . . . . . . . . . . . . . . . . .

b Paid staff or management (include compensation in expenses reported on lines 1c through 1i)?

c Media advertisements? . . . . . . . . . . . . . . . . . . . . . . . .

d Mailings to members, legislators, or the public? . . . . . . . . . . . . . . . .

e Publications, or published or broadcast statements? . . . . . . . . . . . . . .

f Grants to other organizations for lobbying purposes? . . . . . . . . . . . . . .

g Direct contact with legislators, their staffs, government officials, or a legislative body? . . .

h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? . .

i Other activities? . . . . . . . . . . . . . . . . . . . . . . . . . .

j Total. Add lines 1c through 1i . . . . . . . . . . . . . . . . . . . . . .

2 a Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? . .

b If “Yes,” enter the amount of any tax incurred under section 4912 . . . . . . . . . .

c If “Yes,” enter the amount of any tax incurred by organization managers under section 4912 .

d If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? . . .

Part III-A Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 

501(c)(6).

Yes No

1 Were substantially all (90% or more) dues received nondeductible by members? . . . . . . . . . 1 

2 Did the organization make only in-house lobbying expenditures of $2,000 or less? . . . . . . . . . 2 

3 Did the organization agree to carry over lobbying and political expenditures from the prior year? . . . . 3 

Part III-B Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 

501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No,” OR (b) Part III-A, line 3, is 

answered “Yes.”

1 Dues, assessments and similar amounts from members . . . . . . . . . . . . . . . 1 

2 Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of 

political expenses for which the section 527(f) tax was paid).

a Current year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2a 

b Carryover from last year . . . . . . . . . . . . . . . . . . . . . . . . . . 2b

c Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2c 

3 Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues . . 3 

4 If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the

excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying 

and political expenditure next year? . . . . . . . . . . . . . . . . . . . . . . 4 

5 Taxable amount of lobbying and political expenditures (see instructions) . . . . . . . . . . 5 

Part IV Supplemental Information

Complete this part to provide the descriptions required for Part I-A, line 1; Part I-B, line 4; Part I-C, line 5; Part II-A (affiliated group 

list); Part II-A, line 2; and Part II-B, line 1. Also, complete this part for any additional information.

Schedule C (Form 990 or 990-EZ) 2012
Schedule C (Form 990 or 990-EZ) 2012 Page 4

Part IV Supplemental Information (continued)

Schedule C (Form 990 or 990-EZ) 2012