SCHEDULE A 

(Form 990 or 990-EZ)

Department of the Treasury 

Internal Revenue Service 

Public Charity Status and Public Support

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

4947(a)(1) nonexempt charitable trust.

▶ Attach to Form 990 or Form 990-EZ. ▶ See separate instructions.

OMB No. 1545-0047

2012

Open to Public 

Inspection

Name of the organization Employer identification number

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

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

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

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

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

4 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:

5 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.)

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

7 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.)

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

 9 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.)

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

 11 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.

a Type I b Type II c Type III–Functionally integrated d Type III–Non-functionally integrated

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).

f 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

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

following persons?

(i) 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? . . . . . . . . . . . . . .

Yes No

11g(i)

(ii) A family member of a person described in (i) above? . . . . . . . . . . . . . . . . . 11g(ii)

(iii) A 35% controlled entity of a person described in (i) or (ii) above? . . . . . . . . . . . . . 11g(iii)

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

(i) Name of supported

organization

(ii) EIN (iii) Type of organization

(described on lines 1–9

above or IRC section

(see instructions))

(iv) Is the organization

in col. (i) listed in your

governing document?

(v) Did you notify

the organization in

col. (i) of your

support?

(vi) Is the

organization in col.

(i) organized in the

U.S.?

(vii) Amount of monetary 

support

 Yes No Yes No Yes No 

(A)

(B)

(C)

(D)

(E)

Total

For Paperwork Reduction Act Notice, see the Instructions for 

Form 990 or 990-EZ.

Cat. No. 11285F Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012 Page 2

Part II 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 or if the organization failed to qualify under 

Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in) ▶ (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total

1 Gifts, grants, contributions, and 

membership fees received. (Do not 

include any "unusual grants.") . . .

2 Tax revenues levied for the 

organization’s benefit and either paid 

to or expended on its behalf . . .

3 The value of services or facilities 

furnished by a governmental unit to the 

organization without charge . . . .

4 Total. Add lines 1 through 3 . . . .

5 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) . . . .

6 Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in) ▶ (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total

7 Amounts from line 4 . . . . . .

8 Gross income from interest, dividends, 

payments received on securities loans, 

rents, royalties and income from similar 

sources . . . . . . . . . .

9 Net income from unrelated business 

activities, whether or not the business 

is regularly carried on . . . . .

10 Other income. Do not include gain or 

loss from the sale of capital assets 

(Explain in Part IV.) . . . . . . .

11 Total support. Add lines 7 through 10

 12 Gross receipts from related activities, etc. (see instructions) . . . . . . . . . . . . 12

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 . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Section C. Computation of Public Support Percentage

14 Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f)) . . . . 14 %

15 Public support percentage from 2011 Schedule A, Part II, line 14 . . . . . . . . . . 15 %

16 a 331/3% support test—2012. 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 331/3% support test—2011. 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 . . . . . . . ▶

17 a 10%-facts-and-circumstances test—2012. 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—2011. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ▶

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

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

(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. 

If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in) ▶ (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total

1 Gifts, grants, contributions, and membership fees 

received. (Do not include any "unusual grants.") 

2 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 . . .

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 . . . .

7a Amounts included on lines 1, 2, and 3 

received from disqualified persons .

b 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 

c Add lines 7a and 7b . . . . . .

8 Public support (Subtract line 7c from

line 6.) . . . . . . . . . . .

Section B. Total Support

Calendar year (or fiscal year beginning in) ▶ (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total

9 Amounts from line 6 . . . . . .

10a Gross income from interest, dividends, 

payments received on securities loans, rents, 

royalties and income from similar sources .

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 

12 Other income. Do not include gain or 

loss from the sale of capital assets 

(Explain in Part IV.) . . . . . . .

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

and 12.) . . . . . . . . . .

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 . . . . . . . . . . . . . . . . . . . . . . . . . ▶

Section C. Computation of Public Support Percentage

15 Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f)) . . . . . 15 %

16 Public support percentage from 2011 Schedule A, Part III, line 15 . . . . . . . . . . . 16 %

Section D. Computation of Investment Income Percentage

17 Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f)) . . . 17 %

18 Investment income percentage from 2011 Schedule A, Part III, line 17 . . . . . . . . . . 18 %

19a 331/3% support tests—2012. 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 . ▶

b 331/3% support tests—2011. 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 ▶

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

Part IV 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. Also complete this part for any additional information. (See 

instructions).

Schedule A (Form 990 or 990-EZ) 2012