OMB No. 1545-0047 Schedule of Contributors

Department of the Treasury

Internal Revenue Service

Cat. No. 30613X Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Employer identification number

Organization type (check one):

(Form 990, 990-EZ,

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

Schedule B

Name of the organization

501(c)( ) (enter number) organization

527 political organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

Filers of: Section:

Form 990 or 990-EZ

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

Form 990-PF

Check if your organization is covered by the General Rule or a Special 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.

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, aggregate 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

aggregate 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 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).

General Rule

Special Rules

501(c)(3) taxable private foundation

or 990-PF)

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions

for Form 990, 990-EZ, or 990-PF.

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.

2009

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.
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page _____ of _____ of Part I

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate contributions

(d)

Type of contribution

Person

Payroll

Noncash

(Complete Part II if there is

a noncash contribution.)

$

$

$

$

$

Contributors (see instructions)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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) (2009)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page _____ of _____ of Part I

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate contributions

(d)

Type of contribution

Person

Payroll

Noncash

(Complete Part II if there is

a noncash contribution.)

$

$

$

$

$

Contributors (see instructions)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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) (2009)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page _____ of _____ of Part I

Part I

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate 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)

Aggregate contributions

(d)

Type of contribution

Person

Payroll

Noncash

(Complete Part II if there is

a noncash contribution.)

$

$

$

$

$

Contributors (see instructions)

(a)

No.

(b)

Name, address, and ZIP + 4

(c)

Aggregate 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) (2009)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Part II

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

Page _____ of _____ of Part II

$ / /

$ / /

$ / /

$ / /

$ / /

Noncash Property (see instructions)

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

$ / /

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Part II

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

Page _____ of _____ of Part II

$ / /

$ / /

$ / /

$ / /

$ / /

Noncash Property (see instructions)

(a) No.

from

Part I

(b)

Description of noncash property given

(c)

FMV (or estimate)

(see instructions)

(d)

Date received

$ / /

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization Employer identification number
Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Part III

(a) No.

from

Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations

aggregating 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.) $

(e) Transfer of gift

Relationship of transferor to transferee

Page _____ of _____ of Part III

Transferee’s name, address, and ZIP + 4

(a) No.

from

Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

(a) No.

from

Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

(a) No.

from

Part I

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization Employer identification number

Transferee’s name, address, and ZIP + 4

Transferee’s name, address, and ZIP + 4

Transferee’s name, address, and ZIP + 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Part III

(a) No.

from

Part I

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations

aggregating 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.) $

(e) Transfer of gift

Relationship of transferor to transferee

Page _____ of _____ of Part III

Transferee’s name, address, and ZIP + 4

(a) No.

from

Part I

(b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

(a) No.

from

Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

(a) No.

from

Part I (b) Purpose of gift (c) Use of gift (d) Description of how gift is held

(e) Transfer of gift

Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2009)

Name of organization Employer identification number

Transferee’s name, address, and ZIP + 4

Transferee’s name, address, and ZIP + 4

Transferee’s name, address, and ZIP + 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page 9

General Instructions 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.

Section references are to the Internal

Revenue Code unless otherwise noted.

Purpose of Schedule

Schedule B (Form 990, 990-EZ, or

990-PF) is used to provide information

on contributions the organization

reported on:

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

answering “No” on Form 990, Part IV,

Checklist of Required Schedules, line 2;

on Form 990-EZ, line H; or on Form

990-PF, line 2. See the separate

instructions for these lines on those

forms.

Who Must File

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 XI, Financial

Statements and Reporting, line 1; Form

990-EZ, line G; or Form 990-PF, line J.

Schedule B is:

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.

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.

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.

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.

However, if a section 501(c)(7), (8), or

(10) organization did not receive

aggregate 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.

● Form 990-PF, Return of Private

Foundation, 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,

line 1.

Public Inspection

● Open to public inspection for an

organization that files Form 990-PF,

● Open to public inspection for a

section 527 political organization that

files Form 990 or 990-EZ, or

● 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.

Contributors to be

Listed on Part I

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

aggregating $5,000 or more for the

organization’s tax year. In determining

the aggregate amount, separate and

independent gifts of less than $1,000

can be disregarded.

Special Rules

Note. Terms in bold are defined in the

Glossary of the Instructions for Form

990.
Schedule B (Form 990, 990-EZ, or 990-PF) (2009) Page 10

For more information on noncash

contributions, see the instructions for

Schedule M (Form 990), Noncash

Contributions.

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

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.

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.

Specific Instructions

Note. You can duplicate Parts I through

III if you need more copies. Number

each page of each part.

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 an “anonymous”

donor if the organization has actual

knowledge of such donor’s identity. In

column (c), enter the amount of

aggregate 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.

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, if the donor has fully

given up use and enjoyment of the

property at that time.

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,

total 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 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.

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.

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).